Journal article
Efficacy of Bronchoscopic Thermal Vapor Ablation and Lobar Fissure Completeness in Patients with Heterogeneous Emphysema
Respiration, Vol.83(5), pp.400-406
01/01/2012
DOI: 10.1159/000336239
PMID: 22377613
Abstract
Background: Bronchoscopic thermal vapor ablation (BTVA) ablates emphysematous tissue through a localized inflammatory response followed by contractive fibrosis and tissue shrinkage leading to lung volume reduction that should not be influenced by collateral ventilation. Objectives: To determine the correlation of clinical data from a trial of BTVA with fissure integrity visually assessed by computed tomography (CT). Methods: We conducted a single-arm study of patients with upper lobe-predominant emphysema (n = 44). Patients received BTVA either to the right upper lobe or left upper lobe, excluding the lingula. Primary efficacy outcomes were forced expiratory volume in 1 s (FEV1) and St. George's Respiratory Questionnaire (SGRQ) at 6 months. Lobar volume reduction from CT was another efficacy outcome measurement. The fissure of the treated lobe was analyzed visually on preinterventional CT. Incompleteness of the small fissure, the upper half of the right large fissure and the whole left large fissure were estimated visually in 5% increments, and the relative amount of fissure incompleteness was calculated. Pearson correlation coefficients were calculated for the association between fissure incompleteness and change in efficacy outcomes (baseline to 6 months) of BTVA. Results: A total of 38 out of 44 patients (86%) had incompleteness in the relevant fissure. Calculated relevant fissure incompleteness was a mean of 13% of fissure integrity (range 0-63). Correlation coefficients for the association of incompleteness with outcomes were as follows: FEV1 = 0.17; lung volume reduction = -0.27; SGRQ score = -0.10; 6-min walk distance = 0.0; residual volume (RV) = -0.18, and RV/total lung capacity = -0.14. Conclusions: Lobar fissure integrity has no or minimal influence on BTVA-induced lung volume reduction and improvements in clinical outcomes. Copyright (C) 2012 S. Karger AG, Basel
Details
- Title: Subtitle
- Efficacy of Bronchoscopic Thermal Vapor Ablation and Lobar Fissure Completeness in Patients with Heterogeneous Emphysema
- Creators
- Daniela Gompelmann - Hautklinik HeidelbergClaus Peter Heussel - Thoraxklin Heidelberg, DE-69126 Heidelberg, GermanyRalf Eberhardt - Thoraxklin Heidelberg, DE-69126 Heidelberg, GermanyGregory Snell - Alfred Hosp, Melbourne, Vic, AustraliaPeter Hopkins - Prince Charles Hosp, Lung Transplant Unit, Chermside, Qld, AustraliaKim Baker - University of IowaChristian Witt - Charite, Berlin, GermanyArschang Valipour - Otto Wagner Hosp, Ludwig Boltzmann Inst COPD, Vienna, AustriaManfred Wagner - Klinikum Nurnberg, Nurnberg, GermanyFranz Stanzel - Zentrum Pneumol, Hemer, GermanyJim Egan - Mater Misericordiae Univ Hosp, Adv Lung Dis Program, Dublin, IrelandArmin Ernst - Catholic Development OfficeSteven Kesten - Uptake Med Corp, Tustin, CA USAFelix J. F. Herth - Thoraxklin Heidelberg, DE-69126 Heidelberg, Germany
- Resource Type
- Journal article
- Publication Details
- Respiration, Vol.83(5), pp.400-406
- Publisher
- Karger
- DOI
- 10.1159/000336239
- PMID
- 22377613
- ISSN
- 0025-7931
- eISSN
- 1423-0356
- Number of pages
- 7
- Language
- English
- Date published
- 01/01/2012
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
- Record Identifier
- 9984695835102771
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