Richard K Freeman1, Anthony J Ascioti2, Megan Dake2, Raja S Mahidhara2. 1. Department of Thoracic and Cardiovascular Surgery, St. Vincent Hospital, Indianapolis, Indiana. Electronic address: richard.freeman@stvincent.org. 2. Department of Thoracic and Cardiovascular Surgery, St. Vincent Hospital, Indianapolis, Indiana.
Abstract
BACKGROUND: Patients with severe heart failure often have recurrent pleural effusions that produce dyspnea and shortness of breath. It is unclear whether chemical pleurodesis or the placement of a tunneled pleural catheter that can be used for intermittent pleural drainage produces superior palliation, a shorter hospital stay, and less morbidity. This investigation compares these two treatments. METHODS: Patients with a recurrent, symptomatic, pleural effusion secondary to advanced heart failure who had undergone at least two unilateral thoracenteses were identified. Two patient groups were formed by propensity matching patients who received either talc pleurodesis or a tunneled pleural catheter. Patient demographics, length of stay, need for further intervention for the pleural effusion, and procedural morbidity and mortality were collected and compared. Patients who had undergone ventricular assist device placement or cardiac transplant were excluded. RESULTS: Over a 5-year period, 80 patients undergoing treatment were identified and propensity matched. All 80 patients were classified as having class III or IV heart failure. No significant differences in palliation from their effusion were identified. However, the group treated with a tunneled pleural catheter realized a significantly shorter hospital stay as well as a lower rate of operative morbidity and readmissions than patients undergoing talc pleurodesis. CONCLUSIONS: This investigation found that a tunneled pleural catheter provided palliation of patients' pleural effusions and freedom from reintervention equal to that of talc pleurodesis using thoracoscopy while resulting in a shorter mean length of hospital stay. Lower rates of operative morbidity and readmission related to the pleural effusion were also seen in the tunneled catheter treatment group. This method of palliation of recurrent pleural effusion should be considered for symptomatic patients with advanced heart failure.
BACKGROUND:Patients with severe heart failure often have recurrent pleural effusions that produce dyspnea and shortness of breath. It is unclear whether chemical pleurodesis or the placement of a tunneled pleural catheter that can be used for intermittent pleural drainage produces superior palliation, a shorter hospital stay, and less morbidity. This investigation compares these two treatments. METHODS:Patients with a recurrent, symptomatic, pleural effusion secondary to advanced heart failure who had undergone at least two unilateral thoracenteses were identified. Two patient groups were formed by propensity matching patients who received either talc pleurodesis or a tunneled pleural catheter. Patient demographics, length of stay, need for further intervention for the pleural effusion, and procedural morbidity and mortality were collected and compared. Patients who had undergone ventricular assist device placement or cardiac transplant were excluded. RESULTS: Over a 5-year period, 80 patients undergoing treatment were identified and propensity matched. All 80 patients were classified as having class III or IV heart failure. No significant differences in palliation from their effusion were identified. However, the group treated with a tunneled pleural catheter realized a significantly shorter hospital stay as well as a lower rate of operative morbidity and readmissions than patients undergoing talc pleurodesis. CONCLUSIONS: This investigation found that a tunneled pleural catheter provided palliation of patients' pleural effusions and freedom from reintervention equal to that of talc pleurodesis using thoracoscopy while resulting in a shorter mean length of hospital stay. Lower rates of operative morbidity and readmission related to the pleural effusion were also seen in the tunneled catheter treatment group. This method of palliation of recurrent pleural effusion should be considered for symptomatic patients with advanced heart failure.
Authors: Nikolaj Frost; Christoph Ruwwe-Glösenkamp; Matthias Raspe; Martin Brünger; Bettina Temmesfeld-Wollbrück; Norbert Suttorp; Martin Witzenrath Journal: BMJ Open Respir Res Date: 2020-01