Predicting Right Ventricular Failure After Left Ventricular Assist Device Implantation

Researchers examined the relationship between preoperative pulmonary artery pulsatility index during LVAD implantation and right ventricular failure.

The pulmonary artery pulsatility index (PAPi) is a useful predictor of right ventricular failure (RVF) following the implantation of a left ventricular assist device (LVAD), according to review findings published in The Journal of Heart and Lung Transplantation.

Researchers sought to evaluate the predictive value of preoperative PAPi to RVF in patients that receive LVAD implantation. Study authors organized a search of MEDLINE and EMBASE databases from inception through September 28, 2021, and identified 32 studies reporting on PAPi and RVF following LVAD implantation to review. These studies include 4756 patients, of whom 27.48% have RVF.

The researchers found that the weighted mean of preoperative PAPi associated with RVF is 2.17±2.36, and the weighted mean of preoperative PAPi associated with no RVF is 2.87±3.21. Among LVAD recipients, those who develop RVF have a significantly lower preoperative PAPi than those with no RVF (weighted mean difference, -0.74; 95% CI, -1.00 to -0.49; P <.001). Tricuspid annular plane systolic excursion, RV stroke work index, central venous pressure (CVP), and CVP/pulmonary capillary wedge pressure also predict RVF following LVAD implantation.

There are several limitations to this review, including heterogeneity of the results and publication bias, as well as the inability to analyze critical data. There were also inconsistencies across the 32 studies in timing of procedures, hemodynamic evaluation before LVAD implantation, and the use of preoperative inotropes or mechanical circulatory support.

The study authors wrote, “The confirmation of PAPi as a clinical predictor of RVF opens the path for developing models to better predict RVF in addition to interventions to treat RVF in durable LVAD recipients at high-risk for RVF.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Essandoh M, Kumar N, Hussain N, et al. Pulmonary artery pulsatility index as a predictor of right ventricular failure in left ventricular assist device recipients: a systematic review. J Heart Lung Transplant. Published online April 30, 2022. doi:10.1016/j.healun.2022.04.007