Disclosure(s): No relevant financial relationship(s) to disclose.
Introduction: Right ventricular failure (RVF) is a common and life-threatening complication following left ventricular assist device (LVAD) implantation, associated with increased morbidity and mortality. The pulmonary artery Pulsatility index (PAPi) has emerged as a potential hemodynamic predictor of RV function. This systematic review and meta-analysis aimed to evaluate the association between preoperative PAPi and the development of RVF in patients undergoing LVAD implantation.
Methods: A comprehensive search of PubMed, Embase, and Cochrane was performed through June 2025 for studies assessing PAPi in adult LVAD recipients. Studies were included if they reported preoperative PAPi values and postoperative RVF outcomes. Random-effects meta-analysis was used to estimate mean differences with 95% confidence intervals (CI). Heterogeneity and risk of bias were assessed, and overall quality was rated using GRADE methodology. Artificial Intelligence assist tools were used for improving fluidity, grammar and structure of the writing, not included in data curation, analysis and interpretation.
Results: Total of 27 studies comprising 2,601 patients were included. Overall, 23.42% of patients developed RVF after LVAD implantation. Patients who developed RVF had a significantly lower preoperative PAPi compared to those who did not, with a mean difference of 0.74 (95% CI: 0.49–0.98; p < .001). Subgroup analyses confirmed consistent findings across device types and study designs. Heterogeneity was moderate, and the certainty of evidence was rated as moderate due to observational design and variability in RVF definition.
Conclusions: Lower preoperative PAPi is significantly associated with increased risk of right ventricular failure following LVAD implantation. These findings support the routine use of PAPi in preoperative risk stratification and highlight the need for prospective validation in future studies. Improved predictive models incorporating PAPi may guide perioperative management and RV support strategies in this high-risk population.
