Journal Article

Endobronchial valves for emphysema and persistent air-leak: 10-year experience in an Asian country

Jeong, Byeong-Ho, Kim, Hojoong, Seo, Ki Hyun, Kim, Changhwan, Huh, Jin-Young, Kim, Beong Ki, Kim, Hwan hee, Lee, Ye Jin, Yoon, Ho il, Lee, Seung Jun, Kim, Sung Kyoung, Ra, Seung Won, Cho, Young-Jae, Lee, Sei Won

2024

Overview

Background Endobronchial valve (EBV) therapy, a validated method for bronchoscopic lung volume reduction (BLVR) in severe emphysema, has been explored for persistent air-leak (PAL) management. However, its effectiveness and safety in the Asian population require further real-world evaluation. In this study, we assessed the outcomes of treatment with EBV within this demographic. Methods We conducted a retrospective analysis of medical records from 11 Korean centers. For the emphysema cohort, inclusion criteria were patients diagnosed with emphysema who underwent bronchoscopy intended for BLVR. We assessed these patients for clinical outcomes of chronic obstructive pulmonary disease. All patients with PAL who underwent treatment with EBV were included. We identified the underlying causes of PAL and evaluated clinical outcomes after the procedure. Results The severe emphysema cohort comprised 192 patients with an average age of 70.3 years, and 95.8% of them were men. Ultimately, 137 underwent treatment with EBV. Three months after the procedure, the BLVR group demonstrated a significant improvement in forced expiratory volume in 1 s (+160 mL vs. +30 mL; P  = 0.009). Radiographic evidence of lung volume reduction 6 months after BLVR was significantly associated with improved survival (adjusted hazard ratio 0.020; 95% confidence interval 0.038–0.650; P  = 0.010). Although pneumothorax was more common in the BLVR group (18.9% vs. 3.8%; P  = 0.018), death was higher in the no-BLVR group (38.5% vs. 54.5%, P  = 0.001), whereas other adverse events were comparable between the groups. Within the subset of 18 patients with PAL, the predominant causes of air-leak included spontaneous secondary pneumothorax (44.0%), parapneumonic effusion/empyema (22.2%), and post-lung resection surgery (16.7%). Following the treatment, the majority (77.8%) successfully had their chest tubes removed. Post-procedural complications were minimal, with two incidences of hemoptysis and one of empyema, all of which were effectively managed. Conclusions Treatment with EBV provides substantial clinical benefits in the management of emphysema and PAL in the Asian population, suggesting a favorable outcome for this therapeutic approach.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Analysis / Body mass index / Bronchoscopies / Bronchoscopy / Bronchoscopy - methods / Care and treatment / Chest tubes / Chronic obstructive pulmonary disease / Complications and side effects / Critical Care Medicine / Diagnosis / Dyspnea / Effusion / Emphysema / Emphysema, Pulmonary / Empyema / Empyema - etiology / Empyema - surgery / FDA approval / Female / Forced Expiratory Volume / Health aspects / Hemoptysis / Humans / Intensive / Internal Medicine / Lung diseases / Lung diseases, Obstructive / Male / Medical records / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Mortality / Patient outcomes / Patients / Pneumology/Respiratory System / Pneumonectomy - adverse effects / Pneumothorax / Pneumothorax - etiology / Pneumothorax - surgery / Pulmonary Emphysema / Retrospective Studies / Treatment Outcome / Valves / Ventilation