Introduction: Destination therapy (DT) using mechanical circulatory support (MCS) has been an accepted option for patients in class Ⅳ heart failure who are otherwise not candidates for a cardiac transplant.The recent Heart Mate Ⅱ destination therapy trial demonstrated improved survival with continuous flow (CF) therapy.This study reviews our centers DT experience with MCS in the continuous flow era.Methods: Overall survival, pulsatile flow (PF) survival, and continuous flow survival were analyzed in all patients who received MCS as destination therapy from April, 2005 until March, 2010.Patients initially implanted as bridge to transplant, but never transplanted, were excluded.Results: We performed 97 primary long-term MCS implants during this time period.56 of these were DT implants.These include the HeartMate XVE (31), VentrAssist (5), HeartMate Ⅱ (19), and HeartWare (1) devices.36 patients were enrolled in FDA clinical trials.Our HeartWare patient received an FDA compassionate use exemption.There were 30 device exchanges performed in 21 patients.Overall survival at one, two, and three-years was 77.5%, 64.1%,and 54.6%.Separating out pulsatile vs.continuous flow at one, two and three years was 70.5% vs.88.0%, 59.6% vs 77.0%, 46.5% vs.63.5% (p=.22).Three patients were subsequently transplanted.There was a trend towards improved survival with CF over PF, but it did not reach statistical significance.Conclusions: Our single center experience using mechanical circulatory support for destination therapy demonstrates excellent survival in real world clinical scenarios.Our comprehensive mechanical support program should be reproducible in other medical centers.There was a trend toward improved survival in patients whose initial therapy was a CF device.Our data helps support the validity of destination therapy using mechanical support, with either PF or CF, leading to improved outcomes and survival for patients with end-stage heart failure.