•Assessing hemodynamics helps us manage various adverse events during left ventricular assist device (LVAD) therapy.•Ramp test is a useful tool for disease diagnosis and may improve clinical outcomes.•Non-invasive devices to measure hemodynamics are warranted for better LVAD therapy. Left ventricular assist devices (LVADs) significantly improve outcomes of advanced heart failure patients. However, patients continue to have high readmission rates due to complications ranging from bleeding, thrombosis, heart failure, and infection. Considering that the hallmark benefit of LVAD therapy is improvement in hemodynamics (cardiac unloading and increased cardiac output), hemodynamic assessment on LVAD support is key to better understand these difficult complications and may serve as a tool to resolving them. In this review, we will discuss the hemodynamic changes following LVAD implantation, and the implications and prognostic impact of hemodynamic optimization on outcomes and complications.