Original Article|Articles in Press

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

Published:March 16, 2023DOI:


      • Right ventricular failure remains a significant source of morbidity and mortality
      • Pulmonary artery to aorta ratio is associated with severe right ventricular failure
      • Pulmonary artery to aorta ratio may predict 1-year mortality post LVAD implantation



      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.


      Retrospective observational study between March 2013 and July 2019.


      Single center, quaternary care academic center.


      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.


      Left Ventricular Assist Device.


      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).


      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.

      Graphical Abstract


      Glossary of Abbreviations:

      LVAD (left ventricular assist devices), RVF (right ventricular failure), PA (pulmonary artery), PA/Ao (pulmonary artery to aorta ratio), INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support), RHC (Right heart catheterization), PCWP (Pulmonary capillary wedge pressure), SV (stroke volume), CO (cardiac output), CVP (central venous pressure), sPAP (systolic pulmonary artery pressure), dPAP (diastolic pulmonary artery pressure), mPAP (mean pulmonary artery pressure), PVR (pulmonary vascular resistance), TPG (transpulmonary gradient), dTPG (diastolic transpulmonary gradient), PAPi (pulmonary artery pulsatility index), RVSWI (right ventricle stroke work index), PEAS (pulmonary elastance), CVP/PCWP (central venous pressure/ pulmonary capillary wedge pressure ratio)
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