Summary

We report the first successful implantation of the CARMAT Aeson® total artificial heart (TAH) in Israel, performed as a bridge to transplantation in a patient with advanced biventricular heart failure and severe right ventricular dysfunction precluding left ventricular assist device (LVAD) therapy. The CARMAT Aeson® TAH is a next generation bioprosthetic device equipped with biological valves, hemocompatible membranes, and an integrated sensor array that enables autoregulation of stroke volume to balance left and right circulation, thereby reducing thrombogenicity and improving physiological adaptation. Following implantation, the patient demonstrated rapid hemodynamic stabilization, complete weaning from inotropes, and marked functional recovery. Remarkably, during the index hospitalization he underwent successful elective inguinal hernia repair under general anesthesia, a procedure previously deemed prohibitive due to high cardiovascular risk. This patient is the first CARMAT TAH recipient to undergoing a non-cardiac surgical procedure. Perioperative interruption of anticoagulation was achieved safely without thromboembolic complications, underscoring the device’s biocompatibility and reduced thrombogenicity compared with continuous-flow VADs. The patient was discharged home on postoperative day 61 in an ambulatory state, clinically stable, and remains actively listed for heart transplantation. This case highlights the feasibility and safety of the CARMAT Aeson® TAH in patients with end-stage biventricular failure, with potential advantages over continuous-flow devices, including pulsatile physiology, autoregulation, and reduced risk of bleeding or thrombotic complications. These advantages strengthen its role as an important bridging strategy to heart transplantation.