Supplementary Material for: HYBRID LUNG VOLUME REDUCTION: A CASE SERIES ON COMBINING SURGICAL AND BRONCHOSCOPIC TREATMENT

Introduction
Well-selected patients with advanced emphysema and hyperinflation benefit from lung volume reduction (LVR), including bronchoscopic LVR with endobronchial valves (EBV) and lung volume reduction surgery (LVRS). As bilateral EBV placement may not be advisable, an alternative approach is required. This prospective case series evaluates hybrid LVR, where contralateral LVRS is performed for patients with functional decline despite persistent atelectasis post-EBV.

Case presentation
Six patients underwent hybrid LVR with a median baseline pre-EBV FEV1 of 750 ml (range, 430-880), RV of 226% (187-293) and 6MWD of 342 meters (245-378). Baseline SGRQ was 70 points (47-86). Time between EBV and LVRS was 698.5 days (403-1027), and all had persistent atelectasis at the time of contralateral LVRS. Post-LVRS hospital stay was 5.5 days (2-44), with complications in two patients (chest tube replacement, arrhythmia requiring upgrade to intensive care unit). There was no 90-day mortality. Compared to pre-EBV, six months post-LVRS, FEV1 improved by 80 ml (-20-410), RV decreased by 1000 ml (740-1870), 6MWD increased by 59.5 meters (-65-123), and SGRQ dropped by 11.5 points (-33-19).

Conclusion
This case series on hybrid LVR demonstrates its potential to improve lung function and quality of life in selected patients who experience a deterioration in lung function following successful EBV placement.