Can Severe Pulmonary Arterial Hypertension Patients Undergo Surgery?

Patients with severe pulmonary arterial hypertension (PAH) are generally advised to avoid surgery whenever possible. Due to compromised heart function and the overall high-risk nature of their condition, surgical procedures can pose significant dangers. Especially under general anesthesia, these patients face a heightened risk of acute deterioration in pulmonary artery pressure during or after the procedure, which can lead to life-threatening complications.

When Surgery Is Necessary

While surgery is not absolutely contraindicated for patients with severe PAH, it must be approached with extreme caution. In cases where a procedure is unavoidable—such as certain thoracic or pulmonary surgeries—it is crucial to collaborate closely with a specialized pulmonary hypertension management team. Their expertise can help assess the risks and benefits, and guide the planning of a comprehensive strategy to ensure patient safety.

Preoperative Considerations

Before proceeding with surgery, efforts may be made to stabilize or slightly improve the patient's condition. This could involve optimizing medical therapy to reduce pulmonary artery pressure and improve cardiac function. Only when the patient's cardiovascular status is as stable as possible should surgery be considered.

Multidisciplinary Approach for Emergency Situations

In emergency scenarios where surgery is unavoidable despite poor heart function, a multidisciplinary team—including anesthesiologists, pulmonary hypertension specialists, critical care physicians, and surgeons—must work together. A detailed plan should be developed to anticipate and manage potential complications, minimizing risks and ensuring the best possible outcomes.

Ultimately, the decision to proceed with surgery in patients with severe PAH must be individualized, weighing the urgency of the procedure against the potential for serious complications. With careful planning, expert collaboration, and close monitoring, some high-risk patients may safely undergo necessary surgical interventions.