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End-stage heart failure is a public health problem affecting an increasing number of patients each year. The lack of donors is leading to increased use of ventricular assist devices (VAD) as a bridge to transplant (BTT). Among patients with advance heart failure, those with biventricular failure have the worst prognosis. Implantation of a total artificial heart (TAH) is an alternative to durable biventricular VAD support providing possibility of ambulatory care. In this report we present our experience with the implantation of the Syncardia TAH, the first in the area of Eastern Europe (worldwide 1741), in a patient awaiting transplantation with critical biventricular failure and very low cardiac output. The patient was a 47-old-year-male patient with end-stage heart failure due to virus-negative myocarditis refractory to conservative heart failure treatment and immunosuppression. For circulatory stabilization a peripheral veno-arterial extracorporeal membrane oxygenator (VA-ECMO) was implanted. Four days later the Syncardia TAH was implanted as a BTT strategy. Postoperatively the patient was anticoagulated systematically with acetylsalicylic acid 100 mg daily and warfarin with target INR 2-3.5. The postoperative period was complicated by stroke on post-operative day 5 and later by sepsis with hypotension and renal failure. Stroke presented as expressive aphasia and later resolved completely. After 67 days the patient was discharged with a portable console (Freedom driver) to ambulatory care. In our institutional programme we consider for TAH heart transplant candidates with biventricular failure and the need for a fast increase in cardiac output, malignant uncontrolled ventricular tachyarrhythmias, complex congenital heart diseases, and those with ventricular morphology unsuitable for LVAD implantation. [ABSTRACT FROM AUTHOR]