Although the basics of anesthetic management in heart transplantation are well-known, the practical approach differs with the experience and available technology in-hand. The purpose of this study was to assess our early anesthetic experience and to raise future directions in heart transplantation operations. Twenty-seven patients who were underwent heart transplantation from 2003 to 2008 were retrospectively evaluated from anesthetic and surgical charts. Patients’ characteristics potential to have impact on anesthetic management as well as early postoperative outcome were recorded. Average age was 31.5 ± 21.2 years and average body weight was 58.6 ± 17.4 kg. Anesthetic technique included induction with midazolam, fentanyl and etomidate followed by maintenance with isoflurane, air/O2 and fentanyl infusion. One patient was underwent both heart and kidney transplantation and another was performed heart transplantation and coronary artery bypass surgery at the same operation. Preoperatively, 17 patients had poor ventricular function, 15 had pulmonary hypertension, 5 had internal cardiodefibrilator device and 3 had intracardiac thrombi. Besides standard invasive monitoring, pulse contour cardiac output measurement device was used in three patients and pulmonary artery catheterization was performed in five. As critical events noted, one patient developed cardiac arrest at induction and resuscitated. There were not any major events other than minor transient hemodynamic changes in other patients. Ultrafiltration was performed in 22 patients with an average of 119 ± 1311 mL. Intraoperative use of packed red blood cells and fresh frozen plasma were 2.8 U ± 1.4 U and 3.4 ± 2.6 respectively. Total ischemic time was 218 ± 82 minutes. Lactate level at the end of surgery was 4.5. In the postoperative period, rhythm problems were observed in 4 patients, 17 patients required renal replacement therapy and 5 patients had revisions due to bleeding. There were no operative mortality; in-hospital mortality was 11% (3 patients). Our findings demonstrate that patients undergoing heart transplantation operations constitute high-risk for anesthetic management. Construction of standard institutional protocols may provide better evaluation and safer operative follow-up.