title: The impact of targeted therapies for pulmonary hypertension on pediatric intraoperative morbidity or mortality.
abstract: BACKGROUND
  Pulmonary hypertension (PHT) is a significant risk factor for major adverse events during anesthesia, with a reported incidence of 5% to 7%, secondary to acute pulmonary hypertensive crises or right ventricular ischemia. Newer therapies for treating PHT have reduced mortality. In this single-center study, we investigated the frequency of major and minor events during anesthesia under the current strategies to manage PHT.
  
  
  METHODS
  We reviewed the records of children with PHT who underwent noncardiopulmonary bypass procedures from 2008 to 2012. Clinically important symptoms, physical signs, and results of investigations present before anesthesia were recorded. The incidence and type of intraoperative complications and death (up to 7 days) were collected.
  
  
  RESULTS
  Data were collected for 122 patients undergoing 284 procedures. Minor (3.9%) and major (3.2%) complication rates were unchanged from previous publications. The etiology of PHT was not significant for complications (P = 0.14). Disease-modifying agents were not associated with reduced complications: 4.1% in treated versus 8.6% untreated (all P > 0.14). Patients receiving home oxygen had more complications (P = 0.02). Multiple logistic regression identified age and degree of PHT as significant predictors of complications (all P ≤ 0.03).
  
  
  CONCLUSIONS
  The risk for adverse events during anesthesia in patients with PHT remains high, despite newer disease-modifying treatments. Risk factors for complications include age and severity of PHT.
authors.affiliation: From the Department of Anesthesia, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Katherine
authors.initials: K
authors.lastname: Taylor
authors.forename: Dagmar
authors.initials: D
authors.lastname: Moulton
authors.forename: Xiu Yan
authors.initials: XY
authors.lastname: Zhao
authors.forename: Peter
authors.initials: P
authors.lastname: Laussen
mesh_terms: D000293:Adolescent; D000758:Anesthesia / Q000401:mortality; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D007223:Infant; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D007432:Intraoperative Period; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors