Endobronchial Valves for Emphysema without Interlobar Collateral Ventilation

Patients with severe emphysema and no collateral ventilation were assigned to receive endobronchial valves or standard care. Despite valve removal in a third of the patients, an intention-to-treat analysis showed improved function and reduced symptoms in patients who received valves. Bronchoscopic lung-volume reduction with the use of one-way endobronchial valves has emerged as a potential treatment for patients with severe emphysema. This treatment was previously investigated in the randomized, controlled Endobronchial Valve for Emphysema Palliation Trial (VENT), 1 which showed significant but moderate improvements in forced expiratory volume in 1 second (FEV 1 ): an increase from baseline of 4.3% (95% confidence interval [CI], 1.4 to 7.2). Post hoc analyses of the VENT data suggested that endobronchial-valve treatment might be more effective in patients who had a complete fissure (as compared with an incomplete fissure) between the lobe that was targeted . . .