Surgical Compared to Bronchoscopic Lung Volume Reduction in Patients With Severe Emphysema

NCT ID: NCT04537182

Last Updated: 2024-05-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

120 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-09-01

Study Completion Date

2028-03-31

Brief Summary

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The investigators plan to perform a randomized controlled trial that compares bilateral lung volume reduction surgery (LVRS) with bronchoscopic lung volume reduction (BLVR) using endobronchial valves in terms of efficacy and patient safety.

Detailed Description

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Advanced lung emphysema has a considerable impact on quality of life in patients with chronic obstructive pulmonary disease. There are positive reports of surgical as well as bronchoscopic volume reduction in selected patients, but data comparing LVRS and BLVR is unfortunately lacking to date. The investigators therefore anticipate that their study will make an important contribution to the worldwide efforts in better understanding selection and management of surgical and bronchoscopic treatment of emphysema patients and that it will be of high public interest.

Conditions

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Emphysema

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

International, multi-center, open label, morphology- and site-stratified, 1:1 randomized, actively controlled
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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LVRS treatment group

A bilateral lung volume reduction surgery (LVRS) by video-assisted thoracoscopic surgery (VATS) is performed under general anesthesia with double lumen endobronchial intubation. Unilateral treatment is accepted in cases with severe adhesions or intraoperative instability making a bilateral procedure unsafe.

Group Type EXPERIMENTAL

Lung volume reduction surgery

Intervention Type PROCEDURE

Lung volume reduction by surgery

BLVR study group

Unilateral bronchoscopic lung volume reduction with endobronchial valves (EBV) is performed using a flexible bronchoscope under general anesthesia and under full attendance of an anesthesiologist. Valves are placed unilaterally in segmental or subsegmental bronchi in the target lobe with the goal of complete atelectasis.

Group Type ACTIVE_COMPARATOR

Bronchoscopic lung volume reduction with valves

Intervention Type PROCEDURE

Lung volume reduction with endobronchial valves.

Interventions

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Lung volume reduction surgery

Lung volume reduction by surgery

Intervention Type PROCEDURE

Bronchoscopic lung volume reduction with valves

Lung volume reduction with endobronchial valves.

Intervention Type PROCEDURE

Other Intervention Names

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LVRS BLVR

Eligibility Criteria

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Inclusion Criteria

* Patients suffering from emphysema (all morphologies, uni- or bilateral distribution) potentially qualifying for both study procedures, LVRS or BLVR (if possible, perfusion scintigraphy within \< 6 month of screening, CT scan within \< 4 months of screening)
* Age ≥ 30 and ≤ 80 years
* Body Mass Index (BMI) ≥ 16, but ≤ 35 kg/m2
* Non-smoking for 3 months prior to screening interview
* Patient is able to understand and willing to sign a written informed consent document.

Exclusion Criteria

* FEV1 more than 50% predicted
* TLC less than 100 % predicted, RV less than 175% predicted, RV/TLC less than 58% predicted, and DLCO ≤ 20% predicted in homogeneous emphysema and DLCO ≤ 15% in heterogeneous emphysema, respectively
* PaO2 ≤ 6.0 kPa (45mm Hg) at ambient air (only applicable for homogeneous morphology!)
* PaCO2 ≥ 6.6 kPa (50 mmHg) at ambient air (only applicable for homogeneous morphology!)
* Patients with incomplete interlobar fissures as revealed by quantitative computed tomography analysis with StratX® (fissure completeness ≤ 80%)
* Patients with collateral ventilation as evidenced by bronchoscopic Chartis® measurement (only performed if fissure completeness according to StratX® is \< 95%)
* 6-minute walking distance ≥ 470m
* More than two COPD exacerbation episodes requiring hospitalization in the last year
* More than two instances of pneumonia episodes in the last year
* Unplanned weight loss ≥ 10% within 90 days prior to enrollment
* Pulmonary hypertension as evidenced by Delta Psyst RV-RA \> 35 mmHg on recent echocardiography (within 3 months prior to screening) and confirmed by RHC (mPAP ≥ 35 mmHg) and signs of moderate to severe RV dysfunction.
* Evidence of left ventricular ejection fraction (LVEF) less than 45% on recent echocardiography (within 3 months prior to screening)
* History of exercise-related syncope
* Myocardial infarction or congestive heart failure within 6 months of screening
* Clinically significant arrhythmias that might put the patient at risk in regard to the interventions
* Prior LVR (any method), bullectomy, or lobectomy
* Clinically significant bronchiectasis with expectoration of ≥ 2 tablespoons/day.
* Pulmonary nodule requiring surgery
* Unable to safely discontinue anticoagulants or dual antiplatelet therapy for 7 days
* Patients with a life expectancy of less than one year
Minimum Eligible Age

30 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Isabelle Opitz, Professor, MD

OTHER

Sponsor Role lead

Responsible Party

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Isabelle Opitz, Professor, MD

Prof. MD

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Isabelle Opitz, Prof. MD

Role: PRINCIPAL_INVESTIGATOR

University of Zurich

Locations

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Universitätsklinik für Thoraxchirurgie, Medical University of Vienna

Vienna, , Austria

Site Status RECRUITING

University Hospital Leuven

Leuven, , Belgium

Site Status RECRUITING

Rigshospitalet, University of Copenhagen

Copenhagen, , Denmark

Site Status RECRUITING

Kantonsspital Aarau

Aarau, Canton of Aargau, Switzerland

Site Status RECRUITING

Lausanne University Hospital (CHUV)

Lausanne, Canton of Vaud, Switzerland

Site Status RECRUITING

University Hospital Zurich, Division of Thoracic Surgery

Zurich, Canton of Zurich, Switzerland

Site Status RECRUITING

Countries

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Austria Belgium Denmark Switzerland

Central Contacts

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Isabelle Opitz, Prof. MD

Role: CONTACT

+41 44 255 11 11

Albana Rexhepaj, PhD

Role: CONTACT

+41 44 255 92 30

Facility Contacts

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Clemens Aigner, Prof. Dr.

Role: primary

+43 (0)1 40400-56440

Karl Kreissl

Role: backup

Laurens Ceulemans, Prof MD

Role: primary

Rene Horsleben Petersen, Prof. PhD

Role: primary

+45 35450525

Tina Refstrup Lund

Role: backup

Franco Gambazzi, PD MD

Role: primary

Thorsten Krueger, Prof MD

Role: primary

Isabelle Opitz, Prof MD

Role: primary

+41 44 255 11 11

Other Identifiers

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SINCERE

Identifier Type: -

Identifier Source: org_study_id

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