The development of severe heart failure is the main cause of postoperative mortality after the surgical treatment of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). Two patients with ALCAPA who developed low cardiac output and could not be weaned from cardiopulmonary bypass (CPB) after aortic reimplantation of the anomalous left coronary artery were successfully treated with a centrifugal left ventricular assist device (LVAD) and extracorporeal membrane oxygenation (ECMO). The circulation of a 10-month-old infant with severe left ventricular dysfunction was supported 192 h postoperatively with a LVAD and a 9-year-old boy with severe right ventricular failure received ECMO support for 99 h following surgery. Both patients survived and, 4 and 9 months after surgery, are asymptomatic and have normal ventricular function. If CPB (up to 3 h) is not effective in improving ventricular function after surgery for ALCAPA, ECMO or LVAD must be used since myocardial recovery in these patients can occur only after prolonged extracorporeal circulatory support.