The left ventricular assist device–outflow Doppler trace contains useful information. We analyze this signal during a venous arterial–extracorporeal membrane oxygenation (VA-ECMO) weaning trial in a patient after left ventricular assist device replacement (Heartmate-III; Abbott, USA), complicated by right ventricular dysfunction necessitating VA-ECMO support.

Compared to the left ventricle, a centrifugal continuous-flow left ventricular assist device pump is more afterload-sensitive but only minimally preload-responsive.1,2  The amount of flow generated at fixed pump speed (revolutions per minute) is inversely proportional to the pressure gradient across the pump head.

Reducing VA-ECMO flow during a weaning trial dramatically decreases afterload to the left ventricular assist device, resulting in increased left ventricular assist device flow by reducing the pressure gradient across the pump head. This is reflected by an increase in the pulsed-wave Doppler baseline (Panels A and...

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