Muhanned Abu-Hijleh1,2, Kim Styrvoky3, Vikram Anand3, Fernando Woll3, Lonny Yarmus4, Michael S Machuzak5, Daniel A Nader6, Timothy W Mullett7, D Kyle Hogarth8, Jennifer W Toth9, Ghazwan Acash10, Roberto F Casal11, Stephen Hazelrigg12, Douglas E Wood13. 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@UTSouthwestern.edu. 2. University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, POB Building II, Dallas, TX, 75390, USA. Muhanned.Abu-Hijleh@UTSouthwestern.edu. 3. Division of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA. 4. Division of Pulmonary and Critical Care, Section of Interventional Pulmonology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA. 5. Department of Pulmonary, Allergy, Critical Care Medicine and Transplant Center, Interventional Pulmonology, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA. 6. Department of Medicine, Pulmonary and Critical Care Medicine, Interventional Pulmonology, Cancer Treatment Centers of America, Tulsa, OK, USA. 7. Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky, Lexington, KY, USA. 8. Section of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA. 9. Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA. 10. Department of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Lahey Hospital and Medical Center, Tufts University School of Medicine, Burlington, MA, USA. 11. Department of Pulmonary Medicine, Interventional Pulmonology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA. 12. Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA. 13. Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA.
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.
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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