Rapid Switch From Subcutaneous to Intravenous Treprostinil in Precapillary Pulmonary Hypertension by Pump Implantation

Abstract

Limited data are available on the transition from subcutaneous to intravenous prostacyclin in precapillary pulmonary hypertension. We performed a retrospective analysis of all patients who were switched from subcutaneous to intravenous treprostinil with an implantable infusion pump. We included 85 consecutive, clinically stable patients (mean age 66 years and range 16–85), who had been treated with subcutaneous treprostinil for mean 9 months (range 1–78) before pump implantation. An interdisciplinary expert panel defined standards for this procedure before the first implantation. As the first patient experienced a significant hypotensive episode indicating treprostinil overdose postoperatively, the time span to stop subcutaneous treprostinil was reduced to 60 minutes for all following patients. No events associated with the switch from subcutaneous to intravenous treprostinil were observed during postoperative hospital stay in 84 (98.8%) patients. Taking into account a likely depot effect of subcutaneous treprostinil patients can safely be switched to the intravenous route by the implantation of an infusion pump.

Intravenous Treprostinil in Severe Inoperable Chronic Thromboembolic Pulmonary Hypertension Using Implantable Pumps—Single-Center Experience over More Than a Decade

“…Preoperative management of the patients followed our standards developed for patients diagnosed with PAH [ 15 , 16 ]: Treprostinil was initiated subcutaneously and uptitrated under close supervision of specialized nursing staff in an outpatient setting. Both uptitration and dose adjustments during long-term treatment were based on signs and symptoms of PH as reported both by the patient and responsible nursing staff as well as results obtained at control visits.…”

“…The pump was placed in the pump pocket, the catheter was tunneled towards the central venous access, and the two catheters were connected. Based on the experience in the first PAH patient implanted [ 16 ], we did not calculate the catheter volume as recommended as a basis for calculating the time the pump would need to fill the catheter with medication but stopped SC administration 60 min after the connection of the intravenous catheters in all patients to avoid an overlap and overdose effects. Postoperatively, blood pressure, oxygen saturation, and heart rate were continuously monitored for 24 h. All pump refills were done by dedicated, specifically trained staff at our outpatient clinic.…”