Continuous-flow left ventricular assist devices (CF-LVAD) are now providing years of safe circulatory support with enhanced quality of life. We present four cases of patients with advanced heart failure who received support for greater than 5-years with the HeartMate II CF-LVAD. One patient continues with support at 7.5 years and has decided to not undergo cardiac transplantation. Another patient has also had LVAD support for 7.7 years, initially with a pulsatile flow LVAD, and then was switched to the HeartMate II, which has continued to support him for the last 6.6 years. Two other patients have undergone heart transplant after support times of 5.46 years and 5.75 years. Few complications occurred and the patients had very active lifestyles during support. Explant analysis revealed very low bearing wear and minimal pannus.