Perspective:

The LVAD community certainly benefits from studies aimed at detecting device complications and improving device performance. At this time, however, no standard definition for ‘device optimization’ exists in the field of mechanical circulatory support (MCS), and data on morbidity or mortality are lacking to support intermittent aortic valve opening or speed adjustments used herein to guide LVAD speed adjustment. Likewise, there really is no standard definition for device thrombosis, aside from INTERMACS definitions of serum hemoglobin and definitive diagnosis in the form of pathology and device review at the time of LVAD explant. Diagnosis reliant on device confirmation of clot is fraught with bias, and many argue serum-free hemoglobin and/or LDH are insensitive or nonspecific. These issues aside, this analysis is a good foundation for using echocardiography to understand LVAD function and LVAD complications. Independent assessment, inter- and intra-observer variability of the above measurements, and positive and negative predictive values of the ‘optimal slope’ need to be examined in further study. Importantly, we need to know what defines optimal device function.