Frailty is a biological syndrome of impaired physiological and homeostatic reserve and heightened vulnerability to stressors, resulting from multiple morbidities, ageing and disability [94], occurring in nearly 10% of the patients in the INTERMACS Registry [95]. Frailty contains at least one of the following phenotype symptoms: shrinking, weakness, exhaustion, slowness and inactivity. No specific definition has been validated, with the exception of the Fried scale [94, 96]. Frailty leads to significantly longer duration of mechanical ventilation, length of stay and long-term mortality in patients with LT-MCS [47, 48, 95]. After LT-MCS implantation, regression of frailty may occur [97]. Advanced age is a risk factor for frailty and comorbidities. However, several retrospective studies revealed acceptable outcomes after LT-MCS implantation in the elderly. Therefore, age alone should not be used as an exclusion criterion for LT-MCS implantation [98, 99].