Outcomes of noncardiac, nonobstetric surgery in patients with PAH: an international prospective survey

Abstract

We conducted an international, prospective, 3-year questionnaire-based survey among 11 pulmonary hypertension centres to assemble data from patients with pulmonary arterial hypertension (PAH) undergoing noncardiac and nonobstetric surgery.Data were collected between July 2007 and June 2010 from 114 patients with PAH (70% female, mean age 57 years) who underwent major surgery. At the time of surgery, 43% were in functional class III/IV. 82% of the interventions were performed under general anaesthesia and 18% under spinal anaesthesia. Major complications occurred in seven (6.1%) of the patients, of whom four died, resulting in an overall perioperative mortality rate of 3.5%. The mortality rate was 15% (two out of 13) in emergency procedures, compared with 2% (two out of 101) in nonemergency procedures (p50.01). Risk factors for major complications were an elevated right atrial pressure (OR 1.1, 95% CI 1.0-1.3; p50.01), a 6-min walking distance ,399 m at the last preoperative assessment (OR 2.2, 95% CI 1.1-3.7; p50.04), the perioperative use of vasopressors (OR 1.5, 95% CI 1.2-2.7; p50.03) and the need for emergency surgery (OR 2.4, 95% CI 1.4-3.6; p50.01).Major surgery in patients with PAH continues to be a high-risk procedure, particularly when emergency interventions are needed.

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

“…It is unclear as to which form of anaesthesia is preferable, but epidural is probably better tolerated than general anaesthesia [165][166][167]. Patients usually maintained on oral therapy may require temporary conversion to i.v.…”

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

“…Nie ma jasności, jaki rodzaj znieczulenia należy preferować, niemniej znieczulenie nadtwardówkowe jest przypuszczalnie lepiej tolerowane niż ogólne [165][166][167]. Chorzy leczeni doustnie mogą wymagać czasowego przejścia na leczenie i.v.…”

2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

“…Selected examples of low-risk procedures include cataract and plastic surgery. 34,35 Procedures with a risk of MACE of ≥1% are considered elevated risk. Many previous risk-stratification schema have included intermediate-and high-risk classifications.…”