Pulmonary Vascular Disease: Pulmonary Arterial Hypertension |

Critical Evaluation: First Assessment of Surgical Interventions of Intravenous Treprostinil Administration With a Gas Driven Implantable Pump: Long-Term Follow Up in a Center With More Than 36 Pumps Implanted FREE TO VIEW

Regina Steringer-Mascherbauer, MD; Uwe Fröschl, MD; Josef Aichinger, MD; Reinhold Fuegger, MD
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KH Elisabethinen, Linz, Austria

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A494. doi:10.1016/j.chest.2016.02.516
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SESSION TITLE: Pulmonary Arterial Hypertension

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, April 17, 2016 at 01:00 PM - 02:00 PM

PURPOSE: 2009 a gas driven implantable infusion pump was introduced for intravenous delivery of treprostinil for patients with pulmonary hypertension (PH). Since 2010 our center has acquired vast experience with this innovative treatment, as we consider parenteral treprostinil without the frequent local side effects of subcutaneous infusion a major step forward. A fully implantable pump system minimizes the risk of rare but life-threatening line infections as compared to intravenous delivery with external pumps, but requires surgical intervention in case of drug delivery issues.

METHODS: At our specialized PH center data are documented in ELPHREG (Elisabethinen Linz Pulmonary Hypertension Registry).

RESULTS: Between September 2010 and April 2015 more than 36 patients were implanted and followed up. As previously reported no intraoperative complications were observed. During follow-up of more than 63 patient-years only 5 surgical interventions in 4 patients became necessary 2, 4, 8 and 28 months after implantation. While a catheter-kinking was managed with local anesthesia the other interventions required general anesthesia. One pump had to be refixed after rupture of fixation at the fascia, another patient was revised for possible catheter occlusion; the mechanically damaged part was replaced. A catheter loop due to non coaxial implantation required a complete catheter replacement in a second session. One pump had to be replaced as substantial weight loss led to rotation of the pump that made refill nearly impossible. Despite a seroma that resolved without surgical intervention after the pump replacement no complications were observed.

CONCLUSIONS: - To the best of our knowledge this is the first report on surgical interventions in a large cohort of PH patients with the implanted pump. In our cohort intravenous delivery of treprostinil with this pump is effective. Necessary interventions were performed without complications.

CLINICAL IMPLICATIONS: We recommend close patient monitoring at a specialized expert center and to renew the complete catheter in case of catheter alarm. If necessary, pumps can be replaced safely.

DISCLOSURE: The following authors have nothing to disclose: Regina Steringer-Mascherbauer, Uwe Fröschl, Josef Aichinger, Reinhold Fuegger

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