Despite impressive strides in pharmacologic therapy for heart failure (HF), cumulative evidence from epidemiologic studies suggests that there has been no improvement in the prognosis for this condition over the past 40 years. Several aspects of the pathophysiology of HF are not influenced by drug therapy. Hospitalizations for acute decompensated HF have continued to increase in recent years despite the use of complex and costly drug regimens. Cardiac assist devices offer a promising approach to the management of this challenging problem. The authors review the ways in which these devices are being used to manage HF in different settings and highlight the latest advances in this rapidly evolving field.