Endobronchial valves

What does EBV insertion involve?

An EBV is put into the airways using flexible tube with a camera attached (abronchoscope). This is done with you asleep under a general anaesthetic. Three valves are usually needed to treat one lobe of the lung but this may vary. Although the EBV is designed to be permanent, it can be removed if needed.

Before fitting an EBV your surgeon will test for collateral ventilation. Collateral ventilation may cause an EBV not to work.

What is collateral ventilation?

Air normally flows in and out of the lung via the airways. Parts of lung may also be connected to each other. This allows air to flow between parts of the lung, bypassing the airway. This bypassing is called collateral ventilation.

EBVs only control air flow in the airway, if air can bypass the airway the EBV cannot control the flow through the lung tissue and deflate the diseased part of the lung.

Who can have EBV therapy?

Detailed hospital assessments of your fitness and your lungs are required to check if EBVs may help you. These include testing your heart, breathing tests, walking tests and scans. EBVs work best for people who have patchy emphysema, with some parts of the lung severely affected and others parts more healthy.

Is the procedure painful?

You will be asleep for the procedure. You will have a sore throat, this should settle over a few days. You should not be in pain after this.

What are the risks?

The risks here are a guide; your own risk may vary. You should discuss the risks and benefits of surgery with your surgeon, especially if you are worried. Since you will already have severe lung disease the risks of an anaesthetic are higher.

Minor more common risks

You may feel feverish for a few hours after surgery. You may have a hoarse voice at first, this should settle. Air may escape from the lung and get into the space between the lung and the chest wall; this is called a pneumothorax (also known as a collapsed lung). If this occurs you will need to stay in hospital have a chest drain to remove the air. A pneumothorax is more likely to occur if the valve works very well and collapses the area of emphysema quickly. Chest pain and shortness of breath may be signs of a pneumothorax.

The valve may become dislodged or more rarely you may cough up a valve, this is not dangerous but of course this valve is no longer working. Another valve can be fitted if you found the valve helped. You may notice an increase in mucous or wheezing, a flare up of your emphysema symptoms may happen that needs treatment. You may get a chest infection after surgery that requires treatment. You cough up a small amount of blood.

Major less common risks

A collapsed lung may be difficult to treat with a chest drain and the valves may have to be removed. A flare up of your emphysema symptoms or chest infection may become severe. Shortness of breath from these problems may become severe enough to require help from a ventilator machine or be fatal.

This can be with a face mask with you fully awake. It may also be need via a tube in your windpipe with you under sedation. If you need help breathing via a tube for a long time it may be better to have a temporary tracheostomy. This is a tube put in through the neck which is removed once breathing improves. Coughing up a large amount of blood can happen but is very rare.

Recovery after EBV

If you feel well you will be able to go home the next day. Once you have recovered from the anaesthetic (usually 48 hours) you can return to your normal activities.

If the valve works you will find a slow improvement in shortness of breath and ability to do activities. The degree of improvement varies a lot from person to person.

If you feel unwell after you have left hospital, either contact your doctor or attend the emergency department.

What are the alternatives?

If you are well enough to cope with a bigger operation lung volume reduction surgery is an established treatment for emphysema. You must still undergo a thorough specialist assessment first.

Most people with emphysema do not undergo surgery, the usual care for emphysema includes:

• not smoking
• exercise, there are classes for improving your lung function and learning more about the lungs across the country
• finding the right medications (including inhalers) to suit you
• managing flare-ups whether at home or with the help of your doctor
• healthy diet
• oxygen or ventilator machines at home

Even if you have surgery, you should continue with these aspects of usual care with the support of your hospital doctor and GP.

Treatment with EBVs will not prevent you from having lung surgery if you require it in the future. It is your choice whether to go ahead with surgery or choose another kind of treatment. We will respect your wishes and support you in choosing the treatment that suits you. You are always welcome to seek a second opinion.