Development of durable left ventricular assist devices (LVADs), based on rotary flow blood pumps, began in earnest after the successful implantation of a catheter-mounted axial flow blood pump via intravascular access in 1988. This device, the Hemopump, successfully supported the circulation of a patient in cardiogenic shock secondary to acute rejection of a transplanted heart. Duration of support was 46 hours, resulting in complete recovery of cardiac function and hospital discharge. In effect, this sentinel event demonstrated that continuous-flow blood pumps could be used to support patients in cardiogenic shock. This held true in spite of many widely held paradigms against rotary blood pumps regarding blood damage, diminished pulsatility, and thrombosis. At this writing, 50,000 patients have been implanted with durable LVADs based on rotary blood pumps as a bridge to cardiac transplantation or destination support as long as 10 years.