Vericiguat Use in Right Heart Failure Management Following Left Ventricular Assist Device Implantation: A Case Report

Right heart failure (RHF) is a major cause of mortality in patients using left ventricular assist devices (LVADs). Vericiguat, an oral soluble guanylate cyclase stimulator, has recently been used to treat chronic heart failure (HF) with a reduced ejection fraction (EF) and is expected to improve RHF owing to its pulmonary vasodilatory and inotropic properties in patients with an LVAD. A 62 year old woman with advanced HF due to cardiac sarcoidosis was transferred to our center with HF recurrence and left ventricular (LV) thrombosis. Since her status became inotropic-dependent post-thrombectomy, an LVAD was implanted. Right heart catheterization before LVAD implantation suggested combined pre- and post-capillary pulmonary hypertension. Postoperative RHF requiring a temporary right VAD (RVAD) was noted. Despite the administration of oral inotropes and pulmonary artery vasodilators, including pimobendan and sildenafil, the low cardiac output associated with RHF persisted post-RVAD withdrawal. Upon the addition of vericiguat, her cardiac output increased and RHF improved; moreover, the interventricular septal position was optimized. Treatment strategies for RHF after LVAD implantation are limited; therefore, vericiguat may be an additional therapeutic option for RHF in patients with an LVAD.