Abstract 13005: The Prognostic Role of Systemic Arterial Pulsatility Index in Surgical Aortic Valve Replacement

Abstract

Introduction: Ventricular-arterial coupling (VAC) dynamics reflect the interaction between myocardial and vascular functions and are known to influence cardiac outcomes. Systemic arterial pulsatility index (SAPi = [systemic systolic pressure-systemic diastolic pressure]/pulmonary capillary wedge pressure) is a metric of VAC, incorporating pulse pressure and left ventricular filling pressure. We hypothesized that SAPi would be associated with adverse outcomes in patients undergoing surgical aortic valve replacement (SAVR) and or concomitant coronary artery bypass graft surgery (CABG). Methods: This was a retrospective analysis of patients who underwent SAVR +/- CABG at a tertiary academic center from 2008 to 2016. SAPi was calculated using right heart catheterization hemodynamics prior to surgery. Logistic regression model was used to evaluate the relationship between SAPi and mortality. Results: Among 133 patients (mean age 73.4, 43% female) who underwent SAVR, 37 (28%) underwent concomitant CABG. The median SAPi was 4.3 (IQR 2.76-6.40). Patients with SAPi > 4.3 had a lower risk of mortality during the mean follow up of 6.9 years (OR 0.39 95% CI 0.18-0.85). Increasing SAPi was associated with a lower risk of mortality (OR 0.88 per unit increase in SAPi, 95% CI 0.76-0.99). A receiver operator characteristic curve is shown in Figure 1 with SAPI as a continuous variable adjusted for age. Area under the curve was 0.64 (95% CI 0.533-0.743). Conclusions: SAPi, a hemodynamic marker of VAC, was associated with mortality in patients undergoing SAVR +/- CABG. SAPi may have potential utility in pre-operative risk stratification of patients undergoing SAVR +/- CABG.