The clinical prognosis of advanced heart failure is very poor. As an advanced treatment for advanced heart failure, heart transplantation or left ventricular assist device can significantly prolong the survival time and improve the quality of life of patients. The establishment of advanced heart failure center, accurate identification and timely referral of patients with advanced heart failure, and the establishment of standardized clinical diagnosis and treatment decision-making process are very important for the treatment of advanced heart failure. This article summaries the current indications, contraindications, and decision-making approaches for heart transplantation and/or left ventricular assist device(LVAD) implantation in the context of the latest clinical decision-making progress in the treatment of advanced heart failure.