**Abstract**

Heart failure is a growing pandemic with a rising societal burden. Heart failure affects 3.6 million people in Europe and 5 million in the United States annually. The United States alone spends 30.7 billion annually managing heart failure, and that number is expected to eclipse 70 billion by 2030. Many people are not orthotopic heart transplant candidates, and many who are may not live long enough to receive a transplant. As a result, durable left ventricular assist devices (LVAD) have become both a bridging therapy and a destination therapy, necessitating a robust continuing care system. LVAD programs are expanding to fill this need. This chapter aims to cover the spectrum of LVAD continuing care from initial implantation to the outpatient clinic. This chapter will cover essential care practices for maintaining LVAD function, including driveline care, battery management, and alarm response/tracking. Troubleshooting the common issues and complications patients might experience, such as low flow alarms, bleeding, infection, and right heart failure. Emphasize the importance of the primary caregiver's involvement and how to prepare them by providing resources for education, training, and ongoing support. Lastly, it will cover ethical concerns and the role of palliative care in the process.

**Keywords:** LVAD, left ventricular assist device, advanced heart failure, advanced therapies, durable mechanical circulatory support, durable LVAD, end stage heart failure
