Given the limitation of donor hearts, extended criteria cardiac transplantation (ECCT) strategies have been formally adopted at a number of transplant centers. The premise of ECCT is to match patients who fall outside traditional listing criteria (such as age 65 or older or significant co-morbidities including significant renal insufficiency, peripheral arterial disease including carotid artery disease, or poorly controlled diabetes mellitus) with donor hearts having high risk features. This study reviews ECCT outcomes at a single center. Adjusted survival for standard criteria cardiac transplant (SCCT) vs ECCT was as follows at 1 (89% vs. 86%; p=0.18) and 5 (77% vs. 66%; p=0.035) years. Although a lower survival with ECCT is seen, this same group has demonstrated it is superior to survival with medical managment.