Innovation to impact

The talented team at Sunnybrook’s Schulich Heart Program performed two firsts amid the pandemic using transcatheter aortic valve implantation.

After living through the horrors of Buchenwald, Leib Wagschal is thankful for every moment he gets with his 19 grandchildren and great-grandchildren. But the 90-year-old Holocaust survivor is even more grateful than usual of late – and it’s thanks to Sunnybrook, he says.

That’s because Leib recently became the first person at Sunnybrook – and one of the first in Canada – to benefit from the Sentinel Cerebral Protection System.

Leib Wagschal, pictured with his wife Charlotte. Both are grateful for the care Leib received from the Schulich Heart Program team.

Pioneering leadership

This innovative device protects against stroke during an endovascular procedure, such as a transcatheter aortic valve implantation (TAVI). The Sentinel’s small dual filter is designed to capture and remove plaque or debris that could travel up to the brain. It is inserted using a catheter from the patient’s wrist artery and positioned with X-ray guidance, just before the TAVI procedure. This minimally invasive approach is suitable for patients, like Leib, who are not candidates for open-heart surgery. Once the TAVI is in place, the Sentinel is removed.

“Leib’s case – and outcome – is a wonderful example of Sunnybrook’s pioneering leadership in TAVI procedures,” says Dr. Sam Radhakrishnan, medical director of the TAVI program, who cared for Leib. To date, the TAVI program has performed a handful of cases with the Sentinel, and is about to embark on a clinical trial looking at its use in patients deemed at higher risk of stroke post-TAVI.

Back to what he loves

Leib was rushed to Sunnybrook after he collapsed while walking to synagogue. “I just dropped, in the middle of the road,” he says. Following a short stay in the hospital for his TAVI procedure, Leib was able to return home to his loving wife Charlotte.

The care I received was terrific. I had very good doctors and nurses who treated me kindly,” says Leib.

A lifelong baker, Leib is thankful he is well enough to return to making challah and other pastries for his family – and for having the chance to make such a safe, happy life in Canada in the first place. “If somebody had come to me when I was 12 years old in Buchenwald, and told me that one day I would be married and have children, I would have thought it was impossible.” says Leib.

Catalyst for care

Offering cutting-edge technology like the Sentinel and other heart device options to more patients reflects the ethos of the Schulich Heart Program, says Dr. Harindra Wijeysundera, who was appointed as its new chief in October 2020. “We want to innovate not just for the sake of innovating, but so that all Ontarians have access to these developments,” he says. “We want to translate innovation into impact.”

There is no other Canadian program in the cardiovascular space that really goes through the entire arc of performing new procedures with a variety of devices and then advocating to make them part of health-care policy so that they are widely available,” says Dr. Wijeysundera. “Philanthropy serves as a catalyst for the pathway to greater access to care, allowing us to build the strongest case for securing sustained government funding.”

TAVI is a perfect example: Sunnybrook was one of the first centres in Canada to start using TAVI devices, which were originally funded entirely by donors. The program is funded to perform 385 TAVI procedures this year alone, making it the largest in Canada.

Accelerating timelines

The TAVI technology repairs the aortic valve by allowing a replacement heart valve to be inserted without open-heart surgery. A compact version of the valve is put into a catheter and threaded through an artery in the leg until it is in place, where it releases to full size and begins to work immediately. While open-heart surgery patients typically spend about 10 days in hospital, TAVI patients require just three to five days.

In summer 2020, that timeline was shortened even further, as the Schulich Heart Program completed its first same-day TAVI procedure on Linda Averill, who has dedicated her career to patients at Sunnybrook since she began working here in 1975 as a registered nurse.

I’ve always loved Sunnybrook, and I learned so much here,” says Linda, who shares a personal connection to the hospital through her father.

“My dad helped build the first building at Sunnybrook upon his return from War,” says Linda. “I first applied to work at Sunnybrook because I knew it was a teaching hospital, and I wanted the opportunity to learn. It has been so inspiring to see the progression of how we treat things over the years. Sunnybrook really never stops innovating.”

Linda Averill photographed on the Sunnybrook’s Bayview campus. Her father helped build the first building at Sunnybrook upon his return from War.

With the TAVI, Linda had a chance to experience that progress from the patient side as well. In 2005, she had her aortic valve replaced using open-heart surgery. Then, when that valve began to wear out, she became eligible for the TAVI.

An avid volunteer and gardener, Linda had spent the months before her surgery short of breath and tired, and was very relieved when Sunnybrook said she could get a TAVI even in the midst of the COVID-19 pandemic. She was also excited at the prospect of having the procedure in the morning, and leaving less than 12 hours later.

But mostly, Linda was just happy to feel better. “When they got me up and walking after the operation, it was like night and day,” she says. “The difference felt like a miracle.”

“Miracle” is also a word Leib uses to describe the impact TAVI has had on his life.