Background Optimal device for bridge to heart transplant (BTT) is unknown. We compared costs and complications associated with left ventricular assist device (LVAD) versus intra-aortic balloon pump (IABP) as primary BTT strategies, as well as outcomes one-year post heart transplant (HTx). Methods 11 IABP patients were matched with 11 LVAD patients by age ± 5 years, body mass index (BMI) ± 5 k g/m², and exact blood type. The mean age was 54±9 years, 18% were female, and mean BMI was 27±4 kg/m² (Table 1). Two IABP (18.2%) patients crossed over to LVAD or ECMO. Results Average cost of index hospitalization did not reach statistical significance between LVAD and IABP patients based on primary device modality (median[IQR]: 183[175-221] vs 241[218-261]) (p=0.065). Total BTT costs were higher for LVAD patients (449[379-657] vs 244[225-348]) (p=0.012) (see Figure 1). Complications are listed in Table 2. Eight (73%) LVAD and all IABP patients were alive at one year post-HTx (p=0.25). Other one-year outcomes from time of HTx were similar (Table 3). Conclusion BTT with LVAD compared to IABP is associated with higher costs. For patients who can be stabilized on IABP, IABP is a cost-effective method.