The awareness and treatment of coronary artery disease has improved to a great extent in last few years. This has resulted in decrease in morbidity and mortality due to acute and chronic heart failure. The principle of management of patients with systolic heart failure is “remodel, repair or replace” the damaged ventricle, depending on the clinical status of the patient and the stage of heart failure. The ventricle can be repaired by revascularization, ventricular assist devices (VAD) and stem cell therapy. This chapter highlights the left ventricular assist devices (LVAD) in detail along with its surgical implantation, pre-procedural planning and percutaneous LVAD. It is necessary for the cardiologists taking care of HF patients to be aware of all the options so that these therapies can be offered to them as a rescue or salvage option when significant progress is not achieved by the conventional modalities of treatment.