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On the fourth floor of the Peter Munk Cardiac Centre, Gail Power takes great pleasure in watching the smile return to Robert's face, her husband of 44 years. It was only a few short months ago his chances at survival looked bleak.
"Life was not worth living," says Robert, recalling the daily struggles he coped with as his heart function deteriorated. "I had no energy at all. It was an effort to move, I had no appetite, and all I did was sleep."
Robert's heart condition prevented him from spending time with the people he loved. On a recent camping trip, when friends and family were enjoying each other's company, Robert slept the better part of the day.
"I could not play with my grandkids or help out friends with household projects. My heart condition deteriorated to a point where I simply had difficulty dressing and taking care of myself. Everyone would comment on how bad I looked and how much I slept. It was no way to keep on living."
An abnormal heart rhythm
In 2006, to help control his arrhythmia, a common condition whereby the heart can beat too fast, too slow, or with an irregular rhythm, doctors treated Robert with a device called an implantable cardioverter defibrillator (ICD). Similar to a pacemaker, ICD's are used to control abnormal heart rhythms, but also have the additional advantage of issuing high-energy electrical pulses to treat certain dangerous arrhythmias. When an ICD senses an abnormal heart rhythm, it administers a brief, intense electrical shock to the heart, correcting the abnormal rhythm.
"The ICD worked for a long time," says Robert, a native of Halifax, Nova Scotia, who has lived with his family in Haliburton, ON for almost 20 years. "But as my heart condition worsened, the ICD began to fail. Doctors thought it may have been a complication having to do with kidney or lung infection and medicated me for it."
In the fall of 2014, Robert's heart function had regressed to what is termed as Advanced, or Stage D Heart Failure, whereby conventional heart therapies and symptom management strategies that he had undergone no longer worked. Robert's failing heart could no longer meet the needs of his body.
Heart failure – a growing concern in Canada
Sadly, Robert's case is not an isolated incident. The impact of heart failure on the Canadian health care system is tremendous. Rapidly rising in prevalence, heart failure is the most common reason for hospital admission.
As Robert's condition worsened, he was eventually referred to The Ted Rogers Centre of Excellence in Heart Function at the Peter Munk Cardiac Centre. The largest program of its kind in Canada, it specializes in replacement strategies for Advanced Heart Failure, including mechanical circulatory support and heart transplantation. Because of the exceptional talent and the emergence of extraordinary medical discoveries and the development of new and innovative treatments for heart diseases and disorders made at the Peter Munk Cardiac Centre, patients like Robert are afforded a second chance at life.
On Oct. 31, 2014, a surgical team led by Dr. Vivek Rao, Chief of Cardiovascular Surgery at the Peter Munk Cardiac Centre,
successfully implanted a novel mechanical device,
the HeartMate IIITM,into Robert's heart. The surgery was part of a first-in-Canada clinical trial for this new technology. Manufactured by Thoratec, a leader in the field of Left Ventricular Assist Devices (LVAD), the HeartMate IIITM is the most advanced technology currently available in mechanical circulatory support.
A Canadian first and Robert's new lifeline
"We are honoured to be the first and only site in Canada to take part in this clinical trial," says Dr. Rao. "Robert's options were rapidly running out and given the increasingly weak state of his health, a transplant was simply not an option. Having this type of assist device available to support the pumping of blood to Robert's heart was really his only lifeline."
Having had a long history of academic achievement in the field of mechanical circulatory support, and as a leading training centre for these types of devices, the Peter Munk Cardiac Centre was a natural fit to trial the HeartMate IIITM.
Known as a 'heart pump', the HeartMate IIITM is implanted near the heart and is specifically designed to replicate the pumping action of a heart that is too fragile to pump on its own. The LVAD replaces the failing heart's left ventricle which circulates oxygen-rich blood throughout the body. The device is attached to the aorta and is able to pump up to 10 litres of blood per minute – the same amount as a healthy heart.
For a high-risk patient such as Robert, it meant less invasive surgical implantation, reduced blood trauma and better portability with an active lifestyle.
'I even did a little dance with my wife today – I have hope again'
"The device takes some time getting used to," explains Robert. "I know the healing process takes time, but I'm feeling better each and every day. I can feel my strength returning and have much less pain; I can walk around a store now and not have to go to the car to sleep; I even did a little dance with my wife today. I have hope again."
Further to Robert's procedure, Dr. Rao and his surgical team have successfully implanted two more HeartMate IIITM devices, completing the Canadian clinical trial. As Dr. Rao explains, results have been positive:
"Compared to past models, this is a smaller, more reliable device, and it should prove to be a more durable device. Because of greater clearances in the pump housing, we are witnessing a better handling of the blood flow. We anticipate the adverse complications we commonly see with older models, such as bleeding, strokes and infections will be reduced as a result."
For Gail, the advantages of Robert's new heart pump have been immediate:
"There really wasn't much of anything that Robert could do anymore," says Gail. "I've seen a big change in him in such a short time. And he smiles a lot more now."
"I would like to thank all the staff who were involved in my stay at the Peter Munk Cardiac Centre," says Robert. "The teams of doctors and nurses provided me with such good care and showed genuine concern for my health as well as for my family. Now, I can look forward to a future."