Preoperative Pulmonary Artery to Aorta Diameter Ratio as a Predictor of Postoperative Severe Right Ventricular Failure and 1-Year Mortality Following Left Ventricular Assist Device Implantation

Objectives To evaluate the association of pulmonary artery diameter and pulmonary artery to aorta diameter ratio (PA/Ao) with right ventricular failure and mortality within 1 year after left ventricular assist device implantation. Design Retrospective observational study between March 2013 and July 2019. Setting Single center, quaternary care academic center. Participants Adults (≥ 18 years old) receiving a durable LVAD. Inclusion if 1) a chest CT scan was performed within 30 days before the LVAD and 2) a right and left heart catheterization was completed within 30 days before the LVAD. Interventions Left Ventricular Assist Device. Measurements Total of 176 patients were included in this study. Median PA diameter and PA/Ao ratio were significantly greater in the severe RVF group (p = 0.001, p < 0.001 respectively). ROC analysis revealed PA/Ao and RVF as predictors for mortality (area under the curve 0.725, 0.933 respectively). Logistic regression analysis predicted probability gave a PA/Ao ratio cutoff point of 1.04 (p < 0.001). Survival probability was significantly worse in patients with a PA/Ao ratio ≥ 1.04 (p=0.005). Conclusions PA/Ao ratio is an easily measurable noninvasive indicator that can be used as a predictor of RVF and 1-year mortality post LVAD implantation.