The development of the artificial heart is one of the most compelling and controversial sagas in modern medicine. It represents humanity’s relentless drive to conquer heart failure, the ultimate organ breakdown. For decades, the pursuit of a fully functioning replacement heart has straddled the line between scientific triumph and ethical boundary pushing, leading to the sophisticated devices we see today.
The Audacious Idea: Early Concepts and Animal Trials
The theoretical groundwork for mechanical circulatory support dates back to the early 19th century, but the concept became a tangible goal in the mid-20th century. A pivotal figure was Dr. Willem Kolff, a Dutch-born physician who invented the dialysis machine during World War II. After moving to the United States, Kolff became a pioneer of artificial organs, dedicating his work to the mechanical heart.
Early devices were tested on animals, leading to small, incremental gains in survival time. The first documented attempt to implant a total artificial heart (TAH) in a human was performed by Dr. Denton A. Cooley and Dr. Domingo Liotta in Houston in 1969. The patient, a 47-year-old man, received the Liotta-Cooley heart as a “bridge to transplant,” surviving for nearly three days until a donor heart could be found. Although the patient later died, the procedure proved that a mechanical device could fully sustain human life, marking a monumental first step.
The Jarvik-7 and the Quest for Permanence
The history of the TAH took a dramatic turn in the 1980s with the Jarvik-7. Developed by Dr. Robert Jarvik under the guidance of Dr. Kolff, the Jarvik-7 was a pneumatic (air-driven) device made of aluminum and polyurethane, designed to replace both failed ventricles.
On December 2, 1982, surgeon Dr. William DeVries implanted the Jarvik-7 into retired dentist Dr. Barney Clark as the world’s first permanent total artificial heart. Dr. Clark lived for 112 days, constantly tethered to a 400-pound external air compressor—a machine dubbed “Big Blue.” The case captivated the world, but it also exposed the profound challenges of early artificial hearts:
- Complications: Subsequent patients experienced severe complications, most notably blood clots leading to strokes, and high rates of infection where the drivelines exited the body.
- Quality of Life: Being confined and tethered severely limited the patients’ mobility and quality of life.
Due to the high complication rate for permanent use, the Jarvik-7 was eventually restricted, but it established the TAH’s critical role: not as a permanent replacement, but as a temporary “bridge to transplantation (BTT).” Today, a direct descendant of the Jarvik-7, the SynCardia Total Artificial Heart (TAH), remains the only FDA-approved device for BTT in the US.
The Modern Landscape: VADs and Next-Generation TAHs
The pursuit of the permanent artificial heart did not stop, but the focus largely shifted to Ventricular Assist Devices (VADs). VADs assist, rather than replace, the patient’s native heart, pumping blood from one or both of the failing chambers. Modern, continuous-flow VADs are compact, quiet, and have become the dominant form of mechanical circulatory support, used successfully for both BTT and Destination Therapy (DT)—a permanent solution for patients ineligible for a transplant.
However, for patients with biventricular failure (both sides of the heart failing) or severe anatomical issues, the need for a Total Artificial Heart (TAH) remains. Today’s TAH technology is advancing rapidly:
- SynCardia TAH: As the current clinical standard, it functions as a temporary BTT, often using a portable driver (the Freedom Portable Driver) that allows patients to leave the hospital while awaiting a donor heart.
- Carmat TAH: Developed in France, this device represents a major leap toward a permanent solution. It utilizes highly biocompatible materials (like bovine tissue) to minimize clotting risk and includes embedded sensors to automatically regulate blood flow based on the patient’s activity level, mimicking a biological heart’s response.
- BiVACOR TAH: Currently undergoing clinical trials, the BiVACOR TAH is a revolutionary design. It features a single, magnetically suspended, rotating disk (impeller) that creates two separate flow paths for the left and right sides of the heart. This simplicity aims to reduce mechanical wear and improve durability, offering a truly innovative path toward a long-term, compact TAH.
The history of the artificial heart is a testament to the surgical and engineering visionaries who dared to replace the organ considered the very seat of life. From the bulky, air-driven pumps of the 1980s to the sleek, self-regulating devices in development today, the mechanical heart continues its evolution, offering hope and sustained life for those with end-stage heart failure.
