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Carmat aims to meet a major public health challenge related to cardiovascular diseases, namely heart failure, the leading cause of death in the world. More specifically, Carmat aims to provide a lasting solution to the treatment of terminal heart failure, a disease for which there are very few effective options today, the main one being heart transplants.

Heart Failure

Heart Failure occurs when the heart can no longer carry out its essential function as a “blood pump” and provide a sufficient cardiac output to satisfy the metabolic needs of the organism. It primarily affects the left chamber of the heart, then the right chamber leading to biventricular heart failure. At this stage, vital organs such as the brain, liver and kidneys do not receive enough nutrients and oxygen to function properly. The main symptoms of the disease include fatigue, shortness of breath (even at rest), and fluid retention.

Heart failure is a global pandemic affecting at least 26 million people and is increasing in prevalence (1). Despite significant advances in therapies and prevention, approximately 5% of this population have terminal heart failure, described as endstage heart failure, refractory to current medical treatment (2, 3). As heart failure is a progressive disease, the prognosis is poor: less than 50% survival five years after diagnosis (4,5).

Heart transplantation has offered the gold standard therapy; however, this therapy is constrained by the paucity of donors, which limits the number of transplants to about 5,500 patients per year (6). This gap between supply and demand prompted the development of mechanical circulatory support (MCS) systems.

Carmat aims to provide a long-term solution to treat end-stage biventricular heart failure, rated as Class IV under the NYHA system(7), for which a heart transplant is still the only truly effective alternative treatment.

(1): Lund LH, Savarese G. Global Public Health Burden of Heart Failure. Cardiac Failure Review. 2017;03(01).
(2): Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019;139(10):e56-e528.
(3): Ammar KA, Jacobsen SJ, Mahoney DW, Kors JA, Redfield MM, Burnett JC, Jr., et al. Prevalence and prognostic significance of heart failure stages: application of the American College of Cardiology/American Heart Association heart failure staging criteria in the community. Circulation. 2007;115(12):1563-70.
(4) : Stehlik J. et al. The Registry of the International Society for Heart and Lung Transplantation: 29th Official Adult Heart Transplant Report—2012 J Heart Lung Transplant October 2012 Volume 31, Issue 10, Pages 1052–1064
(5) : Miller L. W. Is Left Ventricular Assist Device Therapy Underutilized in the Treatment of Heart Failure? Circulation 2011;123;1552-1558
(6): ISHLT Annual registry Paper, Journal of heart and lung transplantation Volume 39, Issue 10, P997-1002, October 01,2020, Secular changes in organ donor profiles and impact on heart and lung transplantation

The Carmat Total Artificial Heart

Carmat

The system comprises 3 parts : 

The implanted prosthesis consisting of the following components :

  • 4 biological valves at the inlet and outlet provide unidirectional pulsatile blood flow
  • 2 ventricles, each separated by a membrane into two smaller cavities, one for the blood and one for the actuator fluid. The blood-contacting layer of this membrane is made of biocompatible materials
  • 2 micro pumps that push the actuator fluid to the membranes and generate the systole and diastole
  • Embedded electronics, microprocessors and sensors allow autoregulated responses to changing patient physiological needs
  • a flexible external bag contained the actuator fluid
  • a percutaneous cable connecting the prosthesis to external components

The external equipment provides the mobility and autonomy needed to lead a near-normal life. It weighs <5kg and includes a controller and lithium-ion batteries providing an autonomy of about 4 hours

The hospital care console : The medical team must use the hospital care console (HCC) to operate the prosthesis during implantation and track how the device is functioning

How does the Carmat TAH work?

The Carmat TAH is an active implantable medical device intended to replace the ventricles of the native heart in patients suffering from advanced heart failure. The Carmat TAH system is an electro-hydraulically driven device with the shape close to that of a human heart. Once the Carmat TAH is connected, it duplicates the action of a normal heart, providing mechanical circulatory support and restoring normal blood flow through the body. Carmat TAH is an active implantable medical device undergoing international clinical investigation.

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