Real-Time 3-Dimensional Echocardiographic Assessment of Current Continuous-Flow Rotary Left Ventricular Assist Devices

Mechanical circulatory support has emerged as a valuable solution for the management of patients with end-stage heart failure either being used as a bridge to transplant/recovery or as destination therapy. As the field is advancing toward a broader spectrum of applications, mechanical and anatomic complications of the surgical procedure have been quickly overcome with experience and comparative outcomes. Echocardiography has contributed tremendously to this process, playing an important role in the perioperative evaluation of the device and timely predicting and consequently avoiding potential pitfalls. Although specific echocardiographic considerations might be applied to every device (Table 4), a routine stepwise examination involves (1) ventricular and device deairing, (2) competency of the device, and (3) cannulae alignment and patency. Although complementary and supplementary to 2-dimensional imaging, the interrogation of cannulae positioning and alignment has been improved significantly and simplified by the introduction of RT3D echocardiography. Intraoperative RT3DE not only provides improved accuracy and reproducibility of ventricular volumes and function, but has also provided better understanding of ventricular spatial relationships. In conclusion, the present authors think that RT3D echocardiography will be used routinely for perioperative planning and assessment of LVADs and as a guiding tool for several percutaneous procedures, among them the percutaneous implantation of certain types of LVADs (TandemHeart, Fig 5). In the setting of LVAD implantation, there is currently enough evidence to support the addition of 3-dimensional imaging to traditional 2-dimensional echocardiography in 2 particular scenarios: (1) quantification of LV volume and ejection fraction and (2) complete interrogation of the inflow and outflow cannulae.