**Abstract**

A host of complications are common after left ventricular assist device (LVAD) surgery. Perhaps none is more challenging to manage than recurrent heart failure (HF). HF in an LVAD patient is associated with substantial morbidity and increased mortality. HF can occur early or late, can present abruptly or insidiously, and can be due to an array of LVAD-specific problems including pump thrombosis and cannula obstruction, or intrinsic cardiac problems such as right ventricular failure or valvular disease. These disparate etiologies require specific testing and distinct therapeutic strategies. This chapter reviews the causes of recurrent HF after LVAD surgery with particular attention to evaluation and management strategies that can identify and treat these distinct etiologies.

**Keywords:** LVAD, recurrent heart failure, right heart failure, outflow graft obstruction, valvular heart disease
