Cardiac transplantation is currently the preferred long-term treatment of eligible patients with end-stage advanced heart failure. The availability of donor hearts is limited and not all patients may tolerate cardiac transplantation. Implantable left ventricular assist devices (LVADs), that fully or partly support the left ventricle, are suggested as an alternative therapy for patients with end-stage advanced heart failure. In our report from 2008, we concluded that LVAD may prolong life and improve quality of life, yet the number of complications and costs were very high. Newer types of LVADs were at the time under investigation in clinical trials. The National Council for Priority Setting in the Health Care recommended in 2008 that LVAD should only be offered to patients for a limited period, for example while awaiting cardiac transplantation (bridge to transplant). Questions to reconsider the recommendations have been raised. We were commissioned by the Norwegian Directorate of Health to perform a health technology assessment (HTA) on LVAD as destination therapy.