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Respiratory physicians at Macquarie University Hospital are using IBV Valve for emphysema treatment

During the 1990s, the use of bilateral Lung Volume Reduction Surgery (LVRS) for treating chronic obstructive pulmonary disease (COPD) rapidly increased. LVRS involves surgical resection of the most diseased part of a lung thereby allowing the remaining healthier sections of the lung to function more effectively. While for some patients there is an improved quality of life following LVRS, there is also an increased mortality and morbidity rate.

However, an alternative, minimally invasive procedure is now available to Australian patients suffering from obstructive lung disease such as emphysema. Endoscopic Lung Volume Reduction (ELVR) involves having an umbrella-shaped, one-way valve endoscopically positioned into the airway serving the affected lobe. The valve is introduced via a delivery catheter threaded through the working channel of a flexible bronchoscope.

Macquarie University Hospital (MUH) is one of the first private hospitals in Australia to introduce ELVR, with the first procedure being conducted in 2012. Alvin Ing, an interventionist pulmonologist and associate professor of medicine at Macquarie University and the University of Sydney, is one of the few physicians performing the ELVR procedure.

He explained, “ELVR involves implanting a small, one-way valve into the airway of the most severely damaged lobe so that when a patient exhales, air is able to flow through the valve and out of the lobe fed by the airway. However, when the patient inhales, the valve closes and blocks air from entering the lobe.

“The valve helps the most damaged lobe deflate, thus permitting better ventilation of the less damaged lobe and, overall, improves matching of ventilation to perfusion in the lung generally. Mucous is also expelled through the valve helping prevent post-obstructive atelectasis and pneumonia.”

Prof Ing uses a device called the IBV Valve, which consists of a nitinol frame covered with a polymer membrane and five anchors that securely grip the walls of the target bronchial passage. Once in place, the valve limits airflow to damaged tissue while allowing trapped air and fluid to escape.

Patient selection is the key part of the success of the ELVR, as the procedure is not for every emphysema sufferer. Patients must have moderately severe to severe COPD and must be stabilised on medical therapy first and undertaken pulmonary rehabilitation. They must also show gas trapping in the lung and heterogeneity of the disease with no communication between the targeted, most damaged lobe and the rest of the lung.

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