Background: This video describes a sternal-sparing Heartmate II insertion. A non-sternotomy approach facilitates entry into the thorax at time of transplantation, avoids redo sternotomy and its associated risks, and may protect the RV from unrestricted dilation post-operatively. Methods: A sternal sparing approach was performed on selected patients who did not require concomitant valve procedures. A representative procedure was recorded in high-definition. To facilitate understanding, this video was segmented into 9 steps and incorporated simple explanatory animations. Results: The steps of the procedure are as follows: (1) Exposure: develop the pre-peritoneal space for placement of the pump pocket via a 5cm subxiphoid incision, exposure the LV apex via a 5cm left minithoracotomy over the 6th rib, and expose the ascending aorta via a 4cm right minithoracotomy above the 3rd rib. (2) Tunnel the driveline via the subxiphoid incision. (3) Cannulate the groin, and start CPB immediately prior to coring the apex. (4) Core the surgical apex. (5) Attach the sewing ring to the LV apex. (6) Lay the LVAD in pre-peritoneal space and connect it to the sewing ring. (7) Open the right cardiophrenic fold and tunnel the outflow in the right pleural space. (8) Anastomosis to outflow graft to aorta (9) Deair, connect the outflow graft to the HMII, and wean from CPB. Conclusions: This video describes a safe sternal-sparing method for Heartmate II insertion, segmented into 9 steps with accompanying video footage and simplified illustrations. Implementing sternal-sparing approaches for Heartmate II insertion may benefit carefully selected patients.