One Heart Surgery, Two Procedures: A Canadian First

Dale Robarts was tired. Even the simplest tasks were draining him of breath and energy. He would go about his life in two-minute chunks and then have to sit down to catch his breath again. Something was seriously wrong.

Dale was diagnosed with two separate heart problems: one of his heart valves wasn't opening properly, and another was leaking. He came to Sunnybrook, which specializes in minimally invasive surgeries to fix both problems. Little did he know he was about to make history.

Dale is the first Canadian patient to receive two specific heart procedures at the same time: TAVI and Mitral Clip. TAVI, or transcatheter aortic valve implantation, replaces a faulty heart valve with a new one, allowing blood to flow from the heart to the body properly. The Mitral Clip is another tiny but mighty device. It's fished up to the problem of the heart to plug the leak.

Both procedures can be done by feeding catheters through a small incision in the leg or arm leading up to the heart, sparing patient riskier open heart surgery. And for some patients who aren't candidates for open heart surgery -- estimated to be about one third of patients who need an aortic valve replacement -- this approach offers them a welcome and potentially lifesaving option.

Dr. Gideon Cohen, Chief of Cardiac Surgery at Sunnybrook, has done many TAVI procedures. "Some patients are simply too high risk for whatever reason. Either they are too elderly or have too many co-morbidities or other illnesses which preclude them from undergoing conventional aortic valve replacement."

Dale knew he needed to have both procedures done, but it wasn't at first clear if they could do them together. "They said they would do one, and then a month later, they would come back and do the other one," says Dale. "So I asked Dr. Cohen if they could do both of them at once. He said we usually don't do that but we'll see when we have a look. So after the operation he told me they had done that both. I thought that was just great!"

"This patient, it was a perfect storm where it was the right thing to do for him," says Dr. Sam Radhakrishnan, Director of the Catheterization Lab at Sunnybrook and one of Dale's doctors. "It does have to be individualized but I suspect there are patients, more patients than we've treated thus far, that could potentially have the procedures at the same time." For suitable candidates, this brings with it a host of benefits, including less exposure to sedation, reduced time in hospital and a faster recovery.

Dale was thrilled to be part of this pioneering move. And equally happy to feel well when finally returning to his day-to-day activities. "I'm getting stronger, able to do more without feeling tired. The breathing is much easier and I'm not short of breath. It worked out real well."