Our Research has been Funded by British Lung Foundation, British Heart Foundation, Wellcome Trust, Cystic Fibrosis Trust European Union, Ministry of Defence European Respiratory Society Thanks to the team
Treatment Lung transplantation and lung volume reduction Heinrike Wilkens, Gerhard W. Sybrecht Universitätsklinikum des Saarlandes Innere Medizin V D – 66421 Homburg/Saar ERS Research Seminar September 28-29th 2007, Como, Italy
but there is no good evidence for improved survival rate
Stavem, K., O. Bjortuft, et al. (2006). "Lung transplantation in patients with chronic obstructive pulmonary disease in a national cohort is without obvious survival benefit." Heart Lung Transplant 25(1): 75-84.
Effect of lung-volume-reduction surgery in patients with severe emphysema Lung volume reduction surgery versus conservative treatment in severe emphysema H. Wilkens, G.W. Sybrecht et al. Eur Respir J 2000; 16: 1043±1049 LVRS is effective in selected patients, NETT-Study: subgroup analysis survival benefit for patients with heterogeneus emphysema and low exercise capacity Fishman et al NEJM 2003; 348; 21:2059-73
PATIENTS AT HIGH RISK OF DEATH AFTER LUNG-VOLUME–REDUCTION SURGERY National Emphysema Treatment Trial Research Group N Engl J Med, Vol. 345, No. 15 October 11, 2001 FEV1 < 20% and DLCO < 20% or Homogeneous Emphysema randomization N=70 conservative N=70 LVRS
Key Clinical Endpoints Feasibility Study - Change at 6 Months over Baseline for patients with initial RV/TLC ratio above the median of 0.67* Study Population (n=18) Mean Change % Change p-value Residual Volume (RV) -870 mL -14.1% 0.022 Total Lung Capacity (TLC) -460 mL -5.6% 0.12 Forced Vital Capacity (FVC) 17.8% 0.065 Dyspnea Index (mMRC) -0.5 0.035 *data accepted for publication in JTCVS
Europe EASE Sites - All Univ Med Center Otto Wagner Saarland Clinic Royal Brompton OUE Sites : The Alfred Hospital, Melbourne Santa Casa Hospital, Porto Alegre, Brazil 14 centers in US-States Mater Misericordiae Fundación Jiménez Díaz Papworth Asklepios Fachkliniken Policlinico Milano Thoraxklinik Nottingham City Hosp.
Current / Investigational Therapies Homogeneous Heterogeneous Investigational Surgical Medical X Airway bypass (Endoscopic) X Biologic LVR (Endoscopic) X Endobronchial valves (Endoscopic) X X Lung transplantation X Lung volume reduction surgery (LVRS) X X Supplemental oxygen X X Pulmonary rehabilitation X X Steroids X X Long-acting bronchodilators Emphysema Distribution
Feasibility and safety of airway bypass stent placement and influence of topical mitomycin C on stent patency . Choong CK, Haddad FJ, Gee EY, Cooper JD. J Thorac Cardiovasc Surg. 2005 Mar;129(3):632-8.
Prolongation of patency of airway bypass stents with use of drug-eluting stents . Choong CK, Phan L, Massetti P, Haddad FJ, Martinez C, Roschak E, Cooper JD. J Thorac Cardiovasc Surg. 2006 Jan;131(1):60-4.
Feasibility and safety of the airway bypass procedure for patients with emphysema. Rendina EA, De Giacomo T, Venuta F, Coloni GF, Meyers BF, Patterson GA, Cooper JD. J Thorac Cardiovasc Surg. 2003 Jun;125(6):1294-9.
DES Feasibility Study : Accepted to J Thorac Cardiovasc Surg.