Page 24 - An Innovation Spirit ...

Heart surgery in
awake patients:
the new frontier
A leading-edge procedure backed by the Peter Munk Cardiac Centre
Innovation Committee is a lifesaver for high-risk patients like David McCallum
By Shelley White
Last year, David McCallum was
far from living life to the fullest. improve his quality of life, but
“I was feeling pretty sick,”
says the 88-year-old resident
of Scarborough, Ont. “I
couldn’t function properly
while walking, breathing;
there was pain, everything.”
A visit to the doctor and an
angiogram revealed that Mr.
McCallum suffered from severe
aortic stenosis (narrowing of
the aortic valve in the heart),
which was the cause of his
debilitating symptoms. Mr.
McCallum’s condition would
22 Peter Munk Cardiac Centre
require intervention, not only to the leg. It’s a life-saving option ministry there were Canadian
also to prevent degeneration
of his heart muscle that could
become life-threatening.
“It affected me all the
way round,” he says.
Mr. McCallum was referred
to the cardiologists at the Peter Fund program. “We thought it
Munk Cardiac Centre (PMCC),
and the team decided that he was
a candidate for a leading-edge
procedure called Transcatheter
Aortic Valve Implantation, or
TAVI, which involves inserting a
new valve through a catheter in
for patients who are too sick or
high-risk for open heart surgery.
TAVI was one of the first
projects approved by the Peter
Munk Cardiac Centre Innovation
Committee back in 2012, says Dr.
Harry Rakowski, cardiologist,
who leads the Innovation
was important for the PMCC
and UHN [University Health
Network] to help lead this
innovative device that would
help people for whom there
was little alternative hope.”
Though TAVI procedures had
been happening at the centre
and elsewhere for a few years,
says Dr. Rakowski, at the time it
was not yet approved or funded
by the Ministry of Health and
Long-Term Care in Ontario,
and “we felt we needed to do
some implants to prove to the
centres capable of doing it
well, with good outcomes.”
But Mr. McCallum’s TAVI
procedure would be particularly
groundbreaking – he would
be the first patient in Ontario
to undergo an “awake TAVI,”
without general anesthetic. By
using only local anesthetic at
the site of the catheter insertion,
as well as “conscious sedation,”
awake TAVIs result in decreased
procedure time and are less
invasive, allowing patients
a faster recovery and earlier
discharge from the hospital.
When PMCC cardiologist
Dr. Eric Horlick explained the
procedure to Mr. McCallum, he
says he felt quite comfortable
going forward with it. “I’d
had a couple of stents put in a
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