Nowadays, durable mechanical circulatory support (MCS) in form of ventricular assist devices (VADs) represents a successful therapeutic option for the treatment of patients with end-stage heart failure. These devices can support patients waiting for a suitable donor (bridge to transplant) or non-transplant candidates failing medical therapy (as destination therapy). Over the past several decades, various innovations and concepts were implemented and tested. First generation of VADs (e.g., TCI HeartMate, Novacor N100) consisted of large pumps with complex mechanical systems that generated a pulsatile flow to match the physiological hemodynamics as good as possible. However, these pumps were plagued with high complication rates. Subsequent generations of rotational blood pumps were smaller, allowed intrathoracic implantation, and required only a fraction of power, which resulted in a huge improvement in the quality of life for patients. Nonetheless, different complications such as thrombosis, infection, or bleeding still occur frequently. Wireless energy transfer to avoid infections, preservation of pulsatile blood flow, or endothelialization of the inner surfaces of the pump to increase hemocompatibility are just few examples of the latest promising research projects. At last, at the pinnacle of LVAD stands the idea of a fully self-regulating smart-pump with incorporated sensors enabling the pump to adequately adjust to the patient’s momentary physiologic needs.