An artificial heart is a device that replaces the

heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide to t ...

. Artificial hearts are typically used to bridge the time to

heart transplantation A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease when other medical or surgical treatments have failed. , the most common procedu ...

, or to permanently replace the heart in the case that a heart transplant (from a deceased human or, experimentally, from a deceased genetically engineered pig) is impossible. Although other similar inventions preceded it from the late 1940s, the first artificial heart to be successfully implanted in a human was the Jarvik-7 in 1982, designed by a team including

Willem Johan Kolff Willem Johan "Pim" Kolff (February 14, 1911 – February 11, 2009) was a pioneer of hemodialysis, artificial heart, as well as in the entire field of artificial organs. Willem was a member of the Kolff family, an old Dutch patrician fam ...

William DeVries William Castle DeVries (born December 19, 1943) is an American cardiothoracic surgeon, mainly known for the first transplant of a TAH (total artificial heart) using the Jarvik-7 model. Early years and Medical School William DeVries was born ...

and Robert Jarvik. An artificial heart is distinct from a

ventricular assist device A ventricular assist device (VAD) is an electromechanical device for assisting cardiac circulation, which is used either to partially or to completely replace the function of a failing heart. The function of a VAD differs from that of an artific ...

(VAD; for either one or both of the ventricles, the heart's lower chambers), which can be a permanent solution also, or the

intra-aortic balloon pump The intra-aortic balloon pump (IABP) is a mechanical device that increases myocardial oxygen perfusion and indirectly increases cardiac output through afterload reduction. It consists of a cylindrical polyurethane balloon that sits in the aorta ...

– both devices are designed to support a failing heart. It is also distinct from a

cardiopulmonary bypass Cardiopulmonary bypass (CPB) is a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and oxygen to the body. The CPB pump itself is often referred to as a ...

machine, which is an external device used to provide the functions of both the heart and lungs, used only for a few hours at a time, most commonly during

cardiac surgery Cardiac surgery, or cardiovascular surgery, is surgery on the heart or great vessels performed by cardiac surgeons. It is often used to treat complications of ischemic heart disease (for example, with coronary artery bypass grafting); to co ...

. It is also distinct from a ventilator, used to support failing lungs, or the extracorporeal membrane oxygenation (ECMO), which is used to support those with both inadequate heart and lung function for up to days or weeks, unlike the bypass machine.

History

Origins

A synthetic replacement for a heart remains a long-sought "holy grail" of modern medicine. The obvious benefit of a functional artificial heart would be to lower the need for

heart transplant A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease when other medical or surgical treatments have failed. , the most common procedu ...

s because the demand for organs always greatly exceeds supply. Although the heart is conceptually a pump, it embodies subtleties that defy straightforward emulation with synthetic materials and power supplies. Consequences of these issues include severe foreign-body rejection and external batteries that limit mobility. These complications limited the lifespan of early human recipients from hours to days.

Early development

The first artificial heart was made by the Soviet scientist

Vladimir Demikhov Vladimir Petrovich Demikhov (russian: Владимир Петрович Демихов; July 31, 1916 – November 22, 1998) was a Soviet scientist and organ transplantation pioneer, who performed several transplants in the 1940s and 1 ...

in 1938. It was implanted in a dog. On 2 July 1952, 41-year-old

Henry Opitek Henry Opitek (January 6, 1911 – March 13, 1981) became the first patient to survive open heart surgery in 1952. On July 3, 1952, Opitek, a 41-year-old male suffering from shortness of breath, made medical history at Harper University Hospital ...

, suffering from shortness of breath, made medical history at Harper University Hospital at

Wayne State University Wayne State University (WSU) is a public research university in Detroit, Michigan. It is Michigan's third-largest university. Founded in 1868, Wayne State consists of 13 schools and colleges offering approximately 350 programs to nearly 25,000 ...

in Michigan. The Dodrill-GMR heart machine, considered to be the first operational mechanical heart, was successfully used while performing heart surgery. Ongoing research was done on calves at

Hershey Medical Center Penn State Health Milton S. Hershey Medical Center (MSHMC) is a 628-bed non-profit, tertiary, research and academic medical center located in Hershey, Pennsylvania, servicing the Central Pennsylvania area. MSHMC is the region's only university-le ...

, Animal Research Facility, in Hershey, Pennsylvania, during the 1970s.

Forest Dewey Dodrill Forest Dewey Dodrill (January 26, 1902 – June 28, 1997) was a medical doctor at Harper University Hospital at Wayne State University in Michigan who performed the first successful open heart surgery using a mechanical pump. Biography Dodrill wa ...

, working closely with Matthew Dudley, used the machine in 1952 to bypass Henry Opitek's left ventricle for 50 minutes while he opened the patient's left atrium and worked to repair the mitral valve. In Dodrill's post-operative report, he notes, "To our knowledge, this is the first instance of survival of a patient when a mechanical heart mechanism was used to take over the complete body function of maintaining the blood supply of the body while the heart was open and operated on." A

heart–lung machine Cardiopulmonary bypass (CPB) is a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and oxygen to the body. The CPB pump itself is often referred to as a ...

was first used in 1953 during a successful open heart surgery.

John Heysham Gibbon John Heysham Gibbon (September 29, 1903 – February 5, 1973) was an American surgeon best known for inventing the heart–lung machine and performing subsequent open-heart surgery, open-heart surgeries which revolutionized heart surger ...

, the inventor of the machine, performed the operation and developed the heart–lung substitute himself. Following these advances, scientific interest for the development of a solution for heart disease developed in numerous research groups worldwide.

Early designs of total artificial hearts

In 1949, a precursor to the modern artificial heart pump was built by doctors William Sewell and

William Glenn William Wallace Lumpkin Glenn (August 12, 1914 – March 10, 2003) was an American cardiac surgeon who co-created an early version of an artificial heart and was the developer of a technique for the treatment of congenital heart defects. Glen ...

of the

Yale School of Medicine The Yale School of Medicine is the graduate medical school at Yale University, a private research university in New Haven, Connecticut. It was founded in 1810 as the Medical Institution of Yale College and formally opened in 1813. The primary te ...

using an

Erector Set Erector Set (trademark styled as "ERECTOR") was a brand of metal toy construction sets which were originally patented by Alfred Carlton Gilbert and first sold by his company, the Mysto Manufacturing Company of New Haven, Connecticut in 1913. In ...

, assorted odds and ends, and dime-store toys. The external pump successfully bypassed the heart of a dog for more than an hour.

Paul Winchell Paul Winchell (''né'' Wilchinsky; December 21, 1922 – June 24, 2005) was an American actor, comedian, humanitarian, inventor and ventriloquist whose career flourished in the 1950s and 1960s. From 1950 to 1954, he hosted ''The Paul Winchell S ...

invented an artificial heart with the assistance of

Henry Heimlich Henry Judah Heimlich (February 3, 1920 – December 17, 2016) was an American thoracic surgeon and medical researcher. He is widely credited as the inventor of the Heimlich maneuver, a technique of abdominal thrusts for stopping choking, first ...

(the inventor of the

Heimlich maneuver Abdominal thrusts, also known as the Heimlich maneuver or Heimlich manoeuvre, is a first aid procedure used to treat upper airway obstructions (or choking) by foreign objects. American doctor Henry Heimlich is often credited for its creation. ...

) and held the first patent for such a device. The University of Utah developed a similar apparatus around the same time, but when they tried to patent it, Winchell's heart was cited as prior art. The university requested that Winchell donate the heart to the University of Utah, which he did. There is some debate as to how much of Winchell's design Robert Jarvik used in creating Jarvik's artificial heart. Heimlich states, "I saw the heart, I saw the patent and I saw the letters. The basic principle used in Winchell's heart and Jarvik's heart is exactly the same. " Jarvik denies that any of Winchell's design elements were incorporated into the device he fabricated for humans which was successfully implanted into Barney Clark in 1982. On 12 December 1957,

, the world's most prolific inventor of artificial organs, implanted an artificial heart into a dog at Cleveland Clinic. The dog lived for 90 minutes. In 1958,

Domingo Liotta Domingo Santo Liotta (29 November 1924 – 31 August 2022) was an Argentine surgeon and pioneer of heart surgery who created multiple cardiac prostheses, including the first total artificial heart used in a human being. Early life Domingo Sant ...

initiated the studies of TAH replacement at Lyon, France, and in 1959–60 at the

National University of Córdoba The National University of Córdoba ( es, Universidad Nacional de Córdoba,) is an institution of higher education in the city of Córdoba, Argentina. Founded in 1613, the university is the oldest in Argentina, the third oldest university of t ...

, Argentina. He presented his work at the meeting of the American Society for Artificial Internal Organs held in Atlantic City in March 1961. At that meeting, Liotta described the implantation of three types of orthotopic (inside the pericardial sac) TAHs in dogs, each of which used a different source of external energy: an implantable electric motor, an implantable rotating pump with an external electric motor, and a pneumatic pump. In 1964, the

National Institutes of Health The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late ...

started the Artificial Heart Program, with the goal of putting an artificial heart into a human by the end of the decade.Sandeep Jauhar: ''The Artificial Heart.'' New England Journal of Medicine (2004): 542–544. The purpose of the program was to develop an implantable artificial heart, including the power source, to replace a failing heart. In February 1966,

Adrian Kantrowitz Adrian Kantrowitz (October 4, 1918 – November 14, 2008) was an American cardiac surgeon whose team performed the world's second heart transplant attempt (after Christiaan Barnard) at Maimonides Medical Center in Brooklyn, New York on December ...

rose to international prominence when he performed the world's first permanent implantation of a partial mechanical heart (left ventricular assist device) at

Maimonides Medical Center Maimonides Medical Center is a non-profit, non-sectarian hospital located in Borough Park, in the New York City borough of Brooklyn, in the U.S. state of New York. Maimonides is both a treatment facility and academic medical center with 711 ...

. In 1967, Kolff left Cleveland Clinic to start the Division of Artificial Organs at the

University of Utah The University of Utah (U of U, UofU, or simply The U) is a public research university in Salt Lake City, Utah. It is the flagship institution of the Utah System of Higher Education. The university was established in 1850 as the University of De ...

and pursue his work on the artificial heart. # In 1973, a calf named Tony survived for 30 days on an early Kolff heart. # In 1975, a bull named Burk survived 90 days on the artificial heart. # In 1976, a calf named Abebe lived for 184 days on the Jarvik 5 artificial heart. # In 1981, a calf named Alfred Lord Tennyson lived for 268 days on the Jarvik 5. Over the years, more than 200 physicians, engineers, students and faculty developed, tested and improved Kolff's artificial heart. To help manage his many endeavors, Kolff assigned project managers. Each project was named after its manager. Graduate student Robert Jarvik was the project manager for the artificial heart, which was subsequently renamed the Jarvik 7. In 1981,

submitted a request to the FDA for permission to implant the Jarvik 7 into a human being. On 1 December 1982, William DeVries implanted the Jarvik 7 artificial heart into Barney Clark, a dentist from Seattle who had severe

congestive heart failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, ...

. Clark lived for 112 days tethered to an external pneumatic compressor, a device weighing some , but during that time he experienced prolonged periods of confusion and a number of instances of bleeding, and asked several times to be allowed to die.

First clinical implantation of a total artificial heart

On 4 April 1969,

and Denton A. Cooley replaced a dying man's heart with a mechanical heart inside the chest at

The Texas Heart Institute The Texas Heart Institute is an independent, nonprofit organization that is improving cardiovascular health through trailblazing research, thought leadership, education, and patient care to forge a better future for those with cardiovascular diseas ...

Houston Houston (; ) is the most populous city in Texas, the most populous city in the Southern United States, the fourth-most populous city in the United States, and the sixth-most populous city in North America, with a population of 2,304,580 i ...

as a bridge for a transplant. The man woke up and began to recover. After 64 hours, the pneumatic-powered artificial heart was removed and replaced by a donor heart. However thirty-two hours after transplantation, the man died of what was later proved to be an acute pulmonary infection, extended to both lungs, caused by fungi, most likely caused by an immunosuppressive drug complication. The original prototype of Liotta-Cooley artificial heart used in this historic operation is prominently displayed in the

Smithsonian Institution The Smithsonian Institution ( ), or simply the Smithsonian, is a group of museums and education and research centers, the largest such complex in the world, created by the U.S. government "for the increase and diffusion of knowledge". Founded ...

's National Museum of American History "Treasures of American History" exhibit in Washington, D.C.

First clinical applications of a permanent pneumatic total artificial heart

The first clinical use of an artificial heart designed for permanent implantation rather than a bridge to transplant occurred in 1982 at the

. Artificial kidney pioneer

started the Utah artificial organs program in 1967. There, physician-engineer Clifford Kwan-Gett invented two components of an integrated pneumatic artificial heart system: a ventricle with hemispherical diaphragms that did not crush red blood cells (a problem with previous artificial hearts) and an external heart driver that inherently regulated blood flow without needing complex control systems. Independently,

designed and patented a similarly shaped ventricle and donated the patent to the Utah program. Throughout the 1970s and early 1980s, veterinarian Donald Olsen led a series of calf experiments that refined the artificial heart and its surgical care. During that time, as a student at the University of Utah, Robert Jarvik combined several modifications: an ovoid shape to fit inside the human chest, a more blood-compatible polyurethane developed by biomedical engineer Donald Lyman, and a fabrication method by Kwan-Gett that made the inside of the ventricles smooth and seamless to reduce dangerous stroke-causing blood clots. On 1 December 1982,

implanted the artificial heart into retired dentist Barney Bailey Clark (born 21 January 1921), who survived 112 days with the device, dying on 23 March 1983. Bill Schroeder became the second recipient and lived for a record 620 days. Contrary to popular belief and erroneous articles in several periodicals, the Jarvik heart was not banned for permanent use. Today, the modern version of the Jarvik 7 is known as the SynCardia temporary Total Artificial Heart. It has been implanted in more than 1,350 people as a bridge to transplantation. In the mid-1980s, artificial hearts were powered by dishwasher-sized pneumatic power sources whose lineage went back to Alfa Laval

milking machines A dairy is a business enterprise established for the harvesting or processing (or both) of animal milk – mostly from cows or buffaloes, but also from goats, sheep, horses, or camels – for human consumption. A dairy is typically located on ...

. Moreover, two sizable catheters had to cross the body wall to carry the pneumatic pulses to the implanted heart, greatly increasing the risk of infection. To speed development of a new generation of technologies, the National Heart, Lung, and Blood Institute opened a competition for implantable electrically powered artificial hearts. Three groups received funding:

Cleveland Clinic Cleveland Clinic is a nonprofit American academic medical center based in Cleveland, Ohio. Owned and operated by the Cleveland Clinic Foundation, an Ohio nonprofit corporation established in 1921, it runs a 170-acre (69 ha) campus in Cleveland, ...

in Cleveland, Ohio; the College of Medicine of Pennsylvania State University (

Penn State Hershey Medical Center Penn State Health Milton S. Hershey Medical Center (MSHMC) is a 628-bed non-profit, tertiary, research and academic medical center located in Hershey, Pennsylvania, servicing the Central Pennsylvania area. MSHMC is the region's only university-le ...

) in Hershey, Pennsylvania; and AbioMed, Inc. of Danvers, Massachusetts. Despite considerable progress, the Cleveland program was discontinued after the first five years.

First clinical application of an intrathoracic pump

On 19 July 1963, E. Stanley Crawford and

implanted the first clinical Left Ventricular Assist Device (LVAD) at

The Methodist Hospital Houston Methodist Hospital is the flagship quaternary care hospital of Houston Methodist academic medical center. Located in the Texas Medical Center in Houston, Texas, Houston Methodist Hospital was established in 1919 during the height of the ...

in Houston, Texas, in a patient who had a cardiac arrest after surgery. The patient survived for four days under mechanical support but did not recover from the complications of the cardiac arrest; finally, the pump was discontinued, and the patient died.

First clinical application of a paracorporeal pump

On 21 April 1966,

Michael DeBakey Michael Ellis DeBakey (September 7, 1908 – July 11, 2008) was a Lebanese-American general and cardiovascular surgeon, scientist and medical educator who became Chairman of the Department of Surgery, President, and Chancellor of Baylor College ...

and Liotta implanted the first clinical LVAD in a paracorporeal position (where the external pump rests at the side of the patient) at The Methodist Hospital in Houston, in a patient experiencing cardiogenic shock after heart surgery. The patient developed neurological and pulmonary complications and died after few days of LVAD mechanical support. In October 1966, DeBakey and Liotta implanted the paracorporeal Liotta-DeBakey LVAD in a new patient who recovered well and was discharged from the hospital after 10 days of mechanical support, thus constituting the first successful use of an LVAD for postcardiotomy shock.

First VAD patient with FDA approved hospital discharge

In 1990 Brian Williams was discharged from the

University of Pittsburgh Medical Center The University of Pittsburgh Medical Center (UPMC) is a $23billion integrated global nonprofit health enterprise that has 92,000 employees, 40 hospitals with more than 8,000 licensed beds, 800 clinical locations including outpatient sites and d ...

(UPMC), becoming the first VAD patient to be discharged with Food and Drug Administration (FDA) approval. The patient was supported in part by bioengineers from the University of Pittsburgh's McGowan Institute.

Total artificial hearts

Approved medical devices

SynCardia

SynCardia is a company based in Tucson, Arizona, which currently has two separate models available. It is available in a 70cc and 50cc size. The 70cc model is used for biventricular heart failure in adult men, while the 50cc is for children and women. As good results with the TAH as a bridge to

accumulated, a trial of the CardioWest TAH (developed from the Jarvik 7 and now marketed as the Syncardia TAH) was initiated in 1993 and completed in 2002. The SynCardia was first approved for use in 2004 by the

US Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food ...

. As of 2014, more than 1,250 patients have received SynCardia artificial hearts. The device requires the use of the Companion 2 in-hospital driver, approved by the FDA in 2012, or the Freedom Driver System, approved in 2014, which allows some patients to return home, to power the heart with pulses of air. The drivers also monitor blood flow for each ventricle. In 2016, Syncardia filed for bankruptcy protection and was later acquired by the private equity firm Versa Capital Management.

Carmat bioprosthetic heart

On 27 October 2008, French professor and leading

specialist Alain F. Carpentier announced that a fully implantable artificial heart would be ready for clinical trial by 2011 and for alternative transplant in 2013. It was developed and would be manufactured by him, biomedical firm CARMAT SA, and venture capital firm Truffle Capital. The prototype used embedded electronic sensors and was made from chemically treated animal tissues, called "biomaterials", or a "pseudo-skin" of

biosynthetic Biosynthesis is a multi-step, enzyme-Catalysis, catalyzed process where substrate (chemistry), substrates are converted into more complex Product (chemistry), products in living organisms. In biosynthesis, simple Chemical compound, compounds are mo ...

microporous material A microporous material is a material containing pores with diameters less than 2 nm. Examples of microporous materials include zeolites and metal-organic frameworks. Porous materials are classified into several kinds by their size. The recom ...

s. According to a press-release by Carmat dated 20 December 2013, the first implantation of its artificial heart in a 75-year-old patient was performed on 18 December 2013 by the Georges Pompidou European Hospital team in Paris (France). The patient died 75 days after the operation. In Carmat's design, two chambers are each divided by a membrane that holds hydraulic fluid on one side. A motorized pump moves hydraulic fluid in and out of the chambers, and that fluid causes the membrane to move; blood flows through the other side of each membrane. The blood-facing side of the membrane is made of tissue obtained from a sac that surrounds a cow's heart, to make the device more biocompatible. The Carmat device also uses valves made from cow heart tissue and has sensors to detect increased pressure within the device. That information is sent to an internal control system that can adjust the flow rate in response to increased demand, such as when a patient is exercising. This distinguishes it from previous designs that maintain a constant flow rate. The Carmat device, unlike previous designs, is meant to be used in cases of terminal heart failure, instead of being used as a bridge device while the patient awaits a transplant. At 900 grams it weighs nearly three times the typical heart and is targeted primarily towards obese men. It also requires the patient to carry around an additional Li-Ion battery. The projected lifetime of the artificial heart is around 5 years (230 million beats). In 2016, trials for the Carmat "fully artificial heart" were banned by the National Agency for Security and Medicine in Europe after short survival rates were confirmed. The ban was lifted in May 2017. At that time, a European report stated that Celyad's C-Cure cell therapy for ischemic heart failure "could only help a subpopulation of Phase III study participants, and Carmat will hope that its artificial heart will be able to treat a higher proportion of heart failure patients". The Carmat artificial heart was approved for sale in the European Union, receiving a

CE marking On commercial products, the letters CE (as the logo ) mean that the manufacturer or importer affirms the good's conformity with European health, safety, and environmental protection standards. It is not a quality indicator or a certificatio ...

on December 22, 2020. Its stock price increased over a third upon the announcement of the news.

Historical prototypes

Total artificial heart pump

The

U.S. Army The United States Army (USA) is the land service branch of the United States Armed Forces. It is one of the eight U.S. uniformed services, and is designated as the Army of the United States in the U.S. Constitution.Article II, section 2, cl ...

artificial heart pump was a compact, air-powered unit developed by Kenneth Woodward at

Harry Diamond Laboratories The Harry Diamond Laboratories (HDL) was a research facility of the Ordnance Development Division of the National Bureau of Standards and later the US Army, most notable for its work on proximity fuzes in World War II. The organization was founde ...

in the early to mid-1960s. The Army's heart pump was partially made of

plexiglass Poly(methyl methacrylate) (PMMA) belongs to a group of materials called engineering plastics. It is a transparent thermoplastic. PMMA is also known as acrylic, acrylic glass, as well as by the trade names and brands Crylux, Plexiglas, Acrylite, ...

, and consisted of two valves, a chamber, and a suction flapper. The pump operated without any moving parts under the principle of fluid amplification – providing a pulsating air pressure source resembling a heartbeat.

POLVAD

Since 1991, the Foundation for Cardiac Surgery Development (FRK) in

Zabrze Zabrze (; German: 1915–1945: ''Hindenburg O.S.'', full form: ''Hindenburg in Oberschlesien'', Silesian: ''Zŏbrze'', yi, זאַבזשע, Zabzhe) is an industrial city in Silesia in southern Poland, near Katowice. The west district of the Si ...

, Poland, has been working on developing an artificial heart. Nowadays, the Polish system for heart support POLCAS consists of the artificial ventricle POLVAD-MEV and the three controllers POLPDU-401, POLPDU-402 and POLPDU-501. Presented devices are designed to handle only one patient. The control units of the 401 and 402 series may be used only in hospital due to its big size, method of control and type of power supply. The control unit of 501 series is the latest product of FRK. Due to its much smaller size and weight, it is significantly more mobile solution. For this reason, it can be also used during supervised treatment conducted outside the hospital.

Phoenix-7

In June 1996, a 46-year-old man received a total artificial heart implantation done by Jeng Wei at Cheng-Hsin General Hospital in

Taiwan Taiwan, officially the Republic of China (ROC), is a country in East Asia, at the junction of the East and South China Seas in the northwestern Pacific Ocean, with the People's Republic of China (PRC) to the northwest, Japan to the nort ...

. This technologically advanced pneumatic Phoenix-7 Total Artificial Heart was manufactured by Taiwanese dentist

Kelvin K. Cheng Kevin K. Cheng (born around 1945), developed the Phoenix total artificial heart, first used in a human in 1985 in an emergency in a person whose donor heart was being acutely rejected. Cheng was a dentist by profession and the Phoenix heart he de ...

, Chinese physician T. M. Kao, and colleagues at the

Taiwan TAH Research Center Taiwan, officially the Republic of China (ROC), is a country in East Asia, at the junction of the East and South China Seas in the northwestern Pacific Ocean, with the People's Republic of China (PRC) to the northwest, Japan to the northeas ...

Tainan Tainan (), officially Tainan City, is a special municipality in southern Taiwan facing the Taiwan Strait on its western coast. Tainan is the oldest city on the island and also commonly known as the "Capital City" for its over 200 years of his ...

. With this experimental artificial heart, the patient's BP was maintained at 90–100/40–55 mmHg and cardiac output at 4.2–5.8 L/min. The patient then received the world's first successful combined heart and kidney transplantation after bridging with a total artificial heart.

Abiomed hearts

The first

AbioCor AbioCor was a total artificial heart (TAH) developed by the Massachusetts-based company AbioMed. It was fully implantable within a patient, due to a combination of advances in miniaturization, biosensors, plastics and energy transfer. The AbioC ...

to be surgically implanted in a patient was on 3 July 2001. The AbioCor is made of titanium and plastic with a weight of 0.9 kg (two pounds), and its internal battery can be recharged with a transduction device that sends power through the skin. The internal battery lasts for half an hour, and a wearable external battery pack lasts for four hours. The FDA announced on 5 September 2006, that the AbioCor could be implanted for humanitarian uses after the device had been tested on 15 patients. It is intended for critically ill patients who cannot receive a heart transplant. Some limitations of the current AbioCor are that its size makes it suitable for less than 50% of the female population and only about 50% of the male population, and its useful life is only 1–2 years. By combining its valved ventricles with the control technology and roller screw developed at Penn State, AbioMed designed a smaller, more stable heart, the AbioCor II. This pump, which should be implantable in most men and 50% of women with a life span of up to five years, had animal trials in 2005, and the company hoped to get FDA approval for human use in 2008. After a great deal of experimentation,

Abiomed Abiomed, Inc. is a medical device technology company that operates as a stand-alone business within Johnson & Johnson's MedTech Segment. Abiomed develops and manufactures temporary external and implantable mechanical circulatory support devices. ...

has abandoned development of total official hearts as of 2015. Abiomed as of 2019 only markets heart pumps, "intended to help pump blood in patients who need short-term support (up to 6 days)", which are not total artificial hearts.

Frazier-Cohn

On 12 March 2011, an experimental artificial heart was implanted in 55-year-old Craig Lewis at The Texas Heart Institute in Houston by O. H. Frazier and William Cohn. The device is a combination of two modified

HeartMate II A ventricular assist device (VAD) is an electromechanical device for assisting cardiac circulation, which is used either to partially or to completely replace the function of a failing heart. The function of a VAD differs from that of an artifici ...

pumps that is currently undergoing bovine trials. Frazier and Cohn are on the board of the BiVACOR company that develops an artificial heart. BiVACOR has been tested as a replacement for a heart in a sheep. So far, only one person has benefited from Frazier and Cohn's artificial heart. Craig Lewis had amyloidosis in 2011 when his heart gave out and doctors pronounced that he had only 12 to 24 hours to live. After obtaining permission from his family, Frazier and Cohn replaced his heart with their device. Lewis survived for another 5 weeks after the operation; he eventually died from liver and kidney failure due to his amyloidosis, after which his family asked that his artificial heart be unplugged. Soft Total Artificial Heart sTAH

Current prototypes

Soft artificial heart

On 10 July 2017, Nicholas Cohrs and colleagues presented a new concept of a soft total artificial heart in the Journal of Artificial Organs. The heart was developed in the Functionals Materials Laboratory at ETH Zurich. (Cohrs was listed as a doctoral student in a group led by Professor Wendelin Stark at ETH Zurich.) The soft artificial heart (SAH) was created from silicone with the help of 3D printing technology. The SAH is a silicone monoblock. It weighs 390g, has a volume of 679 cm³ and is operated through pressurized air. "Our goal is to develop an artificial heart that is roughly the same size as the patient's own one and which imitates the human heart as closely as possible in form and function" says Cohrs in an interview. The SAH fundamentally moves and works like a real heart but currently only beats for 3000 beats (which corresponds to a duration of 30 to 50 minutes for an average individual's heart beat) in a hybrid mock circulation machine. Following which the silicone membrane (2.3 mm thick) between the Left Ventricle and the Air Expansion Chamber ruptured. The working life of a more recent Cohrs prototype (using various polymers instead of silicone) was still limited, according to reports in early 2018, with that model providing a useful life of 1 million heartbeats, roughly ten days in a human body. At the time, Cohrs and his team were experimenting with CAD software and 3D printing, striving to develop a model that would last up to 15 years. "We cannot really predict when we could have a final working heart which fulfills all requirements and is ready for implantation. This usually takes years", said Cohrs.

Others

centrifugal pump Centrifugal pumps are used to transport fluids by the conversion of rotational kinetic energy to the hydrodynamic energy of the fluid flow. The rotational energy typically comes from an engine or electric motor. They are a sub-class of dynamic ...

or an

axial-flow pump An axial-flow pump, or AFP, is a common type of pump that essentially consists of a propeller (an axial impeller) in a pipe. The propeller can be driven directly by a sealed motor in the pipe or by electric motor or petrol/diesel engines mounted ...

can be used as an artificial heart, resulting in the patient being alive without a

pulse In medicine, a pulse represents the tactile arterial palpation of the cardiac cycle (heartbeat) by trained fingertips. The pulse may be palpated in any place that allows an artery to be compressed near the surface of the body, such as at the n ...

. Other pulse-less artificial heart designs include the

from Thoratec, which uses an

Archimedes screw The Archimedes screw, also known as the Archimedean screw, hydrodynamic screw, water screw or Egyptian screw, is one of the earliest hydraulic machines. Using Archimedes screws as water pumps (Archimedes screw pump (ASP) or screw pump) dates back ...

; and an experimental artificial heart designed by Bud Frazier and Billy Cohn, using turbines spinning at 8,000 to 12,000 RPMs. A centrifugal artificial heart which alternately pumps the

pulmonary circulation The pulmonary circulation is a division of the circulatory system in all vertebrates. The circuit begins with deoxygenated blood returned from the body to the right atrium of the heart where it is pumped out from the right ventricle to the lungs ...

and the systemic circulation, causing a pulse, has been described. Researchers have constructed a heart out of foam. The heart is made out of flexible silicone and works with an external pump to push air and fluids through the heart. It currently cannot be implanted into humans, but it is a promising start for artificial hearts.

Hybrid assistive devices

Patients who have some remaining heart function but who can no longer live normally may be candidates for ventricular assist devices (VAD), which do not replace the human heart but complement it by taking up much of the function. The first Left Ventricular Assist Device (LVAD) system was created by

Baylor College of Medicine Baylor College of Medicine (BCM) is a medical school and research center in Houston, Texas, within the Texas Medical Center, the world's largest medical center. BCM is composed of four academic components: the School of Medicine, the Graduate S ...

in 1962. Another VAD, the Kantrowitz CardioVad, designed by

, boosts the native heart by taking up over 50% of its function. Additionally, the VAD can help patients on the wait list for a heart transplant. In a young person, this device could delay the need for a transplant by 10–15 years, or even allow the heart to recover, in which case the VAD can be removed. The artificial heart is powered by a battery that needs to be changed several times while still working. The first heart assist device was approved by the FDA in 1994, and two more received approval in 1998. While the original assist devices emulated the pulsating heart, newer versions, such as the Heartmate II, developed by The Texas Heart Institute of Houston, provide continuous flow. These pumps (which may be centrifugal or

axial flow An axial compressor is a gas compressor that can continuously pressurize gases. It is a rotating, airfoil-based compressor in which the gas or working fluid principally flows parallel to the axis of rotation, or axially. This differs from other ...

) are smaller and potentially more durable and last longer than the current generation of total heart replacement pumps. Another major advantage of a VAD is that the patient keeps the natural heart, which may still function for temporary back-up support if the mechanical pump were to stop. This may provide enough support to keep the patient alive until a solution to the problem is implemented. In August 2006, an artificial heart was implanted into a 15-year-old girl at the

Stollery Children's Hospital The Stollery Children's Hospital is a 218 bed children's hospital that opened in October 2001. It is a "hospital within a hospital," being situated within the University of Alberta Hospital and co-located with Mazankowski Alberta Heart Institute i ...

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. It was intended to act as a temporary fixture until a donor heart could be found. Instead, the artificial heart (called a Berlin Heart) allowed for natural processes to occur and her heart healed on its own. After 146 days, the Berlin Heart was removed, and the girl's heart functioned properly on its own. On 16 December 2011 the Berlin Heart gained U.S.

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approval. The device has since been successfully implanted in several children including a 4-year-old Honduran girl at

Children's Hospital Boston Boston Children's Hospital formerly known as Children's Hospital Boston until 2012 is a nationally ranked, freestanding acute care children's hospital located in Boston, Massachusetts, adjacent both to its teaching affiliate, Harvard Medical Sch ...

. Several continuous-flow ventricular assist devices have been approved for use in the European Union, and, as of August 2007, were undergoing clinical trials for FDA approval. In 2012, Craig Lewis, a 55-year-old Texan, presented at the

Texas Heart Institute The Texas Heart Institute is an independent, nonprofit organization that is improving cardiovascular health through trailblazing research, thought leadership, education, and patient care to forge a better future for those with cardiovascular diseas ...

with a severe case of

cardiac amyloidosis Cardiac amyloidosis is a subcategory of amyloidosis where there is depositing of the protein amyloid in the cardiac muscle and surrounding tissues. Amyloid, a misfolded and insoluble protein, can become a deposit in the heart's atria, valves, or ...

. He was given an experiment continuous-flow artificial heart transplant which saved his life. Lewis died 5 weeks later of liver failure after slipping into a coma due to the amyloidosis. In 2012, a study published in the New England Journal of Medicine compared the Berlin Heart to extracorporeal membrane oxygenation (ECMO) and concluded that "a ventricular assist device available in several sizes for use in children as a bridge to heart transplantation uch as the Berlin Heartwas associated with a significantly higher rate of survival as compared with ECMO." The study's primary author, Charles D. Fraser Jr., surgeon in chief at Texas Children's Hospital, explained: "With the Berlin Heart, we have a more effective therapy to offer patients earlier in the management of their heart failure. When we sit with parents, we have real data to offer so they can make an informed decision. This is a giant step forward." Suffering from end-stage heart failure, former Vice President Dick Cheney underwent a procedure at INOVA Fairfax Hospital, in Fairfax Virginia in July 2010, to have a Heartmate II VAD implanted. In 2012, he received a heart transplant at age 71 after 20 months on a waiting list.

References

General references

* George B. Griffenhagen and Calvin H. Hughes. ''The History of the Mechanical Heart''. Smithsonian Report for 1955, (Pub. 4241): 339–356, 1956.
"Donor saves Detroit pastor living on artificial heart"
Fox News. 18 May 2018

Inline citations

External links

* Kembrey, Melanie (17 August 2010)
"Artificial heart a medical marvel"
''Fairfield City Champion''. Archived 6 July 2011. {{DEFAULTSORT:Artificial Heart American inventions Implants (medicine) Cardiology

Heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide to t ...

1937 in medicine 20th-century inventions