skip to main content

Manajemen Perioperatif pada Pasien Hipertensi Pulmonal Akibat Kelainan Jantung Kiri yang Menjalani Operasi Bedah Jantung

Departemen Anestesiologi dan Terapi Intensif, Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada, Yogyakarta, Indonesia

Received: 12 Oct 2022; Published: 31 Mar 2023.

Citation Format:
Abstract

Hipertensi pulmonal akibat kelainan jantung kiri (PH-LHD) pada pasien yang menjalani bedah jantung dihubungkan dengan tingginya komplikasi, peningkatan risiko luaran buruk, dan kenaikan mortalitas perioperatif. Manajemen praoperatif pada pasien PH-LHD meliputi anamnesis, pemeriksaan fisik, pemeriksaan penunjang, serta kateterisasi jantung kanan untuk menegakkan diagnosis definitif. Optimalisasi praoperatif dilakukan dengan memastikan kondisi euvolemik, meneruskan pengobatan sebelumnya, sampai memberikan perawatan intensif pada kondisi gagal jantung dekompensasi akut. Selain pemantauan invasif standar, pemantauan transesophageal echocardiography intraoperatif digunakan untuk menganalisis PH dan mengenali kelainan jantung kiri yang menyebabkan PH. Induksi anestesi dilakukan dengan teknik anestesi balans antara opioid dan agen inhalasi dosis rendah. Pada PH-LHD yang disebabkan lesi katup, target hemodinamik disesuaikan dengan jenis kelainan katupnya. Target manajemen pascaoperatif adalah menghindari dan mengobati gagal ventrikel kanan dengan mengatasi aritmia, melakukan strategi ventilasi mekanik pelindung ventrikel kanan, memastikan keseimbangan cairan, dan memberikan dukungan obat vasoaktif jika diperlukan.

Note: This article has supplementary file(s).

Fulltext View|Download |  Research Instrument
Untitled
Subject
Type Research Instrument
  Download (B)    Indexing metadata
 common.other
CTA
Subject
Type Other
  Download (18KB)    Indexing metadata
Keywords: anestesi kardiak; bedah jantung; hipertensi pulmonal; manajemen perioperatif; penyakit jantung kiri

Article Metrics:

  1. Vachiéry JL, Tedford RJ, Rosenkranz S, et al. Pulmonary hypertension due to left heart disease. Eur Respir J. 2019;53(1):1801897. doi: 10.1183/13993003.01897-2018
  2. Gelzinis TA. Pulmonary Hypertension in 2021: Part I—Definition, Classification, Pathophysiology, and Presentation. J Cardiothorac Vasc Anesth. Published online July 2021:S1053077021005723. doi: 10.1053/j.jvca.2021.06.036
  3. Fang JC, DeMarco T, Givertz MM, et al. World Health Organization Pulmonary Hypertension Group 2: Pulmonary hypertension due to left heart disease in the adult—a summary statement from the Pulmonary Hypertension Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2012;31(9):913-933. doi: 10.1016/j.healun.2012.06.002
  4. Al-Omary MS, Sugito S, Boyle AJ, Sverdlov AL, Collins NJ. Pulmonary Hypertension Due to Left Heart Disease: Diagnosis, Pathophysiology, and Therapy. Hypertension. 2020;75(6):1397-1408. doi: 10.1161/HYPERTENSIONAHA.119.14330
  5. Aras MA, Psotka MA, De Marco T. Pulmonary Hypertension Due to Left Heart Disease: an Update. Curr Cardiol Rep. 2019;21(7):62. doi: 10.1007/s11886-019-1149-1
  6. Lam CSP, Roger VL, Rodeheffer RJ, Borlaug BA, Enders FT, Redfield MM. Pulmonary Hypertension in Heart Failure With Preserved Ejection Fraction. J Am Coll Cardiol. 2009;53(13):1119-1126. doi: 10.1016/j.jacc.2008.11.051
  7. Weitsman T, Weisz G, Farkash R, et al. Pulmonary Hypertension with Left Heart Disease: Prevalence, Temporal Shifts in Etiologies and Outcome. Am J Med. 2017;130(11):1272-1279. doi: 10.1016/j.amjmed.2017.05.003
  8. Fox DL, Stream AR, Bull T. Perioperative Management of the Patient With Pulmonary Hypertension. Semin Cardiothorac Vasc Anesth. 2014;18(4):310-318. doi: 10.1177/1089253214534780
  9. Minai OA, Yared JP, Kaw R, Subramaniam K, Hill NS. Perioperative Risk and Management in Patients With Pulmonary Hypertension. Chest. 2013;144(1):329-340. doi: 10.1378/chest.12-1752
  10. Genuardi MV, Shpilsky D, Handen A, et al. Increased Mortality in Patients With Preoperative and Persistent Postoperative Pulmonary Hypertension Undergoing Mitral Valve Surgery for Mitral Regurgitation: A Cohort Study. J Am Heart Assoc. 2021;10(5). doi: 10.1161/JAHA.120.018394
  11. Deljou A, Sabov M, Kane GC, et al. Outcomes After Noncardiac Surgery for Patients with Pulmonary Hypertension: A Historical Cohort Study. J Cardiothorac Vasc Anesth. 2020;34(6):1506-1513. doi: 10.1053/j.jvca.2019.10.059
  12. Sarkar MS, Desai PM. Pulmonary hypertension and cardiac anesthesia: Anesthesiologist’s perspective. Ann Card Anaesth. 2018;21(2):116-122. doi: 10.4103/aca.ACA_123_17
  13. Galiè N, McLaughlin VV, Rubin LJ, Simonneau G. An overview of the 6th World Symposium on Pulmonary Hypertension. Eur Respir J. 2019;53(1):1802148. doi: 10.1183/13993003.02148-2018
  14. Simonneau G, Montani D, Celermajer DS, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J. 2019;53(1):1801913. doi: 10.1183/13993003.01913-2018
  15. Lee F, Mielniczuk LM. Pulmonary Hypertension Due to Left Heart Disease—A Practical Approach to Diagnosis and Management. Can J Cardiol. 2021;37(4):572-584. doi: 10.1016/j.cjca.2020.11.003
  16. Naeije R, Gerges M, Vachiery JL, Caravita S, Gerges C, Lang IM. Hemodynamic Phenotyping of Pulmonary Hypertension in Left Heart Failure. Circ Heart Fail. 2017;10(9). doi: 10.1161/CIRCHEARTFAILURE.117.004082
  17. Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Respir J. 2015;46(4):903-975. doi: 10.1183/13993003.01032-2015
  18. Rosenkranz S, Lang IM, Blindt R, et al. Pulmonary hypertension associated with left heart disease: Updated Recommendations of the Cologne Consensus Conference 2018. Int J Cardiol. 2018;272:53-62. doi: 10.1016/j.ijcard.2018.08.080
  19. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the spec. Eur J Heart Fail. 2016;18(8):891-975. doi: 10.1002/ejhf.592
  20. Charalampopoulos A, Lewis R, Hickey P, et al. Pathophysiology and Diagnosis of Pulmonary Hypertension Due to Left Heart Disease. Front Med. 2018;5:174. doi: 10.3389/fmed.2018.00174
  21. Murray JF. Pulmonary edema: pathophysiology and diagnosis. Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis. 2011;15(2):155-160, i
  22. Sysol JR, Machado RF. Classification and pathophysiology of pulmonary hypertension. Contin Cardiol Educ. 2018;4(1):2-12. doi: 10.1002/cce2.71
  23. Assad TR, Hemnes AR, Larkin EK, et al. Clinical and Biological Insights Into Combined Post- and Pre-Capillary Pulmonary Hypertension. J Am Coll Cardiol. 2016;68(23):2525-2536. doi: 10.1016/j.jacc.2016.09.942
  24. Wood C, Balciunas M, Lordan J, Mellor A. Perioperative Management of Pulmonary Hypertension. A Review. J Crit Care Med. 2021;7(2):83-96. doi: 10.2478/jccm-2021-0007
  25. Thunberg CA, Gaitan BD, Grewal A, Ramakrishna H, Stansbury LG, Grigore AM. Pulmonary Hypertension in Patients Undergoing Cardiac Surgery: Pathophysiology, Perioperative Management, and Outcomes. J Cardiothorac Vasc Anesth. 2013;27(3):551-572. doi: 10.1053/j.jvca.2012.07.017
  26. Steppan J, Heerdt PM. Preoperative Assessment and Perioperative Management of the Patient with Pulmonary Vascular Disease. Clin Chest Med. 2021;42(1):133-141. doi: 10.1016/j.ccm.2020.11.013
  27. Pilkington SA, Taboada D, Martinez G. Pulmonary hypertension and its management in patients undergoing non-cardiac surgery. Anaesthesia. 2015;70(1):56-70. doi: 10.1111/anae.12831
  28. Groban L, Butterworth J. Perioperative Management of Chronic Heart Failure: Anesth Analg. 2006;103(3):557-575. doi: 10.1213/01.ane.0000226099.60493.d9
  29. Califf RM, Adams KF, McKenna WJ, et al. A randomized controlled trial of epoprostenol therapy for severe congestive heart failure: The Flolan International Randomized Survival Trial (FIRST). Am Heart J. 1997;134(1):44-54. doi: 10.1016/S0002-8703(97)70105-4
  30. Kalra PR, Moon JCC, Coats AJS. Do results of the ENABLE (Endothelin Antagonist Bosentan for Lowering Cardiac Events in Heart Failure) study spell the end for non-selective endothelin antagonism in heart failure? Int J Cardiol. 2002;85(2-3):195-197. doi: 10.1016/S0167-5273(02)00182-1
  31. Packer M, McMurray J, Massie BM, et al. Clinical effects of endothelin receptor antagonism with bosentan in patients with severe chronic heart failure: results of a pilot study. J Card Fail. 2005;11(1):12-20. doi: 10.1016/j.cardfail.2004.05.006
  32. Guazzi M, Samaja M, Arena R, Vicenzi M, Guazzi MD. Long-Term Use of Sildenafil in the Therapeutic Management of Heart Failure. J Am Coll Cardiol. 2007;50(22):2136-2144. doi: 10.1016/j.jacc.2007.07.078
  33. Lewis GD, Shah R, Shahzad K, et al. Sildenafil Improves Exercise Capacity and Quality of Life in Patients With Systolic Heart Failure and Secondary Pulmonary Hypertension. Circulation. 2007;116(14):1555-1562. doi: 10.1161/CIRCULATIONAHA.107.716373
  34. Kido K, Coons JC. Efficacy and Safety of the Use of Pulmonary Arterial Hypertension Pharmacotherapy in Patients with Pulmonary Hypertension Secondary to Left Heart Disease: A Systematic Review. Pharmacother J Hum Pharmacol Drug Ther. 2019;39(9):929-945. doi: 10.1002/phar.2314
  35. Levy JH, Bailey JM, Deeb GM. Intravenous milrinone in cardiac surgery. Ann Thorac Surg. 2002;73(1):325-330. doi: 10.1016/S0003-4975(01)02719-9
  36. Han B, Wang Q. Study on the clinical efficacy of specific phosphodiesterase inhibitor in patients with pulmonary hypertension due to left heart disease. Exp Ther Med. Published online June 13, 2018. doi: 10.3892/etm.2018.6310
  37. Price LC, Martinez G, Brame A, et al. Perioperative management of patients with pulmonary hypertension undergoing non-cardiothoracic, non-obstetric surgery: a systematic review and expert consensus statement. Br J Anaesth. 2021;126(4):774-790. doi: 10.1016/j.bja.2021.01.005
  38. Senoner T, Velik-Salchner C, Tauber H. The Pulmonary Artery Catheter in the Perioperative Setting: Should It Still Be Used? Diagnostics. 2022;12(1):177. doi: 10.3390/diagnostics12010177
  39. Brown JA, Aranda-Michel E, Kilic A, et al. The impact of pulmonary artery catheter use in cardiac surgery. J Thorac Cardiovasc Surg. Published online February 2021:S0022522321001859. doi: 10.1016/j.jtcvs.2021.01.086
  40. Jacobzon E, Hasin T, Lifschitz A, et al. Is There a Need for a Pulmonary Artery Catheter in Cardiac Surgery Today? Semin Cardiothorac Vasc Anesth. 2021;25(1):29-33. doi: 10.1177/1089253220951322
  41. Kumar MG, Puri GD. Transesophageal Echocardiographic Approach to a Patient with Suspected Pulmonary Hypertension in the Intraoperative Period. J Perioper Echocardiogr. 2017;5(2):49-63. doi: 10.5005/jp-journals-10034-1071
  42. Baumgartner H, Hung J, Bermejo J, et al. Echocardiographic Assessment of Valve Stenosis: EAE/ASE Recommendations for Clinical Practice. J Am Soc Echocardiogr. 2009;22(1):1-23. doi: 10.1016/j.echo.2008.11.029
  43. Hahn RT, Saric M, Faletra FF, et al. Recommended Standards for the Performance of Transesophageal Echocardiographic Screening for Structural Heart Intervention: From the American Society of Echocardiography. J Am Soc Echocardiogr. 2022;35(1):1-76. doi: 10.1016/j.echo.2021.07.006
  44. Nicoara A, Skubas N, Ad N, et al. Guidelines for the Use of Transesophageal Echocardiography to Assist with Surgical Decision-Making in the Operating Room: A Surgery-Based Approach. J Am Soc Echocardiogr. 2020;33(6):692-734. doi: 10.1016/j.echo.2020.03.002
  45. Gille J, Seyfarth HJ, Gerlach S, Malcharek M, Czeslick E, Sablotzki A. Perioperative Anesthesiological Management of Patients with Pulmonary Hypertension. Anesthesiol Res Pract. 2012;2012:1-16. doi: 10.1155/2012/356982
  46. Öztekin I, Yazici S, Öztekin DS, Goksel O, Issever H, Canik S. Effects of Low-dose Milrinone on Weaning from Cardiopulmonary Bypass and after in Patients with Mitral Stenosis and Pulmonary Hypertension. YAKUGAKU ZASSHI. 2007 Feb 1;127(2):375–83
  47. Cui WW, Ramsay JG. Pharmacologic approaches to weaning from cardiopulmonary bypass and extracorporeal membrane oxygenation. Best Practice & Research Clinical Anaesthesiology. 2015 Jun;29(2):257–70
  48. Paternot A, Repessé X, Vieillard-Baron A. Rationale and Description of Right Ventricle-Protective Ventilation in ARDS. Respir Care. 2016 Oct;61(10):1391–6
  49. Nowroozpoor A, Malekmohammad M, Seyyedi SR, Hashemian SM. Pulmonary Hypertension in Intensive Care Units: An Updated Review. Tanaffos. 2019 Mar;18(3):180–207

Last update:

No citation recorded.

Last update: 2024-05-27 08:21:32

No citation recorded.