Status of permanent cardiac replacement for end-stage congestive heart failure

Abstract. Permanent replacement of the heart in patients with end-stage congestive heart failure has long been sought after as the most definitive solution to an ever-growing problem. While cardiac transplantation is an effective therapy for many patients with end-stage congestive heart failure, this potential has been limited by the donor organ shortage and other limitations of long-term survival inherent in cardiac transplantation. While research and development of the total artificial heart continues to be of considerable interest, present-day mechanical circulatory support most commonly involves the use of left ventricular assist devices as a bridge to transplantation. Pneumatic and electromechanical pumps are now commonly employed in modern transplant practices with excellent hemodynamic function. The TCI HeartMate left ventricular assist device is now approved by the Food and Drug Administration for clinical implantation, with excellent preliminary results. Advances in the area of temporary and extended mechanical circulatory support are crucial to the ultimate development of a totally implantable artificial heart.