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Original Research: INTERVENTIONAL PULMONOLOGY |

Treatment of Persistent Pulmonary Air Leaks Using Endobronchial Valves

John M. Travaline, MD, FCCP; Robert J. McKenna, Jr, MD, FCCP; Tiziano De Giacomo, MD; Federico Venuta, MD, FCCP; Steven R. Hazelrigg, MD, FCCP; Mark Boomer, MD; Gerard J. Criner, MD, FCCP; for the Endobronchial Valve for Persistent Air Leak Group*
Author and Funding Information

From the Temple University School of Medicine (Drs. Travaline and Criner), Philadelphia, PA; Cedars-Sinai Medical Center (Dr. McKenna), Los Angeles, CA; the University of Rome (Drs. De Giacomo and Venuta), Rome, Italy; Southern Illinois University School of Medicine (Dr. Hazelrigg), Springfield, IL; and Saint Francis Hospital (Dr. Boomer), Tulsa, OK.

John M. Travaline, MD, FCCP, Professor of Medicine, Temple Lung Center, 3401 North Broad St, Philadelphia, PA 19140; e-mail: trav@temple.edu

*Members and affiliations for the Endobronchial Valve for Persistent Air Leak Group are listed in the Appendix.


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(2):355-360. doi:10.1378/chest.08-2389
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Background:  Prolonged pulmonary air leaks are a significant source of frustration for patients and physicians. When conventional therapy fails, an alternative to prolonged chest tube drainage or surgery is needed. Bronchoscopic blockage of a bronchus can be performed with the hope of accelerating closure of the air leak by reducing the flow of air through the leak. To our knowledge, this article presents the largest series of patients with prolonged air leaks treated with an endobronchial valve.

Methods:  With Internal Review Board approval, endobronchial valves were compassionately placed using flexible bronchoscopy in patients with prolonged air leaks at 17 international sites.

Results:  Between December 2002 and January 2007, 40 patients (15 women; mean age ± SD, 60 ± 14 years) were treated with one to nine endobronchial valves per patient. The air leaks had recurrent spontaneous pneumothorax (n = 21), postoperative (n = 7), iatrogenic (n = 6), first-time spontaneous pneumothorax (n = 4), bronchoscopic lung volume reduction (n = 1), and trauma (n = 1) etiologies. Nineteen patients (47.5%) had a complete resolution of the air leak, 18 (45%) had a reduction, 2 had no change, and 1 had no reported outcome. The mean time from valve insertion to chest tube removal was 21 days (median, 7.5 days; interquartile range [IQR], 3 to 29 days) and from valve procedure to hospital discharge was 19 ± 28 days (median, 11 days; IQR, 4 to 27 days).

Conclusions:  Use of endobronchial valves is an effective, nonsurgical, minimally invasive intervention for patients with prolonged pulmonary air leaks.

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