This review highlights the ongoing challenges and unclear clinical benefits of using pulmonary vasodilators to manage pulmonary hypertension and right ventricular dysfunction in patients supported by left ventricular assist devices.
Caution advised on routine pulmonary vasodilator use in LVAD patients; leaves open need for RCTs to clarify benefits.
Left ventricular assist devices (LVADs) improve survival and quality of life in patients with advanced heart failure. Despite these benefits, combined post- and precapillary pulmonary hypertension can be particularly problematic in patients on LVAD support, often exacerbating right ventricular (RV) dysfunction. Both persistently elevated pulmonary vascular resistance and RV dysfunction are associated with adverse outcomes, including death after LVAD. These observations have led to significant interest in the use of pulmonary vasodilators to treat pulmonary hypertension and preserve RV function among LVAD-supported patients. Although pulmonary vasodilators are commonly used for the treatment of pulmonary hypertension and RV dysfunction in LVADs, the benefits of this practice remain unclear. The purpose of this review is to highlight the current challenges in managing pulmonary vascular disease and RV dysfunction in patients with heart failure on LVAD support.
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Sparrow et al. (2018) studied this question.
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