A 37-year-old man suffered from systolic heart failure as a result of idiopathic dilated cardiomyopathy since 1995 and was followed up in our cardiology department. In June 2006, the patient arrived at our outpatient clinic with an acute renal impairment and all manifestations of acute heart failure. He was already registered on the waiting list for heart transplantation (Eurotransplant) as a highly urgent request. The patient underwent heart transplantation but the reperfused allograft was totally akinetic and we decided to place a biventricular assist device immediately. The patient fully recovered after seven days of biventricular circulatory support and was discharged on the 38th day after the transplantation. Three years later, he is in good general condition without any manifestation of rejection. We conclude that biventricular assist device implantation is a good indication after post-cardiotomy failure and it should be started as early as possible before shock and possible irreversible organ damage.