Patients with end-stage congestive heart failure that remain symptomatic despite optimal guideline-directed medical therapy may be candidates for orthotopic heart transplantation, mechanical circulatory support (MCS) devices as a bridge to transplant or as destination therapy, investigational studies, or palliative care.(1-3) While MCS as a bridge to transplant may improve hemodynamic function, stabilize or reverse end organ damage and improve wait-list mortality, the subsequent transplant procedure may be more complex and may impact post-transplantation outcomes.(2,4,5) While there is data to suggest that short-term mortality may be increased(6) and overall survival may be reduced in MCS as a bridge to transplant,(7) most studies demonstrate that both short term (typically defined as length of intensive care unit stay and overall hospital stay) and long-term outcomes (patient survival at 1, 3 and 5 years) are similar.(8-12)