Clinical utilization of the artificial heart.

During the past 30 years the artificial heart has evolved from a bioengineering concept to clinical reality. To date four patients have had an artificial heart implanted as a permanent device, while over 150 artificial hearts have been utilized temporarily as a bridge to cardiac transplantation. Increased use of this device requires that a number of issues be critically addressed: (1) criteria for patient selection; (2) operative techniques for implantation including size of device and its position in the mediastinum; and (3) management of the patient in the intensive care unit (ICU), in particular, regimens of anticoagulation, assessment of adequacy of organ perfusion, and prevention of sepsis. This chapter is a discussion of these bioengineering and clinical concerns with respect to the Jarvik total artificial heart (TAH). Clinical data are presented which highlight the current problems with these devices and the areas of future research that need to be undertaken.