*Purpose: Right ventricular (RV) dysfunction after heart transplantation (HTx) is not uncommon. The cause of RV dysfunction may be due to inadequate preservation, high pulmonary artery pressures, and extensive bleeding where high volumes of fluid are administered to the RV which begins to dilate. Recovery of RV dysfunction after HTx is not clear. There does not appear to be good biomarkers or hemodynamics that can predict easy recovery. The use of the pulmonary artery pulsatility index (PAPi) is defined as [(systolic pulmonary artery pressure – diastolic pulmonary artery pressure)/central venous pressure]. This is a novel hemodynamic index that can predict the severity of RV failure. It is not clear whether the use of PAPi can predict which patients would recover more rapidly from RV dysfunction.

*Methods: Between 2010 and 2019, we assessed 33 HTx patients who developed RV failure, characterized by central venous pressure greater than 15 mmHg, pulmonary capillary wedge less than 15 mmHg, and echocardiographic RV function or dysfunction noted as moderate to severe. These patients were assessed for PAPi and followed by serial echocardiograms until RV function normalized. Correlation of PAPi to duration of RV dysfunction was recorded. PAPi was calculated at the time of established RV dysfunction, where PAPi value ≤1 was defined as abnormal. The time to recovery of RV function was correlated to PAPi as defined as normal versus abnormal.

*Results: Abnormal PAPi patients compared to normal PAPi patients revealed a trend in longer time to recovery of RV dysfunction (111.3 vs. 36.3 days, p=0.071). This longer recovery time in the abnormal PAPi group persisted despite fewer patients with pulmonary hypertension. (See table.)

*Conclusions: In HTx patients with RV dysfunction, the use of PAPi may be a prognostic marker for RV recovery and may even be a benchmark to determine if RV unloading with sildenafil may be appropriate.

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