In this statement, we have generally refrained from using the designations of bridge to transplant and destination therapy in accordance with the more recent randomized trials in this field [2a]. This decision relates to the fact that, although a cardiac transplant is intended in the majority of LT-MCS recipients, only a minority will ever receive a donor organ in Europe. In a recent report of the ELEVATE (Evaluating the HeartMate 3 with Full MagLev Technology in a Post-Market Approval Setting) registry of more than 450 consecutive patients (mainly European) undergoing implantation of LT-MCS, only 2% received a transplant after 1 year, despite 26% of the patients receiving an implant as a destination therapy strategy [2b]. The latter also underscores the need for guidance of long-term management of MCS recipients, which consequently is an integral part of this statement.