Fissure Closure With the AeriSeal System for CONVERTing Collateral Ventilation Status (CONVERT)

Severe emphysema subjects will be consented using an Ethics Committee approved Informed Consent Form (ICF) for baseline evaluations. Subjects with ≥ 50% lobar emphysema destruction (evaluated quantitatively by using percentage lung volume occupied by low-attenuation regions/voxels) and identified as potentially having collateral ventilation, with fissure completeness ≥ 80% from the Quantitative Computed Tomography (QCT) report (CV status later to be confirmed by Chartis assessment at Visit 2) will undergo additional QCT assessment for the feasibility of directing AeriSeal to the appropriate segment to seal the anatomical defect. Subjects in whom this is considered feasible will be enrolled. Enrolled subjects will undergo a bronchoscopy procedure during which the presence of collateral ventilation will be confirmed using the Chartis Pulmonary Assessment System (Pulmonx Corporation) and if confirmed, will undergo AeriSeal treatment in the segment(s) feeding the collateral channel. A minimum 10 mL volume of AeriSeal will be delivered per segment, with a total delivered volume limit of 40 mL per subject (including re-treatment, if needed) in a total of three segments. Subjects will be hospitalized for a minimum of two (2) nights for observation and discharged if stable. Following discharge, subjects will be contacted daily for at least 7 days via telephone to assess status and solicit any Adverse Events. Subjects that have little to no collateral ventilation at the initial bronchoscopy, as assessed by the Chartis Pulmonary Assessment System, will be exited from the study. Six (6) weeks following the AeriSeal treatment, subjects will undergo a second bronchoscopy procedure for assessment of collateral ventilation status of the AeriSeal treated lobe with Chartis. If the Chartis assessment shows presence of collateral ventilation (CV+) at the lobar level, Chartis will be used to assess collateral ventilation at the segmental level to identify the segment with open collaterals. A second treatment with AeriSeal will be considered, provided the total delivered volume inclusive of the original treatment does not exceed 40 mL per subject. The post-procedure follow-up assessments for the second treatment will be repeated as after the initial treatment. If the Chartis assessment determines little to no collateral ventilation (CV-) in the AeriSeal treated lobe, the lobe will be treated with Zephyr Valves as per the standard valve placement procedure. Subject will be hospitalized for a minimum of three (3) nights post-valve placement procedure and discharged with follow-up in accordance with this protocol, which includes standard post-valve placement follow-up. Subjects who do not convert from CV+ to CV- status will continue to be observed for safety through 12 months following AeriSeal treatment or re-treatment, whichever is later. The primary AeriSeal endpoint is the percentage of study subjects that are successfully converted from a positive collateral ventilation (CV+) status in the treated lobe to having little to no collateral ventilation (CV-) in the treated lobe. Following the procedure for Zephyr Valve placement, subjects will be required to undergo Pulmonary Rehabilitation as per the local/national guidelines of each participating institution; at least 20 supervised sessions. A High Resolution Computed Tomography (HRCT) will be performed at 45-days post-Zephyr Valve procedure to determine Treated Lobe Volume Reduction (TLVR). Lung function will be assessed by measuring post-bronchodilator FEV1. A valve adjustment procedure will be considered if there is lack of TLVR (≤ 350 mL reduction from the pre-valve assessment) following evaluation of the High-resolution computed tomography (HRCT) to determine which valve needs to be replaced or addition of a new valve at a previously missed airway. Subjects will also be evaluated at 3-months, 6-months, and 12 months following Zephyr Valve placement.