Advanced heart failure patients who are classified as bridge-to-transplant (BTT) often remain on mechanical circulatory support (MCS) for long durations due to the limited supply of donor organs. Here we present the outcomes of patients who have been supported by the HeartWare® ventricular assist device (HVAD®) system for more than two years. In the HeartWare BTT and Continued Access Protocol (CAP) trial, 74 of the 382 total patients (19.4%) had more than two years of MCS with a mean time of 1045 days on device. The long-term group was more frequently female, non-white, and had INTERMACS profiles 4 – 7. Post-implant adverse event rates including bleeding, cardiac arrhythmia, infection, stroke, renal dysfunction, and right heart failure were less frequent in the long-term cohort. In addition, the long-term cohort displayed significant improvements in KCCQ, EQ-5D, and six minute walk scores from baseline values. The rate of heart transplantation was lower for the long-term cohort which may have been a result of their sex and blood type. However, most of these patients are still listed for cardiac transplantation and maintained their quality of life profiles through three years of support.