After decades of development, ventricular assist devices (VADs) have evolved into the current generation of magnetically levitated blood pumps, achieving revolutionary progress in terms of implantation into the chest and large-scale clinical application. VADs have become an effective means of treating heart failure, which is a major global public health challenge. Despite these achievements, up to 89% of patients are readmitted within five years due to complications such as gastrointestinal bleeding, stroke, infection, and blood pump malfunction. Therefore, it is necessary to further study the mechanisms of blood damage of various blood components; to further develop and comprehensively utilize numerical simulations, in vitro bench testing, animal experiments, and other methods to more comprehensively evaluate blood pump performance. Innovative design of VADs are also needed to improve blood compatibility, meet the needs of different patient groups, and improve patients’ quality of life. In this review, the research progress on evaluation and design methods of VADs in 2024 both domestically and internationally is summarized, including advances in the study of blood damage mechanisms; the use of numerical simulations, in vitro bench testing, and animal experiments to evaluate blood pump performance; the progress in design and optimization of blood pump, new concept blood pump, and bio-coatings. The aim is to support the development of VADs and further improve their clinical therapeutic benefits.