Abstract: Different mechanical circulatory support systems (MCSS) have been in clinical use since 1987 to keep patients alive by assisting the heart during cardiac recovery after open heart surgery, myocardial infarction, acute graft failure after heart transplantation, or as a bridge to transplantation in heart transplant candidates. Four different hospitals in Germany used the Berlin Heart Assist Device. Up until 1993, there were 22 patients in the “recovery” group; 4 patients were weaned from the system, and only 1 patient was discharged from the hospital. In 112 patients the Berlin Heart Assist Device was implanted for the purpose of a bridge to transplantation, 68 were transplanted and 46 patients left the hospital. It was concluded that patients may be kept alive with this system for weeks and months after any kind of cardiogenic shock. Complete cardiac recovery may be achieved in patients with early posttransplant graft failure. Reliable prediction of outcome in bridge–to–transplantation patients requires further experience and improvement of system components.