Cardiothoracic & vascular anesthesia
Postoperative Pulmonary Artery Pulsatility Index Improves Prediction of Right Ventricular Failure After Left Ventricular Assist Device Implantation
Authors' conclusion
The inclusion of postoperative PAPi offers more robust predictive power for right ventricular failure in patients undergoing durable LVAD implantation, compared with the use of existing risk scores alone.
Study context
- Population
- Adults undergoing durable left ventricular assist device (LVAD) implantation with CPB under GA and pulmonary artery catheter, tertiary academic centre, 2017–2019
- Participants
- 67 adults
- Exposure
- Michigan score with vs without postoperative pulmonary artery pulsatility index (PAPi) for predicting right ventricular failure
- Outcome
- Right ventricular failure (composite:
- Right ventricular mechanical circulatory support
- Inhaled pulmonary vasodilator ≥48 h
- Inotrope use ≥14 days or at discharge)
Methodological detailssingle-centre, observational
- Single-centre
- Observational
Main finding
As reported in the abstract
Right ventricular failure
Odds ratio (95% CI)
Preoperative transpulmonary gradient
1.15(1.02–1.28)
Preoperative cardiac index
0.83(0.71–0.98)
Postoperative PAPi
0.85(0.75–0.97)
- Incidence of right ventricular failure
- 30% (n = 20)
Observational data: associations, not effects.
Further findings
| Outcome | AUC | P value |
|---|---|---|
| Predictive performance of Michigan score with vs without postoperative PAPi | 0.73 v 0.56 | P = 0.03 |
- Predictive performance of Michigan score with vs without postoperative PAPi — Optimal cutoff for postoperative PAPi
- 1.56
Original publication
Postoperative Pulmonary Artery Pulsatility Index Improves Prediction of Right Ventricular Failure After Left Ventricular Assist Device Implantation. J Cardiothorac Vasc Anesth. Published 10 October 2023. doi:10.
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