Acute cardiogenic shock has a mortality rate of 80–90%, that of chronic terminal heart failure is about 50%. For this reason, mechanical circulatory support systems were developed both for acute bridging of a potentially reversible cardiogenic shock and for longer term therapy in the form of a bridge-to-transplantation method. The application of a mechanical circulatory support method must be decided in close cooperation between cardiologist and heart surgeon if a cardiogenic shock or, despite optimal drug therapy and optimized preload, a severe underperfusion persists. As a matter of principle, a potential reversibility of the cardiogenic shock or a potential indication for heart transplantation should exist.