Ventricular assist device (VAD) has been applied for treatment of end-stage heart failure. Three major purposes of VAD are a bridge to transplantation, a bridge to recovery and a destination therapy (permanent VAD implantation). In Japan, only paracorporeal ventricular assist device (Toyobo-NCVC type) is approved for coverage by health insurance. Survival after Toyobo VAD implantation has been improving greatly Survivals 1, 3, 5-years after implantation are 75%, 75% and 58% respectively in our experience. Several implantable VADs are under clinical trials in Japan. Implantable VAD has many advantages, such as allowing patients to be discharged and being resistant to infection. Heart transplantation was performed in more than 70,000 cases worldwide. At present, approximately 3,000 transplantations were performed annually. Survivals after 1, 3, 5, 10-years are 86%, 79%, 72% and 51%. Fifty-seven heart transplantations were performed in Japan since 1999. Survivals after 1, 3, 5-years in Japan are 98%, 98% and 94%, which are far superior to world average results.