1Heart Matters - November 2011

With a goal of transforming the way

that vascular care is delivered, Dr.

Robert Maggisano has been named the

inaugural Chair in Vascular Surgery at

Sunnybrook Health Sciences Centre.

The $3 million endowment fund will allow

Dr. Maggisano, a vascular surgeon at

Sunnybrook, to enhance the development

and evaluation of less invasive image-

guided vascular interventions, with a

strong focus on education.

“Sunnybrook is a world leader in providing

safe, less invasive endovascular surgery. A

priority of the Chair will be to disseminate

new knowledge to both students and

practicing surgeons,” says Dr. Maggisano,

Associate Professor, Department of Surgery,

University of Toronto. “My motto is make a

difference and make a difference now. By

ensuring that new knowledge is applied to

patient care, we can make a difference now

in saving patients’ lives.”

Sunnybrook has highly regarded expertise

in catheter-based treatments of aneurysmal

and occlusive diseases, as well as

surgical treatment of complex tertiary and

quaternary thoraco-abdominal disease.

Since beginning to perform endovascular

aneurysm repairs (EVAR) in 2006 with the

support of funding from the Sunnybrook

Foundation, the organization has been

recognized as a leader in the use of this

technique. This minimally invasive technique

is safer than conventional open aneurysm

repair, results in shortened hospital stays

and a quicker recovery time for patients

with aortic aneurysms. Typical open surgery

means a seven or eight hour operation and

six weeks’ to three months’ recovery, while

EVAR surgery takes an hour or two and

patients are out of the hospital within days.

A key to success has been Sunnybrook’s

highly skilled multidisciplinary health team

with strengths in imaging, endovascular

therapies, intensive care, basic and clinical

research and also teaching. “This is a

cohesive group, supported by Sunnybrook’s

Schulich Heart Centre, and readily shares

knowledge, cases and assists one another

in order to achieve quality patient care and

education,” adds Dr. Maggisano.

Over the last few years, the team’s clinical

and teaching strengths have been boosted

by the additions of Dr. Giuseppe Papia

and Dr. Andrew Dueck to the vascular

surgery team.

Sunnybrook has become a regional resource

for continuing education in endovascular

Heart Matters

Heart MattersWelcome to the fifth issue of Heart Matters. Every few months, you’ll find updates on Schulich Heart Centre innovations, clinical services, education and staff activities. If you would like to receive future issues of Heart Matters via email, please send a request to marie.sanderson@sunnybrook.ca.

Volume 2, Issue 2 | November 2011

Dr. Maggisano Photo by Doug Nicholson

care, serving as a teaching and learning

hub for hospitals within the Central LHIN.

Another priority for Dr. Maggisano is to build

bridges with industry to modify and develop

new endovascular products for the benefit

of patients. The Chair in Vascular Surgery

at Sunnybrook Health Sciences Centre will

ensure the organization is actively involved

in evaluating, critiquing and developing new

endovascular devices.

Schulich Heart Centre Redevelopment Complete

Photo by Dale Roddick

Schulich Heart Centre redevelopment

The opening of the newly renovated

Schulich Short Stay Unit on B3 on

Monday, August 15, 2011 marked

the end of the Schulich Heart Centre

Redevelopment Project. Pictured

at the blessing of the unit are Dr.

Bradley Strauss, Chief of the Schulich

Heart Centre and Susan Michaud,

Operations Director for the Schulich

Heart Centre.

New Chair to transform the way vascular chair is delivered

Draft Nov. 2011

2Heart Matters - November 2011

Million-dollar heart researchBy Jim Oldfield

The Canadian Institutes of Health Research has awarded a research team led by Dr. Jack Tu $995,919 over four years. The grant is for research to measure and improve quality of care for ST-segment elevation myocardial infarction (STEMI) patients in Ontario.

One-third of heart attacks are STEMIs. Although the condition is treatable with thrombolytic (clot-dissolving) drugs or primary percutaneous coronary intervention (revascularization via a balloon-tipped catheter or other techniques, commonly called PCI), patient survival rates vary in Ontario from 7% to 14%. Tu and his team will study reasons for this regional variation, then issue report cards that will include methods for improving care in each area. If all regions in the province achieved optimal survival rates, then the researchers estimate 600 lives could be saved each year.

“Our hypothesis is that regions with a well-organized STEMI care program, offering PCI with timely patient transfers between receiving hospitals by well-trained EMS staff, will do better,” says Tu, a senior scientist in the Schulich Heart Research Program at Sunnybrook Research Institute who holds the Canada Research Chair in Health Services Research.

Only 14 hospitals in Ontario offer PCI, which has a success rate of over 90% versus 60% for thrombolytic therapy, in part because it requires a catheterization lab and a large medical team. This difference in treatment availability likely accounts for some of the regional variation in survival rates, but Tu says other factors could be at play. “It

could be that patients are sicker or poorer in some regions. Those patients might be expected to have worse outcomes,” says Tu, who is also a professor at the University of Toronto. “As well, there is a shortage of family doctors in certain regions in Ontario, so adequacy of primary care could be a factor, as could quality of care provided within the hospital.”

Tu has assembled a multidisciplinary team of researchers to tease out which factors are affecting care in each region. The team includes researchers with expertise in methods and statistics, scientists from other provincial health care systems and interventional cardiologists who have

implemented STEMI care systems with primary PCI.

Dr. Harindra Wijeysundera, an interventional cardiologist who manages the quality improvement component of Sunnybrook’s STEMI care program will be participating. Wijeysundera has experienced the challenges of growing the program since its inception in 2007, when the standard practice at Sunnybrook was administration of thrombolytics. Sunnybrook’s STEMI team now does PCI exclusively for local patients and those in the catchment areas for North York General and Humber River Regional hospitals.

A health services scientist who will complete his PhD this year, Wijeysundera is keen to work with Tu’s team. “The core group has been together for quite a while under Jack’s leadership, and has produced insightful, high-impact work that has contributed to changes in care,” he says.

Wijeysundera expects this grant will spur changes in STEMI care, but says those changes could be complex because the ideal treatment may not be a one-size-fits-all solution. Switching to primary PCI requires infrastructure changes, for example, that may not be feasible in some regions. Further, in the north, large distances between hospitals, along with limited access to specialists, could require that STEMI programs are highly customized for specific regions. “Our grant will not likely say, ‘This is what you should do,’” says Wijeysundera. “It will prepare an inventory of the options, what works and what doesn’t.”

Dr. Tu

When: Wednesday, November 23, 2011

Where: Sunnybrook Health Sciences Centre, Harrison Hall, EG21 (E Wing, Ground Floor)

Join us for this full day, state-of-the-art Cardiovascular Disease Management Workshop. Highlights will include sessions on cardiovascular imaging, vascular disease management, and new surgical/interventional methods.

Save the Date: Schulich Heart Program Research Day

For more information, please contact Jean Rookwood at 416.480.5653 or by e-mail jean.rookwood@sunnybrook.ca

Draft Nov. 2011

3Heart Matters - November 2011

At the heart of the summitBy Eleni Kanavas

Sunnybrook Research Institute (SRI) hosted the fourth annual Canadian CTO Summit on June 10, 2011. Researchers, clinicians and industry partners from around the world gathered in Sunnybrook’s Harrison Hall for a research day devoted to chronic total occlusions (CTOs).

Chronic total occlusions are blocked coronary arteries that affect an estimated 20% of patients with coronary artery disease and more than 50% of patients with peripheral (limb) arterial disease.

Studies have shown that revascularization, a surgical procedure that restores blood supply to an organ, of coronary CTOs can significantly improve angina and left ventricular function.

The conference, Translating Science to the Clinic, focused on the benefits of revascularization, tissue characterization of preclinical and clinical CTOs, and new imaging modalities and treatment strategies for CTOs.

Dr. Graham Wright, an imaging scientist and director of the Schulich Heart Research Program at SRI, moderated the workshop. The symposium featured keynote speakers Dr. Gerald Werner from Klinikum Darmstadt in Germany and Dr. Patrick Whitlow from the Cleveland Clinic in the U.S.

“In the past few years, we’ve summarized work on characterizing models of this disease that we’ve developed,” Wright said in his opening remarks. “Today we look forward to a lot of collaborative discussion

on new ideas, as well as how far we’ve come, what we’ve learned and where we’re going based on what we’ve learned.”

Wright is also a professor at the University of Toronto and co-lead investigator of the Canadian Institutes of Health Research (CIHR) team in occlusive vascular disease. He holds the Canada Research Chair in Imaging for Cardiovascular Therapeutics.

During a session on new treatments and imaging strategies, Dr. Bradley Strauss, chief of the Schulich Heart Centre at Sunnybrook, presented results from a “first-in-patient” trial he led using an enzyme called collagenase to soften coronary occlusions in patients. Strauss, who is also a senior scientist at SRI and co-principal investigator of the CIHR team, and his lab developed collagenase 10 years ago. Results since then have shown steady progress. He presented preclinical findings at earlier CTO summits that showed using

Heart Healthy ChiliSubmitted by Andrea Ho, Registered Dietitian, Schulich Heart Centre

As the weather is cooling down and the leaves are turning colours, a bowl of chili is not only a hearty way to warm up on a cool autumn day, it can also be a heart healthy source of fibre. This chili recipe is packed with soluble fibre from the beans, which helps to lower LDL-cholesterol, as well as insoluble fibre from the vegetables, which helps with bowel regularity and blood sugar management.

Nutritional Content (Per serving)

Calories 368kcal

Protein 28g

Fat 9g

Saturated Fat 1.6g

Fibre 8.2g

Sodium 313mg

Cholesterol 46mg

Ingredients (Makes 6 servings)

1 can (540mL) red kidney beans, drained and rinsed well (reduces 40% of sodium)500g extra lean ground beef1 packet sodium-reduced taco seasoning1 onion, diced2 carrots, peeled and diced2 celery stalks, diced1 can (796mL) no salt added diced or whole tomatoes, pureed1 cup frozen corn, 1 cup frozen peas

1 tbsp olive oil

Preparation

1. Heat olive oil in a non-stick pan over medium-high heat. Sautee onions for 2-3 minutes until soft.

2. Add ground beef and cook for 5-6 minutes until completely cooked through, using a spatula to break up the beef. Pour off any additional fat that has cooked out of the beef. Add taco seasoning and mix well.

3. Mix in carrots, celery, beans, and tomatoes, cover, and bring to a boil. Turn heat down to medium and let simmer for 1 hour, stirring occasionally.

4. Serve in bowls with a sprinkling of chopped scallions, shredded partly-skim old cheddar cheese, or a warm, crusty whole wheat dinner roll.

Image Approval Pending

Dr. Sergey Yalonetsky, a former Fellow with Dr. Strauss, spoke on “A Preclinical Model

for Coronary CTO”.

Continued on page 4

Draft Nov. 2011

4Heart Matters - November 2011

9th Annual Vascular Golf DaySunnybrook’s 9th annual Vascular Clinic Golf Tournament took place on Wednesday, September 7, 2011. The day was a huge success with over $2 million raised in support of the Division of Vascular Surgery, the Schulich CVS Program and institutional initiatives. Through his role as the inaugural Chair in Vascular Surgery at Sunnybrook, Dr. Robert Maggisano will enhance the

development and evaluation of less invasive image-guided vascular interventions, with a strong focus on education and transforming vascular care. “The goal is to make a difference now and save more lives,” says Dr. Maggisano. Pictured are Dr. Robert Maggisano and Peter Rocca, chair of the 9th annual Vascular Golf Day.

Continued from page 3

collagenase to break down the arterial blockage significantly increased guide wire crossing rates.

“Dr. Strauss has been working on CTOs for a very long time, and I think we’re seeing major advances from his career investment in this field,” Wright said.

Twenty male patients participated in the study, which was a collaboration between Sunnybrook and St. Michael’s Hospital. During the procedure, Strauss used a microcatheter to inject the collagenase into the CTO to soften plaque buildup in the artery and allow for stenting the next day.

Strauss and his team had an 80% success rate, crossing and stenting 16 of the 20 patients in the study without damaging any of the normal layers of the blood vessels during angioplasty. All patients had a follow-up three-month coronary computed tomography angiogram, as mandated by Health Canada. The exam showed that the artery remained open for those who had a successful crossing.

“Many of these cases still remain very challenging; I think CTO angioplasty remains the most challenging of any part of angioplasty that’s being done,” Strauss said in his presentation. “They are not done in two minutes even with this type of therapy, but nevertheless, some cases are easier than others.”

The CIHR team grant is in its last year of funding. Wright said they will work on ways to keep it going next year.

Snapshot on ResearchA new study at the Schulich Heart

Centre will help guide interventions to

enhance the delivery of quality care to

patients with acute coronary syndrome.

The study, using focus groups and

face-to-face interviews, will guide care

providers on how to integrate best

practices in their day-today practice.

Patient education is a primary focus,

with the goal of promoting patients’

understanding of their illness as to

the diagnosis, modifiable risk factors

and preventative measures to prevent

re-admission to the hospital. For more

information, please contact Ma Lou

Galapin.

Dr. Bradley Strauss; Diane Galbraith from the Alberta Provincial Project for Outcome

Assessment in Coronary Heart Disease (APPROACH) at the University of Calgary and Dr. Harindra Wijeysundera, an interventional

cardiologist at Sunnybrook.

Dr. Maggisano and Peter Rocca

Honouring Dr. Gideon Cohen

On Monday, November 7, 2011, the Sephardic Kehila Community Centre will honour Dr. Gideon Cohen, surgeon in the Division of Cardiac and Vascular Surgery at Sunnybrook, at their gala dinner. Dr. Cohen, together with the Honourable Peter Kent, Minister of the Environment, will be recognized for outstanding contribution to the community.

Improving Quality of Care in the CVICU

A multidisciplinary group including CVICU surgeons, cardiac anaesthetists, respiratory therapists, nurse educators and nursing staff have come together to identify suitable patients for early extubation after coronary artery bypass grafting (CABG). With a focus on patient safety, the group is developing an algorithm for this practice. Currently patients are extubated approximately 9 to 11 hours after surgery. The new benchmark, which focuses on ensuring selected patients are stable, will look at extubating from 4 to 6 hours following CABG. Benefits to patients include earlier mobility and comfort levels. Staff education will take place in November and the anticipated start date is in December 2011.

Draft Nov. 2011