Replacement of the Heart with a Mechanical Device

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Abstract
For a close observer of the National Institutes of Health Artificial Heart Program since its inception in 1964, the landmark report by DeVries et al.1 on the first long-term clinical use of the total artificial heart simultaneously marks a finale and a first step into uncharted territory. With the advent of orthotopic cardiac replacement, physicians will encounter issues in the handling of intractable cardiac failure that they have never faced before. Treatment decisions will be buffeted by unprecedented emotional and moral forces and open to challenge from countless directions, as becomes apparent from the process described by Woolley.2 In such . . .