Non-pulsatile left ventricular assist device (LVADs) systems have attained more interest for long-term use. We present the results of mechanical circulatory support (MCS) with pulsatile and non-pulsatile LVAD in use in patients for more than 1 year. Between February 1999 and February 2006, 48 patients (mean age, 51; range, 20-72 years) received an LVAD: 24 each had pulsatile (Group A) and non-pulsatile MCS (Group B). Mean support time was 862 days (range, 366-1876 days) in Group A, and 631 days (range 368-1129 days) in Group B. In Group A, 20 patients (80%) were at home for more than 1 year, in Group B, 21 patients (88%). Five VAD-related complications occurred (4 pump exchanges, 1 controller exchange). Echocardiography showed better LV unloading, and the LV end-diastolic diameter was significantly lower in Group A (60 mm) than in Group B (69 mm). Neither the number of driveline/cannula infections nor the number of bleeding and embolic complications differed significantly between groups. Thirty-two patients received heart transplants, 11 died, and 5 still have the VAD. Although echocardiographic data show that pulsatile LVADs seem to better unload the LV, this could not be confirmed by data from right ventricle catheterization. Owing to sufficient LV unloading, longer device durability, less need of anticoagulation therapy, and greater quality of life, non-pulsatile devices are preferred for long-term use. Nevertheless, both systems can be used with good quality of life and an acceptable rate of complications for extended periods of time.