Home discharge with the total artificial heart (TAH) necessitates a shift in focus to quality of life in the TAH patient (pt) including functional ability. The purpose of this study was to evaluate the cardiorespiratory responses to graded exercise in pts with the TAH compared to both advanced heart failure (HF) and LVAD pts.A retrospective study was conducted on previously gathered data of TAH, LVAD and HF pts who underwent symptom-limited cardiopulmonary exercise testing (CPET). Clinical data was abstracted from the medical record and ANOVA was performed to compare groups.Fourteen TAH pts safely underwent treadmill CPET with results listed in Table 1 including p-values indicating significance. Clinical characteristics were similar between groups except for hemoglobin and BMI. Peak oxygen consumption (VO 2 ), %pred. VO2, VAT, %pred. VO2 @ VAT, OUES, and peak MAP were significantly lower in the TAH compared with LVAD and HF groups. Hemoglobin was also significantly lower in the TAH pt. Peak RER was significantly higher and a trend towards an elevated VE/VCO2 slope was noted in the TAH. Waveform analysis was available for 11 TAH pts wherein 9 out of 11 exhibited a full-fill pattern at peak exercise.This is the first study to examine maximal exercise capacity in a group of TAH pts. Exercise capacity is significantly reduced in the TAH pt below that observed in LVAD and advanced HF. Although the TAH provides excellent cardiac output, limitations to performance on the CPET may be related to persistent anemia and limited ability of the pump to modulate output for activity. These data also provide a baseline for expected functional status and has implications on the ADL tolerance of these individuals.