Total artificial heart--concepts and clinical use.

End-stage congestive heart failure remains the leading cause of death in the United States. Despite advances in medical treatment, it also remains the most common reason for admission to the hospital. The gold standard of treatment for the failing heart, orthotopic heart transplantation, is limited by a shortage of donor hearts. There are also a significant number of patients who are not transplant candidates due to comorbid conditions and/or inability to tolerate immunosuppressive therapy. To meet the need for this latter group, the medical field has embraced ventricular assist device (VAD) therapy to extend survival and improve quality-of-life for the end-stage cardiac patient. This therapy, however, has been currently limited to the failing left ventricle and is still fraught with complications that limit long-term and widespread use. The total artificial heart, as currently available with two devices, is rapidly becoming the treatment of choice for biventricular failure.