ADJUNCTIVE USE OF INHALED NITRIC-OXIDE DURING IMPLANTATION OF A LEFT-VENTRICULAR ASSIST DEVICE

Background: The aim of this study was to evaluate the efficacy of inha led nitric oxide in the prevention and reversal of pulmonary hypertens ion during and after left ventricular assist device implantation. Meth ods: Inhaled nitric oxide (20 ppm) was administered to seven consecuti ve patients undergoing implantation of a left ventricular assist devic e at the time of implantation and for the first 24 hours after operati on. Results: Withdrawal of inhaled nitric oxide at 24 hours after oper ation was associated with a significant rise in both the transpulmonar y gradient (from 8 +/- 1 to 14 +/- 2 mm Hg, p < 0.01) and in pulmonary vascular resistance (from 110 +/- 19 to 196 +/- 32 dynes.sec.cm(-5), p < 0.01). In two patients, the rise in pulmonary vascular resistance resulted in a critical fall in left ventricular assist device flow and hemodynamic deterioration, necessitating urgent reinstitution of inha led nitric oxide. Conclusion: The administration of inhaled nitric oxi de at the time of left ventricular assist device implantation prevents rises in pulmonary vascular resistance that in some patients result i n critical reductions in left ventricular assist device flow. We sugge st that inhaled nitric oxide is a useful adjunctive treatment that sho uld be routinely available at the time of left ventricular assist devi ce implantation.