Heart failure is the final common pathway of a large variety of disorders that result in profound myocardial dysfunction. The definitive therapy for advanced heart failure continues to be orthotopic heart transplantation, which is substantially limited by the profound shortage of the available donor organs. Mechanical circulatory support devices (MCS), including durable left ventricular assist devices (LVADs), have emerged as an alternative intended to fill the growing gap between available organs and the rising need for cardiac replacement. HeartMate 3 (HM3) left ventricular assist device is the newest device to receive worldwide approval for the surgical therapy of advanced heart failure. The HM3 is a fully magnetically levitated centrifugal flow VAD that has been engineered for enhancing hemocompatibility. Three key design features – an artificial pulse, wide blood flow passages, and a bearing-less rotor – minimize shear force on the blood and minimize stasis within the pump. Multiple studies have shown improved survival, fewer adverse events, and improved hemocompatibility compared to earlier designs. In this chapter, we review the preclinical, clinical, and post-approval development of the most implanted ventricular assist device, the Abbott HeartMate 3.