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Heart failure patient receives milestone implant at the Peter Munk Cardiac Centre

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Patrick
"Patrick," who prefers his real name not be used, became the 200th patient to be surgically-implanted with a left ventricular assist device (LVAD), or mechanical heart, in Fall 2016 -- a milestone for the Peter Munk Cardiac Centre, home to Canada's largest mechanical heart program.(Photo: PMCC/UHN)

By his own admission, "Patrick's" story is not particularly remarkable. That is until you consider this haunting phrase as he recounts his medical journey: "It happened, literally, from one day to the next."

Patrick, who does not want his real name used in this story, is a married father of two adult children who retired from a bank after more than 30 years, exercised regularly, ate well and never had any problems with his heart.

Then, one day in August 2013, feeling particularly unwell, he was taken to St. Michael's Hospital in downtown Toronto, where doctors diagnosed an arrhythmia (irregular heartbeat). During this medical intervention, his heart stopped three times.

Patrick was fitted with a defibrillator and pacemaker to regulate his heartbeat. Doctors told him that when the device fired, "it would feel like a punch in the chest," he recalls.

Following this hospital visit, life continued for Patrick without incident – until almost exactly three years later, August 2016. "I was feeling really very poorly, couldn't walk 10 feet," he recounts. "I was at death's door. It happened literally from one day to the next."

After being admitted to St. Michael's Hospital again, he was promptly transferred to the Peter Munk Cardiac Centre (PMCC) a week later and examined by heart failure specialists.​

MILESTONES

Nov. 2001 First ventricular assist device ((VAD)/mechanical heart implant at the Peter Munk Cardiac Centre

Oct. 2010 First Canadian left ventricular assist device (LVAD) implant (DuraHeart) at PMCC

Oct. 2014 First Canadian implant of next-generation mechanical heart device (HeartMate 3)

Sept. 2016 200th LVAD implant at PMCC​

"I retained much fluid, felt very bad, [was] out of breath, no stamina," says Patrick. "I couldn't walk far, would be pushed in a wheelchair if any distance was involved. My defibrillator did not go off when I was in heart failure."


The Independence
Marnie Rodger, Nurse Practitioner, Peter Munk Cardiac Centre checks the pump speed, flow of blood through the pump and the power of patient Patrick's left ventricular assist device (LVAD) through reading on the controller. Patrick is the 200th patient to be implanted with an LVAD at PMCC, home to the largest Mechanical Heart Program in Canada. (Photo: PMCC/UHN)​

He underwent a heart biopsy which yielded a diagnosis of giant cell myocarditis – a rare disorder characterized by enlargement or inflammation of the heart muscle (myocardium).

"My heart had deteriorated so that is was only operating at 20 per cent of its normal function. It was going downhill fast," he says.

After his diagnosis, things moved swiftly. In a span of three weeks, he was administered medication to release the fluid build-up, which could have negatively impacted his kidneys. Then came open heart surgery in the Fall of 2016 to implant a left ventricular assist device (LVAD) – a powerful mechanical heart device which supports the pumping of blood to the aorta and to the rest of the body.

Unbeknownst to Patrick, his LVAD surgery represented a major milestone at the Peter Munk Cardiac Centre. He became the 200th patient to be implanted with an LVAD since PMCC's Mechanical Circulatory Support, or Mechanical Heart Program, began implanting the cardiac-assist device in 2001.

Over that span, the mechanical pump device has evolved with advances in technology and through testing in clinical trials. In the last five years or so, the Program has also received an incrementally larger portion of funding from the government  – which was not the case in its infancy – and as a result can now do many more procedures annually than it did in the early days.

BY THE NUMBERS:

$100,000 Average cost of a mechanical heart

25-30 Average number of mechanical hearts implanted at PMCC, annually

75 per cent Cost per mechanical heart funded by the Ministry of Health and Long-term Care

25 per cent​ Cost per mechanical heart cost funded through philanthropy

125 Number of mechanical hearts that could be implanted at PMCC annually, if funding was available

6 + years and counting Longest-surviving left ventricular assist device (LVAD) patient from PMCC

9 years  Longest-surviving LVAD patient worldwide

"I really feel blessed to have been admitted to the PMCC," says Patrick. "The team of doctors and nurses here are just first class.  The team was remarkable in its depth.

"Every day, the number of doctors visiting my bedside was beyond belief, whether it was the surgeon to see how I was doing, or a respirologist, dietitian, physical therapist, or rheumatologist, pharmacist, social worker and others," he says.

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"I was very impressed with the technology which was part of my treatment. Much of it was portable, and was brought to my bed-side, such as x-rays, echocardiograms, colonoscopy, ultrasounds, bronchoscopy, and other machines and procedures.​

"I'm already so far ahead of when I was admitted."

Patrick now awaits a heart transplant.​​

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