Heart Substitution: Transplantation and Total Artificial Heart. The Texas Heart Institute Experience

Two methods of heart substitution have been used at the Texas Heart Institute: cardiac transplantation and the total artificial heart (TAH). Cardiac transplantation is an effective means of saving patients with endstage heart disease and, since the introduction of the immunosuppressive agent cyclosporine, survival has increased significantly. In a recent series from July 1982 to May 1984, 25 patients underwent cardiac transplantation at the Texas Heart Institute. Nineteen of these patients are alive, in Functional Class I, and leading normal lives. A major disadvantage of cardiac transplantation is that it cannot be used on an emergency basis for postcardiotomy patients. In this situation, TAH has been used twice (1969 and 1981) as the first stage to maintain circulation prior to subsequent cardiac transplantation. In both instances, the TAH functioned well until a satisfactory donor was found. This demonstrates the feasibility of the two-staged concept and encourages further development of cardiac prostheses.