Echocardiographic Findings in Stable Outpatients with Properly Functioning HeartMate II Left Ventricular Assist Devices Yan Topilsky, MD, Jae K. Oh, MD, Fawn W. Atchison, MD, PhD, Dipesh K. Shah, MD, Valentina M. Bichara, MD, John A. Schirger, MD, Sudhir S. Kushwaha, MD, Naveen L. Pereira, MD, and Soon J. Park, MD, Rochester, Minnesota Background: Continuous-flow left ventricular assist devices (LVADs) have become part of the standard of care for the treatment of advanced heart failure. However, knowledge of normal values for transthoracic echocar- diographic examination and measurements in these patients are lacking. Methods: All transthoracic echocardiographic examinations in 63 consecutive patients, performed 90 and 180 days after surgery with the implantation of a HeartMate II continuous-flow LVAD between February 2007 and January 2010, were retrospectively analyzed. All patients had to be outpatients at 3 and 6 months after surgery and considered stable on LVAD therapy (New York Heart Association class I or II and no need for inotropes, intravenous furosemide, or hospitalization). Results: End-diastolic and end-systolic diameters and left ventricular mass decreased considerably compared with baseline measurements before LVAD implantation. Mitral inflow deceleration time increased (188 6 70 vs 132.5 6 27 msec, P = .009) and left atrial volume (84.1 6 33 vs 141.7 6 62 mL, P = .003) and E/e 0 ratio decreased (20.3 6 9 vs 26 6 11, P = .01), all consistent with decreased left ventricular filling pressure. Estimated right ventricular (RV) and right atrial pressure decreased significantly (34.1 6 10 vs 51.7 6 14 mm Hg and 9.5 6 5 vs 14.4 6 5 mm Hg, respectively, P < .0001 for both). Quantitatively estimated RV function (P = .02), RV fractional area change (27.9 6 10% vs 37.4 6 10.9%, P < .0001), and the RV index of myocardial performance (0.32 6 0.1 vs 0.65 6 0.2 vs 0.32 6 .01, P < .0001) improved, suggesting improved RV efficiency. LVAD therapy resulted in significant decreases in the severity of mitral regurgitation. Tricuspid regurgitation improved in patients who had concurrent tricuspid surgical correction and was unchanged otherwise. Aortic regurgitation severity in- creased 3 months after LVAD implantation. There were no significant differences in any of the echocardio- graphic parameters in the 6-month evaluation compared with the 3-month evaluation. Conclusions: This is the first report of selected typical echocardiographic values in a group of stable patients with normally functioning HeartMate II continuous-flow LVADs. A stable functioning continuous LVAD is associated with evidence of efficient unloading of the left ventricle, improved RV function, significant improve- ment in mitral regurgitation, improvement in tricuspid regurgitation only in patients undergoing repair, and increased aortic regurgitation. These normal data provide a basis for future echocardiographic studies after LVAD implantation. (J Am Soc Echocardiogr 2011;24:157-69.) Keywords: Left ventricular assist device, rpm Left ventricular (LV) assist devices (LVADs) are designed for mechanical support for patients with severe systolic heart failure. LVAD therapy provides effective long-term circulatory support as a bridge to transplan- tation or as destination therapy. 1-4 In most cases, axial flow pumps have replaced pulsatile LVADs because they have been shown to have improved survival and have less device failure. 5,6 Recently, the HeartMate II continuous-flow assist device (Thoratec Corporation, Pleasanton, CA) was approved for use as a bridge to transplantation or as destination therapy by the US Food and Drug Administration. Preoperative and postoperative transthoracic echocardiography has a major role in the management of patients with LVADs. Transthoracic echocardiography is frequently used to assist in patient selection for LVAD therapy, evaluation of proper native heart and LVAD function, and troubleshooting for possible device malfunc- tions. 7-11 Although continuous LVAD therapy has been in clinical use for a number of years, a comprehensive summary of normal values for the different echocardiographic measurements in these patients has not been reported to date. We report here for the first time echocardiographic parameters, including LV linear dimensions, chamber areas, valvular function, and Doppler evaluation, obtained From the Division of Cardiovascular Diseases (Y.T., J.K.O., V.M.B., J.A.S., S.S.K., N.L.P.), the Division of Cardiovascular Surgery (D.K.S., S.J.P.), and the Department of Anesthesiology (F.W.A.), Mayo Clinic, Rochester, Minnesota. Reprint requests: Soon J. Park, MD, Mayo Clinic, St. Marys Hospital, 2nd Street SW, GO-138SE, Rochester, MN 55902 (E-mail: park.soon@mayo.edu). 0894-7317/$36.00 Copyright 2011 by the American Society of Echocardiography. doi:10.1016/j.echo.2010.12.022 157