Since 1972, 280 patients with severe irreversible myocardial damage have been referred to La Pitié Hospital, Paris, for heart transplantation; 95 were excluded on account of absolute contra-indications. Owing to the limited number of available transplants, only 66 of the 185 remaining patients were transplanted. Transplantation was orthotopic in all but 3 cases: 1 patient had heterotopic transplantation and 2 had heart-lung transplantation. The most common post-operative problems were graft rejection and complications of the immunosuppressive treatment; 82% of the transplanted patients were discharged 2 months on average after surgery; 47% overcame the first year problems and resumed an almost normal social and professional life; 21 are still alive, one of them after 9 years. During the last 2 years, technical refinements and the advent of more potent immunosuppressive agents (anti-lymphocyte serum from rabbits, cyclosporin A) and better diagnostic methods (repeated endomyocardial biopsies and immunological surveillance) have resulted in considerable improvement in the patients' outcome, with an actuarial survival rate of 77% at one year and 70% at two years. Since transplants are now better tolerated after the second year and since they possess remarkably good and durable functional properties, this reduction in early and late mortality, which used to be the main cause of failure, raises hopes of a marked increase in prolonged and satisfactory survival.