Discussion:
Secondary aortic regurgitation is a recognizable complication occurring after cf-LVAD implantation [2]. Severe enough, it can affect the hemodynamic performance of the LVAD manifesting with signs of end-organ hypoperfusion. Combined with right ventricular insufficiency, less invasive therapeutic options like TAVI seemed adequate but were not possible, and although high risk, the patient was listed for urgent heart transplantation which took place a few months later. The operative and postoperative course was unremarkable with gradual recovery of kidney function and marked improvement of patient symptoms.