Page 8 - Peter Munk Toronto Star

M8⎮TORONTO STAR SATURDAY, JANUARY 31, 2015 ON ON1

PETER MUNK CARDIAC CENTRE

Nurses prep the equipment for surgery. Everyone wears scrubs, masks, hairnets and lead to protect them from X-ray radiation. A balloon that will he

The heart of the team

A group of multidisciplinary medical doctors work together
to solve some of the country’s most complex cardiac cases

DANIEL OTIS VI”): a non-invasive surgical technique for through tricky incisions; Horlick and Osten sound probe placed dow
high-risk patients in need of aortic valve are experts at non-invasive techniques, esophagus, and an X-ray m
STAFF REPORTER replacements. such as TAVI. been placed over the ope
doctors occasionally ask t
It’s a complex case. The patient has bladder cancer. While TAVI procedures are usually per- “We take the skills of multiple people and ject dye into the patient’s b
He also has a narrowed heart valve, cardiac calcifica- formed through an artery in the groin, this use them on patients with complex prob- ing crucial stages of the su
tion, a stent and a pacemaker. He’s taking a blood patient’s abdominal aneurysm and nar- lems,” Horlick says. “In the past, patients image contrast.
thinner. Then there’s his abdominal aneurysm. rowed blood vessels would make that diffi- like this would get morphine and an apol-
cult. ogy.” Using the guidewire, one
The cancer needs to be operated on as soon as gists feeds a small balloon
possible, but the cardiac stress the surgery would The patient’s coronary arteries, more- The operating room is awash in fluores- an instant, the heart is s
cause could prove fatal. So a multidisciplinary team of over, are abnormally close to the problem- cent and LED lights. It’s a hive of activity: balloon expands, stretchi
doctors from the Peter Munk Cardiac Centre atic valve and the new valve could inadver- rushing, buzzing, busy hands and beeps as valve and leaving behind a
(PMCC) has decided to start the patient’s treatment tently cause pre-existing calcification in more than a dozen medical staff tend to the cage and a new valve made
by mending his weak heart. the patient’s heart to block those arteries patient, ready equipment and monitor in- a cow’s heart.
and send him into cardiac arrest. struments and screens. Everyone wears
“The University Health Network is all about treating scrubs, masks, hairnets and lead vests that The patient’s heart begi
the person who has nowhere else to turn,” veteran So, the medical team has decided to start run from their necks to their knees to pro- The six-hour operation is
cardiac surgeon Dr. R.J. Cusimano says. with a bypass as a fail-safe. To avoid the tect them from X-ray radiation.
aneurysm and narrowed blood vessels, “All that preparation w
Part of Toronto’s University Health Network they will operate from the tip of the pa- The patient lies prostrate on the operat- few seconds,” Cusimano
(UHN), the PMCC is using multidisciplinary medical tient’s heart via an incision in the side of his ing table. His heart can just be seen beating procedure. “It was truly a
teams to tackle Canada’s most complex cardiac cases. chest. through an opening in his exposed ribs.
Groups of up to a dozen medical staff can tend to a He’s already been connected to a heart- For a long time after the
single patient, sharing knowledge and expertise gar- “Rather than having a cardiologist or lung machine that can provide life support mano stands beside the p
nered from their respective fields to enhance patient heart surgeon do this on their own, we put in the event of an emergency and a second thumb applying pressure
care and treat multi-faceted medical issues. the two together,” Rubin says of TAVI pro- pacemaker has been placed in his chest to heart while the nurses an
cedures. alter the pace of his heart during different wrap up their work and di
“We believe that patients are best served in a team- stages of the surgery. A suction tube even
based approach and that’s how we try and manage “They see it from different perspectives. collects spilled blood that is recycled via a “If you cut your hand, you
patients — especially when we are using newer, more The heart surgeon is used to sorting things cell saver machine for later use. it to stop bleeding,” he sa
complicated technologies,” Dr. Barry Rubin, the out through an incision; the cardiologist is your hand or your heart, i
PMCC’s chair and medical director, says. used to sorting things out without making After the bypass comes the crucial valve cess.”
an incision — so the two of them come replacement. From the apex of the heart,
“When you have multiple different perspectives, we together using advanced imaging equip- one of the cardiologists manually feeds in a Cusimano looks wistfull
also think that gives you a better opportunity to be ment in the operating room.” guidewire. into his patient’s life.
able to solve the problems that you run into, and
indeed to plan to try and avoid those problems.” Cusimano is working with cardiologists The doctors watch everything they do on “I’ve been doing this sin
Dr. Eric Horlick and Dr. Mark Osten on this monitors, displaying images from an ultra- get a rush out of putting m
Multidisciplinary medical teams meet weekly at the case. Cusimano is an expert at operating body’s heart,” he says. “It
PMCC to discuss cases. In this one, doctors decided never get tired of.”
on a transcatheter aortic valve implantation (or “TA-

Lights are dimmed so that, from left, Dr. Eric Horlick, Dr. R. J. Cusimano and Dr. Mark Osten can see displays. Dr. R.J. Cusimano, cardiac surgeon, and cardiologist Dr. Mark Osten look at a patient’s hea