@Article{chd.12860,
AUTHOR = {Varun Aggarwal, Sebastian C. Tume, Marco Rodriguez, Iki Adachi, Antonio G. Cabrera, Hari Tunuguntla, Athar M. Qureshi},
TITLE = {Pulmonary artery pulsatility index predicts prolonged inotrope/ pulmonary vasodilator use after implantation of continuous flow left ventricular assist device},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {6},
PAGES = {1130--1137},
URL = {http://www.techscience.com/schd/v14n6/38929},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> Predictors of right ventricle (RV) dysfunction after continuous‐flow left 
ventricular assist device (CF‐LVAD) implantation in children are not well described. 
We explored the association of preimplantation Pulmonary Artery Pulsatility index 
(PAPi) and other hemodynamic parameters as predictors of prolonged postoperative 
inotropes/pulmonary vasodilator use after CF‐LVAD implantation.<br/>
<b>Design:</b> Retrospective chart review.<br/>
<b>Setting:</b> Single tertiary care pediatric referral center.<br/>
<b>Patients:</b> Patients who underwent CF‐LVAD implantation from January 2012 to 
October 2017.<br/>
<b>Interventions:</b> Preimplantation invasive hemodynamic parameters were analyzed to 
evaluate the association with post‐CF‐LVAD need for prolonged (>72 hours) use of 
inotropes/pulmonary vasodilators.<br/>
<b>Measurements and main results:</b> Preimplantation cardiac catheterization data 
was available for 12 of 44 patients who underwent CF‐LVAD implant during the 
study period. Median (IQR) age and BSA of the cohort were 15.3 years (10.2, 18) 
and 1.74 m2
 (0.98, 2.03). Group 1 (n = 6) included patients with need for prolonged 
inotropes/pulmonary vasodilator use after CF‐LVAD implantation and Group 2 (n = 6) 
included those without. Baseline demographic parameters, cardiopulmonary bypass 
time, and markers of RV afterload (pulmonary vascular resistance, PA compliance and 
elastance) were similar among the two groups. PAPi was significantly lower in group 
1 compared to group 2 (0.96 vs 3.6, respectively; P = .004). Post‐LVAD stay in the 
intensive care unit was longer for patients in group 1 (46 vs 23 days, P = .52). Brain 
natriuretic peptide was significantly higher at 3 months after implantation in group 
1; P = .01.<br/>
<b>Conclusions:</b> The need for inotropes/pulmonary vasodilators in the postoperative 
period can be predicted by the preimplantation intrinsic RV contractile reserve as 
assessed by PAPi rather than the markers of RV afterload. Further investigation and 
correlation with clinical outcomes is needed.},
DOI = {10.1111/chd.12860}
}