Sequential Bilateral Bronchoscopic Lung Volume Reduction With One-Way Valves for Heterogeneous Emphysema Alfonso Fiorelli, MD, PhD, Antonio D’Andrilli,

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Sequential Bilateral Bronchoscopic Lung Volume Reduction With One-Way Valves for Heterogeneous Emphysema Alfonso Fiorelli, MD, PhD, Antonio D’Andrilli, MD, Marco Anile, MD, PhD, Daniele Diso, MD, PhD, Camilla Poggi, MD, Mario Polverino, MD, Giuseppe Failla, MD, Federico Venuta, MD, Erino Angelo Rendina, MD, Mario Santini, MD The Annals of Thoracic Surgery Volume 102, Issue 1, Pages 287-294 (July 2016) DOI: 10.1016/j.athoracsur.2016.02.018 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Timing of second bronchoscopic lung volume reduction for the 14 patients of the bilateral group. The Annals of Thoracic Surgery 2016 102, 287-294DOI: (10.1016/j.athoracsur.2016.02.018) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 In the bilateral group, an increase of (A) forced expiratory volume in 1 second (FEV1 [p < 0.05]), (B) forced vital capacity (FVC [p < 0.05]), (C) reduction of residual volume (RV [p < 0.05]), (D) 6-minute walk time (6MWT [p < 0.05]), and (E) St. George’s Respiratory Questionnaire (SGRQ [p < 0.05]) were observed as long as 12 months after initial (blue lines) and repeated (red lines) bilateral lung volume reduction. The Annals of Thoracic Surgery 2016 102, 287-294DOI: (10.1016/j.athoracsur.2016.02.018) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Bilateral group (blue lines) versus unilateral group (red lines) showed no significant difference regarding the changes of (A) forced expiratory volume in 1 second (FEV1 [p = 0.4); (B) forced vital capacity )FVC [p = 0.08]); (C) residual volume (RV [p = 0.9]); (D) 6-minute walk test (6MWT [p = 0.3]); and (E) St. George’s Respiratory Questionnaire (SGRQ [p = 0.1]). The Annals of Thoracic Surgery 2016 102, 287-294DOI: (10.1016/j.athoracsur.2016.02.018) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Comparison of survival rates between the bilateral group (blue line) and unilateral group (red line) showed no significant difference (p = 0.6; hazard ratio 1.24; 95% confidence interval: 0.46 to 3.32). The Annals of Thoracic Surgery 2016 102, 287-294DOI: (10.1016/j.athoracsur.2016.02.018) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions