Heart failure is the inability of the heart to pump blood at a rate commensurate with the requirements of the metabolizing tissues. This growing population of patients with refractory end-stage heart failure has been a major catalyst for the development of devices that assist or even replace the failing heart. The concept of using left-ventricular assist devices (LVADs) as the means of permanent therapy is based on the success of their use in heart transplant candidates, who developed refractory heart failure and were ‘bridged’ to transplantation with LVADs. VAD technology will need to achieve several important milestones to significantly minimize associated complications, improve outcomes and quality of life while reducing cost. This chapter will discuss the current and future directions of cardiac assist devices.