Background: The use of left ventricular assist devices (LVADs) as an alternative to transplant, or destination therapy (end of life support), is an increasingly important option for patients with end-stage heart failure. Prior studies have examined hospital costs for LVAD implants performed during investigational studies (e.g., REMATCH), but none has been published since that trial was completed. Methods: We performed a retrospective analysis of 23 consecutive patients who had a HeartMate XVE pump implanted as destination therapy at 2 high-volume ventricular assist device implant centers after US Food and Drug Administration approval in October 2003. We evaluated survival to discharge during the implantation hospitalization, hospital length of stay, and hospital costs, and compared them with outcomes reported from the REMATCH (RM) trial. Results: All patients in this cohort implanted post-REMATCH (PRM) had class IV heart failure and were similar in age, gender, and nearly all other pre-implantation clinical measures to the RM subjects. Mean hospital costs for PRM patients were 40% lower than for RM patients when measured from implantation to discharge ($128,084 vs $210,187, p < 0.01). PRM patients who survived implantation hospitalization had 48% lower costs than those who did not survive ($114,979 vs $215,456, p < 0.01), a finding similar to the RM experience. PRM patients in this cohort were more likely to survive to discharge compared with RM patients (87.0% vs 67.3%, p = 0.09). Mean hospital length of stay was 25% lower in the PRM group (44 vs 33 days) but did not reach statistical significance (p = 0.50). Conclusions: Outcomes with use of LVADs as destination therapy have improved in the post-REMATCH era, including significantly lower hospital costs as well as strong trends toward better survival to hospital discharge and shorter average length of stay.