Reduction of Adverse Events With Phosphodiesterase 5 Inhibitors Post LVAD Implantation: Is It Time for a Randomized Trial?

The improved survival of patients with advanced heart failure after left ventricular assist device (LVAD) implantation together with the scarcity of donor hearts has significantly increased the population of LVAD-supported patients. However, despite the improvement in LVAD technology and the advent of third-generation continuous flow LVADs, complications such as those related to hemocompatibility and stroke rates remain ongoing clinical chal-lenges. Thus, improvement in LVAD technology should be coupled with innovative medical management to further reduce adverse events. We have previously shown a strong associa-tion between post LVAD implant phosphodiesterase-5 inhibitors (PDE-5i) use and fewer thrombotic events, as well as improved survival in 2 observational studies. We caution, never-theless, the use of PDE-5i based on these observations and encourage clinicians to support enrollment in a randomized control trial. A randomized control trial will determine the effi-cacy and safety of PDE-5i use after implantation in patients with a centrifugal flow LVAD. (J Cardiac Fail 2022;28:1733-1737)

Automated summary

The increased population of LVAD-supported patients and ongoing clinical challenges necessitate improvement in LVAD technology and innovative medical management. The use of post LVAD implant phosphodiesterase-5 inhibitors (PDE-5i) has shown a potential association with reduced thrombotic events and improved survival. However, further randomized control trials are needed to determine the efficacy and safety of PDE-5i in patients with centrifugal flow LVAD.