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Severe cardiogenic shock in the setting of acute decompensated heart failure, refractory to aggressive pharmacologic intervention is synonymous with high mortality. Recent innovative advancements in mechanical circulatory system [MCS] has provided some semblance of hope, with use exponentially increasing due to the favorable outcomes. These devices serve as bridge towards definitive therapy by providing hemodynamic stability. The TandemHeart^® (LivaNova Inc) has gained increased notoriety due to the increased degree of support provided in in left ventricular failure. A nationwide shock database analysis found increased mortality benefits of TandemHeart^® over Impella^®. However, there continues to remain scarce data and limited clinical trials demonstrating the efficacy of TandemHeart^® over other devices. We present three assorted cases of cardiogenic shock refractory to Impella^® successfully managed with the TandemHeart^® system. We discuss the indication, utility, and the potential benefits provided by the TandemHeart^® system including ability to add oxygenator in circuit, ease to convert to VA-ECMO, use in prosthetic aortic valve, and capable of offloading left atrium and left ventricle.