Is a totally implantable artificial heart realistic?

Area of Science:

• Biomedical Engineering
• Cardiovascular Surgery
• Infectious Disease

Background:

• Intrathoracic implantation of the Jarvik 7 total artificial heart (J-7 TAH) is associated with a high incidence of local infection.
• Infection rates with J-7 TAH increase with longer implantation times, contrasting with left ventricular assist devices (LVADs).
• The prevailing belief is that intrathoracic cardiac prostheses carry a higher risk of infection.

Purpose of the Study:

• To investigate the physiological acceptability of total artificial hearts (TAHs).
• To explore the technical feasibility of totally implantable artificial hearts (TAHs).
• To identify and address challenges in TAH design and function.

Main Methods:

• Comparative analysis of infection rates between intrathoracic TAH and abdominal LVAD.
• Examination of structural differences between volumetrically dynamic TAH and stationary LVADs.
• Evaluation of inflammatory tissue responses to intrathoracic pulsating devices.

Main Results:

• Volumetric differences between TAH and LVADs may contribute to infection risks.
• Intrathoracic implantation of pulsating devices can lead to inflammatory tissue formation, creating potential sites for bacterial growth.
• Key challenges for totally implantable TAH include anatomical compatibility, reliable control, and long-term operation.

Conclusions:

• The design of TAH, particularly its dynamic pumping action, may predispose it to higher infection rates when implanted intrathoracically.
• Resolving anatomical compatibility, control systems, and long-term operational reliability are crucial for developing clinically useful totally implantable TAH systems.
• Further research into device design and implantation strategies is needed to mitigate infection risks associated with intrathoracic artificial hearts.