The effects of Treprostinil in high-risk patients after total cavo-pulmonary connection procedure

Abstract Background: We hypothesized that administration of Treprostinil after high-risk total cavo-pulmonary connection (TCPC) procedure may be benefit for hemodynamics and post-operative recovery. Methods: From 2015 to 2022, among patients who underwent TCPC procedure and received Treprostinil therapy in our single center, high-risk patients (mean pulmonary arterial pressure= 15mmHg) were retrospectively analyzed. Patients were separated into satisfactory recovery group and delayed recovery group based on whether the post-operative length of stay was more than 30 days. The peri-operative date of the two groups were investigated to find possible indicators to improve the post-operative recovery as the primary outcome. The hemodynamics data after 24 hours maintaining dose of Treprostinil were investigated as the second outcome. Results: Among 371 TCPC patients, 24 patients were included in our study. There were 9 patients in satisfactory recovery group and 15 patients in delayed recovery group. The statistical difference existed in the maintaining dose of Treprostinil (p=0.005), pleural effusion volume (p=0.001) and renal replacement therapy (p=0.022). Through multivariable analysis, only Treprostinil was of statistical difference (p=0.027). The ROC curve shown that maintaining dose>19.5 ng/kg/min was the cut off point, with the area under curve 0.852, sensitivity 0.89, specificity 0.8. During the observation of hemodynamic data, the mean pulmonary artery pressure decreased from 14±4 to 12±3 mmHg (p<0.001) with no severe complications. Conclusion: In patients after TCPC procedure, the Treprostinil therapy can decrease mean pulmonary artery pressure without severe complication. A maintaining dose of Treprostinil >19.5 ng/kg/min is benefit to shorten the post-operative length of hospital stay.