[Clinical experience with the use of implantable vascular systems in advanced heart failure]. / Esperienza clinica di utilizzo dei sistemi per accesso vascolare impiantabili nelle cardiopatie in stadio avanzato.

ABSTRACT

BACKGROUND: Patients with end-stage cardiomyopathy frequently require acute or chronic infusional treatments and long hospitalization. Availability of a simple and safe vascular access is a true necessity for these patients, especially in case of inotropic or diuretic outpatient treatment. In this study we have evaluated the usefulness and the applicability of implantable vascular access in the management of end-stage cardiomyopathy. Technical problems and both short and long term complications have been analysed. METHODS: Nineteen implantable vascular system (16 Port-A-Cath, Pharmacia; 3 Celsite, Bruneau) have been implanted in a group of 15 patients with end-stage cardiomyopathy. All patients had been previously hospitalized and needed prolonged infusional therapy. Implantation was performed in local anaesthesia with technique derived from pace-maker implantation. RESULTS: All the interventions were well tolerated, average procedural time was 30 min (range 20-60 min). No procedural complications occurred. Re-implantation of the system was required in 2 patients due to catheter thrombosis, In 1 patient due to catheter rupture caused by wrong positioning of infusion needle, and in 1 patient due to inflammatory reaction. In 2 further cases catheter thrombosis was treated with local infusion of urokinase. In 1 patient the catheter was repositioned after dislocation. The average in situ permanence of the systems was 8 months (range 15 day-18 months). CONCLUSIONS: Vascular implantable systems have proved useful and easily applf1p4e in the management of patients with end stage cardiomyopathy. After training some of the implied complications are easily avoidable. The use of this device has concurred to reduce duration and frequency of hospitalizations.