Multidisciplinary perioperative management of pulmonary arterial hypertension in patients undergoing noncardiac surgery

José L. Díaz-Gómez, Juan G. Ripoll, Isabel Mira-Avendano, John E. Moss, Gavin D. Divertie, Ryan D. Frank, Charles Dwayne Burger

Research output: Contribution to journalArticle

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Abstract

Objectives To describe the effect of implementing a contemporary perioperative pulmonary hypertension (PH)-targeted protocol in patients with pulmonary arterial hypertension (PAH) undergoing noncardiac surgery (NCS). Methods The data of consecutive patients with PAH diagnosed by right heart catheterization who underwent NCS between January 1, 2006 and February 9, 2016 were reviewed. Patient demographics, etiology of PAH, clinical features, diagnostic data, utilization of PH-specific medications, and trend of perioperative complications rate were recorded during the study period. Results In the base cohort of 375 patients, 37 had NCS. The mean age at surgery was 62 years. Most patients were women (78%) classified in group 1 PAH. At the time of the surgery, 86% were New York Heart Association functional class III/IV and 97% had American Society of Anesthesiologists classifications 3 and 4. A larger proportion of patients displayed lower PAH risk scores between 2006 and 2011 (P = 0.045). Conversely, a higher percentage of patients exhibited moderately high to very high PAH risk scores between 2012 and 2016 (P = 0.003). Perioperative and anesthetic-related morbidity was 27%, and no difference was observed between either period (P = 0.944). Most of the complications (70%) were related to general anesthesia. Two deaths (5%) occurred in our study group, both during the 2006-2011 period. Conclusions The combination of a multidisciplinary perioperative approach, utilization of novel pulmonary vascular disease-targeted therapy, adequate perioperative optimization, and thoughtful selection of anesthetic technique seems to be a potential strategy to at least maintain similar perioperative outcomes among higher- and lower-risk patients with PAH undergoing NCS.

Original languageEnglish (US)
Pages (from-to)64-73
Number of pages10
JournalSouthern Medical Journal
Volume111
Issue number1
DOIs
StatePublished - Jan 1 2018

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Pulmonary Hypertension
Anesthetics
Cardiac Catheterization
Vascular Diseases
General Anesthesia
Lung Diseases
Demography
Morbidity

Keywords

  • noncardiac surgery
  • pulmonary arterial hypertension
  • pulmonary arterial hypertension-specific therapies

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Multidisciplinary perioperative management of pulmonary arterial hypertension in patients undergoing noncardiac surgery. / Díaz-Gómez, José L.; Ripoll, Juan G.; Mira-Avendano, Isabel; Moss, John E.; Divertie, Gavin D.; Frank, Ryan D.; Burger, Charles Dwayne.

In: Southern Medical Journal, Vol. 111, No. 1, 01.01.2018, p. 64-73.

Research output: Contribution to journalArticle

Díaz-Gómez, José L. ; Ripoll, Juan G. ; Mira-Avendano, Isabel ; Moss, John E. ; Divertie, Gavin D. ; Frank, Ryan D. ; Burger, Charles Dwayne. / Multidisciplinary perioperative management of pulmonary arterial hypertension in patients undergoing noncardiac surgery. In: Southern Medical Journal. 2018 ; Vol. 111, No. 1. pp. 64-73.
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