Multimodality imaging for the evaluation and management of patients with long-term (durable) left ventricular assist devices

Left ventricular assist devices (LVADs) are gaining increasing importance as therapeutic strategy in advanced heart failure (HF), not only as bridge to recovery or to transplant but also as destination therapy. Even though long-term LVADs are considered a precious resource to expand the treatment options and improve clinical outcome of these patients, these are limited by peri-operative and post-operative complications, such as device-related infections, haemocompatibility-related events, device mis-positioning, and right ventricular failure. For this reason, a precise pre-operative, peri-operative, and post-operative evaluation of these patients is crucial for the selection of LVAD candidates and the management LVAD recipients. The use of different imaging modalities offers important information to complete the study of patients with LVADs in each phase of their assessment, with peculiar advantages/disadvantages, ideal application, and reference parameters for each modality. This clinical consensus statement sought to guide the use of multimodality imaging for the evaluation of patients with advanced HF undergoing LVAD implantation. Graphical Abstract Use of multimodality imaging for pre-operative, peri-operative, and post-operative evaluation of patients with left ventricular assist devices. AR, aortic regurgitation; AV, aortic valve; CT, computed tomography; CMR, cardiac magnetic resonance; LV, left ventricular; LVAD, left ventricular assist device; PET, positron emission tomography; PFO, patent foramen ovale; RV, right ventricular; TOE, transoesophageal echocardiography; TR, tricuspid regurgitation; TTE, transthoracic echocardiography.