The perioperative management of mechanical support patients can be challenging. These patients are plagued by decompensated heart failure resulting in a low output state and, consequently, end-organ dysfunction. Furthermore, they are often deconditioned and immobile due to their recent decline. The triggers for intervention can be acute or chronic with patients needing either emergent temporary support such as ECMO or elective durable support. In either scenario, a standardized approach to patient management can help optimize short- and long-term outcomes.