P-208EXTENDING THE BENEFIT OF VOLUME REDUCTION IN EMPHYSEMA: THE USE OF ENDOBRONCHIAL VALVE THERAPY AS A FURTHER STAGE AFTER LUNG VOLUME REDUCTION SURGERY

Objectives: Traditionally we have performed staged bilateral video-assisted thoracoscopic (VATS) lung volume reduction (LVR). Because redo surgery in emphysema patients involves dealing with postoperative adhesions on fragile lungs we have only in rare exceptions performed VATS on previously operated lungs. With the introduction of bronchoscopic lung reduction (endobronchialvalve [EBV] insertion) we have been able to perform lung reduction twice on the same lung and have analysed the outcome. Methods: Endobronchial Zephyr valves (PulmonX) were inserted into 10 patients (eight male; two female), median age 59 (47-74) years who had previously undergone VATS LVRS (four patients bilateral; six unilateral). All valves were positioned in a previously operated lung. The time interval between the last LVRS and EBV insertion was 4.6 years (1.2-8.8 years). The patients were followed prospectively after treatment, recording changes in: health status (SF36 questionnaire), dynamic and static lung volumes. Two patients had not reached three months follow-up. Results: There was no 30-day mortality. None of the patients required a chest drain for a haemo- or pneumothorax after the insertion of EBV. Significant physiological improvements in relief of obstruction and reduction in volume were seen after VATS LVRS. There was a further significant reduction in TLC after EBV insertion. Conclusion: The use of further endobronchial volume reduction in those who have previously received LVRS is feasible and safe and shows potential benefit. However, the patients should not expect the same magnitude of improvement. Disclosure: No significant relationships.