Non-cardiothoracic non-obstetric surgery in mild-moderate pulmonary hypertension: Perioperative management of 28 consecutive individual cases

¹ Université Paris-Sud 11, UPRES EA 2705, Centre National de Référence de l'Hypertension Artérielle Pulmonaire, Service de Pneumologie et Réanimation respiratoire, Hôpital Antoine-Béclère, Assistance Publique - Hôpitaux de Paris, Clamart, France
² Université Paris-Sud 11, Département d'Anesthésie-Réanimation, Hôpital Antoine-Béclère, Assistance Publique - Hôpitaux de Paris, Clamart, France

^* To whom correspondence should be addressed. E-mail: marc.humbert{at}abc.aphp.fr.

	Abstract

Anesthetic management and follow-up of well-characterized patients with pulmonary arterial hypertension (PAH) presenting for non-cardiothoracic non-obstetric surgery has rarely been described.

We reviewed details of consecutive patients and perioperative complications from January 2000 to December 2007. Repeat procedures in duplicate patients were excluded. Longer-term outcomes included New York Heart Association (NYHA) functional class; 6-minute walk distance (6MWD) and invasive hemodynamics.

Twenty-eight patients were identified having major (57%) or minor surgery under general (GA) (50%) and regional anaesthesia (RA). At the time of surgery, 75% patients were in NYHA functional class I-II. Perioperative deaths occurred in 7%. Perioperative complications, all related to pulmonary hypertension (PH), occurred in 29% of all patients and in 17% with no deaths in scheduled procedures. In emergencies (n=4), perioperative complication and death rates were higher (100% and 50% respectively, p<0.005). Risk factors for complications were higher emergency surgery (p<0.001), major surgery (p=0.008), and long operative time (193 vs. 112 minutes, p=0.003). No significant clinical or hemodynamic deterioration was seen in survivors at 3–6 or 12 month post-operative follow-up.

Despite optimal management in this mostly non-severe PH population, perioperative complications were common, although survivors remained stable at 6 months. Emergency procedures, major surgery and long operations were associated with increased risk.