Heart failure is a major healthcare problem associated with morbidity and mortality. Despite progress in treatments, the prognosis of heart failure remains poor. Standard treatments for heart failure include medical therapy, resynchronization therapy, and cardiac surgery. Heart failure teams providing guideline based care assist in the optimal management for advanced heart failure. Progression of heart failure despite optimal management may be treated with heart transplant. In non-transplant eligible patients, implantable left ventricular assist devices (LVADs) may improve patients 'quality of life and survival. Advances in LVADs, including smaller size, increased device durability, and (near) totally implantable devices, may enable LVADs to become an option in less sick patients. Evolving therapeutics such as stem cells and novel therapeutics may be combined with LVADs to allow myocardial recovery. This article will review current and developing strategies in the surgical management of heart failure with an emphasis on LVAD therapy.