We reviewed current concepts and techniques of cardiac assistance, including orthotopic and heterotopic cardiac allografting. Whereas intraaortic balloon counterpulsation has had the greatest clinical use, other techniques are now becoming available, including the implantable abdominal left ventricular assistance device, and much effort is being expended on the development of artificial hearts and their power sources. Despite the present technical shortcomings, exciting advances have occurred in the clinical management of intractable acute or chronic ventricular failure and cardiogenic shock since the introduction of circulatory assistance in man. The continued development and implementation of these techniques will help reduce the still unacceptably high mortality rate in this group of patients.