In profound heart failure, ventricular assist systems (VAS) have been used to maintain the systemic circulation and promote recovery of the failing heart. The authors' data suggest that the heart may not recover sufficiently if the patient needs left ventricular assist beyond 10 days. Recently, the authors treated six patients who were supported by VAS more than 3 weeks and were weaned from VAS. Four of six patients were weaned from VAS and continue well, despite marginal cardiac function. In the other two patients, the natural heart did not sustain stable recovery, but their general conditions made them fit to be candidates for heart transplantation. Based on these data, long-term support should be considered to promote recovery of heart function with the use of VAS for profound heart failure.