The HeartWare® Ventricular Assist System is the newest circulatory support device to be commercially launched in Europe. Here we report the most recent international clinical experience with the system. The HeartWare® Ventricular Assist System is a small, full support (10L/min) centrifugal pump with advanced flow characteristics it employs a wearless hydromagnetic impeller system operated by external controller and battery components. Since March 2006, 99 patients at 10 centers received the device. The pump was implanted in the pericardial space in all patients using a midline sternotomy or thoracotomy without requirement for an abdominal pump pocket. There were 86 males and 13 females ranging in age from 16 to 74 years (mean 50.4 ±13.3) of which 32% had ischemic disease. BSA ranged from 1.35 to 2.56 m2 (mean 1.9 ± 0.23).The implant technique varied with 82 patients having a sternotomy and 17 undergoing a thoracotomy. 96/99 implants used CPB. The duration of support was a mean of 251 ± 243 days with 26 patients supported > 1 year and 6 patients supported > 2 years. The most common significant adverse events were all cause bleeding (0.35 events/patient year) and all cause infection (0.33 events/patient year). 22 patients were been transplanted, 4 were weaned after recovery, 61 remain on support and 12 patients have died. Currently, 88% of these 99 patients are alive on the device, have been transplanted, or have survived 60 days after weaning for recovery. Actuarial survival at 2.5 years is 80%. Long term circulatory support with the miniature HeartWare® Ventricular Assist System is feasible. The device performs well for greater than 1 year with low adverse event rates. The data also demonstrate the versatility of the HeartWare® System to support a wide range of patients using minimally invasive implant techniques.