Management und postoperatives Überleben bei chirurgischen Eingriffen an Patienten mit schwerer pulmonaler Hypertonie – retrospektive Analyse eines Zentrums

Seyfarth, HJ; Wirtz, Hubert; Gille, Jochen; Gerlach, Stefan; Grachtrup, Sabine; Winkler, Jörg; Sablotzki, Armin

doi:10.1055/s-0041-110294

Cited by 5 publications

(2 citation statements)

References 11 publications

(18 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, close attention was paid to avoid circulatory dysregulation and hypothermia as well as hypoxemia, hypercapnia or pain spikes/stress as all of these can affect pulmonary hemodynamics [ 19 , 20 ]. PAH therapy was continued in all patients during the perioperative period.…”

Section: Methodsmentioning

confidence: 99%

Periprocedural safety and outcome after pump implantation for intravenous treprostinil administration in patients with pulmonary arterial hypertension

et al. 2021

View full text Add to dashboard Cite

Methods In this retrospective observational study, we analyzed all patients with pulmonary arterial hypertension undergoing LenusPro® pump implantation between November 2013 and October 2019 at our center. Periprocedural safety was assessed by describing all complications that occurred within 28 days after surgery; complications that occurred later were described to assess long-term safety. Clinical outcomes were measured by comparison of clinical parameters and echocardiographic measurements of right ventricular function from baseline to 6-months-follow-up. Results Fifty-four patients underwent LenusPro® pump implantation for intravenous treprostinil treatment during the investigation period. Periprocedural complications occurred in 5 patients; the only anesthesia-related complication (right heart failure with recovery after prolonged intensive care and death in the further course) occurred in the only patient who underwent general anesthesia. All other patients underwent local anesthesia with or without short-acting (analgo-) sedation. Eighteen long-term complications occurred in 15 patients, most notably pump pocket or catheter related problems. Transplant-free survival rates at 1, 2, and 3 years were 77 %, 56 %, and 48 %, respectively. Conclusions Subcutaneous pump implantation under local anesthesia and conscious analgosedation while avoiding intubation and mechanical ventilation is feasible in patients with advanced PAH. Controlled studies are needed to determine the safest anesthetic approach for this procedure. Background/Objectives Intravenous treprostinil treatment via a fully implantable pump is a treatment option for patients with advanced pulmonary arterial hypertension. However, there is no consensus on the preferred anesthetic approach for the implantation procedure. Primary objective was to assess periprocedural safety with particular attention to feasibility of local anesthesia and conscious analgosedation instead of general anesthesia. Long-term safety and clinical outcomes were secondary endpoints.

show abstract

Section: Methodsmentioning

confidence: 99%

Periprocedural safety and outcome after pump implantation for intravenous treprostinil administration in patients with pulmonary arterial hypertension

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The perioperative mortality rate of patients with pulmonary hypertension is approximately 1-18%, and the complication rate ranges from 6.1% to 42%. [298][299][300][301][302][303][304][305][306][307][308][309][310] The risks are 3-4-fold higher than for those without pulmonary hypertension. 298,304-306 Sustained hypoxemia (0.5-28%), 302,308 congestive heart failure (1.5-11%), 302,310 right-sided heart failure (3.5-10.7%), 300,310 arrhythmia (0.5-12%), 301,302 hemodynamic instability/hypotension (1.1-10.7%), 298, 300 and sepsis (0.9-10.4%) 306, 308 have been reported as perioperative complications.…”

Section: ▋ 71 Complications and Risk Factors ▋ 711 Perioperative Comp...mentioning

confidence: 99%

JCS 2022 Guideline on Perioperative Cardiovascular Assessment and Management for Non-Cardiac Surgery

Hiraoka,

Tanabe,

Izuta

et al. 2023

Circ J

View full text Add to dashboard Cite

show abstract

Perioperative approach to precapillary pulmonary hypertension in non-cardiac non-obstetric surgery

et al. 2021

View full text Add to dashboard Cite

Pulmonary hypertension (PH) confers a significant challenge in perioperative care. It is associated with substantial morbidity and mortality. A considerable amount of information about management of patients with PH has emerged over the past decade. However, there is still a paucity of information to guide perioperative evaluation and management of these patients. Yet, a satisfactory outcome is feasible by focusing on elaborate disease-adapted anaesthetic management of this complex disease with a multidisciplinary approach. The cornerstone of the peri-anaesthetic management of patients with PH is preservation of right ventricular (RV) function with attention on maintaining RV preload, contractility and limiting increase in RV afterload at each stage of the patient's perioperative care. Pre-anaesthetic evaluation, choice of anaesthetic agents, proper fluid management, appropriate ventilation, correction of hypoxia, hypercarbia, acid–base balance and pain control are paramount in this regard. Essentially, the perioperative management of PH patients is intricate and multifaceted. Unfortunately, a comprehensive evidence-based guideline is lacking to navigate us through this complex process. We conducted a literature review on patients with PH with a focus on the perioperative evaluation and suggest management algorithms for these patients during non-cardiac, non-obstetric surgery.

show abstract

Management und postoperatives Überleben bei chirurgischen Eingriffen an Patienten mit schwerer pulmonaler Hypertonie – retrospektive Analyse eines Zentrums

Abstract: A careful and structured planning of surgical interventions in patients with PH and the choice of surgical procedure and anesthesia adapted to the conditions of PH might help avoid complications. Further multicentric studies are needed.

Cited by 5 publications

References 11 publications

Periprocedural safety and outcome after pump implantation for intravenous treprostinil administration in patients with pulmonary arterial hypertension

Periprocedural safety and outcome after pump implantation for intravenous treprostinil administration in patients with pulmonary arterial hypertension

JCS 2022 Guideline on Perioperative Cardiovascular Assessment and Management for Non-Cardiac Surgery

Perioperative approach to precapillary pulmonary hypertension in non-cardiac non-obstetric surgery

Contact Info

Product

Resources

About