**Figure 9.**

*Algorithm for the assessment and management of recurrent heart failure (HF) in the LVAD patient. Depending on the severity of the underlying lesion, patients may be hemodynamically stable or unstable at initial evaluation. In the unstable patient, a more targeted diagnostic evaluation should be performed to rapidly identify the cause of HF. LFT = liver function testing; CBC = complete blood count; LDH = lactate dehydrogenase; CT = computed tomography; ICD = implantable cardioverter defibrillator; SBRT = stereotactic body radiation therapy. LVAD-specific causes in red; intrinsic cardiac causes in blue; non-cardiac causes in yellow.*

### *Recurrent Heart Failure after Left Ventricular Assist Device Placement DOI: http://dx.doi.org/10.5772/intechopen.107022*

an RVAD after the initial operation. Concomitant RVAD implant was associated with >2-fold lower mortality vs. RVAD implant after completion of LVAD surgery [88]. In the IMACS registry, RVAD use was associated with substantially lower survival. Further, within the RVAD group, there was progressively worse survival with longer times between LVAD and RVAD surgery (1-year survival: LVAD only 82.9%; RVAD at time of LVAD implant, 58.5%; RVAD ≤14 days after LVAD, 51.6%; RVAD 15–30 days after LVAD, 32.4%) [30]. A major limitation of these studies is a lack of propensity matching and the inability to fully control for baseline differences, identifying an urgent area for future research.
