Cardiac allograft vasculopathy (CAV) is one of the major complications after heart transplantation (HTx) that contributes to graft failure and significant morbidity and mortality. This chapter explores the epidemiology, pathophysiology, and clinical features, as well as diagnosis, medical and surgical management of CAV. Advancements in post-HTx immunosuppression, imaging technology, and risk stratification techniques will lead to improved quality of life and longevity after transplant.