Pulmonary hypertension (PH) remains a significant clinical challenge with considerable morbidity and mortality. While advancements in medical therapies have improved symptom control and patient quality of life, the disease often progresses, necessitating additional or alternative interventions. Surgical strategies, traditionally reserved for advanced cases, are now evolving as viable options across broader patient populations. This review explores current trends and emerging surgical techniques for managing PH, with an emphasis on their mechanisms, indications, and outcomes relative to medical therapies.

Key surgical interventions include pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), and, for cases of end-stage right ventricular failure, lung transplantation. PEA, primarily indicated for chronic thromboembolic pulmonary hypertension (CTEPH), has shown to provide significant long-term benefits in appropriately selected patients, often leading to a curative outcome. BPA, an evolving, less-invasive procedure, has expanded therapeutic options for patients not suited to PEA, with growing evidence of symptom and hemodynamic improvements. Lung transplantation remains a critical option for select patients with refractory PH despite maximal medical and interventional therapy. Advances in patient selection, surgical techniques, and post-operative care have led to improved outcomes in transplant patients, although the scarcity of donor organs remains a significant limitation.

Emerging studies underscore the importance of timely intervention with these surgical approaches, suggesting that earlier consideration of surgical options may improve survival and quality of life compared to late-stage medical management alone. Future research is necessary to refine patient selection criteria and optimize perioperative protocols to further enhance the safety and efficacy of surgical interventions. This review highlights the shifting paradigm in PH management from a predominantly pharmacologic approach to an integrated model that includes surgical intervention as an essential component in the treatment algorithm.

Alina Cornea graduated from UMF Carol Davila in Bucharest, Romania, and relocated to Ireland in 2016. Over the years, she has been actively involved in cardiothoracic surgery research, particularly in the areas of heart and lung transplantation and mechanical circulatory support. She has recently published her research findings in several prominent medical books, including Thoracic Surgery: Cervical, Thoracic, and Abdominal Approaches (Springer, 2020, editors Nistor, Tsui et al.), New Insights in Pulmonary Hypertension (2023, chapter, editors Surani S. et al.), and Pulmonary Emphysema: Recent Updates (2024, chapter, editor Kian Chung Ong). Additionally, she co-authored a chapter in Comprehensive Interventions in End-Stage Cardiomyopathy: Mechanical Circulatory Support and Heart Transplantation(Etiology, Prevention, and Management of Cardiomyopathy, edited by Ernest A. Adeghate, May 2024). Currently, she is involved in the development of the Research Center at Beacon Academy in Dublin, Ireland. This program is designed to train students and junior doctors in medical and surgical sciences, with a special focus on pulmonary hypertension and cardiovascular diseases.