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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