Despite improvements in surgical technique and perioperative myocardial preservation, a proportion of patients undergoing cardiac surgery are at risk of developing postoperative low output syndrome. Approximately 1% to 1.5% of patients undergoing cardiac surgery cannot be weaned from cardiopulmonary bypass despite adequate volume loading, metabolic stabilization, physiologic pacing, and full inotropic or intra-aortic balloon support [1, 2]. In addition, 10%–15% patients with acute myocardial infarction and subsequent cardiogenic shock , and up to 20% of patients awaiting cardiac transplantation , may be candidates for more extensive circulatory support. Circulatory support may be instituted for true ventricular “assistance” for post-cardiotomy, cardiogenic shock or as a “bridge” to cardiac transplantation when a donor heart is not immediately available. In the former case, the patient’s ventricle is expected to recover and in the latter it is not. An indeterminate number of those patients undergoing ventricular assistance will fail to recover myocardial function and by default will become part of the bridge to transplant group.