CLINICAL RESEARCH: PULMONARY HYPERTENSION
Impact of Pulmonary Hypertension on the Outcomes of Noncardiac Surgery
Predictors of Perioperative Morbidity and Mortality
Gautam Ramakrishna, MD*,
Juraj Sprung, MD, PhD ,
Barugur S. Ravi, MD*,
Krishnaswamy Chandrasekaran, MD, FACC*,* and
Michael D. McGoon, MD, FACC*
* Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota.
Manuscript received November 17, 2004;
revised manuscript received February 2, 2005,
accepted February 8, 2005.
* Reprint requests and correspondence: Dr. Krishnaswamy Chandrasekaran, 200 First Street SW, Rochester, Minnesota 55905. (Email: kchandra{at}mayo.edu).
OBJECTIVES: We sought to determine the predictors of short-term morbidity and mortality (<30 days) after noncardiac surgery in patients with pulmonary hypertension (PH).
BACKGROUND: Pulmonary hypertension is considered to be a significant preoperative risk factor.
METHODS: The PH and surgical data bases were matched from 1991 to 2003. Patients were excluded if PH was secondary to left heart disease, not present before surgery, or the procedure involved cardiopulmonary bypass. Univariate and multivariate logistic regression analyses were used to identify variables associated with short-term morbidity and mortality.
RESULTS: Of 1,276 patients in the PH database, 145 patients (73% female) met all study criteria. The mean age (±SD) was 60.1 ± 16.0 years. Right ventricular systolic pressure (RVSP) (mean ± SD) on the two-dimensional echocardiogram was 68 ± 21 mm Hg. There were 60 patients (42%) who experienced one or more short-term morbid event(s) (1.8 events/patient experiencing any event). A history of pulmonary embolism (p = 0.01), New York Heart Association functional class  II (p = 0.02), intermediate- to high-risk surgery (p = 0.04), and duration of anesthesia >3 h (p = 0.04) were independent predictors of short-term morbidity. There were 10 early deaths (7%). A history of pulmonary embolism (p = 0.04), right-axis deviation (p = 0.02), right ventricular (RV) hypertrophy (p = 0.04), RV index of myocardial performance 0.75 (p = 0.03), RVSP/systolic blood pressure 0.66 (p = 0.01), intraoperative use of vasopressors (p < 0.01), and anesthesia when nitrous oxide was not used (p < 0.01) were each associated with postoperative mortality.
CONCLUSIONS: In patients with PH undergoing noncardiac surgery with general anesthesia, specific clinical, diagnostic, and intraoperative factors may predict worse outcomes.
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Abbreviations and Acronyms
| | 2D echo = two-dimensional Doppler echocardiogram | | IQR = interquartile range | | LOS = length of hospital stay | | MPAP = mean pulmonary artery pressure | | 6MWT = six-minute walk test | | NYHA = New York Heart Association | | PH = pulmonary hypertension | | RV = right ventricular | | RVIMP = right ventricular index of myocardial performance | | RVSP = right ventricular systolic pressure | | SBP = systolic blood pressure |
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