“It gives you a 3D map of where you are in terms of placing the catheters,” Dr. Strauss says. “Our experts have really been taking the lead on this.”
Dr. Strauss says as leader of the Schulich Heart Centre, he strives for innovation and wants to maintain a cutting-edge program that embraces new technology.
“And then, of course, bring it all to patients.”
Transcatheter Aortic Valve Implantation
When Ron Armstrong travelled to Buffalo, New York last winter to catch a few games in the World Junior Hockey Championships, he dreaded each final buzzer. And not because of anything that was happening on the ice.
“I didn’t want to have to go outside,” he recalls. “It was so hard to walk and move around.”
Ron, 77, had a long history of heart problems and had undergone two open-heart bypasses, one in 1975 and another in 1996.
When he began having chest pains and difficulty breathing last year, he thought it was angina again. Instead, his aortic valve was deteriorating.
Narrowing of the aortic valve, or stenosis, occurs when the aortic valve, which keeps oxygen-rich blood flowing from the heart into the largest artery in the body, becomes blocked, impairing flow of blood to the rest of the body.
“These patients experience bad chest pains, profound fainting attacks, significant shortness of breath, leading all the way to heart failure,” says Dr. Sam Radhakrishnan, an interventional cardiologist. “Once they develop these symptoms, particularly the heart failure symptoms, unfortunately medications are solely palliative. They don’t treat the underlying problem. And by not treating the underlying problem, the valve continues to narrow such that the heart is unable to cope and ultimately fails.”
Mortality is upwards of 50 per cent in the first year for patients with critical aortic stenosis.
“That’s worse than most cancers actually,” Dr. Radhakrishnan says.
Ron visited a cardiac surgeon who advised him it would be too risky to operate on the valve in the traditional way: open-heart surgery.
But he told Ron of a new procedure being offered at Sunnybrook, where a team of cardiologists and surgeons could repair the valve without opening the chest.
During transcatheter aortic valve implantation (TAVI), a team of specialists, including a cardiologist, a cardiac surgeon and a vascular surgeon, accesses the body through an artery in the groin, or through a small incision under the collar bone or in the chest wall, and advances the valve to the heart.
“It was unbelievable, like snapping your fingers and feeling better,” Ron says. “I immediately felt better. Before I even went for my follow-up appointment a month later, I was already going down to the gym in my condo and going on the bike.”
Inside the catheterization lab, it takes a whole team to perform a TAVI.
Dr. Giuseppe Papia, vascular surgeon, says each procedure involves a combination of techniques: expertise from the cardiologists, cardiac surgeons and vascular surgeons.
“The exciting thing about the vascular team at Schulich is that we provide a service that I don’t think you’ll find anywhere else in Ontario and possibly in Canada: the endovascular work we do in the cath lab,” Dr. Papia says. “When it comes to TAVI, the question is, ‘Can you get to the vessels?’ That’s what Dr. Andrew Dueck and I do. We are the access guys in a sense.”
Dr. Papia says that team approach is what sets the Schulich program apart from other heart centres.
“We really benefit from our combined knowledge sharing and skills,” he says. “We pick the best procedure and we treat patients. We pick the best procedure for each patient.”
Dr. Radhakrishan agrees.
“Our TAVI program is unique in Canada in that interventional cardiologists, cardiac surgeons and vascular surgeons are involved in the majority of cases. While it’s fair to say that virtually all TAVI programs screen for eligible patients through multidisciplinary assessments, many still compartmentalize off the actual procedure to those that can be performed by interventional cardiologists alone or cardiac surgeons alone. That’s not the approach we’ve taken, and frankly, I think we’ve been very successful, because it brings the collective expertise of the relevant Schulich Heart Centre specialists to the table for every patient.
“Our collaborative approach has enabled us to be on the leading edge of this remarkable and novel procedure in Canada.”