PURPOSE: Preoperative clinical risk assessment for predicting post operative pulmonary complications (PPC) among patients with pulmonary arterial hypertension (PAH) undergoing cardiac surgery largely involves the identification of pre operative risk factors. No single study supports that similar risk factors may predict occurrence of postoperative pulmonary complications in patient with pulmonary arterial hypertension which may contribute to morbidity, mortality, and length of hospital stay.
METHODS: A total of 32 patients (Male:34%; Female:66%) with mild to severe pulmonary arterial hypertension who underwent elective cardiac surgery at our Center were followed up to investigate the rate of occurrence of post-operative pulmonary complications (atelectasis, pneumonia and respiratory failure). Ancillaries (i.e. arterial blood gas, chest radiograph, pulmonary function test, six-minute walk test and 2D echocardiography or hemodynamic studies) were performed to identify its association with the development of PPCs.
RESULTS: Only 19% of the patients in this cohort developed postoperative pulmonary complication which is mainly postoperative pneumonia. Among the preoperative clinical factors considered, significant association between postoperative pneumonia and both the severity of pulmonary arterial hypertension and WHO functional class were noted with a p value of 0.004 and 0.018, respectively. Age (p=0.541), BMI (p=0.637), smoking history (p=0.796) and presence of comorbidities were not significantly associated with the development of postoperative pneumonia. Similarly, ventilatory defect either restrictive or obstructive and 6MWD (p=0.165) test did not correlated significantly to postoperative outcome of these patients.
CONCLUSION: In conclusion, Preoperative pulmonary complications occurred in 19% of patients. This study confirms that, among the preoperative clinical and laboratory variables evaluated, the severity of pulmonary arterial hypertension and WHO functional class predicts occurrence of postoperative pneumonia.
CLINICAL IMPLICATIONS: Patients with pulmonary arterial hypertension are at increased risk in developing postoperative pulmonary complications. Their risk is directly related to the severity of PAH.
DISCLOSURE: Christopher Cortes, No Financial Disclosure Information; No Product/Research Disclosure Information