Mind The Gap - Crossing Borders Study

Inclusion Criteria: 1. Diagnosis of emphysema with a treatable target for endobronchial valves (Zephyr). 2. Subjects of both genders of at least 35 years of age at the time of the baseline visit. 3. Understand and voluntarily sign a patient informed consent form. 4. 15 % predicted ≤ FEV1 ≤ 50% predicted. 5. RV ≥ 175% predicted, and TLC ≥ 100% predicted and RV/TLC ≥ 55%. 6. 6MWD ≥ 140 meters. 7. Dyspnea score of ≥2 on the mMRC scale of 0-4. 8. Non-smoker \> 6 months prior to signing the informed consent. 9. Chartis CV positive between target and ipsilateral lobe Exclusion Criteria: 1. Evidence of active pulmonary infection. 2. Evidence of clinically significant bronchiectasis. 3. History of more than 3 exacerbations with hospitalizations over the past 12 months. 4. Myocardial infarction or other relevant cardiovascular events in the past 6 months. 5. Prior lung surgery, Lung volume reduction surgery, lung transplantation, lobectomy, or pneumonectomy. 6. Prior endoscopic lung volume reduction. 7. Unstable pulmonary nodule requiring follow-up 8. Pregnant of nursing women. 9. Hypercapnia defined by PaCO2 \> 8.0kPa, or Hypoxemia defined by PaO2 \< 6.0kPa, both measured on room air. 10. Any disease with high probability of mortality within 24 months. 11. Patient is on an antiplatelet agent (such as Plavix) or anticoagulant therapy (such as LMWH or coumarins), which cannot be stopped periprocedural. 12. Patient was involved in other pulmonary drug studies within 30 days prior to this study. \-