The total artificial heart: where have we been, where are we now, where are we going?

The incidence and prevalence of end-stage heart failure continue to rise; however, the number of donor hearts available for transplantation continues to be limited. Therefore, alternatives to transplantation, such as the use of total artificial hearts (TAH), are necessary. The long and winding road to the development and implantation of the ideal TAH remains under construction. Although efforts have been ongoing for almost a century, researchers and clinicians continue to improve currently available TAHs and design and construct new models. With mortality and morbidity rates decreasing, particularly at high-volume centers with a dedicated team and carefully selected patients, the use of TAHs as a bridge to transplantation, and even destination therapy in clinical trials, the future of TAHs is bright.