Left ventricular assist device (LVAD) is an important therapeutic option for advanced congestive heart failure. While heart transplantation offers excellent survival and quality of life, its use is limited due to a shortage of donor organs. Implantable left ventricular assist device technology has improved considerably, and currently used devices may last even > 10 years in a patient. LVADs are being used increasingly both as bridge-to-transplantation and as destination therapy. With the advances of mechanical circulatory support, the selection of patients has undergone many changes over the last decade. Determining who is a suitable LVAD candidate is important to understanding the overall risk and outcomes. This chapter provides a comprehensive summary of key factors to be considered when evaluating LVAD candidacy, including cardiac pathophysiology, comorbidities, and psychosocial aspects. Additionally, some of the common complications associated with LVAD therapy are briefly reviewed.