Sunnybrook leads in TAVI expertise, research and training

Procedure treats patients with severely damaged aortic valve

Since its inception in 2009, Sunnybrook's Schulich Heart Centre's TAVI program has provided access to a lifesaving heart procedure for 150 elderly or frail patients not well enough to undergo traditional aortic valve replacement surgery.  Now, the centre is sharing its expertise with other Canadian centres to ensure that patients across the country have access to the less invasive procedure.

Transcatheter Aortic Valve Implantation, or TAVI, addresses the narrowing of the aortic valve, or "stenosis", a fairly common condition in today's aging population. If left untreated, stenosis can cause the heart muscle to thicken as it works harder to pump blood through the body, potentially leading to heart failure.

TAVI at Sunnybrook is a team effort, with an Interventional Cardiologist, Cardiac Surgeon, Vascular Surgeon, cardiac imaging experts, cardiac anaesthesiologist, as well as Cath Lab nurses, all working together to implant a new valve percutaneously (without opening the patient's chest).  The procedure takes between two and three hours, about half as long as conventional open-heart surgery for these complex patients, and may be carried out under general or local anaesthesia, with or without sedation.  Benefits to patients include reduced pain and less need for postoperative pain medication, smaller scars, a shorter stay in the hospital and a faster recovery.

Under the leadership of Dr. Sam Radhakrishnan, Director of the Cardiac Cath Labs and Physician-Lead of Sunnybrook's TAVI program and Dr. Stephen Fremes, surgical lead for the TAVI program, the hospital is guiding training for other Canadian hospitals to initiate their own TAVI programs.  "It's a priority to continue our leadership role in research and training for TAVI.  In addition to helping to establish TAVI programs in London, Kingston and Victoria, we're also teaching new techniques to a mature TAVI program in Quebec.  Disseminating this knowledge across Canada will greatly improve the health of some of the most critically ill heart patients in the country," says Dr. Radhakrishnan.

When Sunnybrook first started performing TAVI, the procedure was unfunded, so the hospital developed its expertise thanks to generous donations to the Sunnybrook Foundation, with each case costing approximately $35,000.  In January 2013, Sunnybrook was approved by the Ontario Ministry of Health to proceed with 75 fully funded procedures for the 2013 fiscal year.  Sunnybrook is one of only 6 programs in the province to be provided with Ministry TAVI funding and the expectation is for growth of the program to 90 cases in 2014.  Sunnybrook will continue to submit data to the Cardiac Care Network on TAVI outcomes.

For patients like Margery Brennan, a 72-year-old who wasn't able to stay by herself as she had difficulty walking, life before TAVI simply "wasn't good."  Margery underwent TAVI in December 2012 and says, "My heart went right back to normal, I felt like a brand new person. Now I'm able to do my own housework and have a new lease on life."

Like many TAVI patients, Margery returned home after only a few days and resumed many of her normal activities within a couple of weeks rather than a couple of months.