Since its initial application in the pediatric patient population, the Berlin Heart EXCOR ventricular assist device has become a widely accepted form of mechanical circulatory support in Europe and the USA. The versatility of the device makes it ideal for pediatric patients because it can be tailored to the size and needs of the patient. In this review, we will explore the broad range of clinical applications of this device including bridge to cardiac transplantation, bridge to recovery, and bridge to bridge implantation where the need for cardiac transplantation may be unclear but long-term mechanical support may be required.