Initial Experience With the Aeson Total Artificial Heart in Patients With Ventricular Septal Defect After Acute Myocardial Infarction

Background Post‐myocardial infarction ventricular septal defect (VSD) is a rare but highly lethal complication of acute myocardial infarction. In cases of extensive septal destruction, surgical reconstruction is often not feasible. We report the first clinical experience with implantation of the Aeson total artificial heart (TAH) in patients with irreparable post‐infarction VSD. Methods This multicenter retrospective analysis included 10 male patients with severe cardiogenic shock who underwent Aeson TAH implantation at four centers in Germany and France between November 2022 and March 2025. All patients required temporary mechanical circulatory support before implantation. Previous surgical VSD repair had failed in four patients, while six were considered unsuitable for surgical reconstruction because of extensive basal septal defects involving the atrioventricular valve apparatus. Results Following TAH implantation, early extubation was achieved in most patients, whereas three required temporary veno‐venous extracorporeal membrane oxygenation support. No cases of permanent renal failure, irreversible hepatic dysfunction, or neurological complications such as stroke were observed. Eight patients (80%) were successfully bridged to heart transplantation after a median support duration of 167 days, while one patient remains on ongoing device support. During a median follow‐up of 351 days (interquartile range, 202–470 days), four patients died. Overall survival was 80% at 6 months and 60% at 1 year after implantation. Conclusions Aeson TAH implantation appears to be a feasible bridge‐to‐transplant strategy for selected patients with irreparable post‐myocardial infarction VSD. The procedure provided hemodynamic stabilization, facilitated recovery of end‐organ function, and resulted in favorable short‐ to mid‐term outcomes in an otherwise fatal clinical condition.