Biventricular assist device (BVAD) has been shown to be effective for bridge to heart transplantation with an acceptability low incidence of adverse effects in critically ill heart failure patients. We report the case of a 44-year-old man with severe acute ischemic heart failure who was supported with the Thoratec paracorporeal biventricular assist system. After an initial uneventful postoperative course the patient experienced a splenic rupture which required a splenectomy. The pathological mechanism of this outcome remains unclear. Two months after discharge, the patient underwent heart transplantation and had no postsplenectomy sepsis or thrombotic complications at the last follow-up.