Aortic Insufficiency following left ventricular assist device (LVAD) implantation can potentially limit the success of mechanical circulatory support. We examined the prevalence of significant aortic insufficiency in all patients after LVAD in the outpatient clinic at our institution. We analyzed the role of aortic valve opening in the development of aortic valve insufficiency. Currently, 121 patients are treated in our outpatient clinic with an HVAD (n=90) or HeartMate II (n=31) and were analyzed in a retrospective study. The mean age of the 14 female and 107 male patients was 55 ± 12. Ischemic cardiomyopathy was diagnosed in 42% of patients. All echocardiographic aspects thought to influence aortic insufficiency (AI) in these patients were analyzed. AI was considered significant if more than mild. Median LVAD support duration was 431 days. Significant AI were founded in 35 patients (29%). In 10 patients an AI had already shown before LVAD implantation. De novo AI occurred in median after 210 days of support. No patient presented severe AI. 11 patients had a prosthetic aortic valve with no significant AI developing in this group. Permanently closed aortic valve correlated with greater prevalence of aortic insufficiency when compared with complete or incomplete opening from aortic valve (P= 0.02). There was no significant difference between device flow in patients with or without aortic insufficiency. Etiology of the cardiomyopathy and the type of device had no significant influence to the development of aortic valve insufficiency. Aortic insufficiency has a high prevalence following assist device continuous flow support. Echocardiographic parameters are an integral part of ambulatory care of these patients and can guide the optimal setting from LVAD. Aortic valve that does not open should be avoided in order to prevent aortic insufficiency. Bioprosthetic aortic valve replacement is an adequate strategy for AI at VAD implantation.