Heart failure is a disease affecting 6.2 million adults in the United States, resulting in morbidity and mortality in the short and long term. While options such as mechanical circulatory support and transplantation are considered a solution when medical management is not sufficient, heart transplantation (HTX) is regarded as the better option with a lower incidence of multiorgan failure. A limiting step for heart transplantation is the inadequate donor pool so options like donation after circulatory death and xenotransplantation have emerged as alternatives. The cardiac anesthesiologist plays a pivotal role in the perioperative management of both donors and recipients and a full understanding of the nature of the disease, pathophysiology, and perioperative management is paramount to the success of a heart transplantation program. The authors include an index case to illustrate the multidisciplinary approach to the disease and the implications of managing these complex patients presenting to the operating room.
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