Mechanical circulatory support is an invaluable tool in the care of children with severe refractory cardiac failure. As the field of mechanical circulatory support has evolved in children, the frequency of ventricular assist device use has been increasing steadily with excellent results. Ventricular assist devices are being used with increasing frequency in children with cardiac failure refractory to medical therapy for primary treatment as a long-term bridge to recovery or transplantation. This review, part of the Pediatric Cardiac Intensive Care Society/Extracorporeal Life Support Organization Joint Consensus Statement on Mechanical Circulatory Support, focuses on ventricular assist device implantation and management, as well as anticipation and management of complications.