Mechanical circulatory support systems in the form of left ventricular assist devices (LVADs) and total artificial hearts (TAHs) are alternatives to conventional medical treatment for patients with end-stage heart failure. These devices are used as a bridge to transplantation, bridge to recovery, or as destination therapy (permanent use) for patients who are not candidates for heart transplants. In the past several years, the LVAD landscape has rapidly evolved away from volume-displacement pulsatile technology toward continuous-flow (CF) rotary pumps due to their simplicity, increased mechanical reliability, improved durability, smaller size, and better outcomes (i.e., enhanced survival with less morbidity). Based on the sixth annual report of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS), All LVADs implanted in 2012 and 2013 were CF rotary LVADs. Among such CFLVADs, the HeartMate II (Thoratec Corp., Pleasanton, CA), an axial flow rotary pump, is the most popular device, implanted in more than 20,000 patients worldwide. With regard to TAHs, currently, the AbioCor TAH (Abiomed, Inc., Danvers, MA) as a permanent pulsatile implantable system and the CardioWest TAH (SynCardia Systems, Inc., Tucson, AZ) as a pneumatic system are the only TAHs approved by the FDA for use in the US. However, both are large pulsatile devices and require operation of 4 valves. As an alternative, the ongoing development of CFTAHs, which would replace the native ventricles with either 2 implantable CF devices or a single-piece device, is expected to serve a unique heart failure patient population. Cleveland Clinic’s CFTAH is a centrifugal-flow device and has one motor and one rotating assembly supported by a hydrodynamic bearing. The right hydraulic output is self regulated by passive axial movement of the rotating assembly to balance itself with the left output. The initial CFTAH in vivo studies have exhibited excellent hemodynamic status, end-organ function, pump performance, and biocompatibility without any anticoagulation therapy.