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Welling JBA, Koster TD, Slebos DJ. From plugging air leaks to reducing lung volume: a review of the many uses of endobronchial valves. Expert Rev Med Devices 2023; 20:721-727. [PMID: 37409351 DOI: 10.1080/17434440.2023.2233435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/03/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION One-way endobronchial valve treatment improves lung function, exercise capacity, and quality of live in patients with severe emphysema and hyperinflation. Other areas of therapeutic application include treatment of persistent air leak (PAL), giant emphysematous bullae, native lung hyperinflation, hemoptysis, and tuberculosis. AREAS COVERED In this review, we will assess the clinical evidence and safety of the different applications of one-way endobronchial valves (EBV). EXPERT OPINION There is solid clinical evidence for the use of one-way EBV for lung volume reduction in emphysema. Treatment with one-way EBV can be considered for the treatment of PAL. The application of one-way EBV for giant bullae, post lung transplant native lung hyperinflation, hemoptysis, and tuberculosis is under investigation and more research is required to investigate the efficacy and safety of these applications.
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Affiliation(s)
- Jorrit B A Welling
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - T David Koster
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Keenan JC, Cho RC, Wong J, Dincer HE. Utility of Functional Pneumonectomy by Using Intrabronchial Valves: First Case Series and Single Center Experience. J Bronchology Interv Pulmonol 2022; 29:269-274. [PMID: 34879034 DOI: 10.1097/lbr.0000000000000829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intrabronchial valves are approved for bronchoscopic lung volume reduction in chronic obstructive pulmonary disease patients and used for prolonged air leak. There is no data on bronchoscopic functional pneumonectomy (BFP) when treating patients with persistent air leak (PAL) or for lung volume reduction purposes. METHODS In this observational study, 10 consecutive patients who failed to improve with traditional therapies were assessed after they underwent BFP for PAL or lung volume reduction. RESULTS Ten patients underwent 17 valve placement procedures; 82 valves were placed (median: 8; range: 5 to 12). BFP was performed in 1 single lung transplant patient with hyperinflation of native lung compromising lung function. The rest of the patients had prolonged air leak because of various reasons; spontaneous (n=7) and postoperative (n=2). Pneumonia was the only procedure-related complication seen in 1 patient. Of patients with prolonged air leak with chest tubes (n=9), all had successful chest tube removal (median of 7 days; range: 3 to 21 d). The valves were removed within 6 weeks of chest tube removal in 6 patients. Prebronchoscopic and post-BFP actual forced expiratory volume in first second values in 2 transplant patients. CONCLUSION PAL usually occurs in patients with severe underlying lung condition or after surgery. Management of PAL can be challenging despite pleurodesis (medical or surgical). BFP offers a minimally invasive management option.
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Affiliation(s)
- Joseph C Keenan
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, MN
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Slama A, Taube C, Kamler M, Aigner C. Lung volume reduction followed by lung transplantation-considerations on selection criteria and outcome. J Thorac Dis 2018; 10:S3366-S3375. [PMID: 30450243 DOI: 10.21037/jtd.2018.06.164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Lung transplantation (LuTX) and lung volume reduction (LVR), either surgical (LVRS: lung volume reduction surgery) or endoscopic (ELVR: endoscopic lung volume reduction), are established therapies in the treatment of end-stage chronic obstructive pulmonary disease (COPD) patients. Careful patient selection is crucial for each intervention. If these techniques are sequentially applied there is a paucity of available data and individual center experiences vary depending on details in selection criteria and operative technique. This review aims to summarize the published data with a focus on LuTX after LVRS. This review covers patient selection for LuTX and LVR, technical considerations, limitations and outcomes. Published literature was identified by systematic search on Medline and appropriate papers were reviewed. Seven case reports/series, 7 comparative observational studies and one multicenter database analysis incorporating a total of 284 patients with LuTX and LVR were evaluated. Prior LVR can significantly affect intraoperative and postoperative risks after subsequent LuTX. Careful patient selection and timing and the choice of appropriate techniques such as minimal invasive LVRS and using ECMO as extracorporeal support during LuTX if required can minimize those risks, ultimately leading to very good postoperative outcomes in terms of lung function and survival. LVRS has the potential to delay listing and to bridge patients to LuTX by improving their physical condition while on the waiting list. After single lung transplantation (SLuTX) contralateral LVRS can counteract the deleterious effects of native lung hyperinflation (NLH). LVR and LuTX are adjunct therapies in the treatment of end-stage COPD. The combination of both can safely be considered in selected patients.
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Affiliation(s)
- Alexis Slama
- Department of Thoracic Surgery, West German Center for Lung Transplantation, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Christian Taube
- Department of Pneumology, West German Center for Lung Transplantation, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Markus Kamler
- Department of Thoracic Transplantation, West German Center for Lung Transplantation, University Medicine Essen - University Clinic, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, West German Center for Lung Transplantation, University Medicine Essen - Ruhrlandklinik, Essen, Germany
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Pearmain L, Krysiak P, Blaikley J, Alaloul M. Persistent air leak after pulmonary transplantation. BMJ Case Rep 2017; 2017:bcr-2017-220176. [PMID: 28751430 PMCID: PMC5614144 DOI: 10.1136/bcr-2017-220176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2017] [Indexed: 11/03/2022] Open
Abstract
A 59-year-old man with bilateral apical emphysema underwent a double lung transplant for end-stagechronic obstructive pulmonary disease leaving remnant right apical native tissue due to pleural adhesions. Initial postoperative course was uneventful until the chest drains were removed. This revealed a small pneumomediastinum, which progressively increased in size causing gross surgical emphysema. Re-insertion of the chest drain stabilised the patient so that the cause could be identified and corrected. Two bronchoscopies excluded anastomotic dehiscence as a cause. Therefore the subcostal wound was refashioned under video-assisted thoracoscopic surgery in case there was a defect. Unfortunately this also failed to halt the air leak; therefore another cause was sought. A multidisciplinary team meeting review of the radiology revealed that the patient's native bullous tissue was still inflated. Subsequent bronchoscopy revealed a native bronchial communication, due to variant anatomy, proximal to the surgical anastomosis. This was subsequently occluded using a bronchial valve allowing the patient to make a swift recovery.
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Affiliation(s)
- Laurence Pearmain
- Department of Respiratory Medicine, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
- Piper Hanley Group, University of Manchester Institute of Human Development, Manchester, UK
| | - Piotr Krysiak
- Department of Respiratory Medicine, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - John Blaikley
- Department of Respiratory Medicine, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
- Division of infection, Immunity and Respiratory medicine, University of Manchester, Manchester, UK
| | - Mohamed Alaloul
- Department of Respiratory Medicine, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
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Lane CR, Tonelli AR. Lung transplantation in chronic obstructive pulmonary disease: patient selection and special considerations. Int J Chron Obstruct Pulmon Dis 2015; 10:2137-46. [PMID: 26491282 PMCID: PMC4608618 DOI: 10.2147/copd.s78677] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity. Lung transplantation is one of the few treatments available for end-stage COPD with the potential to improve survival and quality of life. The selection of candidates and timing of listing present challenges, as COPD tends to progress fairly slowly, and survival after lung transplantation remains limited. Though the natural course of COPD is difficult to predict, the use of assessments of functional status and multivariable indices such as the BODE index can help identify which patients with COPD are at increased risk for mortality, and hence which are more likely to benefit from lung transplantation. Patients with COPD can undergo either single or bilateral lung transplantation. Although many studies suggest better long-term survival with bilateral lung transplant, especially in younger patients, this continues to be debated, and definitive recommendations about this cannot be made. Patients may be more susceptible to particular complications of transplant for COPD, including native lung hyperinflation, and development of lung cancer.
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Affiliation(s)
- C Randall Lane
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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Perch M, Riise GC, Hogarth K, Musani AI, Springmeyer SC, Gonzalez X, Iversen M. Endoscopic treatment of native lung hyperinflation using endobronchial valves in single-lung transplant patients: a multinational experience. CLINICAL RESPIRATORY JOURNAL 2014; 9:104-10. [PMID: 24506317 DOI: 10.1111/crj.12116] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 01/08/2014] [Accepted: 01/25/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hyperinflation of the native lung (NLH) is a known complication to single-lung transplantation for emphysema. The hyperinflation can lead to compression of the graft and cause respiratory failure. Endobronchial valves have been used to block airflow in specific parts of the native lung, reducing the native lung volume and relieving the graft. OBJECTIVE We report short-term follow-up and safety from 14 single-lung transplant patients with NLH treated with bronchoscopic lung volume reduction using endobronchial valves. METHODS Retrospective clinical information related to endobronchial valve treatment was obtained from four centres. All patients were treated with IBV(TM) Valve System (Spiration, Olympus Respiratory America, Redmond, WA, USA). All patients had evidence of severe NLH with mediastinal displacement. RESULTS A total of 74 IBV valves were placed in 14 patients, with an average of 5.3 (range 2-10). Five patients had two procedures with staged treatment. Eleven patients reported symptom relief, and nine had lung function improvements. There was a significant increase in forced expiratory volume in 1 s of 9% (P = 0.013) and forced vital capacity of 15% (P = 0.034) within the first months after treatment. There were no reported device-related adverse events nor reports of migration. Two patients had pneumothorax. One patient had pneumonia in the location of the valve placement, and another had infection within days. Three other patients were hospitalised with infection 2 months after treatment. CONCLUSIONS Treating NLH with IBV endobronchial valves leads to clinical improvement in the majority of patients, and the treatment has an acceptable safety.
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Affiliation(s)
- Michael Perch
- Department of Cardiology, Section for Lung Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Affiliation(s)
- Pallav L Shah
- The NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, , London, UK
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Lee P, Khoo KL. A review of current bronchoscopic interventions for obstructive airway diseases. Ther Adv Respir Dis 2012; 6:297-307. [PMID: 22878625 DOI: 10.1177/1753465812455448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Obstructive diseases of the airway are a diverse group, although they share in common airway narrowing as a sequel to inflammation, which leads to increased work of breathing. Optimal treatment strategies for this heterogeneous group of asthma, chronic bronchitis and emphysema should be multidimensional and embrace pharmacological and nonpharmacological means as well as surgery in a highly select group of patients with emphysema. We review the current status of the bronchoscopic interventions that have been in development for the past decade with the objectives of providing better symptom control in asthma and palliation in individuals with emphysema who are otherwise poor candidates for lung volume reduction surgery.
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Affiliation(s)
- Pyng Lee
- Yong Loo Lin Medical School, National University of Singapore, Respiratory and Critical Care Medicine, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore.
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Kemp SV, Carby M, Cetti EJ, Herth FJ, Shah PL. A potential role for endobronchial valves in patients with lung transplant. J Heart Lung Transplant 2010; 29:1310-2. [DOI: 10.1016/j.healun.2010.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 06/20/2010] [Indexed: 10/19/2022] Open
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Pato O, Rama P, Allegue M, Fernández R, González D, Borro JM. Bronchoscopic lung volume reduction in a single-lung transplant recipient with natal lung hyperinflation: a case report. Transplant Proc 2010; 42:1979-81. [PMID: 20620561 DOI: 10.1016/j.transproceed.2009.12.071] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 12/29/2009] [Indexed: 12/29/2022]
Abstract
After single lung transplantation for emphysema native lung hyperinflation is a common complication that may cause respiratory failure. Herein we have reported satisfactory bronchoscopic lung volume reduction in a left single-lung transplant recipient with native lung hyperinflation, who suffered from Medical Research Council (MRC) class 3 dyspnea and chest pain. Three endobronchial valves (Zephyr; Emphasys Medical, Redwood, Calif, United States) were placed into the segmental bronchi of the right upper lobe, using videobronchoscopy under general anesthesia. Postoperative chest computed tomography revealed subsegmental atelectasis in that lobe. The clinical benefit was an improved MRC dyspnea class from 3 to 2, which was still present at 4 months after the procedure, although there were no remarkable changes in spirometric parameters.
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Affiliation(s)
- O Pato
- Department of Anesthesiology and Perioperative Medicine, A Coruña University Hospital, A Coruña, Spain
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Sexton P, Garrett JE, Rankin N, Anderson G. Endoscopic lung volume reduction effectively treats acute respiratory failure secondary to bullous emphysema. Respirology 2010; 15:1141-5. [PMID: 20723138 DOI: 10.1111/j.1440-1843.2010.01824.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Emphysema often affects the lungs in a heterogeneous fashion, and collapse or removal of severely hyperinflated portions of lung can improve overall lung function and symptoms. The role of lung volume reduction (LVR) surgery in selected patients is well established, but that of non-surgical LVR is still being defined. In particular, use of endobronchial LVR is still under development. This case report describes a 48-year-old non-smoker with severe bullous emphysema complicated by acute hypercapnic respiratory failure, who was successfully treated by endobronchial valve placement while intubated in an intensive care unit.
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Affiliation(s)
- Paul Sexton
- Department of Respiratory Medicine, Middlemore Hospital, Mangere, Auckland, New Zealand
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Abstract
PURPOSE OF REVIEW Interventional pulmonology is a rapidly expanding field offering less invasive therapeutic procedures for significant pulmonary problems. Many of the therapies may be new for the anesthesiologist. Although less invasive than surgery, some of these procedures will carry significant risks and complications. The team approach by anesthesiologist and pulmonologist is key to the success of these procedures. RECENT FINDINGS Many modalities for central airway obstruction have emerged, including the expanding application of airway stenting procedures. Diagnostic bronchoscopy with ultrasound guidance promises great advances in lung cancer staging. New bronchoscopic treatments of asthma and emphysema are actively under investigation. Advances in anesthetic agents and techniques for interventional pulmonology procedures have also occurred. SUMMARY This review is intended to familiarize the anesthesiologist with current and rising therapeutic modalities for pulmonary disease. Knowledge of interventional pulmonology facilitates planning and preparation for well tolerated and effective procedures.
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