Artificial heart or heart transplantation are required for the treatment of profound heart failure. Total artificial heart (TAH) and ventricular assist system (VAS) were developed from late 1950s and 2 extracorporeal pneumatic Japanese VASs (Toyobo VAS and Zeon VAS) were introduced to clinical field from 1980. Now, over 850 patients were applied several types of VASs including Japanese VASs. And 80% of heart transplant recipients were supported by VASs for 714 days (mean). Small size implantable left VAS (LVAS) are required and several types of non-pulsatile pump, including 2 Japanese made centrifugal pumps, are under clinical trials. And destination therapy by using implantable pulsatile LVAS for end-stage heart failure patients has been started in United States and is performed in United States and Europe. In near future, artificial heart and heart transplantation will be selected according to the conditions of the patients with profound heart failure.