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categories: ["bodies"]categories: ["bodies"]tags: ["circulatory support", "implants", "heart failure", "transplantation", "medical devices", "haemocompatibility"]tags: ["circulatory support", "implants", "heart failure", "transplantation", "medical devices", "haemocompatibility"]summary: "Mechanical devices that take over some or all of the heart's pumping function, from routine ventricular assist pumps to total replacements used mainly as a bridge to transplant."summary: "Mechanical devices that take over some or all of the heart's pumping function, from routine ventricular assist pumps to total replacements used mainly as a bridge to transplant."updated: "2026-07-27"updated: "2026-10-29"humanEvidence: "Randomized trials in adults with advanced heart failure show left ventricular assist devices improve survival, the magnetically levitated pump holding its advantage at five years; total artificial hearts rest on bridge-to-transplant series."humanEvidence: "Randomized trials in adults with advanced heart failure show left ventricular assist devices improve survival, the magnetically levitated pump holding its advantage at five years; total artificial hearts rest on bridge-to-transplant series."access: "Implanted in specialist cardiac surgery centres in high-income health systems; a durable assist device and its implantation run to hundreds of thousands of dollars, and total artificial hearts are used in tens of patients a year."access: "Implanted in specialist cardiac surgery centres in high-income health systems; a durable assist device and its implantation run to hundreds of thousands of dollars, and total artificial hearts are used in tens of patients a year."reversibility: "difficult"reversibility: "difficult"lines 50–57 → 50–5735 unchanged lines not shown
{ "year": "1969", "title": "First clinical use", "text": "Denton Cooley implants a device designed by Domingo Liotta in a patient at the Texas Heart Institute as a bridge to transplant, supporting him for roughly three days." }, { "year": "1969", "title": "First clinical use", "text": "Denton Cooley implants a device designed by Domingo Liotta in a patient at the Texas Heart Institute as a bridge to transplant, supporting him for roughly three days." }, { "year": "1982", "title": "Jarvik-7", "text": "William DeVries implants the pneumatic Jarvik-7 in Barney Clark at the University of Utah as permanent therapy. Clark survives 112 days, tethered to a large pneumatic console, and the case triggers lasting debate about experimental surgery." }, { "year": "1982", "title": "Jarvik-7", "text": "William DeVries implants the pneumatic Jarvik-7 in Barney Clark at the University of Utah as permanent therapy. Clark survives 112 days, tethered to a large pneumatic console, and the case triggers lasting debate about experimental surgery." }, { "year": "2001", "title": "REMATCH", "text": "A randomised trial shows that a left ventricular assist device roughly halves one-year mortality compared with medical therapy in patients ineligible for transplant, converting assist devices from a bridge into a destination therapy." }, { "year": "2001", "title": "REMATCH", "text": "A randomised trial shows that a left ventricular assist device roughly halves one-year mortality compared with medical therapy in patients ineligible for transplant, converting assist devices from a bridge into a destination therapy." }, { "year": "2004–2010", "title": "The rotary turn", "text": "Continuous-flow pumps displace pulsatile ones. A pneumatic total artificial heart is approved as a bridge to transplant, and remains the only one in sustained use for two decades." }, { "year": "2004-2010", "title": "The rotary turn", "text": "Continuous-flow pumps displace pulsatile ones. A pneumatic total artificial heart is approved as a bridge to transplant, and remains the only one in sustained use for two decades." }, { "year": "2024–2025", "title": "Magnetically levitated total heart", "text": "A titanium rotary total artificial heart with a single levitated rotor is implanted in its first patients, one of whom is supported for more than a hundred days before transplant." } { "year": "2024-2025", "title": "Magnetically levitated total heart", "text": "A titanium rotary total artificial heart with a single levitated rotor is implanted in its first patients, one of whom is supported for more than a hundred days before transplant." }]]`````` lines 67–77 → 67–779 unchanged lines not shown
Total replacement is a different problem, because both ventricles must be removed and both circulations driven, and because there is no residual native function to fall back on if the device stops.Total replacement is a different problem, because both ventricles must be removed and both circulations driven, and because there is no residual native function to fall back on if the device stops. The pneumatic total artificial heart approved in the United States in 2004 as a bridge to transplant is the descendant of the Jarvik-7 and has been implanted in well over a thousand patients; the pivotal study reported that most recipients survived to transplantation, against poor odds without it.[^copeland2004] It works, and it is bulky, noisy, and tethers the patient to a driver. A fully implantable pulsatile device tested in the early 2000s reached a handful of patients, one supported for well over a year, and was discontinued.The pneumatic total artificial heart approved in the United States in 2004 as a bridge to transplant is the descendant of the Jarvik-7 and has been implanted in well over a thousand patients; the pivotal study reported that most recipients survived to transplantation, against poor odds without it.[^copeland2004] It works, but it is bulky and noisy and tethers the patient to a driver. A fully implantable pulsatile device tested in the early 2000s reached a handful of patients, one supported for well over a year, and was discontinued. A French bioprosthetic design combines a hybrid membrane of bovine pericardium on the blood-contacting side with electrohydraulic actuation and pressure sensors that adjust output automatically, and received European marking; its manufacturer has struggled financially, and its long-term availability is uncertain as of 2026.A French bioprosthetic design combines a hybrid membrane of bovine pericardium on the blood-contacting side with electrohydraulic actuation and pressure sensors that adjust output automatically, and received European marking; its manufacturer has struggled financially, and its long-term availability is uncertain as of 2026. The most recent entrant abandons the anatomical metaphor entirely. It uses a single titanium rotor, magnetically levitated, with impeller surfaces on both faces so that one spinning part drives both the systemic and pulmonary circulations. There are no valves and no flexing membranes, and therefore nothing to fatigue. First implanted in a patient in 2024 as a bridge to transplant, it has since supported a patient for more than a hundred days, with early feasibility testing continuing. Whether a valveless rotary total heart is haemocompatible over years rather than months is the question the device exists to answer.The most recent entrant abandons the anatomical metaphor entirely. It uses a single titanium rotor, magnetically levitated, with impeller surfaces on both faces so that one spinning part drives both the systemic and pulmonary circulations. There are no valves and no flexing membranes, and therefore nothing to fatigue. First implanted in a patient in 2024 as a bridge to transplant, it has since supported a patient for more than a hundred days, with early feasibility testing continuing. Its central test is whether a valveless rotary total heart is haemocompatible over years rather than months. ```compare```compare{{lines 93–99 → 93–9915 unchanged lines not shown
**Thrombosis and stroke.** Blood clots on foreign surfaces and where flow stagnates. Patients require anticoagulation, which shifts risk toward haemorrhage; stroke, both ischaemic and haemorrhagic, remains the most feared complication.**Thrombosis and stroke.** Blood clots on foreign surfaces and where flow stagnates. Patients require anticoagulation, which shifts risk toward haemorrhage; stroke, both ischaemic and haemorrhagic, remains the most feared complication. **Acquired von Willebrand syndrome.** High shear in a rotary pump unfolds and cleaves the large von Willebrand factor multimers that mediate platelet adhesion. Combined with reduced pulsatility, which promotes intestinal angiodysplasia, this produces gastrointestinal bleeding in a substantial fraction of patients — a bleeding disorder manufactured by the device in a patient who also needs anticoagulation.**Acquired von Willebrand syndrome.** High shear in a rotary pump unfolds and cleaves the large von Willebrand factor multimers that mediate platelet adhesion. Combined with reduced pulsatility, which promotes intestinal angiodysplasia, this produces gastrointestinal bleeding in a substantial fraction of patients. The device thus creates a bleeding disorder in a patient who also needs anticoagulation. **Haemolysis.** Shear damages red cells directly, releasing free haemoglobin, which scavenges nitric oxide and injures the kidney. The mechanism is the same one that defeated cell-free oxygen carriers described in [[artificial-blood]].**Haemolysis.** Shear damages red cells directly, releasing free haemoglobin, which scavenges nitric oxide and injures the kidney. The mechanism is the same one that defeated cell-free oxygen carriers described in [[artificial-blood]]. lines 104–110 → 104–1104 unchanged lines not shown
The percutaneous driveline is the single largest source of avoidable morbidity. It is a permanent breach of the skin, and infection along it is common with time. The problem is generic to devices that cross the body surface: bone-anchored limbs face the same skin-implant interface, discussed in [[osseointegration]], and it is the reason most [[neuroprosthetics]] are fully implanted with an inductive link rather than wired through the skin. Transcutaneous energy transfer, in which power is coupled through intact skin by induction, has been demonstrated and has not become standard, because the coupling efficiency, heat generation and internal battery lifetime all impose their own costs. Implanted stimulators such as those used in [[deep-brain-stimulation]] solved a version of this problem by drawing milliwatts; a circulatory pump draws several watts continuously, which is what makes wireless power hard. A fully implanted system also has to solve what happens when the internal battery fails.The percutaneous driveline is the single largest source of avoidable morbidity. It is a permanent breach of the skin, and infection along it is common with time. The problem is generic to devices that cross the body surface: bone-anchored limbs face the same skin-implant interface, discussed in [[osseointegration]], and it is the reason most [[neuroprosthetics]] are fully implanted with an inductive link rather than wired through the skin. Transcutaneous energy transfer, in which power is coupled through intact skin by induction, has been demonstrated and has not become standard, because the coupling efficiency, heat generation and internal battery lifetime all impose their own costs. Implanted stimulators such as those used in [[deep-brain-stimulation]] solved a version of this problem by drawing milliwatts; a circulatory pump draws several watts continuously, which is what makes wireless power hard. A fully implanted system also has to solve what happens when the internal battery fails. > [!key] Why mechanical support is not a bridge to nowhere> [!key] Why mechanical support is not a bridge to nowhere> Roughly four and a half thousand heart transplants are performed annually in the United States against a far larger population with advanced heart failure, the imbalance described in [[organ-shortage]]. Devices are the only intervention whose supply is not capped by donation, which is why they persist despite complication rates that would be unacceptable in almost any other field. The alternative supply strategies are edited pig hearts, described in [[xenotransplantation]], and grown tissue, described in [[lab-grown-organs]] — neither of which has supported a human for as long as a pump has.> Roughly four and a half thousand heart transplants are performed annually in the United States against a far larger population with advanced heart failure, the imbalance described in [[organ-shortage]]. Devices are the only intervention whose supply is not capped by donation, which is why they persist despite complication rates that would be unacceptable in almost any other field. The alternative supply strategies are edited pig hearts, described in [[xenotransplantation]], and grown tissue, described in [[lab-grown-organs]]. Neither has supported a human for as long as a pump has. ## Outlook## Outlook lines 112–118 → 112–1181 unchanged line not shown
Cost is the quiet constraint. A durable assist device and its implantation run to hundreds of thousands of dollars, which restricts the therapy to health systems that can absorb it and makes it a standing example of the problems collected under [[access-and-inequality]].Cost is the quiet constraint. A durable assist device and its implantation run to hundreds of thousands of dollars, which restricts the therapy to health systems that can absorb it and makes it a standing example of the problems collected under [[access-and-inequality]]. The honest comparison is that mechanical support has a track record measured in decades and hundreds of thousands of patients, while every biological alternative has a track record measured in months and single figures. The question for the next decade is not whether pumps will be replaced but whether a total artificial heart can become a destination therapy rather than a waiting room, which requires a device that neither clots nor bleeds its recipient, and no design has yet demonstrated that over years.Mechanical support has a track record measured in decades and hundreds of thousands of patients; every biological alternative has one measured in months and single figures. For the next decade the open question is less whether pumps will be replaced than whether a total artificial heart can become a destination therapy rather than a waiting room. That requires a device that neither clots nor bleeds its recipient, and no design has yet demonstrated that over years. ## See also## See also removed, struck through added, underlinedLine numbers count the serialised markdown of each revision, frontmatter included.
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