Perspective:

The use of an iPVD like iEPO and iNO after OHT and LVAD implantation is common because RVF occurs frequently postoperatively and is associated with morbidity and mortality in the population. Existing evidence for use of these agents is limited by study heterogeneity, small sample sizes, protocol differences, and limited long-term follow-up. The current study adds significantly to the literature and directly compares two commonly used agents. The results provide evidence of equivalence between the therapies, and with the appeal of potential cost-savings with iEPO use, this may become a more attractive option. It is interesting to note that there was a nonstatistically significant signal toward higher mortality with iEPO use at longer follow-up. However, it is unclear if can be attributed to a therapy used only during the index hospitalization; more follow-up studies are needed to clarify this observation. It will also be important going forward to consider what patients are most likely to benefit from iPVD after major cardiac surgery to better target our interventions.