Echocardiography (ECHO) is indispensable for evaluation of patients with
terminal chronic heart failure (HF) who require transplantation or mechanical
circulatory support by a left- or biventricular assist device (LVAD or BiVAD,
respectively). In LVAD candidates, ECHO represents the first-line investigation
necessary for a timely discovery of heart-related risk factors for potentially
life-threatening post-operative adverse events, including identification of
patients who necessitate a biventricular support. ECHO is also required for
intra-operative guiding of VAD implantation and finding of the most appropriate
setting of the device for an optimal ventricular unloading, postoperative
surveillance of the VAD support, and monitoring of the RV changes in LVAD
recipients. Thanks to the ECHO, which has decisively contributed to the proof
that prolonged VAD support can facilitate cardiac reverse remodeling and
functional improvement to levels which allow successful weaning of carefully
selected patients from LVAD or BiVAD, the previous opinion that chronic
non-ischemic cardiomyopathy (NICMP) is irreversible could be refuted. In patients
with normalized and stable right heart catheter-derived hemodynamic parameters
obtained at short-term interruptions of VAD support, ECHO has proved able to
predict post-weaning long-term freedom from HF recurrence in patients with
pre-implant terminal chronic NICMP. The purpose of this article is to offer an
actualized theoretical and practical support for clinicians engaged in this
particularly challenging and topical issue especially due to the new practical
aspects which have emerged in conjunction with the growing use of long-term
ventricular assist devices as bridge-to-transplantation or as destination
therapy, as well as the increasing evidence that, in some patients, such VAD can
become a bridge-to-recovery, allowing the removal of the device after a longer
support time.