In individuals with end-stage left heart failure, a left ventricular assist device can save their lives. The pulmonary arterial pressure, wedge pressure, and pulmonary vascular resistances all fall as a result. Despite sufficient LV unloading, post capillary pulmonary hypertension remains in a considerable proportion of individuals. The pulmonary venous congestion and accompanying drop in nitric oxide levels could be one explanation. This finding has heightened interest in pulmonary vasodilators, particularly Phosphodiesterase 5 inhibitors (PD-5 I). They improve Nitric Oxide (NO) signaling by increasing the availability of cyclic guanosine monophosphate. Sildenafil has been shown to significantly reduce mPAP and PVR 2-4 weeks following LVAD installation and to wean from inotropic support within the first 72 hours, allowing the patient to be successfully intubated. However, while the research appears to support its usage in the early postoperative period, there are insufficient data on its long-term effectiveness.
