Ventricular assist devices are an integral part of therapy for patients with end-stage heart failure. Devices can either bridge to recovery or to transplantation. Options for ventricular assist devices include those that are centrifugal, pulsatile, and new rotary/axial devices. Care of the patient on a ventricular assist device is multifaceted, involving pharmacologic or mechanical support of the right ventricle, management of systemic vascular resistance, and manipulation of the hematologic system to avoid bleeding or thrombosis. In addition, care of these patients involves support of all end organs and avoidance of infectious complications. Care of these patients is complex, requiring a highly integrated team for optimal outcome.