Left ventricular assist devices (LVADs) have emerged as a beneficial therapeutic strategy proven to improve the morbidity and mortality of patients with advanced heart failure. Continuous-flow rotary LVADs have been developed in the hopes of delivering circulatory support in a more durable manner with fewer device-related complications. The HeartMate(®) II continuous-flow left ventricular assist system (LVAS; Thoratec Corporation, Pleasanton, CA, USA) has become the standard of care for heart failure patients who require long-term mechanical circulatory support. The efficacy of the HeartMate II has been demonstrated in patients where temporary support with an LVAD is needed until a suitable donor organ can be found for transplant (termed 'bridge to transplantation'), as well as for terminally-ill heart failure patients who are not candidates for transplant ('destination therapy'). When directly compared with a pulsatile LVAD, the implantation of a HeartMate II LVAS resulted in an overall improvement in survival with a reduction in the number of device-related complications and adverse events. The purpose of this article is threefold: to describe the history of the development of continuous-flow LVADs; to describe the technology of the HeartMate II; and, finally, to review the clinical outcomes in patients who have been implanted with the device.