Endobronchial closure of the bronchopleural fistula with the ventricular septal defect occluder: a case series

Yang Bai,Jing Chi,Shuliang Guo,Yishi Li

doi:10.1186/s12890-021-01676-3

Abstract

ObjectivesThe ventricular septal defect (VSD) occluder has been reported to be a novel method for the closure of bronchopleural fistula (BPF). Our study was to confirm the use of VSD occluder in treating BPF after pneumonectomy or lobectomy.Methods We performed a single-center, retrospective study of 10 consecutive patients (8 men and 2 women aged 29–70 years) with postoperative BPF receiving the VSD occluder treatment. We used the HeartR™ Membranous VSD occluder (Lifetech Scientific Co., Shenzhen, China) for the closure of BPF through flexible bronchoscopy under general anesthesia. Demographic characteristics, BPF characteristics, and clinical outcomes were collected from patients’ files using the standardized data abstraction forms.ResultsThe underlying diseases were lung cancer in 6 patients, pulmonary tuberculosis in 3, and bronchiectasis in 1. Right-sided BPFs occurred in 6 patients, and left-sided BPFs occurred in 4. Five patients were underweight with a body mass index < 18.5 kg/m2. The VSD was placed in all 10 patients with a 100% technical success rate and a 70% complete closure rate during follow-up with no complications, on a median follow-up period of 115 days (range 46–975 days). In 1 patient, the VSD occluder was reinstalled with complete closure; in 1 and 2 patients with underweight and chronic empyema, the VSD occluders partially and completely failed with good physical tolerance, respectively.ConclusionsOur study demonstrated the bronchoscopic closure of BPF after lung resection using the VSD occluder is an off-label but safe and effective method. We prefer to stabilize the BPF by eradicating the underlying diseases and providing nutritional support to those receiving VSD occluder closure treatment.

Highlights

The bronchopleural fistula (BPF) is an uncommon but major complication of lung resection, associated with high mortality, especially in lung cancer patients [1]
This study aims to present our experience in treating postpneumonectomy BPF with the HeartRTM Membranous ventricular septal defect (VSD) occluder (Lifetech Scientific Co., Shenzhen, China)
A total of ten consecutive patients with post-pneumonectomy or post-lobectomy BPF receiving the insertion of HeartRTM Membranous VSD occluder were recruited in this study (Table 1)

Summary

Introduction

The bronchopleural fistula (BPF) is an uncommon but major complication of lung resection, associated with high mortality, especially in lung cancer patients [1]. Most patients with postpneumonectomy BPF are debilitated and have chronic empyema, leading to high morbidity [2]. The Amplatzer vascular occluder has been used increasingly and successfully in selected BPF patients worldwide [13,14,15]. In the most extensive case series (31 patients), improvement or resolution of BPF occurred in 96 % of patients treated with the Amplatzer vascular occluder, lasting for up to 18 months [16]. This study aims to present our experience in treating postpneumonectomy BPF with the HeartRTM Membranous VSD occluder (Lifetech Scientific Co., Shenzhen, China). We have presented our data with an emphasis on long-term outcomes, especially in those with underweight or chronic empyema

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Conclusion