Tables
- Table 1– Baseline characteristics (last measurements prior to surgery) of the entire patient population and of patients with or without major perioperative complications (POCs)
All patients POC No POC Subjects n 114 7 107 Age years 57 (48–67) 54 (46–67) 57 (48–67) Female 80 (70) 5 (71) 75 (70) Type of PAH Idiopathic PAH 57 (50) 2 (28.6) 51 (48) Familial PAH 2 (1.8) 1 (14) 1 (1) Associated PAH 55 (48) 4 (57) 55 (51) NYHA class# NYHA I/II 61 (54) 1 (14) 60 (56) NYHA III/IV 49 (43) 6 (86) 43 (41) 6MWD¶ 6MWD <399 m 46 (40) 6 (86) 40 (37) 6MWD ≥399 m 49(43) 1 (14) 48 (45) Haemodynamics mRAP+ mmHg 7 (3–10) 7 (4–10) 7 (3–10) mPAP§ mmHg 45 (38–55) 49 (38–58) 45 (38–55) mPCWPƒ mmHg 9 (6–12) 9 (7–12) 9 (6–12) Cardiac output## L·min−1 5.0 (4.2–5.9) 5.1 (4.3–6.0) 5 (4.2–5.9) Cardiac index¶¶ L·min−1·m-2 2.9 (2.5–3.5) 2.9 (2.4–3.3) 2.9 (2.5–3.5) PVR+ dyn·s·cm−5 579 (368–804) 616 (368–952) 579 (368–804) SvO2++ % 66 (63–70) 66 (62–69) 66 (63–70) Interval between last RHC and surgery months 9 (4–26) 6 (3–14) 9 (4–26) Type of surgery Abdominal 45 (39) 4 (57) 41 (38) Gynaecology/urology 22 (19) 1 (14) 21 (20) Trauma/orthopaedic 21 (18) 1 (14) 20 (19) Other 26 (22) 1 (14) 27 (25) Location of surgery PH centre 86 (75) 4 (57) 82 (77) Other 28 (25) 3 (43) 25 (23) Urgency Elective/intermediate 101 (89) 3 (43) 98 (92) Emergency 13 (11) 4 (57) 9 (8) Monotherapy PDE5I 17 (15) 1(14) 16 (15) ETRA 23 (20) 2 (28) 21 (20) Prostanoid (nebulised) 1 (1) 0 (0) 1 (1) Prostanoid (parenteral) 11 (10) 1 (14) 10 (10) Combination therapy ETRA + PDE5I 22 (19) 0 (0) 22 (21) ETRA + PDE5I + prostanoid (nebulised) 2 (2) 1 (14) 1 (1) ETRA + PDE5I + prostanoid (parenteral) 6 (5) 0 (0) 6 (6) Prostanoid (nebulised) + PDE5I 1 (1) 0 (0) 1 (1) Prostanoid (parenteral) + PDE5I 9 (8) 0 (0) 9 (8) ETRA + prostanoid (nebulised) 2 (2) 0 (0) 2 (2) ETRA + prostanoid (parenteral) 1 (1) 0 (0) 1 (1) Data are presented as median (interquartile range) or n (%), unless otherwise stated. PAH: pulmonary arterial hypertension; NYHA: New York Heart Association; 6MWD: 6-min walking distance; mRAP: mean right artery pressure; mPAP: mean pulmonary artery pressure; mPCWP: mean pulmonary capillary wedge pressure; PVR: pulmonary vascular resistance; SvO2: mixed venous oxygen saturation; RHC: right heart catheterisation; PH: pulmonary hypertension; PDE5I: phosphodiesterase-5-inhibitor; ETRA: endothelin receptor antagonist. #: missing, n=4; ¶: missing, n=9; +: n=111; § : n=114; ƒ: n=106; ##: n=113; ¶¶: n=100; ++: n=87.
- Table 2– Major perioperative complications and fatalities after noncardiac, nonobstetric surgery in patients with pulmonary arterial hypertension (PAH)
Patient Age Sex PAH type Type of surgery Anaesthesia Urgency Complications Outcome 1 49 F POPH Gynaecology (mastectomy for breast cancer) General Elective Right heart failure requiring catecholamines Recovered 2 61 F POPH Trauma surgery (total hip-arthoplasty) Spinal Intermediate Refractory right heart failure Died 3 73 M PVOD Vascular surgery (saphenectomy) Spinal Elective Right ventricular failure requiring catecholamines Recovered 4 73 M IPAH Abdominal (bowel obstruction) General Emergency Sepsis Died 5 38 F CTD-PAH Abdominal (open cholecystectomy) General Intermediate Right ventricular failure requiring catecholamines Recovered 6 40 F FPAH Abdominal (laparoscopic cholecystectomy) General Elective Bacterial peritonitis and sepsis Died 7 78 F IPAH Abdominal (exploratory laparotomy) General Emergency Post-operative respiratory failure, sepsis Died F: female; M: male; POPH: portopulmonary hypertension; PVOD: pulmonary veno-occlusive disease; IPAH: idiopathic PAH; CTD: connective tissue disease; FPAH: familial PAH.
- Table 3– Univariate analysis of risk factors for major complications after surgery in patients with pulmonary arterial hypertension
OR (95% CI) p-value Age years 0.9 (0.9–1.0) 0.52 6MWD m 2.2 (1.1–3.7) 0.04 NYHA functional class 1.04 (0.5–2.0) 0.72 mRAP mmHg 1.1 (1.0–1.3) 0.01 Cardiac index L·min−1·m−2 1.6 (0.92–4.9) 0.36 mPAP mmHg 0.97 (0.8–1.1) 0.21 PVR dyn·s·cm−5 0.91 (0.78–1.1) 0.22 SvO2 % 1.2 (0.9–1.3) 0.07 Surgery performed in PH centre 0.2 (0.05–1.0) 0.06 General versus spinal anaesthesia 1.9 (0.3–2.7) 0.50 Use of vasopressors 1.5 (1.2–2.7) 0.03 Emergency procedure 2.4 (1.4–3.6) 0.01 6MWD: 6-min walking distance; NYHA: New York Heart Association; mRAP: mean right artery pressure; mPAP: mean pulmonary artery pressure; PVR: pulmonary vascular resistance; SvO2: mixed venous oxygen saturation; PH: pulmonary hypertension.
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