 Heart transplantation is considered the gold-standard therapy for end-stage systolic heart failure but the shortage of donor hearts in Germany and other countries has led to widespread use of left ventricular assist devices LVAD. Even on the transplant list, patients condition often deteriorate due to worsening heart failure so that they need an LVAD as a bridge until transplantation. The high mortality one in five patients on the waiting list dies within 1 year reflects the severity of the disease. In comparison, technical progress has reduced the complication rate seen with assist devices and, according to recent data, mortality during LVAD support is low. Patient status prior to LVAD implantation is a strong indicator for postoperative outcome, i.e. patients in worse condition are more likely to develop complications. Thus, the comparison between the standard indication and early LVAD implantation T-status appears timely and clinically necessary. 