Pre-LT-MCS evaluation of pulmonary function is mandatory [107]. There is a high prevalence of chronic obstructive pulmonary disease among patients with HF that can lead to a worse prognosis. Restrictive abnormalities and/or altered alveolocapillary transfer may be a consequence of chronic pulmonary venous congestion. Re-evaluation after correction of fluid overload is recommended. To assess pulmonary hypertension, invasive haemodynamic assessment of pulmonary vascular resistance (PVR) is mandatory. Normalization of high PVR following LT-MCS support, thereby enabling a successful heart transplant (HTx), has been shown previously [108, 109].