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Endobronchial Valve Placement For Complex Air-leaks After Pulmonary Resection
Jennifer Risi, MD, Stephanie Baltaji, MD, Sophia Barber, DO, Benny Weksler, MD, Tanya Marshall, MD, Sohini Ghosh, MD, Aarthi Ganesh, MD, Lawrence Crist, DO, Hiran C. Fernando, MD.
Allegheny General Hospital, Pittsburgh, PA, USA.
BACKGROUND: Prolonged air leak (PAL) occurs in around 15% of patients after lung resection and can lead to extended length of stay and additional morbidity. Endobronchial Valves (EBVs) were initially developed for lung volume reduction in emphysema patients, however EBV have been increasingly used for PAL. Most series have included primary (non-operative) and post-operative PAL. Our study reviews outcomes after EBV placement specifically for patients with air-leaks after lung resection.
METHODS: We conducted a retrospective study of patients who underwent EBV placement for air-leak after lung-resection. Indications for EBV placement included high air-leak rate, inability to place to water-seal, and patient inability/reluctance for discharge with a chest-tube. Valve effectiveness was evaluated using air leak rates before and after valve placement, chest tube removal, and the need for additional pleural procedures. Adverse events after EBV placement were assessed.
RESULTS: Over a 45-month period over 650 pulmonary resections were performed. EBV were placed in 24 patients after lobectomy (19), segmentectomy (2), or wedge resections (3). The median number of valves placed was 3. The median time from surgery to EBV placement was 7 days. Digital drainage systems were used in 18/24 patients. Mean air leak rate decreased significantly (p<0.001) from 1178 ml/min to 370 ml/min on post-operative day 1 (POD1), with complete resolution on POD1 in 7(29%). Median hospital stay after EBV placement was 6(2-14) days. In-patient chest tube removal was achieved in 14(58.3%) of patients (median of 4.5 days). Adverse events occurred in 7 patients, 2 were considered related to the EBV placement (both hypoxia). Six patients required additional procedures including additional EBV (1), blow holes (1), pleurodesis (1), chest-tube replacement (2) and completion lobectomy (1). There were two deaths (one from a pulmonary embolus; the second from a cerebrovascular accident/pneumonia occurring after discharge). EBV were removed in remaining patients at mean of 84 (30-276) days.
CONCLUSIONS:EBV placement is effective in decreasing air leak rate, facilitating discharge and chest-tube removal. EBVs are a useful addition to the thoracic surgeon’s armamentarium for managing complex air-leaks. Further studies will help optimize patient selection and timing of EBV placement.
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