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Heart Matters

Welcome to the first issue of Heart Matters. Every few months, you'll find updates We welcome your suggestions for content and your articles for future issues. Please send any ideas and/or submissions to [email protected]

Volume 1, Issue 1 | February, 2010

on Schulich Heart Centre innovations, clinical services, education and staff activities.

Sunnybrook's Cardiac Surgery Founder Receives Order of Canada

Sunnybrook Health Sciences Centre is proud to congratulate Dr. Bernard S. Goldman on his recent appointment to the Order of Canada. Dr. Goldman founded the cardiac surgery program at Sunnybrook's Schulich Heart Centre, which has become one of the country's leading research and teaching centres for surgical interventions to treat cardiovascular disease. This honour is bestowed upon Dr. Goldman for his contributions to the field of cardiac surgery and cardiac care. Dr. Goldman is a renowned clinician, researcher and educator who has been a mentor for countless professionals in this field and has saved the lives of literally thousands of patients over his 41-year career. Dr. Goldman has pioneered new approaches to aortic valve replacement, coronary artery bypass grafting and cardiac pacing. Dr. Goldman came to Sunnybrook in 1989 and established what has become one of Canada's leading divisions of cardiac surgery. He served as Head of the Division of Cardiac Surgery from 1989 to 1999 and as Surgeon in Chief of Sunnybrook from 1999 to 2003. "Dr. Goldman is a true innovator and leader in his field and Sunnybrook is fortunate to In addition to his role as Cardiac Surgeon, Dr. Goldman is a Professor of Surgery at the University of Toronto, Editor of the Journal of Cardiac Surgery and Chairman of Save a Child's Heart Canada, providing heart surgery to children from underprivileged countries at no cost. He has led numerous research efforts to improve the care of have him as a member of our team," said Dr. Barry McLellan, President and CEO of Sunnybrook Health Sciences Centre. " This is a well deserved honour that complements what has been an outstanding career." cardiovascular surgery patients, has authored hundreds of peer reviewed articles, contributed chapters to medical text books and has recently published the second edition of Heart Surgery in Canada: Memoirs, Anecdotes, History and Perspectives. To honor the significant contributions of Dr. Goldman, Sunnybrook has established the Dr. Bernard S. Goldman Chair in Cardiovascular Surgery. The Chair supports initiatives in teaching, innovation and clinical evaluation. The Goldman Chair was created to address the changing face of cardiovascular surgery, to train surgeons who are adept at leading-edge procedures and attract the best international talent in the field. Dr. Goldman was also the recent recipient of the Sunnybrook Foundation's Rose Award for his outstanding service in support of Sunnybrook's philanthropic objectives. Among his many other philanthropic activities, Dr. Goldman played an active role in raising funds for the renovation of the Schulich Heart Centre, currently underway at Sunnybrook. The $25 million project will create a new, world-class, technologically advanced Schulich Heart Centre.

Heart Matters - February 2010


Aging, Complex Heart Patient's Needs Met With New Procedure

A new program at Sunnybrook's Schulich Heart Centre is improving 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 Percutaneous Aortic Valve Intervention (PAVI) program at Sunnybrook Health Sciences Centre. "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 and Vascular Surgeon 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. "This program will do wonders to improve the health of some of the most critically ill heart patients in Ontario," says Dr. Brian Gilbert, Chief of the Schulich Heart Program. "About half of all patients with stenosis do not get treated because they are considered too old or too frail for traditional surgery. This program makes it possible for us to offer the very best cardiovascular care for our patients so they can return to the best possible quality of life sooner." To continue providing this life-saving procedure to patients, Sunnybrook Foundation is raising funds to purchase the heart valves used in this procedure. Anyone interested in making a donation can go to

Registered Nurses: Barbara Needham, Robin Kay, Kristine Mulholland, Antoineta Rabiega, Sabina Bakar-Irwin, Michelle Porter, Margaret Gadke, Vevien Braga Anaesthesia Assistant: Elihu Henry Anaesthetist: Dr. Sophia Wong Interventional Cardiologists: Dr Sam Radhakrishnan, Dr Brad Strauss, Dr. Eric Cohen (absent) Cardiac Surgeons: Dr. Steve Fremes, Dr. Gideon Cohen Vascular Surgeon: Dr. Andrew Dueck (absent)


Heart Matters - February 2010

Minimally Invasive Bypass Surgery Expedites Recovery for Heart Patients

"In the past, we would have to treat those patients with drugs alone, which is not ideal," says Dr. Moussa, who is also a lecturer in the Department of Surgery at the University of Toronto. "Now, using a technique called hybrid revascularization, we are performing minimally invasive beating heart bypass on the most important coronary artery down the front of the heart and inserting stents into the other vessels. This will give more people access to potentially life-saving surgery." During traditional bypass surgery, the surgeon makes a long incision to completely split the sternum (sternotomy) and access the heart. Patients are then placed on a heart and lung machine which acts as a substitute for their own and allows surgeons

Dr. Fuad Moussa (right) with his patient, Emil Boychuk

to work on a stopped heart. People who undergo this surgery generally recover in about six-to-eight weeks. Alternatively, with a small thoracotomy, beating heart approach, the surgeon can perform the operation through a tiny incision under the left nipple (four or five centimeters wide) while the heart continues to beat. This technique lowers the risk of complications such as stroke, lung problems and kidney problems which are associated with the use of a heart-and-lung machine. It also means patients have reduced pain and less need for postoperative pain medication, smaller scars, a shorter stay in the hospital and a faster recovery. Sunnybrook is one of only a few health sciences centres in Canada currently offering this surgical alternative to traditional bypass surgery.

Every year in Ontario, approximately 7,000 people with coronary artery disease benefit from having bypass surgery. Unfortunately, there are some cases where patients with two or three blocked arteries would benefit from surgical intervention but are not well enough to withstand conventional bypass surgery. But now, patients receiving treatment in Toronto have access to an alternative procedure to fix clogged arteries and improve blood flow to the heart. In March 2009, Sunnybrook's Schulich Heart Centre became the first centre in Toronto to offer minimally invasive, beating-heart bypass surgery. Both conventional bypass surgery and minimally invasive coronary artery bypass grafting restore blood flow to the heart when there is a buildup of plaque inside the blood vessels. The advantage of using a minimally invasive technique rather than the traditional approach is that it allows the surgeon to work on a beating heart through a small chest incision (small thoracotomy)

Heart Matters - February 2010

without having to split the breastbone and place patients on a heart-and-lung machine while surgeons work on the stopped heart. "Offering a minimally invasive alternative to traditional bypass surgery provides extraordinary benefits for our patients," says Dr. Fuad Moussa, cardiac surgeon at Sunnybrook's Schulich Heart Centre. "While we have been performing conventional bypass surgery successfully for many years, the new techniques we are now introducing at Sunnybrook minimize operative risks and patient trauma associated with opening up the chest and stopping the heart. This means patients can often return home after only a few days and resume many normal activities within a couple of weeks rather than months."

Visit Dr. Moussa's blog: Ask Your Cardiac Surgeon @ 3

Partnership Improves Care for Heart Patients in York Region

recurrent heart attacks, stroke, in-hospital length of stay and costs. By coordinating services with Toronto EMS and partner hospitals, we're able to dramatically reduce the time between when a patient presents with STEMI symptoms and when we treat them which further improves outcomes for heart patients." The partnership between Sunnybrook and North York General was the first of its kind within Toronto. There now exists a coordinated collaboration between Toronto EMS and four heart centres in the GTA to provide this cutting-edge care to virtually

Sunnybrook's Code STEMI Team

all STEMI patients in the city 24/7. "Because of the Code STEMI initiative, I received the right care, in the right place, at the right time and my quality of life has returned to normal."

- Terry Jamison, Sunnybrook's first STEMI patient.

A new partnership between Sunnybrook Health Sciences Centre, Humber River Regional Hospital (HRRH) and Toronto Emergency Medical Services (EMS) is improving care for heart patients living in the York Region. Effective Monday October 5, 2009, patients presenting with signs and symptoms of a heart attack, or STEMI (ST-elevation myocardial infraction) in the Humber River Regional Hospital area are taken directly to a 24 hour catheterization laboratory at Sunnybrook's Schulich Heart Centre to receive emergency angioplasty. After patients undergo angioplasty and are stabilized, they are transferred back to their own regional hospital for monitoring and recovery. The initiative is modeled on a very successful partnership already established between Sunnybrook, North York General Hospital and Toronto EMS called "Code STEMI". Before the Code STEMI project was initiated, patients experiencing the signs and symptoms of a heart attack were delivered by EMS to the closest hospital for treatment with clot busting drugs. If required, arrangements could then be made to transfer them to a larger centre like Sunnybrook for angioplasty.

"The initiation of this partnership is fantastic news for heart attack patients in the city," says Dr. Sam Radhakrishnan, Interventional Cardiologist and physician-lead of the Code STEMI Program at Sunnybrook. "We know that the benefits of receiving timely angioplasty include reductions in: death,

Here is how a Code STEMI works:

· A patient with chest pain calls 911. · A special ambulance crew of advanced care paramedics arrives at the scene. · Advanced care paramedics obtain a targeted history from the patient and use an electrocardiogram (ECG) to determine if something is wrong. · If a STEMI (type of heart attack) is confirmed, paramedics call Sunnybrook's Cardiac Care Unit (CCU) using a dedicated STEMI hotline and relay the vital information to a CCU nurse. · A `Code STEMI' is immediately triggered at Sunnybrook which activates cath lab team members (Interventional cardiologists and nursing staff). · The patient arrives at Sunnybrook and is taken to a prepared cath lab where an emergency angioplasty is performed. Through a small catheter inserted into the patient's wrist or groin, a balloon and stent are positioned at the site of the blocked heart blood vessel (artery) causing the heart attack. The balloon and stent are expanded to open the blocked artery, restoring normal flow of blood and oxygen to the heart and stopping the heart attack. · Following the angioplasty, the patient is transferred to a CCU bed at Sunnybrook for monitoring and nursing care.


Heart Matters - February 2010

One Man Inspires a Community to Raise $20 Million to Fight Canada's Number One Killer

The people of Ontario will have more access than ever to the latest life-saving, minimally invasive cardiovascular treatments thanks to the visionary leadership of one of S.Schulich Canada's foremost philanthropists, Seymour Schulich. Mr. Schulich has made a $10-million investment in the heart centre that bears his name. He challenged Sunnybrook Foundation to raise $10 million by the end of 2008 to rebuild the Schulich Heart Centre at Sunnybrook. The Foundation did just that and Mr. Schulich has made this $10-million gift to Sunnybrook to match those donations dollar-for-dollar. This transformational gift follows a long history of investment Mr. Schulich has made in Sunnybrook. Along with $5 million previously raised, the people of Toronto and the GTA have contributed a total of $25 million to create a new, world-class, technologically advanced Schulich Heart Centre. "I am so impressed by the people who rallied around my challenge," says Mr. Schulich. "Sunnybrook can't deliver worldclass innovations in cardiovascular care without the support of private donors. People responded generously to this match in spite of the tough economic times. This achievement is quite remarkable." Construction on the new Centre is currently underway. The centerpiece of this project is the Dr. Brian W. Gilbert Cardiovascular Acute Care Unit, a state-of-the-art unit that will replace the current unit, which was built more than 40 years ago. This new facility will set national standards for patient care, feature the most advanced medical equipment, and, most importantly, will ensure the best possible outcomes for patients. "Sunnybrook's Schulich Heart Centre is truly changing the way cardiovascular disease is treated," says Dr. Brian Gilbert, the Centre's chief. "Our scientists and clinicians are developing cutting-edge ways to look at the heart and diagnose problems earlier and more accurately. Our team continues to pioneer, minimally invasive heart procedures that allow patients to recover faster, spend less time in hospital and get back to their normal lives sooner. Now, with the incredible support of Mr. Schulich and the many other generous donors, we will provide our team with the first-class facility they need to continue inventing the future of health care." "Cardiovascular disease is still the number one killer in Canada," said Dr. Barry McLellan, President and CEO of Sunnybrook. "This $25-million investment will help save lives. Mr. Schulich's generosity, and that of those he inspired, enables us to create a revitalized Schulich Heart Centre to deliver the best possible care to the province's most critically ill heart patients. We are profoundly grateful for this gift to Sunnybrook and the people we serve."

Schulich Heart Centre Redevelopment Project Update

· The Schulich Heart Centre Redevelopment Project involves renovation of five large wings of the hospital and the updating of medical equipment through the centre, creating new facilities for the Schulich Heart Centre and ensuring the best technologies in the world are available to our patients. It also includes a new, cutting-edge cardiac critical care unit. · We have now completed phase one of construction and have moved into phase two. · Patients and staff from the Schulich Heart Centre nursing units are relocating temporarily in order to accommodate construction on the nursing units. · A great deal of planning has taken place to ensure the moves occur as smoothly as possible. Care will proceed as usual during and after the moves, with the same care team following patients to their new, temporary location. · Construction for the full project is on schedule for completion in summer of 2011.

Arrhythmia Invasive Suite Project (A.I.S.): Home of the first Robotic Electrophysiology Lab LAB in Toronto Heart Matters - February 2010

Artist rendering of a new CCU patient suite


Study Examines Use of Meditation and Yoga to Manage Blood Pressure

Volunteers are needed for a study to help determine if mindfulness-based stress reduction is effective for lowering elevated blood pressure The old adage "mind over matter" is being put to the test at Sunnybrook Health Sciences Centre. Sunnybrook, in collaboration with the Heart and Stroke Foundation of Ontario, is conducting a study to determine if teaching meditation techniques to people who are in the early stages of developing hypertension is an effective intervention for lowering blood pressure. Preventing and controlling high blood pressure is shown to be one of the most effective strategies for reducing the incidence of cardiovascular disease and death. Stress has been associated with greater cardiovascular risk and stress management is a recommended intervention for patients with high blood pressure. Led by Dr. Sheldon Tobe, Nephrologist at Sunnybrook Health Sciences Centre, the HARMONY (Hypertension Analysis of Stress Reduction using Meditation & Yoga) study examines a relaxation therapy known as Mindfulness-Based Stress Reduction (MBSR) to see whether it can lower blood pressure and delay or prevent the progression of hypertension. MBSR is a structured program that teaches participants to take charge of their health and well-being and has been shown to alleviate stress and treat certain medical conditions. "My hope is that this may lead to the day when physicians can refer patients with high blood pressure to trained health practitioners who can deliver standardized, effective lifestyle therapy," says Dr. Tobe, who is also an Associate Professor in Medicine at the University of Toronto. Dr. Tobe and his team of researchers are recruiting 70 people over the next year to participate in this research. Participation may be required for up to ten months. During this study period, participants Office of Dr. Sheldon Tobe Nephrology Research Sunnybrook Health Sciences Centre 2075 Bayview Avenue, Room C-504 Phone: 416-480-6100 extension 1641 E-mail: [email protected] All queries will remain strictly confidential. will be asked to come to Sunnybrook for monthly blood pressure assessments and study visits. Also, over the course of nine weeks, participants will attend ten sessions of MBSR in a group setting at Toronto General Hospital. Each session is two-and-a-half hours long. One of these sessions will be a day-long mindfulness meditation retreat that takes place on a Saturday or Sunday. In addition to this, participants will be asked to complete some practice at home. In order to be eligible for this research study, participants must meet the following criteria: · Between 20 to 75 years of age · Have been diagnosed with high-normal or high blood pressure · Not be taking any medication for elevated blood pressure · Be willing to participate in the ten sessions (over a period of nine weeks) of MindfulnessBased Stress Reduction As compensation for each participant's time in the study, they will receive MBSR therapy and MBSR materials as well as reimbursement for parking costs to attend study sessions. Please feel free to visit for more information. If you would like to participate, or have any questions regarding your eligibility or if you would like to come in and have your blood pressure assessed, please contact:

The Hypertensive group at the Schulich Heart Centre is led by Dr. Martin Myers and Dr. Sheldon Tobe, both leaders in the diagnosis and treatment of hypertension.


Heart Matters - February 2010

Notable Presentations

Sunnybrook Cardiovascular Nurses at the Canadian Cardiovascular Congress 2009

Reprinted with permission from Nursing Voice, Fall 2009

Malou Galapin, APN, Schulich Heart Centre

3. Glycemic Control in the Cardiovascular Intensive care Unit (Heather Harrington & Leasa Knechtel)

The 10th Canadian Cardiovascular Congress (CCC) was held in Edmonton, Alberta from October 24-28, 2009. This annual event is hosted by the Canadian Cardiovascular Society and the Heart and Stroke Foundation of Canada. CCC provides world-class education, interactive scientific program, and learning tracks within a cardiovascular specialty. Several Sunnybrook Cardiovascular Nurses attended the event. RNs from the Schulich Heart Program and the Cardiovascular Intensive Care Unit presented three posters and two oral presentations. Their presentations included the following:

Poster Presentation:

1. The STEMI Experience: Changes, Challenges and Outcomes (Rob Fuerte, Josie Ng Lee & Dana Murray)

Heather Harrington & Leasa Knechtel

Oral Presentation:

1. A Coronary Anomaly: A Case Study of When an Acute Coronary Syndrome (ACS) was not Coronary Artery Disease (Charlene Lester, Elaine MacLagan & Julie Macdonald) 2. Discovering Best Practice in the Management of Patients Undergoing a Tilt-table Test: Development and evaluation of a protocol on tilt-table testing (Malou Galapin, Savitri Persaud & Chantal Kangudie) Sunnybrook was well represented at the CCC. Supporting the nurses at this event is consistent with Sunnybrook's commitment to research and education.

Dana Murray & Josie Ng Lee


Promoting Patient Safety in a Cardiac Center: Knowledge Transfer Strategies for Increasing the Use of a Safety reporting System Chantal Kangudie, Evelyn Cruz, Maisie Meneses, Maria Sia & Kathleen Twiss)

Savi Persaud & Malou Galapin

Maisie Menezes, Kathleen Twiss, Maria Sia & Evelyn Cruz

Heart Matters - February 2010


Schulich Heart Centre Smoking Cessation Program is Helping Patients Kick the Habit

Sunnybrook Speaker Series Schulich Heart Centre

The Heart of the Matter:

Innovations in Cardiovascular Therapies

Join us for a heart healthy evening TUESDAY, FEBRUARY 23, 2010 6:30 ­ 8:30 P.M.

Leading Sunnybrook experts will discuss: · · Code STEMI: Saving Hearts Around the Clock ­ Dr. Sam Radhakrishnan, Cardiologist Unblocking Impenetrable Arteries: A New Procedure ­ Dr. Bradley Strauss, Cardiologist EndoVascular Aortic Repair (EVAR): Evolution of Intervention ­ Dr. Andrew Dueck, Vascular Surgeon Minimally Invasive "Beating Heart" Bypass Surgery ­ Dr. Fuad Moussa, Cardiac Surgeon A New Way to Fix a Broken Heart Valve ­ Dr. Eric Cohen, Cardiologist and Dr. Stephen Fremes, Cardiac Surgeon

The Schulich Heart Centre has initiated a pilot program aimed at providing patients with the support they need to quit smoking. The program identifies smokers on admission, provides stopsmoking counselling and medication during hospitalization, links patients back to community resources and provides followup after discharge from hospital. This program is modeled after the successful Ottawa Heart Institute initiative. The Ottawa Model for Smoking Cessation has been credited with an average of 11 per cent increase in smoking cessation rates within nine hospitals in the Ottawa region. Shannon Furey, a smoking cessation counselor, has implemented this pilot program in both the Schulich Heart Centre and the Odette Cancer Centre.

· · ·

Moderator: Dr. Brian Gilbert, Chief, Schulich Heart Program Please RSVP your attendance by February 22, 2010 Phone: 416.480.4117 e-mail: [email protected] Free Admission Free Parking, Garage One

Tuesday, February 23, 2010 6:30 ­ 8:30 p.m. McLaughlin Auditorium, Bayview Campus E Wing Ground Floor, 2075 Bayview Avenue

Presentations are available online after the event. Visit and see Sunnybrook Connection.


1. 2. Goldman, BS. M.D., B.Sc. (Med), F.R.C.S. (C), & Belanger, S. B.A., M.L.S. (Eds.): Heart Surgery in Canada; Memoirs, Anecdotes, History & Perspective. (2nd ed.) Longman: Toronto, 2009 Turner, S., Onalan, O., & Bickle, B.: "Prevention of Death in Chronic Kidney Disease: The Role of Implantable Cardioverter Defibrillators", Canadian Association of Nephrology Nurses and Technologists Journal, JulSept; 19(3): 29-36; quiz 37-8, 2009 Cohen, G., Zagorski, B., Christakis, GT., Joyner, CD., Vincent, J., Sever, J., Harbi, S., Feder-Elituv R., Moussa, F. Goldman, BS., & Fremes, SE.: "Are Stentless Valves Hemodynamically Superior to Stented Valves? Long-Term Follow-Up of a Randomized Trial Comparing Carpentier-Edwards Pericardial Valve with the Toronto Stentless Porcine Valve", Journal of Thoracic and Cardiovascular Surgery, January 15, 2010



Heart Matters - February 2010



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