Abstract Mechanical circulatory support is of increasing interest because of its considerable demographic importance concerning myocardial failure and because of stagnant transplantation volumes. This study offers an overview of the present state of the art. Institutions with a mechanical circulatory assist program usually dispose of a decision chart for the various systems. There are devices with intra- or extracorporeal pump positions and with long- or short-term application. The various possibilities of mechanical circulatory assistance are presented, along with their technical properties, indications, and results. Currently, the application is concerned with technical reliability and limited biocompatibility with thrombembolic, neurological, and infectious complications. With some further developments, the present state of the art is supposed to enable a widespread application as bridging systems and as long-term therapy of heart failure within the next few years.