While advancements in pharmaceutical, device, and pacemaker technologies have reduced the overall need for heart transplantation in recent years, a subset of patients with advanced heart failure regrettably does not respond to conventional medical or device therapies. For these individuals, advanced options such as artificial hearts, mechanical circulatory support devices, and heart transplantation become critical considerations. The optimal timing and selection of these sophisticated interventions necessitate evaluation and ongoing management by experienced heart failure specialists or specialized medical centers. It is important to note that all these advanced procedures are successfully performed within our country.