Endobronchial Treatment of Bronchopleural Fistulas by Using Intrabronchial Valve System: A Case Series

Podgaetz, Eitan; Andrade, Rafael S.; Zamora, Félix; Gibson, Heidi; Dinçer, H. Erhan

doi:10.1053/j.semtcvs.2015.06.005

Cited by 18 publications

(20 citation statements)

References 12 publications

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“…The valves were deployed after a median time of 19 days from drain insertion, as in other reports (3)(4)(5)(6)(7)(8)(9)(10)(11). However, 19/67 (28%) patients were treated with less than 2 weeks.…”

Section: Discussionmentioning

confidence: 98%

“…Due to the low incidence of PALs, in order to collect a large number of cases, we planned a multicenter study including all high volume Italian Centers. Consistent with previous protocols (3)(4)(5)(6)(7)(8)(9)(10)(11), EBVs were deployed after identification of the air- leaks source using the "balloon occlusion" method. We occluded only segmental bronchi supplying the source of air-leak, and avoided performing a complete lobar exclusion in patients undergoing previous lobectomy to preserve ventilation in limited residual areas of the lung.…”

Section: Discussionmentioning

confidence: 99%

“…We occluded only segmental bronchi supplying the source of air-leak, and avoided performing a complete lobar exclusion in patients undergoing previous lobectomy to preserve ventilation in limited residual areas of the lung. This strategy reduced the number of valves used compared to other studies (3,(5)(6)(7)(8)(9)(10)(11). Seven patients with unsuccessful bronchoscopic identification of air leak source were excluded from EBV treatment.…”

Section: Discussionmentioning

confidence: 99%

“…All patients were treated with Zephyr EBV (Zephyr, Pulmonx Corporation-Redwood City, CA, USA). In Europe, CE Mark cleared the use of EBVs for the treatment of emphysematous patients, and for damaged lung resulting in air-leaks (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Thus, no specific approval by Institutional Review Board (IRB) was needed.…”

Section: Methodsmentioning

confidence: 99%

“…In 2001 an American College of Chest Physicians (ACCP) consensus statement did not recommend bronchoscopy for the treatment of PAL (1,2). However, in the last two decades encouraging results have been reported in small case series (3)(4)(5)(6)(7)(8)(9)(10)(11)(12) and review articles (13,14) by the use of bronchial valves, originally designed for management of emphysema. There are currently 2 commercially available types of bronchial valves; the Zephyr endobronchial valve (EBV) (Zephyr, Pulmonx Corporation-Redwood City, CA, USA) and Spiration intra bronchial valves (IBV) (Olympus Respiratory America-Redmond, WA, USA).…”

Section: Introductionmentioning

confidence: 99%

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Unidirectional endobronchial valves for management of persistent air-leaks: results of a multicenter study

Fiorelli¹,

D’Andrilli²,

Cascone³

et al. 2018

J. Thorac. Dis

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Background: To evaluate the efficacy of Endo-Bronchial Valves in the management of persistent air-leaks (PALs) and the procedural cost. Methods: It was a retrospective multicenter study including consecutive patients with PALs for alveolar pleural fistula (APF) undergoing valve treatment. We assessed the efficacy and the cost of the procedure. Results: Seventy-four patients with persistent air leaks due to various etiologies were included in the analysis. In all cases the air leaks were severe and refractory to standard treatments. Sixty-seven (91%) patients underwent valve treatment obtaining a complete resolution of air-leaks in 59 (88%) patients; a reduction of air-leaks in 6 (9%); and no benefits in 2 (3%). The comparison of data before and after valve treatment showed a significant reduction of air-leak duration (16.2±8.8 versus 5.0±1.7 days; P<0.0001); chest tube removal (16.2±8.8 versus 7.3±2.7 days; P<0.0001); and length of hospital stay (LOS) (16.2±8.8 versus 9.7±2.8 days; P=0.004). Seven patients not undergoing valve treatment underwent pneumo-peritoneum with pleurodesis (n=6) or only pleurodesis (n=1). In only 1 (14%) patient, the chest drainage was removed 23 days later while the remaining 6 (86%) were discharged with a domiciliary chest drainage removed after 157±41 days. No significant difference was found in health cost before and after endobronchial valve (EBV) implant (P=0.3). Conclusions: Valve treatment for persistent air leaks is an effective procedure. The reduction of hospitalization costs related to early resolution of air-leaks could overcome the procedural cost.

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