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Introduction: In the setting of acute lung injury or Acute Respiratory Distress Syndrome (ARDS), prone positioning has been shown to convey survival and outcome benefits. Our aim is to prove the technical feasibility and benefit of this therapy in a patient with a total artificial heart (TAH). Case Report: We present the case of a previously healthy 29-year-old man who presented to the emergency room complaining of one week of hemoptysis, preceded by several months cough. He was found on chest CT to have multiple bilateral segmental pulmonary emboli and on echocardiography, severe bilateral ventricular dysfunction and evidence of pulmonary hypertension. On the second day of admission his hemodynamics acutely deteriorated; thus, he was emergently placed on venoarterial extra corporeal membrane oxygenation (ECMO). He never recovered biventricular function, and 9 days later a total artificial heart (Syncardia, Tuscon AZ) was implanted. The patient had remained intubated and ventilator dependent through all of this, while having persistent fevers and leukocytosis. He underwent repeated chest CT, revealing bilateral multifocal pneumonias. Due to limited improvement despite broad spectrum antibiotic therapy and intermittent bronchoscopy for bronchial toileting, he was placed in prone position in a Rotaprone Therapy System (KCI, San Antonio, TX) for a total of 5 days. There were no technical complications in regards to the patient's driveline or sternal incision. Hemodynamically, the patient had variations in flow and chamber filling at the extremes of rotation (left side or right side down), likely from the TAH compressing mediastinal structures. Repeat chest CT was performed one week after proning was complete showing no worsening of his lungs, with a repeat two weeks later demonstrating improvement in his pneumonias. Discussion and Conclusion: Prone positioning is feasible and manageable in the setting of the patient with a total artificial heart. While prone therapy remains widely debated in the realm of critical illness, we propose that its use should and must be studied and implemented in the setting of ventilator associated pneumonia as well as appropriate scenarios in patients with all means of mechanical circulatory support, such as total artificial hearts, ventricular assist devices, intra-aortic balloon pumps, and/or ECMO.