The total artificial heart

In the 1960s, cardiac surgeons and biomedical engineers pioneered the development of total artificial hearts (TAH) for the treatment of left and right heart failure. As we mark the 10th anniversary of the first implantation of the AbioCor device, the use of TAH has been limited, having failed to reach its envisioned potential and promise as an alternative therapy to heart transplantation. The Syncardia/CardioWest device, originally developed 30 years ago as the Jarvik TAH and later renamed the CardioWest TAH, continues to be used clinically in over 50 centers within the US and Europe having supported over 900 patients worldwide. Syncardia continues to develop TAH technology as evidenced by their recent introduction of a new portable pneumatic driver that enables patients to be discharged from the hospital. In contrast to TAH devices, continuous flow ventricular assist devices (VAD) have made tremendous technological strides and are rapidly gaining widespread clinical acceptance. The VAD technology has demonstrated extraordinary safety and reliability records through evolving technologies, advanced biocompatible materials, and improved patient management. Subsequently, the number of TAH implantations remains low compared to the growth in LVAD implants. Nonetheless, the Syncardia/CardioWest TAH remains an important and viable option for patients with severe biventricular failure and end organ dysfunction. Overall, a 79% survival rate has been achieved in patients supported with a Syncardia/CardioWest TAH as bridge-to-transplantation. In this review article, a brief history on the evolution of TAH devices, their current use and emerging use of evolving continuous flow VAD technology as chronic biventricular and TAH device systems are presented.