Ventricular assist devices (VADs) play an important role in managing cardiogenic shock and end-stage heart failure. Temporary devices may be implanted percutaneously or surgically and are employed to manage shock refractory to medical therapy. Durable devices are implanted surgically and utilized in patients unable to wean from inotropic or temporary support. Left ventricular assist devices (LVADs) are the most common form of durable support. In patients who are candidates for durable LVAD implantation, echocardiography is the first-line imaging modality for patient selection, operative management, and post-implantation monitoring and optimization. In this chapter, we will focus on the role of echocardiography in patients with durable LVADs.