Ayyaz Ali, MD, is the surgical director of the Yale Medicine Advanced Heart Failure, Heart Transplantation, and Mechanical Circulatory Support Program. A cardiac surgeon who specializes in heart transplantation and other treatments for severe heart failure, he cares for adults of all ages.
Dr. Ali was interested in the heart as far back as high school. He realized in medical school that cardiac surgery would be a way for him to combine a variety of skills and interests. “A cardiac surgeon must have a lot of dexterity. There are a lot of fine movements and precision when you do these surgeries, so you have to be quite meticulous,” he says. “Then you have to combine that with a high level of complex, intellectual decision-making and make the right choices for patients with complicated problems in a limited amount of time.”
Heart failure may be managed initially with medication, but it is a progressive disease, and many patients eventually will need advanced surgical care. In addition to heart transplants, Dr. Ali can implant left ventricular assist devices (LVADs), which are mechanical heart pumps that can restore the flow of blood around the body and serve as either as a temporary solution while the patient is waiting for a donor heart or a permanent solution for those who wouldn’t be able to tolerate a heart transplant.
At Yale, Dr. Ali plans to keep increasing the volume of heart transplants performed, serving people in Connecticut and beyond. “What I really want to do is make sure no one ever has to go out of state for a heart transplant,” he says. The ability to undergo heart transplantation close to home is especially important for patients after their operation due to the frequent and complex long-term follow-up appointments required to facilitate their long-term survival. “There's nothing more convenient than being able to get this continuing care at a center that is close to home,” he says.
The average wait for a transplantable heart can be more than six months (although it can be sooner or later depending on a variety of factors). Dr. Ali, an assistant professor of cardiac surgery at Yale School of Medicine, has undertaken pioneering research on an approach called donation after circulatory death (DCD) heart transplantation. This technique, which is only performed at four hospitals worldwide (U.K and Australia) allows transplant surgeons to use hearts for transplant even after the donor’s circulation and heart have stopped and the organ has been without blood supply for several minutes. “In England, I was involved in a program where we performed the first 50 of these DCD transplants in the world with results that were comparable to conventional heart transplants,” he says.
While the FDA has yet to approve devices Dr. Ali needs to recover DCD hearts, he hopes to eventually introduce the approach at Yale. “This could potentially double the number of donor hearts that we can use to save lives,” he says.