Infection and thrombosis in total artificial heart technology: Past and future challenges - A historical review

On the basis of animal testing and a single clinical implant during the 196 0s, development of the total artificial heart (TAH) began in earnest in the 1970s. The goal was to produce a pump that could treat biventricular heart failure or any other condition that necessitated removal of the patient's native heart. The early TAHs were pneumatically powered, with externalized drivelines. After undergoing in vivo evaluation in hundreds of sheep and ca lves at several centers (mainly the Utah Heart Institute), these pumps were implanted in humans, initially for permanent cardiac replacement and later for bridging to transplantation. In both the in vivo experimental setting and the clinical setting, infection and thrombosis were problematic, infect ion being encountered much more frequently than thrombosis in clinical case s. To minimize these problems, four research groups, funded by NIH, began i n 1988 to develop permanent, transcutaneously powered, totally implantable, electromechanical TAHs. For the first time, TAH technology was able to min imize infection and thrombosis, as confirmed by current in vivo studies. Th ese new TAHs will undergo preclinical, pre-IDE studies this year and clinic al trials in the near future. This article briefly reviews the evolution of TAH technology, with an emphasis on the prevention and management of infec tion and thrombosis.