The HeartMate 3 Left Ventricular Assist System (Abbott) was designed with a fully magnetically levitated centrifugal continuous-flow pump to address concerns about thrombosis with the mechanical-bearing axial continuous-flow HeartMate II device. In the randomized MOMENTUM 3 trial, the two pumps were compared in 366 patients with advanced heart failure (either as bridge to transplantation or destination therapy). The composite primary end point (survival at 2 years free from disabling stroke or reoperation because of a malfunctioning device) occurred in 79.5% of patients in the HeartMate 3 group compared with 60.2% of patients in the HeartMate II group (HR 0.46, 95% CI 0.31–0.69, P < 0.001 for superiority). Of note, the overall rate of stroke was lower with the centrifugal-flow pump than with the axial-flow pump (10.1% versus 19.2%; HR 0.47, 95% CI 0.27–0.84, P = 0.02).