New Mechanical Circulatory Support Devices

Dr. Mangi
At Yale, we currently offer the Heartmate-2 Left Ventricular Assist Device, which is the only device that is FDA approved for Destination Therapy. Yale is the largest Destination Therapy Center in New England. We also use the Heartmate-2 as a bridge to heart transplantation as well as a bridge to recovery. We use the Centrimag short term ventricular assist device in patients with acute cardiac shock or acute lung failure. We are one of the most experienced centers in the country with this device. We will be participating in several clinical trials including the total artificial heart, third generation left ventricular assist devices, and totally implantable left ventricular assist devices in the future.

Synopsis of My Clinical Research

My clinical research revolves around examining ways and means to improve results and outcomes in patients with advanced heart and lung failure. Specifically, our group has described the use of artificial lungs to support patients to lung transplantation, predictors of rejection after lung transplantation, and how to manage patients who have high levels of circulating antibodies prior to lung transplantation. We are also examining novel ways to support critically ill patients, and are especially interested in patient populations that have previously not been thought to be candidates for surgical therapy. We are also exploring new surgical techniques and approaches in the hope of achieving better outcomes in patients with critical heart and lung failure. Specifically, the use of short term devices to bridge critically ill patients to permanent left ventricular assist devices; how to increase the donor pool for heart transplantation; and the addition of mitral valve repair to LVAD implantation. 

Separately, we also participate in five active clinical trials and registries looking at LVAD implantation in patients with Class IIIB heart failure, the management of atrial fibrillation in patients with mitral regurgitation; the management of mitral regurgitation in patients with coronary artery disease; and the management of patients too sick to separate from the heart lung machine. We are currently evaluating four additional devices and two additional registries for the appropriateness of participating in their clinical trials as well.

Tutorial on LVADs available at Yale

LVAD is an acronym for Left Ventricular Assist Device.  The left ventricle is the major pumping chamber of the heart and sends blood to the rest of the organs in the body.  When the left ventricle fails, it can no longer provide the blood supply that the other organs in the body need.  This can result in a state of shock, and death.  In the simplest terms, an LVAD is a device which assists the failing left ventricle by diverting the blood-flow from the ventricle into a small pump, which then propels the blood into the aorta and to the rest of the organs. There are two types of pumps which currently exist. One kind resides within the body and gets its power supply by batteries which are external to the body.  Patients can go home with this type of pump.  The second type of pump actually resides outside the body.  This is used in critically sick patients and these patients have to stay in the intensive care unit.