artificial heart artificial heart an artificial heart is a device that replaces the heart. artificial hearts are typically used to bridge the time to heart transplantation, or to permanently replace the heart in the case that a heart transplant (from a deceased human or, experimentally, from a deceased genetically engineered pig) is impossible. 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. artificial heartan artificial heart displayed at the london science museum 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 can be a permanent solution also, 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 origins a synthetic replacement for a heart remains a long-sought "holy grail" of modern medicine. the obvious benefit of a functional artificial heart would be to lower the need for heart transplants because the demand for organs always greatly exceeds supply. although the heart is conceptually a pump, it embodies subtleties that defy straightforward emulation with synthetic materials and power supplies. consequences of these issues include severe foreign-body rejection and external batteries that limit mobility. these complications limited the lifespan of early human recipients from hours to days. early development the first artificial heart was made by the soviet scientist vladimir demikhov in 1938. it was implanted in a dog. on 2 july 1952, 41-year-old henry opitek, suffering from shortness of breath, made medical history at harper university hospital at wayne state university in michigan. the dodrill-gmr heart machine, considered to be the first operational mechanical heart, was successfully used while performing heart surgery. ongoing research was done on calves at hershey medical center, animal research facility, in hershey, pennsylvania, during the 1970s. forest dewey dodrill, working closely with matthew dudley, used the machine in 1952 to bypass henry opitek's left ventricle for 50 minutes while he opened the patient's left atrium and worked to repair the mitral valve. in dodrill's post-operative report, he notes, "to our knowledge, this is the first instance of survival of a patient when a mechanical heart mechanism was used to take over the complete body function of maintaining the blood supply of the body while the heart was open and operated on." a heart–lung machine was first used in 1953 during a successful open heart surgery. john heysham gibbon, the inventor of the machine, performed the operation and developed the heart–lung substitute himself. following these advances, scientific interest for the development of a solution for heart disease developed in numerous research groups worldwide. early designs of total artificial hearts in 1949, a precursor to the modern artificial heart pump was built by doctors william sewell and william glenn of the yale school of medicine using an erector set, assorted odds and ends, and dime-store toys. the external pump successfully bypassed the heart of a dog for more than an hour. paul winchell invented an artificial heart with the assistance of henry heimlich (the inventor of the heimlich maneuver) and held the first patent for such a device. the university of utah developed a similar apparatus around the same time, but when they tried to patent it, winchell's heart was cited as prior art. the university requested that winchell donate the heart to the university of utah, which he did. there is some debate as to how much of winchell's design robert jarvik used in creating jarvik's artificial heart. heimlich states, "i saw the heart, i saw the patent and i saw the letters. the basic principle used in winchell's heart and jarvik's heart is exactly the same. " jarvik denies that any of winchell's design elements were incorporated into the device he fabricated for humans which was successfully implanted into barney clark in 1982. on 12 december 1957, willem johan kolff, the world's most prolific inventor of artificial organs, implanted an artificial heart into a dog at cleveland clinic. the dog lived for 90 minutes. in 1958, domingo liotta initiated the studies of tah replacement at lyon, france, and in 1959–60 at the national university of córdoba, argentina. he presented his work at the meeting of the american society for artificial internal organs held in atlantic city in march 1961. at that meeting, liotta described the implantation of three types of orthotopic (inside the pericardial sac) tahs in dogs, each of which used a different source of external energy: an implantable electric motor, an implantable rotating pump with an external electric motor, and a pneumatic pump. in 1964, the national institutes of health started the artificial heart program, with the goal of putting an artificial heart into a human by the end of the decade. the purpose of the program was to develop an implantable artificial heart, including the power source, to replace a failing heart. in february 1966, adrian kantrowitz rose to international prominence when he performed the world's first permanent implantation of a partial mechanical heart (left ventricular assist device) at maimonides medical center. in 1967, kolff left cleveland clinic to start the division of artificial organs at the university of utah and pursue his work on the artificial heart. in 1973, a calf named tony survived for 30 days on an early kolff heart. in 1975, a bull named burk survived 90 days on the artificial heart. in 1976, a calf named abebe lived for 184 days on the jarvik 5 artificial heart. in 1981, a calf named alfred lord tennyson lived for 268 days on the jarvik 5. over the years, more than 200 physicians, engineers, students and faculty developed, tested and improved kolff's artificial heart. to help manage his many endeavors, kolff assigned project managers. each project was named after its manager. graduate student robert jarvik was the project manager for the artificial heart, which was subsequently renamed the jarvik 7. in 1981, william devries submitted a request to the fda for permission to implant the jarvik 7 into a human being. on 1 december 1982, william devries implanted the jarvik 7 artificial heart into barney clark, a dentist from seattle who had severe congestive heart failure. clark lived for 112 days tethered to an external pneumatic compressor, a device weighing some 400 pounds (180 kg), but during that time he experienced prolonged periods of confusion and a number of instances of bleeding, and asked several times to be allowed to die. first clinical implantation of a total artificial heart on 4 april 1969, domingo liotta and denton a. cooley replaced a dying man's heart with a mechanical heart inside the chest at the texas heart institute in houston as a bridge for a transplant. the man woke up and began to recover. after 64 hours, the pneumatic-powered artificial heart was removed and replaced by a donor heart. however thirty-two hours after transplantation, the man died of what was later proved to be an acute pulmonary infection, extended to both lungs, caused by fungi, most likely caused by an immunosuppressive drug complication. the original prototype of liotta-cooley artificial heart used in this historic operation is prominently displayed in the smithsonian institution's national museum of american history "treasures of american history" exhibit in washington, d.c. first clinical applications of a permanent pneumatic total artificial heart the first clinical use of an artificial heart designed for permanent implantation rather than a bridge to transplant occurred in 1982 at the university of utah. artificial kidney pioneer willem johan kolff started the utah artificial organs program in 1967. there, physician-engineer clifford kwan-gett invented two components of an integrated pneumatic artificial heart system: a ventricle with hemispherical diaphragms that did not crush red blood cells (a problem with previous artificial hearts) and an external heart driver that inherently regulated blood flow without needing complex control systems. independently, paul winchell designed and patented a similarly shaped ventricle and donated the patent to the utah program. throughout the 1970s and early 1980s, veterinarian donald olsen led a series of calf experiments that refined the artificial heart and its surgical care. during that time, as a student at the university of utah, robert jarvik combined several modifications: an ovoid shape to fit inside the human chest, a more blood-compatible polyurethane developed by biomedical engineer donald lyman, and a fabrication method by kwan-gett that made the inside of the ventricles smooth and seamless to reduce dangerous stroke-causing blood clots. on 1 december 1982, william devries implanted the artificial heart into retired dentist barney bailey clark (born 21 january 1921), who survived 112 days with the device, dying on 23 march 1983. bill schroeder became the second recipient and lived for a record 620 days. contrary to popular belief and erroneous articles in several periodicals, the jarvik heart was not banned for permanent use. today, the modern version of the jarvik 7 is known as the syncardia temporary total artificial heart. it has been implanted in more than 1,350 people as a bridge to transplantation. in the mid-1980s, artificial hearts were powered by dishwasher-sized pneumatic power sources whose lineage went back to alfa laval milking machines. moreover, two sizable catheters had to cross the body wall to carry the pneumatic pulses to the implanted heart, greatly increasing the risk of infection. to speed development of a new generation of technologies, the national heart, lung, and blood institute opened a competition for implantable electrically powered artificial hearts. three groups received funding: cleveland clinic in cleveland, ohio; the college of medicine of pennsylvania state university (penn state hershey medical center) in hershey, pennsylvania; and abiomed, inc. of danvers, massachusetts. despite considerable progress, the cleveland program was discontinued after the first five years. first clinical application of an intrathoracic pump on 19 july 1963, e. stanley crawford and domingo liotta implanted the first clinical left ventricular assist device (lvad) at the methodist hospital in houston, texas, in a patient who had a cardiac arrest after surgery. the patient survived for four days under mechanical support but did not recover from the complications of the cardiac arrest; finally, the pump was discontinued, and the patient died. first clinical application of a paracorporeal pump 1966 debakey ventricular assist device. on 21 april 1966, michael debakey and liotta implanted the first clinical lvad in a paracorporeal position (where the external pump rests at the side of the patient) at the methodist hospital in houston, in a patient experiencing cardiogenic shock after heart surgery. the patient developed neurological and pulmonary complications and died after few days of lvad mechanical support. in october 1966, debakey and liotta implanted the paracorporeal liotta-debakey lvad in a new patient who recovered well and was discharged from the hospital after 10 days of mechanical support, thus constituting the first successful use of an lvad for postcardiotomy shock. first vad patient with fda approved hospital discharge in 1990 brian williams was discharged from the university of pittsburgh medical center (upmc), becoming the first vad patient to be discharged with food and drug administration (fda) approval. the patient was supported in part by bioengineers from the university of pittsburgh's mcgowan institute. total artificial hearts syncardia syncardia is a company based in tucson, arizona, which currently has two separate models 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 good results with the tah as a bridge to heart transplant accumulated, a trial of the cardiowest tah (developed from the jarvik 7 and now marketed as the syncardia tah) was initiated in 1993 and completed in 2002. the syncardia was first approved for use in 2004 by the us food and drug