Nearly 2 decades after the seminal REMATCH trial1 first demonstrated a marginal survival benefit in transplant-ineligible patients treated with an implantable left ventricular assist device (LVAD), contemporary 1-year LVAD survival exceeds 80%. With improved outcomes and quality of life, LVAD use has proliferated, with more than 15 000 implantations since 2006 and an annual implantation rate exceeding 2000 per year across an ever-growing number of implanting centers.1,2 While most current LVADs are implanted as a bridge to cardiac transplantation, an increasing proportion of patients with end-stage heart failure are consenting to indefinite mechanical circulatory support (MCS) therapy. With an increasing prevalence of advanced heart failure in an aging population, this trend is expected to continue.