Durable mechanical circulatory support, represented by the left ventricular assist device (LVAD), plays an important role in the treatment of patients with end-stage heart failure. The introduction of levitation technologies (magnetic or hydraulic) has substantially improved the hemocompatibility and survival of LVAD, further transforming the therapeutic philosophy for LVAD (evidenced by increased proportion of destination therapy). In the future, fully implantable LVADs will further improve patients' quality of life, while physiologically adaptive pulsatile pumps are expected to achieve even greater improvements in hemocompatibility. This article provides a review of the application of durable mechanical circulatory support (dMCS) in patients with end-stage heart failure, focusing on the current status of LVAD, its indications and timing of surgery, as well as future development directions.