Bronchoscopic Thermal Vapor Ablation (BTVA) for Lung Volume Reduction

Inclusion Criteria: 1. Age: \> 40 and ≤ 75 years old 2. Diagnosis of heterogeneous emphysema with upper lobe predominance 3. FEV1 \< 45% predicted 4. TLC \> 100% predicted 5. RV \> 150% predicted 6. 6-minute walk test \> 140 meters 7. mMRC ≥ 2 (mMRC) 8. Non-smoking for 3 months 9. Optimized medical management and completed pulmonary rehabilitation Exclusion Criteria: 1. Known α-1-antitrypsin deficiency 2. BMI \< 15 kg/m2 or \> 35 kg / m2 3. History of pneumothorax within previous 18 months 4. History of heart and / or lung transplant, lung volume reduction surgery (LVRS), median sternotomy, bullectomy, and/or lobectomy 5. Respiratory infections or recurring COPD exacerbations \> 3 hospitalizations in past 12 months or active infection 6. History of the (EF) ≤ 40%; Stroke; Unstable Myocardial Ischemia; FEV1 \< 15% predicted; DLCO \< 20% predicted; pulmonary hypertension; indwelling pacemaker or implantable cardiac defibrillator (ICD); pregnancy or breastfeeding