The shortage of appropriate donor hearts and the expanding pool of patients waiting for a heart transplantation have led to growing interest in alternative strategies, particularly in mechanical circulatory support. With expanding clinical experience and continued technical advances, continuous-flow pumps are evolving from bridge to transplantation to destination therapy for advanced heart failure. This review describes the clinical use and outcome of currently available miniaturized left ventricular assist devices (LVADs). It provides an outlook of the ongoing process of the miniaturization of LVADs, new concepts of partial support and, furthermore, it commentates on the current challenges with LVADs and the 5-year perspective.