Copyright © 2020. Published by Elsevier Inc. PURPOSE: The purpose of this study was to determine the national trends in utilization, mortality, cost, and length of stay (LOS) associated with implantation of biventricular assist devices (BiVADs) using the National Inpatient Sample (NIS) database. METHODS: This study was a retrospective analysis of NIS from 2009 to 2015 for surgically implanted internal (n = 538) and external BiVADs (n = 727). Exploratory analyses were performed to explain the trends found in utilization, mortality, cost, and LOS. RESULTS: From 2009 to 2015, the utilization of all BiVADs decreased (4.8% per year, p < 0.001) driven by the decline in utilization of external BiVADs (9.4% per year, p < 0.001). Compared to external BiVADs, internal BiVADs were associated with lower mortality (45.4% vs. 59.1%, p = 0.024), but longer LOS (64.0 vs. 20.0 days, p < 0.001) and higher incidence of renal failure (85.6% vs. 74.0%, p = 0.020). During this time period, there was no significant change in mortality; however, cost and LOS associated with all BiVAD implantations increased significantly. Only those who died during hospitalization had an increase in cost (15% per year, p < 0.001) and LOS (52% per year, p = 0.002) (Figure 1). The latter trends remained significant even after controlling for complications (e.g., gastrointestinal bleed and renal failure) and co-morbidities. CONCLUSION: The decline in utilization of BiVADs between 2009 and 2015 coincided with the increase in utilization of LVADs during this time. Declining BiVAD utilization can be related to the improvement in the LVAD technology and outcomes as well as the availability of percutaneous temporary circulatory support. Although the advancement in LVAD technology has led to decrease in mortality rate and reduction in cost and LOS, BiVAD mortality remained the same over time with a rise in cost and LOS. Future studies are required to investigate optimal BiVAD configurations and strategies, as well as patient selection in order to improve mortality and reduce LOS and cost for BiVAD patients.