Ventricular assist devices (VADs) are mechanical circulatory support devices used for advanced heart failure patients. Early VADs (first generation) suffered from limitations such as short battery life, frequent mechanical failure, and high rates of infection, hemorrhage, and thrombus. Second-generation VADs improved by adopting an axial motor system with the texturized interior surface to decrease thrombotic events. Third-generation VADs further minimized thrombosis with centrifugal flow and magnetically or hydraulically levitated components. VAD implantation is undertaken for various reasons, including bridge-to-transplant (BTT), bridge-to-recovery (BTR), bridge-to-decision (BTD), and destination therapy (DT). This chapter details the surgical implantation technique and discusses post-surgical management and potential complications. Advancements in VAD technology, along with proper surgical technique and proactive management, are continuously improving patient outcomes and increasing lifespan for those with VADs.