The field of durable left ventricular assist devices has advanced dramatically since its introduction into the clinical realm. From the first-generation pulsatile HeartMate XVE device to the second-generation continuous axial flow HeartMate-2 to the current third-generation centrifugal flow devices, the left ventricular assist device has undergone significant evolution. This review describes the technology and its changes over the course of time, with a focus on the fundamental question: Has anything changed?