This review traces the evolution of centrifugal blood pumps in mechanical circulatory support (MCS) systems. Initially met with concerns over blood damage and thrombus formation, centrifugal pumps have become crucial components in ventricular assist devices (VADs) and extracorporeal membrane oxygenation (ECMO) due to their simplified drive mechanisms and adaptability. This paper outlines three generations of centrifugal pump development: first-generation pumps with sealing components, second-generation pumps utilizing pivot bearings, and third-generation pumps employing contactless bearings. Each iteration addressed previous limitations, particularly regarding thrombus formation and durability. Current regulatory challenges surrounding the duration of pump use in MCS are examined, highlighting the discrepancy between approved usage times and clinical needs. This paper notes ongoing efforts to extend approved use periods, citing examples of pumps cleared for extended use in various jurisdictions. This historical perspective provides insights into the technological advancements that have enhanced the safety, efficacy, and durability of centrifugal blood pumps in MCS applications.