Right-Heart Catheterization and Unilateral Pulmonary Artery Occlusion Test for Perioperative Risk Assessment Before Pneumonectomy.

The assessment of patients undergoing lung resection surgery has evolved enormously in recent years thanks to advances in perioperative diagnostics and developments in anesthetic and surgical techniques. These patients are often high-risk due to comorbidities, age, and the perioperative risk associated with the surgery itself. The decision to proceed with surgery for an individual patient usually involves a risk assessment using commonly accepted guidelines for operability, which include standardized evaluations.1 The “three-legged stool” approach is a widely accepted assessment method evaluating 3 basic components of respiratory function such as respiratory mechanics, pulmonary parenchymal function and the cardio-respiratory interaction.2,3 However, some other perioperative factors besides the traditional assessment tools could help to more accurately assess and predict perioperative risk in this surgical population.4 The unilateral pulmonary artery occlusion (UPAO) test was likely first suggested by Carlens, et al, in 19515 and reported upon a number of times since then; it may be a useful addition to the preoperative evaluation. The UPAO test simulates the resulting reduction in pulmonary vascular bed after lung resection surgery and estimates the increases in pulmonary vascular resistance and PA pressure.6 Although its availability has increased in recent years, there is no consistent anesthesiology and perioperative care literature that supports this technique as a routine practice,7,8 hence its application is not standardized.