Efficacy of a Fully Implantable Pleural Device in the Management of Complex Pleural Effusions

TL;DR

A fully implantable pleural catheter was found to be a safe and effective treatment for patients with complex pleural effusions who cannot undergo traditional procedures.

Contribution

The study introduces a fully implantable pleural catheter as a novel solution for managing complex pleural effusions in fragile patients.

Findings

The fully implantable catheter had a 12% complication rate, mostly mild.

Over half of patients were managed successfully with home nursing services.

Nearly 50% of patients survived six months post-implantation.

Abstract

Recurrent pleural effusion is usually treated with VATS talc poudrage. However, this option is not applicable to some fragile patients with complex health conditions. In these cases, long-term symptom relief and fewer hospital visits should be the main goal. A widely used alternative is the indwelling pleural catheter, a partially implanted device that allows for frequent drainage of fluid through a tube that leaves the body of the patient externally. The external portion, however, can cause problems. We evaluated clinical outcome of a fully implantable pleural catheter in 150 patients with recurrent pleural effusion that were not suitable for VATS talc poudrage. This device proved to be safe and effective in the management of these fragile patients and did not interfere with oncological treatment when needed.

VATS talc poudrage is the standard treatment for recurrent pleural effusion, but it is not feasible when the lung does not re-expand, or for fragile patients who are unfit for general anesthesia. In these situations, indwelling pleural catheters (IPC) are a valuable option to offer long-term symptom relief and reduce hospitalization, with the only limitation being that an external portion of the device is needed in the majority of available devices. This study evaluates the efficacy and safety of a fully implantable pleural catheter in managing recurrent pleural effusion in patients who are unfit for traditional treatments. A retrospective, single-center analysis was conducted from April 2018 to August 2024, involving 150 patients that underwent Celsite® DRAINAPORT implantation. The study measured the percentage of procedures with complications, the type of follow up, six months survival rate, cause of death, and the number of oncological treatments administered after implantation. Results indicated a complication rate of 12%, of which most were mild and manageable. Over half of the patients were successfully managed by home nursing services. Nearly 50% of the patients survived after six months, whereas 28.7% received subsequent oncological treatments. This suggests that this type of device is a safe and effective alternative for managing recurrent pleural effusion in patients with limited treatment options.

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