To understand the needs and requirements in the development of rotary blood pumps, we have to consider the current use and limitations of blood pumps in cardiac surgery. There are 5 different fields of indications for blood pumps in cardiac surgery. First, there is the possibility to use rotary blood pumps in the cardiopulmonary bypass system. Second, miniaturized rotary blood pumps can be used to support beating heart surgery. Third, we expect a growing use of rotary blood pumps in short-term ventricular support. The same applies to the field of chronic cardiac failure and long-term myocardial support. Finally, miniaturized rotary blood pumps can be used to support the ventricle during myocardial infarction. Rotary blood pumps are expected, based on their features, to progress in all these indications.