Bronchoscopic thermal vapor ablation (BTVA) in patients with severe upper lobe emphysema: Lung function outcomes of a prospective international registry

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Background: BTVA can lead to an improvement in lung function and quality of life in patients with severe upper lobe emphysema. However, real-life data are lacking. Methods: Data from the international BTVA register were analysed. Patients who had undergone at least one BTVA procedure between 05/2017 and 06/2024 and who had a follow-up of 6 and/or 12 months were included. In the current analysis, lung function changes were analysed at 6 and 12 months after the first procedure. Results: The BTVA registry included 261 patients from 17 centres who underwent a total of 398 procedures. Data on 6- and 12-month follow-up were available for 161 and 150 patients, respectively. Of these, 75 (46.6 %) were female. The mean age was 64.4±7.2 years and the body mass index was 24.2 ± 4.1 kg/m². After the procedure, there was a significant improvement in lung function after 6 months: ΔFEV1 (mL) +49; p=0.006, ΔFEV1 (%) +1.8; p<0.001, ΔFVC (mL) +116; p=0.003, ΔFVC (%) +3.4; p<0.001, ΔRV (mL) -500; p<0.001, ΔRV (%) -19.7; p<0.001. This improvement was also sustained after 12 months: ΔFEV1 (mL) +28; p=0.104, ΔFEV1 (%) +1.71; p=0.010, ΔFVC (mL) +147; p=0.002, ΔFVC (%) +4.4; p<0.001, ΔRV (mL) -458; p<0.001, ΔRV (%) -19.1; p<0.001. Conclusion: The results suggest a sustained improvement in lung function up to 12 months after BTVA. However, the COVD-19 pandemic led to a substantial reduction in available follow-up data. To ensure a comprehensive evaluation of the long-term effects of this intervention, data of treated patients should continue to be included in the registry.

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