CHARACTERISTICS AND PROCEDURAL OUTCOMES IN PATIENTS WITH PROLONGED AIR-LEAK UNDERGOING ENDOBRONCHIAL VALVES PLACEMENT (EBV): A RETROSPECTIVE CASE SERIES

Abstract

TOPIC: Disorders of the Pleura TYPE: Original Investigations PURPOSE: Endobronchial valves (EBV)are FDA approved for bronchoscopic lung volume reduction in certain COPD patients. EBV has also emerged as a therapeutic option for patients with pneumothorax (PTX) and persistent air leak. Limited data is available about the characteristics of this patient population and their procedural outcomes. METHODS: We retrospectively reviewed all patients who underwent EBV placement for pneumothorax with prolonged airleak at a tertiary referral center over a 5-year period. Outcomes assessed included length of stay (LOS), need for repeated procedure or further surgical intervention, and resolution of airleak at discharge. RESULTS: Between 2015 and 2020, 36 patients underwent evaluation for EBV for PTX. Secondary spontaneous pneumothorax (SSP) was the primary diagnoses in 25/36 (70%) with COPD as the primary underlying lung disease in 20/25 (80%). Only 30% of patients had VATS with or without resection prior to EBV placement. Median LOS was 25 days with a median of 12 days from pneumothorax onset to EBV placement and 13.5 days between EBV placement and discharge. Early placement of EBV was significantly associated with shorter LOS (R2=0.68; p<0.001). A second bronchoscopy procedure was required during the same admission in 15/36 (41%) for either recurrence or continued air-leak with additional (28%) or replacing (17%) previously placed EBV. Primary Spontanous Pneumothorax (PSP) patients were the least likely to need repeat EBV procedures as compared to patient with SSP [0/4 (0%) vs. 13/25 (52%) respectively; p= 0.05]. Prior lobectomy (p=0.02), older age (p=0.03) and laterality of PTX were more likely to have a second procedure (left greater than right sided PTX (9/11 9 (81%) vs. 6/25 (24%); p=0.001). Median number of EBV placed was 3. Post lobectomy patients had a higher number of total valves compared to other patients (4.5 vs. 3.0 respectively; p=0.03), but none of those patients required an additional surgical intervention. Neither total number valves nor number of lobes targeted affected LOS, need for 2nd procedure, or the need for further surgical intervention after EBV placement. Following EBV, 25/36 patients (70%) had resolution of their airleak without subsequent surgical intervention, 7/36 (20%) required surgical intervention for persistent airleak post EBV placement and 5/36 (14%) patients were discharged with chest tube in place due to persistent airleak. CONCLUSIONS: EBV were effective in stopping airleak in the majority of patients with pneumothorax and persistent airleak. Early placement of EBV significantly correlated with shorter LOS. Further studies are needed to identify patient population who are at risk and would benefit the most from early EBV placement. CLINICAL IMPLICATIONS: EBV can effictively stop airleak and potentially reduce hospital length of stay in patients with pneumothorax and prolonged airleak. DISCLOSURES: No relevant relationships by Mamoon Al Ahmad, source=Web Response No relevant relationships by Yaser Dawod, source=Web Response No relevant relationships by Syed Nazeer Mahmood, source=Web Response No relevant relationships by Jessica Wang Memoli, source=Web Response