RT Journal Article
SR Electronic
T1 Pneumothorax following valve treatment
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P3702
VO 44
IS Suppl 58
A1 Daniela Gompelmann
A1 Felix J.F. Herth
A1 Claus Peter Heussel
A1 Hans Hoffmann
A1 Hendrik Dienemann
A1 Ralf Eberhardt
YR 2014
UL http://erj.ersjournals.com/content/44/Suppl_58/P3702.abstract
AB 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%.