[Outpatient diuretic treatment of terminal heart failure by a completely implantable venous infusion system]

In severe heart failure with peripheral and enterohepatic congestion resistance to diuretics with inactivation of oral furosemide is a common finding. Impaired bioavailability is most likely related to pharmacodynamic and especially to pharmacokinetic reasons. To ensure efficient drug delivery and effective treatment with diuretics, venous access devices (port-systems) were implanted in 10 patients (eight men and two women, age between 57 and 80 years). All patients were in heart failure functional class III-IV and had a history of recurrent episodes of severe decompensation; none was suitable for heart transplantation. Injections of furosemide and other drugs were performed 1-4 times a day; one female patient performed the intravenous injections herself, in three cases the partners and in six cases the practitioner or an outpatient nurse performed the injections. All patients were treated on an outpatient basis, i.e., at home or in nursing homes. The port-implantation was followed up between 30 and 742 days (1-24 months); no serious complications were observed. Both patients and their partners were considered to well tolerate and accept the port-systems. Totally implantable venous access devices promise to reduce the number and severeness of cardiac decompensations in chronic preterminal heart failure by application of daily intravenous furosemide. This form of outpatient treatment will ameliorate the quality of life and stabilize the course of these severely and chronically ill patients.