New Approach for the Treatment of Bronchopleural Fistula After Pulmonary Resection: The Role of Endobronchial Valves

SESSION TITLE: Cardiothoracic Surgery Global Case Reports SESSION TYPE: Global Case Report Poster PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM INTRODUCTION: Bronchopleural fistula (BPF) following lung resection is a devastating complication, associated with significant morbidity and mortality. The usual therapy for BPF includes prolonged courses of antibiotics, pleural drainage and surgical repair. Several endobronchial techniques such as the application of ethanol, tissue sealants, fibrin glue, or coils have also been used with different degrees of success. Recently, the use of one-way endobronchial valves (EBVs) is emerging as a powerful and minimally invasive procedure to facilitate BPF closure in patients who had not responded to standard therapy. In this report we describe our first experience with this novel procedure in one patient with persistent air leak after lung resection. CASE PRESENTATION: The patient was a 74-year-old man who underwent a left lower lobectomy due to epidermoid lung cancer. There were not complications in the inmediate postoperative course and BPF was not observed. He recovered from his surgery uneventfully; however, he presented 2 months postoperatively with left lower-lobe pneumonia, empyema and central BPF owing to a stump leak visibly seen as a hole via bronchoscopy. Unfortunately, the medical condition of the patient was not optimal to attempt surgical closure of the BPF. He was treated with antibiotics for 4 weeks, and no pleural drainage was placed. Following the antibiotic therapy, a bronchoscopy was performed and after therapeutic aspiration of the purulent secretions from the cavity of the left lower lobectomy, the BPF was identified. A guidewire was placed under direct vision, and a small-sized endobronchial valve EBV Zephyr® 4.0 (Pulmonx) was loaded, inserted, and deployed into the fistula with an excellent fit and position. No complications related to the procedure were observed. The patient tolerated the procedure and was transferred to the recovery room. Hospital admission was not needed. Four months after the valve placement, the patient is doing well, with no infection and the fistula is completely closed. DISCUSSION: BPF leads to significant morbidity for patients, and complications have prompted the need for a nonsurgical, minimally invasive approach to treat these patients. The use of EBVs has been recently described as a novel alternative treatment for BPF. By preventing air flow back through the affected airway, the airleak is minimized and the fistula may eventually close. EBVs placement has been demonstrated to be well tolerated with few complications reported. CONCLUSIONS: Despite our limited experience, we hold that EBVs placement in central BPF after lung resection is a safe, cost-effective and minimally invasive intervention. Reference #1: Berkowitz D. Management of Bronchopleural Fistulas. En: Ernst A, Herth F. Principles and Practice of Interventional Pulmonology. Springer Science+Business Media New York; 2013. p. 435-48. Reference #2: Travaline JM, McKenna Jr RJ, De Giacomo T, Venuta F, Hazelrigg SR, Boomer M, et al. Endobronchial Valve for Persistent Air Leak Group. Treatment of persistent pulmonary air leaks using endobronchial valves. Chest. 2009;136:355-60. DISCLOSURE: The following authors have nothing to disclose: M.J. Bernabé Barrios, G. Rodríguez Trigo, C. Pinedo Sierra, M. Calderón Alcalá, A.M. Gómez Martínez, J.R. Jarabo Sarceda, F. Hernando Trancho, J.L. Álvarez-Sala Walther No Product/Research Disclosure Information