In Japan, implantable left ventricular assist device therapy has been reimbursed since 2011, and it has been developed as a tool for bridge to transplant with an annual implant number over 150 according to J-MACS registry. So far, certified VAD centers are expanded nationwide, and implantable LVAD is available in virtually all over the place in Japan. J-MACS registry has shown beautiful survival rate and most of them could be bridged to transplant. Such a success should be a continuous effort by each implant center, and in this session, we would like to discuss how a variety of centers (i.e. transplant center, non-transplant VAD center close to transplant center, VAD center away from transplant center) manage advanced heart failure patients with LVAD. We also would like to talk about the VAD-related complications and how we can avoid re-hospitalization. In this regard, newly analyzed data from J-MACS on complications help a lot for discussion. In terms of future perspectives, an experienced speaker from US will provide us an overview of new devices that will be introduced to Japanese market soon. Finally, we should discuss about coming destination therapy in the view of US experience as well as Japanese standpoint.