Long-term durable mechanical circulatory support (LT-MCS) has evolved significantly in the last decade. Today’s devices have become more reliable, and their durability has increased whereas device-related complications have drastically decreased compared with earlier generations of devices. In addition to a growing population with end-stage heart failure (HF), these developments have led to a notable increase in MCS implants, particularly of continuous-flow left ventricular assist devices (CF-LVADs). In Germany only, nearly 1000 LVADs were implanted in 2016 [1]. Thus, LT-MCS has become a standard of care in the treatment of end-stage HF. Moreover, the availability of smaller blood pumps together with growing clinical experience has expanded the target population by extending LT-MCS to patients with more complex conditions, including elderly and paediatric patients, patients with congenital heart defects and patients with advanced comorbidities. This expansion has resulted in a significant increase in the complexity of all aspects of management of these patients from selection to postoperative management, which is recognized in the presented consensus statement.