Cardiac Transplantation and Advanced Heart Failure Surgery: Current Evidence and Evolving Practice

The management of end-stage heart failure through cardiac transplantation and surgical alternatives represents one of the most complex and consequential domains in cardiothoracic surgery. This chapter reviews contemporary criteria and evolving practices in cardiac transplant recipient and donor selection, organ preservation techniques including normothermic machine perfusion, and the management of post-transplant complications including rejection, cardiac allograft vasculopathy, and infection. Surgical options for advanced heart failure beyond transplantation — including surgical ventricular reconstruction, high-risk revascularization, and the role of total artificial heart — are also examined in the context of the growing population of patients with refractory heart failure.