Mechanical circulatory support (MCS) evolved with advances in cardiac surgery, where postcardiotomy shock was a problem. In the 1990s, percutaneous cardiopulmonary support (PCPS) was introduced as a less invasive system. Subsequently, direct left ventricular support with a ventricular assist device (VAD) was introduced for patients with severe heart failure, such as those eligible for heart transplantation (bridge to transplantation). This chapter presents a historical review of our efforts in such MCS and, in particular, the achievements of implantable VADs at Osaka University. In addition to the above-mentioned “bridge to transplantation” strategy, the “bridge to recovery” strategy has been developed and the current progress is presented.