On December 2, 1982, the first permanent artificial heart, the Jarvik-7, was implanted in Barney Clark by surgeon William C. DeVries at the University of Utah. The procedure was a landmark event in cardiac technology, though the patient survived for 112 days before his death. The artificial heart was a large, external device requiring a 400-pound air compressor to operate, and the surgery was highly experimental at the time.

First Artificial Heart: मेडिकल की सबसे बड़ी खोज

An artificial heart is a device that replaces the heart. Artificial hearts are typically used as a bridge to heart transplantation, but ongoing research aims to develop a device that could permanently replace the heart when a transplant—whether from a deceased human or, experimentally, from a genetically engineered pig—is unavailable or not viable. As of December 2023, there are two commercially available full artificial heart devices; both are intended for temporary use (less than a year) for patients with total heart failure who are awaiting a human heart transplant.

Although other similar inventions preceded it from the late 1940s, the first artificial heart to be successfully implanted in a human was the Jarvik-7 in 1982, designed by a team including Willem Johan Kolff, William DeVries, and Robert Jarvik.[1]An artificial heart is distinct from a ventricular assist device (VAD; for either one or both of the ventricles, the heart’s lower chambers), which may also be a permanent solution, or the intra-aortic balloon pump – both devices are designed to support a failing heart. It is also distinct from a cardiopulmonary bypass machine, which is an external device used to provide the functions of both the heart and lungs, used only for a few hours at a time, most commonly during cardiac surgery. It is also distinct from a ventilator, used to support failing lungs, or the extracorporeal membrane oxygenation (ECMO), which is used to support those with both inadequate heart and lung function for up to days or weeks, unlike the bypass machine.

History

The origin of the artificial heart dates back to early hypotheses in the 19th century, with the first working device successfully tested in a dog in 1937 by Soviet scientist Vladimir Demikhov. The first human implantation occurred in 1969.

● Conceptual Phase (early 1800s: The French physiologist César Julien Jean Legallois first hypothesized in 1812 that the heart’s function could be mechanically substituted to maintain blood flow. This idea remained largely theoretical for over a century.

● First Animal Implantation (1937): Vladimir Demikhov developed and implanted a total artificial heart into a dog, which survived for 5.5 hours. This marked the first practical demonstration of a total artificial heart.

● Heart-Lung Machine (1953) A breakthrough came with the successful clinical use of the heart-lung machine by Dr. John Heysham Gibbon during open-heart surgery. This device oxygenated the blood outside the body, allowing surgeons to operate on a stopped heart.

● First Human Use (1969): The first total artificial heart to be implanted in a human was the Liotta-Cooley artificial heart. Dr. Denton Cooley and Dr. Domingo Liotta implanted the pneumatic pump in a patient as a temporary “bridge to transplant” measure. The patient lived for 64 hours before a donor heart was transplanted.

● First Permanent Artificial Heart (1982) The Jarvik-7, developed by Robert Jarvik under the guidance of Willem Johan Kolff, was the first artificial heart intended for permanent use. It was implanted into retired dentist Barney Clark by Dr. William DeVries at the University of Utah. Clark survived for 112 days, demonstrating that long-term survival with a mechanical heart was possible.

Since these pioneering efforts, research has focused on improving device durability, reducing complications like blood clots and infection, and creating smaller, fully implantable systems.

Early development

The early development of the artificial heart involved several key milestones driven by a desire to mechanically support or replace the function of a failing heart. The primary goal was to create a device that could effectively pump blood through the body without causing excessive damage to blood cells, infection, or rejection by the body.

● Conceptual Phase (early 1800s): The French physiologist César Julien Jean Legallois first proposed in 1812 that mechanical pumps could potentially sustain blood flow in organs.

● First Animal Implantation (1937): Soviet scientist Vladimir Demikhov successfully implanted a total artificial heart (TAH) into a dog, which survived for several hours, marking the first practical demonstration of the concept.

● Heart-Lung Machine (1953): A critical breakthrough came with the invention of the heart-lung machine by Dr. John Heysham Gibbon. This external device oxygenated blood and maintained circulation during open-heart surgery, allowing surgeons to operate on a stopped heart for the first time.

● Early Prototypes & Animal Testing (1950s-1970s): Driven by pioneers like Willem Kolff and Domingo Liotta, numerous prototypes were developed and tested in animals, primarily calves and sheep. These efforts focused on improving biomaterials (like polyurethane and Dacron) and pump design to reduce blood clots and increase survival times.

● National Institutes of Health (NIH) Program (1964): The U.S. government established a program with the ambitious goal of developing a human-implantable artificial heart by the end of the decade, spurring significant research efforts.

● First Human Implantation (1969): Dr. Denton Cooley and Dr. Domingo Liotta performed the first human implantation of a TAH as a temporary “bridge to transplant” for a patient in end-stage heart failure. The patient, Haskell Karp, survived for 64 hours before a donor heart was found, proving the viability of the approach.

These initial developments faced significant challenges, including material incompatibility leading to blood clots, infections due to external power lines, and device size limitations. However, they laid the essential groundwork for later, more successful devices like the Jarvik-7, and for modern temporary support systems like the SynCardia TAH.

Early designs of total artificial hearts

Early total artificial heart (TAH) designs were primarily pneumatically powered, pulsatile devices that used flexible diaphragms to pump blood. These devices were externally connected to large drive consoles via tubes that passed through the skin. Here are the key early designs :

● The Liotta-Cooley Artificial Heart (1969)Design :

This device consisted of two external pneumatic pumps with Dacron-reinforced flexible sacs (chambers) designed to fit inside the patient’s chest.

Mechanism: Compressed air pulsed into the external chambers forced the blood out of the internal sacs, mimicking a natural heartbeat.

Use: It was used as the first human “bridge to transplant” for a 47-year-old patient in Houston. The patient survived for 64 hours with the device before receiving a donor heart.

Power Source: a large, external console provided the compressed air and controlled the heart rate. The original prototype is now displayed at the Smithsonian Institution.

● The Jarvik-7 Artificial Heart (1982)Design :

Developed by Robert Jarvik under the guidance of Willem Kolff, the Jarvik-7 was also a pneumatically powered TAH, but it was designed for permanent use (destination therapy). It featured two polyurethane ventricles with mechanical, single-leaflet valves.

Mechanism: A four-layered polyurethane diaphragm inside each chamber was pushed by pulsed air, displacing blood and creating a pulsatile flow.

Use: The first recipient, retired dentist Barney Clark, lived for 112 days with the device. Later, patients using the Jarvik-7 as a bridge to transplant achieved much longer survival times.

Power Source: The patient was tethered to a large external drive console (initially weighing over 400 pounds) via reinforced drivelines that exited the left side of the abdomen.

Legacy The Jarvik-7 design evolved into the modern SynCardia TAH, which is the only FDA-approved TAH currently available for temporary use as a bridge to transplant.

These early designs, while pioneering, were limited by issues such as the large size of the external equipment, the risk of infection at the driveline exit sites, and complications related to blood clotting (thromboembolism) and bleeding due to necessary anticoagulation therapy.

First clinical implantation of a total artificial heart

The first clinical implantation of a total artificial heart (TAH) in a human was performed by Dr. Denton A. Cooley in Houston, Texas, on April 4, 1969. The device, known as the Liotta-Cooley artificial heart, was implanted into a 47-year-old man with severe heart failure as a temporary measure (a “bridge to transplant”). The patient survived for 64 hours before a donor heart became available for transplantation. He died 32 hours after the second operation due to an acute infection.

Later, the first artificial heart intended for permanent use (destination therapy), the Jarvik-7, was implanted on December 2, 1982, at the University of Utah in Salt Lake City. The recipient, retired dentist Barney Clark, lived for 112 days with the device.

First clinical applications of a permanent pneumatic total artificial heart

The first clinical application of a permanent pneumatic total artificial heart (TAH) was the implantation of the Jarvik-7 into patient Barney Clark on December 2, 1982, at the University of Utah in Salt Lake City. The operation was performed by a surgical team led by Dr. William C. DeVries. The device was intended as a permanent solution (destination therapy) for Clark, who was suffering from end-stage heart failure and was not a candidate for a heart transplant.

Patient: Barney Clark, a 61-year-old retired dentist.

Device: The Jarvik-7, a pulsatile, air-driven pump made of plastic and titanium, with two sizable catheters that exited the body to connect to a 400-pound external drive console.

Outcome: Clark lived for 112 days after the operation before dying on March 23, 1983, from complications, including a stroke, infections, and multiple organ system failure, not device failure itself.

Significance: The highly publicized case proved the feasibility of using a mechanical device for long-term support and paved the way for further research and development in artificial hearts, which are now primarily used as a temporary bridge to heart transplantation.

First clinical application of an intrathoracic pump

The first clinical application of an intrathoracic pump (specifically, a left ventricular assist device, or LVAD) occurred on July 19, 1963, at The Methodist Hospital in Houston, Texas. The device was implanted by surgeons E. Stanley Crawford and Domingo Liotta treated a patient who had suffered a cardiac arrest after surgery. The pneumatic-powered pump was positioned inside the patient’s chest and connected the left atrium to the descending thoracic aorta, bypassing the left ventricle. The pump provided mechanical support for four days, successfully clearing the patient’s pulmonary edema, but the patient never recovered from the pre-existing complications of the cardiac arrest and ultimately died.

This procedure marked a significant step in the development of mechanical circulatory support, paving the way for future, more successful ventricular assist devices and total artificial hearts.

First clinical application of a paracorporeal pump

The first successful clinical application of a paracorporeal pump (a ventricular assist device, or VAD, with the pump located outside the body) occurred in October 1966. The procedure was performed by Dr. Michael E. DeBakey and Dr. Domingo Liotta at The Methodist Hospital in Houston, Texas. A pneumatically-driven paracorporeal left ventricular assist device was used to support a female patient experiencing cardiogenic shock after complex heart valve surgery.

Temporary Support: The device was used as a temporary measure to allow the patient’s native heart to recover from the stress of surgery (a “bridge to recovery”).

Duration: The VAD provided mechanical circulatory support for 10 days.

Outcome: The patient successfully recovered heart function, was weaned from the device, and was discharged from the hospital. She lived for several more years before dying in a car accident.

This case marked the first time a patient survived after receiving mechanical circulatory support from a paracorporeal ventricular assist device. This differs from the first unsuccessful clinical application of a VAD (an intracorporeal pump), which was implanted earlier by Liotta and Crawford in 1963.

First VAD patient with FDA-approved hospital discharge

The first patient with an FDA-approved hospital discharge while on a VAD used the Thoratec HeartMate IP (implantable pneumatic) device.

The HeartMate IP was the first VAD to receive FDA approval (in 1994) for “bridge to transplantation” with the specific allowance for patients to be discharged from the hospital and ambulate using a portable pneumatic console. This was a significant advance, as earlier VADs and total artificial hearts required the patient to remain in the hospital, tethered to large, stationary consoles.

While historical records confirm the device was approved for home use and was used successfully in many patients who were then discharged, the specific name of the first patient discharged under this particular FDA approval is not readily available in the search results, as medical literature often focuses on the device, clinical trials, and outcomes rather than individual patient identities (except high-profile initial implants like Barney Clark).

Total artificial hearts(Approved medical devices)

Carmat Aeson bioprosthetic heart

The CARMAT Aeson is a sophisticated bioprosthetic total artificial heart (TAH) designed to be a physiological alternative for patients suffering from end-stage biventricular heart failure. It is unique because its blood-contacting surfaces are made of chemically treated animal tissues (bovine pericardium), which enhances biocompatibility and reduces the need for aggressive anticoagulation medication.

Key Features and Technology

● Biocompatible Materials: The internal surfaces that contact the blood are lined with glutaraldehyde-treated bovine (cow) pericardium to minimize the risk of blood clots (thrombosis), infection, and immune rejection, which are common issues with older, purely synthetic artificial hearts.

● Physiological Design The Aeson device has two pumping ventricles that use an electrohydraulic system and biological valves, mimicking the pulsatile flow and shape of a human heart more closely than previous models.

● Autoregulation (Auto-Mode): Embedded electronics, microprocessors, and pressure sensors allow the device to automatically adjust its pumping rate and flow volume in real-time based on the patient’s physical activity and venous return, providing a more natural physiological response.

● External System: The implant is connected by an 8 mm driveline to an external routing module and a portable controller/battery pack, which patients carry in a bag, offering mobility and quality of life.

● Clinical Use and Status Indication: The Aeson TAH is currently approved in the European Union (receiving CE marking in December 2020) as a “bridge to transplant” therapy for patients with end-stage biventricular heart failure who cannot be treated with other options.

● Clinical Trials: In the United States, the device is being assessed within the framework of an FDA-approved Early Feasibility Study (EFS). The goal of these studies is to confirm its safety and performance, eventually leading to approval for commercial use and potentially as a permanent solution (destination therapy).

● Goal The ultimate aim of the CARMAT project is to provide a reliable, long-term alternative to heart transplantation, addressing the critical shortage of donor organs worldwide.

SynCardia

SynCardia Systems is a company based in Tucson, Arizona, which currently has two separate models of their artificial heart available. It is available in a 70cc and 50cc size. The 70cc model is used for biventricular heart failure in adult men, while the 50cc is for children and women. As of 2014, more than 1,250 patients have received SynCardia artificial hearts. The device has two drive systems available for patients to use: the Companion 2 in-hospital driver, approved by the FDA in 2012, or the Freedom Driver System, approved in 2014. The Companion 2 replaced the Circulatory Support System Console, which was the original drive system for the heart. The Freedom Driver System is a compact portable driver for greater mobility, and can allow some patients to return home. To power the heart, the drivers send pulsed air through the drivelines into the heart. The drivers also monitor blood flow for each ventricle.

In 199,1, the rights to the Jarvik-7 were transferred to CardioWest, who resumed testing of the heart. Following good results with the TAH as a bridge to heart transplant, a trial of the CardioWest TAH was initiated in 1993 and completed in 2002. After the completion of this trial, CardioWest became SynCardia. The SynCardia total artificial heart was first approved for use in 2004 by the US Food and Drug Administration. Though the SynCardia shares its design with the Jarvik-7, improvements have been made throughout its lifespan, reducing the occurrence of stroke and bleeding.

Lifespan while being supported by the device has also drastically improved, with one patient being supported by the device for over 7 years (2,555 days). In 2016, SynCardia filed for bankruptcy protection and was later acquired by the private equity firm Versa Capital Management. In 2021, SynCardia was acquired by Hunniwell Lake Ventures under its portfolio company, Picard Medical. In April 2023, SynCardia filed to become a publicly traded company via A PAC.

Historical prototypes and devices

Total artificial heart pump

The U.S. Army artificial heart pump was a compact, air-powered unit developed by Kenneth Woodward at Harry Diamond Laboratories in the early to mid-1960s. The Army’s heart pump was partially made of plexiglass and consisted of two valves, a chamber, and a suction flapper. The pump operated without any moving parts under the principle of fluid amplification – providing a pulsating air pressure source resembling a heartbeat.

Jarvik Hearts

The Jarvik line of hearts was developed by the now-defunct medical device company Symbion, by medical device researchers Willem Kolff and Robert Jarvik, in conjunction with the University of Utah. These hearts were developed through animal trials and culminated in the Jarvik-7 100, the original model that was used in the first clinical trials of the heart. Jarvik-7 hearts were made primarily of biocompatible plastics and polymers. These hearts used four Medtronic-Hall valves and consisted of two “ventricles” which contained multi-layer low-stress diaphragms.

The Jarvik-7 was powered pneumatically by two transcutaneous drivelines attached to a large compressed-air drive console, originally called the Utahdrive. The drive console contained two independent drive systems for redundancy, data recording devices, and backup compressed air cylinders. The Jarvik-7 was later developed in a smaller 70cc variant so that it would fit better in the chest cavities of more patients. Another development that came to the Jarvik-7 was the introduction of a battery-powered portable drive system the size of a briefcase that later patients took advantage of. Contrary to popular belief and erroneous articles in several periodicals, the Jarvik-7 heart was not permanently banned for use. After a hostile takeover, Symbion’s facilities had lost FDA compliance in 1990 and required that the devices be destroyed.

After the rights to the device had been transferred to CardioWest Technologies, an investigational study was approved in 1993. CardioWest Technologies became SynCardia in 2003, which currently produces the modern version of the Jarvik-7, known as the SynCardia temporary Total Artificial Heart.

Phoenix-7

In June 1996, a 46-year-old man received a total artificial heart implantation done by Jeng Wei at Cheng-Hsin General Hospital in Taiwan. This technologically advanced pneumatic Phoenix-7 Total Artificial Heart was manufactured by Taiwanese dentist Kelvin K. Cheng, Chinese physician T. M. Kao, and colleagues at the Taiwan TAH Research Center in Tainan, Taiwan. With this experimental artificial heart, the patient’s BP was maintained at 90–100/40–50 mmHg and cardiac output at 4.2–5.8 L/min.

The patient then received the world’s first successful combined heart and kidney transplantation after bridging with a total artificial heart.

POLVAD

Since 1991, the Foundation for Cardiac Surgery Development (FRK) in Zabrze, Poland, has been working on developing an artificial heart. Nowadays, the Polish system for heart support, POLCAS, consists of the artificial ventricle POLVAD-MEV and the three controllers POLPDU-401, POLPDU-402, and POLPDU-501. Presented devices are designed to handle only one patient. The control units of the 401 and 402 series may be used only in a hospital due to their large size, method of control, and type of power supply. The control unit of the 501 series is the latest product of FRK. Due to its much smaller size and weight, it is a significantly more mobile solution. For this reason, it can also be used during supervised treatment conducted outside the hospital.

AbioMed hearts

The first AbioCor to be surgically implanted in a patient was on 3 July 2001. The AbioCor is made of titanium and plastic with a weight of 0.9 kg (two pounds), and its internal battery can be recharged with a transduction device that sends power through the skin. The internal battery lasts for half an hour, and a wearable external battery pack lasts for four hours. The FDA announced on 5 September 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 cannot receive a heart transplant. Some limitations of the current AbioCor are that its size makes it suitable for less than 50% of the female population and 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 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. After a great deal of experimentation, AbioMed has abandoned development of total artificial hearts as of 2015. Abiomed, as of 201,9, only markets heart pumps, “intended to help pump blood in patients who need short-term support (up to 6 days)”, which are not total artificial hearts.

Frazier-Cohn

On 12 March 2011, an experimental artificial heart was implanted in 55-year-old Craig Lewis at The Texas Heart Institute in Houston by O. H. Frazier and William Cohn. The device was a combination of two modified HeartMate II pumps, which had undergone bovine trials. So far, only one person has benefited from Frazier and Cohn’s artificial heart. Craig Lewis had amyloidosis in 2011 and sought treatment. After obtaining permission from his family, Frazier and Cohn replaced his heart with their device. Lewis survived for another 5 weeks after the operation; he eventually died from liver and kidney failure due to his amyloidosis, after which his family asked that his artificial heart be unplugged.

Current prototypes

Current prototypes of total artificial hearts (TAHs) are focused on improving biocompatibility, durability, and patient quality of life through miniaturization and advanced technology.

The main prototypes currently undergoing human clinical trials are the CARMAT Aeson and the BiVACOR Artificial Heart, both aiming to move beyond the current standard-of-care (the SynCardia TAH) to become a long-term, possibly permanent, solution.

Prototypes in Clinical Trials

● CARMAT Aeson (France) :

Technolog: The Aeson is a pulsatile, electro-hydraulic bioprosthetic heart, meaning its blood-contacting surfaces are lined with chemically treated animal (bovine) tissue to minimize blood clots and the need for strong anticoagulants.

Features: It uses internal sensors and microprocessors to automatically adjust the heart rate and blood flow based on the patient’s activity level, mimicking the body’s natural physiological response.

Status: It has received CE marking approval in the European Union for use as a “bridge to transplant” and is currently in early feasibility studies in the U.S.

● BiVACOR Artificial Heart (Australia/U.S.) :

Technology: This device uses a unique, single moving part: a magnetically levitated (MagLev) dual-sided rotor to pump blood to both the systemic and pulmonary circulations.

Features: The magnetic levitation technology eliminates mechanical wear and tear, potentially increasing the device’s lifespan to 10 years or more and reducing the risk of complications. It is also designed to be relatively silent.

Status: It received FDA authorization for an early feasibility study and has been successfully implanted in several patients in the U.S. and Australia as a bridge to transplant as of late 2024 and early 2025.

Research-Stage Prototypes

Several other concepts are in earlier stages of development :

● Soft Total Artificial Heart (sTAH): Researchers at ETH Zurich are developing a silicone monoblock heart using 3D bioprinting technology that fundamentally moves and works like a natural heart. This is currently in early testing phases and not yet ready for human trials.

● Scandinavian RealHeart: This prototype is based on a unique physiological concept that uses the movement of the atrio-ventricular valve plane to pump blood, aiming to reproduce natural blood flow patterns more closely. It is currently in the animal trial phase of development.

The artificial heart replaces the human heart and is mainly used as a temporary solution for patients awaiting a transplant.

Key Events in Development:

• Early Concepts (1800s): First theoretical ideas proposed by Legallois in 1812.
• First Animal Implant (1937): Soviet scientist Demikhov implanted a device in a dog for 5.5 hours.
• Heart-Lung Machine (1953): Enabled surgeons to operate on stopped hearts.
• First Human Use (1969): Liotta-Cooley heart used as a bridge to transplant for 64 hours.
• First Permanent Implant (1982): Jarvik-7 implanted in Barney Clark, who survived 112 days. First demonstration of long-term survival.

Device Differences:

• Artificial heart: replaces the whole heart.
• VAD: assists one or both ventricles, can be long-term.
• Cardiopulmonary bypass and ECMO: temporary, external support for heart/lungs.

Approved and Notable Devices:

• Jarvik-7/SynCardia: First permanent artificial heart, now improved for temporary use. Over 1,250 patients supported.
• CARMAT Aeson: Bioprosthetic, EU-approved. Uses animal tissue for better compatibility.
• Other Prototypes: AbioCor (fully implantable, limited lifespan/fit); BiVACOR (MagLev tech, long-term use, trial phase).

Current Status:

• Only a few devices are commercially available; most are for temporary use as a bridge to transplant.
• Modern research focuses on miniaturization, durability, reducing complications, and permanent solutions.

Main Challenges:

• Thromboembolism, infection at device exit sites, limited battery life, or large external consoles.

Recent Clinical Milestones:

• First VAD patient discharged home with HeartMate IP (1994).
• Long survival times are now possible (SynCardia patient: over 7 years).

Future Direction:

• Striving for a permanent, fully implantable, reliable, and functional artificial heart as a lasting alternative to human transplantation.

Conclusion

The conclusion for artificial hearts is that, while they are currently a successful, life-saving temporary solution for a specific group of patients with severe biventricular failure, ongoing research and development of next-generation devices are rapidly advancing towards a future in which permanent, fully implantable, and biocompatible hearts become a clinical reality. Newer prototypes like the CARMAT Aeson (using bioprosthetic materials) and the BiVACOR (using magnetic levitation continuous flow) are currently in human clinical trials in the U.S. and Europe, aiming to address the limitations of current technology and provide a long-term alternative to heart transplantation. The ultimate goal is to offer a functional, reliable, and “forgettable” heart replacement for thousands of patients annually who currently have no other viable options.