Heart failure has reached epidemic proportions in the United States. More than 5 million patients are treated for heart failure and approximately a half a million new patients are diagnosed with this disease each year in the United States. Recent pharmacological therapies have been used for the treatment of this patient population, but heart failure remains a major source of morbidity and mortality for patients. Orthotopic heart transplantation is a viable treatment option for heart failure patients; however, cardiac transplantation is limited by the donor availability. Limited donor organ availability has led to the development of alternative therapeutic strategies, including xenotransplantation, mechanical support devices, and cell transfer/tissue engineering protocols. This review highlights the current treatment modalities and emerging strategies for the treatment of advanced heart failure.