Early Experience with the CARMAT Bioprosthetic Artificial Heart

Early development of mechanical circulatory support was aimed at replacing the native ventricles by a total artificial heart (TAH). However, progress was limited by the constraints of the then-available technologies and let to a shift toward implantable left ventricular assist devices (LVADs), supporting the left heart only. Over time, LVADs underwent a technological metamorphosis from valve-containing large devices placed in extra-thoracic pump pockets to valveless rotary flow devices that can be placed directly in the thoracic cavity using less-invasive surgical techniques [1]. These rotary flow devices contain narrow gaps and mechanical or hydrodynamic bearings and produce continuous flow in a high-shear environment. Despite the use of high levels of anticoagulation, pump thrombosis, acquired von Willebrand factor deficiency, and gastrointestinal bleeding have been observed with the use of these devices, indicating poor hemocompatibility [2, 3]. In addition, 10–40% patients with advanced left ventricular dysfunction treated by LVADs develop right ventricular dysfunction, resulting in complications related to right-sided congestion, such as renal failure and right heart failure [4].