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A variety of modalities have been used to treat postoperative <jats:styled-content style=\"fixed-case\">RVF<\/jats:styled-content>, including management of volume status, intravenous inotropes and vasodilators, and right\u2010sided mechanical support. Inhaled vasodilator agents are a unique treatment option aimed at minimizing systemic absorption by delivering therapy directly to the pulmonary vasculature. Current <jats:styled-content style=\"fixed-case\">LVAD<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">CTX<\/jats:styled-content> guidelines endorse inhaled vasodilators for managing postoperative <jats:styled-content style=\"fixed-case\">RVF<\/jats:styled-content>; however, no guidance is offered regarding agent selection, dosing, or administration. A review of the current literature confirms that inhaled pulmonary vasodilator agents have been shown to decrease pulmonary artery pressure when used in the perioperative period of <jats:styled-content style=\"fixed-case\">CF<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">LVAD<\/jats:styled-content> implant or <jats:styled-content style=\"fixed-case\">CTX<\/jats:styled-content>. However, the literature regarding the potential impact on clinical outcomes (e.g., survival or risk of developing <jats:styled-content style=\"fixed-case\">RVF<\/jats:styled-content>) is lacking with these medications. Based on our assessment of the literature, we suggest that when <jats:styled-content style=\"fixed-case\">RVF<\/jats:styled-content> occurs in the setting of a normal pulmonary vascular resistance (<jats:styled-content style=\"fixed-case\">PVR<\/jats:styled-content>), traditional inotropic therapy (e.g., dobutamine) should be used. Conversely, if the <jats:styled-content style=\"fixed-case\">PVR<\/jats:styled-content> is elevated (&gt; 250 dynes\/sec\/cm<jats:sup>5<\/jats:sup> or 3 Wood units), or the patient has other evidence of a high right ventricular afterload (i.e., a transpulmonary gradient &gt; 12 mm Hg), then an inhaled pulmonary vasodilator would be the preferred initial pharmacologic agent. Drug selection depends largely on the institution's capacity to safely prepare and administer the medication, along with formulary considerations, such as the high costs associated with inhaled iloprost and inhaled nitric oxide.<\/jats:p>","DOI":"10.1002\/phar.1959","type":"journal-article","created":{"date-parts":[[2017,5,25]],"date-time":"2017-05-25T12:58:21Z","timestamp":1495717101000},"page":"944-955","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Inhaled Pulmonary Vasodilator Therapy for Management of Right Ventricular Dysfunction after Left Ventricular Assist Device Placement and Cardiac Transplantation"],"prefix":"10.1002","volume":"37","author":[{"given":"Leah A.","family":"Sabato","sequence":"first","affiliation":[{"name":"Heart Failure and Cardiac Transplantation Department of Pharmacy UC Health\u2010University of Cincinnati Medical Center Cincinnati 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