title: The total artificial heart for biventricular heart failure and beyond.
abstract: OBJECTIVE
  Treatment options for late-stage biventricular heart failure are limited but include medical therapy with intravenous inotropes, biventricular assist devices (Bi-VADs) and the total artificial heart (TAH). In this manuscript, we review the indications, surgical techniques and outcomes for the TAH.
  
  
  RESULTS
  The TAH offers biventricular replacement, rather than 'assistance', as the device is placed orthotopically after excision of the entire ventricular myocardium and all four native valves. In contrast to patients with Bi-VADs, patients with the TAH have no postoperative inotrope requirements, arrhythmias or inflow/outflow cannulae-related complications. Additionally, patients participate in rehabilitation early after device placement and the development of a portable drive may facilitate hospital discharge in the USA. Furthermore, total heart replacement may be ideal for heart failure associated with unique anatomical and mechanical complications.
  
  
  CONCLUSIONS
  The TAH is an effective therapeutic option for the treatment of patients dying of heart failure who may not be suitable candidates for left ventricular assist devices.
authors.affiliation: Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia 23298-0204, USA. vkasirajan@mcvh-vcu.edu
authors.forename: Vigneshwar
authors.initials: V
authors.lastname: Kasirajan
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Tang
authors.forename: Gundars J
authors.initials: GJ
authors.lastname: Katlaps
authors.forename: Keyur B
authors.initials: KB
authors.lastname: Shah
mesh_terms: D005260:Female; D006333:Heart Failure / Q000534:rehabilitation / Q000601:surgery*; D006352:Heart Ventricles / Q000473:pathology; D006354:Heart, Artificial; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities