title: Tunneled Pleural Catheter Placement with and without Talc Poudrage for Treatment of Pleural Effusions Due to Congestive Heart Failure.
abstract: BACKGROUND
  There is a paucity of evidence regarding the role of tunneled pleural catheters in pleural effusions caused by congestive heart failure that is refractory to medical management.
  
  
  OBJECTIVE
  The aim of this study was to assess the feasibility of tunneled pleural catheter drainage for treatment of refractory pleural effusions associated with congestive heart failure, either when used alone or with concomitant talc pleurodesis performed during thoracoscopy.
  
  
  METHODS
  This was a retrospective cohort study. We identified patients with congestive heart failure and recurrent symptomatic pleural effusions who were treated between 2005 and 2015 by placement of a tunneled pleural catheter. Patients underwent either thoracoscopy followed by talc poudrage and pleural catheter placement (group 1) or catheter insertion alone (group 2).
  
  
  RESULTS
  Forthy-three catheters were inserted in 36 patients, with 15 placed in group 1 and 28 in group 2. Successful pleurodesis was seen in 80% in group 1 and 25% in group 2. The median time of catheter placement was 11.5 days in group 1 and 66 days in group 2. There was a significant decrease in hospital admissions and pleural interventions after catheter placement compared with before insertion (P < 0.05).
  
  
  CONCLUSIONS
  This single-center, retrospective study demonstrated the feasibility of catheter placement used alone or with talc poudrage for the treatment of refractory pleural effusions associated with congestive heart failure. The addition of talc poudrage might increase the pleurodesis rate and reduce the days to catheter removal in highly selected patients. Prospective studies on a larger number of patients are warranted to verify the safety and efficacy of this intervention.
authors.affiliation: 1 Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Adnan
authors.identifier: http://orcid.org/0000-0002-6203-5343
authors.initials: A
authors.lastname: Majid
authors.affiliation: 2 Division of Pulmonary Diseases, Critical Care, and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana.
authors.forename: Fayez
authors.initials: F
authors.lastname: Kheir
authors.affiliation: 1 Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Meghan
authors.initials: M
authors.lastname: Fashjian
authors.affiliation: 3 Department of Respiratory Medicine, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Trust, Cambridge, United Kingdom; and.
authors.forename: Sumit
authors.initials: S
authors.lastname: Chatterji
authors.affiliation: 4 Section of Interventional Pulmonology, Clinica Alemana, Universidad Del Desarrollo, Santiago, Chile.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Fernandez-Bussy
authors.affiliation: 1 Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Ochoa
authors.affiliation: 1 Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: George
authors.initials: G
authors.lastname: Cheng
authors.affiliation: 1 Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Erik
authors.initials: E
authors.lastname: Folch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004322:Drainage / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000209:etiology / Q000628:therapy*; D018700:Pleurodesis / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D013627:Talc / Q000008:administration & dosage*; D000069258:Thoracentesis / Q000379:methods; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D013627:Talc
keywords: New York Heart Association; congestive heart failure