Trend in Pulmonary Artery Pulsatility Index Pre- to Post-LVAD Implantation

Abstract

Purpose The pre-operative pulmonary artery pulsatility index (PAPi) is associated with severe right ventricular failure (RVF) after LVAD implantation. We set out to assess how the PAPi trends pre- to post-operatively in patients with and without severe RVF. Methods A single-center retrospective study of 230 patients who received a continuous-flow durable LVAD between 1/2006 and 9/2016. PAPi was defined as: [(PA systolic - PA diastolic) ÷ RA pressure]. Severe RVF was defined as meeting criteria for clinical RVF and having inotropes > 14 days after implant, inotropes re-started after 14 days of implant, RVAD placement during implant admission, and death from RVF during implant admission. The hemodynamics pre-implant and post-operatively at 6, 24, and 72 hours were examined. Results In our 230-patient cohort, 62 patients (27%) were found to have severe RVF. Patients with severe RVF had a lower pre-operative (p-value = 0.04), 6-hour post-LVAD (p-value Conclusion The PAPi declines significantly post-operatively in patients with severe RVF and without severe RVF at 6 and 24 hours. For patients with severe RVF, the PAPi significantly improves from 6 to 72 hours post-operatively.