Practice Update: Cardiology

CONFERENCE COVERAGE

10

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 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.

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.

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

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.

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

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

PRACTICEUPDATE CARDIOLOGY