It is a basic refrigeration system. So, yes, essentially it 'exchanges' heat by using a compressor, an evaporator coil (cooling coil in the car) and a condenser coil (behind the radiator).
The refrigerant is the 'medium' which absorbs heat at the evaporator and then rejects it at the condenser.
A refrigeration system just moves heat from one place to another, that is it's only function.
It is a sealed system (and under fairly high pressure) so, in theory, it should never need 're-gassing' unless it springs a leak somewhere. However on cars, in practice, they can lose refrigerant without there being a 'leak' as such. This is because the neoprene seal between the compressor and clutch (the bit driven by the belt from the engine) can shrink if not lubricated properly. It is lubricated when the system is running and can dry out if the a/c isn't used for long periods.
When run, the seal will expand as it is being lubricated, so can 'reseal' itself, meaning no leaks but some refrigerant has escaped so the system will need 'topping up' or 're-gassing'.
This seal leaking is the reason why every car manufacturer will say the a/c system should be used on a regular basis.
The a/c system in a car uses very little refrigerant (around 200 grams). It is 'critically charged', ie needs an exact amount of refrigerant for it to operate properly. If the system loses even a small amount of refrigerant, it won't work properly. They also have safety switches, so if the refrigerant charge drops by too much, it will stop the compressor from kicking in to protect the system from damage.
Of course, there are also a myriad of other things that can fail on the system, like any other electro-mechanical system.
HTH.