The treatment of terminal heart failure is a growing market not only for cardiologists but also for cardiac surgeons. The difference to conventional cardiac surgery is the absolute need for true multidisciplinarity and the fact that the actual surgical part is only a small piece in the puzzle of the management of these patients. Adequate preoperative and postoperative ambulatory treatment is the key to success and is often provided by the cardiac surgeon. As a heart failure surgeon not only comprehensive cardiac surgical skills are required but also a deep understanding of cardiological and intensive care treatment concepts in order to be able to provide the optimal treatment to each specific patient. This article provides an overview of the possibilities and requirements for colleagues interested in a career as a heart failure surgeon.