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

Abstract

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.

Modified Silicone Stent in the Treatment of Bronchopleural Fistula: Clinical Observation of 17 Cases

“…The utility of these materials was restricted to small BPFs (< 3 mm in size). The other strategy is occlusive devices, mainly included: stents and their modi cations, Amplatzar™ devices [24,25], endobronchial valves (EBVs) [26], and the endobronchial Watanabe spigot (EWS) [27]. However, many of these are expensive or not routinely available in developing countries.…”

Modified silicone stent for the treatment of post-surgical bronchopleural fistula: A clinical observation of 17 cases

“…The utility of these materials was restricted to small BPFs (<3 mm in size). The other strategy is to apply occlusive devices, which mainly consisted of stents and the modi ed stents such as Amplatzar™ devices [27,28], endobronchial valves [29], and the endobronchial Watanabe spigot [30]. However, these devices suffered from the limitation of being expensive or cannot routinely be available in many developing countries.…”

A customized, covered metallic stent to repair a postoperative bronchopleural fistula: a promising endobronchial approach

“…Recently, bronchoscopic closure of BPFs has become possible; this is less invasive than surgery. The various techniques and devices include adhesives/glues (6,7), agents promoting the formation of granulation tissue (8), coils (9), silicone spigots (10), one-way valves (11), Amplatzer devices (12,13), and stents (14,15). Hollaus et al retrospectively studied 29 patients with postoperative BPFs who underwent bronchoscopic treatment (6).…”