Ten Years of Intrabronchial Valve Use for Treatment of Persistent Air Leaks

BACKGROUND: Persistent air leaks (PALs), nonhealing fistulas between the bronchoalveolar and pleural space existing for at least 5 to 7 days, are challenging to manage. With the humanitarian use device exemption from the United States Food and Drug Administration beginning in 2008, intrabronchial valves (IBVs) for use in PALs research exist as a burgeoning knowledge base. METHODS: We completed a single-center retrospective cohort review of IBV placement for PAL from 2015 to 2025. Descriptive statistics were used to analyze demographic and outcomes data. Fine-Gray analysis was used to determine the impact of the duration of PAL before IBV placement on the probability of ever resolving air leaks. RESULTS: A total of 66 cases were reviewed. Patient comorbidities included COPD (43.9%), acute respiratory distress syndrome (28.8%), ILD (16.7%), lung cancer (16.7%), and prior lung transplant (3.0%). Overall, PAL resolution was 63.6% with an average time to air leak resolution after IBV placement of 10.8 days (95% CI: 4.8-16.8; n=42). One-year all-cause mortality was 36.4% (24/66). Each additional 10 days with a chest tube in place before IBV placement corresponded to a 10% lower probability of PAL resolution over time (sHR: 0.901; 95% CI: 0.815-0.996; P=0.042). The cumulative incidence of PAL resolution at 30 days was 39.4% (95% CI: 6.2-72.6) in patients with ILD versus 66.3% (95% CI: 52.6-79.9) in patients without ILD. CONCLUSION: The use of IBVs for the treatment of PALs remains an effective treatment option. The effectiveness of air leak resolution may be influenced by the timing of IBV placement.