Total artificial heart

Abstract

Given the shortage of organ donors and lack of biologic alternatives, mechanical circulatory support is gaining importance both as a bridge-to-transplantation and as destination therapy. In the majority of patients, a left ventricular assist device alone is sufficient, but some require long-term biventricular support. For those, implantation of a total artificial heart (TAH) with removal of the native heart is a drastic but reliable option. In addition, advanced intracardiac thrombosis or destruction of the heart due to infective endocarditis or myocardial infarction may leave no other option. Currently, the Syncardia TAH is the only commercially available system. In selected centers with appropriate infrastructure and surgical expertise, the Syncardia TAH and its predecessors has been implanted in more than 1,000 patients with good results. However, indications for TAH implantation and its alternatives are still being discussed with some controversy. This chapter reviews the history of TAH development and summarizes indications, implantation technique, and clinical results.