The continuing and increasing discrepancy between the number of available donor hearts and the number of patients who might benefit from cardiac transplantation has prompted efforts in the development of xenotransplantation, mechanical assist devices, and cardiomyoplasty techniques. We briefly review recent work in these three fields. The results of experimental xenotransplantation between closely related species are improving slowly with currently available drugs, and clinical trials in this field may be possible in the near future. Implantable ventricular assist devices are also at a stage of development where permanent implantation is likely to be followed by a reasonable and worthwhile period of patient survival. With regard to cardiomyoplasty, steady progress is being made in clarifying exact indications and patient selection, as well as confirming the potential benefits.