In Reply We agree with Drs Jabuonski and Lazarus that both operator expertise and a multidisciplinary approach are important for emphysema treatment.
To minimize the effect of operator experience and for safety reasons, the first 3 procedures in each center with no experience with lung volume reduction coil treatment (7 of 10 centers in the REVOLENS study) were proctored by a physician who had performed at least 10 such procedures. Jabuonski and Lazarus propose analyzing the outcomes stratified by center. However, the limited number of patients treated by lung volume reduction coils in each center (mean, 5 patients per center) does not allow any robust statistical analyses stratified by center. They also state that “the results of this study might be significantly different in a country like the United States where such devices are not available apart from clinical trials.” In France, lung volume reduction coil treatments have also so far only been used in clinical trials. A large randomized multicenter study (the RENEW study) involving 26 sites with 20 sites in the United States was recently published and found a modest improvement in the 6-minute walk test results at 1 year, with overall efficacy results very close to the REVOLENS study.1
Deslée G, Marquette CH, for the REVOLENS Study Group. Lung Volume Reduction Coils for Severe Emphysema—Reply. JAMA. 2016;315(23):2621-2622. doi:10.1001/jama.2016.3486