Mechanical circulatory support devices (MCSD) include the use of extra corporeal circulatory support, implantable ventricular assist devices (VAD), and total artificial hearts. The need for smaller implantable devices, with control systems that facilitated return to community living, motivated the next generation of devices. The International Registry for Mechanically Assisted Circulatory Support (INTERMACS) has developed a classification system of heart failure (HF) that best identifies their urgency and status and is tailored to the indications of MCS. Careful selection of patients is a cornerstone in a successful VAD program. VADs provide left-, right-, or bi-ventricular support. MCSD are classified according to the duration of support, low characteristics, and/or pump mechanism. Preoperative preparation should focus on optimizing end-organ function and right ventricle (RV) function. Outpatient management represents more efficient use of health care resources and is of high importance for patient quality of life.