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Inhaled nitric oxide plus iloprost in the setting of post-left assist device right heart dysfunction
Theofani Antoniou1, Christos Prokakis, Georgios Athanasopoulos
1Department of Cardiac Anesthesiology, Onassis Cardiac Surgery Center, Athens, Greece.
The Annals of Thoracic Surgery
|June 26, 2012
Summary
Inhaled vasodilators, including nitric oxide and iloprost, effectively reduced pulmonary hypertension and improved right ventricular function in patients with left ventricular assist device implants, avoiding the need for mechanical support.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Medical Devices
Background:
- Pulmonary hypertension and right ventricular (RV) dysfunction are potential complications following left ventricular assist device (LVAD) implantation.
- Effective management is crucial to prevent adverse outcomes and the need for additional mechanical support.
Purpose of the Study:
- To evaluate the efficacy of inhaled vasodilators in reducing RV afterload in patients with RV dysfunction post-LVAD.
- To determine if this approach can obviate the need for temporary RV mechanical support.
Main Methods:
- A study involving 7 patients with RV dysfunction post-LVAD implantation.
- Treatment included inotropes, inhaled nitric oxide (NO), and iloprost.
- Hemodynamic parameters and tricuspid annular velocity were monitored before and during vasodilator administration.
Main Results:
- Inhaled vasodilators significantly reduced pulmonary vascular resistance (PVR), mean pulmonary artery pressure (MPAP), and RV systolic pressure.
- LVAD flow, LV flow rate index, and tricuspid annular velocity showed considerable increases.
- Combination therapy with inhaled NO and iloprost demonstrated an additive effect, significantly improving RV function.
Conclusions:
- Inhaled vasodilators, particularly the combination of NO and iloprost, effectively target the pulmonary vasculature.
- This treatment strategy sufficiently decreases PVR and MPAP, enhances RV function, and avoids the requirement for RV assist devices.
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