S. Gupta1,2, T. L. Demmy1,2, M. Hennon1,2, C. Nwogu1,2, A. Picone1,2, S. Yendamuri1,2, E. U. Dexter1,2 1State University Of New York At Buffalo,Medicine,Buffalo, NY, USA 2Roswell Park Cancer Institute,Thoracic Surgery,Buffalo, NY, USA
Introduction:
Prolonged air leak (PAL), defined as an air leak present for longer than 5 days, occurs in 4-9% of patients following lung resection (LR). Bronchoscopic intrabronchial valve (IBV; Olympus, Redmond, WA) placement is an FDA-approved treatment for PAL after LR. IBV placement is also used off-label in other conditions such as spontaneous pneumothorax, severe emphysema and bronchopleural fistula. We conducted a retrospective review of our institutional outcomes after IBV placement.
Methods:
Twenty four patients had a total of 28 IBV placements between 8/2013-6/2017. Presence of air leak was determined by measuring air leak flow using a digital chest drainage system or by visual confirmation of bubbling in the water seal chamber of a pleural drainage reservoir. Removal of IBV is performed 6 weeks after air leak resolution. One patient with severe bullous emphysema had no air leak at the time of IBV placement.
Results:
Most patients had 3-5 IBV placed (see Table 1). Twelve patients had IBV placement after LR and 7 patients for spontaneous pneumothorax (n=6) or bullous emphysema (n=1; EMPH). LR included 7 lobectomy, 2 bilobectomy, 2 wedge resection, and 1 exploratory thoracotomy with unplanned wedge resection. Air leak resolution among 11 LR patients occurred at most 1 week after IBV placement for 6 patients, 2 weeks for 2 patients, 1 month for 1 patient, and 2 months for 2 patients. All patients with IBV post LR had chest tube removal prior to discharge (n=2) or management as an outpatient (n=10). Ten patients in the LR group are alive with follow up ranging from 14-59 months. For the two LR patients who died, death occurred 354 days and 389 days following IBV placement. Five EMPH patients were discharged from the hospital with resolved air leak, but only 2 are alive. Among the 5 EMPH patients with PAL resolution, duration of leak post-IBV was at most 1 week for 2 patients, 1 month for 1 patient, and 2 months for 2 patients. Death in the 5 EMPH patients occurred 10, 45, 63, 187 and 487 days following IBV procedure. Patients who had surgery for pleural disease (PD) developed PAL due to intraoperative lung damage. Although there was good resolution of air leak with IBV for PD, like EMPH patients, survival was low. Two patients with bronchopleural fistula associated with empyema had IBV placement of 1 valve each with resultant blockage of the fistula. Both are alive.
Conclusion:
IBV placement has a good success rate in resolving PAL after LR and enabled hospital discharge. The higher death rate in EMPH and PD patients following IBV placement may be impacted by underlying medical disease. In order to identify patients appropriate for IBV placement or factors that influence outcomes after IBV placement, further study is needed.
