Impact of Pulmonary Hypertension on the Outcomes of Noncardiac Surgery Predictors of Perioperative Morbidity and Mortality

ObjectivesWe sought to determine the predictors of short-term morbidity and mortality (<30 days) after noncardiac surgery in patients with pulmonary hypertension (PH).BackgroundPulmonary hypertension is considered to be a significant preoperative risk factor.MethodsThe 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.ResultsOf 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.ConclusionsIn patients with PH undergoing noncardiac surgery with general anesthesia, specific clinical, diagnostic, and intraoperative factors may predict worse outcomes

Impact of age on pulmonary artery systolic pressures at rest and with exercise

Aim: It is not well known if advancing age influences normal rest or exercise pulmonary artery pressures. The purpose of the study was to evaluate the association of increasing age with measurements of pulmonary artery systolic pressure at rest and with exercise. Subjects and methods: A total of 467 adults without cardiopulmonary disease and normal exercise capacity (age range: 18–85 years) underwent symptom-limited treadmill exercise testing with Doppler measurement of rest and exercise pulmonary artery systolic pressure. Results: There was a progressive increase in rest and exercise pulmonary artery pressures with increasing age. Pulmonary artery systolic pressures at rest and with exercise were 25 ± 5 mmHg and 33 ± 9 mmHg, respectively, in those <40 years, and 30 ± 5 mmHg and 41 ± 12 mmHg, respectively, in those ≥70 years. While elevated left-sided cardiac filling pressures were excluded by protocol design, markers of arterial stiffness associated with the age-dependent effects on pulmonary pressures. Conclusion: These data demonstrate that in echocardiographically normal adults, pulmonary artery systolic pressure increases with advancing age. This increase is seen at rest and with exercise. These increases in pulmonary pressure occur in association with decreasing transpulmonary flow and increases in systemic pulse pressure, suggesting that age-associated blood vessel stiffening may contribute to these differences in pulmonary artery systolic pressure