The assist devices demonstrate the safety and reliability of these systems in the management of end-stage cardiac failure, not only in an in-hospital setting, but also in the cohort of OOH patients. The OOH option has led to a significant improvement in the quality of life of those patients. However, VADs are still associated with a considerable number of complications. The newly introduced fully implantable system (LionHeart) has reduced significantly the system-related infection complications. Further miniaturization of the systems might reduce the comorbidities and increase the acceptance of this therapeutic option in the management of end-stage cardiac failure.