Wilhelmi and colleagues from Hannover Medical School have presented an echocardiographic assessment of long-term survivors of heart transplantation. Their results corroborate those demonstrated by other surveys, ie, (1) general “preservation” of left ventricular morphology and systolic function beyond the first decade and (2) a significant incidence of left atrial dysfunction, right ventricular enlargement and tricuspid regurgitation. The main problem with isolated surveys of graft left ventricular function after transplantation is the inherent bias in the survey method, ie, their authors are most often interested in the characteristics of current survivors rather than also in those that died. The study design biases the cohort in favor of normal graft function because significant graft dysfunction is fatal in short order. A more important statistic is the actuarial freedom from graft LV dysfunction at 10 years. This is a challenging calculation because one may not know when to include patients for whom LV dysfunction was a finding proximate to a fatal incidence of infection or rejection. The bias, in any case, allows little to be said about results and little to act upon. In designing clinical surveys, it is important to see the forest through the trees, ie, (1) the actuarial freedom from death at 10 years following transplantation is only 38%–42% in four recent reports and (2) the actuarial freedom from significant CAD decreases steadily with years post-transplantation and is 50%–70% at 10 years. In the present era, surveys of standard clinical databases should be designed to detect trends and suggest properly conducted studies of factors pertinent to survival and quality of life. The effectiveness of OKT3 induction, CMV prophylaxis, Ca++ channel blockers, and lipid-lowering agents were first suspected from such databases. The future dataset may include the plethora of both donor and recipient genotypes (beyond the major histocompatibility complex) pertinent to the immunological response. An example is the donor interleukin-4 promoter gene, which was recently presented by Bijlsma and colleagues from Utrecht. An analysis of their polymorphisms may pinpoint the most important immunological processes and thus suggest therapeutic interventions if not better donor/recipient matching. The authors’ data on right ventricular (RV) and tricuspid valve function suggest the “other evil” facing long-term survivors of transplantation. Twenty nine percent of patients had impaired RV function, often associated with significant tricuspid regurgitation. This finding may be consistent with the fact that, despite “well-preserved” left ventricular function, 23 out of their 65 patients were in NYHA Class III or IV. Prior studies, particularly by Chan and colleagues at Stanford, show that TR is common and, although initially asymptomatic, ultimately becomes so and may well require valve replacement. The time has come to understand the causes of this problem. If the problem relates primarily to the technique of bi-atrial anastomosis, the alternative technique should be used. If the problem is due primarily to the technique of endomyocardial biopsy, we should be compulsive in modifying the catheter sheath (as has been previously suggested), increasing the precision of the technique using echocardiographic guidance, and in continuing to seek sensitive and specific noninvasive methods of detecting acute rejection.