“Refractory pulmonary hypertension” is a phrase none of us in this field wants to hear. First, it means this patient is not doing well. Second, it makes us question our therapeutic approach: could I have done better; could I have been more aggressive with therapy; why did this patient fail? Yet, we know that, despite our best efforts, some patients with pulmonary arterial hypertension (PAH) will not “do well,” and we will be faced with the daunting task of how best to care for these patients.
In this issue of Advances, we address the options for the failing patient; hopefully, the following articles will better prepare you for this situation and will provide you with a blueprint of how to approach such a patient. In this issue, we discuss options such as lung transplantation, atrial septostomy, Potts anastomoses, bridging and mechanical therapies such as ECMO, and palliative care—all of which should be performed in a center with expertise in these complex entities.
I thank all those who contributed to this effort: the authors of the various articles and the participants in the Roundtable. In sum, I hope discussion of this difficult subject will make your PAH life a little easier.