I think it is proper to return to the first dogma—the superiority of cardiac transplantation to other surgical techniques in patients with heart failure. As I mentioned previously, that dogma was discarded basically because there had been a shortage of hearts for transplantation. However, it would be worthwhile to compare the results: transplantation vs these other procedures I have mentioned assuming hearts were available. To do this, we compared 4 groups of patients. We compared UNOS (United Network for Organ Sharing) status II cardiac transplantation patients with patients undergoing CAB surgery for ischemic cardiomyopathy, mitral valve repair plus CAB surgery for ischemic regurgitation, and finally, left ventricular reconstruction that included a few patients undergoing the Batista procedure. The cardiac transplant patients were UNOS status II, that is, these were not the most acutely ill patients. We found that the mortality for the various procedures included heart transplantation at 5.8%, CAB surgery for ischemic cardiomyopathy at 4%, mitral valve repair plus CAB surgery at 6.7%, and finally, left ventricular reconstruction at 4%. Essentially all these procedures had equivalent mortalities. Clearly, transplantation was not superior from that standpoint. We also noted that the 3-year survival, for these various procedures were essential equivalent. The most interesting difference was that of cost. A heart transplantation costs $76 000 despite the fact that these patients were in the hospital a relatively short period. This was owing to the procurement cost of $30 000. The CAB surgery costs $25 000, the mitral valve repair plus CAB surgery costs $32 000; and finally, the left ventricular reconstruction costs $27 000.12 Clearly alternative procedures in selected patients were at the very least equivalent to cardiac transplantation.