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Introduction The pulmonary artery pulsatility index (PAPi) is an emerging hemodynamic marker correlated with severe post-LVAD RVF in single-center cohort studies. We set out to examine if this is generalizable in a multi-institutional analysis. Hypothesis The preoperative PAPi correlates with RVF as defined by new INTERMACS criteria (INTERMACS-RVF), severe RVF, and death at 1-year. Methods We performed a dual-center retrospective study of 404 patients from Ohio and New York who received a continuous-flow durable LVAD and had a pre-operative PAPi measurement. The PAPi was defined as: [(PA systolic - PA diastolic) ÷ RA pressure]. Severe RVF was defined as meeting criteria for clinical RVF and having inotropes > 14 days after implant, inotropes re-started 14 days after implant, RVAD placement during implant admission, and death from RVF during implant admission. A multivariate analysis of predictors of post-LVAD severe RVF was conducted. A survival analysis was performed to examine pre-operative PAPi as a predictor of 1-year mortality. Results In our cohort of 404 patients, 84 (21%) had severe RVF. Multivariable logistic regression for severe RVF (controlling for age, INTERMACS level, creatinine, and gender) showed that creatinine > 1.5 (OR 2.24, p=0.002, 95% CI [1.43-4.42]) and total bilirubin > 2.5 (OR 2.87, p=0.004, 95% CI [1.39-5.93]) significantly increased the odds of severe RVF, and a PAPi Figure 1 ) and INTERMACS-RVF (c-statistic=0.63) were similar. With respect to survival, the final multivariable model (controlling for age, gender, and ethnicity) showed a PAPi Conclusion PAPi

Introduction Early RVF after LVAD implant has been studied using varying definitions. We set out to compare the new INTERMACS post-LVAD RVF criteria and traditional severe RVF definitions in our multi-institutional cohort. Hypothesis The INTERMACS RVF and severe RVF definition will both show increased mortality at 1-year. Methods We performed a dual-center retrospective study of 471 patients who received a continuous-flow durable LVAD and data available to assess RVF severity. The new INTERMACS RVF definition stratifies RVF into mild, moderate, severe, and acute-severe. Severe RVF was defined as meeting criteria for clinical RVF and having inotropes > 14 days after implant, inotropes re-started after 14 days of implant, RVAD placement during implant admission, and death from RVF during implant admission. A survival analysis of the INTERMACS RVF and severe RVF definitions was performed. A multivariate analysis using clinical markers associated with post-LVAD mortality was then completed to assess the independent effect of the RVF definitions. Results Of the 471 patients, 100 (21%) had severe RVF. Stratified by INTERMACS-RVF, 279 (59%) had no RVF, 37 (8%) had mild RVF, 53 (11%) had moderate RVF, 57 (12%) had severe RVF, and 47 (17%) had acute-severe RVF. Our multivariate model (adjusted for age, gender, and ethnicity) for predictors of 1-year mortality showed that PAPi Conclusion Our multi-institutional cohort shows that severe RVF and INTERMACS RVF severe and acute-severe predict mortality at 1-year, and notably shows that mild and moderate INTERMACS RVF do not predict mortality. The new INTERMACS classification of RVF provides more granularity in stratifying RVF and may be more clinically applicable.