Evaluation and Management of Pulmonary Hypertension in Noncardiac Surgery: A Scientific Statement From the American Heart Association. Issue 17 (16th March 2023)

• Record Type: Journal Article
• Authors: Rajagopal, Sudarshan; Ruetzler, Kurt; Ghadimi, Kamrouz; Horn, Evelyn M.; Kelava, Marta; Kudelko, Kristina T.; Moreno-Duarte, Ingrid; Preston, Ioana; Rose Bovino, Leonie L.; Smilowitz, Nathaniel R.; Vaidya, Anjali
• Is Part Of: Circulation. Volume 147:Issue 17(2023)
• Page Start: 1317
• Page End: 1343
• Publication Date: 2023-03-16
• Subjects: AHA Scientific Statements -- hypertension -- pulmonary -- prevalence -- pulmonary surgical procedures -- ventricular dysfunction; Blood -- Circulation -- Periodicals; Cardiovascular system -- Periodicals; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Blood Circulation; Cardiovascular System; Vascular Diseases; 616.1
• DOI: 10.1161/CIR.0000000000001136
• Languages: English
• ISSNs: 0009-7322

Abstract

Abstract : Pulmonary hypertension, defined as an elevation in blood pressure in the pulmonary arteries, is associated with an increased risk of death. The prevalence of pulmonary hypertension is increasing, with an aging population, a rising prevalence of heart and lung disease, and improved pulmonary hypertension survival with targeted therapies. Patients with pulmonary hypertension frequently require noncardiac surgery, although pulmonary hypertension is associated with excess perioperative morbidity and death. This scientific statement provides guidance on the evaluation and management of pulmonary hypertension in patients undergoing noncardiac surgery. We advocate for a multistep process focused on (1) classification of pulmonary hypertension group to define the underlying pathology; (2) preoperative risk assessment that will guide surgical decision-making; (3) pulmonary hypertension optimization before surgery to reduce perioperative risk; (4) intraoperative management of pulmonary hypertension to avoid right ventricular dysfunction and to maintain cardiac output; and (5) postoperative management of pulmonary hypertension to ensure recovery from surgery. Last, this scientific statement highlights the paucity of evidence to support perioperative pulmonary hypertension management and identifies areas of uncertainty and opportunities for future investigation.