SESSION TITLE: Pleural Disease
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 29, 2014 at 02:45 PM - 04:15 PM
PURPOSE: Tunneled pleural catheters (TPC) have proven to be safe and effective in the management of malignant pleural effusions. There is a lack of data demonstrating the safety and efficacy of TPC in non-malignant effusions, specifically those caused by congestive heart failure (CHF), refractory to medical management. The aim of our study is to assess the safety and effectiveness of TPC when used in this patient population.
METHODS: We performed a retrospective study from June 2005 to March 2014 of patients who had a TPC placed for the palliation of symptomatic and recurrent pleural effusions.
RESULTS: A total of 435 patients were identified and 31 had CHF-related pleural effusion with a total of 37 TPC placed. Of those 18 were males with a median age of 86 years (ranging from 61-97). The most common presenting symptoms included dyspnea (n=19), cough (n=4) and chest pain (n=4). Six patients had bilateral insertion of TPC. Diastolic CHF was present in 21 patients, systolic CHF in 15 patients and combined dysfunction in 1 patient. At time of insertion of TPC, median serum BNP was 2516 pg/mL, (362-50144) and pleural pro-BNP was 3521 pg/mL (1329-22390). There were 15 TPC placed at time of thoracoscopy and talc poudrage while 22 TPC were used as the only treatment. Successful pleurodesis was seen in 11 patients (73%) after talc poudrage and in 4 patients (18%) where TPC was used as the only treatment. When we compared the 6-month preoperative and 6-month postoperative readmissions and thoracentesis rates, there was a statistically significant difference. Complications included hypoxia and hypotension in 1 patient (2%), cellulitis in 3 patients (8%), and empyema in 1 patient (2%) and all resolved with supportive treatment and oral/IV antibiotics. The median length of time the TPC remained was 20 days, with a range of 2-343 days.
CONCLUSIONS: The off-label use of TPC for benign refractory pleural effusion in patients with CHF is safe and effective. The benefits translate into symptomatic improvement, decrease readmission rates and repeat thoracentesis.
CLINICAL IMPLICATIONS: The use of TPC is both safe and effective for management of benign pleural effusion caused by CHF, reducing both hospital admissions and repeat thoracenteses.
DISCLOSURE: The following authors have nothing to disclose: Meghan Fashjian, Erik Folch, Elisa Roca, Aishatu Aloma, Adnan Majid
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