The preoperative evaluation of advanced heart failure patients plays an essential role in therapy decision-making and is based on patients’ current condition and presence of comorbidities, potentially affecting future outcomes. The optimization of end-organ function may significantly improve the postoperative results and prevent potential adverse events, and, therefore, should be addressed in the preoperative setting. The relevant comorbidities can be divided into two large groups: cardiac and noncardiac conditions. An overview of such a delicate issue is herein reported, particularly focusing on portential left ventricular assist device (LVAD) recipients.