There are limited therapeutic options for final treatment of end-stage heart failure. Among them, implantation of a total artificial heart (TAH) is an acceptable strategy when suitable donors are not available. TAH development began in the 1930s, followed by a dramatic evolution of the actuation mechanisms operating the mechanical pumps. Nevertheless, the performance of TAHs has not yet been optimized, mainly because of the low biocompatibility of the blood-contacting surfaces. Low hemocompatibility, calcification, and sensitivity to infections seriously affect the success of TAHs. These unsolved issues have led to the withdrawal of many prototypes during preclinical phases of testing. This review offers a comprehensive analysis of the pathophysiological events that may occur in the materials that compose TAHs developed to date. In addition, this review illustrates bioengineering strategies to prevent these events and describes the most significant steps toward the achievement of a fully biocompatible TAH.

中文翻译：

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人工心脏总进化中的生物相容性挑战。

终末期心力衰竭的最终治疗方法有限。其中，当没有合适的捐献者时，植入全人工心脏（TAH）是可以接受的策略。TAH的开发始于1930年代，随后是操作机械泵的致动机构的巨大发展。尽管如此，TAH的性能尚未得到优化，这主要是由于血液接触表面的生物相容性低。血液相容性低，钙化和对感染的敏感性严重影响TAH的成功。这些未解决的问题导致在临床前测试阶段撤回了许多原型。这篇综述提供了对迄今为止开发的构成TAHs的材料中可能发生的病理生理事件的全面分析。此外，