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Harutyunova S, Benjamin N, Eichstaedt C, Marra AM, Xanthouli P, Nagel C, Grünig E, Egenlauf B. Long-Term Safety, Outcome, and Clinical Effects of Subcutaneous and Intravenous Treprostinil Treatment in Patients with Severe Chronic Pulmonary Arterial Hypertension. Respiration 2023; 102:579-590. [PMID: 37544296 DOI: 10.1159/000531169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/16/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Current guidelines recommend treatment with parenteral prostacyclin analogs in patients with severe pulmonary arterial hypertension (PAH), who have insufficient response to treatment. Real-life data are sought to help physicians in treatment decisions and clinical care of patients. OBJECTIVE This study analyzed safety, clinical effects, and long-term outcomes of subcutaneous (sc) and/or intravenous (iv) treprostinil via different pump systems in consecutive patients with PAH. METHODS Thirty-seven patients with severe progressive PAH despite dual combination therapy (20 female, mean age: 52.3 ± 15 years, mean pulmonary vascular resistance: 12.1 ± 5.1 WU) were initiated with add-on treprostinil sc and were routinely clinically assessed. Changes in clinical parameters, adverse events, and outcome were analyzed retrospectively. RESULTS In 24 of 37 patients, treprostinil administration was continued iv via implantation of LENUS Pro® pump after 3 ± 1.3 months, 6 patients continued with sc therapy, and 7 discontinued treatment. After 3, 6, 9, and 12 months of treprostinil treatment, patients showed a significant improvement in mean 6-min walk distance and tricuspid annular plane systolic excursion compared to baseline. In 8 of the 24 patients, iv pumps required surgical revision. During a mean follow-up of 2.82 ± 1.95 years, 12 patients died, four received lung transplantation. Transplant-free survival after 1, 2, and 3 years was 85.7%, 69.2%, and 65.3%, respectively. CONCLUSION sc treprostinil as add-on to double combination treatment significantly improved exercise capacity and right heart function. In most patients, treprostinil could be continued via more tolerable iv administration approach (LENUS Pro® pump), showing reasonable overall survival with respect to the severity of PAH.
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Affiliation(s)
- Satenik Harutyunova
- Center for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany,
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany,
| | - Nicola Benjamin
- Center for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Christina Eichstaedt
- Center for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Institute of Human Genetics, Laboratory for Molecular Genetic Diagnostics, Heidelberg University, Heidelberg, Germany
| | - Alberto M Marra
- Center for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
- Internal Medicine Section, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Panagiota Xanthouli
- Center for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Christian Nagel
- Center for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Pneumology, Clinic Baden-Baden, Baden-Baden, Germany
- Practice of Pneumology, Max Grundig Clinic Bühlerhöhe, Bühl, Germany
| | - Ekkehard Grünig
- Center for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Benjamin Egenlauf
- Center for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
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2
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Evaluation of the Quality and Effect of 360° Safe Indwelling Infusion of Peripheral Venous Indwelling Needle in Pediatric Clinic. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1499927. [PMID: 35432822 PMCID: PMC9010149 DOI: 10.1155/2022/1499927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/24/2022] [Indexed: 11/26/2022]
Abstract
To evaluate the application effect of the 360° safe indwelling infusion program of peripheral venous indwelling needle in the infusion room of pediatric outpatient clinic. A total of 1,000 children who received indwelling needle infusion were randomly divided into experimental group (n = 500; 360° safe indwelling needle) and control group (n = 500; a routine indwelling needle). The incidence of indwelling needle-related complications and adverse events in the experimental group was significantly lower than that in the control group, and the number of indwelling days, indwelling needle usage rate, and parent satisfaction were significantly higher than those in the control group. The 360° safe indwelling infusion program can significantly reduce the incidence of complications and adverse events, and improve the quality of the indwelling needle infusion. The 360° safe indwelling infusion can effectively improve the comprehensive quality and safety of nursing care in the outpatient infusion room.
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3
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Kamp JC, Fuge J, Karsten JF, Rümke S, Hoeper MM, Park DH, Kühn C, Olsson KM. Periprocedural safety and outcome after pump implantation for intravenous treprostinil administration in patients with pulmonary arterial hypertension. BMC Pulm Med 2021; 21:164. [PMID: 33992098 PMCID: PMC8126130 DOI: 10.1186/s12890-021-01541-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 05/11/2021] [Indexed: 02/08/2023] Open
Abstract
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 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 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 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.
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Affiliation(s)
- Jan C Kamp
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jan F Karsten
- Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Stefan Rümke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Da-Hee Park
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christian Kühn
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Karen M Olsson
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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4
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Huang ST, Xu N, Sun KP, Chen Q, Cao H. Effect of Treprostinil on the Early Postoperative Prognosis of Patients with Severe Left Heart Valvular Disease Combined with Severe Pulmonary Hypertension. Ann Thorac Cardiovasc Surg 2021; 27:18-24. [PMID: 32493870 PMCID: PMC8043024 DOI: 10.5761/atcs.oa.20-00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate the effect of treprostinil on the early postoperative prognosis of patients with severe left heart valvular disease combined with severe pulmonary hypertension (PAH). METHODS A retrospective study including 55 patients with severe left heart valvular disease combined with severe PAH who underwent left heart valve replacement in our hospital between January 2019 and May 2019 was conducted. Patients were divided into two groups (treprostinil group and control group), and the clinical data of patients in the two groups were compared and analyzed. RESULTS Compared with the preoperative status, the mean postoperative pulmonary artery pressure (mPAP) in both groups was significantly lower. Compared with the control group, the treprostinil group had a significantly lower mPAP. Moreover, the postoperative mechanical ventilation time, intensive care unit (ICU) stay, and hospital stay of the treprostinil group were significantly shorter than those of the control group. There were no serious drug-related side effects in either group. CONCLUSIONS Treprostinil can improve the early postoperative prognosis of patients with severe left heart valvular disease combined with severe PAH undergoing prosthetic valve replacement.
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Affiliation(s)
- Shu-Ting Huang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ning Xu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Kai-Peng Sun
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
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5
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Stubbe B, Opitz CF, Halank M, Habedank D, Ewert R. Intravenous prostacyclin-analogue therapy in pulmonary arterial hypertension - A review of the past, present and future. Respir Med 2021; 179:106336. [PMID: 33647836 DOI: 10.1016/j.rmed.2021.106336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/03/2021] [Accepted: 02/06/2021] [Indexed: 02/02/2023]
Abstract
Therapy with intravenous prostacyclin analogues in patients with pulmonary arterial hypertension (PAH) has been established for decades and is an integral component of the current guidelines for the treatment of pulmonary hypertension. Initially, these drugs were infused by external pump systems via tunnelled right atrial catheters with the need for cooling and frequent exchange of drug reservoirs. Associated complications included, among others, catheter-related infections. More recently, fully implantable pump systems have been developed with drug reservoirs that are filled transcutaneously, allowing intervals between refills of several weeks. This technique results in a low rate of infections. Epoprostenol, iloprost and treprostinil have all been used intravenously in PAH, but titration, dosing and dose escalation in long-term therapy are not standardized. Intravenous prostacyclin analogues are still under-used, despite available data suggesting that early and broad application of these therapies as part of risk-oriented, guideline-directed combination therapy for patients with PAH may lead to a survival benefit. This review provides a detailed overview of the drugs, infusion systems and dosing strategies used for intravenous therapy in patients with PAH.
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Affiliation(s)
- Beate Stubbe
- Department of Internal Medicine B, University Hospital Greifswald, Greifswald, Germany.
| | - Christian F Opitz
- Department of Cardiology, DRK Kliniken Berlin and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Halank
- Universitätsklinikum Carl Gustav Carus, Medizinische Klinik 1, Bereich Pneumologie, Dresden, Germany
| | - Dirk Habedank
- Department of Cardiology, DRK Kliniken Berlin and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ralf Ewert
- Department of Internal Medicine B, University Hospital Greifswald, Greifswald, Germany
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6
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Kopp G, Hachulla AL, Noble S, Bringard A, Soccal PM, Beghetti M, Lador F. Unexpected Acceleration in Treprostinil Delivery Administered by a Lenus Pro® Implantable Pump in Two Patients Treated for Pulmonary Arterial Hypertension. Front Med (Lausanne) 2020; 7:539707. [PMID: 33195292 PMCID: PMC7662390 DOI: 10.3389/fmed.2020.539707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 09/28/2020] [Indexed: 12/02/2022] Open
Abstract
Intravenous treprostinil administration by an implantable pump is an attractive option for pulmonary arterial hypertension (PAH) treatment and is the subject of recent publications. Short-term studies are promising, but there is still a lack of long-term prospective data. We analyzed the treprostinil flow rate administered by the Lenus Pro® implantable pump in 2 patients suffering from PAH during follow-up times of respectively 4.2 and 3 years. The flow rate delivered by the pumps in these 2 patients exceeded the manufacturer admitted margin of error within 2 years and continued to increase to reach, respectively, 158 and 120% of the expected flow rate at the end of the follow up. In one case, the implantable pump had to be removed for this reason. The ex-vivo flow rate of the withdrawn pump determined in the laboratory reached 173% of the predicted value. This correlated with the in-vivo measurement, which suggests a continuous flow increase even after pump removal and without treprostinil use. Spontaneous flow increase from such an implantable pump is a potentially major pitfall, which needs to be identified and actively managed by the responsible clinicians.
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Affiliation(s)
- Garance Kopp
- Division of Pneumology, University Hospitals of Geneva, Genève, Switzerland
| | - Anne-Lise Hachulla
- Division of Radiology, University Hospitals of Geneva, Genève, Switzerland.,Pulmonary Hypertension Program, University Hospitals of Geneva, Genève, Switzerland
| | - Stéphane Noble
- Pulmonary Hypertension Program, University Hospitals of Geneva, Genève, Switzerland.,Division of Cardiology, University Hospitals of Geneva, Genève, Switzerland.,Medical Faculty, University of Geneva, Genève, Switzerland
| | - Aurélien Bringard
- Division of Pneumology, University Hospitals of Geneva, Genève, Switzerland.,Medical Faculty, University of Geneva, Genève, Switzerland.,Division of Anesthesiology, Pharmacology, and Intensive Care, University Hospitals of Geneva, Genève, Switzerland
| | - Paola M Soccal
- Division of Pneumology, University Hospitals of Geneva, Genève, Switzerland.,Pulmonary Hypertension Program, University Hospitals of Geneva, Genève, Switzerland.,Medical Faculty, University of Geneva, Genève, Switzerland
| | - Maurice Beghetti
- Pulmonary Hypertension Program, University Hospitals of Geneva, Genève, Switzerland.,Medical Faculty, University of Geneva, Genève, Switzerland.,Pediatric Cardiology Unit, Children's Hospital, University Hospitals of Geneva, Genève, Switzerland
| | - Frédéric Lador
- Division of Pneumology, University Hospitals of Geneva, Genève, Switzerland.,Division of Cardiology, University Hospitals of Geneva, Genève, Switzerland.,Medical Faculty, University of Geneva, Genève, Switzerland
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7
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Feldman J, Habib N, Fann J, Radosevich JJ. Treprostinil in the treatment of pulmonary arterial hypertension. Future Cardiol 2020; 16:547-558. [PMID: 32391733 DOI: 10.2217/fca-2020-0021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Despite progress over the past 30 years, pulmonary arterial hypertension remains a condition with high morbidity and mortality. Pharmacological and technological advances have shifted the approach to treating pulmonary arterial hypertension. Recent developments revolve heavily around novel routes of drug administration and delivery. In 2009, inhaled treprostinil was approved followed by oral treprostinil in 2013 providing patients with more convenient routes of administration compared with the parenteral alternatives. We are on the cusp of having the first fully implantable infusion pump for continuous intravenous treprostinil delivery. In 2019, generic treprostinil was approved, making the medication much more affordable for patients. In this review, we discuss in detail the recent developments surrounding both traditional and novel treprostinil products.
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Affiliation(s)
| | - Naomi Habib
- University Medical Center, Phoenix, AZ 85006, USA
| | - Jade Fann
- St. Joseph's Hospital & Medical Center, Phoenix, AZ 85013, USA
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8
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Álvarez-Fuente M, Garrido-Lestache E, Rivero N, Centella T, Lamas MJ, Pérez-Caballero C, Vázquez JL, Del Cerro MJ. Implantable LENUS pro pump for treprostinil infusion in three pediatric patients. Pediatr Pulmonol 2020; 55:1254-1258. [PMID: 32149476 DOI: 10.1002/ppul.24707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Prostanoid treatment in patients with severe pulmonary arterial hypertension (PAH) has been proven safe and effective. Subcutaneous administration of treprostinil has side effects, which limits their use and acceptance. An implantable pump for continuous intravenous treprostinil infusion has been recently approved. We describe our experience with the implantable pump in three pediatric patients. DESCRIPTION OF CASES The LENUS pro pump was implanted in three adolescents with severe PAH, who were treated with tadalafil, ambrisentan, and subcutaneous treprostinil. The indication of the Lenus pro pump implantation was the local side effects of subcutaneous treprostinil (pain, inflammation, and local infection) that were not well tolerated and that severely decreased their quality of life. The pump was surgically implanted under general anesthesia.One patient, in functional class IV, suffered postoperative hemodynamic instability and small pneumothorax, requiring an increase in treprostinil dose up to 85 ng/kg/min and a decrease 9 days after the pump implantation. The second patient who was discharged 4 days after surgery with treprostinil at 60 ng/kg/min reported improvement in his quality of life, but the dose requirement increased up to 92 ng/kg/min. After a 21-month follow-up, this patient received a lung transplant. The third patient presented a hematoma at the pump site with no other complications and had a follow-up of 9 months with an improvement in her quality of life. COMMENTS Implantable pumps for continuous parenteral prostanoid infusion in pediatric patients are an alternative to external pumps, especially when familiar psychological or psychomotor issues hinder the use of external pumps.
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Affiliation(s)
| | | | - Natalia Rivero
- Department of Pediatric Cardiology, Ramon y Cajal Hospital, Madrid, Spain
| | - Tomasa Centella
- Department of Pediatric Cardiac Surgery, Ramon y Cajal Hospital, Madrid, Spain
| | - Maria J Lamas
- Department of Pediatric Cardiac Surgery, Ramon y Cajal Hospital, Madrid, Spain
| | | | - Jose L Vázquez
- Pediatric Intensive Care Unit, Ramon y Cajal Hospital, Madrid, Spain
| | - Maria J Del Cerro
- Department of Pediatric Cardiology, Ramon y Cajal Hospital, Madrid, Spain
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Richter MJ, Harutyunova S, Bollmann T, Classen S, Fuge J, Gall H, Gerhardt F, Ghofrani HA, Gunkel H, Grünig E, Halank M, Heine A, Klose H, Lange TJ, Neurohr C, Nickolaus K, Opitz CF, Rosenkranz S, Seyfarth HJ, Tello K, Ewert R, Olsson KM. Flow rate variance of a fully implantable pump for the delivery of intravenous treprostinil in pulmonary arterial hypertension. Pulm Circ 2020; 10:2045894020910136. [PMID: 32206306 PMCID: PMC7074510 DOI: 10.1177/2045894020910136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 02/07/2020] [Indexed: 01/31/2023] Open
Abstract
Implantable infusion pumps might improve the convenience and safety of intravenous treprostinil for pulmonary arterial hypertension. The LENUS Pro® pump (approved in Europe) has a fixed flow rate. Based on 126 pumps and 2853 refills, we retrospectively analyzed the actual flow rate from 09/2010 to 09/2018. A relevant flow rate variance is evident after three years; therefore, flow rate monitoring and dose adjustment are mandatory.
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Affiliation(s)
- Manuel J Richter
- Department of Pneumology, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany.,Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany.,German Center for Lung Research (DZL), Giessen, Germany
| | - Satenik Harutyunova
- Center for Pulmonary Hypertension, Thorax Clinic at the University Hospital Heidelberg, Heidelberg, Germany
| | - Tom Bollmann
- Department of Internal Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Simon Classen
- Department of Vascular Surgery, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany
| | - Jan Fuge
- German Center for Lung Research (DZL), Giessen, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Henning Gall
- Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany.,German Center for Lung Research (DZL), Giessen, Germany
| | - Felix Gerhardt
- Department III of Internal Medicine and Cologne Cardiovascular Research Center (CCRC), Cologne University Heart Center, Cologne, Germany
| | - Hossein A Ghofrani
- Department of Pneumology, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany.,Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany.,German Center for Lung Research (DZL), Giessen, Germany.,Department of Medicine, Imperial College London, London, UK
| | | | - Ekkehard Grünig
- Center for Pulmonary Hypertension, Thorax Clinic at the University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Halank
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Alexander Heine
- Department of Internal Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Hans Klose
- Department of Pneumology, University of Hamburg, Hamburg, Germany
| | - Tobias J Lange
- Department of Internal Medicine II, Division of Pneumology, University Medical Center Regensburg, Regensburg, Germany
| | - Claus Neurohr
- Department for Pneumology and Respiratory Medicine, Robert-Bosch-Hospital, Gerlingen, Germany
| | - Kai Nickolaus
- Department of Pneumology, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany
| | | | - Stephan Rosenkranz
- Department III of Internal Medicine and Cologne Cardiovascular Research Center (CCRC), Cologne University Heart Center, Cologne, Germany
| | | | - Khodr Tello
- Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany.,German Center for Lung Research (DZL), Giessen, Germany
| | - Ralf Ewert
- Department of Internal Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Karen M Olsson
- German Center for Lung Research (DZL), Giessen, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
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10
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Udi J, Köhler TC, Grohmann J, Bäuml M, Grundmann S, Bode C, Biever P, Duerschmied D. A challenging case of severe pulmonary bleeding in a patient with congenital ventricular septal defect (VSD) and Eisenmenger syndrome: extracorporeal membrane oxygenation (ECMO) support and weaning strategies. Clin Res Cardiol 2019; 109:403-407. [PMID: 31501999 DOI: 10.1007/s00392-019-01544-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/28/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Josefina Udi
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany. .,Department of Internal Medicine III, Medical Intensive Care, Medical Center, University of Freiburg, Freiburg, Germany.
| | | | - Jochen Grohmann
- Department of Congenital Heart Defects and Pediatric Cardiology, Heart Center, University of Freiburg, Freiburg, Germany
| | - Marina Bäuml
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany.,Department of Internal Medicine III, Medical Intensive Care, Medical Center, University of Freiburg, Freiburg, Germany
| | - Sebastian Grundmann
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany.,Department of Internal Medicine III, Medical Intensive Care, Medical Center, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany.,Department of Internal Medicine III, Medical Intensive Care, Medical Center, University of Freiburg, Freiburg, Germany
| | - Paul Biever
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany.,Department of Internal Medicine III, Medical Intensive Care, Medical Center, University of Freiburg, Freiburg, Germany
| | - Daniel Duerschmied
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany.,Department of Internal Medicine III, Medical Intensive Care, Medical Center, University of Freiburg, Freiburg, Germany
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11
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Olsson KM, Richter MJ, Kamp JC, Gall H, Heine A, Ghofrani HA, Fuge J, Ewert R, Hoeper MM. Intravenous treprostinil as an add-on therapy in patients with pulmonary arterial hypertension. J Heart Lung Transplant 2019; 38:748-756. [DOI: 10.1016/j.healun.2019.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/10/2019] [Accepted: 05/01/2019] [Indexed: 12/01/2022] Open
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Abstract
This article provides an overview of pulmonary arterial hypertension (PAH), beginning with the initial pathologic recognition of pulmonary hypertension more than 100 years ago and progressing to the current diagnostic categorization of PAH. It reviews the epidemiology, pathophysiology, genetics, and modern treatment of PAH. The article discusses several important recent studies that have highlighted the importance of new management strategies, including serial risk assessment and combination pharmacotherapy.
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Affiliation(s)
- Mark W Dodson
- Department of Medicine, Intermountain Medical Center, 5121 South Cottonwood Street, Building 2, Suite 307, Murray, UT 84107, USA
| | - Lynette M Brown
- Department of Medicine, Intermountain Medical Center, 5121 South Cottonwood Street, Building 2, Suite 307, Murray, UT 84107, USA; Pulmonary Division, University of Utah, 24 North 1900 East, Wintrobe Building, Room 701, Salt Lake City, UT 84132, USA
| | - Charles Gregory Elliott
- Department of Medicine, Intermountain Medical Center, 5121 South Cottonwood Street, Building 2, Suite 307, Murray, UT 84107, USA; Pulmonary Division, University of Utah, 24 North 1900 East, Wintrobe Building, Room 701, Salt Lake City, UT 84132, USA.
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Long-term safety and outcome of intravenous treprostinil via an implanted pump in pulmonary hypertension. J Heart Lung Transplant 2018; 37:1235-1244. [DOI: 10.1016/j.healun.2018.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 05/13/2018] [Accepted: 06/11/2018] [Indexed: 11/22/2022] Open
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Koestenberger M, Hansmann G. Should we use the oral selective IP receptor agonist selexipag off-label in children with pulmonary arterial hypertension? Pulm Circ 2018; 8:2045894018793580. [PMID: 30260767 PMCID: PMC6161208 DOI: 10.1177/2045894018793580] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We discuss the currently available data on the use of the prostacyclin mimetic selexipag in children and adolescents with pulmonary arterial hypertension (PAH). Future indications may include transitioning from intravenous prostacyclin/prostacyclin analog to oral selexipag, and vice versa, or adding selexipag as a third oral PAH-targeted agent in children not responding well to dual PAH therapy.
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Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, Austria
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Germany
- Georg Hansmann, Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany. Martin Koestenberger, Department of Pediatrics, Medical University of Graz, Auenbruggerplatz 34/2, Graz 8036, Austria.
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Desole S, Richter MJ, Heine A, Ewert R. Intravenous treprostinil via an implantable pump in pediatric pulmonary arterial hypertension. Pulm Circ 2018; 9:2045894018788846. [PMID: 29944075 PMCID: PMC6295941 DOI: 10.1177/2045894018788846] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Intravenous prostacyclin-based therapy improves survival in children with pulmonary arterial hypertension (PAH), but is typically administered via an external infusion pump, which places a considerable burden on the patient. Implanted pumps may overcome some of the limitations of external pumps. We describe the first long-term use of an implanted pump for intravenous treprostinil delivery in a pediatric patient with PAH. Our patient was experiencing marked dyspnea on exertion despite triple combination therapy with bosentan, sildenafil, and inhaled iloprost. Parenteral prostacyclin-based therapy was discussed and the patient rejected options involving external pumps; she finally chose intravenous treprostinil delivery via an implanted pump (LENUS Pro®; fixed flow rate; 20 ml reservoir). The patient underwent pump implantation in July 2012 (aged 14 years) under general anesthesia with no peri- or postoperative complications. She showed marked improvements in fatigue and dyspnea over the subsequent weeks, and her inhaled iloprost regimen was slowly decreased and stopped after six months. During follow-up, the pump showed an unexpected, progressive increase in flow rate that allowed a treprostinil dose of 170 ng/kg/min to be achieved, but at the cost of shortened intervals between refills. The pump was therefore replaced in August 2017 with a newer model with an adjustable flow rate (Siromedes®). A catheter dislocation was corrected under local anesthesia one week after the replacement surgery. The patient is currently receiving treprostinil 170 ng/kg/min with percutaneous refills every 12–13 days. Thus, implantable pumps might be a valuable alternative to external pumps for treprostinil infusion in pediatric PAH.
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Affiliation(s)
- Susanna Desole
- 1 Division of Pneumology and Infectious Diseases", Ernst-Moritz-Arndt University, Germany
| | - Manuel Jonas Richter
- 2 Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Germany
| | - Alexander Heine
- 1 Division of Pneumology and Infectious Diseases", Ernst-Moritz-Arndt University, Germany
| | - Ralf Ewert
- 1 Division of Pneumology and Infectious Diseases", Ernst-Moritz-Arndt University, Germany
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Zelniker TA, Huscher D, Vonk-Noordegraaf A, Ewert R, Lange TJ, Klose H, Dumitrescu D, Halank M, Held M, Gall H, Pittrow D, Hoeper MM, Frankenstein L. The 6MWT as a prognostic tool in pulmonary arterial hypertension: results from the COMPERA registry. Clin Res Cardiol 2018; 107:460-470. [PMID: 29368137 DOI: 10.1007/s00392-018-1207-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 01/22/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND In patients with pulmonary arterial hypertension, the 6-Minute Walk Test (6MWT) is recommended for risk stratification and follow-up by all guidelines. However, the prognostic value of the 6MWT has been discussed controversially. We sought to compare and validate all published 6MWT cut-off points. METHODS From the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA)-registry we identified 2391 patients with pulmonary arterial hypertension who had at least one documented 6MWT measurement. A Medline search identified a total of 21 different threshold values for either single-point or change of 6MWT. All values were tested individually for prognostication of 1-year, 2-year and 3-year all-cause mortality. RESULTS The highest positive likelihood ratio was a cut-off value < 165 ms, whereas the best negative likelihood ratio was found to be a threshold of 440 ms. Furthermore, improvement in 6MWT had considerably less predictive value on mortality and survival than deterioration. Moreover, absolute single-point values outperformed change values for both improvement and worsening. CONCLUSION Our data confirmed the prognostic relevance of the 6MWT and support the cut-off values stated in most recent guidelines. Furthermore, these results explain why changes in 6MWT did not correlate consistently with prognosis in previous studies.
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Affiliation(s)
- Thomas A Zelniker
- Department of Cardiology, Angiology, Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Dörte Huscher
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Anton Vonk-Noordegraaf
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
| | - Ralf Ewert
- Department of Internal Medicine, University of Greifswald, Greifswald, Germany
| | - Tobias J Lange
- Department of Internal Medicine II, Division of Pneumology, University Medical Center Regensburg, Regensburg, Germany
| | - Hans Klose
- Department of Respiratory Medicine, University Medical Center Hamburg-Eppendorf, Center of Oncology, Hamburg, Germany
| | - Daniel Dumitrescu
- Herzzentrum der Universität zu Köln, Klinik III für Innere Medizin, Cologne, Germany
| | - Michael Halank
- Department of Internal Medicine I, Carl Gustav Carus University Hospital, Technical University of Dresden, Dresden, Germany
| | - Matthis Held
- Department of Internal Medicine, Respiratory Medicine and Cardiology, MissioClinic, Würzburg, Germany
| | - Henning Gall
- Universities of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL), Giessen, Germany
| | - David Pittrow
- Institute for Clinical Pharmacology, Medical Faculty, Technical University Dresden, Dresden, Germany
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, 30623, Hannover, Germany
- German Centre of Lung Research (DZL/BREATHE), Hannover, Germany
| | - Lutz Frankenstein
- Department of Cardiology, Angiology, Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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Future Applications of the Selective Prostacyclin (IP) Receptor Agonist Selexipag in Pediatric Pulmonary Hypertension. Pediatr Cardiol 2017; 38:1523-1524. [PMID: 28785777 DOI: 10.1007/s00246-017-1699-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
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