Background: The purpose of the present study was to determine the impact of preoperative percutaneous cardiopulmonary support (PCPS) on long-term survival following implantation of a left ventricular assist device (LVAD). Methods and Results: Between 1999 and 2010, we used implantable (n=12) and paracorporeal (n=91) LVADs in 103 consecutive cardiomyopathy patients as a bridge to transplantation. Prior to LVAD implantation, all patients received inotropes, and 25 patients (24%) received PCPS because of cardiogenic shock. Postoperatively, there were no early mortalities within 30 days after surgery, and patients survived on LVAD for 560±391 days, of whom 9 patients recovered and 32 underwent heart transplantation after 711±360 days of LVAD support. More patients with preoperative PCPS required nitric oxide inhalation and prolonged inotropic support to maintain adequate LVAD flow. In addition, bilirubin level at 1 month after LVAD implantation was significantly higher in patients with preoperative PCPS. Cox regression analysis identified preoperative PCPS support as the only significant predictor for death after LVAD implantation and overall survival was significantly better in patients without preoperative PCPS. Conclusions: Despite adequate hemodynamic support after LVAD implantation, patients with preoperative PCPS had significantly worse survival. LVAD should be used for patients with end-stage heart failure, before PCPS is required for hemodynamic support. (Circ J 2012; 76: 88-95)