While the introduction of novel heart failure (HF) therapeutics has improved the quality of life and survival in advanced HF patients, overall morbidity and mortality are still high. Patients with refractory end-stage HF may ultimately require either short or long-term mechanical circulatory support (MCS) or heart transplantation. Once the patient is deemed to have advanced HF and likely to benefit from advanced therapies, the optimal strategy for implantation should include selecting the most appropriate MCS device with the best durability and lowest incidence of adverse events and which provides adequate cardiac output for either one or both failing ventricles. This chapter provides an overview of the current indications and outcomes of MCS devices used in patients with advanced HF.