Mechanical circulatory support (MCS) is becoming the mainstay of therapy for patients with advanced heart failure, both for patients needing support as a bridge to transplantation and for those who require the device as a destination therapy. As more and more devices are implanted, there is a need to address effective discharge planning, arrange appropriate follow-up, anticipate and address complications, and develop strategies for long-term care. In this article, we will discuss issues surrounding discharge and challenges of managing patients with MCS in the outpatient setting.