According to the guidelines of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), elective surgery is expected to have an increased risk in patients with pulmonary hypertension. Epidural anaesthesia is thought to be better tolerated than general anaesthesia. (Eur Heart J. 2009; 2493-2537.)
Dear Colleague,
The validity of the EHJ 2009 guidelines is confirmed by the proceedings of the new PH guidelines (published in JACC decembre 2013).
Elective surgery increases the risk of right heart failure in severe PAH patient. As a consequence, the expected benefit of elective surgery should be weighted with the haemodynamic risk. In any case, in my opinion, these patients should always be discussed in a multidiscipllinary PH expert group (involving ICU, anesthesiologists, cardiologists and pulmonologists) in order to anticipate possible postoperative deterioration and prepare the perioperative complicatons.
Kind regards.
FL
Hello Frederic,
thank you so much for your reply. Surgery was postponed and the patient was accessed in an multidisciplinary board as you just mentioned. After medical management over a 12 - week - period, laparoscopic cholecystectomy was performed. Surgery and recovery were uneventful.
It is worth noting that patients with such conditions are not frequently candidates for elective procedures. However, i agree with you that the JACC guidelines were very helpful in this cases.
Once again, thank you for your reply.
PA