Shortage of donors enhances harvesting of borderline hearts. When such organs fail, a ventricular assist device may salvage the patient waiting for either recovery or for retransplantation. We describe a series of 12 patients who required circulatory support following orthotopic heart transplantation, with the use of four different devices. Four patients survived. The aim of this study is to define: (1) what is the best timing for implantation; (2) which is the best ventricular assist device in this indication; and (3) a subgroup of acute right heart failure with a specific outcome.