The benefits of left ventricular assist device (LVAD) therapy in advanced heart failure are clear—device implantation can prolong patient survival, enhance functionality, and improve quality of life.1 Since US Food and Drug Administration approval of the first continuous-flow LVAD in 2008, utilization has grown rapidly, and now, >2500 devices are placed annually.1 Given the current epidemic of heart failure, this volume may only be scratching the surface. Current estimates suggest that there are upwards of 250 000 to 300 000 potential LVAD candidates in the United States alone.2 Despite technological and design advances, broader application of LVAD therapy remains limited in part by its relatively high rate of adverse events (AEs). Six-month freedom from rehospitalization is only 40%, whereas 70% of patients will experience an AE within the first year of support.1 See Article by Levin et al In this issue of Circulation : Heart Failure , Levin et al retrospectively described hemolytic events of HeartMate II (St. Jude Medical, Pleasanton, CA) patients at 2 large academic medical centers. Specifically, they compared outcomes for patients with hemolysis managed with surgical versus medical therapy, to determine the most effective strategy.3 Their findings were humbling. One-year freedom from stroke or death was 87.5% and 49.5% in the surgical and medical cohorts, respectively. Resolution of primary hemolysis without stroke, death, or recurrent hemolysis was only 44% in patients treated with medical therapy, compared to 63% in patients treated operatively. Even more sobering is the realization that the surgical cohort first failed medical therapy, and thus, the true treatment response to medical therapy alone was a paltry 29%. In summary, the principal finding was that for patients meeting the author’s definition of hemolysis, a surgical strategy (after failed medical intervention) resulted in less death or stroke than a medical strategy alone, …