Mechanical circulatory support is necessary when heart failure becomes refractory to medical support. It is typically instituted when organ dysfunction occurs as a result of hypoperfusion. Enthusiasm has recently developed for the role of mechanical circulatory support in the ever-growing population of heart failure patients. Indeed, efforts in developing this technology have allowed for the relatively recent development of a variety of complete circulatory support devices. The use of left ventricular assist devices (LVADs) in patients with advanced heart failure results in a clinically meaningful survival benefit and an improved quality of life, and LVADs could be an acceptable alternative therapy for selected patients who are not candidates for cardiac transplantation.