Prognostic value of pulmonary artery pulsatility index for perioperative adverse cardiovascular events in patients undergoing surgery for mitral regurgitation.

Background: The pulmonary artery pulsatility index (PAPi) demonstrates prognostic value across cardiopulmonary conditions, yet its utility in mitral regurgitation (MR) perioperative risk stratification remains undefined. This study aimed to evaluate whether the PAPi could independently predict perioperative adverse cardiovascular events in patients with MR, and to explore whether its addition to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II provided incremental value. Methods: This ambidirectional cohort study enrolled 302 consecutive patients with moderate-to-severe MR undergoing mitral valve surgery. PAPi was calculated as pulmonary artery pulse pressure (pulmonary artery systolic pressure minus diastolic pressure) divided by right atrial pressure, all estimated by echocardiography. Patients were grouped by PAPi tertiles and followed for 3 months. The primary endpoint was major adverse cardiovascular events (MACEs). Exploratory endpoints included mechanical ventilation duration and inotropic support. Incremental value was assessed by integrating PAPi into EuroSCORE II. Results: Patients were stratified into low PAPi (<3.4, n=99), intermediate PAPi (3.4-4.8, n=101), and high PAPi (>4.8, n=102) groups. MACE incidence was 37.4% (37/99), 10.9% (11/101), and 3.9% (4/102), respectively (χ Conclusions: The echocardiography-derived PAPi predicts perioperative MACE in patients with MR. Incorporation of this index into traditional risk scoring systems provides incremental value for preoperative risk assessment and facilitates the identification of high-risk patients.