Background: Ventricular assist devices (VADs) provide a bridge to transplantation for patients awaiting heart transplant. Because of its intra-abdominal placement, the potential exists for major abdominal complications. The purpose of this study is to identify VAD-associated abdominal complications and their incidence, and to describe preventive measures. Methods: Records of patients having had VAD placement were identified from our registry from April 12, 1995, when the first VAD placement occurred, to July 15, 2003. Each patient was evaluated for the occurrence of an abdominal complication, defined as mechanical small bowel obstruction, infection with an abdominal source, hernia, or other abdominal pathology occurring after VAD placement. Results: One hundred twenty-four VADs were implanted in 100 patients. Of these patients, 82 received one VAD, 13 received two devices, four received three devices, and one patient received four devices. Twelve abdominal complications occurred in 11 patients (11%). There was a 36% (4/11) pre-transplant mortality rate in patients with an abdominal complication, compared to 17% (15/89) pre-transplant mortality in patients without an abdominal complication (p = 0.21). Three of five patients with abdominal infection died. Conclusions: Abdominal complications after VAD placement are common. Intra-abdominal VAD infection is the most common and serious complication, leading to a mortality rate of 60% in our population. Additionally, small bowel obstructions, incisional and inguinal hernias, acalculous cholecystitis, and pancreatitis also occurred. Appropriate preventive measures may decrease the risk of developing many of these complications.