Various means to assist the failing heart surgically will include, according to the order of simplicity and readiness of their application, intraaortic balloon pumping (IABP), veno-arterial bypass with oxygenator (VAB), and ventricular assist device (VAD). However, when the severity of the cardiac failure is beyond the capacity of these assist devices, the use of the total heart replacement device (total artificial heart-TAH) will be the final solution. Increase of the cardiac output by the use of IABP is limited being less than 1.0l/min. Results of VAB has been poor. The number of VAD cases reported to date is over 200 in the world. Thirty-six percent of them were successfully weaned, but only 15.8% of the patients were discharged. Among 14 cases experienced in Japan, 2 patients survived longer than one month following the VAD removal. The recent overall world result has been steadily improving. The TAH has been used in five patients in the world. In the first two patients TAH was used as a temporary relief assuming heart transplantation later, which was proposed by Cooley as two-staged heart replacement in 1969. In the recent three TAH was applied being expressly stated as a permanent device. Timely judgment and decision when to apply are most important.