CirculationAHA SCIENTIFIC STATEMENTEvaluation and Management of PulmonaryHypertension in Noncardiac Surgery:A ScientificStatement From the American Heart AssociationSudarshan Rajagopal,MD,PhD,FAHA,Vice Chair';Kurt Ruetzler,MD,PhD,FAHA,Chair';Kamrouz Ghadimi,MD,MHS FAHA;Evelyn M.Horn,MD;Marta Kelava,MD;Kristina T.Kudelko,MD;Ingrid Moreno-Duarte,MD;loana Preston,MD;Leonie L.Rose Bovino,PhD,APRN,AGACNP-BC,FAHA;Nathaniel R.Smilowitz,MD,MS;Anjali Vaidya,MD;on behalf of theAmerican Heart Association Council on Cardiopulmonary,Critical Care,Perioperative and Resuscitation,and the Council onCardiovascular and Stroke NursingABSTRACT:Pulmonary hypertension,defined as an elevation in blood pressure in the pulmonary arteries,is associated withan increased risk of death.The prevalence of pulmonary hypertension is increasing,with an aging population,a risingprevalence of heart and lung disease,and improved pulmonary hypertension survival with targeted therapies.Patientswith pulmonary hypertension frequently require noncardiac surgery,although pulmonary hypertension isassociated withexcess perioperative morbidity and death.This scientific statement provides guidance on the evaluation and managementof pulmonary hypertension in patients undergoing noncardiac surgery.We advocate for a multistep process focused on(1)classification of pulmonary hypertension group to define the underlying pathology;(2)preoperative risk assessment thatwill guide surgical decision-making:(3)pulmonary hypertension optimization before surgery to reduce perioperative risk;(4)intraoperative management of pulmonary hypertension to avoid right ventricular dysfunction and to maintain cardiac写output;and(5)postoperative management of pulmonary hypertension to ensure recovery from surgery.Last,this scientificstatement highlights the paucity of evidence to support perioperative pulmonary hypertension management and identifiesareas of uncertainty and opportunities for future investigation.Key Words:AHA Scientific Statements hypertension pulmonary prevalence pulmonary surgical procedures ventricular dysfunctionhttp:/ulmonary hypertension (PH)is a heterogeneousfor the evaluation and management of PH in patientsgroup of disorders that result in an elevation inundergoing noncardiac surgery.blood pressure in the pulmonary arteries (meanpulmonary artery [PA]pressure [mPAP]>20 mm Hg).1Increased mPAP is consistently associated with anOVERVIEW OF PHincreasedrisk of death.?The prevalence of PH isPH can result in right-sided heart failure (RHF)withincreasing,with an aging population,a rising prevalenceunique pathophysiology.This is most notable in pulmonaryof heart and lung disease,and improved PH survival witharterial hypertension(PAH),an obliterative pulmonary vas-targeted therapies.3 Patients with PH frequently requireculopathy characterized by endothelial and smooth musclenoncardiac surgery.In a large nationwide study from thecell proliferation.This leads to destruction of and abnormalUnited States,PH wa
