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Review
. 2020 Nov;8(21):1469.
doi: 10.21037/atm-20-1551.

Bronchoscopic lung volume reduction: status quo

Massa Zantah  1 , Andrew J Gangemi  1 , Gerard J Criner  1
Affiliations
Review

Bronchoscopic lung volume reduction: status quo

Massa Zantah et al. Ann Transl Med. 2020 Nov.

Abstract

Emphysema is associated with irreversible loss of lung compliance leading to gas trapping and hyperinflation. Surgical lung volume reduction has proven to improve lung function, exercise capacity, cardiac health and survival in patients with advanced emphysema; however, this procedure is associated with significant morbidity and mortality. Bronchoscopic lung volume reduction (BLVR) has emerged as an alternative approach for these patients. In this article, we review the different techniques used for the purpose of this procedure, its advantages and disadvantages. In addition, we discuss in length valve therapy and the studies that led to its recent FDA approval. Finally, we provide thought-provoking challenges that may be topics for further future investigation to enhance the efficacy and benefit of this technique.

Keywords: Bronchoscopic lung volume reduction (BLVR); endobronchial valves; lung volume reduction surgery (LVRS).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-1551). The series “Lung Emphysema” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Minimally invasive lung volume reduction options. Only endobronchial valves (Zephyr® Endobronchial Valves shown in the top left and the Spiration Valve System® shown in the bottom left) are currently FDA-approved.
Figure 2
Figure 2
Available deployment catheters for the Zephyr® Endobronchial Valve. From left to right: J-shaped delivery catheter (4.0–7.0 mm), straight 4.0–7.0 mm delivery catheter, straight 5.5–8.5 mm delivery catheter. Note markings on the tips to measure airway length and lateral phalanges to determine airway diameter.
Figure 3
Figure 3
Sizing catheter for the Spiration Valve System®. The balloon is inflated in the target bronchus; using the manufacturer’s provided graph, valve sizes can be correlated with the instilled volume of saline.
Figure 4
Figure 4
Algorithm for referral for advanced interventions for emphysema. Medical management should be optimized prior to consideration for any of these advanced therapies. Reprinted with permission of the American Thoracic Society. Copyright © 2020 American Thoracic Society. All rights reserved. Vogelmeier CF, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 report: GOLD executive summary. Am J Respir Crit Care Med 2017;195:557-82. The American Journal of Respiratory and Critical Care Medicine is an official journal of the American Thoracic Society.
See this image and copyright information in PMC

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