Background As left ventricular assist device (LVAD) support duration increases, quality of life (QoL) becomes a concern. We reviewed the QoL in patients on LVAD support for ≥1 year. Methods We retrospectively reviewed our prospective database for patients supported ≥1 year by HeartMate pulsatile- (HM1) or continuous-flow (HM2) LVADs from 2000 to 2009. Transplant or death before 1 year merited exclusion. Metabolic equivalents of tasks (METs), the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the 6-minute walk distance (6MWD), and New York Heart Association (NYHA) class were reviewed. Complications and re-admissions were assessed. Results Thirty patients were supported for ≥1 year (7 HM1s, 23 HM2s). Mean support duration was 594 ± 173 days. Mean QoL metrics/functional status indicators at 12 months were: 6MWD, 393 ± 290 m; MET tolerance, 3.3 ± 1; MLHFQ, 35 ± 31; and NYHA, 1.4 ± 0.6. Mean re-admissions/year was 2.9 ± 2, with a duration of 13.8 ± 21 days. Three patients were never re-admitted. Mean out-of-hospital time was 471 ± 172 days (87.3% of days). Infectious complications led to 43% of re-admissions and occurred in the: drive-line (47%) at 442 ± 236 days; blood (37%) at 472 ± 257 days; and LVAD pocket (20%) at 550 ± 202 days. Twenty-three patients (77%) required additional operations (1.7 ± 1.8/year). The most common indication was drive-line infection, but ranged from ischemic bowel to defibrillator exchange. Eight required LVAD exchanges for mechanical ( n = 4), electrical ( n = 3), and thrombotic ( n = 1) issues. Conclusions Although LVAD support is not without complications, patients spend the majority of time outside the hospital enjoying a good quality of life.