Heart Matters. Canadian First: TAVI and MitraClip Procedures Performed at the Same Time

Transcription

1 Heart Matters Volume 7, Issue 1 Winter 2016 Canadian First: TAVI and MitraClip Procedures Performed at the Same Time By Monica Matys Dr. Sam Radhakrishnan, director of the catheterization lab (pictured above), along with his colleagues performed two state-of-the-art procedures in one surgery: TAVI and MitraClip. Photo by Doug Nicholson Dale Robarts was tired. Even the simplest tasks were draining him of breath and energy. He would go about his life in twominute chunks and then have to sit down to catch his breath again. Something was seriously wrong. Dale was diagnosed with two separate heart problems: one of his heart valves wasn t opening properly, and another was leaking. He came to Sunnybrook, which specializes in Continued on page 2 1

2 TAVI and MitraClip Procedures Performed at the Same Time (continued...) Continued from page 1 minimally invasive surgeries to fix both problems. Little did he know he was about to make history. Dale is the first Canadian patient to receive two specific heart procedures at the same time: TAVI and MitraClip. TAVI, or transcatheter aortic valve implantation, replaces a faulty heart valve with a new one, allowing blood to flow from the heart to the body properly. The MitraClip is another tiny but mighty device. It s fished up to the problem of the heart to plug the leak. Both procedures can be done by feeding catheters through a small incision in the leg or arm leading up to the heart, sparing patient riskier open heart surgery. And for some patients who aren t candidates for open heart surgery estimated to be about one third of patients who need an aortic valve replacement this approach offers them a welcome and potentially lifesaving option. Dale Robarts became the first patient at Sunnybrook to receive TAVI and MitraClip procedures at the same time. This patient, it was a perfect storm where it was the right thing to do for him, says Dr. Sam Radhakrishnan, Director of the Catheterization Lab at Sunnybrook and one of Dale s doctors. It does have to be individualized but I suspect there are patients, more patients, than we ve treated thus far that could potentially have the procedures at the same time. For suitable candidates, this brings with it a host of benefits, including less exposure to sedation, reduced time in hospital and a faster recovery. Dale was thrilled to be part of this pioneering move. And, he s equally happy to feel well when finally returning to his day-to-day activities. I m getting stronger, able to do more. It worked out real well. Congratulations to the large team who worked together to successfully complete these procedures. Do you want to learn more about TAVI or MitraClip procedures? Find more information on the Your Health Matters blog health.sunnybrook.ca 2

3 Congratulations Sunnybrook Moments Winners Sunnybrook Moment of Service Excellence certificates are awarded by the Office of the Patient Experience in honour of outstanding service and dedication to our patients. Valerie Vibert, RN, C3 A patient wrote to express her gratitude to Valerie for her wonderful care and patience. The patient said Valerie was always smiling and compassionate. Even when many people were calling Valerie in various directions, she took the time to address all concerns. The patient said she is thankful Valerie cared for her that day. Dr. Gideon Cohen, Head, Cardiac Surgery A patient s father wrote to thank Dr. Cohen for saving his son s life. He said he has never witnessed such dedication from a physician not only to patients, but also their families. He said Dr. Cohen is incredibly skilled and sets the standard for caring and compassion. Their family will be forever thankful. Do you have a compliment to share about a staff member or volunteer? Send a note to patient.experience@sunnybrook.ca 3

4 New Minimally Invasive Procedure Introduced to Reduce Stroke Risk Schulich Heart Centre researchers are introducing a new minimally invasive procedure at Sunnybrook to reduce the risk of stroke. Atrial fibrillation, a condition involving irregular heart rhythms, is increasingly common as the population ages. It is a leading cause of stroke, with strokes due to atrial fibrillation being quite severe. The blood thinner warfarin has been a common treatment, says Dr. Sheldon Singh. But, patients have to be regularly monitored and dosages altered often. While newer blood thinners don t require as much monitoring, not everyone is eligible to receive these new drugs as their risk of bleeding is high. And so, Schulich researchers are looking at non-drug ways to reduce the risk of stroke. On the left side of the heart, there s a small appendage like a little pocket that seems to produce clots in a lot of people, explains Dr. Singh. This new device is inserted to block up the Dr. Sheldon Singh, along with a team of others, is looking at new ways to reduce stroke risk. appendage so that any clots formed cannot get out and move through the body to the brain. The device is approved in United States, with studies showing good outcomes, less bleeding and, over time, fewer cardiovascular and stroke events including death. Dr. Singh and his colleagues are also involved in designing an international study to evaluate a new device that tries to recreate the current way of removing the appendage performed by surgeons during open heart surgery without the need for surgery. This minimally invasive procedure loops off left atrial appendage, effectively excluding it from the heart without opening the chest. All of this work compliments the work of our Sunnybrook Brain Program and that of the Schulich Electrophysiology and Structural Heart Programs. Furthermore, experts in Health Outcomes Research and Health Economics who work with us here in the Heart Program will be vital to allow us study the effectiveness of these procedures. Schulich is a great place to be doing this! Other key members of this research team are Dr. Eric Cohen, Dr. Ilan Lashevsky and Dr. Fuad Moussa. New Cardiac Care Network - Society of Thoracic Surgeons (STS) Database goes live The Cardiac Care Network is leading the province-wide adoption of the STS National Database for Cardiac Surgery patients. Established in 1989 for quality improvement and patient safety among cardiothoracic surgeons, it s the world s premiere clinical registry for adult cardiac surgery. The Database has grown exponentially, both in terms of participation and stature, and has become the gold standard for clinical registries. More than 3,000 surgeons currently participate. Participation in the registry helps improve patient outcomes, identifies initiatives and new areas for quality improvement, documents the quality of care delivered, and enables risk modelling of major procedures. Quarterly performance outcomes reports in a risk adjusted format allowing for comparison of local outcomes to regional benchmarks and national standards are provided. Sunnybrook s Schulich Heart Program is the second provincial site to go live with the adoption of the database. 4

5 Schulich Nurse Travels to Help Others Rosie Wang, in blue hat, volunteered with Habitat for Humanity in the Philippines this past year. For one Schulich nurse, the need to help others goes far beyond Sunnybrook s walls. Rosie Wang, a Cath Lab Nurse at Sunnybrook, has been spending her vacation volunteering around the world for the past 10 years. She started overseas volunteering in interior China, where she worked with a local hospital, teaching and exchanging knowledge. She also volunteered in a mobile health clinic in India for three trips, and spent time in Morocco at a physiotherapy clinic for children with disabilities. The past August, Rosie travelled to a remote island in the Philippines to build houses with Habitat for Humanity. It was different than my other medicalbased trips, she said. I was laying bricks, carrying cement and doing hands-on labour. But we weren t just building houses; we were building homes. The group helped build a community for 370 families displaced after 2013 Typhoon Yolanda. Rosie says the opportunity to help others was what drew her into a career in nursing. I was born and raised in India, and I saw people living and working there to help and make a difference, and that really made an impact on me and inspired me, she said. I wanted to have a skill that could help others and take me around the world. That is why I chose nursing I absolutely love my job and I love that these skills can help people all around the world. Continued on page 6 5

6 Continued from page 5 She says each trip provides her with new perspectives on life and the world. I m just one person, and so much needs to be done in this world. One person can t do it all, she says But when I volunteer, for that day, I m more than one person to the person I am helping. To them, that day, I am the world. For that day, I can show that person that they are loved and cared for, and that means so much to me. The Heart Matters newsletter offers updates on Schulich Heart Centre innovations, clinical services, education and staff activities. We welcome your suggestions for content and your articles for future issues. If you would like to receive future issues of Heart Matters via , please send a request to Alexis.Dobranowski@ sunnybrook.ca or call Save the Date Join us for an evening talk on Heart Health Tuesday February 16, :30 8:30 P.M. Sex and Other Matters of the Heart Leading Sunnybrook experts will discuss: Fixing the Mitral Valve Without Surgery: Dr. Gideon Cohen, Chief of Cardiac Surgery Sexual Dysfunction and Heart Disease: Dr. David Newman, Cardiologist New Approaches to Cholesterol Management: Claudia Bucci, Pharmacist Moderator: Dr. Bradley Strauss, Chief, Schulich Heart Centre Please RSVP your attendance by February 15, 2016 Phone: speaker.series@sunnybrook.ca Sunnybrook Speaker Series New Toronto Heart Attack Collaborative Online Database The Toronto Heart Attack Collaborative has relaunched its website and database, which allows users to track heart attack-to-balloon treatment times across the Toronto hospitals. Users can log in to view reports featuring anonymous patient outcomes, and compare their statistics with other hospitals. The new website also features a forum where heart healthcare providers can log in to discuss treatment best practices, research and more. The Schulich Heart Program led the development of the database. 6

7 Nursing Education Update: D3 nurses have new medical directive D3 nurses are now the first acute care ward RNs at Bayview Campus with a medical directive to use automated external defibrillators (AEDs) if a patient on the unit has a cardiac arrest when no doctor is present. An AED - automated external defibrillator - is a portable device that checks the heart rhythm and prompts the user whether or not to defibrillate send an electric shock to the heart - to try to restore a normal rhythm during cardiac arrest. Patients on D3 are one of the most at high-risk populations for cardiac arrest. While the Code Blue team is immediately sent to manage these events, it was recognized even more could be done to help these patients before the team arrives. When defibrillation is required, and delivered within three minutes, there is a greater chance of successful resuscitation. The D3 team developed medical directives and trained all D3 RNs to use the AED. Now if a patient has a cardiac arrest when no doctor is nearby, Code Blue protocols still take place, but on D3 this now includes early access to defibrillation. While these occurrences are rare, it is expected to this new initiative will improve outcomes for these patients. This medical directive will also be extended soon to the Acute Care Nursing Resource Team members that frequently provide care on D3. Congratulations to Rick Radu, Doctor of Nursing Practice Congratulations to Rick Radu, Nurse Practitioner, who recently successfully defended his doctor of nursing practice thesis. His thesis, titled The effect of a quality improvement program for nurses on patient satisfaction examines and addresses an area of knowledge deficit for staff RNs, aimed at increasing emotional support and increase patient satisfaction rates on D3 and in the CVICU. His pilot study confirms a preexisting potential knowledge gap. The study demonstrates a short training and education session (one hour) increased awareness and improved RNs knowledge and skills of emotional support by 40 percent. The future NRCC reports for patient satisfaction ratings on D3 patients are expected to reflect this improvement. The research suggests Registered Nurses from other specialties would benefit from a focused educational module on emotional support. Rick is now the first Nurse Practitioner to complete the Doctor of Nursing Practice (DNP) a practice-focused degree at Sunnybrook. Congratulations on this achievement, Rick! 7

8 Innovative Procedure Saves Limbs & Lives The four ulcers on his left foot had become so painful When a physician told Christopher Kent but there was hope. With the pain in his foot close to prostheses are actually really good these days, that the 67-year-old could unbearable, he signed the he was unimpressed. no longer stand at his form authorizing amputation He didn t want a prosthetic leg, he wanted woodworking bench. He in the event surgery was to keep his own. couldn t have safely operated unsuccessful. machinery anyway, his wife Linda points out, given the medication he was taking to ease the pain. Finally a diabetic specialist recognized Christopher s non-healing ulcers as a symptom of peripheral arterial disease, a narrowing of the arteries in his leg caused by his diabetes. He sent Dr. Papia started at midnight, Christopher recalls. At 5 o clock in the morning, I woke up and saw I had two feet, he says with a big smile. Dr. Papia had performed bypass surgery, using a vein from the same leg to bypass the artery down to Christopher s foot. But bypass surgery is a temporary Christopher to Sunnybrook, fix, Dr. Papia explains. The Christopher Kent and Dr. Guiseppe Papia. where vascular surgeons arteries continue to harden, Dr. Andrew Dueck and Dr. Giuseppe Papia were gaining nationwide attention for saving patients legs and lives with image-guided angioplasties. This method of enlarging a narrowed artery using a balloon is typically used for heart patients but our vascular surgeons are using it to save legs. So many diabetic patients have painful sores on their feet that won t heal and it s not being recognized as a vascular problem that we can fix, Dr. Papia says. Without treatment, half these patients won t survive two years. In Christopher s case, his disease had progressed so far that when Dr. Papia attempted angioplasty, the blockage was too solid to break through. Christopher had developed gangrene and the threat of amputation loomed. the disease process continues. To maintain his bypass and prevent an amputation, I later performed angioplasty on the very tiny arteries in Christopher s leg. For most patients, angioplasty works the first time. With Christopher, we had to try something different. At Sunnybrook, we do everything we can to save people s lives and limbs. Now, Christopher is almost as good as new. He visits Dr. Papia every three months and gets a Doppler ultrasound to test his blood flow. Now, Christopher is building a guitar in his workshop, chasing after his toddler grandson and, Linda says with a laugh, he s back to taking the garbage out. But Dr. Papia refused to give up. He scheduled an urgent surgical appointment to try a different tactic to save Thank you, Dr. Papia! Christopher s leg. It might not work, Christopher was told, 8