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Perioperative Management of Patients With Pulmonary Hypertension for Non-Cardiac Surgery

  • Elaine I. YangEmail author
Surgery and Perioperative Care (CR MacKenzie and SM Goodman, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Surgery and Perioperative Care

Abstract

Pulmonary hypertension (PH) is associated with significant morbidity and mortality. While the advent of disease-modifying therapies in the treatment of PH has dramatically increased the life expectancy of these patients, they remain at high risk for perioperative complications. Outcome studies suggest that patients with PH undergoing non-cardiac surgery have higher morbidity and mortality than those without, independent of severity. Despite these risks, more and more of these patients are presenting for non-cardiac surgery. Patients with rheumatologic disorders in particular often have pulmonary arterial hypertension (PAH), a group that is associated with a poorer prognosis. Yet, these patients invariably develop debilitating joint diseases and not uncommonly present for elective surgery. Preoperatively, patients with PH should be appropriately risk stratified based on functional class, etiology, exercise capacity, pulmonary hemodynamics, and the risk of surgery. If the risks and benefits assessment proves favorable, they should undergo optimization prior to surgery, with any chronic therapy continuing without cessation through the perioperative period. A multidisciplinary approach involving all intraoperative physicians is imperative to forming a safe intraoperative plan based on the inherent physiology underlying the patient’s disease. Finally, because complications in this patient population often occur postoperatively, patients should be monitored in an appropriate setting with a goal of preventing right ventricular dysfunction. In this review article, we focus on the evaluation, risk stratification, and optimization of patients with PH undergoing non-cardiac surgery.

Keywords

Pulmonary hypertension Non-cardiac surgery Perioperative 

Notes

Compliance with Ethics Guidelines

Conflict of Interest

Elaine I. Yang declares no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with animals. Institutional review board approval was obtained for human subjects studies.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of AnesthesiologyHospital for Special SurgeryNew YorkUSA

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