A total artificial heart (TAH) is a device that replaces the heart’s damaged ventricles and valves. It helps restore circulation and controls the flow of blood to and from the heart.

According to a 2021 article, the SynCardia Total Artificial Heart is the only TAH device that the Food and Drug Administration (FDA) approves. Around 2,000 individuals have received this type of cardiac treatment.

A 2019 study suggests that the use of cardiac replacement devices may increase as the number of people developing cardiovascular problems rises.

This article looks at TAH surgery in more detail and discusses its risks and alternative treatments.

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Surgeons implant a TAH through a procedure to replace the ventricles and supply blood to the lungs and other organs.

A TAH comes with four mechanical valves. A surgeon uses these to connect the device to the heart’s upper chambers and arteries.

The United Kingdom’s National Health Service (NHS) explains that an external portable device controls the TAH. The device is rechargeable, weighs approximately 7 kilograms, and can easily fit in a bag.

Learn about the anatomy of the heart here.

Types of TAHs

A doctor may recommend that a person receives one of two TAH options.

SynCardia’s 70cc TAH is the FDA’s only approved TAH for people who have biventricular failure. Doctors sometimes recommend it for people with heart failure while they wait for a heart transplant.

SynCardia’s 50cc TAH is a smaller device that may suit those whose body may not fit the 70cc TAH.

According to the National Heart, Lung, and Blood Institute (NHLBI), a TAH may be a potential long-term solution for people who have heart failure, where the heart no longer pumps enough blood supply to the body. Those who cannot have a heart transplant procedure may also benefit from this device.

A TAH has FDA approval as a bridge to a transplant. This means that doctors may recommend one if a person has heart failure while they wait for a heart transplant.

The NHS notes a case in which a person had familial dilated cardiomyopathy with worsening symptoms. They received a diagnosis of end stage heart failure.

Doctors typically recommend a left ventricular assist device (LVAD) to improve circulation in those with heart failure. However, this person could not receive an LVAD, as it would not have supported their heart’s right side. Because of this, doctors made the decision to give them a TAH.

A 2014 article states that a TAH may also benefit some children with end stage biventricular heart failure, provided they have a body surface area of over 1.7 square meters.

People may have to spend a week at the hospital before having TAH surgery. A surgeon will explain how they can prepare for the procedure and what they can do once they return home.

The NHLBI lists the tests that may take place before the TAH surgery. These include:

  • Blood tests: These identify a person’s blood type, ensuring they receive the correct blood type during surgery if needed. The tests also help the medical team check a person’s liver and kidney function.
  • Chest imaging: This produces images of the heart, lungs, and chest. Doctors use imaging tests to confirm that a person’s body is the right size for the TAH.
  • Electrocardiogram (ECG): ECGs monitor the heart’s rhythm and show doctors when the heart is beating faster or slower than it typically would.
  • Lung function tests: These indicate whether a person will need a ventilator while having the TAH implanted.

A TAH implantation procedure is complex, and it can take up to 9 hours. People present in the operating room during the procedure will include surgeons, surgical nurses, and anesthesiologists, and may include engineers to set up the TAH.

The surgery typically happens as follows:

  1. The anesthesiologist administers sedative medication. This ensures that the person feels comfortable and is unconscious during surgery. They also monitor the person’s heart rate, blood pressure, and oxygen levels.
  2. A doctor inserts a breathing tube into the person’s windpipe, then connects it to a ventilator to help with breathing.
  3. Surgeons stop the person’s heart. They perform the operation while a heart-lung bypass machine supplies blood throughout the person’s body. They remove this device once the TAH is in place.
  4. Doctors perform tests to confirm that the person’s TAH is working correctly.

After TAH implantation surgery, a person may have to remain in hospital for a month to recover. They may still require a ventilator, and also a feeding tube to receive fluids. A person may also require a tube to help drain urine, which will also help their healthcare team check whether the person’s kidneys are working correctly.

An intraveous line that goes into the neck or leg can also help doctors monitor the TAH’s status to check that there are no complications.

Additionally, surgical team members will explain the next steps that a person can follow after their hospital stay, and how to care for the TAH.

Doctors may prescribe anti-clotting medications for people who have undergone TAH implantation. These may include warfarin, aspirin, or clopidogrel. These medications may also suit those who have had a heart valve replacement or have vascular disease.

It is important to attend follow-up visits, as these allow the healthcare team to check for anemia, high blood pressure, or kidney failure.

A person with a TAH should read the device’s manual and contact their surgeon if they have any questions.

The American Heart Association recommends certain lifestyle changes to support heart function, such as:

According to a 2014 article, some people with a TAH may experience bleeding, a blood clot, infection, or TAH malfunction. The article calls for further research into TAHs, so that people will have an easier way to recharge their external device and help prevent device malfunctions.

Most infections after TAH implantation occur in the lungs and urinary tract system. Other risks associated with having a TAH include:

In some cases, infection and hemorrhagic complications can be life threatening.

A ventricular assist device may be an option for people who have heart failure on one side. It supports the heart until it can fully supply blood on its own again. Surgeons may also recommend one while a person waits for a heart transplant or if they cannot have a heart transplant.

There are also medications that can help treat heart failure, including:

  • Beta-blockers: These include bisoprolol and carvedilol. They help improve the heart’s pumping function and slow the heart rate.
  • Aldosterone antagonists: These include spironolactone and eplerenone. They help the kidneys release extra water and salt from the blood, as fluid can build up in people with heart failure.
  • Diuretics: Diuretic drugs include furosemide, indapamide, and bumetanide, among others. They eliminate the excess fluids that accumulate in the body, including in the lungs.

Learn about other medications for treating heart failure here.

A doctor may recommend TAH implantation for people with heart failure and those waiting for a heart transplant.

The procedure is complex and can take a long time to perform. It requires different types of doctors in the operating room.

Complications may arise in those who have a TAH, so it is important for them to visit a surgeon for regular checkups after the surgery.