Pulmonary hypertension, characterized by high blood pressure in the arteries of the lungs and the right side of the heart, increases the risk of complications and death in patients undergoing surgery. A team of international experts with the participation of Dr. Antonio Roman, Director of Healthcare of the Vall d'Hebron University Hospital, has drawn up a consensus document for the management of this type of patient with the aim of reducing the risks associated with the operation and improving their clinical evolution. The work, published in The Journal of Heart and Lung Transplantation, was commissioned to a group of experts in pulmonary hypertension by the International Society of Heart and Lung Transplantation in response to the need for a guide for all professionals who care for these patients.
The new guideline is published after more than four years of intense work and responds to the problems that arise with patients suffering from pulmonary hypertension who require surgical treatment for different reasons. "Accurate risk assessment and diagnosis is necessary to be able to offer or not offer surgical treatment to these patients", explains Dr. Roman.
The international consensus document includes recommendations for the follow-up of patients with pulmonary hypertension before, during and after different types of surgery. In relation to preoperative evaluation, the paper emphasizes the assessment of the risk posed by surgery for each patient. It depends, among others, on the cause of the pulmonary hypertension, the patient's condition at the time of surgery, the fact of suffering from other diseases and the type and urgency of the surgery. A multidisciplinary team consisting of pulmonary hypertension specialists, anesthesiologists, surgeons, intensivists, pharmacists and nurses will be in charge of preparing a plan for the operation. The experts also stress the importance of stabilizing patients as much as possible and improving the function of the right ventricle of the heart before undergoing the operation.
During the intervention, the publication details the recommendations regarding anesthesia, in which the use of local anesthesia is recommended, if possible, as it is safer than general anesthesia. Regarding mechanical ventilation, the experts emphasize its necessity to avoid oxygen deprivation in the patients, but they explain the strategies that would be advisable to avoid undesired effects.
After the operation, it is essential to closely monitor patients, especially during the first 48-72 hours, when there is a greater risk of complications, such as infections, sepsis, arrhythmias, etc. Above all, it is important to control pain without opioid drugs and to ensure adequate oxygenation.
The document also sets out strategies for the management of possible complications or cardiac failure, as well as characteristic aspects to be taken into account in each type of intervention, whether cardiac or non-cardiac.