Ventricular assist devices (VADs) are associated with conditions that may complicate the perioperative course of pediatric heart transplants. A 7-year-old girl with dilated cardiomyopathy supported by a Toyobo-NCVC left VAD (Toyobo-National Cardiovascular Center, Osaka, Japan), a pulsatile extracorporeal device, and preoperatively anticoagulated with warfarin presented for orthotopic heart transplant. The course was complicated by persistent bleeding treated with prothrombin complex concentrate and refractory postbypass vasoplegia treated with methylene blue. Preoperative anticoagulation and the presence of a VAD are associated with postbypass coagulopathy and vasoplegia. We describe a case in which these conditions were successfully treated with no thrombotic complications and minimal need of vasopressors for hemodynamic stability.