Background: Recently, the survival outcome of precapillary pulmonary hypertension (pc-PH) has been remarkably improved, with the progress of treatment options. Hence, the number of non-cardiovascular, non-obstetric surgeries for patients with pc-PH will be expected to increase. The perioperative clinical outcome from Western countries has been reported, but data from Asia have not been described.
Method and Results: From January 2008 to December 2020, a total of 33 pc-PH cases (82% female, mean age 53 years) underwent the initial non-cardiovascular, non-obstetric surgeries with general anesthesia at National Hospital Organization Okayama Medical Center. We retrospectively assessed variables associated with perioperative complications using binary logistic analysis. Perioperative complications were defined as heart failure, respiratory failure, renal failure, hepatic failure and sepsis. At the time of surgery, 17 cases (52%) were in World Health Organization functional class III/IV, and 16 cases (49%) were treated with parenteral prostacyclin. Preoperative mean pulmonary arterial pressure >40 mmHg was in nine cases (27%). Emergency surgery was performed in six cases (18%). Preoperative use of catecholamines was undertaken in seven cases (21%). Perioperative complications occurred in seven cases (21%), of whom one (3%) died. The predictive factor for perioperative complications was preoperative mean pulmonary arterial pressure using multivariate regression analysis (P < 0.05), of which the cut-off value was 31 mmHg from the receiver operating characteristic curve (area under the curve: 0.920; sensitivity: 1.000; specificity: 0.731).
Conclusions: Mean pulmonary arterial pressure was significantly associated with perioperative complications. Careful perioperative management would be recommended for pc-PH with high mean pulmonary arterial pressure.
Yoichi Sugiyama, Hiroto Shimokawahara, Ayane Miyagi, Takeshi Suetomi, Aiko Ogaya, Hiromi Matsubara, National Hospital Organization Okayama Medical Center, Japan