Can right ventricular-pulmonary artery coupling predict perioperative right ventricular failure after on-pump cardiac surgery? A systematic review and prognostic evidence map

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Perioperative right ventricular failure after on-pump cardiac surgery. Intervention: Right ventricular-pulmonary artery (RV-PA) coupling vs. Conventional right-heart phenotypes (TAPSE, RV longitudinal strain). Primary outcome: Perioperative right ventricular failure and difficult/failed cardiopulmonary bypass separation.

Nora Knez; Mislav Puljević; Hrvoje Gašparović

doi:10.15836/ccar2026.251

November 1, 2026Cardiologia CroaticaOpen Access

Can right ventricular-pulmonary artery coupling predict perioperative right ventricular failure after on-pump cardiac surgery? A systematic review and prognostic evidence map

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Key result

RV-PA coupling lacks sufficient evidence to reliably predict postoperative right ventricular failure.

Why the study?

Does non-invasive right ventricular-pulmonary artery coupling predict perioperative right ventricular failure and mortality in adults undergoing on-pump cardiac surgery?

Key Points

To evaluate whether right ventricular-pulmonary artery (RV–PA) coupling and conventional right-heart phenotypes reliably predict perioperative right ventricular failure after adult on-pump cardiac surgery.
Systematic review and prognostic evidence map evaluating adult on-pump cardiac surgery (CABG, valve, aortic, or combined procedures) indexed through June 12, 2026.
Quality was assessed using the QUIPS tool for prognostic factor studies and PROBAST for prediction models; quantitative meta-analysis required at least three clinically and statistically compatible independent cohort families.
Direct coupling evidence for postoperative right ventricular failure and difficult bypass separation was limited to 1 independent family with unadjusted comparisons, yielding very low certainty.
Of 653 candidate synthesis clusters, 7 reached the prespecified three-family threshold but none met full clinical and statistical compatibility, precluding meta-analysis.
High risk of bias on the QUIPS tool was most frequent for statistical analysis and reporting (45/55) and confounding (38/55).

Study Design

Type

Systematic Review

Structured PICO

Does non-invasive right ventricular-pulmonary artery coupling predict perioperative right ventricular failure and mortality in adults undergoing on-pump cardiac surgery?

P

Population

55 reports representing 48 cohort families of adults undergoing on-pump coronary artery bypass grafting, valve, aortic, or combined cardiac surgery.

E

Exposure

Non-invasive right ventricular-pulmonary artery (RV-PA) coupling metrics (e.g., TAPSE/PASP or TAPSE/sPAP)

C

Comparator

Conventional right-heart and pulmonary-hypertension phenotypes (e.g., preoperative TAPSE, RV longitudinal strain)

O

Outcome

Perioperative right ventricular failure (RVF) and difficult/failed cardiopulmonary bypass (CPB) separationhard clinical

Right ventricular-pulmonary artery coupling currently provides perioperative risk enrichment rather than validated prediction of postcardiotomy right ventricular failure due to sparse direct evidence, heterogeneous outcome definitions, and lack of external validation.

Limitations

Sparse direct perioperative evidence (only 1 independent cohort family for formal postoperative RV failure)
Marked outcome non-standardization (19 definition rows represented 16 distinct archetypes)
Substantial heterogeneity in markers, thresholds, populations, and follow-up preventing meta-analysis (0 of 653 candidate synthesis clusters met full compatibility)
High risk of bias on QUIPS for statistical analysis/reporting (45/55 reports) and confounding (38/55 reports)
Lack of external validation
Sparse direct perioperative evidence
Substantial heterogeneity in markers, thresholds, populations, and follow-up
Marked outcome non-standardization (19 direct definition rows represented 16 distinct archetypes)
High QUIPS risk of bias for statistical analysis/reporting (45/55) and confounding (38/55)

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Implication

Insufficient evidence precludes validated RV failure prediction with RV-PA coupling; leaves open the need for standardized prospective studies.

Abstract

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Discussion

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Cite This Study

Knez et al. (2026) conducted a systematic review in Perioperative right ventricular failure after on-pump cardiac surgery. Right ventricular-pulmonary artery (RV-PA) coupling vs. Conventional right-heart phenotypes (TAPSE, RV longitudinal strain) was evaluated on Perioperative right ventricular failure and difficult/failed cardiopulmonary bypass separation. Right ventricular-pulmonary artery coupling lacked sufficient direct evidence across 55 reports (48 cohorts) to support meta-analysis or validated prediction of postoperative RV failure.

synapsesocial.com/papers/6af88dff0e4d8f4b089c1c93 https://doi.org/10.15836/ccar2026.251

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Can right ventricular-pulmonary artery coupling predict perioperative right ventricular failure after on-pump cardiac surgery? A systematic review and prognostic evidence map

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Can right ventricular-pulmonary artery coupling predict perioperative right ventricular failure after on-pump cardiac surgery? A systematic review and prognostic evidence map

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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