Pulmonary Vasodilators in LVAD Patients:A Never-Ending Debate

Authors: Maria Benedetto* , Piccone G , Roncarati V and Baiocchi M

DOI: 10.23880/oajc-16000166

Volume 5, Issue 1

Abstract

Left ventricular assist device is a life-saving option in patients with end-stage left heart failure. It leads to a decrease of pulmonary arterial pressure, wedge pressure and pulmonary vascular resistences. However, a post capillary pulmonary hypertension persists in a significant proportion of patients despite adequate LV unloading. A possible explanation is the pulmonary venous congestion and subsequent decrease in the level of nitric oxide. This observation has led to an increased interest for pulmonary vasodilators, especially phosphodiesterase 5 inhibitors (PD-5 I). They enhance the nitric oxide (NO) signaling through the increase of cyclic guanosine monophosphate availability. Sildenafil allows to tritate down the iNO and succesfully extubated the patient; it has been shown to significantly reduce mPAP and PVR 2-4 weeks after LVAD implantation and to wean from inotropic support within the first 72 hours. However, whereas literature seems to support its use in the immediate postoperative period, there are not enough evidences about their long term use. 

Keywords: Pulmonary Vasodilators; Patients; Dysfunction

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