Median sternotomy is associated with specific complications, and sternal wound infections carry a high risk for left ventricular assist device patients. Techniques using thoracotomy incisions and sparing the sternum are therefore being developed to reduce complications and increase patient safety. The HeartWare ventricular assist device (HVAD) continuous flow pump is a miniaturized full support device that lends itself especially well for lateral implantation. We here present our techniques for HVAD implantation with outflow to either the ascending or the descending aorta.