Steven Bush says he was both encouraged and surprised by the thorough attention he received from the team at UHN's Peter Munk Cardiac Centre. (Photo: UHN)

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Steven Bush was no stranger to heart surgery when he arrived for a consult at the Structural Heart Valve Clinic at UHN's Peter Munk Cardiac Centre in January 2022.

In the years leading up to this visit, Steven had undergone a stenting procedure to clear a blocked artery, a pacemaker implant to regulate heart rhythm and a pacemaker replacement, but he was still plagued by fatigue and an alarmingly slow heart rate.

Steven met with Dr. RJ Cusimano, a cardiovascular surgeon at the Peter Munk Cardiac Centre and holder of the David & Stacey Cynamon Professorship in Cardiovascular Surgery Innovation and Education, who spent over an hour with him reviewing his records.

Both encouraged and surprised by the thorough attention he received during this consultation, Steven learned his problems with heart rate and energy level could likely be solved with an aortic valve replacement through a transcatheter aortic valve implantation, also known as a TAVI.

A TAVI is a cutting-edge, minimally invasive procedure performed on select patients suffering from severe to critical aortic stenosis – a heart valve disease involving the narrowing of the aortic valve.

TAVI procedures replace diseased aortic valves with new, healthy valves. Via a catheter inserted in the leg, the new valve is guided directly inside the one being replaced. Once positioned, the new valve is inflated – pushing the old valve tissue up against the sidewall of the aorta and out of its way – and begins working immediately.

Originally developed as an alternative for patients, often 80 or older, who are too sick or high-risk to survive open-heart surgery, TAVIs are now being conducted on younger, less complex patients as well.

"With outcomes continuing to be as good as they are, patients with low and medium risk are also being assessed for TAVI eligibility," says Rebecca Collier-Doyle, a Clinical Nurse Coordinator at the Peter Munk Cardiac Centre.

Steven, at age 77, turned out to be one of those younger, less-complex patients. After undergoing a series of assessments to ensure his condition would best be treated by a TAVI, he was scheduled to undergo an "awake TAVI" – meaning he would not be put under general anesthetic – in August 2022.

Rebecca Collier-Doyle is proud of the team's collective drive to bring innovation to patients with heart disease at UHN's Peter Munk Cardiac Centre. (Photo: UHN)

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