Although individual surgeons and centers employ different methods to insert a left ventricular assist device (LVAD), the fundamental concepts remain true for all. That is, most devices use the apex of the left ventricle (LV) as the inflow site to the pump, which subsequently gives off an outflow graft to the aorta, thus bypassing the ailing LV. Currently available devices do not differ significantly with regard to general implantation technique. The sequence of implantation can vary also from patient to patient, depending on the particular situation. In some cases, concomitant procedures may be performed in conjunction with LVAD implantation without adversely affecting outcome.