Pretransplant Right Ventricular Dysfunction Is Associated With Increased Mortality After Heart Transplantation: A Hard Inheritance to Overcome.

ABSTRACT Background: Right ventricular dysfunction (RVD) is a major issue in patients with advanced heart failure (HF) since it precludes the implantation of left ventricular assist device (LVAD) usually leaving heart transplantation (HTx) as the only available treatment option. Pulmonary artery pulsatility index (PAPi) is a hemodynamic parameter integrating information of right ventricular function and of pulmonary circulation. Our aim is to evaluate the association of pre-operative RVD, hemodynamically defined as a low PAPi, with post- HTx survival. Methods: Consecutive adult HTx recipient at two Italian transplant centers between 2000 and 2018 with available data on pre-HTx right heart catheterization were retrospectively included. RVD was defined as a value of PAPi lower than the 25th percentile of the study population. The association of RVD with 1-year post-HTx mortality and other secondary endpoint was evaluated. Multivariate logistic regression was used to adjust for clinical and hemodynamic variables. Analyses stratified by pulmonary vascular resistance (PVR) status (≥3 WU vs. Results: Among 657 HTx recipients (female 31.1 %, age 53 ± 11 years), patients with pre-HTx RVD (PAPi Conclusions: Pre-operative RVD, evaluated through PAPi, is associated with mortality and morbidity after HTx, providing incremental prognostic value over traditional clinical and hemodynamic parameters.