Heart transplantation had been an only effective treatment for severe congestive heart failure secondary to dilated or ischemic cardiomyopathy. Recently, mitral valve repair and left ventricular reconstruction have been introduced to restore their own cardiac function. These operations can be one of treatment options for relatively stable congestive heart failure patients. For those with severer heart failure complicated with cardiogenic shock or end-organ dysfunction, use of mechanical assist device should be included in the treatment strategies. Perioperative problems of implantation of left ventricular assist device include right heart failure, multi-organ failure, infection and anti-coagulation. Implantable LVAS, which provides potent circulatory assist is useful to overcome organ dysfunction and render good QOL during long waiting period for heart transplantation.