534 Preoperative Pulmonary Artery Pulsatility Index Does not Predict Mortality Post Cardiac Transplantation but PVR is a Prognostic Tool in Patients LVAD-Bridged Patients

Abstract

The Pulmonary artery pulsatility index (PAPi) is a novel haemodynamic marker that has been shown to be a strong predictor of right heart failure and mortality in patients with pulmonary hypertension and advanced heart failure. It’s utility in predicting post transplant outcomes is currently unknown. To determine the prognostic significance of pre-transplant haemodynamic assessment of PAPi, right atrial pressure (RA), and pulmonary vascular resistance (PVR) in predicting mortality post cardiac transplant. All patients who underwent cardiac transplantation between January 2010 and June 2016 were retrospectively analyzed. Preoperative right heart catheter data was obtained. The PAPi was calculated as the systolic pulmonary artery pressure (sPAP)- diastolic pulmonary artery pressure (dPAP) divided by RA. A total of 158 patients age of 48.6±13.5 were studied (115 no LVAD, 43 LVAD pre-transplant), and 3 patients were excluded due to missing data. Using a Mann-Whitney U test for comparison there was no significant difference in the non-LVAD group in RA, PVR or PAPi for mortality post transplant. In the LVAD group there was no significant difference in RA, or PAPi for mortality outcomes, however there was a significant difference in PVR between those that died post transplant (222±100) and those still alive (138±59). Despite having a role in prognostication for right heart failure in pulmonary hypertension and post LVAD implantation, PAPi was not able to discriminate mortality outcomes for patients post cardiac transplantation. PVR remains a marker of mortality in an LVAD cohort bridged to transplant.