Mechanical cardiac support represents a large spectrum of devices, differing by the duration of assistance, the support or replacement of the heart, the mono or bi ventricular assistance, the paracorporal or implantable positioning, the pulsed or continuous flow, the pneumatic or electric power source. We can distinguish: 1) the ECMO/ECLS systems (extracorporeal membrane oxygenation–extracorporeal life support) systems of peripheral extracorporeal circulation, accessible at patient bedside, that benefited from technological developments allowing longer assistance and therefore more indications; 2) the ventricular assist devices (VADs) that comprise pneumatic ventricles (mono- or biventricular, extra- or paracorporal), implantable left-VAD (pulsed-flow electromechanical ventricles and continuous-flow axial pumps), total artificial hearts (partially or totally implantable) and percutaneous left-VAD (available in the catheterization laboratory, still in the development stage). Partial or total mechanical cardiac support, although used in routine for 20 years, remains a technology seldom used outside the operating room. This slow diffusion is due to the small number of indications (end-stage heart failure and different heart failures considered as reversible), but also to its extreme complexity and to the alternative offered by heart transplantation. However, this situation is changing with the decreasing availability of organs and with the improvements of devices.