Pulmonary Artery Pulsatile Index (PAPi) Score May Predict Risk of Gastrointestinal Bleeding in Patients with Left Ventricular Assist Device

Purpose Gastrointestinal bleeding (GIB) is one of the most common complications following left ventricular assist device (LVAD) implantation. Correlation of right heart failure and GIB after LVAD has previously been demonstrated, however no predictive scores have been developed to identify those at risk. The purpose of this this study was to determine if pulmonary artery pulsatility index (PAPi) is a predictor of GIB post LVAD implantation. Methods We retrospectively reviewed electronic medical records of LVAD patients in our institution from 2015 to 2018. All patients with a clinically significant GIB were selected for analysis and compared to a random cohort of matched patients without GIB. A clinically significant GIB was defined as a drop in Hemoglobin >2 g/dL, clinical signs or symptoms of GIB and/or need for transfusion of packed red blood cells. PAPi score was calculated using pre-operative hemodynamics and comparisons between the two groups were completed using a Pearson correlation coefficient. Results A total of 110 LVAD patients were included, 53 were identified to have clinically significant GIB bleeding and were compared to 57 controls. The GIB cohort was found to be more likely to have a PAPi Conclusion PAPi has been shown to be a powerful predictor of right ventricular failure following LVAD implantation. Our study demonstrates that PAPi may also predict other clinically significant outcomes, specifically GIB.