Heart failure is a complex multifaceted syndrome occurring as a result of impaired cardiac function. Understanding the neurohormonal, inflammatory and molecular pathways involved in the pathophysiology of this syndrome has led to the development of effective and widely used pharmacological treatments. Despite this, mortality and hospitalization rates associated with this condition remain high. The natural course of this illness is usually progressive, often leading inexorably to end stage heart failure, for which orthotopic heart transplant is a treatment option but one with limited resource. In the past decade, mechanical circulatory support has emerged as a potential therapy for certain patients with advanced heart failure. This article reviews the published data regarding biomarkers in the setting of mechanical circulatory support, and highlights areas of ongoing work and potential future areas of interest.