New procedure meets needs of aging, complex heart patients


The last thing John Pipher expected when he went to see his family doctor about a persistent cough in May 2008 was to be diagnosed with a life-threatening heart disorder.

The 89-year-old Second World War, Royal Canadian Air Force Veteran and life-long athlete had always been the picture of health and had no reason to suspect there was a problem with his heart. But when he started to feel progressively worse on the drive to his family doctor, he knew something was wrong.

By the time he got to the doctor’s office, he was so sick that he was immediately put into an ambulance and rushed to Sunnybrook Heath Science Centre. Mr. Pipher soon found out that he had a damaged aortic valve and would need surgery to fix the problem.

“Although doctors recommended it, I was just not prepared to undergo open-heart surgery at that time,” recalls John. “I put it off for while but after a year went by, I was told that I could not delay intervention any longer.”

But thanks to the new Percutaneous Aortic Valve Intervention (PAVI) program at Sunnybrook’s Schulich Heart Centre, John could have the intervention he needed without having to undergo traditional aortic valve replacement surgery.

The PAVI program was created to improve access to a potentially lifesaving heart procedure for elderly or frail patients not well enough to undergo traditional aortic valve replacement surgery.

Narrowing of the aortic valve, or “stenosis”, is a fairly common condition in today’s aging population. It occurs when the aortic valve, which keeps oxygen-rich blood flowing from our heart into the largest artery in our body, becomes partially blocked, impairing flow of blood to the rest of the body. If left untreated, stenosis can cause the heart muscle to thicken as it works harder to pump blood through the body – potentially leading to heart failure.

“Surgical replacement of the diseased valve with an artificial one is considered the best treatment for aortic valve stenosis,” says Dr. Sam Radhakrishnan, Interventional Cardiologist and physician-lead of the PAVI program at Sunnybrook. “Unfortunately, many of the patients we see with this condition have significant co-existing medical issues that render them unable to withstand the physical trauma of open-heart surgery. In the past, we have had to treat these patients with drugs alone, which is proven to be less effective than with valve replacement.”

With the introduction of the PAVI initiative at Sunnybrook, patients who are considered too high risk for conventional open-heart surgery to replace or repair the aortic valve may be candidates for a substantially less invasive procedure. In this procedure, a team of doctors including an interventional cardiologist, cardiac surgeon, vascular surgeon and anesthesiologist, are able to implant a new valve percutaneously (without opening the chest).

During a PAVI procedure, the team of doctors inserts a catheter (tube) into an artery in the groin through which they are able to pass further catheters to the diseased heart valve. The doctors are able to see the position of the valve on a screen displaying X-ray images of the inside of the patient’s chest. This technique greatly minimizes the operative risks and patient trauma associated with opening up the chest and stopping the heart. The whole procedure takes an hour and a half, as opposed to twice as long for conventional open-heart surgery, and may be carried out under general anaesthesia or local anaesthesia with, or without sedation.

Minimally invasive valvular interventions offer many benefits to patients including reduced pain and less need for postoperative pain medication, smaller scars, a shorter stay in the hospital and a faster recovery. People who undergo percutaneous valve interventions can often return home after only a few days and resume many normal activities within a couple of weeks rather than a couple of months.

“About half of all patients with stenosis do not get treated because they are considered too old or too frail for traditional surgery,” says Dr. Brian Gilbert, chief of the Schulich Heart Centre. “This program makes it possible for us to offer the very best cardiovascular care for some of the most critically ill heart patients in Ontario.”

For John, having this procedure has meant a much faster recovery than he could have expected with the traditional surgery. He was able to return to his active life and the things he loves to do sooner, including spending time with his wife of 67 years, his five children, nine grandchildren and two great-grandchildren.

“Two weeks after having the procedure, I was back to my morning walks and after three months, I was planning my annual trip to Florida with my wife and a few rounds of golf with one of my sons,” says John. “I am very grateful that this procedure was available to me.”