Left ventricular assist devices (LVAD) are increasingly implanted in advanced heart failure patients to improve survival and quality of life either as a bridge to transplant, bridge to recovery or as destination therapy. LVAD therapy is often accompanied by a profound lowering of pulmonary artery pressure due to mechanical unloading of the left ventricle. Persistent pulmonary hypertension (PH) after LVAD implantation increases the risk of right ventricular failure (RVF). In this context pulmonary vasodilators have been implemented: a) as a strategy to reduce afterload and wean patients with RVF from inotropes in the early postoperative period, b) as long-term therapy aiming to optimize right heart hemodynamics and prevent late RVF and c) in order to lower persistently elevated pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) after LVAD and enable candidacy for heart transplantation. However, considerable uncertainty exists regarding the risks and benefits of these strategies and practices vary widely among institutions. This article provides an overview of the available evidence and existing recommendations regarding the use of pulmonary vasodilators in LVAD recipients.

左心室辅助设备（LVAD）越来越多地植入晚期心力衰竭患者中，以提高生存率和生活质量，成为移植的桥梁，康复的桥梁或目的地疗法。由于左心室的机械负荷，LVAD治疗常伴有肺动脉压力的大幅降低。LVAD植入后持续的肺动脉高压（PH）增加了右心衰竭（RVF）的风险。在这种情况下，已实施了肺血管扩张药：a）作为减少术后负荷的后负荷并使RVF患者从正性肌力治疗中断奶的策略，b）旨在优化右心血流动力学并预防晚期RVF的长期治疗； c）旨在降低LVAD后持续升高的肺动脉压（PAP）和肺血管阻力（PVR），并可以进行心脏移植。但是，在机构之间，这些策略和实践的风险和收益存在很大的不确定性。本文概述了有关LVAD接受者使用肺血管扩张剂的现有证据和现有建议。