Whether they know it or not, dozens of Northern Ontario heart patients have something special in common with Mick Jagger, the world famous front man for The Rolling Stones.
Jagger was recently admitted to a hospital in New York where cardiac surgeons performed a relatively new procedure called the Transcatheter Aortic Valve Replacement (TAVR). In Canada, where the procedure was pioneered, it is called the Transcatheter Aortic Valve Implantation (TAVI).
Jagger came through the surgery just fine and has to rest up in preparation for the Rolling Stones tour of the U.S. and Canada later this year.
On Facebook, the 75-year-old rock and roller posted that he was doing well and on the mend. Jagger also posted “a huge thank you to all the hospital staff for doing a superb job.”
One man who was more than pleased to learn about Jagger's quick recovery was Sudbury-based cardiac surgeon Dr. Mark Henderson at Health Sciences North (HSN).
Aside from being an avid fan of Jagger and the Stones, Henderson knows all about the TAVI procedure which he has been performing at HSN.
In the past year, he said 48 patients from Sudbury and Northern Ontario went through the procedure and are doing well.
Henderson said the procedure has become an accepted alternative to what he calls the classic procedure of open heart surgery.
“It became clear about seven or eight years ago that TAVI was not just a passing fad and it was in fact going to be a viable alternative to surgical aortic valve replacement in many patients,” he told NOMJ.
“Accordingly since Health Sciences North has a busy cardiac surgery program and a busy interventional cardiac program, it was only logical that TAVI would be the next step.”
The procedure is a solution for patients who have heart valve disease, meaning one of the four valves within the heart does not work properly.
Henderson said the aortic valve lets blood flow out of the heart.
“Every single millilitre of blood in your body goes through your aortic valve many, many times a day. About five litres of blood goes through there a minute. And what happens is, in some people as the years ago by, the aortic valve becomes narrowed, or leaking or both,” he said.
“Now if you think about it, you have about 100,000 heartbeats a day. So that means that valve opens, and closes, about 200,000 times a day. It is actually astonishing to me that they don't all wear out.
“In fact only a small percentage do, but when they do, of course since all your blood flow goes through that valve it is critically important to you,” he continued.
Henderson said an aortic valve failure will eventually become a fatal condition if it is not treated.
He said the aortic valve implant involves a puncture into the patient's groin area to access the femoral artery. From there, the tiny valve is inserted via a long narrow tube called a catheter. The surgeons can then use an imaging process such as x-ray to guide the catheter to the aortic valve in the heart.
The new valve is implanted over the damaged valve. The catheter tube is removed and the new valve begins working immediately.
Henderson said early trials of the device revealed it was not robust enough for any long-term use, but that changed through research and development. He said this included work by a Vancouver cardiologist.
“Dr. John Webb of St. Paul's Hospital in Vancouver has had a huge impact. I mean he was in on this right from the start, did a lot of the developmental work and put in many of the first valves,” Henderson said.
Henderson added that Webb was “ probably the leading proponent of this in the world and has trained many, many people including the guys who worked on Mick Jagger.
“So actually the medical and surgical profession owe him a great debt of gratitude for all the work he has done. It is nice to have a Canadian flavour to it as well,” he said.
The benefit of the new procedure is that it has less impact on the patient and the patient's recovery time.
“So the old procedure, which is what my father had, you were admitted to hospital, you had a full general anesthetic, your chest was opened which is quite a violent procedure, you were connected to a heart-lung bypass machine, so your heart is arrested, and then the surgeon replaces the valve with sutures and scalpel.”
Then said Henderson, there would be a brief stay of a couple of days in the ICU (intensive care unit) followed by another seven to 10 days in the hospital.
“After that, you're laid up for at least three months,” he said. “You're not lying in bed, but you're certainly not going back to work. And certainly not out playing golf.
“The TAVI procedure, the way it is done now, you are admitted on the day of the procedure. You have sedation; no general anesthetic. There is no incision in the chest or leg. The catheter is inserted by needle puncture and the new aortic valve, which is somewhat miniaturized, is advanced up to where the aortic valve is then it is deployed,” he explained.
As a veteran cardiac surgeon, Henderson admitted he didn't believe in the procedure when he was first told about it.
“To be honest when I first heard about this I thought it was ridiculous. So I was a skeptic. Obviously I was wrong and other people like John Webb persevered and you know he had some setbacks in the beginning but he kept going and now it is an accepted procedure and it is done all over the world,” said Henderson.
“In fact in some countries like Germany there are very few valve surgeries done. They're all done by TAVI now. They're very aggressive. We're a little more conservative in Canada.
“But each patient is very carefully evaluated by the team. There is a whole team that looks at the patients and a decision is made that in one case surgery is the best choice, or in another case TAVI is the best choice.”
