1 The Peter Munk Cardiac Centre (PMCC), part of University Health Network (UHN) in Toronto, cares for the largest group of patients in the world who were born with heart disease and are over the age of 18.
More than 90 per cent of children born with heart disease become adults who require highly specialized care. These patients could be born with holes in their hearts or major blood vessels that are not connected in the usual way and need regular attention throughout their lives. Every year, the PMCC takes in about 600 patients who were born with heart problems. About 300 come from the Hospital for Sick Children (SickKids) in Toronto, while 300 others arrive from other parts of Canada and from around the world. Due to this constant influx, the PMCC's health-care professionals manage the largest population of patients in the world born with heart problems who are now over 18 years of age. "We really have to be super-specialized to be able to deal with this patient population," says Dr. Barry Rubin, Medical Director of the PMCC. "The vast majority of doctors would not routinely manage these patients."
2 State-of-the-art remote patient monitoring provides real-time treatment information to patients with heart failure.
Patients with heart failure need to be managed constantly, which is hard to do when they're at home. Technological innovation, though, has made real-time monitoring a reality. In tandem with the University Health Network and the Ted Rogers Centre for Heart Research, the PMCC has led the development of a proprietary technology that connects the patient's home scale and a blood pressure cuff to their smartphone. If a patient gains weight – which is critical to watch for, as weight gain can be a sign of worsening heart failure – the smartphone will generate an e-mail that's sent to the patient, telling the patient what he or she needs to do. It may tell the patient to take a water pill, and it will direct the patient to call the doctor, as necessary. Once the patient makes the call, he or she can quickly be assessed, and additional treatment can start right away. This may prevent patients with heart failure from deteriorating and needing to go to the emergency room.
3 Stent grafts that repair life-threatening aortic aneurysms are hand-sewn by a company in Australia and then sent by courier to Toronto.
People who have an aortic aneurysm may need a stent put inside this vessel – the major artery coming from their heart – to prevent it from rupturing. "It's like putting in a new pipe inside of a rusted-out old pipe," says Dr. Rubin. But it's a complicated procedure because everyone needs something a little different, depending on their individual anatomy. To do this properly, stents often need to be customized, and the best way to do that is to sew them by hand, just like one would sew a sock or a scarf. The PMCC works with Australian company Cook Medical to produce these custom stents. Nitinol, a nickel-titanium alloy, is sewn onto a synthetic fabric to create a custom stent graft that is based on the individual patient's aortic anatomy, which is evaluated by the pre-operative CT scan.
4 The PMCC is participating in national and international quality-assessment databases to measure and benchmark patient care. It's the first centre in Canada to do this for every aspect of cardiac and vascular care.
As of this year, the PMCC is sharing its data with a number of national and international databases in order to see how it stacks up against other health-care facilities. It wants to see if there are areas where improvements could be made. Sharing data has helped in the past. In one database, the PMCC found that 75 per cent of its patients were staying more than two days in hospital after aortic aneurysm surgery, while 75 per cent of patients in the U.S. were only staying one day. The PMCC wanted to be more in line with its peers, so it made a number of changes to the way it operates. Now, 80 per cent of patients go home the next day after aneurysm surgery.
5 In 2017, the PMCC will be the first health-care program in the world equipped with next-generation medical-grade holographic imaging technology.
Holograms aren't just being used to bring old musicians back from the dead for one last show. Hospitals are also starting to use them. In 2017, the PMCC will begin using a device, made by a company in Haifa, Israel, that will allow a patient's beating heart to float in space, in real time. Doctors will be able to see a life-sized image of the heart that they can move around and look inside. This is groundbreaking, says Dr. Rubin. Doctors will be able to essentially perform surgical procedures, like a valve replacement with no incision, in the air, by looking at the hologram, while the patient is asleep. They'll be able to see the valve in the image and make sure it's inserted exactly where it needs to go.