During the last decade, it has been clearly demonstrated that mechanical assist devices are capable of supporting patients in the interim before cardiac transplantation. The use of these devices prior to transplantation has provided an important window of opportunity to evaluate critically the devices and their potential for adaptation to permanent systems. The overall survival rates in the bridge-to-transplant patient population have improved. This is in part due to lessons learned in the past several years with regard to better patient selection and applicability of the devices. This review focuses on selected papers published in the past year that have made significant contributions to the evolution of mechanical support.