In conclusion this special edition focuses the attention of the reader on the next step up for mechanical circulatory support. The excellent survival records move towards reducing complications for even better outcomes. We thank the authors who have vast experience in their field and believe these review articles to be not only discussion of published literature but also be seen through the eyes of the practicing doctor. We hope they will be interesting for many specialities medics and allied professionals who are working with patients in advanced heart failure supported by machines.