Pulmonary Arterial Pulsatility Index Predicts Mechanical Circulatory Support Following Heart Transplantation

Background: The incidence of mechanical circulatory support (MCS) for early graft dysfunction (EGD) following heart transplantation varies from 2.3% to 28.2%. Low pulmonary pulsatility index (PAPI) is associated with higher mortality in advanced heart failure and cardiogenic shock. We hypothesized that a lower pulmonary pulsatility index following heart transplantation is associated with MCS use for EGD Methods: Two-center study of consecutive heart transplantation from May 2018 to December 2022. Hemodynamic parameters and inotropic/vasoconstrictor data were investigated on admission to the intensive care unit (T0) and at 6 hours later (T6). Results: Of the 173 patients included in this study, 24 had MCS for EGD. PAPI in the group that required MCS was lower at T0 (1.21 (0.84) vs 1.67 (1.23), p = 0.001) and T6 (0.77 (0.52) vs 1.44 (0.82), p = <0.001). There was no significant difference in recipient characteristics, donor characteristics (donor age and sex matching), and operative factors (warm/cold ischemic time, total ischemic time, cardiopulmonary bypass time) between the 2 groups. On multiple variable regression, PAPI at T6 was associated with delayed MCS independent of total donor organ ischemic time and short-term MCS bridge to transplantation (odds ratio, OR 0.1 (0.036-0.276), p = <0.001). Receiver operating characteristic (ROC) analysis showed an area under the ROC curve of 0.694 for T0 PAPI and 0.832 for T6 PAPI; a cut-off T6 PAPI of 1.22 had sensitivity and specificity of 81% and 65%, respectively. Conclusions: Lower PAPI at T6 (<1.22) is independently associated with MCS use for severe EGD postheart transplantation.