The remarkable success of congenital heart disease management in childhood has resulted in unprecedented survival to adulthood. However, survival to adulthood does not equate to normal life expectancy, with heart failure (HF) emerging as the leading cause of mortality among the adult congenital heart disease (ACHD) population. The long-term management of this highly heterogeneous patient population represents uncharted territory, resulting in a field that is persistently evolving as experience increases. The field remains nascent in the optimal strategies of ACHD-HF prevention and management, including advanced therapies and transplantation. In this chapter, we present the current state of the field and some of the current challenges unique to ACHD patients while promoting collaboration with ACHD experts to continue to inform best practices and improve patient outcomes.