Heart Failure pp 691-709 | Cite as

The Total Artificial Heart

  • Keyur B. Shah
  • Anit K. Mankad
  • Daniel G. Tang
  • Vigneshwar Kasirajan


The total artificial heart (TAH) is an effective means for treating advanced heart failure in patients dying of biventricular heart failure. Furthermore, the device represents a lifesaving alternative for patients with severe shock and anatomical contraindications to ventricular assist device therapy. This chapter reviews the history and evolution of total heart replacement technologies. Furthermore, it outlines general clinical indications, patient selection and management of patients with the TAH.


Heart Failure Heart Transplantation Mechanical Circulatory Support Artificial Heart Left Ventricular Assist Device 


  1. 1.
    LeGallois J. Experiments on the principles of life. Paris: D’Hautel; 1812.Google Scholar
  2. 2.
    Gibbs OS. An Artificial Heart. J Pharmacol Exp Ther. 1930;38(2):197–215.Google Scholar
  3. 3.
    Dodrill FD, Hill E, Gerisch RA. Temporary mechanical substitute for the left ventricle in man. J Am Med Assoc. 1952;150(7):642–4.CrossRefPubMedGoogle Scholar
  4. 4.
    Gibbon JH Jr. Application of a mechanical heart and lung apparatus to cardiac surgery. Minn Med. 1954;37(3):171–185; passim.Google Scholar
  5. 5.
    Nosé Y. The birth of the artificial heart programs in the world: a special tribute to Tetsuo Akutsu and Valerÿ Shumakov. Artif Organs. 2008;32(9):667–83.CrossRefPubMedGoogle Scholar
  6. 6.
    Cooley DA, Liotta D, Hallman GL, Bloodwell RD, Leachman RD, Milam JD. Orthotopic cardiac prosthesis for two-staged cardiac replacement. Am J Cardiol. 1969;24(5):723–30.CrossRefPubMedGoogle Scholar
  7. 7.
    Cooley DA. The total artificial heart. Nat Med. 2003;9(1):108–11.CrossRefPubMedGoogle Scholar
  8. 8.
    Curran WJ. Law-medicine notes. The first mechanical heart transplant: informed consent and experimentation. N Engl J Med. 1974;291(19):1015–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Cooley DA. Feuds: social and medical. Tex Heart Inst J. 2010;37(6):649–51.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Cooley DA, Akutsu T, Norman JC, Serrato MA, Frazier OH. Total artificial heart in two-staged cardiac transplantation. Cardiovasc Dis. 1981;8(3):305–19.PubMedPubMedCentralGoogle Scholar
  11. 11.
    DeVries WC, Anderson JL, Joyce LD, Anderson FL, Hammond EH, Jarvik RK, et al. Clinical use of the total artificial heart. N Engl J Med. 1984;310(5):273–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Copeland JG, Levinson MM, Smith R, Icenogle TB, Vaughn C, Cheng K, et al. The total artificial heart as a bridge to transplantation. A report of two cases. JAMA. 1986;256(21):2991–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Dowling RD, Gray Jr LA, Etoch SW, Laks H, Marelli D, Samuels L, et al. Initial experience with the AbioCor implantable replacement heart system. J Thorac Cardiovasc Surg. 2004;127(1):131–41.CrossRefPubMedGoogle Scholar
  14. 14.
    Dowling RD, Gray Jr LA, Etoch SW, Laks H, Marelli D, Samuels L, et al. The AbioCor implantable replacement heart. Ann Thorac Surg. 2003;75(6 Suppl):S93–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Leprince P, Bonnet N, Rama A, Léger P, Bors V, Levasseur JP, et al. Bridge to transplantation with the Jarvik-7 (CardioWest) total artificial heart: a single-center 15-year experience. J Heart Lung Transplant. 2003;22(12):1296–303.CrossRefPubMedGoogle Scholar
  16. 16.
    El-Banayosy A, Arusoglu L, Morshuis M, Kizner L, Tenderich G, Sarnowski P, et al. CardioWest total artificial heart: bad Oeynhausen experience. Ann Thorac Surg. 2005;80(2):548–52.CrossRefPubMedGoogle Scholar
  17. 17.
    Copeland JG, Smith RG, Arabia FA, Nolan PE, McClellan D, Tsau PH, et al. Total artificial heart bridge to transplantation: a 9-year experience with 62 patients. J Heart Lung Transplant. 2004;23(7):823–31.CrossRefPubMedGoogle Scholar
  18. 18.
    Roussel JC, Sénage T, Baron O, Périgaud C, Habash O, Rigal JC, et al. CardioWest (Jarvik) total artificial heart: a single-center experience with 42 patients. Ann Thorac Surg. 2009;87(1):124–30.CrossRefPubMedGoogle Scholar
  19. 19.
    Copeland JG, Smith RG, Arabia FA, Nolan PE, Sethi GK, Tsau PH, et al. Cardiac replacement with a total artificial heart as a bridge to transplantation. N Engl J Med. 2004;351(9):859–67.CrossRefPubMedGoogle Scholar
  20. 20.
    Kormos RL, Teuteberg JJ, Pagani FD, Russell SD, John R, Miller LW, et al. Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: incidence, risk factors, and effect on outcomes. J Thorac Cardiovasc Surg. 2010;139(5):1316–24.CrossRefPubMedGoogle Scholar
  21. 21.
    Potapov EV, Stepanenko A, Dandel M, Kukucka M, Lehmkuhl HB, Weng Y, et al. Tricuspid incompetence and geometry of the right ventricle as predictors of right ventricular function after implantation of a left ventricular assist device. J Heart Lung Transplant. 2008;27(12):1275–81.CrossRefPubMedGoogle Scholar
  22. 22.
    Puwanant S, Hamilton KK, Klodell CT, Hill JA, Schofield RS, Cleeton TS, et al. Tricuspid annular motion as a predictor of severe right ventricular failure after left ventricular assist device implantation. J Heart Lung Transplant. 2008;27(10):1102–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Kato TS, Farr M, Schulze PC, Maurer M, Shahzad K, Iwata S, et al. Usefulness of two-dimensional echocardiographic parameters of the left side of the heart to predict right ventricular failure after left ventricular assist device implantation. Am J Cardiol. 2012;109(2):246–51.CrossRefPubMedGoogle Scholar
  24. 24.
    Fukamachi K, Horvath DJ, Massiello AL, Fumoto H, Horai T, Rao S, et al. An innovative, sensorless, pulsatile, continuous-flow total artificial heart: device design and initial in vitro study. J Heart Lung Transplant. 2010;29(1):13–20.CrossRefPubMedGoogle Scholar
  25. 25.
    Kirklin JK, Naftel DC, Kormos RL, Stevenson LW, Pagani FD, Miller MA, et al. The fourth INTERMACS annual report: 4,000 implants and counting. J Heart Lung Transplant. 2012;31(2):117–26.CrossRefPubMedGoogle Scholar
  26. 26.
    Kirsch M, Mazzucotelli J-P, Roussel J-C, Bouchot O, N’loga J, Leprince P, et al. Survival after biventricular mechanical circulatory support: does the type of device matter? J Heart Lung Transplant. 2012;31(5):501–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Leprince P, Bonnet N, Varnous S, Rama A, Léger P, Ouattara A, et al. Patients with a body surface area less than 1.7 m2 have a good outcome with the CardioWest Total Artificial Heart. J Heart Lung Transplant. 2005;24(10):1501–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Copeland JG, Smith RG, Bose RK, Tsau PH, Nolan PE, Slepian MJ. Risk factor analysis for bridge to transplantation with the CardioWest Total Artificial Heart. Ann Thorac Surg. 2008;85(5):1639–44.CrossRefPubMedGoogle Scholar
  29. 29.
    Quader MA, Tang D, Katlaps G, Shah KB, Kasirajan V. Total artificial heart for patients with allograft failure. J Thorac Cardiovasc Surg. 2013;145(2):e21–3.CrossRefPubMedGoogle Scholar
  30. 30.
    Copeland JG, Arabia FA, Smith RG, Covington D. Synthetic membrane neo-pericardium facilitates total artificial heart explantation. J Heart Lung Transplant. 2001;20(6):654–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Ensor CR, Cahoon WD, Crouch MA, Katlaps GJ, Hess ML, Cooke RH, et al. Antithrombotic therapy for the CardioWest temporary total artificial heart. Tex Heart Inst J. 2010;37(2):149–58.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Crouch MA, Kasirajan V, Cahoon W, Katlaps GJ, Gunnerson KJ. Successful use and dosing of bivalirudin after temporary total artificial heart implantation: a case series. Pharmacotherapy. 2008;28(11):1413–20.CrossRefPubMedGoogle Scholar
  33. 33.
    Glauber M, Szefner J, Senni M, Gamba A, Mamprin F, Fiocchi R, et al. Reduction of haemorrhagic complications during mechanically assisted circulation with the use of a multi-system anticoagulation protocol. Int J Artif Organs. 1995;18(10):649–55.PubMedGoogle Scholar
  34. 34.
    Szefner J. Control and treatment of hemostasis in cardiovascular surgery. The experience of La Pitié Hospital with patients on total artificial heart. Int J Artif Organs. 1995;18(10):633–48.PubMedGoogle Scholar
  35. 35.
    Shah KB, Tang DG, Kasirajan V, Gunnerson KJ, Hess ML, Sica DA. Impact of low-dose B-type natriuretic peptide infusion on urine output after total artificial heart implantation. J Heart Lung Transplant. 2012;31(6):670–2.CrossRefPubMedGoogle Scholar
  36. 36.
    Delgado R, Wadia Y, Kar B, Ethridge W, Zewail A, Pool T, et al. Role of B-type natriuretic peptide and effect of nesiritide after total cardiac replacement with the AbioCor total artificial heart. J Heart Lung Transplant. 2005;24(8):1166–70.CrossRefPubMedGoogle Scholar
  37. 37.
    Mankad AK, Tang DG, Clark WB, Flattery M, Harton S, Katlaps GJ, et al. Persistent anemia after implantation of the total artificial heart. J Card Fail. 2012;18(6):433–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Levinson MM, Copeland JG, Smith RG, Cork RC, DeVries WC, Mays JB, et al. Indexes of hemolysis in human recipients of the Jarvik-7 total artificial heart: a cooperative report of fifteen patients. J Heart Transplant. 1986;5(3):236–48.PubMedGoogle Scholar
  39. 39.
    Kohli HS, Canada J, Arena R, Tang DG, Peberdy MA, Harton S, et al. Exercise blood pressure response during assisted circulatory support: comparison of the total artifical heart with a left ventricular assist device during rehabilitation. J Heart Lung Transplant. 2011;30(11):1207–13.CrossRefPubMedGoogle Scholar
  40. 40.
    Frazier OH, Cohn WE, Tuzun E, Winkler JA, Gregoric ID. Continuous-flow total artificial heart supports long-term survival of a calf. Tex Heart Inst J. 2009;36(6):568–74.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Frazier OH, Cohn WE. Continuous-flow total heart replacement device implanted in a 55-year-old man with end-stage heart failure and severe amyloidosis. Tex Heart Inst J. 2012;39(4):542–6.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Fumoto H, Horvath DJ, Rao S, Massiello AL, Horai T, Takaseya T, et al. In vivo acute performance of the Cleveland Clinic self-regulating, continuous-flow total artificial heart. J Heart Lung Transplant. 2010;29(1):21–6.CrossRefPubMedGoogle Scholar
  43. 43.
    Kobayashi M, Horvath DJ, Mielke N, Shiose A, Kuban B, Goodin M, et al. Progress on the design and development of the continuous-flow total artificial heart. Artif Organs. 2012;36(8):705–13.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Shiose A, Nowak K, Horvath DJ, Massiello AL, Golding LAR, Fukamachi K. Speed modulation of the continuous-flow total artificial heart to simulate a physiologic arterial pressure waveform. ASAIO J. 2010;56(5):403–9.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Jansen P, Van Oeveren W, Capel A, Carpentier A. In vitro haemocompatibility of a novel bioprosthetic total artificial heart. Eur J Cardiothorac Surg. 2012;41(6):e166–72.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2017

Authors and Affiliations

  • Keyur B. Shah
    • 1
  • Anit K. Mankad
    • 1
  • Daniel G. Tang
    • 2
  • Vigneshwar Kasirajan
    • 2
  1. 1.Pauley Heart Center, Division of CardiologyVirginia Commonwealth University, Medical College of VirginiaRichmondUSA
  2. 2.Division of Cardiothoracic SurgeryVirginia Commonwealth University, Medical College of VirginiaRichmondUSA

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