Management of Severe Scoliosis with Pulmonary Arterial Hypertension: A Single-Center Retrospective Case Series Study

Abstract

Aims To determine the impact of anesthesia encountered and to optimize the treatment of perioperative pulmonary arterial hypertension (PAH) in an effort to improve perioperative management and reduce complications. Methods We conducted a retrospective analysis of scoliosis patients with PAH who underwent scoliosis surgery. Results During this period, we identified a total of 22 patients. Their mean age was 22.18 ± 2.11 years. 16 PAH patients (72.72%) received PAH-specific treatment. Only Propofol-based TIVA was used intraoperatively. During the procedure, pulmonary artery catheters and PICCO catheters were placed in all patients to monitor intraoperative and postoperative mPAP, MAP, PRVI and SRVI. During tracheal intubation and intraoperative awake testing, mPAP generally tended to increase in all patients. 6 patients (27.27%) received intraoperative PAH-Specific therapy. All patients received oral sildenafil (75-100 mg/d orally), and 9 patients received postoperative oral sildenafil combined with nebulized iloprost (20 μg/d); intravenous treprostinil (2 ng/kg/min started and titrated to 10-17.5 ng/kg/min); or bosentan (250 mg/d) postoperatively. 7 patients (31.82%) reported postoperative complications, including 2 cases of respiratory failure requiring reintubation, 1 case of right heart failure, 2 cases of superficial surgical site infection, 1 case of fluid and electrolyte and acid-base imbalances, 2 cases of pneumonia and 1 case of pulmonary oedema with fluid overload. Two patients developed more than 1 postoperative complication. No in-hospital death occurred. Conclusions The anesthetic management of scoliosis patients with PAH is important task that, like its own surgery, relies on the input of the multidisciplinary team for its success. Close monitoring, optimization of systemic blood pressure, pain control, oxygenation and ventilation, avoidance of exacerbating factors, and the use of vasopressors and pulmonary vasodilators when necessary are essential elements of management.

Identification of an increased lifetime risk of major adverse cardiovascular events in UK Biobank participants with scoliosis

“…Likewise, direct compression of the myocardium could occur in conjunction with pulmonary involvement. These events can contribute to the development of cardiac consequences in patients with scoliosis 27. It would be beneficial to include cardiac follow-ups in patients with scoliosis to observe any cardiac alterations as scoliosis progresses, ensuring early intervention.…”

Effectiveness of Halo-Pelvic Traction and Thoracoplasty for Pulmonary Artery Pressure and Cardiopulmonary Function in Patients With Severe Spinal Deformity

“…15 Previous studies indicated that ~3.04% of the patients undergo spinal osteotomy complicated with PAH. 16 The mechanism of PAH induced by spinal deformity is as follows: in contrast, restrictive ventilation disorder will cause alveolar hypoventilation, which leads to hypoxemia and pulmonary vasoconstriction. In contrast, uneven pulmonary ventilation can lead to regional alveolar hypoxia and induce pulmonary artery contraction to maintain the ventilation/perfusion ratio.…”

“…Based on different causes, PAH can be divided into 5 broad categories, and PAH caused by pulmonary disease and/or hypoxia is the important one 15 . Previous studies indicated that ~3.04% of the patients undergo spinal osteotomy complicated with PAH 16 . The mechanism of PAH induced by spinal deformity is as follows: in contrast, restrictive ventilation disorder will cause alveolar hypoventilation, which leads to hypoxemia and pulmonary vasoconstriction.…”

Identification of an increased lifetime risk of major adverse cardiovascular events in UK Biobank participants with scoliosis

“…Likewise, direct compression of the myocardium could occur in conjunction to pulmonary involvement. These events can contribute to the development of cardiac consequences in scoliosis patients [27]. It would be beneficial to include cardiac follow-ups in patients with scoliosis to observe any cardiac alterations as scoliosis progresses, ensuring early intervention.…”