Splanchnic Vein Doppler After Left Ventricular Assist Device Implantation: A Bedside Tool for Assessing Decongestion and Organ Recovery

Noninvasive methods to assess venous congestion and guide decongestion early after left ventricular assist device implantation remain limited. In this prospective, proof-of-concept study, we evaluated whether serial splanchnic venous Doppler assessments reflect changes in fluid balance and organ function in the early postoperative period. Twenty consecutive patients underwent Doppler evaluation of hepatic, portal, and intrarenal veins, along with focused echocardiography, at two time points within the first postoperative week. Clinical, biochemical, and device parameters were recorded concurrently. Patients achieved a significant negative fluid balance (median Δ = -6034 ml [interquartile range -8145 to -3476]) accompanied by consistent improvement in Doppler flow patterns and a reduction in venous excess ultrasound score (p < 0.001). Changes in renal and portal vein Doppler patterns showed moderate associations with net fluid balance, whereas conventional indices such as central venous pressure and inferior vena cava diameter did not. Renal function improved, and right ventricular performance demonstrated parallel recovery. Splanchnic venous Doppler assessment is feasible early after left ventricular assist device implantation and reflects dynamic changes in fluid balance, renal function, and right ventricular performance. These findings suggest that venous Doppler ultrasound may provide a physiologic, bedside method to guide decongestive therapy in this complex population, warranting validation in larger, protocol-driven studies.