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From science fiction to
“almost routine”
Heart surgery techniques and technologies once considered futuristic
are now closer to reality
By Renee Sylvestre-Williams
Permanent artificial hearts,
holographic image-guided
surgery, “incisionless” operations
and reviving dead hearts to use in
transplant recipients may sound
like the stuff of science fiction.
But they’re all expected in the
cardiac surgery of the future
at the Peter Munk Cardiac
Centre (PMCC). Supported by
generous benefactors, a culture
of innovation and a visionary
team that spans disciplines and
is dedicated to cutting-edge
research, even the most futuristic
cardiovascular therapies don’t
seem so far off.
“The field is changing
dramatically,” says Vivek Rao, 48,
Chief of Cardiovascular Surgery
at PMCC, who holds the Munk
Chair in Advanced Cardiac
Therapeutics and is Surgical
Director of the centre’s artificial “was in its heyday,” Dr. Rao
heart program.
Winter 2016
Dr. Rao, a recognized expert in
end-stage heart disease who has
helped build Canada’s largest
advanced heart failure program
at PMCC, has already seen new
technologies and techniques
flourish through discoveries made
there over the last two decades.
“The future of cardiac surgery
is changing in terms of what we
traditionally do day-to-day.”
Born in India, Dr. Rao
immigrated to Canada at the
age of three. He was drawn to
medicine, having come from a
long line of physicians, and was
particularly inspired to pursue
cardiac surgery by a character on
the 1980s TV show St. Elsewhere,
Dr. Mark Craig, who devoted
himself to developing an artificial angioplasty and stenting, Dr. Rao
heart.
Back then, open heart surgery
recalls, with the prevalence
of heart disease and “a flood
of people who needed bypass
surgery. There were few
alternatives.”
In the 1990s, a group of
anti-cholesterol drugs called
statins significantly lowered the
progression of the disease, while
percutaneous or minimally-
invasive therapies, such as
angioplasty and stenting,
provided alternatives to
opening up the chest. The new
medications and techniques
stabilized the amount of bypass
surgery being performed,
especially relative to the growing patients, he points out. Among
and aging population.
Today, many patients opt for
says; although, studies show that
traditional open heart surgery
is often superior in terms of
outcomes. Surgeons are adapting
by trying more minimally-
invasive approaches, in some
cases not using the heart-lung
machine, for example, or making
smaller incisions and enlisting
robots to do coronary bypass
surgery.
“Those innovations and
technologies are still evolving,”
says Dr. Rao, who is a professor
of surgery at the University
of Toronto, noting that
improvements in anaesthesia
and surgery developed or
validated at PMCC mean that
complex cardiac procedures on
high-risk patients once deemed
“inoperable,” such as those
into their 80s, are now “almost
routine.”
Meanwhile, in valve
surgery, catheter-based valve
replacements have proven to be
equal, if not better, in high-risk
the centre’s research is a study to
show whether the same is true in
low-risk patients.
Diseases of the aorta, the biggest
blood vessel in the body, are
another major focus of PMCC,
one of the largest aortic centres
in the country. This is an example
of its multidisciplinary approach.
Someone who needs surgical
treatment for his or her aorta
will meet with a geneticist, an
imaging specialist, a cardiologist
and the aortic surgeon, among
others, he says. “In one clinic visit,
you’re covered from head to toe.”
The PMCC’s multidisciplinary –
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