Inclusion Criteria:  Greater than or equal to 18 years of age: Refractory, advanced heart failure patient that is either: Prospectively identified as a candidate to receive the commercial HVAD system as their first durable left Ventricular Assist Device (LVAD) implant for approved indications; or within 10 days of receiving the commercial HVAD system as their first durable LVAD for approved indications Patient provides written authorization and/or consent per institution and geographical requirements  Exclusion Criteria:  patient who is, or is expected to be inaccessible for follow up patient with previous durable mechanical circulatory support device patient with planned Bi-VAD procedure patient with exclusion criteria required by local law patient is currently enrolled in or plans to enroll in an concurrent drug and/or device study that may confound results (i.e., no required intervention that could affect interpretation of all-around product safety and/or effectiveness). Concomitant observational studies allowed if permitted by IRB/EC