Artificial heart

Artificial heart

Overview
An artificial heart is a mechanical device that replaces the heart
Heart
The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...

. Artificial hearts are typically used in order to bridge the time to heart transplantation
Heart transplantation
A heart transplant, or a cardiac transplantation, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease. As of 2007 the most common procedure was to take a working heart from a recently deceased organ donor and implant it into the...

, or to permanently replace the heart in case transplantation is impossible. The first artificial heart was the Jarvik-7, designed by Robert Jarvik.

An artificial heart is also distinct from a cardiopulmonary bypass machine (CPB), which is an external device used to provide the functions of both the heart and lungs.
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Encyclopedia
An artificial heart is a mechanical device that replaces the heart
Heart
The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...

. Artificial hearts are typically used in order to bridge the time to heart transplantation
Heart transplantation
A heart transplant, or a cardiac transplantation, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease. As of 2007 the most common procedure was to take a working heart from a recently deceased organ donor and implant it into the...

, or to permanently replace the heart in case transplantation is impossible. The first artificial heart was the Jarvik-7, designed by Robert Jarvik.

An artificial heart is also distinct from a cardiopulmonary bypass machine (CPB), which is an external device used to provide the functions of both the heart and lungs. CPBs are only used for a few hours at a time, most commonly during heart surgery.

FDA approved artificial hearts


SynCardia temporary Total Artificial Heart

The SynCardia temporary Total Artificial Heart was the first FDA
Food and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...

-approved total artificial heart. It received FDA approval on October 15, 2004, following a 10-year clinical study.

Originally designed as a permanent replacement heart, it is currently approved as a bridge to human heart transplant for patients dying because both sides of their hearts are failing (irreversible end stage biventricular failure). There have been more than 900 implants of the Total Artificial Heart, accounting for more than 210 patient years of life on this device.

During the 10-year study, 79% of patients receiving the Total Artificial Heart survived to transplant (New England Journal of Medicine 2004; 351: 859–867). This is the highest bridge-to-transplant rate for any heart device in the world. (See FDA Summary of Safety and Effectiveness)

AbioCor Replacement Heart

Unlike the CardioWest TAH, the AbioCor
AbioCor
AbioCor is an artificial heart developed by the Massachusetts-based company AbioMed. It is fully implantable within a patient, due to a combination of advances in miniaturization, biosensors, plastics and energy transfer. The AbioCor runs on a rechargeable source of power...

 Replacement Heart by AbioMed
AbioMed
AbioMed is a manufacturer of medical implant devices, including the AbioCor artificial heart. It is headquartered in Danvers, Massachusetts and has additional offices in Aachen, Germany and Ireland...

 is fully implantable, meaning that no wires or tubes penetrate the skin, and, therefore, there is less risk of infection.

The AbioCor is approved for use in severe biventricular end-stage heart disease patients who are not eligible for heart transplant and have no other viable treatment options. As of April 2011, 14 patients have been implanted with the AbioCor, with one patient living for 512 days with the AbioCor.

The AbioCor received FDA approval under a Humanitarian Device Exemption
Humanitarian Device Exemption
A Humanitarian Device Exemption is an approval process provided by the United States Food and Drug Administration allowing a medical device to be marketed without requiring evidence of effectiveness...

 (HDE) on September 5, 2006. The first implant of the AbioCor since receiving FDA approval in 2006 took place on June 24, 2009, at Robert Wood Johnson University Hospital
Robert Wood Johnson University Hospital
Robert Wood Johnson University Hospital is the clinical campus of the Robert Wood Johnson Medical School in New Brunswick, New Jersey. It provides a full range of health care services as Central New Jersey's only Level 1 Trauma and academic medical center. The hospital is a member of the Robert...

, New Brunswick, New Jersey
New Brunswick, New Jersey
New Brunswick is a city in Middlesex County, New Jersey, USA. It is the county seat and the home of Rutgers University. The city is located on the Northeast Corridor rail line, southwest of Manhattan, on the southern bank of the Raritan River. At the 2010 United States Census, the population of...

. This patient later died on August 23, 2009. (See FDA Summary of Safety and Probable Benefit.)

Origins


A synthetic replacement for the heart remains one of the long-sought holy grails of modern medicine. The obvious benefit of a functional artificial heart would be to lower the need for heart transplant
Heart transplantation
A heart transplant, or a cardiac transplantation, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease. As of 2007 the most common procedure was to take a working heart from a recently deceased organ donor and implant it into the...

s, because the demand for organs always greatly exceeds supply.

Although the heart is conceptually simple (basically a muscle
Muscle
Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...

 that functions as a pump), it embodies subtleties that defy straightforward emulation with synthetic materials and power supplies. Consequences of these issues include severe foreign-body rejection
Transplant rejection
Transplant rejection occurs when transplanted tissue is rejected by the recipient's immune system, which destroys the transplanted tissue. Transplant rejection can be lessened by determining the molecular similitude between donor and recipient and by use of immunosuppressant drugs after...

 and external batteries that limit patient mobility. These complications limited the lifespan of early human recipients to hours or days.

Early development


A heart-lung machine
Heart-lung machine
Cardiopulmonary bypass is a technique that temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the body. The CPB pump itself is often referred to as a heart–lung machine or "the pump"...

 was used in 1953 during a successful open heart surgery. Dr. John Heysham Gibbon
John Heysham Gibbon
John Heysham Gibbon Jr., AB, MD, a surgeon best known for inventing the heart-lung machine and performing the first open heart surgery . He was the son of Dr...

, the inventor of the machine, performed the operation and developed the heart-lung substitute himself.

Although Jarvik created the idea and rough draft for the artificial heart, his models were not created of a material that the human body would accept. Dayton, Ohio's Ival O. Salyer, along with various colleagues, developed a Polymer material that The Human body would not necessarily reject.

On July 3, 1952, 41-year-old Henry Opitek
Henry Opitek
Henry Opitek became the first patient to undergo open heart surgery in 1952.On July 3, 1952, Opitek, a 41-year-old male suffering from shortness of breath, made medical history at Harper University Hospital in Michigan...

, suffering from shortness of breath, made medical history at Harper University Hospital at Wayne State University
Wayne State University
Wayne State University is a public research university located in Detroit, Michigan, United States, in the city's Midtown Cultural Center Historic District. Founded in 1868, WSU consists of 13 schools and colleges offering more than 400 major subject areas to over 32,000 graduate and...

 in Michigan. The Dodrill-GMR
Dodrill-GMR
The Dodrill–GMR machine was the first operational mechanical heart successfully used while performing open heart surgery. It was developed by Dr. Forest Dewey Dodrill, a surgeon at Harper University Hospital in Detroit, and General Motors Research....

 heart machine, considered to be the first operational mechanical heart, was successfully used while performing heart surgery.

Dr. Forest Dewey Dodrill
Forest Dewey Dodrill
Forest Dewey Dodrill was a doctor at Harper University Hospital at Wayne State University in Michigan.Forest Dewey Dodrill was born on 26 January 1902, in Webster Spring. After receiving a bachelor's degree from West Virginia University in 1925, he attended Harvard Medical School, graduating in...

 used the machine in 1952 to bypass Henry Opitek's left ventricle for 50 minutes while he opened the patient's left atrium and worked to repair the mitral valve. In Dr. Dodrill's post-operative report, he notes, "To our knowledge, this is the first instance of survival of a patient when a mechanical heart mechanism was used to take over the complete body function of maintaining the blood supply of the body while the heart was open and operated on."
The scientific interest for the development of a solution for heart disease developed in different research groups worldwide.

Early designs of total artificial hearts


In 1949, a precursor to the modern artificial heart pump was built by doctors William Sewell and William Glenn
William Glenn
William Wallace Lumpkin Glenn was an American cardiac surgeon who co-created an early version of an artificial heart and was the developer of a technique for the treatment of congenital heart defects....

 of the Yale School of Medicine
Yale School of Medicine
The Yale School of Medicine at Yale University is a private medical school located in New Haven, Connecticut, U.S. It was founded in 1810 as The Medical Institution of Yale College, and formally opened its doors in 1813....

 using an Erector Set
Erector Set
Erector Set is the trade name of a toy construction set that is popular in the United States.It consists of collections of small metal beams with regular holes for nuts, bolts, screws, and mechanical parts such as pulleys, gears, and small electric motors.The brand name is currently used for...

, assorted odds and ends, and dime-store toys. The external pump successfully bypassed the heart of a dog for more than an hour.

American ventriloquist and inventor Paul Winchell
Paul Winchell
Paul Winchell was an American ventriloquist, voice actor and comedian, whose career flourished in the 1950s and 1960s...

 invented an artificial heart with the assistance of Dr. Henry Heimlich (the inventor of the Heimlich Maneuver) and held the first patent for such a device. The University of Utah developed a similar apparatus around the same time, but when they tried to patent it, Winchell's heart was cited as prior art. The university requested that Winchell donate the heart to the University of Utah, which he did.
There is some debate as to how much of Winchell's design Dr. Robert Jarvik used in creating Jarvik's artificial heart. Dr. Heimlich states, "I saw the heart, I saw the patent and I saw the letters. The basic principle used in Winchell's heart and Jarvik's heart is exactly the same."[9] Jarvik denies that any of Winchell's design elements were incorporated into the device he fabricated for humans which was successfully implanted into Barney Clark in 1982.[1][10]

On December 12, 1957, Dr. Willem Johan Kolff
Willem Johan Kolff
Willem Johan "Pim" Kolff was a pioneer of hemodialysis as well as in the field of artificial organs. Willem is a member of the Kolff family, an old Dutch patrician family. He made his major discoveries in the field of dialysis for kidney failure during the Second World War...

, the world's most prolific inventor of artificial organs, implanted an artificial heart into a dog at Cleveland Clinic. The dog lived for 90 minutes.

In 1958, Domingo Liotta
Domingo Liotta
Domingo Santo Liotta, MD is a pioneer of heart surgery, creator of multiple cardiac prostheses including the first total artificial heart used in a human being.-Early life:...

 initiated the studies of TAH replacement at Lyon, France, and in 1959–60 at the National University of Córdoba
National University of Córdoba
The National University of Córdoba, , is the oldest university in Argentina, and one of the oldest in the Americas. It is located in Córdoba, the capital of Córdoba Province. Since the early 20th century it has been the second largest university in the country in terms of the number of students,...

, Argentina. He presented his work at the meeting of the American Society for Artificial Internal Organs held in Atlantic City in March 1961. At that meeting, Dr. Liotta described the implantation of three types of orthotopic (inside the pericardial sac) TAHs in dogs, each of which used a different source of external energy: an implantable electric motor, an implantable rotating pump with an external electric motor, and a pneumatic pump.

In 1964, the National Institutes of Health
National Institutes of Health
The National Institutes of Health are an agency of the United States Department of Health and Human Services and are the primary agency of the United States government responsible for biomedical and health-related research. Its science and engineering counterpart is the National Science Foundation...

 started the Artificial Heart Program, with the goal of putting a man-made organ into a human by the end of the decade.

In February 1966, Dr. Adrian Kantrowitz rose to international prominence when he performed the world's first permanent implantation of a partial mechanical heart (left ventricular assist device) at Maimonides Medical Center
Maimonides Medical Center
Maimonides Medical Center is a non-profit, non-sectarian hospital located in Borough Park, Brooklyn. Maimonides is both a treatment facility and academic medical center with 705 beds, and more than 70 primary care and sub-specialty programs...

.

In 1967, Dr. Kolff left Cleveland Clinic to start the Division of Artificial Organs at the University of Utah
University of Utah
The University of Utah, also known as the U or the U of U, is a public, coeducational research university in Salt Lake City, Utah, United States. The university was established in 1850 as the University of Deseret by the General Assembly of the provisional State of Deseret, making it Utah's oldest...

 and pursue his work on the artificial heart.
  • In 1973, a calf named Tony survived for 30 days on an early Kolff heart.
  • In 1975, a bull named Burk survived 90 days on the artificial heart.
  • In 1976, a calf named Abebe lived for 184 days on the Jarvik 5 artificial heart.
  • In 1981, a calf named Alfred Lord Tennyson lived for 268 days on the Jarvik 5.


Over the years, more than 200 physicians, engineers, students and faculty developed, tested and improved Dr. Kolff's artificial heart. To help manage his many endeavors, Dr. Kolff assigned project managers. Each project was named after its manager. Graduate student Robert Jarvik was the project manager for the artificial heart, which was subsequently renamed the Jarvik 7.

In 1981, Dr. William DeVries
William DeVries
-References:...

 submitted a request to the FDA to implant the Jarvik 7 into a human being. On December 2, 1982, Dr. Kolff implanted the Jarvik 7 artificial heart into Barney Clark, a dentist from Seattle who was suffering from severe congestive heart failure. While Clark lived for 112 days tethered to an external pneumatic compressor, a device weighing some 400 pounds (181.4 kg), during that time he suffered prolonged periods of confusion and a number of instances of bleeding, and asked several times to be allowed to die.

On February 11, 2009, Dr. Kolff died at the age of 97 in Philadelphia, Pennsylvania
Pennsylvania
The Commonwealth of Pennsylvania is a U.S. state that is located in the Northeastern and Mid-Atlantic regions of the United States. The state borders Delaware and Maryland to the south, West Virginia to the southwest, Ohio to the west, New York and Ontario, Canada, to the north, and New Jersey to...

.

First clinical implantation of a total artificial heart


On the morning of April 4, 1969, Domingo Liotta
Domingo Liotta
Domingo Santo Liotta, MD is a pioneer of heart surgery, creator of multiple cardiac prostheses including the first total artificial heart used in a human being.-Early life:...

 and Denton A. Cooley
Denton Cooley
Denton Arthur Cooley is an American heart surgeon famous for performing the first implantation of a total artificial heart. Cooley is also founder and surgeon in-chief of the Texas Heart Institute, chief of Cardiovascular Surgery at St...

 replaced a dying man's heart with a mechanical heart inside the chest at The Texas Heart Institute
The Texas Heart Institute
The Texas Heart Institute is a not-for-profit cardiology and heart surgery center located within the Texas Medical Center in Houston, Texas. Founded in 1962 by Dr. Denton A. Cooley, its original charter stated its purpose was “the study and treatment of diseases of the heart and blood vessels...

 in Houston as a bridge for a transplant. The patient woke up and recovered well. After 64 hours, the pneumatic-powered artificial heart was removed and replaced by a donor heart. Replacing the artificial heart proved to be a bad decision, however; thirty-two hours after transplantation, the patient died of what was later proved to be an acute pulmonary infection, extended to both lungs, caused by fungi, most likely caused by an immunosuppressive drug
Immunosuppressive drug
Immunosuppressive drugs or immunosuppressive agents are drugs that inhibit or prevent activity of the immune system. They are used in immunosuppressive therapy to:...

 complication. If they had left the artificial heart in place, the patient may have lived longer.

The original prototype of Liotta-Cooley artificial heart used in this historic operation is prominently displayed in the Smithsonian Institution
Smithsonian Institution
The Smithsonian Institution is an educational and research institute and associated museum complex, administered and funded by the government of the United States and by funds from its endowment, contributions, and profits from its retail operations, concessions, licensing activities, and magazines...

's National Museum of American History
National Museum of American History
The National Museum of American History: Kenneth E. Behring Center collects, preserves and displays the heritage of the United States in the areas of social, political, cultural, scientific and military history. Among the items on display are the original Star-Spangled Banner and Archie Bunker's...

 "Treasures of American History" exhibit in Washington, D.C.

First clinical applications of a permanent pneumatic total artificial heart


The eighty-fifth clinical use of an artificial heart designed for permanent implantation rather than a bridge to transplant occurred in 1982 at the University of Utah
University of Utah
The University of Utah, also known as the U or the U of U, is a public, coeducational research university in Salt Lake City, Utah, United States. The university was established in 1850 as the University of Deseret by the General Assembly of the provisional State of Deseret, making it Utah's oldest...

. Artificial kidney pioneer Dr. Willem Johan Kolff
Willem Johan Kolff
Willem Johan "Pim" Kolff was a pioneer of hemodialysis as well as in the field of artificial organs. Willem is a member of the Kolff family, an old Dutch patrician family. He made his major discoveries in the field of dialysis for kidney failure during the Second World War...

 started the Utah artificial organs program in 1967. There, physician-engineer Dr. Clifford Kwan-Gett invented two components of an integrated pneumatic artificial heart system: a ventricle with hemispherical diaphragms that did not crush red blood cells (a problem with previous artificial hearts) and an external heart driver that inherently regulated blood flow without needing complex control systems. Independently, ventriloquist Paul Winchell
Paul Winchell
Paul Winchell was an American ventriloquist, voice actor and comedian, whose career flourished in the 1950s and 1960s...

 designed and patented a similarly shaped ventricle and donated the patent to the Utah program. Throughout the 1970s and early 1980s, veterinarian Dr. Donald Olsen led a series of calf experiments that refined the artificial heart and its surgical care. During that time, as a student at the University of Utah, Dr. Robert Jarvik combined several modifications: an ovoid shape to fit inside the human chest, a more blood-compatible polyurethane developed by biomedical engineer Dr. Donald Lyman, and a fabrication method by Kwan-Gett that made the inside of the ventricles smooth and seamless to reduce dangerous stroke-causing blood clots. On December 2, 1982, Dr. William DeVries
William DeVries
-References:...

 implanted the artificial heart into retired dentist Dr. Barney Bailey Clark (born January 21, 1921), who survived 112 days with the device, dying on March 23, 1983. Bill Schroeder
William J. Schroeder
William J. Schroeder of Jasper, Indiana, was one of the first recipients of an artificial heart at the age of 52. On November 25 1984, Schroeder became the second human recipient of the Jarvik 7. The transplant was performed at Humana Heart Institute International in Louisville, Kentucky by Dr....

 became the second recipient and lived for a record 620 days.

Contrary to popular belief and erroneous articles in several periodicals, the Jarvik heart was not banned for permanent use. Today, the modern version of the Jarvik 7 is known as the SynCardia temporary CardioWest Total Artificial Heart. It has been implanted in more than 800 people as a bridge to transplantation.

In the mid-1980s, artificial hearts were powered by dishwasher-sized pneumatic power sources whose lineage went back to Alpha-Laval milking machines. Moreover, two sizable catheters had to cross the body wall to carry the pneumatic pulses to the implanted heart, greatly increasing the risk of infection. To speed development of a new generation of technologies, the National Heart, Lung, and Blood Institute
National Heart, Lung, and Blood Institute
The National Heart, Lung, and Blood Institute is a division of the National Institutes of Health, located in Bethesda, Maryland...

 opened a competition for implantable electrically powered artificial hearts. Three groups received funding: Cleveland Clinic
Cleveland Clinic
The Cleveland Clinic is a multispecialty academic medical center located in Cleveland, Ohio, United States. The Cleveland Clinic is currently regarded as one of the top 4 hospitals in the United States as rated by U.S. News & World Report...

 in Cleveland, Ohio; the College of Medicine of Pennsylvania State University
Pennsylvania State University
The Pennsylvania State University, commonly referred to as Penn State or PSU, is a public research university with campuses and facilities throughout the state of Pennsylvania, United States. Founded in 1855, the university has a threefold mission of teaching, research, and public service...

 (Penn State Hershey Medical Center
Penn State Hershey Medical Center
Penn State Milton S. Hershey Medical Center, located in Hershey, Pennsylvania, 10 miles east of Harrisburg, is Penn State’s medical school and academic medical center, and is the only medical school and university hospital in Pennsylvania located outside the urban areas of Philadelphia and...

) in Hershey, Pennsylvania; and AbioMed, Inc. of Danvers, Massachusetts. Despite considerable progress, the Cleveland program was discontinued after the first five years.

Polymeric trileaflet valves ensure unidirectional blood flow with a low pressure gradient and good longevity. State-of-the-art transcutaneous energy transfer eliminates the need for electric wires crossing the chest wall.

The first AbioCor to be surgically implanted in a patient was on July 3, 2001. The AbioCor is made of titanium and plastic with a weight of two pounds, and its internal battery can be recharged with a transduction device that sends power through the skin. The internal battery lasts for a half hour, and a wearable external battery pack lasts for four hours. The FDA announced on September 5, 2006, that the AbioCor could be implanted for humanitarian uses after the device had been tested on 15 patients. It is intended for critically ill patients who can not receive a heart transplant. Some limitations of the current AbioCor are that its size makes it suitable for only about 50% of the male population, and its useful life is only 1–2 years. By combining its valved ventricles with the control technology and roller screw developed at Penn State, AbioMed has designed a smaller, more stable heart, the AbioCor II. This pump, which should be implantable in most men and 50% of women with a life span of up to five years, had animal trials in 2005, and the company hoped to get FDA approval for human use in 2008.

First clinical application of an intrathoracic pump


On the evening of July 19, 1963, E. Stanley Crawford and Domingo Lotta implanted the first clinical Left Ventricular Assist Device (LVAD) at The Methodist Hospital
The Methodist Hospital
The Methodist Hospital is a hospital located in the Texas Medical Center in Houston, Texas. Established in 1919 as an outreach ministry of The United Methodist Church, Methodist is one of the most comprehensive teaching hospitals in the United States, with leading specialists in every field of...

 in Houston, Texas, in a patient who kal aao arrest after surgery. The patient survived for four days under mechanical support but did not recover from the complications of the cardiac arrest; finally, the pump was discontinued, and the patient died.

First clinical application of a paracorporeal pump



On the afternoon of April 21, 1966, Michael DeBakey
Michael E. DeBakey
Michael Elias DeBakey was a world-renowned Lebanese-American cardiac surgeon, innovator, scientist, medical educator, and international medical statesman...

 and Liotta implanted the first clinical LVAD in a paracorporeal position (where the external pump rests at the side of the patient) at The Methodist Hospital in Houston, in a patient experiencing cardiogenic shock after heart surgery. The patient developed neurological and pulmonary complications and died after few days of LVAD mechanical support. In October 1966, DeBakey and Liotta implanted the paracorporeal Liotta-DeBakey LVAD in a new patient who recovered well and was discharged from the hospital after 10 days of mechanical support, thus constituting the first successful use of an LVAD for postcardiotomy shock.

Recent developments


In August 2006, an artificial heart was implanted into a 15-year-old girl at the Stollery Children's Hospital in Edmonton
Edmonton
Edmonton is the capital of the Canadian province of Alberta and is the province's second-largest city. Edmonton is located on the North Saskatchewan River and is the centre of the Edmonton Capital Region, which is surrounded by the central region of the province.The city and its census...

, Alberta
Alberta
Alberta is a province of Canada. It had an estimated population of 3.7 million in 2010 making it the most populous of Canada's three prairie provinces...

. It was intended to act as a temporary fixture until a donor heart could be found. Instead, the artificial heart (called a Berlin Heart) allowed for natural processes to occur and her heart healed on its own. After 146 days, the Berlin Heart was removed, and the girl's heart was able to function properly on its own.

Total artificial heart


In June 1996, a 46-year-old Chinese American Mr. Yao ST received total artificial heart implantation done by Dr. Jeng Wei at Cheng-Hsin General Hospital. This pneumatic Phoenix-7 Total Artificial Heart was manufactured by a dentist Kelvin K Cheng and his colleagues at Taiwan TAH Research Center in Tainan. With this experimental artificial heart, the patient's BP was maintained at 90-100/40-55 mmHg and cardiac output at 4.2-5.8 L/min. After 15 days of bridging, Mr. Yao received combined heart and kidney transplantation. , he is still very well and is currently living in San Francisco.

On October 27, 2008, French professor and leading heart transplant
Heart transplantation
A heart transplant, or a cardiac transplantation, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease. As of 2007 the most common procedure was to take a working heart from a recently deceased organ donor and implant it into the...

 specialist Alain F. Carpentier
Alain F. Carpentier
Alain Frédéric Carpentier M.D. Ph.D. is a French surgeon whom the President of the American Association for Thoracic Surgery calls the father of modern mitral valve repair. He is the recipient of the 2007 Lasker Prize.-Biography:A professor emeritus at Pierre and Marie Curie University, in the...

 announced that a fully implantable artificial heart will be ready for clinical trial by 2011 and for alternative transplant in 2013. It was developed and will be manufactured by him, biomedical firm Carmat, and venture capital firm Truffle. The prototype uses electronic sensors and is made from chemically treated animal tissues, called "biomaterials", or a "pseudo-skin" of biosynthetic
Biosynthesis
Biosynthesis is an enzyme-catalyzed process in cells of living organisms by which substrates are converted to more complex products. The biosynthesis process often consists of several enzymatic steps in which the product of one step is used as substrate in the following step...

, microporous material
Microporous material
A microporous material is a material containing pores with diameters less than 2 nm.Porous materials are classified into several kinds by their size. According to IUPAC notation A microporous material is a material containing pores with diameters less than 2 nm.Porous materials are...

s. Another U.S. team with a prototype called 2005 MagScrew Total Artificial Heart, including Japan and South Korea researchers are racing to produce similar projects.

In August 2010, 50-year-old Angelo Tigano of Fairfield, New South Wales
Fairfield, New South Wales
Fairfield is a western suburb of Sydney, in the state of New South Wales, Australia. Fairfield is located 29 kilometres west of the Sydney central business district and is the administrative centre for the local government area of the City of Fairfield and is also partly in the local government...

, Australia, had his failing heart removed in a five-hour operation and it was replaced with a Total Artificial Heart by surgeon Dr Phillip Spratt, head of the heart transplant unit at St Vincent's Hospital, Sydney
St Vincent's Hospital, Sydney
St Vincent's Public Hospital, Sydney is located in the inner city suburb of Darlinghurst. Though part of the New South Wales state public health system it remains under the auspices of the Sisters of Charity.-History:...

. This was the first case of an artificial heart being implanted into a living human in the southern hemisphere.

On March 12, 2011, an experimental artificial heart was implanted in 55-year-old Craig Lewis at The Texas Heart Institute in Houston by Drs. O. H. Frazier
O. H. Frazier
O. Howard "Bud" Frazier is a distinguished heart surgeon. He is the Director of the Cardiovascular Surgical Research program and the Chief of Cardiopulmonary Transplantation at the Texas Heart Institute . He is also the Chief of Transplant Services at St...

 and William Cohn. The device is a combination of two modified HeartMate II pumps that is currently undergoing bovine trials.

A centrifugal pump
Centrifugal pump
A centrifugal pump is a rotodynamic pump that uses a rotating impeller to create flow by the addition of energy to a fluid. Centrifugal pumps are commonly used to move liquids through piping...

 or an axial-flow pump can be used as an artificial heart, resulting in the patient being alive without a pulse
Pulse
In medicine, one's pulse represents the tactile arterial palpation of the heartbeat by trained fingertips. The pulse may be palpated in any place that allows an artery to be compressed against a bone, such as at the neck , at the wrist , behind the knee , on the inside of the elbow , and near the...

.

This link describes a centrifugal artificial heart which alternately pumps the pulmonary circulation
Pulmonary circulation
Pulmonary circulation is the half portion of the cardiovascular system which carries Oxygen-depleted Blood away from the heart, to the Lungs, and returns oxygenated blood back to the heart. Encyclopedic description and discovery of the pulmonary circulation is widely attributed to Doctor Ibn...

 and the systemic circulation
Systemic circulation
Systemic circulation is the part of the cardiovascular system which carries oxygenated blood away from the heart to the body, and returns deoxygenated blood back to the heart. This physiologic theory of circulation was first described by William Harvey...

, causing a pulse.

In addition to surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

, there is a psychological
Psychology
Psychology is the study of the mind and behavior. Its immediate goal is to understand individuals and groups by both establishing general principles and researching specific cases. For many, the ultimate goal of psychology is to benefit society...

 aspect of the problem of an artificial heart. For example, a quarter of patient
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....

s after surgery prosthetic valvular in the post-operative period formed a specific psychopathological
Psychopathology
Psychopathology is the study of mental illness, mental distress, and abnormal/maladaptive behavior. The term is most commonly used within psychiatry where pathology refers to disease processes...

 symptom
Symptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...

s, received the name Skumin syndrome
Skumin syndrome
Skumin syndrome is a specific mental disorder, which a quarter of the patients develop after the prostheses of the valve heart device and manifests with persistent doubts about the reliability of the implant, fear of its breakdown, fixed negative attitude to physical and psychoemotional load,...

 described in 1978. It is possible that a similar problem will be faced in conducting operations to implant
Implant
Implant can refer to:*Implant , or specifically:**Brain implant**Breast implant**Buttock implant**Cochlear implant**Contraceptive implant**Dental implant**Mini dental implant**Extraocular implant**Fetal tissue implant...

 an artificial heart.

Heart assist devices



Patients who have some remaining heart function but who can no longer live normally may be candidates for ventricular assist devices (VAD), which do not replace the human heart but complement it by taking up much of the function.

The first Left Ventricular Assist Device (LVAD) system was created by Domingo Liotta at Baylor College of Medicine
Baylor College of Medicine
Baylor College of Medicine, located in the Texas Medical Center in Houston, Texas, USA, is a highly regarded medical school and leading center for biomedical research and clinical care...

 in Houston in 1962.

Another VAD, the Kantrowitz CardioVad, designed by Adrian Kantrowitz
Adrian Kantrowitz
Adrian Kantrowitz was an American cardiac surgeon who performed the world's first pediatric heart transplant at Maimonides Medical Center in Brooklyn on December 6, 1967...

, MD, boosts the native heart by taking up over 50% of its function. Additionally, the VAD can help patients on the wait list for a heart transplant. In a young person, this device could delay the need for a transplant by 10–15 years, or even allow the heart to recover, in which case the VAD can be removed.
The artificial heart is powered by a battery that needs to be changed several times while still working.

The first heart assist device was approved by the FDA in 1994, and two more received approval in 1998.
While the original assist devices emulated the pulsating heart, newer versions, such as the Heartmate II, developed by The Texas Heart Institute of Houston, provide continuous flow. These pumps (which may be centrifugal
Centrifugal pump
A centrifugal pump is a rotodynamic pump that uses a rotating impeller to create flow by the addition of energy to a fluid. Centrifugal pumps are commonly used to move liquids through piping...

 or axial flow) are smaller and potentially more durable and last longer than the current generation of total heart replacement pumps. Another major advantage of a VAD is that the patient keeps the natural heart, which may still function for temporary back-up support if the mechanical pump were to stop. This may provide enough support to keep the patient alive until a solution to the problem is implemented.

Several continuous-flow ventricular assist devices have been approved for use in the European Union, and, as of August 2007, were undergoing clinical trials for FDA approval.

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