IRUS Total

Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension

File Description SizeFormat 
Price - ERJ R1.pdfAccepted version391.29 kBAdobe PDFView/Open
Title: Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension
Authors: Price, LC
Montani, D
Jais, X
Dick, JR
Simonneau, G
Sitbon, O
Mercier, FJ
Humbert, M
Item Type: Journal Article
Abstract: The anaesthetic management and follow-up of well-characterised patients with pulmonary arterial hypertension presenting for noncardiothoracic nonobstetric surgery has rarely been described. The details of consecutive patients and perioperative complications during the period January 2000 to December 2007 were reviewed. Repeat procedures in duplicate patients were excluded. Longer term outcomes included New York Heart Association (NYHA) functional class, 6-min walking distance and invasive haemodynamics. A total of 28 patients were identified as having undergone major (57%) or minor surgery under general (50%) and regional anaesthesia. At the time of surgery, 75% of patients were in NYHA functional class I–II. Perioperative deaths occurred in 7%. Perioperative complications, all related to pulmonary hypertension, occurred in 29% of all patients and in 17% of those with no deaths during scheduled procedures. Most (n = 11, 92%) of the complications occurred in the first 48 h following surgery. In emergencies (n = 4), perioperative complication and death rates were higher (100 and 50%, respectively; p<0.005). Risk factors for complications were greater for emergency surgery (p<0.001), major surgery (p = 0.008) and a long operative time (193 versus 112 min; p = 0.003). No significant clinical or haemodynamic deterioration was seen in survivors at 3–6 or 12 months of post-operative follow-up. Despite optimal management in this mostly nonsevere pulmonary hypertension population, perioperative complications were common, although survivors remained stable. Emergency procedures, major surgery and long operations were associated with increased risk.
Issue Date: 31-May-2010
Date of Acceptance: 13-Oct-2009
URI: http://hdl.handle.net/10044/1/42947
DOI: http://dx.doi.org/10.1183/09031936.00113009
ISSN: 1399-3003
Publisher: European Respiratory Society
Start Page: 1294
End Page: 1302
Journal / Book Title: European Respiratory Journal
Volume: 35
Copyright Statement: © 2010 European Respiratory Society
Sponsor/Funder: British Thoracic Society
Funder's Grant Number: Scadding-Morriston Travel Award
Keywords: Respiratory System
11 Medical And Health Sciences
Publication Status: Published
Appears in Collections:National Heart and Lung Institute