Implantable continuous flow axial pumps were introduced to clinical settings in November 1998 with the MicroMed-DeBakey ventricular assist device. Axial pumps continuously unload the failing left ventricle and accurate positioning of the inflow cannula prevents substantial reductions in pump flow. Considerations on the implantation technique are made to minimize surgical trauma, to prevent ventricular collapse, to optimize inflow conditions (flow increased from 4.3 +/- 0.6 to 6.7 +/- 0.3 L/min), and to facilitate the subsequent transplantation.