Heart transplantation has advanced significantly since Lower and Shumway introduced the biatrial anastomosis technique in the 1960s. Although this method is simple and reproducible, it can cause atrial enlargement and associated complications such as sinus node dysfunction and tricuspid regurgitation. The bicaval anastomosis technique addressed these problems by preserving the morphology of the right atrium through individual anastomoses of the superior and inferior vena cava. Further refinements with anastomotic modification have improved anastomotic ease and reduced complications such as anastomotic stenosis. Technically, complex congenital heart disease, including heterotaxy syndrome and failed Fontan, is challenging. In particular, partial heart transplantation for truncus arteriosus is one of the most exciting procedures recently introduced, changing the concept of heart transplantation and the management of complex congenital heart disease. The combination of 3D printing and virtual reality seems promising for the planning of transplantation procedures in various complex situations. Further technical refinements and the introduction of new techniques in heart transplantation are expected to provide more confident status as advanced medicine for end-stage heart failure.