Heart failure (HF) is a condition in which the heart is not able to pump enough blood and oxygen required for organ systems to function. According to recent statistics from the American Heart Association (AHA), about 5.1 million people in the nation suffer from HF; one in nine deaths in 2009 included HF as a contributing cause. About half of people who develop HF die within 5 years of diagnosis. HF costs the nation an estimated $32 billion each year. This total includes the cost of health-care services, medications to treat HF, and missed days of work [1]. Despite several recent promising developments in medical therapy for HF, many patients still progress to advanced stages of HF. The annual mortality rate for patients with advanced HF remains high [2]. Heart transplantation (HT) is the definitive therapy for advanced HF, but it is limited by the availability of donors and strict recipient criteria applied to avoid poor outcomes. Therefore, the alternate treatment of mechanically supporting the ventricles, ventricular assist device (VAD) therapy, has gained an important role in the management of advanced HF (stage D). This chapter discusses the indications, contraindications, and various classifications of mechanical circulatory support (MCS) and individual features of commonly used VADs. Perioperative management of patients undergoing MCS will also be described in detail.