Endobronchial Valve Treatment For Bronchopleural Fistulas - Is Time To Treatment A Predictor Of Success?

Introduction: Bronchopleural fistulas (BPF), defined as substantial and prolonged airleak with persisting pneumothorax following lung surgery, spontaneous pneumothorax, or empyema, are conditions with significant morbidity and mortality. Many of these patients are poor candidates for surgical intervention. Successful minimally invasiv treatment with endobronchial valves (EBV) has been reported. Methods: Data on all patients with BPF treated with EBV in 2013 and 2014 at our institution was registered. EBV treatment failure was defined as death or surgery, success was defined as cessation of the air leak and subsequent removal of the external pleural drainage. Results: In 13 patients with BPF, 32 endobronchial valves were inserted in 22 procedures. Four patients were treated for empyema, two patients had spontaneous pneumothorax and seven had postoperative air leaks, of which three had empyema. Overall, in 9 patients the EBV treatment was successful and the valves were removed within three months. In four patients, however, the air leak either ceased or was substantially reduced, but the pleural cavity remained and the patients subsequently underwent surgery. One of these patients died one month after surgery. Median time from symptoms of BPF to treatment was 26 days (range 12-87) in the nine patients treated successfully, but 400 days (125-972) in the four patients where treatment failed. No treatment failure occurred in patients treated within three months. Conclusion: EBV treatment of bronchopleural fistulas can be successful. Our results suggest that treatment should be performed within three months after debut of symptoms suggestive of BPF.