Heart Matters . Every few months, you’ll find updatessunnybrook.ca/uploads/HM100201.pdf ·...

1Heart Matters - February 2010

Sunnybrook Health Sciences Centre is proud

to congratulate Dr. Bernard S. Goldman

on his recent appointment to the Order of

Canada. Dr. Goldman founded the cardiac

surgery program at Sunnybrook’s Schulich

Heart Centre, which has become one of the

country’s leading research and teaching

centres for surgical interventions to treat

cardiovascular disease.

This honour is bestowed upon Dr. Goldman

for his contributions to the field of cardiac

surgery and cardiac care. Dr. Goldman is a

renowned clinician, researcher and educator

who has been a mentor for countless

professionals in this field and has saved

the lives of literally thousands of patients

over his 41-year career. Dr. Goldman has

pioneered new approaches to aortic valve

replacement, coronary artery bypass

grafting and cardiac pacing.

Dr. Goldman came to Sunnybrook in 1989

and established what has become one

of Canada’s leading divisions of cardiac

surgery. He served as Head of the Division

of Cardiac Surgery from 1989 to 1999 and

as Surgeon in Chief of Sunnybrook from

1999 to 2003.

“Dr. Goldman is a true innovator and leader

in his field and Sunnybrook is fortunate to

Heart Matters

Heart MattersWelcome to the first issue of Heart Matters. Every few months, you’ll find updates

on Schulich Heart Centre innovations, clinical services, education and staff activities.

We welcome your suggestions for content and your articles for future issues. Please

send any ideas and/or submissions to [email protected].

Volume 1, Issue 1 | February, 2010

Sunnybrook’s Cardiac Surgery Founder Receives Order of Canada

have him as a member of our team,” said

Dr. Barry McLellan, President and CEO of

Sunnybrook Health Sciences Centre. “ This

is a well deserved honour that complements

what has been an outstanding career.”

In addition to his role as Cardiac Surgeon,

Dr. Goldman is a Professor of Surgery at the

University of Toronto, Editor of the Journal

of Cardiac Surgery and Chairman of Save

a Child’s Heart Canada, providing heart

surgery to children from underprivileged

countries at no cost. He has led numerous

research efforts to improve the care of

cardiovascular surgery patients, has

authored hundreds of peer reviewed

articles, contributed chapters to medical

text books and has recently published

the second edition of Heart Surgery in

Canada: Memoirs, Anecdotes, History and

Perspectives.

To honor the significant contributions of

Dr. Goldman, Sunnybrook has established

the Dr. Bernard S. Goldman Chair in

Cardiovascular Surgery. The Chair supports

initiatives in teaching, innovation and

clinical evaluation. The Goldman Chair was

created to address the changing face of

cardiovascular surgery, to train surgeons

who are adept at leading-edge procedures

and attract the best international talent in

the field.

Dr. Goldman was also the recent recipient of

the Sunnybrook Foundation’s Rose Award

for his outstanding service in support of

Sunnybrook’s philanthropic objectives.

Among his many other philanthropic

activities, Dr. Goldman played an active role

in raising funds for the renovation of the

Schulich Heart Centre, currently underway

at Sunnybrook. The $25 million project will

create a new, world-class, technologically

advanced Schulich Heart Centre.


A new program at Sunnybrook’s Schulich

Heart Centre is improving access to a

potentially lifesaving heart procedure for

elderly or frail patients not well enough to

undergo traditional aortic valve replacement

surgery.

Narrowing of the aortic valve, or “stenosis”,

is a fairly common condition in today’s aging

population. It occurs when the aortic valve,

which keeps oxygen-rich blood flowing

from our heart into the largest artery in our

body, becomes partially blocked, impairing

flow of blood to the rest of the body. 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.

“Surgical replacement of the diseased

valve with an artificial one is considered the

best treatment for aortic valve stenosis,”

says Dr. Sam Radhakrishnan, Interventional

Cardiologist and Physician-Lead of the

Percutaneous Aortic Valve Intervention

(PAVI) program at Sunnybrook Health

Sciences Centre. “Unfortunately, many

of the patients we see with this condition

have significant co-existing medical issues

that render them unable to withstand the

physical trauma of open-heart surgery. In

the past, we have had to treat these patients

with drugs alone, which is proven to be less

effective than with valve replacement.”

With the introduction of the PAVI initiative at

Sunnybrook, patients who are considered

too high risk for conventional open-heart

surgery to replace or repair the aortic valve

may be candidates for a substantially less

invasive procedure. In this procedure, a

team of doctors including an Interventional

Cardiologist, Cardiac Surgeon and Vascular

Surgeon are able to implant a new valve

percutaneously (without opening the chest).

During a PAVI procedure, the team of

doctors inserts a catheter (tube) into an

artery in the groin through which they

are able to pass further catheters to the

diseased heart valve. The doctors are able

to see the position of the valve on a screen

displaying X-ray images of the inside of

the patient’s chest. This technique greatly

minimizes the operative risks and patient

trauma associated with opening up the

chest and stopping the heart. The whole

procedure takes an hour and a half, as

opposed to twice as long for conventional

open-heart surgery, and may be carried

out under general anaesthesia or local

anaesthesia with, or without sedation.

Minimally invasive valvular interventions

offer many benefits to patients including

reduced pain and less need for

postoperative pain medication, smaller

scars, a shorter stay in the hospital and

a faster recovery. People who undergo

percutaneous valve interventions can

often return home after only a few days

and resume many normal activities within

a couple of weeks rather than a couple of

months.

“This program will do wonders to improve

the health of some of the most critically

ill heart patients in Ontario,” says Dr.

Brian Gilbert, Chief of the Schulich Heart

Program. “About half of all patients with

stenosis do not get treated because they

are considered too old or too frail for

traditional surgery. This program makes

it possible for us to offer the very best

cardiovascular care for our patients so they

can return to the best possible quality of

life sooner.”

To continue providing this life-saving

procedure to patients, Sunnybrook

Foundation is raising funds to purchase the

heart valves used in this procedure. Anyone

interested in making a donation can go to

www.sunnybrook.ca.

Aging, Complex Heart Patient’s Needs Met With New Procedure

Registered Nurses: Barbara Needham, Robin Kay, Kristine Mulholland, Antoineta Rabiega, Sabina Bakar-Irwin, Michelle Porter, Margaret Gadke, Vevien Braga

Anaesthesia Assistant: Elihu Henry

Anaesthetist: Dr. Sophia Wong

Interventional Cardiologists: Dr Sam Radhakrishnan, Dr Brad Strauss, Dr. Eric Cohen (absent)

Cardiac Surgeons: Dr. Steve Fremes, Dr. Gideon Cohen

Vascular Surgeon: Dr. Andrew Dueck (absent)


Every year in Ontario, approximately 7,000

people with coronary artery disease benefit

from having bypass surgery. Unfortunately,

there are some cases where patients with

two or three blocked arteries would benefit

from surgical intervention but are not well

enough to withstand conventional bypass

surgery.

But now, patients receiving treatment in

Toronto have access to an alternative

procedure to fix clogged arteries and

improve blood flow to the heart. In March

2009, Sunnybrook’s Schulich Heart Centre

became the first centre in Toronto to offer

minimally invasive, beating-heart bypass

surgery.

Both conventional bypass surgery and

minimally invasive coronary artery bypass

grafting restore blood flow to the heart

when there is a buildup of plaque inside

the blood vessels. The advantage of using

a minimally invasive technique rather than

the traditional approach is that it allows the

surgeon to work on a beating heart through

a small chest incision (small thoracotomy)

without having to split the breastbone and

place patients on a heart-and-lung machine

while surgeons work on the stopped heart.

“Offering a minimally invasive alternative

to traditional bypass surgery provides

extraordinary benefits for our patients,”

says Dr. Fuad Moussa, cardiac surgeon at

Sunnybrook’s Schulich Heart Centre. “While

we have been performing conventional

bypass surgery successfully for many years,

the new techniques we are now introducing

at Sunnybrook minimize operative risks and

patient trauma associated with opening

up the chest and stopping the heart. This

means patients can often return home after

only a few days and resume many normal

activities within a couple of weeks rather

than months.”

“In the past, we would have to treat those

patients with drugs alone, which is not

ideal,” says Dr. Moussa, who is also a

lecturer in the Department of Surgery at

the University of Toronto. “Now, using a

technique called hybrid revascularization,

we are performing minimally invasive

beating heart bypass on the most important

coronary artery down the front of the heart

and inserting stents into the other vessels.

This will give more people access to

potentially life-saving surgery.”

During traditional bypass surgery, the

surgeon makes a long incision to completely

split the sternum (sternotomy) and access

the heart. Patients are then placed on a

heart and lung machine which acts as a

substitute for their own and allows surgeons

to work on a stopped heart. People who

undergo this surgery generally recover in

about six-to-eight weeks. Alternatively,

with a small thoracotomy, beating heart

approach, the surgeon can perform the

operation through a tiny incision under the

left nipple (four or five centimeters wide)

while the heart continues to beat. This

technique lowers the risk of complications

such as stroke, lung problems and kidney

problems which are associated with the

use of a heart-and-lung machine. It also

means patients have reduced pain and less

need for postoperative pain medication,

smaller scars, a shorter stay in the hospital

and a faster recovery.

Sunnybrook is one of only a few health

sciences centres in Canada currently

offering this surgical alternative to

traditional bypass surgery.

Minimally Invasive Bypass Surgery Expedites Recovery for Heart Patients

Dr. Fuad Moussa (right) with his patient, Emil Boychuk

Visit Dr. Moussa’s blog:

Ask Your Cardiac Surgeon @

http://blogs.sunnybrook.ca/cardiacsurgery/


A new partnership between Sunnybrook

Health Sciences Centre, Humber River

Regional Hospital (HRRH) and Toronto

Emergency Medical Services (EMS) is

improving care for heart patients living in

the York Region.

Effective Monday October 5, 2009, patients

presenting with signs and symptoms of

a heart attack, or STEMI (ST-elevation

myocardial infraction) in the Humber River

Regional Hospital area are taken directly

to a 24 hour catheterization laboratory at

Sunnybrook’s Schulich Heart Centre to

receive emergency angioplasty. After patients

undergo angioplasty and are stabilized, they

are transferred back to their own regional

hospital for monitoring and recovery.

The initiative is modeled on a very

successful partnership already established

between Sunnybrook, North York General

Hospital and Toronto EMS called “Code

STEMI”. Before the Code STEMI project

was initiated, patients experiencing the

signs and symptoms of a heart attack were

delivered by EMS to the closest hospital

for treatment with clot busting drugs. If

required, arrangements could then be

made to transfer them to a larger centre

like Sunnybrook for angioplasty.

Partnership Improves Care for Heart Patients in York Region

“The initiation of this partnership is fantastic news for heart attack patients in the city,” says Dr. Sam Radhakrishnan, Interventional Cardiologist and physician-lead of the Code STEMI Program at Sunnybrook. “We know that the benefits of receiving timely angioplasty include reductions in: death,

“Because of the Code STEMI initiative,

I received the right care, in the right

place, at the right time and my quality

of life has returned to normal.”

- Terry Jamison, Sunnybrook’s first STEMI patient.

• A patient with chest pain calls 911.

• A special ambulance crew of advanced

care paramedics arrives at the scene.

• Advanced care paramedics obtain a

targeted history from the patient and

use an electrocardiogram (ECG) to

determine if something is wrong.

• If a STEMI (type of heart attack) is

confirmed, paramedics call Sunnybrook’s

Cardiac Care Unit (CCU) using a

dedicated STEMI hotline and relay the

vital information to a CCU nurse.

• A ‘Code STEMI’ is immediately

triggered at Sunnybrook which activates

cath lab team members (Interventional

cardiologists and nursing staff).

Here is how a Code STEMI works:

• The patient arrives at Sunnybrook

and is taken to a prepared cath lab

where an emergency angioplasty is

performed. Through a small catheter

inserted into the patient’s wrist

or groin, a balloon and stent are

positioned at the site of the blocked

heart blood vessel (artery) causing the

heart attack. The balloon and stent

are expanded to open the blocked

artery, restoring normal flow of blood

and oxygen to the heart and stopping

the heart attack.

• Following the angioplasty, the

patient is transferred to a CCU bed

at Sunnybrook for monitoring and

nursing care.

recurrent heart attacks, stroke, in-hospital length of stay and costs. By coordinating

services with Toronto EMS and partner

hospitals, we’re able to dramatically reduce

the time between when a patient presents

with STEMI symptoms and when we treat

them which further improves outcomes for

heart patients.”

The partnership between Sunnybrook

and North York General was the first of its

kind within Toronto. There now exists a

coordinated collaboration between Toronto

EMS and four heart centres in the GTA to

provide this cutting-edge care to virtually

all STEMI patients in the city 24/7.Sunnybrook’s Code STEMI Team


The people of Ontario will have more access than ever to the latest life-saving, minimally invasive cardiovascular treatments thanks to the v is ionary leadership of one of Canada’s foremost

philanthropists, Seymour Schulich.

Mr. Schulich has made a $10-million investment in the heart centre that bears his name.

He challenged Sunnybrook Foundation to raise $10 million by the end of 2008 to rebuild the Schulich Heart Centre at Sunnybrook. The Foundation did just that and Mr. Schulich has made this $10-million gift to Sunnybrook to match those donations dollar-for-dollar. This transformational gift follows a long history of investment Mr. Schulich has made in Sunnybrook.

Along with $5 million previously raised, the people of Toronto and the GTA have contributed a total of $25 million to create a new, world-class, technologically advanced Schulich Heart Centre.

“I am so impressed by the people who rallied around my challenge,” says Mr. Schulich. “Sunnybrook can’t deliver world-class innovations in cardiovascular care without the support of private donors. People responded generously to this match in spite of the tough economic times. This achievement is quite remarkable.”

One Man Inspires a Community to Raise $20 Million to Fight Canada’s Number One Killer

S.Schulich

Construction on the new Centre is currently underway. The centerpiece of this project is the Dr. Brian W. Gilbert Cardiovascular Acute Care Unit, a state-of-the-art unit that will replace the current unit, which was built more than 40 years ago. This new facility will set national standards for patient care, feature the most advanced medical equipment, and, most importantly, will ensure the best possible outcomes for patients.

“Sunnybrook’s Schulich Heart Centre is truly changing the way cardiovascular disease is treated,” says Dr. Brian Gilbert, the Centre’s chief. “Our scientists and clinicians are developing cutting-edge ways to look at the heart and diagnose problems earlier and more accurately. Our team continues to pioneer, minimally invasive heart procedures that allow patients to recover faster, spend less time in hospital and get back to their normal lives sooner. Now, with the incredible support of Mr. Schulich and the many other generous donors, we will provide our team with the first-class facility they need to continue inventing the future of health care.”

“Cardiovascular disease is still the number one killer in Canada,” said Dr. Barry McLellan, President and CEO of Sunnybrook. “This $25-million investment will help save lives. Mr. Schulich’s generosity, and that of those he inspired, enables us to create a revitalized Schulich Heart Centre to deliver the best possible care to the province’s most critically ill heart patients. We are profoundly grateful for this gift to Sunnybrook and the people we serve.”

Schulich Heart Centre Redevelopment Project Update

• The Schu l i ch Hea r t Cen t re

Redevelopment Project involves

renovation of five large wings of the

hospital and the updating of medical

equipment through the centre,

creating new facilities for the Schulich

Heart Centre and ensuring the best

technologies in the world are available

to our patients. It also includes a new,

cutting-edge cardiac critical care unit.

• We have now completed phase one

of construction and have moved into

phase two.

• Patients and staff from the Schulich

Heart Centre nursing units are relocating

temporarily in order to accommodate

construction on the nursing units.

• A great deal of planning has taken place

to ensure the moves occur as smoothly

as possible. Care will proceed as usual

during and after the moves, with the

same care team following patients to

their new, temporary location.

• Construction for the full project is on

schedule for completion in summer of

2011.

Arrhythmia Invasive Suite Project (A.I.S.): Home of the first Robotic Electrophysiology Lab LAB in Toronto

Artist rendering of a new CCU patient suite


The old adage “mind over matter” is

being put to the test at Sunnybrook

Health Sciences Centre.

Sunnybrook, in collaboration with

the Heart and Stroke Foundation

of Ontario, is conducting a study

to determine if teaching meditation

techniques to people who are in the

early stages of developing hypertension

is an effective intervention for lowering

blood pressure.

Preventing and controlling high blood

pressure is shown to be one of the

most effective strategies for reducing

the incidence of cardiovascular

disease and death. Stress has been

associated with greater cardiovascular

risk and stress management is a

recommended intervention for patients

with high blood pressure.

Led by Dr. Sheldon Tobe, Nephrologist at Sunnybrook Health

Sciences Centre, the HARMONY (Hypertension Analysis of Stress

Reduction using Meditation & Yoga) study examines a relaxation

therapy known as Mindfulness-Based Stress Reduction (MBSR) to

see whether it can lower blood pressure and delay or prevent the

progression of hypertension. MBSR is a structured program that

teaches participants to take charge of their health and well-being

and has been shown to alleviate stress and treat certain medical

conditions.

“My hope is that this may lead to the day when physicians can refer

patients with high blood pressure to trained health practitioners

who can deliver standardized, effective lifestyle therapy,” says

Dr. Tobe, who is also an Associate Professor in Medicine at the

University of Toronto.

Dr. Tobe and his team of researchers are recruiting 70 people over

the next year to participate in this research. Participation may be

required for up to ten months. During this study period, participants

Study Examines Use of Meditation and Yoga to Manage Blood Pressure

Volunteers are needed for a study to help determine if mindfulness-based stress reduction

is effective for lowering elevated blood pressure

The Hypertensive group at the Schulich Heart Centre is led by Dr. Martin Myers and Dr. Sheldon Tobe, both leaders in the diagnosis

and treatment of hypertension.

will be asked to come to Sunnybrook for

monthly blood pressure assessments and

study visits. Also, over the course of nine

weeks, participants will attend ten sessions

of MBSR in a group setting at Toronto General

Hospital. Each session is two-and-a-half hours

long. One of these sessions will be a day-long

mindfulness meditation retreat that takes place

on a Saturday or Sunday. In addition to this,

participants will be asked to complete some

practice at home.

In order to be eligible for this research study,

participants must meet the following criteria:

• Between 20 to 75 years of age

• Have been diagnosed with high-normal or

high blood pressure

• Not be taking any medication for elevated

blood pressure

• Be willing to participate in the ten sessions

(over a period of nine weeks) of Mindfulness-

Based Stress Reduction

As compensation for each participant’s time in the study, they

will receive MBSR therapy and MBSR materials as well as

reimbursement for parking costs to attend study sessions.

Please feel free to visit www.harmonystudy.ca for more information.

If you would like to participate, or have any questions regarding

your eligibility or if you would like to come in and have your blood

pressure assessed, please contact:

Office of Dr. Sheldon Tobe

Nephrology Research

Sunnybrook Health Sciences Centre

2075 Bayview Avenue, Room C-504

Phone: 416-480-6100 extension 1641

E-mail: [email protected]

All queries will remain strictly confidential.


Sunnybrook Cardiovascular Nurses at the Canadian Cardiovascular Congress 2009

Malou Galapin, APN, Schulich Heart CentreReprinted with permission from Nursing Voice, Fall 2009

The 10th Canadian Cardiovascular Congress (CCC) was held in

Edmonton, Alberta from October 24-28, 2009. This annual event

is hosted by the Canadian Cardiovascular Society and the Heart

and Stroke Foundation of Canada. CCC provides world-class

education, interactive scientific program, and learning tracks

within a cardiovascular specialty.

Several Sunnybrook Cardiovascular Nurses attended the event.

RNs from the Schulich Heart Program and the Cardiovascular

Intensive Care Unit presented three posters and two oral

presentations. Their presentations included the following:

Poster Presentation:

1. The STEMI Experience: Changes, Challenges and

Outcomes

(Rob Fuerte, Josie Ng Lee & Dana Murray)

Dana Murray & Josie Ng Lee

Notable Presentations

Maisie Menezes, Kathleen Twiss, Maria Sia & Evelyn Cruz

2. Promoting Patient Safety in a Cardiac Center: Knowledge

Transfer Strategies for Increasing the Use of a Safety

reporting System Chantal Kangudie, Evelyn Cruz, Maisie

Meneses, Maria Sia & Kathleen Twiss)

Heather Harrington & Leasa Knechtel

3. Glycemic Control in the Cardiovascular Intensive care Unit

(Heather Harrington & Leasa Knechtel)

Oral Presentation:

1. A Coronary Anomaly: A Case Study of When an Acute

Coronary Syndrome (ACS) was not Coronary Artery Disease

(Charlene Lester, Elaine MacLagan & Julie Macdonald)

2. Discovering Best Practice in the Management of Patients

Undergoing a Tilt-table Test: Development and evaluation

of a protocol on tilt-table testing (Malou Galapin, Savitri

Persaud & Chantal Kangudie)

Sunnybrook was well represented at the CCC. Supporting the

nurses at this event is consistent with Sunnybrook’s commitment

to research and education.

Savi Persaud & Malou Galapin


Publications:

1. Goldman, BS. M.D., B.Sc. (Med), F.R.C.S. (C), & Belanger, S. B.A., M.L.S. (Eds.): Heart Surgery in Canada; Memoirs, Anecdotes, History & Perspective. (2nd ed.) Longman: Toronto, 2009

2. Turner, S., Onalan, O., & Bickle, B.: “Prevention of Death in Chronic Kidney Disease: The Role of Implantable Cardioverter Defibrillators”, Canadian Association of Nephrology Nurses and Technologists Journal, Jul-Sept; 19(3): 29-36; quiz 37-8, 2009

3. Cohen, G., Zagorski, B., Christakis, GT., Joyner, CD., Vincent, J., Sever, J., Harbi, S., Feder-Elituv R., Moussa, F. Goldman, BS., & Fremes, SE.: “Are Stentless Valves Hemodynamically Superior to Stented Valves? Long-Term Follow-Up of a Randomized Trial Comparing Carpentier-Edwards Pericardial Valve with the Toronto Stentless Porcine Valve”, Journal of Thoracic and Cardiovascular Surgery, January 15, 2010

Sunnybrook Speaker SeriesSchulich Heart Centre

The Heart of the Matter:Innovations in Cardiovascular Therapies Join us for a heart healthy evening TUESDAY, FEBRUARY 23, 2010 6:30 – 8:30 P.M.

Leading Sunnybrook experts will discuss:

• Code STEMI: Saving Hearts Around the Clock – Dr. Sam Radhakrishnan, Cardiologist

• Unblocking Impenetrable Arteries: A New Procedure – Dr. Bradley Strauss, Cardiologist

• EndoVascular Aortic Repair (EVAR): Evolution of Intervention – Dr. Andrew Dueck, Vascular Surgeon

• Minimally Invasive “Beating Heart” Bypass Surgery – Dr. Fuad Moussa, Cardiac Surgeon

• A New Way to Fix a Broken Heart Valve – Dr. Eric Cohen, Cardiologist and Dr. Stephen Fremes, Cardiac Surgeon

Moderator: Dr. Brian Gilbert, Chief, Schulich Heart Program

Please RSVP your attendance by February 22, 2010Phone: 416.480.4117 e-mail: [email protected]

Free Admission Free Parking, Garage One

Tuesday, February 23, 2010 6:30 – 8:30 p.m.McLaughlin Auditorium, Bayview CampusE Wing Ground Floor, 2075 Bayview Avenue

Schulich Heart Centre Smoking Cessation

Program is Helping Patients Kick

the Habit

The Schulich Heart Centre has initiated

a pilot program aimed at providing

patients with the support they need to

quit smoking. The program identifies

smokers on admission, provides stop-

smoking counselling and medication during

hospitalization, links patients back to

community resources and provides follow-

up after discharge from hospital.

This program is modeled after the

successful Ottawa Heart Institute initiative.

The Ottawa Model for Smoking Cessation

has been credited with an average of 11 per

cent increase in smoking cessation rates

within nine hospitals in the Ottawa region.

Shannon Furey, a smoking cessation

counselor, has implemented this pilot

program in both the Schulich Heart Centre

and the Odette Cancer Centre. Presentations are available online after the event. Visit www.sunnybrook.ca and see Sunnybrook Connection.

Heart Matters . Every few months, you’ll find updatessunnybrook.ca/uploads/HM100201.pdf ·...

Documents

Transcript of Heart Matters . Every few months, you’ll find updatessunnybrook.ca/uploads/HM100201.pdf ·...