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S36 Coil treatment for patients with severe emphysema and bilaterally incomplete fissures; effectiveness and complications after one-year follow-up. a single-centre experience
  1. K Kontogianni1,
  2. V Gerovasili2,
  3. D Gompelmann1,
  4. M Schuhmann1,
  5. CP Heussel3,
  6. FJF Herth1,
  7. R Eberhardt1
  1. 1Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany
  2. 2Department of Respiratory Medicine, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  3. 3Diagnostic and Interventional Radiology with Nuclear Medicine, Chest Clinic (Thoraxklinik) at University of Heidelberg, Heidelberg, Germany

Abstract

Background The aim of this retrospective analysis, was to evaluate the safety and efficacy of Lung Volume Reduction with coils (LVR-Coil) treatment in a single-centre setting in patients with severe heterogeneous emphysema and bilaterally incomplete fissures

Methods In this retrospective analysis 86 patients with severe COPD (♂/♀:40/46, age: 64 ± 7 years) and bilateral incomplete fissures were included. A total of 10 coils were unilaterally implanted in a single lobe. 28 patients received additional treatment of a contralateral lobe. At 90, 180 and 365 days’ follow-up changes in pulmonary function tests, 6-Minute-Walk-Test (6MWT) and modified Medical Research Council (mMRC) dyspnea scale, as well as possible complications were recorded.

Results FEV1 improved significantly at the 90-day follow up (p:0.001) but the improvement was not sustained at 180 and 365 days (0.71 ± 0.21 L vs 0.76 ± 0.23 L vs 0.73 ± 0.22 L vs 0.69 ± 0.18 L). FEV1 improved more than 12% (minimal clinically significant change, MCID) in 30 patients (38%). Vital Capacity improved significantly at the 90- (p < 0.001) and 180-day (p:0:13) follow up but improvement was lost after 365 days. RV improved significantly at 90 days (6.1 ± 1.4 L vs 5.5 ± 1.3 L, p < 0.0001) and at 180 days (6.1 ± 1.4 L vs 5.7 ± 1.2 L, p:0.008), but the improvement was not sustained at 365 days. 6MWT improved at 90 days (247 ± 90 m vs 278 ± 81 m, p < 0.0001) and 180 days (247 ± 90 m vs 267 ± 90 m, p:0.02) but the improvement was lost at the 365-day follow up. Forty-two from 71 (59%) patients improved by more than 26 m (MCID) at 90 days while 21 patients (30%) improved more than 54 m. mMRC improved significantly at 90 and 180 days. In a total of 114 procedures no periprocedural deaths occurred. Four patients died within the first 3 months after the treatment (mortality rate 3.5%). Complications observed within the first 90 days included pneumonia requiring hospital admission (28%), pneumothorax with chest tube insertion (6%), significant, persistent hemoptysis was documented in 4 cases (3.5%) and hypercapnia and hypoxemia in 4.4% and 1.75% respectively.

Conclusions LVR-coil improved PFT, 6MWT and mMRC initially but improvement was lost after 365 days. However, this improvement came at a cost of significant complications and with a 3.5% mortality rate.

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