Using inhaled nitric oxide for a patient with pulmonary hypertension during biventricular assist device surgery in the operating room

Many patients experience hemodynamic collapse associated with severe heart failure despite receiving an optimal medical therapy. Therefore, mechanical circulatory assist devices, such as the intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation (ECMO) device, and ventricular assist device (VAD), are used. In this paper, we report the successful treatment of a 59-year-old male patient with heart failure awaiting heart transplantation. Medication therapy, IABP, and ECMO failed to stabilize his advanced heart failure; therefore, he was suggested to undergo biventricular assist device (BiVAD) implantation surgery as a “bridge” to transplantation. However, the blood flow generated by the VAD was inadequate due to elevated pulmonary artery pressure during surgery. Therefore, we used inhaled nitric oxide to treat pulmonary hypertension and to successfully increase the pulmonary blood flow during BiVAD-implantation surgery.