“It's not something that's really been brought up”: Opportunities and challenges for ongoing advance care planning discussions among individuals living with mechanical circulatory support

•MCS clinicians are the preferred individuals to initiate ongoing ACP conversations.•Establishing ACP as an iterative process is crucial to ongoing discussions.•Inviting MCS individuals to explore discrepancies in expectations enhances ongoing ACP.•Discussing the potential negative aspects of MCS is conducive to ongoing ACP communication.