BACKGROUND: In COPD patients with severe right-sided emphysema, complete major and incomplete minor fissure, implantation of one-way valves in both the right upper (RUL) and middle lobes (ML) is a possible approach for endoscopic lung volume reduction. The aim of this retrospective analysis was to evaluate the response to therapy and the complication rate at 90 days (90d-FU) after combined RUL-ML valve implantation. METHODS: This retrospective, monocentric study included all patients from the Thoraxklinik Heidelberg who underwent RUL-ML valve treatment between 2012 and 2023 with available follow-up data. Quantitative chest imaging, lung function, 6-minute walking distance (6-MWD), complications and indications for re-bronchoscopies until 90d-FU were analysed. RESULTS: 28 patients underwent combined RUL-ML valve treatment, predominantly sequentially (92.86%, n = 26/28). Neither lung function nor 6MWD improved significantly in the overall cohort. However, in the subgroup with heterogeneous emphysema (71.4%, n = 20/28), FEV1 (
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