The prevalence of Heart failure (HF) continues to increase due to the growth of an aging population and the rising incidence of cardiovascular disease. In spite of successful treatments with medical and device therapy, patients with heart failure progress to its advanced stages manifested by refractory symptoms, frequent hospitalizations and poor quality of life. Heart transplantation remains the gold standard treatment for such patients; however, the limited number of available donor organs and contraindications to heart transplantation in multi-morbid patients limits extending transplantation to larger populations. For those with expected prolonged waiting times to find an immunocompatible donor or who need time to reverse a medical contraindication to transplant, durable mechanical circulatory support of the failing heart offers an effective bridging strategy. Outcomes after left ventricular assist device (LVAD) placement have significantly improved with the newer devices. With the introduction of a fully magnetically elevated pump, long-term survival has increased and rates of hemocompatiblity related adverse events have been reduced. Changes to the heart transplant allocation system in 2018 led to a drop in durable LVAD implantations, but numbers of implants for lifelong therapy are increasing. This chapter provides an up to date overview of current LVAD technology and highlights the novel landmark studies that have established LVADs as a therapeutic option for HF.