Options for patients with advanced heart failure used to be limited to heart transplantation, but ventricular assist devices have rapidly evolved into viable treatment options for these patients. How is the newest generation of continuous-flow devices impacting the way we care for patients with advanced heart failure? Which patients are the best candidates for ventricular assist devices, or VADs, and are many patients with VADs now undergoing the procedure as destination therapy, rather than a bridge to transplant? Dr. Leslie Miller, professor and chief of the Integrated Cardiology Programs at Washington Hospital Center and Georgetown University Hospital and School of Medicine, as well as the Walters Chair in Cardiovascular Medicine at Georgetown University in Washington, DC, tells host Dr. Alfred Bove about the evolution of VADs from pulsatile pumps to continuous flow design, and the various applications for these technologies. Will these devices play a more significant role in the treatment of patients with advanced heart failure in years to come?