A single-institution outcome of bronchial valve placement for persistent air leak

Persistent pulmonary air leak happens in a minority of patients with various thoracic pathologies. Spiration (Olympus America Inc.) bronchial valves (BVs) are approved by the Food and Drug Administration under Humanitarian Use Device status to treat persistent air leak after lung resection. We evaluate our experience with use of BVs for air leak resolution attributable to multiple etiologies.

A retrospective review of the use of BVs for persistent air leak at a single institution from 2013 to 2024 was performed. Patient demographics and outcomes were tabulated, and mean, median, and standard deviation were calculated.

A total of 67 unique cases of BV placement for persistent air leak after lung resection (n = 49), iatrogenic or spontaneous pneumothorax, pleural malignancy, bronchopleural fistula or exploratory thoracotomy (n = 18) were analyzed. Air leak resolution was at least 95% across all categories, except for the spontaneous pneumothorax cohort (80%). Only 7% of all patients underwent post-BV pleurodesis. Rate of BV removal for lung resection patients was 86% and 72% for other etiologies. 61% of patients were discharged safely with a chest tube. Ninety-day all-cause mortality rate was 9%.

BV placement is an endoscopic and well-tolerated method that facilitates discharge with chest tube and resolution of air leak for multiple different etiologies, especially after lung resection to which we proposed an algorithm for persistent air leak management.