If the stent revolutionized heart care, the groundbreaking TAVI treatment has raised the bar again. But it took the generosity of donors to ensure the program could continue saving lives.
It's the middle of the afternoon and Gordon Golding is over the moon. He has just visited Joan, his wife, and taken her to get her hair done. "I visit her every day without fail. She sees me, she walks across the room and she gives me the biggest kiss you've ever seen," Gordon says.
But were it not for a leading-edge procedure offered at Sunnybrook four years ago, Gordon might not be around to care for Joan today. At the time, doctors told Gordon he had less than 10 months to live. The then 76-year-old of Stoney Creek, Ont. needed an aortic valve replacement. Having had a heart bypass before, he was not a good candidate for a conventional open-heart surgery.
"So what was I supposed to do – sit in this chair and wait until I fall off?" Gordon says. "I really thought that was going to happen to me. I couldn't breathe. I couldn't even carry the garbage out to the driveway." Joan was with him every step of the way.
Through doctor referrals, Gordon came to Sunnybrook and learned of a new procedure called transcatheter aortic valve implantation (TAVI). Even though fewer than 3,000 patients in the world had undergone TAVI at the time, cardiologists at Sunnybrook were confident this innovative minimally invasive procedure, which requires no opening of the chest, would save Gordon's life.
"I had to believe it was going to work – I had no choice," Gordon says.
TAVI patient Gordon Golding
In the fall of 2009, Gordon became Sunnybrook's first TAVI patient. He was in and out of the hospital in four days, with Joan by his side. "Doctors told me they couldn't ask for anything better," Gordon says.
Joan has since been diagnosed with Alzheimer's disease. Thanks to TAVI, Gordon has been able to care for her and spend time with their three children and five grandchildren.
"Who would be here to look after my wife if I wasn't?" Gordon says. "I'm grateful for the TAVI team and the expert care I received. Simply, I'm grateful for being here. I wake up every morning and every breath I take, I thank Sunnybrook."
Gordon's story is one of many that wouldn't otherwise be told if TAVI wasn't an option to elderly or frail patients not well enough to undergo open-heart surgery. Over a three-year period, the physicians at Sunnybrook's Schulich Heart Centre saved 150 lives with this procedure, which, until January 2013, was entirely funded by generous donor support.
Before TAVI, one-third of patients who needed an aortic valve replacement couldn't be treated. Conventional open-heart surgery was too risky. The staggering number and increasing demand for an alternative minimally invasive treatment prompted Dr. Bradley Strauss to establish a viable TAVI program at Sunnybrook.
"In my more-than-20 years of practice, I've seen two revolutionary game-changing therapies. Stent was first, now TAVI," says Dr. Strauss, then head of cardiology and now also chief of the Schulich Heart Centre.
TAVI allows doctors to insert a catheter into an artery in the groin, through which they are able to reach the aortic valve that has been partially blocked, impairing flow of oxygen-rich blood to the rest of the body. If left untreated, the patient's heart muscle can thicken, as it works harder to pump blood through the body, and potentially lead to heart failure.
Susana Remeny-Prentice was at death's door when, as she describes it, "a true miracle of modern medical advancement, brilliant surgical skills and blessings from above" saved her.
A professional harpist and teacher at the Royal Conservatory of Music in Toronto, Susana woke up one night in October 2011, making strange snoring sounds and gasping for air. Later diagnosed with congestive heart failure, her condition deteriorated rapidly and the outlook was bleak.
Due to her petite frame and space constraints in her aorta, Susana was not an ideal candidate for open-heart surgery. But thanks to TAVI, she has returned to playing the harp and teaching.
"I am thankful and proud to be living proof that TAVI is destined to spread around the world to allow thousands upon thousands more to join my growing team of 'miracle survivors,'" Susana says. "TAVI saved my life."
In 2009, while returning home from Israel where he was visiting one of his trainees perform a TAVI procedure, Dr. Strauss came to the conclusion TAVI is a must-have for Sunnybrook. "It wasn't a question of should or should not," he says. "Whatever we needed to do, we had to get it done."
Aside from getting the hospital and the manufacturer of the surgical device onboard, funding was a major challenge in getting the program started. TAVI was so new, the Ministry of Health and Long-Term Care didn't cover the cost, about $35,000 per procedure.
"It's like having no money in the bank and having to buy something," Dr. Strauss says. "I actually went to people's houses and called them. It was direct solicitation – there was no other way. I was begging for money to do something good. It was not for me."
Dr. Strauss approached friends and patients. One wrote a cheque for $100,000, another for $25,000. With the help of Sunnybrook Foundation and a fellow cardiologist at the Schulich Heart Centre, Dr. Brian Gilbert, $200,000 was raised in a matter of months. It was enough to get TAVI off the ground, but more was needed.
"We had to find money creatively, and we did so through asking and through events like the Sunnybrook Golf Classic," Dr. Strauss says. "We knew if we had stopped, it'd have a bad effect on the program."
Benefactor Irving Ungerman (left) with patient George Bilikopoulos
With the seed money secured, a team of nurses, surgeons, interventional cardiologists and anesthetists was assembled. Under the direction of Dr. Sam Radhakrishnan, interventional cardiologist and director of cardiac catheterization labs, and Dr. Stephen Fremes, a cardiac surgeon at Sunnybrook, TAVI headlined minimally invasive treatments at the Schulich Heart Centre – one of the first in the country to establish such a program. Patients who benefitted from the procedure regarded it as a divine intervention.
Others, like Irving Ungerman, reckoned if it saves lives, money should be no object.
The famed Canadian entrepreneur, art collector, boxing manager and promoter came to Sunnybrook in May 2010 for a stent operation and shared a room with three other patients; one of them was George Bilikopoulos of Lindsay, Ont.
George was a TAVI candidate and desperately needed the procedure. Without it, doctors gave him six months to live. Upon learning George's condition, Irving was inspired to contribute to the TAVI fund.
"I told Dr. Gilbert before I went in for my operation, 'Win, lose or draw, you'll get my $30,000 tomorrow,'" Irving recalls. "The next morning, my wife gave Dr. Gilbert a cheque. I just felt money means nothing – it could ruin you or make you. But ultimately, it could save a life."
Irving, 90, and George, 80, have since become good friends. For George, there are no words that can describe his gratitude toward Irving, whose kind gesture to help TAVI patients felt like a personal one.
"If you can have a picture of my heart, you'll see how I feel about this guy. I can't forget him – can I kiss you?" he says, turning to Irving. "Ever since the procedure, I can't stop moving – I feel so young."
With the help of donors like Irving, a total of $2.5 million raised for TAVI surgical devices has made Sunnybrook one of six sites in Ontario to receive government funding for the program. The investment has also allowed the Schulich Heart Centre to expand its leadership role in TAVI research and education here and abroad, with doctors from six Canadian centres, as well as from Scotland, Israel and Japan, visiting Sunnybrook to start their own programs.
"Looking back, a lot of it was trust when we first asked people for money," Dr. Strauss says. "It's a wonderful program and one of the questions in the future is whether TAVI will be restricted only for those patients who aren't well enough to undergo the traditional aortic valve replacement surgery. We still do not know whether TAVI should be offered to patients as an alternative to open-heart surgery, even when they are good candidates for the conventional surgical approach. That's the question that is currently being investigated and Sunnybrook is fully involved in this research."
I am thankful and
This content was produced by The Globe and Mail's advertising department, in consultation with Sunnybrook. The Globe's editorial department was not involved in its creation.