Combined Valve Implantation Improves Severe Emphysema Outcomes - Physician's Weekly

Photo Credit: Mohammed Haneefa Nizamudeen

Combining Zephyr and Spiration valve therapy benefited patients with COPD and advanced pulmonary emphysema while imparting a manageable risk profile.

Endoscopic lung volume reduction using valves represents a minimally invasive approach for managing severe pulmonary emphysema. Among the available options, the Zephyr and Spiration valves are two distinct systems that can be implanted concurrently within the same procedure.

In a study published in Respiratory Medicine, A. Susanne Dittrich, MD, and colleagues aimed to evaluate the impact of combined valve therapy on lung function, exercise capacity, and patient-reported outcomes for people with severe emphysema undergoing endoscopic lung volume reduction.

“Previous studies focused on the outcome of either Zephyr or Spiration valve treatment, but little is known about a combined implantation of Zephyr and Spiration valves during the same bronchoscopic procedure,” Dr. Dittrich and colleagues explained.

The researchers performed a retrospective analysis of 108 patients with chronic obstructive pulmonary disease (COPD) who underwent simultaneous implantation of Zephyr and Spiration valves. Clinicians tailored the selection and number of valves implanted to each patient’s anatomical requirements. The study authors assessed the effects of the combined treatment on lung function, exercise capacity, and atelectasis formation, along with any associated complications, at 90 and 180 days post-treatment.

At the 90-day follow-up (n=90), the mean change in forced expiratory volume in 1 second (FEV1) was 86.7 ±183.7 mL, and residual volume (RV) showed a mean reduction of -645.3 ±1276.5 mL, with responder rates of 39.8% and 46.5%, respectively. The researchers observed complete atelectasis in 16.7% of patients, while partial atelectasis occurred in 25.5%.

Patients’ 6-minute walk tests increased by an average of 27.0 meters (range, -1.5-68.5). The incidence of pneumothorax at 6 months was 10.2%, aligning with rates reported in randomized controlled trials. However, due to the inclusion of high-risk patients in this cohort, there was a notably higher incidence of severe COPD exacerbations (21.3%) and pneumonia (12.0%) compared with other studies.

The researchers concluded that the simultaneous implantation of Zephyr and Spiration valves yielded significant clinical and functional outcomes improvements, with a manageable risk profile.

“The current data show that simultaneous, combined implantation of Zephyr and Spiration valves can be an effective and safe treatment strategy for endoscopic lung volume reduction in patients with severe emphysema and complete interlobar fissures, especially if the anatomy requires it,” Dr. Dittrich and colleagues concluded.

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