Eur Respir J. 2012 Nov 8. [Epub ahead of print]
Meyer S, McLaughlin VV, Seyfarth HJ, Bull TM, Vizza CD, Gomberg-Maitland M, Preston IR, Barberà JA, Hassoun PM, Halank M, Jaïs X, Nickel N, Hoeper MM, Humbert M.
Hannover, Germany.
Abstract
We conducted an international, prospective, 3-year questionnaire-based survey among 11 pulmonary hypertension centres to assemble data from patients with PAH undergoing non-cardiac and non-obstetric surgery.Data were collected between July 2007 and June 2010 from 114 patients with PAH (70% female, mean age 57 years) who underwent major surgery. At the time of surgery, 43% were in functional class III/IV. Eighty-two percent of the interventions were performed under general anaesthesia, 18% under spinal anaesthesia. Major complications occurred in 7 (6.1%) of the patients, of whom 4 died, resulting in an overall perioperative mortality rate of 3.5%. The mortality rate was 15% (2/13) in emergency procedures compared to 2% (2/101) in non-emergency procedures (p=0.01). Risk factors for major complications were an elevated right atrial pressure (OR 1.1; 95% CI 1.0-1.3; p=0.01), a 6-minute walk distance < 399 meters (OR 2.2; 95% CI 1.1-3.7; p=0.04) at the respective last preoperative assessment, the perioperative use of vasopressors (OR 1.5; 95% CI 1.2-2.7; p=0.03) and the need for emergency surgery (OR 2.4; 95% CI 1.4-3.6; p=0.01).Major surgery in patients with PAH continues to be a high-risk procedure, in particular when patients need to undergo emergency interventions.
PMID:23143546