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Intrabronchial Valves for Air Leaks After Lobectomy, Segmentectomy, and Lung Volume Reduction Surgery

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Abstract

Purpose

Air leaks are common after lobectomy, segmentectomy, and lung volume reduction surgery (LVRS). This can increase post-operative morbidity, cost, and hospital length of stay. The management of post-pulmonary resection air leaks remains challenging. Minimally invasive effective interventions are necessary. The Spiration Valve System (SVS, Olympus/Spiration Inc., Redmond, WA, US) is approved by the FDA under humanitarian use exemption for management of prolonged air leaks.

Methods

This is a prospective multicenter registry of 39 patients with air leaks after lobectomy, segmentectomy, and LVRS managed with an intention to use bronchoscopic SVS to resolve air leaks.

Results

Bronchoscopic SVS placement was feasible in 82.1% of patients (32/39 patients) and 90 valves were placed with a median of 2 valves per patient (mean of 2.7 ± 1.5 valves, range of 1 to 7 valves). Positive response to SVS placement was documented in 76.9% of all patients (30/39 patients) and in 93.8% of patients when SVS placement was feasible (30/32 patients). Air leaks ultimately resolved when SVS placement was feasible in 87.5% of patients (28/32 patients), after a median of 2.5 days (mean ± SD of 8.9 ± 12.4 days). Considering all patients with an intention to treat analysis, bronchoscopic SVS procedure likely contributed to resolution of air leaks in 71.8% of patients (28/39 patients). The post-procedure median hospital stay was 4 days (mean 6.0 ± 6.1 days).

Conclusions

This prospective registry adds to the growing body of literature supporting feasible and effective management of air leaks utilizing one-way valves.

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Acknowledgements

Dr. M. Abu-Hijleh accepts responsibility for the integrity of the submitted work and attests that no undisclosed authors contributed to the manuscript.

Funding

This was a post marketing registry supported by research grants from Spiration (Olympus/Spiration Inc., Redmond, WA, US).

Author information

Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Muhanned Abu-Hijleh, Kim Styrvoky, Vikram Anand & Fernando Woll

  2. Division of Pulmonary and Critical Care, Section of Interventional Pulmonology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Lonny Yarmus

  3. Department of Pulmonary, Allergy, Critical Care Medicine and Transplant Center, Interventional Pulmonology, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA

    Michael S. Machuzak

  4. Department of Medicine, Pulmonary and Critical Care Medicine, Interventional Pulmonology, Cancer Treatment Centers of America, Tulsa, OK, USA

    Daniel A. Nader

  5. Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky, Lexington, KY, USA

    Timothy W. Mullett

  6. Section of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA

    D. Kyle Hogarth

  7. Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA

    Jennifer W. Toth

  8. Department of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Lahey Hospital and Medical Center, Tufts University School of Medicine, Burlington, MA, USA

    Ghazwan Acash

  9. Department of Pulmonary Medicine, Interventional Pulmonology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    Roberto F. Casal

  10. Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA

    Stephen Hazelrigg

  11. Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA

    Douglas E. Wood

  12. University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, POB Building II, Dallas, TX, 75390, USA

    Muhanned Abu-Hijleh

Authors
  1. Muhanned Abu-Hijleh
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  2. Kim Styrvoky
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  4. Fernando Woll
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  5. Lonny Yarmus
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  7. Daniel A. Nader
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  8. Timothy W. Mullett
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  9. D. Kyle Hogarth
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  10. Jennifer W. Toth
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  11. Ghazwan Acash
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  12. Roberto F. Casal
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  13. Stephen Hazelrigg
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  14. Douglas E. Wood
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Corresponding author

Correspondence to Muhanned Abu-Hijleh.

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Conflict of interest

Drs. M. Abu-Hijleh, K. Styrvoky, F. Woll and V. Anand report no conflicts of interest. Dr. L. Yarmus has received research, educational funding and consulting fees from Olympus America. Dr. M. S. Machuzak served as a consultant to Spiration/ Olympus America. Dr. D. A. Nader received research, educational and consulting fees from Olympus America. Dr. D. K. Hogarth served as a consultant to Spiration/ Olympus America. This ended in 2015. Dr. J. Toth has received research, educational and consulting fees from Olympus America. Dr. R. F. Casal served as an educational consultant Olympus America and had research grants from Siemens and Concordia. Dr. S. Hazelrigg reports no conflicts of interest. Dr. D. E. Wood has received research, educational and consulting fees from Olympus America.

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Abu-Hijleh, M., Styrvoky, K., Anand, V. et al. Intrabronchial Valves for Air Leaks After Lobectomy, Segmentectomy, and Lung Volume Reduction Surgery. Lung 197, 627–633 (2019). https://doi.org/10.1007/s00408-019-00268-7

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  • DOI: https://doi.org/10.1007/s00408-019-00268-7

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