1,000th transcatheter heart valve procedure

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A heart valve procedure is enough to make any patient nervous, but Gisela Wegner didn’t show any nerves as doctors at St. Paul’s Hospital performed a transcatheter heart valve (THV) implantation on her while she lay awake without sedation. Wegner’s calm was even more impressive because the procedure was being broadcast around the world and to a conference of doctors in downtown Vancouver.

“If no valve replacement was becoming available or if Dr. (John) Webb had not considered me a candidate, if I went just by medication…the deterioration is frightening, it’s coming so fast,” Wegner said prior to the procedure.

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The THV implantation, on June 5, was the 1,000th procedure for the Centre for Heart Valve Innovation at St. Paul’s Hospital. THV procedures involve inserting a thin tube with a replacement valve into the body through a small incision, then directing it to the heart through an artery. It can be done by making a small hole in the leg or the chest wall. Dr. John Webb, director of interventional cardiology at St. Paul’s, was the first to successfully perform a transcatheter aortic valve implantation (TAVI) through an artery in 2005, which involves inserting a new valve from a small puncture in the leg.

“The Centre for Heart Valve Innovation at St. Paul’s is recognized internationally as a pioneer of innovative, minimally invasive heart valve replacement procedures that provide an alternative for patients who are at higher risk for open-heart surgery. By performing this surgery on patients that are awake, we can reduce the stress and risks of surgery, improve results and avoid complications, and allow patients to return home sooner,” said Dr. Webb.

Only patients who are at high risk for surgery are considered for THV procedures. The Centre for Heart Valve Innovation is now performing half of its THV procedures on patients that are awake. In addition to TAVI, the Centre for Heart Valve Innovation also performs other transcatheter procedures for people with valve disease, including percutaneous mitral valve repair (“MitraClip”).

Dr. Webb is recognized internationally as a leader in these procedures, having the broadest experience in the world and having taught these techniques to healthcare professionals in more than 25 countries. He is not only breaking new ground with medical procedures, but also in the way he teaches others how to conduct this procedure. From offering three-day courses locally, to traveling to all corners of the world to assist with initial cases, Dr. Webb and his team are dedicated to sharing their knowledge so that the TAVI procedure is accessible to all of those who qualify for it. In 2011, St. Paul’s launched the Virtual Teaching Laboratory which provides live feeds of the TAVI procedures at St. Paul’s to medical professionals around the world.

“We bring together cardiologists, cardiac surgeons, nurses, geriatric medicine specialists, the patient and also the family doctor to discuss whether this is something that we can do but also whether it is something that we should do,” said Sandra Lauck, clinical nurse specialist at St. Paul’s.

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Wegner’s procedure was broadcast to the Transcatheter Valve Therapies conference held in Vancouver. The conferencewas designed for interventional cardiologists, cardiovascular surgeons, cardiac imaging specialists, clinical cardiologists, cardiac nurses, cardiovascular technologists, and other healthcare professionals with a special interest in the field of transcatheter valve therapy.

“In just nine years, St. Paul’s Hospital has grown from a trailblazer in TAVI procedures to the home of the Centre for Heart Valve Innovation. This milestone is evidence of the deep commitment of our caregivers and researchers, who have put the needs of patients first and dared to push the boundaries and find new solutions,” said Dianne Doyle, President and CEO of Providence Health Care, which operates St. Paul’s.

Wegner used to exercise regularly but her condition deteriorated dramatically. Without this procedure, doctors expected her lifespan to be shortened considerably.

“Things were quite alright. I exercised, I was in the (St. Paul’s Hospital) Healthy Heart Program. Then I felt my strength was going down, I was having more and more problems and had to give up exercise altogether,” she said.

The Vancouver program is a partnership between St. Paul’s Hospital and Vancouver General Hospital. Sites of the provincial THV program also include Royal Columbian and Royal Jubilee Hospitals.

From her hospital bed just four hours after the procedure, Wegner gave some advice to others who might be in her situation. “If you have the chance to be chosen, be grateful and grab it…I feel blessed. I feel fine, certainly better than before.”