A January 2019 update in Europe stated that the only fully artificial heart currently in the market was the SynCardia device and that Carmat's artificial heart ("designed to self-regulate, changing the blood flow based on the patient’s physical activity") was still in the early stage of trials. That report also indicated that Carmat was, in fact, still hoping to "gain market approval for its implant this year, but is now aiming to achieve this next year. One reason for this is that the complex technology has been undergoing refinements in the manufacturing process".