Pulmonary artery pulsatility index as a predictor of right ventricular failure in left ventricular assist device recipients: A systematic review

Essandoh, Michael; Kumar, Nicolas; Hussain, Nasir; Dalia, Adam A.; Wang, David; Al-Qudsi, Omar; Wilsak, David; Stahl, David; Bhatt, Amar; Sawyer, Tamara R.; Iyer, Manoj H.

doi:10.1016/j.healun.2022.04.007

Cited by 16 publications

(17 citation statements)

References 87 publications

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“…With this development, the patient was emergently listed for heart/lung transplant, UNOS status. 2 On hospital day 5, the patient was taken to the hybrid surgical suite, part of our cardiovascular operating room pavilion for axillary placement of an Impella 5.5 under MAC. Given her fragile cardiopulmonary status and severe pulmonary hypertension, a general anesthetic could result in significant morbidity including the risk of inability to safely extubate following Impella placement.…”

Section: Case Reportmentioning

confidence: 99%

Monitored Anesthesia Care for Axillary Impella 5.5 Placement: A Feasible Option for Patients With Severe Cardiogenic Shock With Relative Contraindication to Intubation

Iyer,

Kumar,

Stein

et al. 2023

Semin Cardiothorac Vasc Anesth

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The Impella 5.5 left ventricular assist device (LVAD) is typically placed in a hybrid operating room with fluoroscopic and echocardiographic guidance under general anesthesia. In this case report, we describe a patient with severe cardiopulmonary failure necessitating an Impella 5.5 as a bridge to heart/lung transplant. Here, we describe the successful placement of the Impella 5.5 with sedation and local anesthesia in order to avoid general anesthesia and the sequelae of positive pressure ventilation in a fragile patient. Impella placement was confirmed with transesophageal echocardiography. This case report demonstrates a novel strategy for placing the Impella 5.5 and, more importantly, opens the possibility to future prospective studies of this technique.

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Section: Case Reportmentioning

confidence: 99%

Monitored Anesthesia Care for Axillary Impella 5.5 Placement: A Feasible Option for Patients With Severe Cardiogenic Shock With Relative Contraindication to Intubation

Iyer,

Kumar,

Stein

et al. 2023

Semin Cardiothorac Vasc Anesth

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“…RVSWI is calculated as [mean pulmonary artery pressure (mPAP)–CVP] × stroke volume index (SVI) × 0.0136. An RVSWI >5 g × m/m 2 (equivalent to 350 mmHg⋅m l /m 2 ) is predictive of RVF after LVAD implant ( 46 , 104 ). Other proposed load-independent metrics include RV dp/dt and direct estimation of end-systolic elastance (Ees) using pressure-volume loops, but there is only preliminary data using these parameters and no proposed cutoffs ( 105 , 106 ).…”

Section: Pre-operative Prediction Of Right Ventricular Failurementioning

confidence: 99%

“…Systolic and diastolic dysfunction will eventually lead to inefficient volume management with a resultant increase in preload and CVP. Elevated pre-operative CVP (>10–14 mmHg depending on the study) has been consistently associated with RVF after LVAD ( 46 , 104 ). Furthermore, CVP increases with vasoplegia, often seen in combination with RVF ( 108 ).…”

Section: Pre-operative Prediction Of Right Ventricular Failurementioning

confidence: 99%

“…As with echocardiographic evaluation, an integrative approach incorporating multiple invasive hemodynamic parameters is likely to improve RVF risk prediction. Pulmonary artery pulsatility index (PAPi) (systolic PA–diastolic PA)/CVP is PAC-derived measurement that reflects both preload and afterload with excellent predictive capacity for RVF at values <1.85–2 ( 91 , 104 , 110 , 111 ). PAPi <1.85 is associated with higher rates of RVF, need for RVAD and mortality.…”

Section: Pre-operative Prediction Of Right Ventricular Failurementioning

confidence: 99%

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Prediction, prevention, and management of right ventricular failure after left ventricular assist device implantation: A comprehensive review

Ródenas-Alesina

Brahmbhatt

Rao

et al. 2022

Front. Cardiovasc. Med.

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Left ventricular assist devices (LVADs) are increasingly common across the heart failure population. Right ventricular failure (RVF) is a feared complication that can occur in the early post-operative phase or during the outpatient follow-up. Multiple tools are available to the clinician to carefully estimate the individual risk of developing RVF after LVAD implantation. This review will provide a comprehensive overview of available tools for RVF prognostication, including patient-specific and right ventricle (RV)-specific echocardiographic and hemodynamic parameters, to provide guidance in patient selection during LVAD candidacy. We also offer a multidisciplinary approach to the management of early RVF, including indications and management of right ventricular assist devices in this setting to provide tools that help managing the failing RV.

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“…A lower pulmonary artery pulsatility score was associated with more severe TR in a post-hoc analysis of the ESCAPE trial and PAPi—but not RAP:PCWP ratio or RVSWI—was a significant predictor of mortality by multivariable Cox regression analysis ( 30 ). Pulmonary artery pulsatility index (PAPi < 1.8) is associated with various measures of right heart failure after LVAD implantation ( 31 ) and pre implantation PAPi score is a predictor of subsequent RVF after LVAD ( 32 ). Even in patients without pulmonary hypertension, significant TR is associated with lower PAPi scores (right ventricular dysfunction) and worse survival ( 33 ).…”

Section: Is It the Tricuspid Valve… Are We Measuring The Wrong Thing?mentioning

confidence: 99%

Tricuspid surgery at the time of LVAD implant: A critique

Hoopes

2022

Front. Cardiovasc. Med.

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Tricuspid regurgitation (TR) is a common finding in patients with end stage heart failure referred for implantation of left ventricular assist devices. While functional TR frequently resolves after left ventricular unloading, patients with residual and progressive TR demonstrate increased rates of RV dysfunction and poor survival. Criteria for intervention on the tricuspid valve have focused on the degree of tricuspid annular dilatation and the severity of tricuspid regurgitant volume. The surgical decision making regarding intervention on the tricuspid valve remains obscure and historical cohort data cannot distinguish cause from effect.

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Pulmonary artery pulsatility index as a predictor of right ventricular failure in left ventricular assist device recipients: A systematic review

Cited by 16 publications

References 87 publications

Monitored Anesthesia Care for Axillary Impella 5.5 Placement: A Feasible Option for Patients With Severe Cardiogenic Shock With Relative Contraindication to Intubation

Monitored Anesthesia Care for Axillary Impella 5.5 Placement: A Feasible Option for Patients With Severe Cardiogenic Shock With Relative Contraindication to Intubation

Prediction, prevention, and management of right ventricular failure after left ventricular assist device implantation: A comprehensive review

Tricuspid surgery at the time of LVAD implant: A critique

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