Bioprosthetic aortic valve changes late after insertion of a left ventricular assist device.

A 60-year-old man had his aortic valve replaced and a HeartMate II ventricular assist device (VAD) inserted; 18 months later, he received a heart transplant. The explanted heart had a grossly fibrotic appearance on the ventricular side, with scar tissue extending onto the cusps. VAD therapy can lead to both acute and chronic changes in the valves, which may be clinically significant.