Since the first implantation of a total artificial heart (TAH) 50 years ago the devices and technique have evolved to provide reliable support for patients with biventricular failure as a bridge to heart transplant. The purpose of this review is to discuss the history and evolution of devices, current devices, critical aspects of patient selection, tips and pitfalls of implantation, and future directions.

The most studied device on the market is the SynCardia TAH, which has been implanted in over 2000 patients worldwide and is the only device that is currently Food and Drug Administration approved as a bridge to transplant. The overall survival in patients supported by the device at 1 year is 42% while those that make it to transplant have a 1 year post transplant survival of 83%. A newer device the Aeson TAH (Carmat, Velizy-Villacoublay, France) was first implanted in France in 2013 and is currently under clinical trial in the United States.

Significant progress has been made in both the technology and technique of TAH implantation and these devices remain both a reliable and sometimes only option for patients with severe biventricular heart failure.