Right ventricular failure (RVF) after durable continuous-flow left ventricular assist device (LVAD) implant is an important cause of patient mortality and morbidity, including progressive end-organ dysfunction, persistent dyspnea, and poor quality of life. While survival on durable LVAD support has improved with each subsequent generation of device technology, the frequency of RVF complicating durable LVAD support has not, impacting 30–40% of patients within 1 year of LVAD implant. While often multifactorial in etiology, RVF in the early postoperative period usually results from progression of preexisting clinical or subclinical right ventricular (RV) dysfunction. During the chronic support phase, RVF may be chronically progressive or de novo in etiology, the latter of which is often the consequence of an underlying LVAD complication. The diagnosis of RVF is derived from information gleaned from the clinical patient encounter, laboratories, echocardiography, and/or hemodynamic parameters that support the presence of reduced right ventricular (RV) stroke volume with or without signs of congestion and organ dysfunction. Once the diagnosis is established, management of RVF is directed at identifying and treating any reversible contributors to RV dysfunction and reducing ventricular wall stress through RV decongestion, pulmonary hypertension management, and optimization of LVAD speeds. Inotrope support or temporary RV mechanical support can be employed to assist RV stroke volume until wall stress is optimized. The chapter herein will review the pathophysiology, diagnosis, and management of RVF in the durable LVAD patient. The chapter will also highlight the challenges in RVF prediction in those being considered for durable LVAD support.