Heart failure remains a leading cause of morbidity and mortality in the United States. While heart transplantation remains the definitive treatment for patients with advanced disease, limited availability of healthy donor organs restricts this life-saving procedure. An alternative therapy is the use of mechanical circulatory support (MCS) devices to supplement native cardiac function using either ventricular assist devices (VAD), or, counterpulsation devices. Despite providing long-term support, VAD implantation is only offered to the sickest patients due to the invasive nature of the procedure (sternotomy, thoracotomy) and high complication rate. The intra-aortic balloon pump (IABP) is a counterpulsation device that functions by augmenting diastole leading to decreased cardiac workload and increased coronary perfusion. Due to its minimally invasive design and significant hemodynamic benefit, the IABP is the most commonly used device as a bridge to transplant. Nevertheless, IABPs were only designed for short-term use limiting their utility beyond the in-patient setting. The recent development of a novel ambulatory IABP device (iVAS NuPulse, Raleigh, NC) may expand the use of counterpulsation therapy to patients at home and provides a versatile minimally invasive solution that may avoid the complications associated with VAD placement. These benefits make this device ideally suited to provide a long-term solution that may function as a bridge to recovery or destination therapy.