AIMS The Berlin Heart EXCORAdult biventricular assist device (BiVAD) is an approved mechanical circulatory support for patients with end-stage biventricular heart failure. In this prospective post-market clinical follow-up study, we present the first clinical experience of the new EXCORAdult pump with bileaflet (BL) valves in Europe. METHODS AND RESULTS After CE-mark approval in August 2014, a total of 12 patients were enrolled with a mean age of 44 years ± 11 (range 21-58 years). The majority of patients (n = 11) were in INTERMACS level 1 or 2. Eight patients had a median pre-operative extracorporeal life support (ECLS) of 6 days (range 1-37 days). Primary end point was survival, either to heart transplantation (HTx), recovery or alive at 12 months on device, whichever occurred first. Secondary end point was the number of adverse events throughout EXCORBiVAD support. Median support time up to last follow-up on EXCORBiVAD device was 248 days (range 57-381 days) and patient survival at 1 year was 92%. Half of the EXCORBiVAD patients (n = 6) were transplanted and five patients were still on support at 1 year post-implantation. Complications during EXCORBiVAD support were thoracic bleeding, exit site infection and ischemic cerebrovascular incidents in three cases, respectively. CONCLUSION The new EXCORAdult pump with BL provides pulsatile high cardiac output with excellent outcome and successful bridging to HTx, particularly in critically ill patients with INTERMACS level 1 or 2 at the time of implantation.