In the period November, 1974 to May 1980, 30 patients underwent heterotopic heart transplantation at Groote Schuur Hospital. One patient subsequently underwent retransplantation for rejection. There were no operative deaths. 15 patients are alive 4 months to almost 5 1/2 years after transplantation. The 1 year survival rate has been 61%. 3 of 6 patients have survived for more than 4 years. 8 of 9 patients whose initial transplant operation was performed during the past 18 months remain alive. 7 patients died from infection, 5 from rejection, and 3 from other causes. The advantages of heterotopic over orthotopic heart transplantation, in particular in allowing patient survival even after graft destruction by irreversible rejection, are discussed.