In the treatment of end-stage heart failure, the role of mechanical circulatory support represented by a durable ventricular assist device (VAD) has been accepted worldwide as a bridge to transplantation (BTT) or destination therapy (DT). In the United States, the priority of such VADs has shifted to DT from original BTT, and the number of DT cases is increasing year by year, exceeding the number of heart transplants. In Japan, the application of implantable VAD has started from bridge to candidacy in the early period before the start of heart transplantation, and the long-term survivals on VAD as BTT under the prolonged waiting period over 5 years have been demonstrated to be comparable to that of heart transplantation. Based on such results of VAD treatment, the introduction of DT has started in April 2021. This article outlines the Japanese version of DT and the future prospects.