Source: International Congress 2016 – Pulmonary hypertension and pulmonary embolism: from the bench to the bedside
Disease area: Pulmonary vascular diseases

Abstract

IntroductionProstacyclin is a treatment of pulmonary arterial hypertension (PAH). Due to its longer half-life and thermostability, treprostinil allows the development of implantable devices for its IV administration. This approach is appealing as it may offer less restrictive use for patients, reducing manipulation of central venous and associated infectious risk.MethodsWe would like to share our experience of 2 cases receiving IV treprostinil by implantable pump.ResultsThe first case is a 46 yo female with drug-induced PAH. Due to clinical and hemodynamic deterioration,subcutaneous treprostinil was introduced. Due to pain at injection site, an implantable pump was proposed (LenusPro 20ml, Tricumed, Germany). We observed during the next 4-years follow-up a gradual decrease in the residual volume of treprostinil present in the device before the refilling, causing it to shorten the time between them. While the pump is theoretically calibrated to a constant flow rate (1.04 ml/day ±10%), the flow increased up to 1.64 ml/day (+58%). The second case is a 22 yo man, followed for idiopathic PAH, diagnosed at age 4. Since age 15, the patient developed numerous catheter-related infections, requiring hospitalization and central line replacement. At age 19, an IV implantable pump was proposed. Similarly, we observed a progressive increase in the flow rate up to 1.52ml/day (+20%) while theoretically calibrated at 1.27 ml/day (± 10%).ConclusionThe flow rate delivered by the implantable pump in these two patients exceeded the upper tolerated limit within 2 year and continued to increase to reach +58 and +20% respectively. Proper clinical validation is needed to assess safety of use of implantable pump in PAH.


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Frédéric Lador (Geneva, Switzerland), Garance Kopp, Anne-Lise Hachulla, Stéphane Noble, Paola M. Soccal, Maurice Beghetti, Frédéric Lador. Spontaneous flow increase from implantable pump for intravenous treprostinil delivery. Eur Respir J 2016; 48: Suppl. 60, 2474

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