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Browse ATS 2021 Abstracts

HomeProgram ▶ Browse ATS 2021 Abstracts
 

ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.

Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.

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Combined Endobronchial Valve Placement and Minimally-Invasive Lobar Fissure Completion in Patients with Severe Emphysema and Collateral Ventilation

Session Title
TP38 - TP038 INTERESTING AND CHALLENGING CASES IN INTERVENTIONAL PULMONOLOGY
Abstract
A2192 - Combined Endobronchial Valve Placement and Minimally-Invasive Lobar Fissure Completion in Patients with Severe Emphysema and Collateral Ventilation
Author Block: D. Ospina-Delgado1, S. P. Gangadharan1, F. Kheir1, M. S. Parikh1, A. Rudkovskaia1, A. Paton1, C. S. Digesu2, A. Majid1; 1Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA, United States, 2Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Purpose: Patients with severe emphysema despite maximal medical therapy can be substantially debilitated, with limited options for therapeutic intervention. Endobronchial valve (EBV) placement can improve dyspnea, exercise tolerance and quality of life. However, patients with incomplete lobar fissures and collateral ventilation (CV) or those with pleural adhesions in the target lobe may experience limited benefit. Here we present a combined approach for EBV placement and a minimally-invasive thoracoscopic lobar fissure completion in two patients with severe emphysema. Case Reports: A 61-year-old man with severe heterogeneous emphysema underwent balloon occlusion with ChartisTM of the right upper lobe (RUL) positive for CV. He was scheduled for a combined major-fissure completion via video-assisted thoracic surgery (VATS) and EBV placement. During initial bronchoscopy, four EBV were placed in the apical, anterior, and posterior segments of the RUL. Immediately after, a right VATS fissure completion of the posterior major and minor fissure using three Endo-GIATM staplers was performed. His postoperative course was complicated by hypercarbic respiratory failure. Consequently, he briefly required BIPAP in the ICU and a persistent air-leak that lasted until the postoperative day (POD) 6, when he was discharged home. At a 1-month follow-up, the patient reported shortness of breath and experiencing a higher exercise tolerance. A 66-year-old woman with severe left upper lobe (LUL) heterogeneous emphysema and incomplete inter-lobar fissures on ChartisTM evaluation was scheduled for a combined VATS and EBV placement. During VATS, adhesion of the LUL to the chest wall was lysed, revealing a thin-walled bulla requiring resection with a single fire of the reinforced purple load Endo-GIATM stapler. The anterior major fissure was then completed with two additional reinforced staple fires. A bronchoscopy was performed and the repeat ChartisTM evaluation was negative for CV. Three EBVs were placed, two in the LUL and one in the lingula. The patient’s postoperative course was complicated by Takotsubo cardiomyopathy and respiratory failure requiring reintubation. However, she quickly recovered and was discharged home on POD-6. At a 1-month follow-up, the patient reported improvement in her dyspnea and exercise capacity. Discussion: In patients with severe heterogeneous emphysema, hyperinflation, and CV, a combined VATS lobar fissure completion, target lobe adhesiolysis, and EBV placement are safe and feasible when performed in centers of excellence by experienced interventional pulmonologists and thoracic surgeons. This combined approach may lead to an increased number of patients that could benefit from endoscopic lung volume reduction with endobronchial valves.