Perioperative Risk and Management in Patients With Pulmonary Hypertension

Minai, Omar A.; Yared, Jean Pierre; Kaw, Roop; Subramaniam, Kathirvel; Hill, Nicholas S.

doi:10.1378/chest.12-1752

Cited by 121 publications

(92 citation statements)

References 68 publications

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“…Development of PH is associated with significant morbidity and mortality 121, 122, 123, 124, 125. Patients on dialysis with PH have significantly lower survival rates than their counterparts without PH, with respective survival rates of 78.6% versus 96.5% at 1 year, 42.9% versus 78.8% at 3 years, and 25.5% versus 66.4% at 5 years 126.…”

Section: Ph In Patients With Esrdmentioning

confidence: 99%

“…Evidence‐based guidelines for the perioperative management of patients with PH are lacking because the AHA/ACC practice guidelines for noncardiac surgery do not list PH as an independent risk factor for postoperative complications 125. Several small studies, however, have suggested that PH is a risk factor for increased peri‐ and postoperative morbidity and mortality.…”

Section: Ph In Patients With Esrdmentioning

confidence: 99%

“…According to the AHA/ACC recommendations specifically addressing cardiac disease evaluation among kidney transplantation candidates, right heart catheterization is reasonable to pursue to confirm echocardiographic evidence of elevated pulmonary arterial pressures 20. Right heart catheterization is also warranted to assess the severity of PH before transplantation to determine whether there is an association with a state of high cardiac output 20, 125. Consultation with a PH specialist should also be considered early because therapy with phosphodiesterase type 5 inhibitors or endothelin receptor antagonists may be needed to facilitate renal transplantation in patients with refractory PH not secondary to AVF‐dependent high cardiac output 121.…”

Section: Ph In Patients With Esrdmentioning

confidence: 99%

“…During surgery, systemic hypotension or abrupt increases in pulmonary artery pressures can cause right ventricular overload and lead to right ventricular systolic dysfunction and decreased cardiac output. Therefore, intraoperative invasive hemodynamic monitoring of pulmonary circulation should be considered 125. Nevertheless, renal transplantation has been shown to be curative for PH under certain circumstances.…”

Section: Ph In Patients With Esrdmentioning

confidence: 99%

See 3 more Smart Citations

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

Bhatti

Galougahi

Paz

et al. 2016

JAHA

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Section: Ph In Patients With Esrdmentioning

confidence: 99%

Section: Ph In Patients With Esrdmentioning

confidence: 99%

Section: Ph In Patients With Esrdmentioning

confidence: 99%

Section: Ph In Patients With Esrdmentioning

confidence: 99%

See 2 more Smart Citations

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

Bhatti

Galougahi

Paz

et al. 2016

JAHA

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“…Pulmonary hypertension may contribute to right ventricular failure. Multiple factors including hypoxia, ischaemia-reperfusion injury, positive pressure mechanical ventilation of the lungs, left ventricular failure and pharmacologic agents such as protamine, may worsen or cause pulmonary hypertension during the peri-operative period [5]. Consequently, the American Society of Echocardiography has published detailed guidelines for the echocardiographic assessment of the right heart [6], and the comprehensive transoesophageal echocardiographic examination now includes additional views focusing on the right heart [7,8].…”

Section: Introductionmentioning

confidence: 99%

Intra‐operative assessment of pulmonary artery pressure by transoesophageal echocardiography

Soliman

Bolliger²,

Skarvan

et al. 2014

Anaesthesia

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SummaryThe clinical value of the estimation of systolic pulmonary artery pressure, based on Doppler assessment of peak tricuspid regurgitant velocity using transoesophageal echocardiography, is unclear. We studied 109 patients to evaluate the feasibility of obtaining adequate Doppler recordings, and compared Doppler estimates with values measured using a pulmonary artery catheter in a subset of 33 patients. Tricuspid regurgitation was evaluated at the midoesophageal level at 0-120°using Doppler echocardiography. A Doppler signal was defined as adequate if there was a ≤ 20°alignment and a full envelope. Doppler estimates of systolic pulmonary artery pressure within 10 mmHg and 15% of the value recorded with the pulmonary artery catheter were considered to be in sufficient agreement. Adequate Doppler signals were obtained in 64/109 (59%) patients before and 54/103 (52%) after surgery. Doppler estimates by transoesophageal echocardiography were within 10 mmHg and 15% of values recorded with the pulmonary artery catheter in 28/33 (75%) patients and 22/31 (55%) patients, respectively. In 7 (21%) patients, the echocardiographic Doppler measurement exceeded the measured systolic pulmonary artery pressure by more than 30%. Our study indicates that estimation of the systolic pulmonary artery pressure using transoesophageal Doppler echocardiography is not a reliable and clinically useful method in anaesthetised patients undergoing mechanical ventilation.

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Effect of pulmonary hypertension on 5‐year outcome of kidney transplantation

et al. 2022

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Pulmonary hypertension affects about one in four patients with advanced chronic kidney disease and significantly increases the risk of death. Kidney transplantation is the recommended management option for patients with progressive or end‐stage kidney disease. However, the resource‐limited nature of kidney transplantation and its intensive peri‐operative and posttransplantation management motivates careful consideration of potential candidates’ medical conditions to optimally utilize available graft organs. Since pulmonary hypertension is known to increase peri‐operative morbidity and mortality among patients living with chronic kidney disease, we performed a retrospective cohort study to assess the impact of pretransplantation pulmonary hypertension on posttransplantation outcome. All patients who underwent single‐organ kidney transplantation at our center in calendar years 2010 and 2011 were identified and the presence of pulmonary hypertension was determined from pretransplantation echocardiography. Outcome was assessed at 5 years following kidney transplantation. Of 350 patients who were included, 117 (33%) had evidence of pulmonary hypertension. The risk of death, graft dysfunction, or graft failure at 5 years after kidney transplantation was higher among those with pulmonary hypertension, primarily owing to an increased risk of graft dysfunction. Importantly, in this institutional cohort of kidney transplant recipients, pretransplant pulmonary hypertension was not associated with a difference in posttransplant survival at 5 years. While institutional and regional differences in outcome can be expected, this report suggests that carefully selected patients with pulmonary hypertension receive similar long‐term benefits from kidney transplantation.

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Perioperative Risk and Management in Patients With Pulmonary Hypertension

Cited by 121 publications

References 68 publications

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

Intra‐operative assessment of pulmonary artery pressure by transoesophageal echocardiography

Effect of pulmonary hypertension on 5‐year outcome of kidney transplantation

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