Implantable central venous access ports for minimally invasive repetitive drainage of pleural effusions.

BACKGROUND: Pleurodesis can often eliminate recurrence of malignant pleural effusions and perhaps even pleural effusions from congestive heart failure. However, for patients with recurrent pleural effusions resistant to pleurodesis or patients unable or unwilling to undergo pleurodesis, thoracentesis is currently the only means for removing a pleural effusion. PRESENTATION OF THE HYPOTHESIS: Central venous access ports used for cancer chemotherapy could be implanted with the lumens placed in the pleural space, allowing on demand drainage of pleural effusions by percutaneous access to the port. TESTING THE HYPOTHESIS: Initial trials with a swine model of pleural effusions could demonstrate proof-of-principle and determine the caliber of catheter lumen optimal for pleural effusion drainage. Subsequently, there could be clinical trials in humans. SIGNIFICANCE OF THE HYPOTHESIS: This could be a useful part of palliative care of patients with cancer and end-stage heart failure and might increase heart failure survival by improving hemodynamics and respiratory function. This technique would create a non-diuretic modality for treatment of congestive heart failure volume overload. Patients could potentially drain pleural effusions at home by accessing ports placed in the anterior chest or abdomen. The proposed technique might also have application for treatment of recurrent ascites.