Heart transplantation is the definitive therapy for end-stage heart failure. This retrospective study included 15 heart recipients aged 25 to 56 in Dr. Masih Daneshvari Hospital, Tehran, Iran over a 2- year period from April 2006 to July 2008. Patients suffered from dilated cardiomyopathy (n= 7) or ischemic cardiomyopathy n=8) with ejection fraction 10November to 20November. Cases with NYHA class V, IV and I symptoms were 2, 10 and 3, respectively. Six patients had to receive intravenous inotropic therapy before surgery. Two patients had a median sternotomy from previous cardiac surgeries. Anesthesia was induced with a narcotic- based technique ( fentanyl - midazolam 9, fentanyl-midazolam-ketamine 6) and maintained in pre bypass period with isoflurane- remifentanyl – midazolam (n=2), propofol-remifentanyl (n=7), fentanyl- midazolam (n=5), and propofol- fentanyl (n=1) as well as muscle relaxants (atracurium, cisatracurium, or pavulon). Rapid sequence induction was performed in 6 recipients. Hemodynamic instability at anesthetic induction was minor in all patients. The ischemic time was 1 to 2.25 hours and time on CPB was 87-220 minutes. The cardiovascular support was necessary in all patients for weaning from CPB. Prostaglandin E1 was given to one patient. Twelve patients were successfully separated from the CPB and three intraoperative deaths were observed. After transportation to ICU all recipients needed inotropic support. The recipients remained intubated for 9-100 hours after surgery. One death occurred on the 12 th posttransplant day due to acute rejection. No mortality was related to anesthetic management. The average hospital stay time was 17.18 ± 5.68 days. Eleven patients recovered and discharged from the hospital. Anesthetic management of patients undergoing heart transplantation is a challenge for anesthesiologists during the prebypass period as well as during the weaning and early post bypass periods.