In 2011, implantable ventricular assist device (iVAD) was initially approved in Japan as bridge-totransplant (BTT) indication. Since then, more than 1,300 iVAD implants were conducted as BTT, and this case number per year is rapidly increasing, especially after the approval of iVAD implant in 2021, as destination therapy (DT) indication. From now on, some of DT patients will be eventually registered for heart transplantation, once their exclusion criteria are cleared, thus extending waiting time of BTT patients, in the setting of serious donor shortage in Japan. Therefore, to improve the outcome of iVAD patients, both BTT and DT, it is imperative to manage device-associated complications, that can occur during prolonged long-term iVAD support. In the present review, we summarize the recent updates on the current trend and the future perspectives of iVAD treatment in Japan, in terms of the effect of DT approval on this treatment modalities and device-associated complications, specifically right ventricular failure and aortic regurgitation.