<p>Mechanical circulatory support (MCS) plays a decisive role in the treatment of heart failure in infants and children with congenital cardiac defects or severe cardiomyopathy due to infections or genetic diseases. A particular challenge for surgeons and perfusionists is the often complex anatomy of the heart both before and after correction of congenital heart defects. Furthermore, the choice of support systems is limited due to the small body size of these young patients. Depending on the underlying disease, comorbidities and body size, various concepts can be considered, including “bridge to recovery”, “bridge to transplant”, “bridge to decision” and, in very rare cases “bridge to destination”. This article provides an overview of the indications, device selection and outcomes of MCS in pediatric cardiac surgery.</p>