Development of mechanical devices for support of the failing heart is a major goal in cardiac surgery. The application of left ventricular assist device (LVAD) is a promising approach in the case of severe and otherwise untreatable cardiac failure. In our experience we have used two external centrifugal pumps for the extracorporeal biventricular cardiac support in a post-transplantation patient who experienced severe rejection six months after heart transplantation. Our own series includes a total of ten implantations of LVAD's with six patients who could be weaned from the device but only one long-term survivor. The clinical results are not encouraging which suggests that the heart of the patient who needs an LVAD has been damaged beyond any chance for later recovery. Obviously timing is the most crucial aspect of the decision to implant the device. It would appear that orthotopic implantation of the transplanted heart remains the method of definitive treatment.