Advanced heart failure refractory to medical management portends high mortality. Previously, inotropic support and intra-aortic balloon pumps (IABPs) were the only tools for patients in cardiogenic shock. Temporary mechanical circulatory support has evolved in the last few decades and revolutionized the management of heart failure. Short-term extracorporeal pulsatile or non-pulsatile cardiac assist devices can be a means to cardiac recovery or a bridge to cardiac transplantation. This chapter focuses on the role of TandemHeart in improving hemodynamic performance and end-organ perfusion.