Periprocedural safety and outcome after pump implantation for intravenous treprostinil administration in patients with pulmonary arterial hypertension.
Pulmonary arterial hypertension
Pump implantation
Treprostinil
Journal
BMC pulmonary medicine
ISSN: 1471-2466
Titre abrégé: BMC Pulm Med
Pays: England
ID NLM: 100968563
Informations de publication
Date de publication:
15 May 2021
15 May 2021
Historique:
received:
27
10
2020
accepted:
11
05
2021
entrez:
16
5
2021
pubmed:
17
5
2021
medline:
16
11
2021
Statut:
epublish
Résumé
In this retrospective observational study, we analyzed all patients with pulmonary arterial hypertension undergoing LenusPro® pump implantation between November 2013 and October 2019 at our center. Periprocedural safety was assessed by describing all complications that occurred within 28 days after surgery; complications that occurred later were described to assess long-term safety. Clinical outcomes were measured by comparison of clinical parameters and echocardiographic measurements of right ventricular function from baseline to 6-months-follow-up. Fifty-four patients underwent LenusPro® pump implantation for intravenous treprostinil treatment during the investigation period. Periprocedural complications occurred in 5 patients; the only anesthesia-related complication (right heart failure with recovery after prolonged intensive care and death in the further course) occurred in the only patient who underwent general anesthesia. All other patients underwent local anesthesia with or without short-acting (analgo-) sedation. Eighteen long-term complications occurred in 15 patients, most notably pump pocket or catheter related problems. Transplant-free survival rates at 1, 2, and 3 years were 77 %, 56 %, and 48 %, respectively. Subcutaneous pump implantation under local anesthesia and conscious analgosedation while avoiding intubation and mechanical ventilation is feasible in patients with advanced PAH. Controlled studies are needed to determine the safest anesthetic approach for this procedure. Intravenous treprostinil treatment via a fully implantable pump is a treatment option for patients with advanced pulmonary arterial hypertension. However, there is no consensus on the preferred anesthetic approach for the implantation procedure. Primary objective was to assess periprocedural safety with particular attention to feasibility of local anesthesia and conscious analgosedation instead of general anesthesia. Long-term safety and clinical outcomes were secondary endpoints.
Sections du résumé
METHODS
METHODS
In this retrospective observational study, we analyzed all patients with pulmonary arterial hypertension undergoing LenusPro® pump implantation between November 2013 and October 2019 at our center. Periprocedural safety was assessed by describing all complications that occurred within 28 days after surgery; complications that occurred later were described to assess long-term safety. Clinical outcomes were measured by comparison of clinical parameters and echocardiographic measurements of right ventricular function from baseline to 6-months-follow-up.
RESULTS
RESULTS
Fifty-four patients underwent LenusPro® pump implantation for intravenous treprostinil treatment during the investigation period. Periprocedural complications occurred in 5 patients; the only anesthesia-related complication (right heart failure with recovery after prolonged intensive care and death in the further course) occurred in the only patient who underwent general anesthesia. All other patients underwent local anesthesia with or without short-acting (analgo-) sedation. Eighteen long-term complications occurred in 15 patients, most notably pump pocket or catheter related problems. Transplant-free survival rates at 1, 2, and 3 years were 77 %, 56 %, and 48 %, respectively.
CONCLUSIONS
CONCLUSIONS
Subcutaneous pump implantation under local anesthesia and conscious analgosedation while avoiding intubation and mechanical ventilation is feasible in patients with advanced PAH. Controlled studies are needed to determine the safest anesthetic approach for this procedure.
BACKGROUND/OBJECTIVES
OBJECTIVE
Intravenous treprostinil treatment via a fully implantable pump is a treatment option for patients with advanced pulmonary arterial hypertension. However, there is no consensus on the preferred anesthetic approach for the implantation procedure. Primary objective was to assess periprocedural safety with particular attention to feasibility of local anesthesia and conscious analgosedation instead of general anesthesia. Long-term safety and clinical outcomes were secondary endpoints.
Identifiants
pubmed: 33992098
doi: 10.1186/s12890-021-01541-3
pii: 10.1186/s12890-021-01541-3
pmc: PMC8126130
doi:
Substances chimiques
Epoprostenol
DCR9Z582X0
treprostinil
RUM6K67ESG
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
164Références
Anesth Analg. 2003 Jun;96(6):1603-16
pubmed: 12760982
J Heart Lung Transplant. 2018 Oct;37(10):1235-1244
pubmed: 30293617
Saudi J Anaesth. 2011 Oct;5(4):395-410
pubmed: 22144928
Eur Respir J. 2017 Aug 3;50(2):
pubmed: 28775047
Am J Transplant. 2010 Sep;10(9):2173-8
pubmed: 20636463
Eur Respir J. 2013 Jun;41(6):1302-7
pubmed: 23143546
J Am Coll Cardiol. 2005 May 17;45(10):1691-9
pubmed: 15893189
Basic Clin Pharmacol Toxicol. 2019 Aug 12;:
pubmed: 31403254
Eur Respir J. 2010 Jun;35(6):1294-302
pubmed: 19897552
Lancet Respir Med. 2016 Apr;4(4):306-22
pubmed: 26975810
Anesthesiol Res Pract. 2012;2012:356982
pubmed: 23097665
Pneumologie. 2016 Feb;70(2):117-22
pubmed: 26894393
Conn Med. 2006 Apr;70(4):239-43
pubmed: 16768070
Clin Res Cardiol. 2017 Mar;106(3):174-182
pubmed: 27670656
Chest. 2017 Dec;152(6):1128-1134
pubmed: 28583617
Pulm Circ. 2020 Mar 13;10(1):2045894020910136
pubmed: 32206306
Eur Respir J. 2019 Jan 24;53(1):
pubmed: 30552088
N Engl J Med. 1996 Feb 1;334(5):296-301
pubmed: 8532025
Eur Heart J. 2016 Jan 1;37(1):67-119
pubmed: 26320113
Clin Res Cardiol. 2017 Oct;106(10):776-783
pubmed: 28429083
Int J Cardiol. 2018 Dec 1;272S:37-45
pubmed: 30190158
J Am Coll Cardiol. 2014 Dec 9;64(22):e77-137
pubmed: 25091544
J Heart Lung Transplant. 2019 Jul;38(7):748-756
pubmed: 31128966
Int J Cardiol. 2018 Dec 1;272S:46-52
pubmed: 30190155
BMC Pulm Med. 2017 Dec 2;17(1):162
pubmed: 29195500