Erosion of the refractory materials in blast furnaces (BFs) greatly limits their campaign life, which seriously reduces the economic benefits of iron and steel plants and endangers workers. Therefore, it is important to detect and monitor the erosion process of refractory materials in the BF hearth. In this review, the mechanisms of physical damage, chemical corrosion, and mechanical erosion of BF hearths during BF operation are analyzed and summarized. In addition, the effects of hearth structure, refractory type, and protective layer on hearth erosion behavior and hearth life are analyzed and discussed. Some longevity technologies of BF hearths are analyzed and compared, such as reasonable hearth structure design, refractory selection, and technologies to form protective layers. Finally, some suggestions and prospects for the future development of long campaign life BF hearths are discussed.