Abstract Rationale Persistent air leaks (PALs), nonhealing fistulas between the bronchoalveolar space and the pleural space existing for at least 5 to 7 days, can be challenging to manage. Intrabronchial valves (IBVs), initially created as a minimally invasive approach to treating severe emphysema, have been demonstrated to be an effective definitive treatment for PALs. With humanitarian device exemption from the United States Food and Drug Administration for use for PAL beginning as recently as 2008, there is a burgeoning knowledge base for choosing when to utilize IBVs. We present data from our institution to help better understand outcomes in a variety of patients. Methods We completed one of the largest single-center retrospective cohort reviews of IBV placement for PAL from 2015-2025. IRB approval was obtained from the University of Maryland Medical Center. Data analyzed including demographic and outcomes data. Fine-Gray analysis was used to determine the impact of duration of PAL prior to IBV placement on probability of ever resolving air leaks, with death as a competing event given severity of illness in our cohort. This modeling was used to adjust specifically for the major comorbidity of interstitial lung disease (ILD). Results A total of 65 cases of IBV placement for PAL were reviewed. Patient comorbidities included emphysema (40.0%), acute respiratory distress syndrome (29.2%), ILD (18.5%), and lung cancer (15.4%). Overall, PAL resolution was 64.6%. Average time to resolution of air leak after IBV placement was 10.8 days (95% CI 4.7-17.0; n = 42). The in-hospital mortality rate of patients receiving IBV was 20.0%. An average of 1.8 valves were placed per patient with 15.4% of patients receiving total lobar occlusion. Every additional 10 days with a chest tube prior to IBV placement was associated with about an 8% lower probability of ever achieving PAL resolution over time (sHR 0.922, 95% CI 0.843-1.009, p = 0.077). Predicted PAL resolution by 30 days was 69.5% in patients without ILD vs 41.7% with ILD (absolute risk increase 27.8%), adjusted for pre-IBV duration. No intra-procedural complications or episodes of massive hemoptysis occurred in this cohort. Conclusions The use of IBV for treatment of PAL remains an effective treatment option. Patients with ILD may have a lower likelihood of PAL resolution and should be carefully counseled on proposed efficacy of treatment. Concurrently, timing of IBV placement may be limited by patients underlying health status, possibly contributing to a lack of early treatment and effective resolution of PAL. This abstract is funded by: None
Caplan et al. (Fri,) studied this question.