“If they can put a man on the moon, why not a minimally invasive way to repair a mitral valve?” Therese Rashotte wanted to know.
A retired nurse in Toronto, Therese was well aware of the risks associated with open-heart surgery and wanted to avoid it when it came time to repair her mitral valve from leaking blood backward into the heart.
“I’d be out of breath after walking one block – and I’m usually a fast walker. It all happened so fast, I was worried because it kept getting worse,” she says.
Mitral regurgitation is one of the most common heart valve diseases in Canada. Not unlike what TAVI does for the aortic valve, MitraClip is a simple device that allows doctors to repair faulty mitral valves without opening the chest, providing a new option for patients with severe symptoms. At about $36,000 per procedure, it is currently not funded by the province and dependent on donor support.
However, with Sunnybrook setting the standard of care for minimally invasive heart procedures, doctors and patients are optimistic donor support will pave the way for MitraClip funding from the province in the near future.
Since April 2011, Sunnybrook has performed 25 MitraClip procedures. Led by Dr. Eric Cohen, deputy chief of the Schulich Heart Centre and the cardiology division, and Dr. Gideon Cohen, head of the cardiovascular surgery division, Sunnybrook was the first in the province to start a MitraClip program. It remains the only site in the Greater Toronto Area and one of only four in the country to offer patients like Therese a second chance in life.
“I knew if they could use the MitraClip, I’d be able to breathe so much easier,” says Therese, a MitraClip candidate who had her procedure in July 2012, with the two Cohen doctors in charge.
Since then, she is back to spending more time with friends, and back to routine.
“To me, it was like a miracle – I was in one day and out the next; it was like nothing was done,” she says. “I’m so glad I found Sunnybrook and Dr. Cohen-times-two – that was my miracle. I feel great, but I’m more grateful than great.”
THE PERCEVAL VALVE
Similar to TAVI, the sutureless, self-expanding Perceval valve is a new option for high-risk patients needing an aortic valve replacement, but at a fraction of the cost. While a surgeon still needs to make a cut to the patient’s chest in this procedure, the Perceval valve doesn’t need to be sewn in. It clips on, which leads to fewer complications and patients are less likely to have heart failure later.
Sunnybrook was the first in North America to perform the procedure about a year ago. Since then, 16 patients have benefitted from the Perceval valve, which costs $12,000 each and is so far funded 100 per cent by donors. The regular valve used in the traditional aortic valve replacement surgery costs $3,500 and is funded by the government.
LEFT ATRIAL APPENDAGE OCCLUSION
With donor support, the Schulich Heart Centre plans to initiate a program to prevent strokes in patients with atrial fibrillation, a common heart rhythm disorder. While the traditional treatment has been to take a blood thinner on a permanent basis, some patients can’t do this because they might already have a bleeding problem; others simply opt not to take a blood thinner.
An alternative approach is to place an occlusion device in the left atrium to seal off the opening of the pouch, trapping any clots inside and preventing them from getting to the brain or other vital organs. This can now be done by a minimally invasive catheter-based procedure, in which doctors insert the device through a vein in the leg, advance it to the left atrium, and implant it in the correct position.
The cost for this procedure is approximately $15,000, including about $12,000 for the device. It‘s available in Europe and at a limited number of hospitals in Canada. The goal for Sunnybrook is to perform 15 to 20 procedures per year.