In the past 5 years, the numbers of ventricular assist device (VAD) systems implanted worldwide have increased exponentially. Thus, since the introduction of the HeartMate II LVAD by Thoratec (Thoratec Inc., Pleasanton, CA, USA) over 10 000 of these pumps have been implanted. The HVAD manufactured by HeartWare (HeartWare Inc., Framingham, MA, USA) has also found widespread application in Europe, and particularly in Germany, before it has even been approved for the US market. The driving force behind the spread of this form of treatment for terminal heart failure was, in the first place, not only the increasingly good results found in studies, but also the results achieved in broad clinical routine with the application of these systems, which have been further developed since VAD use began. The 6-month survival in bridge-to-transplant patients, for example, rose to 93% [1], whereas in 2008 a rate of 82% was reported [2].