The artificial heart is a mechanical pump designed to replace the function of the heart’s failing ventricles, the lower chambers responsible for circulating blood throughout the body and to the lungs. Determining the exact moment of its “invention” is complicated because the technology evolved through decades of incremental scientific progress and engineering breakthroughs, rather than appearing suddenly as a single device. This history is marked by the gradual resolution of complex challenges, moving from theoretical concepts and animal studies to its modern application in human medicine. The artificial heart reflects a continuous effort to provide a life-sustaining solution for patients with end-stage heart failure.
The Conceptual Beginnings of Mechanical Circulation
The theoretical foundation for mechanical circulatory support began long before a device was ready for human use, driven by the pioneering work of Dr. Willem Kolff, often called the “Father of Artificial Organs.” Kolff’s initial success was with the artificial kidney in the early 1940s, which established the possibility of replacing a failing organ’s function with a machine. Inspired by this breakthrough, he began work on the total artificial heart in 1957 at the Cleveland Clinic.
The early phase of development was dominated by two major challenges: finding biocompatible materials and preventing blood clotting. Any material in direct contact with blood had to be non-toxic and incapable of triggering a massive immune or clotting response, a significant hurdle given the materials available. Researchers also struggled to design a reliable, compact power source that could drive the pump and be safely implanted or tethered to the patient.
The initial devices were tested extensively in animals, primarily calves, serving as the crucial intermediate step before human trials. These animal studies refined the mechanical design, tested different materials, and worked out the fluid dynamics necessary to mimic the natural heart’s pulsatile flow. By the late 1960s, some research teams felt their designs justified the first cautious attempts at human implantation.
The Milestone of the First Human Implantation
The first implantation of a total artificial heart into a human occurred in 1969, marking a historic step into clinical practice. On April 4, 1969, Dr. Denton Cooley implanted the Liotta Total Artificial Heart, developed by Dr. Domingo Liotta, into patient Haskell Karp in Houston, Texas. This pneumatic pump was intended only as a temporary measure to keep Karp alive for 64 hours until a suitable human donor heart could be found for transplantation.
Although Karp survived the surgery and received a donor heart, he died shortly after from complications. This event proved the device’s viability as a temporary circulatory bridge and established the concept of the artificial heart as a life-saving, short-term measure. This initial success focused the medical community on using the device as a “bridge to transplant.”
A more publicized milestone occurred on December 2, 1982, when Dr. William DeVries implanted the Jarvik-7 artificial heart into Barney Clark, a retired dentist with terminal heart failure. Unlike the 1969 case, the Jarvik-7 was intended as a permanent replacement, or “destination therapy,” for a patient too ill to qualify for a heart transplant. The device successfully replaced Clark’s failing heart, but required him to be permanently connected to a large, external air compressor. Clark survived for 112 days, demonstrating that a human could live for an extended period entirely supported by a mechanical heart, despite complications from mechanical issues and multiple strokes.
The Evolution of Utility: Bridge vs. Destination Therapy
The outcomes from early permanent implantations, often fraught with complications and short survival times, led to a strategic re-evaluation of the artificial heart’s primary role. The medical community shifted focus from seeking a permanent replacement to utilizing the Total Artificial Heart (TAH) as a sophisticated means of managing end-stage heart failure. This shift resulted in the definition of two distinct therapeutic goals for the TAH and similar mechanical support devices, such as Ventricular Assist Devices (VADs).
The first, and most common, modern use is Bridge to Transplant (BTT). The TAH is implanted temporarily to keep a patient alive and stable while they wait for a compatible donor heart. This strategy prevents the patient from dying from immediate heart failure complications, buying precious time on the transplant list. The TAH stabilizes the patient’s condition, improving their overall health before the eventual transplant surgery.
The second strategy is Destination Therapy (DT), intended for patients with terminal heart failure who are not eligible for a heart transplant due to other medical conditions or advanced age. In this scenario, the TAH or VAD is meant to be a permanent, life-long solution. DT offers the patient an improved quality of life and extended survival compared to traditional medical management. This evolution has transformed the TAH from an experimental device into a powerful, targeted tool for managing the most severe cases of heart failure.