The evolution of mechanical circulatory support at the Texas Heart Institute

Since the 1960s, total artificial hearts (TAHs) and left ventricular assist device (LVADs) have developed in parallel with heart transplantation for end-stage heart failure. In 1969, Cooley first implanted a TAH clinically as a bridge to transplantation. In 1976-79, our institution tested an intraabdominal LVAD, the first to be used clinically as a bridge to transplantation. In 1981, Cooley again implanted a TAH as a bridging device. Beginning in 1982, the Jarvik-7 TAH was used for long-term support in five patients, but serious complications undermined confidence in this application. Nevertheless, the Jarvik-7 was successful as a bridging device in >100 cases. Its successor, the CardioWest TAH, is undergoing clinical testing for bridging. The HeartMate pneumatic LVAD began clinical trials in 1986 and became commercially available 10 years later; the electric version entered clinical trials in 1991, becoming commercially available in 1998. The Jarvik 2000, a small, axial-flow LVAD designed to minimize surgical complications and eventually provide long-term support, is undergoing initial clinical studies here and abroad. The AbioCor is the first totally implantable TAH to transmit power and control transcutaneously, potentially allowing tether-free existence. This TAH is being evaluated in patients ineligible for transplantation.