The SynCardia Total Artificial Heart (SynCardia Systems, Inc., Tucson, Arizona) was originally based off the Jarvik 7 which was designed by Dr. Willem Kolff and Dr. Robert Jarvik at the University of Utah in the late 1960s and first implanted in 1982 by Dr. William DeVries. The SynCardia device is the only commercially available total artificial heart (TAH) in the United States and the only Food and Drug Administration (FDA)-approved TAH device as a bridge to heart transplantation. It is the most studied device having being implanted in over 2000 patients worldwide. Though there are several indications for implantation, the most common indication is severe biventricular failure. There are two available device sizes 50 cc and 70 cc. Patient selection, preoperative planning, and technical aspects of implantation are of critical importance. After SynCardia TAH implantation, rates of survival to transplantation are 52.8–86.6% and even higher in more experienced centers. There is a survival advantage when center volume exceeds ten devices implanted. For those patients who make it to transplant after device implantation, 1-year posttransplant survival is 80–84%. The SynCardia TAH is a viable option for carefully selected patients as a bridge to transplantation. In this chapter, we discuss in detail the history of the SynCardia TAH, patient selection, technique of implantation, and the short- and long-term results of SynCardia TAH implantation.