Endobronchial Valves in Treatment of Persistent Air Leaks: A Systematic Review of Clinical Evidence

Abstract

BackgroundPersistent air leak is one of the most common complications of lung diseases and pulmonary resections. Prolonged hospitalization, increased morbidity, and increased overall treatment costs arise from persistent air leaks. The use of endobronchial valves (EBVs) in the management of air leaks is an important alternative, especially for patients who are not candidates for surgical treatment.Material/MethodsWe retrieved the included studies by performing a systematic search in PubMed and Scopus databases. The references of the included studies were also hand-searched.ResultsWe retrieved 25 case reports and 3 case series from our literature search. The most common cause of persisting air leaks was spontaneous secondary pneumothorax (12/39, 31%). The left upper lobe (13/39, 33%) and right upper lobe (14/39, 36%) were the most frequent locations of air leaks. Most air leaks treated with EBVs ceased in less than 24 h. Three recurrences of air leak were reported and 2 cases of EBV migration were described. No deaths were reported in correlation with EBVs.ConclusionsEBVs are a minimally invasive therapeutical option that may be suitable for the treatment of persistent air leaks regardless of the initial cause, especially in high-risk patients. Nevertheless, studies with better methodological quality are essential to standardize this technique and to provide more evidence on EBV safety issues.

Intrathoracic negative pressure therapy and/or endobronchial valve for pleural empyema minimal invasive management: case series of thirteen patients and review of the literature.

“…The gold standard for the treatment of BPFs remains surgery; however, treatment with EBV implantation should be considered the first-line approach in high-risk patients or in cases where the surgical option has failed [ 15 ].…”

Endobronchial one-way valves for treatment of persistent air leaks: a systematic review

“…The endobronchial one-way valve system comprises a delivery catheter, a loader system and the implantable valves. Endobronchial one-way valve delivery could depend on either larger lumen of the rigid bronchoscopes or longer and thinner flexible bronchoscopes, the latter becomes the most common choice as it could be easily performed under moderate sedation and could help navigate into more distal bronchi [ 68 ]. Former endobronchial one-way valve, the Emphasys® (Emphasys Medical, Inc., Redwood City, CA) is no more commercially circulated.…”

Absence of postoperative pulmonary impermeability in patients with spontaneous pneumothorax

“…Эффективность зарубежных кла-панов при бронхоблокации оценивают в 57-75%, а среднее количество клапанов, используемых на од-ного больного, равно 2 (от 1 до 4) [5,15]. Эффектив-ность применения отечественного клапана оценена авторами в 92% при приемлемой цене изделия [23,24]. При этом результаты применения этих изделий сходны.…”