Implantable ventricular assist device( VAD) is the only evidence-based option to treat stage D heart failure patients with significant symptoms at rest in spite of maximum medical therapy, other than heart transplant. Implantable VADs available in Japan include Evaheart, DuraHeart both from Japan, Jarvik 2000 and HeartMate II both from United States. In Japanese settings, implantable VAD is indicated and insured only for patients who are supposed to have an indication for receiving heart transplant, which means "bridge to transplantation" use. And in Japan, implantable VAD can be implanted for patients less than 65 years old if it needs to be insured. In the University of Tokyo Hospital, the mid-term outcomes of 41 implantable VAD patients were acceptable with 2 hospital deaths, 2 remote deaths and one year survival rate at 88%.Considering the present Japanese situation with extreme shortage of organ donation, the extended application of implantable VADs as "Destination Therapy" is awaited, but quality of life of care-givers as well as patients themselves and sustainable follow-up system provided by healthcare professionals need to be warranted.