This study evaluates the long-term outcomes of heart failure patients undergoing cardiac transplantation with prior left ventricular assist device (LVAD) use as a bridge-to-transplant (BTT) compared to direct-to-transplant (DTT). The findings indicate similar survival rates at 1 and 7 years post-transplant in both groups. Although LVADs increase surgical complexity and incidence of cerebrovascular events, they do not negatively affect overall outcomes, supporting their viability in advanced heart failure care.