Original article
General thoracic
Endoscopic One-Way Valve Implantation in Patients With Prolonged Air Leak and the Use of Digital Air Leak Monitoring

https://doi.org/10.1016/j.athoracsur.2012.12.036Get rights and content

Background

Prolonged alveolar-pleural air leaks are associated with increased morbidity and mortality. Endoscopic valve therapy has been recently introduced as a potential less invasive treatment option. We aimed at quantifying the effects of valve therapy on air leak flow and clinical outcomes in patients with prolonged air leaks.

Methods

We report on a series of 16 patients with high comorbidity and evidence of continuous air leak flow in whom chest tubes remained in place for at least 7 days. After identification of the source of the air leak by use of the balloon occlusion technique, endobronchial one-way valves were implanted. Digital chest tube monitoring was used to assess air leak flow before, during, and after valve implantation until chest tube removal.

Results

The source of the air leak was endoscopically identified in 13 patients (81%). After valve implantation, air leak flow decreased significantly from 871 ± 551 mL/min to 61 ± 72 mL/min immediately after the intervention (p < 0.001). The mean duration of chest tube drainage was 18 ± 8 days before and 9 ± 6 days after the intervention (p < 0.01). Ten patients were considered responders, and 3 patients were nonresponders. Responders demonstrated consistent air leak flow levels below 100 mL/min until chest tube removal. Long-term follow-up was available for 9 patients. No adverse events related to the valve implants were reported at follow-up. Seven patients underwent valve removal without any further complications.

Conclusions

Endoscopic implantation of one-way valves leads to a significant reduction in air leakage flow and may thus be a valuable treatment option in patients with prolonged air leakage.

Section snippets

Patients

Nineteen consecutive patients were evaluated between May 2010 and May 2012. Patients included in the study had to demonstrate persistent continuous air leak, defined as intrathoracic chest tube duration for more than 7 days despite conservative therapy, surgical therapy, or both, with an air leak flow of at least 100 mL/min. Patients referred for evaluation of endoscopic treatment were considered not to be good surgical candidates because of high comorbidities or previous failed surgical

Results

Three patients with intermittent air leak were excluded, leaving 16 patients with evidence of continuous air leakage flow (Fig 1). Table 1 illustrates the patient characteristics, including results of lung function tests. The majority of patients were smokers, with a high prevalence of comorbid disease.

Table 2 provides information on the underlying causes of the prolonged air leaks, prior interventions, average duration of chest tube placement before and after bronchoscopy, and target sites of

Comment

Treatment of prolonged air leaks with endobronchial one-way valves is feasible, is safe, and resulted in successful treatment and reduction of air leakage flow in the majority of patients included in this report.

Patients with prolonged air leaks are at an increased risk of morbidity and mortality in as high as 70% [2]. A variety of risk factors may contribute to prolonged air leaks, including preexisting lung disease, steroid use, prior radiochemotherapy, malnutrition, diabetes, or a

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