Mechanical cardiovascular support, especially through left ventricular assist devices (LVAD), has become an established therapy for chronic heart failure. The main indications are bridging to transplantation and, increasingly, destination therapy. Indications are based on clinical symptoms according to the InterMACS classification. In critically ill patients, there is the possibility of temporary heart support by installing a short-term support system for stabilization and decision-making before permanent support. For the current generation of LVADs, where the miniaturized, magnetically levitated pump is placed intrapericardially in the apex of the left ventricle, a 1-year survival rate of 80–85%, similar to heart transplantation, can be achieved. Potential complications include a risk of thromboembolism, bleeding, and device-associated infections.