Subcutaneous implantation of a new intravenous pump system for prostacyclin treatment in patients with pulmonary arterial hypertension

Desole, Susanna; Velik‐Salchner, Corinna; Fraedrich, Gustav; Ewert, Ralf; Kähler, Christian M.

doi:10.1016/j.hrtlng.2012.07.001

Cited by 14 publications

(8 citation statements)

References 21 publications

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“…Apart from a small pneumothorax which recovered without intervention, no intraoperative complications were observed. Our results are consistent with previous studies and case reports in which patients with PAH underwent successful pump implantation [16][17][18][19][20], and a study in which carefully selected patients with severe PAH underwent successful central venous catheter (CVC) implantation under general anesthesia [21]. In the recent DeliVery for PAH trial (n = 60) intraoperative and perioperative AEs associated with CVC implantation occurred at low rates similar to those observed in our study: the authors reported one case of pneumothorax and three catheter dislocations (all within 1 month of implantation) [16].…”

Section: Discussionsupporting

confidence: 93%

“…The titanium drug reservoir is refilled percutaneously via a silicone septum every 10-30 days under aseptic conditions on an outpatient basis. Initial pilot studies and case reports have demonstrated the feasibility of infusing treprostinil via the LENUS Pro Ò pump [17][18][19]. However, the numbers of patients with PAH included in studies of drug infusion via fully implantable pumps remain small and further data are needed.…”

Section: Introductionmentioning

confidence: 99%

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Intravenous treprostinil infusion via a fully implantable pump for pulmonary arterial hypertension

Ewert

Richter

Steringer‐Mascherbauer

et al. 2017

Clin Res Cardiol

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Intravenous treprostinil infusion via a fully implantable pump for pulmonary arterial hypertension

Ewert

Richter

Steringer‐Mascherbauer

et al. 2017

Clin Res Cardiol

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“…administration via an indwelling line [46]. Implantation of the device requires a surgical procedure that connects a catheter, placed in the superior vena cava, to a pump that is positioned in the subcutaneous tissue of the abdominal wall [80]. Benefits of these systems include a reduced risk of line infections and battery-associated malfunctions as well as improved patient comfort [80].…”

Section: Unmet Needs and Future Strategiesmentioning

confidence: 99%

Recent advances in targeting the prostacyclin pathway in pulmonary arterial hypertension

Lang

Gaine

2015

Eur Respir Rev

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Pulmonary arterial hypertension (PAH) is a severe disease characterised by increased pulmonary vascular resistance, which leads to restricted pulmonary arterial blood flow and elevated pulmonary arterial pressure. In patients with PAH, pulmonary concentrations of prostacyclin, a prostanoid that targets several receptors including the IP prostacyclin receptor, are reduced. To redress this balance, epoprostenol, a synthetic prostacyclin, or analogues of prostacyclin have been given therapeutically. These therapies improve exercise capacity, functional class and haemodynamic parameters. In addition, epoprostenol improves survival among patients with PAH. Despite their therapeutic benefits, treatments that target the prostacyclin pathway are underused. One key factor is their requirement for parenteral administration: continuous intravenous administration can lead to embolism and thrombosis; subcutaneous administration is associated with infusion-site pain; and inhalation is time consuming, requiring multiple daily administrations. Nevertheless, targeting the prostacyclin pathway is an important strategy for the management of PAH. The development of oral therapies for this pathway, as well as more user-friendly delivery devices, may alleviate some of the inconveniences. Continued improvements in therapeutic options will enable more patients with PAH to receive medication targeting the prostacyclin pathway.

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“…A novel, completely implantable delivery system for intravenous treprostinil has been under investigation, with prospects of improving patient convenience and safety. 48 , 49 …”

Section: Subcutaneous and Intravenous Treprostinilmentioning

confidence: 99%

Prostanoid therapies in the management of pulmonary arterial hypertension

LeVarge

2015

TCRM

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Prostacyclin is an endogenous eicosanoid produced by endothelial cells; through actions on vascular smooth-muscle cells, it promotes vasodilation. Pulmonary arterial hypertension (PAH) is characterized by elevated mean pulmonary artery pressure due to a high pulmonary vascular resistance state. A relative decrease in prostacyclin presence has been associated with PAH; this pathway has thus become a therapeutic target. Epoprostenol, the synthetic equivalent of prostacyclin, was first utilized as short-term or bridging therapy in the 1980s. Further refinement of its long-term use via continuous intravenous infusion followed. A randomized controlled trial by Barst et al in 1996 demonstrated functional, hemodynamic, and mortality benefits of epoprostenol use. This work was a groundbreaking achievement in the management of PAH and initiated a wave of research that markedly altered the dismal prognosis previously associated with PAH. Analogs of prostacyclin, including iloprost and treprostinil, exhibit increased stability and allow for an extended array of parenteral and non-parenteral (inhaled and oral) therapeutic options. This review further examines the pharmacology and clinical use of epoprostenol and its analogs in PAH.

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Subcutaneous implantation of a new intravenous pump system for prostacyclin treatment in patients with pulmonary arterial hypertension

Cited by 14 publications

References 21 publications

Intravenous treprostinil infusion via a fully implantable pump for pulmonary arterial hypertension

Intravenous treprostinil infusion via a fully implantable pump for pulmonary arterial hypertension

Recent advances in targeting the prostacyclin pathway in pulmonary arterial hypertension

Prostanoid therapies in the management of pulmonary arterial hypertension

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