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CHESTWorld Congress 2016
15–17 APRIL • SHANGHAI, CHINA
CHEST world congress
2016 brought together
pulmonary, critical
care and sleep
medicine clinicians
from around the
world to experience
interactive hands-on
simulation training,
keynote addresses and
presentations from
leading healthcare
experts on the latest
research in chest
medicine.
A gas-driven pump is used to deliver prostacyclin in patients with severe
pulmonary hypertension and concomitant haematologic malignancy
An implantable gas driven infusion pump has been used to deliver treprostinil to patients with severe pulmonary hyperten-
sion and concomitant haematological malignancy.
P
ulmonary hypertension is a
progressive fatal disease re-
quiring aggressive, specific
therapy. Subcutaneous treprostinil
is associated with local side effects
and intravenous administration with
external pumps with rare but severe
catheter-related infections, explains
Regina Steringer-Mascherbauer, MD,
of KH Elisabethinen, Linz, Austria.
The availability of a gas driven
implantable pump for intravenous
treprostinil administration rep-
resents significant progress. This
surgical approach requires careful
interdisciplinary interaction, how-
ever, as patients with pulmonary
hypertension carry significantly ele-
vated anaesthesia risks, especially if
they harbour relevant comorbidities.
Data were documented in the
Elisabethinen Linz Pulmonary Hy-
pertension Registry.
Between 2012 and 2015, three
patients with severe pulmonary
hypertension and concomitant
haematological malignancy were
implanted. According to standard
operating procedures, all patients
were uptitrated with subcutaneous
treprostinil.
Eligibility for anaesthesia and
pump implantation was indepen-
dently assessed by the pulmonary
hypertension specialist, anaesthe-
siologist, and surgeon. A dedicated
surgical team performed all implan-
tations. No perioperative complica-
tions were observed.
In the third patient, a postopera-
tive bleeding episode was managed
during a hospital stay. No other
complications or infections were
observed. The first patient died
from the underlying malignancy 12
months after pump implantation.
A fourth patient, a 65-year-old
female with post polycythemia vera
myelofibrosis is on the waiting list
for implantation because thrombo-
cytopenia, a known side effect of
ruxolitinib, is now a contraindication
to surgery.
Dr Steringer-Mascherbauer
concluded that the coincidence of
life-threatening diseases presents
an extraordinary challenge. With
intensive cooperation between all
departments involved and extensive
experience with the implantation
procedure, the pump can be safely
offered, even to patients with severe
haematologic comorbidities such as
lymphoma.
The implantation of a gas driven
pump for treprostinil therapy has not
yet been reported in patients with
severe haematologic comorbidity,
and must be restricted to surgically
experienced, specialised pulmonary
hypertension centres.
With intensive cooperation between all departments involved and extensive experience with the
implantation procedure, the pump can be safely offered, even to patients with severe haematologic
comorbidities such as lymphoma.
CONFERENCE COVERAGE
PRACTICEUPDATE CARDIOLOGY
10