Incidence and Outcomes of Revision Bronchoscopies Following Bronchoscopic Lung Volume Reduction (BLVR)

Background: Bronchoscopic lung volume reduction (BLVR) is a minimally invasive procedure used to reduce shortness of breath and improve functionality in some patients with emphysema. While BLVR is often effective for improving dyspnea by causing target lobe atelectasis, the treatment effect can sometimes be lost. This study reviews the incidence of revision bronchoscopies in patients who lost or never achieved target lobe atelectasis following BLVR.

Methods: This retrospective, single-center analysis reviewed patients who underwent BLVR over a 5-year period. All patients were determined to be collateral ventilation negative by an intraprocedural Chartis system assessment. Treatment success was defined as radiographic target lobe atelectasis. For patients who underwent revision bronchoscopies, the EMR was used to review procedure notes, radiographic imaging, post-BLVR analyses, and outpatient clinic notes to collect data on the indication for revision bronchoscopy, intraprocedural observations accounting for loss of treatment effect, revision interventions performed, and outcomes of revision bronchoscopies. After a minimum of 10 postoperative days, at the discretion of the treating physician, an EBV revision bronchoscopy could be performed if target lobe atelectasis was lost or never developed after initial treatment.

Results: Forty-three total valve revision procedures were performed, based on first, second, and third bronchoscopies combined. The most common cause for revision bronchoscopy based on the intraoperative assessment was air leaking around one or more valves from either incorrect sizing of previous valves or airway stretching in 18 revision procedures (42%). Thirty-four revision procedures (79%) were performed for loss of previous atelectasis, and 24 (70%) resulted in the redevelopment of target lobe atelectasis. Nine revision procedures (21%) were performed for lack of initial target lobe atelectasis. Two of the 9 revision procedures (22%) performed for failure to achieve initial atelectasis resulted in new target lobe atelectasis.

Conclusion: Post-BLVR revision bronchoscopies are necessary in ∼20% of patients for either loss of target lobe atelectasis or failure to achieve atelectasis after the initial BLVR procedure. In many cases, especially when atelectasis is lost, revision bronchoscopies can reestablish post-BLVR atelectasis.