Explore pulmonary hypertension challenges through innovative case study format

Pulmonary hypertension is associated with an increased risk of perioperative and postoperative morbidity and mortality for both cardiac and noncardiac surgery, and the precise hemodynamic and clinical parameters needed to optimize a patient for the procedure are often unclear.

Preoperative Pulmonary Hypertension: An Interactive Experience, on Wednesday, from 8:30 am to 9:30 am, in Room 313A at the convention center, will aim to provide some clarity using an innovative case study format. Experts will introduce three challenging but frequently encountered clinical preoperative scenarios, and the audience will be asked to select from a list of preoperative clearance strategies and make an “offer” to each presenter.

Arun Jose, MD, MS
Arun Jose, MD, MS

“This session is going to be valuable because the audience will leave able to identify risk parameters to keep in mind when optimizing a patient with pulmonary hypertension for surgery, but we’ll also discuss the gaps in knowledge where we need more information in terms of operative management or operative clearance of these patients,” said Session Chair, Arun Jose, MD, MS, Assistant Professor of Clinical Internal Medicine at the University of Cincinnati.

Session case studies will include:

  • Cholecystectomy in the Patient With Pulmonary Arterial Hypertension — Belinda Rivera-Lebron, MD, FCCP, University of Pittsburgh
  • Kidney Transplant in the Patient With Pulmonary Arterial Hypertension — Denise Sese, MD, Medical University of South Carolina
  • Knee Replacement in the Patient With Chronic Thromboembolic Pulmonary Hypertension — Dana Kay, DO, University of Cincinnati

Dr. Jose said the session will review the risk factors related to adverse outcomes in noncardiac surgery in patients with pulmonary hypertension, such as anesthetic plans, hemodynamic disease severity, risk scores, and procedure-specific factors like the location and intensity of the surgery.

“These are problems that I confront daily, which is challenging because the surgery and anesthesiology colleagues who I work with want an answer on whether a patient can undergo a procedure, and half the time, I’m not 100% certain because there are so many gray areas and nuances when it comes to risk-stratifying patients with pulmonary hypertension undergoing nonemergency surgeries,” he said.

Presenters will also review treatment goals for pulmonary hypertension, analyze current evidence regarding the impact of pulmonary hypertension on kidney transplantation outcomes, and examine a multidisciplinary approach to enhancing postoperative outcomes.

“We’re not necessarily trying to identify an objectively ‘correct’ answer for these scenarios,” Dr. Jose said. “We want to spark discussions among the presenters and audience that delve into the nuances and various factors that should be taken into consideration when clearing a patient with pulmonary hypertension for surgery, as well as the areas where we still need more information and research.”