Despite optimized heart failure (HF) medical, surgical, and device therapies, many patients may still have progressive, persistent, severe signs and symptoms of HF, thus requiring advanced HF therapies. For a very small fraction of patients with severe biventricular HF and other anatomic or rhythm issues for which durable mechanical circulatory support would not be appropriate, the total artificial (TAH) is often the only viable option as a bridge to transplant. This chapter will describe the history, clinical indications, available devices, and outcomes of TAH as utilized in the US and the world for end-stage HF.