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Cardiac transplant remains the gold standard of care for patients with end-stage heart failure. Unfortunately, due to the limited availability of donor hearts in the United States, not all eligible candidates are able to be transplanted. Since the introduction of mechanical assist devices for the treatment of advanced heart failure, patients gain a significant survival benefit while awaiting transplant. With rapidly evolving technology, it is important to appreciate the advances in the current use of mechanical assist devices.Following a comprehensive analysis of novel therapies in end-stage heart failure, there is an enhancement in quality of life and life expectancy following implantation of left ventricular (LV) assist devices (LVADs). When implanted in suitable patients as bridge-to-transplant or ‘destination therapy’, recipients demonstrate superior outcomes and survival compared with those who remain on optimal medical therapy.The use of LV assist devices (LVADs) as bridge to transplantation has gained popularity over the last decade. It is recognized as an integral treatment modality in end-stage heart failure to those awaiting heart transplantation. When implanted in the appropriately chosen patient, it is superior to medical treatment alone and has shown noninferiority to heart transplantation while allowing for optimal functional status and preservation of end organ function.