Mechanical circulatory support for end-stage heart failure has become routine and is now increasingly used as definitive treatment. Several small devices qualify for this purpose, but only a few have gained US Food and Drug Administration (FDA) approval as yet. Several studies, including the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) study, the Investigation of Non-transplant-Eligible Patients Who Are Inotrope Dependent (INTrEPID) and the HeartMate (HM) II trial have confirmed a significantly improved quality of life and functional capacity after device placement. However, cerebrovascular events, infection and device malfunction still pose a considerable risk to patients and hinder widespread use.