Although thoracic surgery is understood to confer a high risk of postoperative respiratory complications, the substantial haemodynamic challenges posed are less well appreciated. This review highlights the influence of cardiovascular comorbidity on outcome, reviews the complex pathophysiological changes inherent in one-lung ventilation and lung resection, and examines their influence on cardiovascular complications and postoperative functional limitation. There is now good evidence for the presence of right ventricular dysfunction postoperatively, a finding that persists to at least 3 months. This dysfunction results from increased right ventricular afterload occurring both intraoperatively and persisting postoperatively. Although many patients adapt well, those with reduced right ventricular contractile reserve and reduced pulmonary vascular flow reserve might struggle. Postoperative right ventricular dysfunction has been implicated in the aetiology of postoperative atrial fibrillation and perioperative myocardial injury, both common cardiovascular complications which are increasingly being appreciated to have impact long into the postoperative period. In response to the physiological demands of critical illness or exercise, contractile reserve, flow reserve, or both can be overwhelmed resulting in acute decompensation or impaired long-term functional capacity. Aiding adaptation to the unique perioperative physiology seen in patients undergoing thoracic surgery could provide a novel therapeutic avenue to prevent cardiovascular complications and improve long-term functional capacity after surgery.

尽管胸外科手术被认为会带来术后呼吸道并发症的高风险，但所带来的巨大的血流动力学挑战却很少被人们所认识。这篇综述强调了心血管合并症对结果的影响，回顾了单肺通气和肺切除术固有的复杂病理生理变化，并检查了它们对心血管并发症和术后功能限制的影响。现在有充分的证据表明术后存在右心室功能障碍，这一发现至少持续 3 个月。这种功能障碍是由于术中和术后持续增加的右心室后负荷所致。尽管许多患者适应良好，但那些右心室收缩储备减少和肺血管血流储备减少的患者可能会感到困难。术后右心室功能障碍与术后心房颤动和围术期心肌损伤的病因有关，这两种常见的心血管并发症越来越被人们认识到对术后长期影响。为了应对危重疾病或运动的生理需求，收缩储备、流量储备或两者都可能被压垮，导致急性失代偿或长期功能能力受损。帮助接受胸外科手术的患者适应独特的围手术期生理学可以提供一种新的治疗途径，以预防心血管并发症并提高术后长期功能能力。