The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Thomas Cascino reports a relationship with National Heart Lung and Blood Institute that includes funding grants. Dr Cascino reported receiving grants from Johnson & Johnson outside the submitted work. Dr Cowger reported receiving consultant fees from the Abbott Publication Committee during the conduct of the study; fees from Abbott Inc for membership on the advisory board, travel-related compensation, and as a speaker (all for LVAD devices); serving on the steering committee for Tendyne and Cephea Valves, and principal investigator and consultant fees from Medtronic (HVAD device); receiving nonfinancial support from BiVACOR data safety and monitoring board; receiving nonfinancial support as a consultant from Corwave outside the submitted work; and Henry Ford Health received money in support of the MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3 clinical trial and the ARIES trial, both of which are studies of the HeartMate 3 LVAD. Authors would like to thank Drs Francis D. Pagani and Donald S. Likosky for their important contributions to the paper. The project was supported by funding from the 10.13039/100000002National Institutes of Health, 10.13039/100000050National Heart, Lung, and Blood Institute K12 HL138039-02 to Dr Cascino.