Preoperative pulmonary artery pulsatility index and early right ventricular failure after left ventricular assist device implantation: A systematic review and meta-analysis.

Authors

Niti Dalal, Anju Bhardwaj, Ala Mohsen, Abhinav Saxena, Adam Lick, Sapna Desai, Jose Wiley, Sasha Vukelic, Jamil Borgi, Azocar Ruben, Aabha Divya

Published in

JHLT open. Volume 14. Pages 100654. Epub Aug 05, 2026.

Abstract

Right ventricular failure (RVF) remains a major complication after left ventricular assist device (LVAD) implantation. The pulmonary artery pulsatility index (PAPi) is increasingly used as a hemodynamic marker of right ventricular function and reserve, but measurement conditions, thresholds, and RVF definitions vary. We evaluated the association between lower preoperative PAPi and early RVF after LVAD implantation.
We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines. PubMed, Embase, Cochrane CENTRAL, and Scopus were searched from inception through March 22, 2026. Eligible studies evaluated preoperative pulmonary artery pulsatility index and early right ventricular failure after left ventricular assist device implantation. The primary analysis was restricted to baseline measurements with comparable effect estimates. Expanded exploratory analyses incorporated dynamic and optimized measurements.
Eight studies met the inclusion criteria, of which 6 were included in the quantitative synthesis. In the primary analysis, lower baseline pulmonary artery pulsatility index was associated with higher odds of early right ventricular failure (odds ratio, 8.20; 95% confidence interval, 1.29-52.26; p=0.026), with substantial heterogeneity. Leave-one-out sensitivity analysis showed a consistent association with reduced heterogeneity (odds ratio, 3.31; 95% confidence interval, 1.87-5.85; p<0.001). Expanded exploratory analysis confirmed the direction of association.
Lower pulmonary artery pulsatility index is associated with early right ventricular failure after left ventricular assist device implantation. Substantial heterogeneity in thresholds, measurement conditions, and outcome definitions limits interpretation. We propose a standardized framework for hemodynamic assessment and outcome reporting in future studies.

PMID:
42668532
Bibliographic data and abstract were imported from PubMed on 30 Aug 2026.

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