This report describes the first known presentation of illness secondary to SARS-CoV-2 in a patient with long-term LVAD support. At the time of writing, the patient remains critically ill; however, there has been clinical improvement. Recent evidence suggests that patients with cardiovascular comorbidities seem to be at increased risk of morbidity and mortality with COVID-19.2 Notably, prior studies have shown that cellular immunity is compromised among long-term LVAD recipients.3 , 4 This “functionally immunocompromised state” may in part explain the patient's rapid clinical deterioration and prolonged critical illness after infection with SARS-CoV-2. Increased susceptibility to viral infections, particularly COVID-19, in the setting of LVAD has not been reported previously in the literature. Furthermore, this case highlights an important consideration for the management of ARDS, as the safety and efficacy of prone positioning in the presence of LVAD is currently unknown. Finally, we propose the establishment of a COVID-LVAD registry to further understand the impact of COVID-19 on this advanced heart failure population.