It is fascinating to be active and to watch how the exciting field of assisted circulation has evolved over the last 20 years, a field I have been personally involved in since 1972. The general anticipation was especially very high in 1975, a time when the first clinical implantations of assist devices took place. A real break through was expected soon. The feeling was the same in 1986, when I performed my first clinical bridge in Europe, using the Ellipsoid Heart. It was anticipated that the clinical feasibility of the total artificial heart and of assist devices would come much earlier. Today the total artificial heart is no longer an object of discussion. At present the prerequesites for a long-term use of assist devices are given; the technology of the devices in clinical use is so advanced that a long-term use seems to be reality. Another breakthrough that is nearly on the horizon might break all expectations in treating failing hearts. Gene technology may turn out to provide a new effective strategy for avoiding atherosclerosis and treating cardiac failure. It will make possible implantation via a catheter in impaired heart myocysts, which can then develop within the ventricle and result in new muscle mass.