Negative pressure-related complications after valves for emphysema: What else than pneumothorax

Abstract

Background: Among bronchoscopic lung volume reduction modalities, Zephyr valves are the most widely studied. Collateral ventilation has been established as a phenomenon with major implications for patient selection and endobronchial valve (EBV) treatment outcome. Pneumothorax is now the major concern associated with large lung volume changes. Objectives: To describe our 13-year experience with negative pressure-related complications after EBV therapy. Methods: We retrospectively analyzed 176 EBV procedures in 129 patients with emphysema between June 2002 and January 2016. CT scan was used toevaluate volume reduction. Results: Of 129 patients, 8 were treated bilaterally (range 1 to 7 years later, mean 3.1). Lobar exclusion (LE) was done in 106 (77.4%). Non-lobar exclusion was the strategy in 31 (22.6%). Analyses of target lobe volume reduction (TLVR) of patients with the LE strategy demonstrate: 34 (32.08%) had TLVR 50%, and 34 (32.08%) had TLVR > 80%. Pulmonary edema in non-target lung, hemoptysis and pneumothorax were evaluated in groups according to TLVR. Seven patients (6.6%) had edema and/or pneumothorax ex vacuo, eight (7.5%) also had hemoptysis and seven patients (6.6%) had pneumothorax managed with a chest tube. Conclusions: Radiographic infiltrates in non-target lobe, hemoptysis and pneumothorax ex vacuo after massive volume reduction are signs of concern following EBV therapy for emphysema. In patients with complications, we recommend rest, oxygen therapy and pulmonary artery pressure evaluation, as well as ≥ 5 days of inpatient follow-up.