“…There are significant potential risks with HTx and mechanical circulatory support, as described within the ISHLT and the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS Registry). 43,48 Perioperative, early postoperative and long-terms risks to transplantation (including risks of antibody and cell-mediated rejection, among others) and risks with VADs (bleeding, the acquisition of von Willebrand syndrome following continuousflow VAD placement, infection (particularly drive-line related), thromboembolic events, VAD thrombosis and the potential for worsening aortic valve insufficiency), must be discussed with patients. It is therefore imperative to seek early involvement from transplantation centres to access advanced HF expertise.…”