Kaufman Center for Heart Failure Treatment and Recovery, Heart Vascular and Thoracic Institute, Cleveland, Ohio.
University General Hospital of Larissa, Department of Cardiology, Larissa, Greece.
J Card Fail. 2022 Dec;28(12):1733-1737. doi: 10.1016/j.cardfail.2022.06.001. Epub 2022 Jun 8.
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 challenges. Thus, improvement in LVAD technology should be coupled with innovative medical management to further reduce adverse events. We have previously shown a strong association 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, nevertheless, 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 efficacy and safety of PDE-5i use after implantation in patients with a centrifugal flow LVAD.
左心室辅助装置（LVAD）植入后，晚期心力衰竭患者的生存率得到提高，而供体心脏的稀缺性也显著增加了 LVAD 支持患者的数量。然而，尽管 LVAD 技术得到了改进，第三代连续流 LVAD 也问世了，但与血液相容性和卒中发生率相关的并发症仍然是临床面临的挑战。因此，LVAD 技术的改进应该与创新的医疗管理相结合，以进一步降低不良事件的发生。我们之前的两项观察性研究表明，LVAD 植入后使用磷酸二酯酶-5 抑制剂（PDE-5i）与血栓形成事件减少以及生存率提高之间存在很强的相关性。然而，我们提醒大家要谨慎使用 PDE-5i，并鼓励临床医生支持患者参与随机对照试验。一项随机对照试验将确定在使用离心流 LVAD 的患者中，植入后使用 PDE-5i 的疗效和安全性。
