Abstract
Objective: Endoscopic valve implantation presents an effective treatment for patient with advanced emphysema. Particularly patients with low interlobar collateral ventilation benefit from valve therapy. Despite of the minimal-invasive procedure, valve placement is associated with risks, whereby pneumothorax is the most common adverse event.
Methods: Retrospective analysis of the incidence, onset, duration and management of pneumothorax following valve treatment in patients treated from 01/2008 to 12/2013 in the Thoraxklinik Heidelberg.
Results: From 01/2008 to 12/2013, 373 patients were treated by valves (217 x EBV (Pulmonx Inc., USA), 101 x IBV (Olympus Inc., Japan), 55 x EBV/IBV). 234 patients received valves on the left, 136 on the right and 3 patients were treated bilaterally. 67 patients (18%) experienced a pneumothorax. The incidence of pneumothorax at a rate of 21.8% following left-sided therapy was higher compared to 11.8% following right-sided treatment. 21.7% of pneumothoraces occurred following EBV placement, 17.8% following IBV placement. The median time to onset of pneumothorax was 1 day (0-125 days), however 44.2% of the patients developed a pneumothorax at day 3 or later. In 86.6% chest drainage was necessary. The mean duration of chest tube drainage was 9.5 days. Valve explantation was required in 43.9%. In 76.1% no further treatment was necessary, however in 23.9% surgical intervention (1 talc slurry, 13 VATS, 2 thoracotomies) was required.
Discussion: Pneumothorax with an incidence of 18% is the most common complication following valve treatment. Therefore close monitoring following intervention is crucial. In the total patient population, chest drainage is required in 15.5%, further surgical intervention in 4%.
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