Left ventricular assist device (LVAD) placement is a serious surgical procedure. At our center, we accumulated a very large experience with the Novacor LVAD from the very first clinical trial, as well as from more recent experiences with the Jarvik 2000 and the Heart Mate II. This article discusses technical issues that are common to all durable LVAD devices, with special emphasis on strategy and technical considerations aimed at avoiding surgical pitfalls.