Conditions: Congestive Heart Failure
Keywords: Left Ventricular Assist Device Implantation Progressive Left Ventricular Failure
Allocation: RANDOMIZED | Intervention model: PARALLEL
Enrollment: 150
Healthy volunteers: no

Brief summary:
The purpose of this study is to assess the utility of nitric oxide for inhalation during left ventricular assist device (LVAD) implantation following cardiopulmonary bypass (CPB). This is to be assessed by the number of patients in each treatment group meeting failure criteria within 24 hours on study drug, as defined by two or more of the following:

* Left ventricular flow rate index (LVFRI) ≤ 2.0 L/min/m\^2
* Administration of ≥ 20 inotropic equivalents (IE)

  * 10 µg/kg/min dopamine, dobutamine, enoximone or amrinone is equivalent to 10 IE
  * 0.1 µg/kg/min epinephrine or norepinephrine is equivalent to 10 IE
  * 1 µg/kg/min milrinone is equivalent to 15 IE
  * 0.1 U/min vasopressin is equivalent to 10 IE
* Mean arterial pressure (MAP) ≤ 55 mmHg
* Central venous pressure (CVP) ≥ 16 mmHg
* Percent mixed venous oxygen saturation (SvO2) ≤ 55%

Or at least one of the following criteria:

* Failure to wean from cardiopulmonary bypass at least once due to hemodynamic failure. Re-initiation of cardiopulmonary bypass to correct bleeding or other technical issues will not be considere 'failure to wean'
* Death

Detailed description:
40 ppm of either nitric oxide for inhalation or N2 (placebo) will be continuously administered to the patient starting at least 5 minutes prior to initiating the first weaning attempt from CPB and continue until the patient is either extubated, has reached failure criteria, or has been treated with study drug for 48 hours following discontinuation of CPB, whichever come first.

All patients will be monitored peri-operatively with a pulmonary arterial line, central venous line, and systemic arterial line. Baseline data collection by a designated clinical staff member will begin following induction of anesthesia and prior to skin incision. Following a successful wean from cardiopulmonary bypass, post-op data will be collected within 1 hour following end time of surgery. Data will then be collected at 6, 12, 18, 24, and 48 hours from post-op or until extubation, in which case weaning from study drug will begin.

Open label investigational nitric oxide for inhalation may be administered once a patient meets a minimum of two of the failure criteria or fails to wean at least once due to hemodynamic failure from cardiopulmonary bypass.

Arms:
arm 1: Inhaled Nitric Oxide (iNO) at 40 parts per million (ppm) arm 2: Nitrogen (N2) administered at 40 ppm.

Interventions: intervention 1: Nitric Oxide intervention 2: Nitrogen
Intervention descriptions: intervention 1: 40 ppm of Nitric Oxide continuously administered for 48 hours intervention 2: Nitrogen (N2) administered at 40 ppm for 48 hours

Protocol document: