Ventricular assist devices serve as a valuable adjunct to therapy in the setting of profound heart failure. The two largest patient groups—postcardiotomy and those being bridged to transplant—show an average 40–50% survival rate after ventricular assist. Several devices exist including centrifugal, pneumatic, and electrical pumps. Options for ventricular assist include right (RVAD), left (LVAD), and biventricular (BiVAD) support. Knowledge regarding the devices and the pathophysiology of severe heart failure is crucial for the critical care nurse caring for these patients. Critical care nursing interventions for bleeding, renal failure, infection, and other complications will be outlined.