**7.3 AV replacement**

In patients with mixed stenosis or calcific pathology and insufficient AV, the valve can be replaced with a bioprosthesis. While allowing the possibility of AV opening, myocardial recovery, and pump removal, the limitations include a high risk of thrombosis, leaflet fusion, or stenosis [18, 21].

In post-LVAD patient management, AV structure and AI progression are monitored with routine echocardiography [75]. Intermittent AV opening was found to reduce the risk of AI development and improve LV systolic function and ejection fraction (especially in patients with preoperative short HF duration) [5, 6, 20, 22]. Optimization of pump speed (defined as the lowest possible LVAD support level to maintain adequate cardiac output and oxygen) is generally performed in case of mild AI to prevent worsening [6, 76]. If the patient's condition does not improve, surgical intervention will be performed. Approximately 5–10% of LVAD patients require AI-correction procedures after three or more years of LVAD support [6].
