Totally implantable IV Treprostinil therapy in pulmonary hypertension assessment of the implantation procedure

Authors

Aaron B Waxman
Hugh T McElderry
Mardi Gomberg-Maitland
Martin C Burke
Edgar L Ross
Malcolm M Bersohn
Sanjog S Pangarkar
James H Tarver
Dianne L. Zwicke, Advocate Aurora HealthFollow
Jeremy P Feldman
Murali M ChakinalaFollow
Robert P Frantz
Geoffrey B Thompson
Fernando Torres
Richard L Rauck
Kathy Clagg
Louise Durst
Pei Li
Marty Morris
Kara L Southall
Leigh Peterson
Robert C BourgeFollow

Recommended Citation

Waxman AB, Mcelderry HT, Gomberg-maitland M, et al. Totally Implantable IV Treprostinil Therapy in Pulmonary Hypertension Assessment of the Implantation Procedure. Chest. 2017;152(6): 1128-1134. DOI: 10.1016/j.chest.2017.04.188

Affiliations

Aurora Cardiovascular Services

Abstract

BACKGROUND: Prostacyclins improve symptoms and survival in pulmonary arterial hypertension (PAH). In response to risks associated with external delivery systems, an implantable IV infusion system was developed. A multicenter, prospective, single-arm, clinical trial (DelIVery for PAH) was conducted to evaluate this system for treprostinil in PAH. This analysis describes the findings related to the implant procedure.

METHODS: Patients (N = 64) with PAH (World Health Organization group 1) receiving stable IV treprostinil were enrolled. Patients were transitioned to a temporary peripheral IV infusion catheter prior to the procedure. System implantation was performed at 10 centers under general anesthesia or deep IV sedation by clinicians from various specialties. Central venous access was via the cephalic, subclavian, jugular, or axillary vein. Using an introducer and fluoroscopic guidance, the distal tip of the infusion catheter was placed at the superior caval-atrial junction. The catheter was tunneled from the venous access site to an abdominal subcutaneous pocket, where the pump was placed.

RESULTS: Of the 64 patients enrolled, four exited prior to implantation. All 60 implant procedures were successful. At baseline, all patients were receiving treprostinil via an external pump at a mean dose of 71.4 ± 27.8 ng/kg/min (range: 22-142 ng/kg/min). The implant averaged 102 ± 32 min (range: 47-184 min). Clinically significant implant procedure-related complications included one pneumothorax, two infections, and one episode of atrial fibrillation. There were three postimplantation catheter dislocations in two patients. Common implant-related events that were not complications included implant site pain (83%) and bruising (17%).

CONCLUSIONS: The procedure for inserting a fully implantable system for treprostinil was successfully performed, with few complications.

TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01321073; URL: www.clinicaltrials.gov.

Document Type

Article

PubMed ID

28583617