Background Endoscopic valve implantation is a treatment option for selected patients with advanced emphysema. For this purpose, endobronchial (EBV) or intrabronchial valves (IBV) can be used. We analysed the results of treatment after combining the two valve types.

Methods Retrospective analysis after combined IBV (Spiration-Olympus) and EBV (Pulmonx) implantation at the Thoraxklinik Heidelberg from 02/2013 to 11/2021. The decision for combination of valves was made by the investigators during bronchoscopy, based on the special anatomy of the bronchi. The effectiveness and complications were analysed at 90-day follow-up (90d-FU).

Results 89 patients (?/?:55%/45%, age: 65±7 years), with 90d-FU were included in the study. In 95.4±7.2% of the cases the interlobar fissures were visually intact. A mean of 1.8±0.85 EBV and 1.2±0.42 IBV pro patient were implanted. IBV were predominantly implanted in the lower lobes, 88% of them in segment six. FU showed target lobar atelectasis in 53% of cases with significant improvement in FEV1 (0.75±0.22L vs 0.84±0.27L, p<0.00001), residual volume (5.7±1.45L vs 5.0±1.41L, p<0.00001), 6MWT (266±109m vs 302±91m, p<0.0001) and mMRC (3.2±0.9 vs 2.7±1.3, p=0.0021). Pneumothoraces occurred in 11 pat, 6 cases required drainage. A total of 23 pneumonias occurred, 11 with hospitalization. 4 patients reported self-limiting haemoptysis.

Conclusion Combined implantation of IBVs and EBVs resulted in atelectasis of the target lobe in the majority of cases with statistically significant clinical and functional improvement and with an acceptable risk profile.The combination of both valves expands the possibilities of valve therapy according to the bronchus anatomy.