Introduction:
The World Health Organization (WHO) categorizes pulmonary hypertension (PHTN) into 5 groups. Group II classification denotes PHTN secondary to left-heart disease and accounts for nearly 75% of all cases. However, there is limited data regarding the effect of PHTN Group II status on outcomes in the perioperative setting.
Hypothesis:
PHTN WHO Group II is an independent risk factor for adverse cardiopulmonary events in the perioperative setting.
Methods:
Retrospective review of patients who underwent intra-abdominal surgery between January 2014 - August 2019 and had previously obtained an echocardiogram. PHTN Group II was defined as estimated pulmonary artery pressure (EPAP) > 30mmHg on echocardiogram . Other forms of PHTN were excluded. Major adverse cardiovascular events (MACE) were defined as heart failure exacerbation, arrhythmia, myocardial infarction, 30 day readmission, and death. Surgical risk was categorized as low (laparoscopic) or intermediate (open).
Results:
By echocardiogram findings, 65 of the 178 (36.3%) patients included were Group II PHTN. Between surgical risk classes, Group II PHTN was older (mean age 73.7 years v 60.5; P< 0.01), had more comorbidities including systolic (9.70% v 21.5%, P=0.03) and diastolic (22.1% v 34.5%, P < 0.01) heart failure, and were more likely to have a MACE ( 6.2% v 43.1%, P < 0.01). PHTN Group II patients with intermediate-risk surgeries demonstrated significantly more MACE than control (11.2% v 43.7%, P <0.01) without significant difference in comorbidities.
Conclusions:
Group II PHTN is an independent risk factor for MACE in patients undergoing intermediate risk surgery compared to non-PHTN counterparts. Additional studies involving severity of pulmonary hypertension may provide further insight into risk stratification.
A Retrospective Review of Patients with Severe World Health Organization Group 3 Pulmonary Hypertension Evaluated for Lung Transplant: A Single Center Experience
