Endobronchial Valves for Challenging Air Leaks

doi:10.1016/j.athoracsur.2015.04.104

The Annals of Thoracic Surgery

Volume 100, Issue 4, October 2015, Pages 1181-1186

Presented at the Poster Session of the Fiftieth Annual Meeting of The Society of Thoracic Surgeons, Orlando, FL, Jan 25–29, 2014.

https://doi.org/10.1016/j.athoracsur.2015.04.104 Get rights and content

Background

Prolonged air leaks may result in increased morbidity and mortality. Endobronchial valves have been used as a nonoperative treatment. We evaluated the efficacy of endobronchial valves at achieving chest tube removal and hospital discharge for air leaks resulting from varied etiologies.

Methods

All consecutive patients undergoing endobronchial valve placement for persistent air leak were evaluated by a multidisciplinary team at a single institution. Those receiving valves underwent bronchoscopy with balloon occlusion to identify airways contributing to the leak. After airway sizing, unidirectional endobronchial valves were deployed.

Results

During an 18-month period, 21 patients underwent 24 valve placement procedures; 88 valves were placed (median, 3; mean, 3.6; range, 1 to 12). Patient age range was 16 months to 70 years. The underlying cause of persistent air leak was postoperative (n = 8), pneumothorax (n = 11), cavitary lung infection (n = 3), and postpneumonectomy bronchopleural fistula (n = 2). There were no valve-related complications during placement, dwell time, or removal. Three patients died as a result of their underlying disease, unrelated to valves. Of those with chest tubes who survived and were discharged, all had successful removal of their chest tubes. Median duration to chest tube removal after initial valve placement was 15 days (mean, 21 days; range, 0 to 86 days). Median length of stay after final valve placement was 5 days (mean, 15 days; range, 0 to 196 days).

Conclusions

Challenging air leaks often occur in medically compromised patients. They may persist despite multiple interventions. Endobronchial valves offer minimally invasive management. Time to chest tube removal and length of stay are variable, frequently because of clinical status and underlying disease.

Section snippets

Patients and Methods

The Penn State University Institutional Review Board approved this retrospective study with a waiver of consent. All consecutive patients undergoing EBV placement for persistent air leak from October 2011 through May 2013 were included. Seven patients were previously reported 13, 14, 15. Patients with prolonged air leaks were evaluated for EBV placement by a multidisciplinary thoracic surgery and interventional pulmonology team at a single institution. Persistent air leak was defined as

Results

During an 18-month period, 21 patients underwent 24 EBV placement procedures. Eleven were men. The median age was 58 years (mean, 49 years; range, 16 months to 70 years). Eighty-eight valves were placed with a median of 3 valves per procedure (mean, 3.6 valves; range, 1 to 12 valves). The underlying etiologies for prolonged air leak were postoperative air leak (33%; n = 8), pneumothorax (46%; n = 11), cavitary infectious processes (13%; n = 3), and bronchopleural fistula after pneumonectomy

Comment

Endobronchial valves were initially developed for bronchoscopic lung volume reduction surgery in severe heterogeneous emphysema. Their efficacy for management of postoperative air leak was later defined 1, 9, 11, 12. Other case reports have defined additional clinical scenarios in which EBVs were effectively used for elimination of airflow to specific regions of the lung 11, 14, 15, 16, 17, 18, 19, 20. Here, we report a consecutive series of 24 cases of EBV placement for a spectrum of clinical

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Endobronchial silicone spigot in prolonged air leaks: Nationwide study on outcomes and risk factors for treatment failure
2024, Respiratory Investigation
The endobronchial silicone spigot, also known as the endobronchial Watanabe spigot, is used in bronchoscopic interventions to manage prolonged pulmonary air leakage. However, the outcomes of this procedure have not been thoroughly investigated.
Using a Japanese national inpatient database from April 2014 to March 2022, we assessed the clinical characteristics and outcomes of all eligible patients who received the endobronchial spigot. We also investigated risk factors associated with treatment failure. Treatment failure was defined as in-hospital death or the need for surgery after bronchial occlusion.
We analyzed data of 1095 patients who underwent bronchial occlusion using the endobronchial spigot. Among them, 252 patients (23.0%) died during hospitalization, and 403 patients (36.8%) experienced treatment failure. Factors associated with treatment failure included age between 85 and 94 years (odds ratio [OR] 1.83; 95% confidence intervals [CI], 1.04–3.21); male sex (OR 2.43; 95% CI, 1.44–4.11); low Barthel index score; comorbidities of interstitial pneumonia (OR 1.71; 95% CI, 1.18–2.48); antibiotics treatment (OR 1.45; 95% CI, 1.02–2.07); steroids treatment (OR 1.59; 95% CI, 1.07–2.36); and surgery prior to bronchial occlusion (OR 2.08; 95% CI, 1.29–3.35). In contrast, pleurodesis after bronchial occlusion (OR 0.49; 95% CI, 0.32–0.75), and admission to high-volume hospitals were inversely associated with treatment failure (OR 0.58; 95% CI, 0.37–0.90).
The endobronchial Watanabe spigot could be a nonsurgical treatment option for patients with prolonged pulmonary air leaks. Our findings will help identify patients who may benefit from such bronchial interventions.
Hypoxemia After Endobronchial Valve Deployment for Persistent Air Leak
2023, Journal of Cardiothoracic and Vascular Anesthesia
Endobronchial valves (EBVs) are a novel, minimally invasive bronchoscopic management technique for persistent air leaks that fail conservative therapy. Currently, 2 EBVs are available in the United States: the Spiration Valve System (Olympus, Redmond, WA) and the Zephyr Valve (Pulmonx, Redwood, CA). These valves are Food and Drug Administration–approved to reduce hyperinflation in emphysematous patients via bronchoscopic lung-volume reduction. However, more recently, the Spiration Valve has been granted a compassionate use exemption through the Food and Drug Administration for persistent postsurgical air leaks. Despite their popularity, these devices are not free from side effects. As an anesthesiologist, it is vital to be aware of the pathophysiology of this patient population so that safe and effective anesthetics may be provided during valve placement. Here, the use of EBVs is discussed in a patient who presented with a persistent air leak after a transthoracic needle aspiration that failed treatment due to persistent hypoxemia, warranting EBV removal.
Interventional bronchoscopic treatment of lung cancer
2022, Laparoscopic, Endoscopic, and Robotic Surgery
Citation Excerpt :
Han et al reported modified stenting for 148 patients with postpneumonectomy BPF; 95.3% had significant symptom relief one month after stent implantation, and 38.8% had complete recovery of fistula by the time the stent was removed; however, approximately 32.4% died from pulmonary infection, respiratory failure, or hemoptysis.37 In addition, implantation of one-way endobronchial valves has been used in some centers and has proven to be effective, but the complicated procedures and high cost partially limit its widespread use.38 Other treatments for BPF include local injection of bronchoscopic umbilical mesenchymal cells, fibrinogen or thrombin, implantation of ventricular septal defect occluders or atrial septal defect occluders.12,39
Interventional bronchoscopy has developed rapidly in the management of lung cancer. Besides ablative resection of various modalities and balloon dilation/stent placement, which have been widely used in the management of malignant central airway obstruction, bronchoscopic brachytherapy and transbronchoscopic local injection of drugs are also developing. For early-stage peripheral lung cancer, transbronchoscopic ablation and the assisted localization of preoperative peripheral lung nodules by bronchoscopy are the new techniques. In addition, interventional bronchoscopy can manage complications related to lung cancer. Overall, interventional bronchoscopy has been an indispensable component in the treatment of lung cancer and has vast space for development. The review summarizes the recent updates.
[Translated article] Use of an Endobronchial Valve for Management of a Persistent Air-leak in a Child with Necrotizing Pneumonia
2022, Archivos de Bronconeumologia
Pediatric advanced diagnostic and interventional bronchoscopy
2021, Seminars in Pediatric Surgery
The indications and utility of flexible bronchoscopy have expanded over the past few decades with major innovations in design and development of new tools for endobronchial interventions and image-guided tissue sampling techniques. This review highlights the application of advanced diagnostic bronchoscopy (including endobronchial ultrasound and CT navigational techniques), cryotherapy and the use of one-way endobronchial valves for persistent air leak in the pediatric setting.
Intrabronchial valves for persistent pulmonary air leaks in children
2019, Journal of Pediatric Surgery Case Reports
Citation Excerpt :
The IBV system by Spiration is the only FDA-approved device. Studies describing IBV and EBV use for the management of PAL were reported in adult patients and have since been shown to be effective in up to 57%–95% of adult patients with PAL [19–21]. Hance et al. reported an overall 57% effectiveness of bronchoscopy with IBV placement in adult patients who developed PALs related to medical or surgical reasons.
Surgery to address parenchymal lung disease in children is rare. One of the complications of the surgery is a persistent air leak (PAL). Intrabronchial valves (IBV), which received FDA approval for treating PAL in recent years, limit or exclude the inflow of air towards the pleura and allow air and secretions to flow towards central airways. The valves have been effective in adults with PAL but little has been published on their use in children.
Retrospective chart review was performed after IRB approval on patients treated with IBV after surgical excision of lung parenchyma. A literature review was then performed.
2 pediatric patients are presented. Patient 1, a 10 year old girl underwent excision of a lung mass that developed persistent air leak. Traditional conservative methods did not seal the air leak for 23 days but an IBV sealed the leak in 24 h. Patient 2, a 6 year old boy underwent a pneumonectomy with post-operative bronhical leak. The bronchus was repaired but a leak persisted for 36 days. An IBV sealed the leak immediately.
Intrabronchial valves can be used for the management of persistent pulmonary air leaks. We propose a tentative algorithm for using the devices in children with PAL.

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Original articleGeneral thoracicEndobronchial Valves for Challenging Air Leaks

Background

Methods

Results

Conclusions

Section snippets

Patients and Methods

Results

Comment

Ann Thorac Surg

Surg Clin North Am

Ann Thorac Surg

Clin Chest Med

Ann Thorac Surg

Chest

J Pediatr Surg

Ann Thorac Surg

Chest

Chest

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Original article
General thoracic
Endobronchial Valves for Challenging Air Leaks