Lina and Grandchildren
Lina Amaral is the Peter Munk Cardiac Centre’s longest-surviving patient with a Left Ventricular Assist Device (LVAD), marking nine years with the device last summer. The LVAD has given her many more years of life, allowing her to live to see the birth of her two grandchildren. (Tim Fraser Photo)

"Saving lives does not wait for coverage," says Dr. Thomas Forbes of Peter Munk Cardiac Centre (PMCC).

This mantra is critical, especially when it comes to the many mechanical devices doctors implant on an almost regular basis. Since the 1990s, PMCC has been outfitting patients with devices that dramatically improve their quality of life, but if it weren't for philanthropy, surgeons wouldn't always have access to these costly pieces of equipment.

While the government eventually covers some of the cost, it's because of donors that the PMCC team can perform such complex operations.

"We don't turn anybody down for surgery," says Dr. Forbes, R. Fraser Elliott Chair in Vascular Surgery, Division Head of Vascular Surgery, PMCC, UHN Sprott Department of Surgery.

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This sense of responsibility has become synonymous with PMCC's global identity, and it's also why it's routinely chosen to provide cutting-edge equipment for patients who need it most.

life-saving devices
(L to R): The Ascyrus Medical Dissection Stent can be used during complicated surgeries. TAVIs save lives by replacing diseased valves. The LVAD is a metal pump that helps the heart do its job. (Photos: Ascyrus Medical, Edwards Lifesciences LLC, Abbot Medical Devices)

Repairing ruptures – Ascyrus Medical Dissection Stent (AMDS) Cost = $20,000

Last summer, Emily Keizer, 57, was about to set off into the bush to find chanterelle mushrooms with her husband. As she sat down to put on her boots, a searing pain tore through her chest and up through her shoulder blades.

"It was horrible," she says. The professional artist was rushed to the hospital in nearby Timmins, Ont.

A CT scan revealed that an aneurysm in the chest section of her aorta had ruptured and was limiting blood supply to the right side of her brain. Without immediate surgery she would have a severe stroke or die. Emily was helicoptered to the PMCC, where a team led Dr. Maral Ouzounian, cardiac and aortic surgeon, PMCC, Division of Cardiovascular Surgery, UHN Sprott Department of Surgery, was ready even before she arrived.

"When you tear the main blood vessel in your body, every branch that comes off it can be affected by the tear," says Dr. Ouzounian.

Surgeons have always struggled to repair this part of the aorta, which supplies blood to the rest of the body. It wasn't going to be an easy operation. Fortunately, Dr. Ouzounian knew of a device that could make a difference: the Ascyrus Medical Dissection Stent, a dissection-specific hybrid prosthesis.

Dr. Ouzounian
“We would not be able to use the needed devices without philanthropic support,” says Dr. Maral Ouzounian. (Photo: Tim Fraser)

The device, which is approved by Health Canada for use at PMCC but is not yet funded by Ontario's Ministry of Health, resembles a tube of chicken wire made of fabric and metal that gets implanted into the branched-off section of the aorta to help it heal and keep blood flowing through the proper channels.

It's so new that only a few sites in Canada have access to this specialized device. It was this access that enabled Dr. Ouzounian to successfully use this device to repair Emily's aorta after an intensive five-hour surgery.

Had it not been for philanthropy, and the expertise of the PMCC team, they wouldn't have been able to use the stent that allowed Emily to walk out of the surgery alive.

After a week, she went home, where she picked up where she left off: hunting for mushrooms.

"I can't believe someone gave me the chance to be here," Emily says.

Keeping hearts beating – Left Ventricular Assist Device (LVAD) Cost = $130,000

When Lina Amaral was just 44, she began to feel sick.

"I couldn't breathe," she says. "When I bent down, I felt like I would explode."

She was diagnosed with congestive heart failure – doctors suspected it was caused by a virus that had attacked her heart. By age 51, she was being treated at PMCC with end-stage heart failure.

"They didn't think I was going to make it," says Lina.

A transplant seemed to be the only way to help her, but she needed a perfectly compatible heart since her antibodies were so high. Unfortunately no such hearts were available.

In 2009, Dr. Vivek Rao, Division Head of Cardiovascular Surgery, offered Lina something else: a left ventricular assist device (LVAD).

This "mechanical heart" – a metal, battery-operated pump that gets implanted directly into the heart –  has traditionally been used as a temporary bridge to a transplant, keeping a patient alive as they wait to receive a new heart. Now, they're often used as a permanent support for those who have been deemed ineligible for a transplant.

People with LVADs find it life-changing.

"They have the energy to resume their daily activities and even do things that were once out of the question," says Dr. Rao. It was only in 2017, 16 years after the PMCC opened its mechanical heart program, that the government started funding the device for patients not eligible for transplant.

It now funds 45 implants a year at PMCC. Before then, it was solely philanthropy that funded the first 200 devices, including Lina's.

While Lina is no longer a candidate for a transplant, her LVAD will keep her alive for many more years.

"I got a second chance at life," says Lina, who is PMCC's longest-surviving patient with an LVAD. Last fall, she became a grandmother of two and is grateful she can see her grandchildren grow.

"It's a great sense of satisfaction to see Lina," says Dr. Rao. "She was so sick before and I know how this device has changed her life for the better."

Transcatheter Aortic Valve Implant (TAVI) Cost = $25,000

When the valve that connects the heart to the aorta becomes calcified, the opening narrows and prevents blood from flowing properly to the body.

"That's a problem," says Dr. Ouzounian. "Once the narrowing is severe and patients develop trouble breathing, 50 per cent die within two years."

Dr. Thomas Forbes
"We're using the best equipment, the best techniques and the best people," says Dr. Thomas Forbes. (Photo: Tim Fraser)

Fortunately, patients can undergo a TAVI procedure to replace the diseased valve without open heart surgery. This device gets implanted via a catheter threaded through a blood vessel. The complex and life-saving procedure is only partially covered by the province.

Custom-made branched and fenstrated endografts Cost = $35,000

An aneurysm is fatal if it ruptures.

Those who have an aneurysm in the aorta in their chest must get it repaired so it doesn't burst, but blood also needs to continue flowing through the aorta's branches to the legs, kidneys, brain and more.

To repair these complex aneurysms in a minimally invasive way, doctors use an endovascular graft, which fits inside the aorta and looks like a "fancy toilet paper roll with branches," says Dr. Forbes.

Since this graft has to fit perfectly, the manufacturer makes a custom device for each surgery. That requires careful imaging of the patient and extensive planning between the surgeon and the

Peter Munk Cardiac Centre Annual Report featured in The Globe and Mail's Report on Business.

The Peter Munk Cardiac Centre is a leader in cardiovascular care, helping patients now and well into the future. Teaming up with ALLCAPS Content, the Peter Munk Cardiac Centre 2020 annual report highlights how the Centre is working to meet the needs of patients today while anticipating and responding to what they need one, five and ten years into the future. Flip through to read featured stories about cutting-edge research, medical innovations, and the dedication and courage of the Peter Munk Cardiac Centre's staff and patients. Read the report online.

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