Patients with chronic biventricular failure with severe right ventricular failure are not good candidates for LT-MCS with LVAD therapy alone. Biventricular support with 2 blood pumps (implantable or extracorporeal) or implantation of a total artificial heart (TAH) should be considered. However, patients presenting with acute biventricular failure could initially be treated with a biventricular assist device (BiVAD) and may ultimately prove to be candidates for LVAD support only after a period of right ventricle (RV) unloading with a temporary right ventricular assist device (RVAD).