We retrospectively analyzed the impact of recipient, donor, and operative factors on the operative mortality and morbidity of 36 consecutive infant heart transplantations. Operative survival was excellent at 94%. Among 34 survivors, operative morbidity in 12 patients included acute severe allograft failure with or without prolonged ventilatory support. The cohort was characterized by age less than 4 months (32 of 36), a diagnosis of hypoplastic left heart syndrome (29 of 36), and the use of circulatory arrest (27 of 36); these variables were colinear and could not be used to predict operative mortality or morbidity. None of the remaining recipient, donor, or operative characteristics predicted survival or acute severe allograft failure. A donor-to-recipient weight ratio greater than 2 and a circulatory arrest time greater than 39 minutes predicted the need for prolonged ventilatory support. Despite the need for aggressive or prolonged support after 12 of 36 transplantations, operative survival was high at 94% (34 of 36 procedures, 32 of 34 patients). The use of less restrictive donor criteria combined with aggressive management of acute allograft failure can result in excellent operative survival after infant heart transplantation.