For patients with "stage D refractory heart failure" as stated by the The Japanese Circulation Society (JCS) 2017/The Japanese Heart Failure Society (JHFS) 2017 Guidelines for Diagnosis and Treatment of Acute and Chronic Heart Failure, extensive therapeutic methods including implantation of ventricular assist device (VAD) and/or heart transplantation, as well as terminal care. An implantable VAD is a device designed to support patients for a long term of several years. This device has its most part buried in the body with its driveline penetrated out through the skin to connect with a controller and butteries. In Japan, implantable VADs started to be used in 2011, and now 3 devices are available in a commercial basis, that is, EVAHEART 2, HeartMate II and Jarvik 2000. They are available when a patient has been listed as a candidate for heart transplantation, and recently the usage of implantable VAD as destination therapy that is applied for patients who are not eligible for heart transplantation but would get benefit from circulatory support, enough to be free from hospital-bound status and enjoy high quality of life. If this device can prove to improve heart failure patients' symptoms, resulting in decreasing medical expense, surely it would be widely accepted as a promising therapy to treat heart failure.