The program was started in October 2004. Patients under 65 years of age are eligible for heart transplantation. More than 140 patients have been treated, with outcomes comparable to those of American centers and large Italian Centers. The ISMETT Heart Transplantation Program is supported by a VAD program, normally called Artificial Heart. This enables acute treatment of patients with cardiogenic shock, and patients with chronic cardiac decompensation. Long-term ventricular mechanical support was conceived primarily to face the high number of patients on the transplant waiting list who are unable to wait any longer due to the worsening of their disease. State-of-the-art VADs are made of miniature centrifugal pumps, totally implantable in the patient’s rib cage. This procedure is now performed at IRCCS-ISMETT with a minimally-invasive approach. Thanks to the reduced size, the new VADs allow a more rapid mobilization of the patient, and early hospital discharge. The patient, properly educated, can manage his/her device at home, with the continuing support of the VAD hospital team.