Implanting Total Artificial Heart

The CardioWest Total Artificial Heart (TAH-t), formerly known as the Jarvik-7, is a pneumatically driven, biventricular replacement device designed for patients with end-stage biventricular heart failure who are not responsive to maximal medical therapy and are awaiting transplantation. Implantation involves median sternotomy, excision of the diseased ventricles while preserving the atrial cuffs and great vessels, and anastomosis of the device’s atrial and vascular connectors to the patient’s native structures. The two polyurethane ventricles, each with mechanical valves, are connected to an external pneumatic driver via percutaneous drivelines, allowing pulsatile blood flow to both systemic and pulmonary circulations. The procedure demands meticulous hemostasis, precise sizing to avoid compression of mediastinal structures, and coordination with the perfusion and anesthesia teams to ensure stable hemodynamics during weaning from cardiopulmonary bypass. Postoperatively, anticoagulation management, infection prevention, and patient–device interface education are critical to successful bridging to transplantation.