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Toronto (July 16, 2007) - In a Canadian first, a team of medical professionals at University Health Network's Peter Munk Cardiac Centre (PMCC) at Toronto General Hospital performed two percutaneous or "through the skin" procedures to insert a new type of left ventricular assist device (LVAD), into high risk cardiac patients. The device does the work of the heart by continuing to pump a patients blood, while doctors work to improve the blood flow in severely blocked arteries.
The device, called an Impella 2.5, is a minimally invasive catheter pump that is 4 millimeters in diameter. It can be implanted into the femoral artery, a large artery in the muscles of the thigh, through a small incision in the groin. The pump is then guided up to a blocked artery where it is then activated and can supply the heart with up to 2.5 litres of blood per minute. This provides the heart with support in extremely critical situations. The percutaneous insertion allows for rapid positioning of the device into the left ventricle where blood is then pumped from the left ventricle into the ascending aorta – reducing the heart's workload. This makes the insertion of a stent, an expandable tube that is inserted into a constricted blood vessel, a much safer procedure. Once the stent is in place and blood flow is improved, the pump is retracted through the same means in which it was inserted.
Typically angioplasty, the mechanical widening of a narrowed or obstructed blood vessel, would be the method used to open a blood vessel to allow normal blood flow, but in patients with weakend hearts this could potentially cause further damage to the blood vessels. Open heart surgery may then be considered to help restore proper blood flow. However, in patients with compromised hearts, this type of very invasive surgery is also considered high risk.
The first patient, a 52 year old woman, had a pre-existing weak heart due to years of smoking and diabetes, which made angioplasty risky to perform. The patient was treated in mid June, with the help of the device which pumped blood from the heart, keeping her stable throughout the procedure, and allowing her doctors to safely insert a stent into her blocked artery. The patient was awake during the procedure and was able to respond to questions from the medical team. She was discharged from the hospital the next day in very good condition.
The second patient, an 83 year old man with severe coronary disease, was referred to the PMCC from another area hospital after it was determined that neither angioplasty or bypass surgery were an option due to his poor health. PMCC doctors agreed that there was a very high risk in treating this patient with angioplasty. Having successfully used the LVAD pump for the first time three weeks before, they were confident that using it again would allow them to safely treat this patient and return normal blood flow to his heart. The procedure was performed in early July, with the patient being discharged the next day. He is expected to recover well from the procedure.
"This procedure demonstrates that high risk patients, with existing heart conditions can potentially be treated safely without surgery using this device," said Dr. Vladimir Dzavik, Head of Interventional Cardiology at the Peter Munk Cardiac Centre, who performed both procedures. "It is still early, but it shows great promise. It is our hope that the Peter Munk Cardiac Centre will be able to lead a Canadian study using this device."
"These type of firsts can only be performed with the knowledge and innovation of a highly skilled staff," said Dr. John Parker, Medical Director, Peter Munk Cardiac Centre. "We have exceptional medical, perfusion and nursing teams in our program, and these two procedures could not have been accomplished without all of their collective expertise."
The Peter Munk Cardiac Centre (PMCC) is the premier cardiac centre in Canada. Since it opened in 1997, the PMCC has saved and improved the lives of cardiac patients from around the world. Each year, approximately 17,000 patients receive the innovative and compassionate care from the PMCC multidisciplinary heart team. The PMCC is based at Toronto General Hospital – a member of University Health Network, which also includes Toronto Western Hospital and Princess Margaret Hospital. All three are research and teaching hospitals affiliated with the University of Toronto.
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