Artificial Hearts: Indications, Types, and Clinical Role

An artificial heart is a mechanical device that replaces or assists the native heart's pumping function. Two main categories exist:

1. Total Artificial Heart (TAH)

• Replaces both ventricles and all four valves (e.g., SynCardia TAH).
• Requires external pneumatic driver (portable Freedom® driver available).
• Indicated for biventricular failure.

2. Ventricular Assist Device (VAD) — More Common

• LVAD: Left ventricular assist (most common; HeartMate 3, HeartWare).
• RVAD: Right ventricular assist (temporary, often percutaneous).
• BiVAD: Both ventricles.

Primary Indications

1. Bridge to transplant (BTT): Support until donor heart available.
2. Destination therapy (DT): Permanent support for transplant-ineligible patients (age, comorbidities, psychosocial).
3. Bridge to recovery: Temporary support for potentially reversible cardiomyopathy (myocarditis, postpartum, post-cardiotomy).
4. Bridge to decision: Stabilize while evaluating transplant candidacy.

Patient Selection

• End-stage heart failure (INTERMACS profiles 1–4)
• Failed maximal medical therapy
• Adequate psychosocial support, compliance
• No irreversible end-organ damage (unless combined transplant)

Complications

• Bleeding (anticoagulation required)
• Infection (driveline, pump pocket)
• Thromboembolism (stroke)
• Device malfunction
• Right heart failure post-LVAD
• Arrhythmias

Outcomes

HeartMate 3: 2-year survival ~80% (DT), >85% (BTT). Quality of life improves significantly (NYHA IV → I/II).

Artificial hearts are life-saving for selected advanced heart failure patients, with evolving technology reducing complications.