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Steve Segal was the first person to undergo Sunnybrook's new minimally invasive mitral valve program. (Doug Nicholson. Not to be printed, broadcast or transmitted without the permission of MediaSource or its representatives.)
Steve Segal was the first person to undergo Sunnybrook's new minimally invasive mitral valve program. (Doug Nicholson. Not to be printed, broadcast or transmitted without the permission of MediaSource or its representatives.)

Heart Health

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A faulty mitral valve had been keeping Steve off the greens, until a team from Sunnybrook repaired that valve using a leading-edge minimally invasive mitral valve repair procedure.

Doctors had been monitoring 58-year-old Steve’s leaky mitral valve for over 20 years.

A faulty mitral valve means the flaps of the heart’s one-way mitral valve don’t close properly and leak, causing blood to flow backward into the left atrium. This means decreased blood flow to the body, placing extra burden on the left ventricle and the lungs.

As Steve’s leak worsened, so did his energy level. He wasn’t able to “leap tall buildings,” he jokes.

But in seriousness, Steve says, the leak did affect his day-to-day life: he suffered extreme fatigue, couldn’t walk long distances, couldn’t take the stairs and had frequent headaches.

Then Steve heard of a brand new procedure used by Sunnybrook’s team of experts, made up of surgeons and cardiologists, who can repair faulty mitral valves without open-heart surgery.

In April 2011, Steve was the first patient at Sunnybrook to undergo the state-of-the-art percutaneous – where access to inner organs is gained via needle-puncture of the skin, rather than by cutting the patient open – mitral valve repair procedure. Sunnybrook is now one of just two centres in Canada offering it.

During this ultrasound-assisted procedure, a small catheter is delivered to the heart through a blood vessel in the leg. The surgeon then carefully clips the faulty flaps of the mitral valve back together. The heart continues to beat normally during the procedure, which takes only about 75 minutes.

“I was out of the hospital in a day, and it might have been even sooner if I wasn’t the first patient,” Steve says. “I’m walking up stairs now. I’m riding the exercise bike.”

While surgeons have been repairing leaky mitral valves for years by splitting open the breast bone, this new clipping procedure means faster recovery with fewer complications, says Dr. Gideon Cohen, cardiovascular surgeon. To date, a third of all patients who need mitral valve repair haven’t been treated because they are not physically able to withstand conventional open-heart surgery. It’s simply too high risk.

“The results with this mitral clip procedure have been truly remarkable,” he says. “Patients have enjoyed shorter hospital stays, less pain and an earlier return to normal activities.”

As someone who had open-heart surgery to fix a nearly ruptured aorta eight years ago, Steve saw immediately the benefits of the minimally invasive mitral clip procedure. He says there’s simply no comparison.

“I was in the hospital for over a month after my surgery in 2004,” he says. “With the clips, you aren’t exposed to the trauma of surgery, the insult to the body. There’s less chance of infection because you aren’t opened up.”

And the best part: he got to recuperate at home in the care – and cooking, he laughs – of his wife and two children.

The mitral clip procedure is the latest in a series of minimally invasive procedures being pioneered at the Schulich Heart Centre. From beating heart bypass, to replacing faulty aortic valves through an opening the size of a fingernail, Schulich’s team of expert cardiologists, cardiac surgeons, vascular surgeons and cardiac anesthetists are working together to come up with the most innovative ways to treat the heart and damaged blood vessels.

It was just 50 years ago that open-heart procedures were becoming popular. And now, surgeons and cardiologists are trying to find more and more ways to do procedures without opening patients up at all.

“It’s a huge deal – cutting someone’s chest open, putting them on a heart-lung machine, keeping them in hospital to try to recover,” Schulich Heart Centre Chief Dr. Strauss says. “Clearly that is very invasive.”

Schulich’s experts have been at the forefront of designing and implementing new less invasive options. In Sunnybrook’s Arrhythmia Invasive Suite, for example, surgeons don’t even invade the patient’s personal space.

“What’s really unique when you are watching the procedure is that the doctor isn’t even in the room,” Dr. Strauss says. “They are all sitting in a room next door and it looks like they are playing computer games. That’s pretty minimally invasive.”

It’s stereotaxis, a way of locating where a surgeon needs to be in the heart by the use of these magnets that are beside the patient.

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