Invasiv mechanical circulatory support is the approach for cardiogenic shock, either till recovery or as bridge to transplantation. The five most common ventricle assist devices including the total artificial heart have been used in more than 500 cases worldwide. The international registry reports 219 assisted cases with primary intention of transplantation. Heart transplantation was performed in 159 patients (73%) resulting in 99 (45%) hospital survivors. However, a broad armentarium of mechanical circulatory support systems is required to achieve improved clinical results.