ECHOCARDIOGRAPHIC EVALUATION OF PATIENTS WITH A LEFT-VENTRICULAR DEVICE

Limited donor heart availability is primarily responsible for the rene wal of interest in mechanical left ventricular assist devices (LVADs) as a bridge to transplantation. Donor availability is unlikely to incr ease significantly in the near future. Experience to date has shown th at many patients can be maintained long enough to undergo transplantat ion, and LVADs may be acceptable as alternate therapy in some who may not be candidates for transplantation. However, criteria for noninvasi ve evaluation of patients on LVADs have not been developed. In a prosp ective study using serial echocardiography, we found that aortic valve opening, aortic forward flow, nonlaminar flow in the left ventricle, and mismatch of Doppler derived cardiac output at the pulmonic valve a nd device output are associated with device malfunction. Echocardiogra phy was diagnostic in five of six patients with clinical instability u nrelated to the device. These findings suggest that echocardiography i s helpful in the routine evaluation of patients on LVADs.