The main cause of death during the early phase of MCS. Moreover, pre-implant levels of IL-6 have been associated with hemodynamic status, as defined by Interagency Registry for Mechanically Assisted Circulatory Support profiles, with higher levels in patients presenting critical INTERMACS profiles. Since the signal pathways, IL-6-dependent, and specific monocyte attracting chemokines, such as IL-8, are proposed as crucial triggers in controlling monocyte activation, an important condition in the development of MOF and of haemostatic complications, it can be assumed that they play a critical role in affecting outcomes during the early phase of LVAD support. The aims of this study were to assess whether preoperative IL-6, IL-8 and neopterin levels affect postoperative inflammatory response and short-term outcomes in LVAD-recipients. The main findings of this study may be summarized as follows: 1) ESHF-patients supported by LVAD with preoperative IL-6 levels higher than 8.3 pg/mL are more susceptible of poor early outcome, longer ICU stay and hospitalisation, when compared to patients with lower IL-6 levels; 2) postoperatively, LVAD-patients with IL-6 levels higher than 8.3 pg/mL showed a more pronounced neopterin and IL-8 release, and MOF severity. Recent advances in MCS, specifically implantable CF-LVAD therapy, are providing alternatives for patients waiting for heart transplantation, for patients who are HT ineligible or anticipated to experience recovery after LV-unloading. Every centre involved in advanced HF treatments has to evaluate patient specific risk profile according to one’s own experience and to data reported by larger studies. With worsening of clinical status, the need for LVAD increases as well as the peri-operative risk, and optimal operative timing becomes difficult. In this setting, clinical indications, absolute or relative contraindications are not universally accepted because of contrasting published data. With regard to risk stratification in ESHF-patients, little is known about baseline inflammatory profiles and their impact on clinical outcome and prognosis, and it’s reasonable to speculate a role of inflammatory system on the outcome of these fragile patients. In the present study, pre-implant levels of IL-6, IL-8 and neopterin were investigated to evaluate the impact of these monocyte-related inflammatory mediators on the inflammatory response and outcome in LVAD patients. IL-8, a known chemokine attracting monocyte on endothelial cells, neopterin, a pteridine produced by PI-103 activated macrophages, and IL-6-dependent signals, mainly associated to progression of HF, are proposed as crucial triggers in controlling monocyte activation and recruitment in vascular inflammation and endothelial dysfunction, important factors for development of MOF. Moreover, neopterin is a key pteridine that links inflammation and redox state in heart failure. Indeed macrophages, stimulated by interferon-gamma, generate neopterin that interferes with reactive species, such as peroxynitrite, inducing myocardial contractile failure. However, in our cohort of LVAD-candidates, only patients with preoperatively elevated IL-6 levels.