Late systemic (right) ventricular failure is common after the Mustard procedure for transposition of the great arteries (TGA), and mechanical circulatory support may be required for patients presenting with refractory heart failure; however, clinical experience with this approach is limited. We describe the use of the Impella 5.0 (Abiomed Inc., Danvers, Massachusetts) as a bridge to HeartMate 3 implantation in a highly sensitized patient with severe pulmonary hypertension following the Mustard procedure for TGA.