The Total Artificial Heart

Abstract

In the early 1800s, an awareness of potential ventricular failure stimulated interest in artificial heart replacement. In 1937 the first total artificial heart (TAH) was implanted into the chest of a dog by Russian physicians. The primary driving force for mechanical cardiac assistance developed from the necessity for circulatory assistance in order to perform corrective cardiac surgery. In 1953 the first successful closure of an atrial septal defect using extracorporeal circulation was performed. During the following decade the concept of using mechanical devices to assist the failing heart was aggressively pursued. This culminated in the first implant of a TAH in a human in 1969 as a bridge to transplant. Clinical implant of the TAH as a permanent device was performed in 1982 by researchers at the University of Utah. This patient lived for 112 days. Three successive permanent implants were performed in Louisville, Kentucky, with one patient surviving for 620 days. All of these permanent TAH patients suffered from device-related complications including bleeding, infection, and thromboembolic events. It became apparent that the present configuration of the TAH with its external drive lines and large air console was not ideal for long-term support. In 1985 the first implant of the Symbion J-7-100 TAH (Jarvik-7) as a bridge to transplant was performed. This patient was supported by the device for 9 days and was successfully transplanted and discharged home. Since 1985 more than 170 patients have been bridged using the Symbion J-7 TAH with more than 70% of these patients being successfully transplanted. The incidence of thromboembolic events has dramatically reduced with better understanding of anticoagulation requirements. Infection continues to be the greatest potential complication with these patients. In spite of this, the pneumatic TAH has proved to be an adequate bridge to transplant device.