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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.