LOOKING AHEAD Peter Munk shares how his support will live on

HEARTS AND MINDS Peter unique Dalglish Clinic takes holistic approach

CARDIAC REGENERATION Munk unlocking the Cardiac heart’s secrets Centre

An innovative spirit and rich legacy of firsts with more to come OFC1 Peter Munk Cardiac Centre November 2015

DM161656_PgOFC_PMCC_FALL_2015.indd 1 15-10-05 10:09 AM A heart for leadership in Peter innovation, technology Munk and treatment. Cardiac Centre Winter 2016

FEATURES 3 CARDIAC SURGERY GAME-CHANGERS The spirit of innovation and the long, rich history of world firsts that define the Peter Munk Cardiac Centre Dr. Barry Rubin, Medical Director, Peter 24 Munk Cardiac Centre, CUTTING-EDGE MEDICAL University Health IMAGING SAVING LIVES Network (UHN) From the increased use of CT scans to diagnose heart and vascular disease to multimodal practitioners with expertise in cardiology, vascular surgery and radiology, PMCC drives advances in medical methods and technology

28 INNOVATION FUND PAVES THE WAY A unique approach at PMCC inspires sta to push new ideas forward that improve patient outcomes and break new ground Life saving. in research 34 COAXING THE HEART Life changing. TO HEAL ITSELF How Dr. Phyllis Billia and her team hope to unlock the secrets of the heart Courage lives here. with genetic reprogramming

INSIDE THE CENTRE We at Apollo Health and Beauty Care applaud the world-leading efforts of the Peter Munk Cardiac Centre in transforming the future of cardiac and vascular 10 Ted Rogers Centre for Heart Research 15 Dalglish Family Hearts and Minds Clinic care for patients across Canada and the world by integrating excellence in 18 CT scanning platform clinical care, research, innovation and teaching. 20 Peter Munk 22 TAVI success 39 National reach 41 Cardiac surgery ON THE COVER 45 Vascular surgery Many hands make up the multidisciplinary 48 Prevention and rehab medical team working together at the Peter 50 Patient journey Munk Cardiac Centre (PMCC) to perform 52 Volunteering coronary bypass 54 Donations surgery on a middle- APOLLO HEALTH AND BEAUTY CARE aged patient with 56 Funding innovation heart disease. Photo by Tim Fraser.

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DM161656_PgIBC_PMCC_FALL_2015.indd 1 15-10-05 3:21 PM DM161656_Pg01-57_PMCC_FALL_2015.indd 1 15-10-05 11:45 AM FIRSTS Peter Munk Changing the way Cardiac Centre cardiac surgery is practised EDITOR-IN-CHIEF Steve Tustin With a history of “firsts” and a spirit of innovation among its staff, patients and benefactors,

ART DIRECTOR the Peter Munk Cardiac Centre has produced a legacy of breakthroughs in cardiovascular Frank Perito medicine. Its pioneering research is influencing cardiac surgery across the world today

FEATURE WRITERS Judy Gerstel by Mary Gooderham Mary Gooderham Marjo Johne Shelley White

CONTRIBUTORS Bryan Borzykowski Jennifer D. Foster Marlene Habib DONORS Jennifer Hough David Israelson Renee Sylvestre-Williams

PHOTOGRAPHY (Is it any wonder why so many world firsts happen Tim Fraser Tibor Kolley at the Peter Munk Cardiac Centre?) Fred Lum Fred Thornhill

GLOBE EDGE

Teena Poirier DIRECTOR, CONTENT MARKETING GROUP

Sean Stanleigh MANAGING EDITOR, GLOBE CONTENT STUDIO

Michael Grier BUSINESS DEVELOPMENT DIRECTOR

Liz Massicotte PROGRAM MANAGER

Sally Pirri DIRECTOR, PRODUCTION, THE GLOBE AND MAIL

Isabelle Cabral PRODUCTION CO-ORDINATOR, THE GLOBE AND MAIL It was a discovery that would change the way surgery is done and transform the future

PETER MUNK CARDIAC CENTRE magazine of cardiac medicine. In 1935, a team of researchers at Toronto General Hospital (TGH) led is designed and produced by by Charles Best, known for his involvement in the discovery of insulin, and Gordon Murray, a The Globe and Mail Custom Content Group. prominent surgeon, developed a purified supply of heparin, a powerful blood anti-coagulant Printing and pre-press by DM Digital+1 that they used for the first time in patients. ¶ Heparin has remained essential in medicine, preventing blood clots from forming in procedures from open heart surgery to organ transplants, and preventing blood clots from enlarging in conditions such as deep vein thrombosis (DVT). And the hospital which now houses the Peter Munk Cardiac Centre (PMCC), has continued its Thank you to our donors who make it possible. record of pioneering research, with a spirit of innovation among its staff, patients and benefactors producing a legacy of breakthroughs in cardiovascular medicine.  petermunkcardiaccentre.ca 416 -340 -3935 www.tgwhf.ca

Winter 2016 3

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“It’s truly amazing the number of patients across Canada and a constant and unrelenting focus at the root of the aorta, the main excellence…Everyone wants to profoundly affecting – indeed, in facilities such as the Multi- of world and Canadian ‘firsts’ around the globe, Dr. Rubin says, on innovation,” he says. blood vessel coming out of the be part of a successful story.” revolutionizing – the diagnosis Purpose Operating Room, named that have happened here,” says with more recent firsts focusing Cardiac surgeon Dr. Tirone heart. It remains the worldwide “We’re moving Dr. Rubin says the centre’s and treatment of cardiovascular for the late R. Fraser Elliott, who Barry Rubin, Medical Director of on complex angioplasty and David has made history himself standard for treating the vision to provide the best disease. left a generous gift supporting the Peter Munk Cardiac Centre stenting procedures that make at PMCC since his arrival in 1979, condition. from big cardiovascular care in the world Linda Flockhart, Clinical its state-of-the art imaging (PMCC) and Professor of Surgery surgery less invasive. with a series of firsts that include Dr. David, 70, who was chief of is shared and supported by Director of the PMCC, who equipment. Three times the size at the University of Toronto. “We’re moving from big a procedure named for him. cardiovascular surgery from 1980 incisions to the “staggering generosity” of began as a bedside nurse in the of a traditional operating room, “We’ve changed the way that incisions to small incisions to no The David Operation, which he to 2011 and has completed more philanthropists such as Peter Cardiovascular Intensive Care the multipurpose operating room cardiac surgery is practised incisions at all,” he comments, pioneered in 1988, preserves the than 15,000 operations, says small incisions Munk, founder and chairman Unit in the late 1980s, says that can handle complex chest, heart everywhere.” noting that the ability to fix heart aortic valve in treating aneurysms that innovation, a collaborative to no incisions emeritus of Barrick Gold “surpassing the boundaries” in and vascular procedures and Dr. Rubin, a vascular surgeon valves, coronary approach Corporation, who, with a history complex areas such as stem other types of surgery, and it was who started there in 1995, says arteries and and global at all.” of heart disease in his family, cell research, heart failure, the first of its kind in Canada. that seminal technologies, aortic aneurysms outreach are made his first gift of $5-million sleep studies, aneurysms The family of Ted Rogers has groundbreaking discoveries and this way means “not encouraged, Dr. Barry Rubin, in 1993. Mr. Munk and his wife, and arrhythmia is “part of our donated $130-million to establish Medical Director, leading figures in cardiac health “patients even in but expected” Peter Munk Cardiac Centre Melanie, established the Peter identity.” Staff take pride in the Ted Rogers Centre for Heart at the PMCC “have influenced their 80s and 90s at the PMCC. Munk Cardiac Centre in 1997; each startling advance and “get Research at the Hospital for cardiovascular care across the can safely undergo He’s brought his their donations to the centre have restless if it’s been awhile since Sick Children, UHN and the world today.” life-enhancing procedures to approaches. Highlights for him totalled $65-million. something new has happened.” University of Toronto. It will allow These include the invention therapies.” 59 centres in 27 include the PMCC’s brand-new Such contributions allowed the Patients are “offered a lifeline” the PMCC to do collaborative in 1950 of the first pacemaker, The almost 1,000 different countries facilities, the development of care centre to develop its unique co- by the centre, but are also critical groundbreaking research in which millions of patients depend staff at the centre, around the world, maps for cardiac conditions and ordinated, team-based approach to its success, she explains, with technologies, processes and on to keep their hearts beating, part of the University marked on a its imaging technologies. “Before and a structured way to manage those in areas such as the adult strategies to fight heart failure, and the first use of hypothermia Health Network map in his office the patient leaves the operating innovation, Dr. Rubin says, congenital heart program, the with a goal of reducing hospital to perform heart surgery in 1953, (UHN), follow three corridor. room, you know how the heart supporting research initiatives by largest in Canada, “advocating admissions for the condition by both led by William (Bill) Bigelow, core operating He was the is working. Talk about quality staff at all levels and studies that for care and pushing us forward. 50 per cent within a decade. a remarkable heart surgeon and principles that Dr. first clinician in assurance.” evaluate new technologies and We’re going through this journey Such external partnerships founding chief of cardiovascular Rubin developed Canada to develop Dr. David would like to see procedures outside the Ontario together.” It’s especially gratifying “expand our brand outside the surgery. The first unit in the world in consultation with a database of advances in areas such as Ministry of Health and Long-Term to see patients who were gravely four walls of the centre,” Dr. Rubin dedicated to the management his executive team: patient care, which genetics and molecular changes Care. The funds have helped ill return for follow-up visits, says. of patients after a heart attack they function in revealed that the in heart disease, noting that the PMCC “attract superstars “walking down the hall with their The centre is “ideally was created at Toronto General multidisciplinary centre’s surgeons the PMCC encourages young from around the world,” creating families, looking totally normal.” positioned to be a world-leader Hospital in 1971. teams, try to use the Dr. Tirone David, cardiac surgery pioneer had “unparalleled researchers to use creativity, endowed chairs and establishing More and more patients are in cardiovascular care,” Dr. Rubin Such developments have best equipment in clinical outcomes” which attracts the donor Centres of Excellence, where undergoing minimally-invasive says, but that requires constant saved and improved the lives the world and “have through their novel community. “Excellence breeds clinicians and scientists are surgery using advanced imaging vigilance and reinvestment.

1988 The first aortic valve sparing operation to treat an aortic root aneurysm (known as the David 2007 First analysis of the 2010 First CorMatrix PMCC 1950 First pacemaker 1977 First description of Operation). Young patients with aneurysms of the fatal heart rhythm ventricular Regenerative Tricuspid Valve Dr. William (Bill) Bigelow was the DNA associated proteins aortic root, the main blood vessel that comes out 1990 First fibrillation in explanted human implant The tricuspid valve first to thread a wire in any human disease 1982 First surgery to map of the heart, are frequently associated with specific practical genetic hearts Ventricular fibrillation is a allows blood flow from the main World though a patient’s Drs. Michael Sole and potentially lethal arrhythmias genetic syndromes. Previously, these test for viral leading cause of sudden death veins in the chest into the right vein to the patient’s C.C. Liew described that did not require an incision in patients were treated with a synthetic infection of the worldwide, and it could not atrium of the heart. CorMatrix is heart and deliver an the role of non-histone the heart This built on previous graft that had a mechanical aortic heart Drs. Michael previously be studied in humans. a regenerative medicine product Firsts electrical impulse that chromatin proteins, work where it was necessary valve, which required lifelong anti- Sole and C.C. With this program, Dr. Kumar that provides a sca old for caused the heart to which are important to cut open the heart muscle to coagulation or a tissue valve with Liew were the Nanthakumar’s group was able the body to recreate a natural beat when its own for gene structure and cure the arrhythmia, and led to limited durability. This operation first to use gene to study the hearts of patients tricuspid valve. More than 100 electrical system had function, in patients the development of non-invasive preserved the patient’s own aortic amplification to who had died from ventricular CorMatrix implants have now failed. Millions of patients with excess heart techniques to treat patients with valve, improved the quality of life identify Coxsackie fibrillation. This led to the been performed worldwide to now depend on pacemakers muscle (hypertrophic life-threatening abnormal heart and is now the established worldwide virus infection of discovery of why some patients repair the tricuspid valve since to keep their hearts beating. cardiomyopathy). rhythms, like ventricular tachycardia. standard for treating this condition. the heart. develop this lethal heart rhythm. PMCC first used this technique.

1950 1960 1970 1980 1990 2000 2010 2015

1935 First clinical 1953 First use of hypothermia for 1962 First unit dedicated to the 1976 First use of real-time 1987 First prospective study of 1991 First aortic valve 2008 First demonstration 2012 First completely intraoperative use of heparin heart surgery During the Second management of patients after ultrasound to assess the severity iliac and femoral artery balloon replacement using the Toronto that sleep deficiency can stem cell transplantation for cardiac Heparin stops blood World War, Dr. Bigelow noted that a heart attack opened with the of narrowed blood vessels angioplasty Narrowing or SPV bioprosthesis St. Jude cause heart disease This repair Previous e orts at stem cell from clotting and soldiers with devastating injuries who support of Mr. Percy Gardiner, Non-invasive ultrasound allows blockage of the arteries to the Medical (in St. Paul, Minn.) explains why chronic lack of transplantation for heart repair after is used worldwide became very cold on the battlefield Toronto General Hospital (TGH) physicians to determine how legs may cause disabling pain acquired the rights to manufacture sleep or shift work is not just a heart attack required processing during the vast could survive their injuries. By lowering Trustee. This unit was established narrowed blood vessels are. The and may lead to amputation. The the Toronto SPV valve, and the associated with an increased of the cells over days to weeks. The majority of open body temperature, at TGH by Drs. Kenneth Brown and PMCC designed and built the first PMCC was the first to establish Toronto General Hospital was the risk of cardiovascular disease, PMCC was the first to harvest, process hearts surgeries. The he was able to Robert MacMillan, focused nurses, device that could record blood that balloon dilation (angioplasty) main site to train surgeons from but can actually cause heart and transplant a patient’s own stem first use of heparin safely stop the physicians and surgeons on the flow in patients’ arteries in real was a minimally-invasive around the globe to learn this new disease by preventing the cells during heart bypass surgery to treat a patient was circulation, a care of patients with disease of the time. These real-time frequency approach that could e ectively technique of valve replacement. daily repair and renewal of directly into the damaged area of by a team led by Dr. discovery that heart (coronary) arteries and was the analyzers are now an integral treat impaired circulation. This valve proved to be better tissues that happen in the the heart, with cell processing taking Gordon Murray and made open precursor to all coronary intensive component of every ultrasound Worldwide, angioplasty is now hemodynamically, but not as heart. place completely within the operating Dr. Charles Best at heart surgery care units in the world today. machine used to assess blood used much more than open durable as stented valves room environment (in a dedicated Toronto Western possible. flow in arteries and veins. bypass surgery to improve the and was discontinued in regenerative medicine facility). Hospital. circulation to the legs. 2005.

4 Peter Munk Cardiac Centre Winter 2016 5

DM161656_Pg01-57_PMCC_FALL_2015.indd 4 15-10-05 11:46 AM DM161656_Pg01-57_PMCC_FALL_2015.indd 5 15-10-05 11:46 AM HIGHRISK FIRSTS

doctors here to agree with the cardiologist at the other hospital,” Maria recounts. Instead, “he told us that if he were going to Her age is 95, “but inside operate on a 94-year-old lady, it was going to be my mom.” “The main risk was that I she is much younger” would have been wrong about her outcome,” says Dr. Cusimano. “Most patients and families Esther Barbieri is the oldest heart patient Dr. Robert James Cusimano has ever can accept death, especially in operated on – and now she’s dancing again! high-risk situations. The more difficult outcome is prolonged or permanent disability,” he says. “In her case, any neurological impact such as stroke or memory loss would have been the absolute worst case. That Unquestionably, the most striking on her own after becoming a is why we surgeons are so thing about Esther Barbieri is widow in 1969. She immigrated happy when our patients wake how young she looks. A youthful, to Canada at the age of 66 up normally after an operation, radiant glow sweeps across her and, outside of regular visits whether we show it or not.” elegant face and belies her age. to her home country, lives in Esther became the oldest She is the matriarch of a the Greater Toronto Area with patient Dr. Cusimano has huge, close-knit family – nine her youngest daughter. ever operated on. Her overall children, 30 grandchildren, 46 Her journey to the Peter good health, physical strength great-grandchildren, five great- Munk Cardiac Centre (PMCC) and heart health history – great-grandchildren – scattered came almost by accident. all positives – were key to across three different continents. In July 2014, she had a heart Dr. Cusimano’s decision. A native of Peru, Esther has attack – the first health scare The Barbieri family waited, been a picture of health for of her life. Visits to two other wondered, wished and paced Esther Barbieri was almost all of her 95 years. Active, hospitals eventually led to her during the 3.5-hour procedure, turned away for surgery independent, a lover of dance being fitted with a stent. Things which happened on November by other hospitals and travel, Esther is also an avid improved, but only for a short 26, 2014. “We were drinking before meeting Dr. Robert James (R.J.) walker – known to outrun just time. She had several worrisome coffee like crazy,” remembers Cusimano, cardiac about anyone to catch the bus. episodes in the months to Maria, tears welling. surgeon at the Peter She was a seamstress in her follow, including fainting spells “When Dr. Cusimano came Munk Cardiac Centre. homeland, raising her children and shortness of breath. out, he came out with both his “The cardiologist at the thumbs in the air, smiling. We other hospital told us she knew right away everything couldn’t be operated on, that was okay,” says Maria. her heart had been damaged,” “He told us, ‘Your mom is 94, says Maria Barbieri, the eighth but inside she is much younger.’” of Esther’s nine children. “Now that her heart is fixed, “He was going to prepare she faces a prolonged survival a report to let doctors here [at with a good quality of life. At that PMCC] know that there was age, quality of life is our primary not much to do. He wouldn’t goal. She will likely not die from touch her because of her heart disease, so she may live for age. It was devastating. It many years,” says Dr. Cusimano was like all the doors were “There is no word to describe closed,” recalls Maria. how grateful we are,” says Maria. Esther’s valve was in urgent “Total elation,” adds Maria’s need of replacement. She went husband, John Simpson. into cardiac arrest during one In January 2015, Dr. Cusimano hospital visit, but she came back. gave Esther the green light She was referred to the PMCC to go dancing – one of her in November 2014, where doctors passions. And just three months determined she wouldn’t be a after surgery she was in Lima, candidate for a Transcatheter Peru, where she stayed until Aortic Valve Implantation Mother’s Day to celebrate (TAVI) procedure. The race to with family there. Her next big find another option ensued. adventure? Esther has been Enter, Dr. R.J. Cusimano, a planning to travel to Italy to cardiac surgeon at the PMCC. visit Maria’s three brothers. In tandem with a medical Adds Dr. Cusimano: “She is team, he decided surgery supposed to send me a postcard was the only option. on her 100th birthday. That “We were expecting may very well happen.”

6 Peter Munk Cardiac Centre Winter 2016 7

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Congenital Cardiac Centre. “We have a good rapport,” says Maria, a mother of three. “The joke is, [Dr. Oechslin] always Mustard Baby has twice wants me to have the stress test, and I always refuse.” “We see Maria once a year defied the odds to monitor her heart function and heart rhythm,” Dr. Oechslin says. “Her lifestyle is healthy, Marina operator Maria Willing pays careful attention to she is physically active and she her heart health with the help of congenital heart disease specialists watches her diet and her weight. She also has good genes.”

There is little doubt that Maria She had developed atrial FEELING TRULY BLESSED Willing has lived up to her fibrillation and was experiencing Today, Maria and her husband, name throughout her life. irregular heart rhythms. She knew Brad Willing, own and operate a Born with “blue baby something was terribly wrong. marina in Haliburton, Ont. Open syndrome” in June 1961, Maria Maria vividly recalls sitting in from April to October, Maria was given six months to live. her Renfrew kitchen: “I just sat manages a busy convenience The syndrome is also known as there thinking, ‘I’m going to die.’” store situated in the marina. the transposition of the great Not one to give up, but feeling She attributes her youthfulness arteries – a form of cyanotic heart she had nowhere to turn, she to the careful attention she disease where the pulmonary called the Hospital for Sick pays to maintaining her health. and systemic circulation run Children. “I told them I had had “In August 2014 I got sick, and parallel instead of in a series, the Mustard Procedure. They I thought I was going to have a resulting in a low blood-oxygen immediately said, ‘Can you get heart attack,” she says. “I didn’t level. She had two holes made here tomorrow?’” Maria drove to want to take the chance, so my into her heart at only three Toronto, only to realize they were friends graciously offered to weeks of age to allow mixing referring to the nearest children’s lend their time to help out.” Maria Willing of the blue (non-oxygenated) hospital – the Children’s Hospital Maria and Brad often sneak in remembers sitting and pink (oxygenated) blood. of Eastern Ontario in Ottawa. an evening cruise aboard their in her Renfrew, Ont., favourite pontoon in the summer. kitchen at age 30 A MUSTARD BABY THE WRONG WAY, BUT “I like the calmness the water thinking, “I’m going to Blue babies had a less than THE RIGHT CHOICE makes me feel,” she says. “I have die”. As a child, her 20 per cent survival rate back “I went the wrong way, but all the time in the world to enjoy life was saved by a then, but Maria defied all odds, made the right choice,” says the water. We are truly blessed.” surgical procedure growing stronger each day. Maria. “They saw me at Sick performed by Dr. On May 16, 1963, Maria made Kids and immediately referred SPECIAL EXPERTISE William Mustard. She has since been medical history and became the me to Dr. Peter McLaughlin at In the 1980s, the Mustard followed by adult poster girl for the groundbreaking Toronto General Hospital.” Procedure was replaced by the congenital heart surgical procedure performed by Maria had to be cardioverted Jatene Procedure, the arterial specialists at the Peter Dr. William Mustard at Toronto’s three times, which involved switch procedure to repair Munk Cardiac Centre. Hospital for Sick Children. A converting an abnormally complete transposition of the heroic repair to the fast heart rate (arrhythmia) great arteries. All survivors of the transposition of the great to a normal rhythm through Mustard (Jatene) Procedure – arteries that allows electricity or medication. like all patients born with oxygenation of the blood Then she had a stroke, congenital heart disease of in the lungs, it became but within a week she was moderate or great complexity – known worldwide as the fitted with a pacemaker. had to be transferred to adult Mustard Procedure. Maria attributes her survival congenital heart disease By 1987, the procedure to the fine work of the doctors centres with special expertise. had saved more than 500 at the Toronto General Hospital. According to Dr. Oechslin, babies at the Hospital Now 54 years old, she attends “patients with a Mustard for Sick Children and annual follow-ups at the Toronto Procedure are at risk for long-term thousands worldwide. Congenital Cardiac Centre complications and require long- Survival to adulthood at the Peter Munk Cardiac term follow-up in a specialized increased to 80 per cent Centre (PMCC). “I always take centre. Fifty per cent of patients for these “Mustard babies.” a few days off and go on a with a Mustard Procedure who The hospital lost mini vacation to Toronto with graduated from the Hospital for touch with Maria over my girlfriends,” she says. Sick Children are not associated the years – her family Maria has developed a with an adult congenital heart lived in Whitby, Ont., strong relationship with her disease program and are lost then Renfrew, Ont. It former cardiologist, Dr. Vera to follow-up. We don’t know wasn’t until she was 30 Rose, who retired about three where they are and how they years old, facing another years ago, and now she’s are doing. Only an emergency complication, that she was under the care of Dr. Erwin brings some of them back to drawn back to Toronto. Oechslin, director of the Toronto the health-care system.”

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DM161656_Pg01-57_PMCC_FALL_2015.indd 8 15-10-05 11:47 AM DM161656_Pg01-57_PMCC_FALL_2015.indd 9 15-10-05 11:47 AM by 50 per cent over the next and the late Ted Rogers Cardiac Centre], and we’d like to 01 Dr. Heather Ross says putting decade. himself for understanding reduce it to five or six. It feels like fewer people in hospital for “Heart failure is an epidemic,” that establishing the research the right time to make all these cardiac treatment will mean better she says. “There are about half centre can address all three things happen.” treatment for everyone long term. a million Canadians with heart issues. She agrees that, for all Dr. Ross says that since the failure. About 50,000 new cases the Rogers’ accomplishments in Ted Rogers Centre for Heart 02 Dr. Vivek Rao, Division Head, are diagnosed each year, and the communications and business, Research was established last Cardiovascular Surgery (right) average life expectancy for those in a few generations the name November, “I find myself waking and the team perform a coronary diagnosed is about 2.1 years, a may be best remembered for the up at three in the morning with bypass. little longer for women.” family’s contribution to heart ideas.” She smiles at the notion Putting fewer people in the research. that she develops ideas the same 03 Being bold and aspirational hospital for treatment will mean “That would be nice,” Dr. Ross way as Rolling Stones guitarist are the goals, says Dr. Mansoor better treatment for everyone in says. Keith Richards, who composed Husain, IInterim Director, Ted the long term, she explains. “I had the privilege of caring Satisfaction after waking up in Rogers Centre for Heart Research “Hospitalization is one of the for Mr. [Ted] Rogers. When we the middle of the night. (and Senior Scientist, Toronto markers of poor prognosis. As talked, he always wanted to talk Then Dr. Ross pulls out a chart, General Research Institute). much as we know that we do about ‘what’s next’ – that’s what amazing, good work in hospitals, he was like,” she says. The Rogers if you’re a heart failure patient family’s $130-million donation coming to the hospital, it’s a toward creating the research marker that you’re in some centre is the largest single trouble.” monetary gift ever made to a Treating hearts in a hospital Canadian health-care institution. is also more expensive and less Top-quality research and cost-effective than prevention attracting the world’s best and outpatient treatment. A experts to work here can lead to 50 per cent reduction is “a more effective treatment, more reasonable expectation of what’s efficient use of health-care funds preventable,” she says. and better measurement of what “There’s a convergence. We treatments work best and what have an epidemic. We have breakthroughs are on the way. government trying to deal with In addition to the target of costs and, at the same time, we reducing hospitalizations by 50 have the issue of benchmarking per cent over a decade, “I added for what we should be doing to the goal of reducing length of stay ensure the standard of care,” Dr. by 20 per cent,” Dr. Ross says. Ross explains. “On average, the length of stay She credits the Rogers family is about 10 to 12 days [at the

01

Dr. Heather Ross loves talking started. That’s why it’s the Centre about the heart and all its for Heart Research. I think A heartfelt medical machinations and ‘heart function’ is a reasonable mysteries, but there’s one term term,” she adds, though she she’s not fond of – “heart failure.” acknowledges “that the global “It’s a terrible name,” says community still calls it ‘heart mission Dr. Ross, Cardiologist, Peter failure.’” Munk Cardiac Centre, and While the world-respected Medical Director, Cardiac cardiologist believes that Dr. Heather Ross and the Ted Rogers Transplant Program, Toronto the terminology matters, Dr. Centre for Heart Research aim to end an General Hospital, and a driving Ross will relent and use the force at the Ted Rogers Centre not-her-favourite term to talk “epidemic”, cut hospital stays for Heart Research. about her goal — actually, the “Really, heart failure implies research centre’s goal – to reduce 02 03 By David Israelson that you’ve lost before you hospitalization for heart failure

10 Peter Munk Cardiac Centre Winter 2016 11

DM161656_Pg01-57_PMCC_FALL_2015.indd 10 15-10-05 11:47 AM DM161656_Pg01-57_PMCC_FALL_2015.indd 11 15-10-05 11:47 AM Since 1937, Export Packers has been building its international reputation “What’s really fun for innovation and quality in the import/export and marketing of food is bringing people showing how to streamline medications that address specific scanning, so the medical team commodities. Headquartered in Brampton, just outside of Toronto, Canada, patient care, which she, too, functional problems with more can see images of the patient’s we operate five key business segments: International Trading, Domestic together in the conceived in the middle of the precision than ever before. heart while they work. Food Service, Retail, Asian and Fresh Seafood. night. Doctors aim to be able to take The next step is to use a same room who “I had it laminated, so I could cells from a patient’s skin or hologram, now being tested in show it to everyone at the centre, blood and grow a “piece of your Israel, that produces a three- We continuously strive to be a premiere wouldn’t have and we could discuss it,” she says. heart” in a dish, which can be dimensional image of the heart diversified international food company, delivering gotten together if The research centre’s blend used to replace worn-out parts, in the air above the patient on a commitment of quality, price and a level of of expertise and enthusiasm is he says. “This is personalized the table. Doctors can measure customer service no one else can match, in a it weren’t for the already leading the way toward medicine,” Dr. Husain explains, different-sized stents using the culture that is performance driven. breakthroughs that still seem taking account of the individual hologram to see which one fits Rogers’ gi
. We like science fiction, though they variables in everyone’s makeup best, without invasive trial and are real. and minimizing the chance of error. probably should “We were told to be bold, be rejection after a transplant. The technology is breathtaking, have gotten aspirational, and that’s what Dr. Barry Rubin, Medical but perhaps what’s most we’re doing,” says Dr. Mansoor Director of the Peter Munk important is how the centre together and now Husain, Interim Director, Cardiac Centre, is similarly encourages collaboration and Ted Rogers Centre for Heart excited about the breakthroughs teamwork, Dr. Ross says. we are, and all of a Research (and Senior Scientist, taking place already. “What’s really fun is bringing sudden people are Toronto General Research He conducts tours at the centre, people together in the same Institute). showing three operating rooms: room who wouldn’t have gotten talking, and ideas For example, researchers one from a few years ago that’s together if it weren’t for the JEFF & HONEY RUBENSTEIN are gaining new insights into well-equipped with diagnostic, Rogers’ gift. We probably should are bouncing,” diastolic heart activity, which as well as surgical, equipment; have gotten together and now occurs “when the heart pumps a newer one with more we are, and all of a sudden Dr. Heather Ross, properly, but it doesn’t relax sophisticated imaging tools; and people are talking, and ideas are AND FAMILY Cardiologist, Peter Munk Cardiac Centre, and Medical Director, Cardiac Transplant properly,” he says. This is the newest state-of-the-art room bouncing,” she says. Program, Toronto General Hospital leading to new treatments and that integrates ultra-fast body “And it’s great.” PROUD SUPPORTERS OF

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IS PROUD TO SUPPORTIS PROUD TO SUPPORT

THE QUALITYTHE QUALITY AND INNOVATION AND INNOVATION OF THE OF THE

PETERPETER MUNK CARDIAC MUNK CENTRE CARDIAC 01 CENTRE

numerous health issues, including palate problems, congenital heart The holistic defects, psychiatric issues such as anxiety and/or schizophrenia and learning disabilities. It affects one in 2,000 infants, and, until approach to 22q recently, trying to get a diagnosis, especially for adults, has driven families into a tailspin of years A world-first facility treats the complex, multisystem health needs of adults of doctors’ visits before getting with this little-understood genetic disease an accurate diagnosis and a treatment plan. But, instead of the patient going to see different By Renee Sylvestre-Williams doctors in different locations on different days, the doctors come to the patient and do all their “I really like going because you a home. There is carpet on the dedicated to the adult treatment tests and checkups at the clinic. can get all your tests done in one floor, and the waiting room looks and research of a little-known “We call it the diagnostic place,” says Genevieve Dalglish. more like a living room with genetic disease called 22q11.2 odyssey,” says Dr. Anne Bassett, “I’m treated like gold. I like my a light-grey leather sectional Deletion Syndrome (22q11.2DS), Director of the Dalglish Clinic. doctors very much.” Ms. Dalglish couch. The lights are warm, not colloquially known as 22q. She explains that it can take years is talking about the Dalglish harsh, and the reception desk is It was previously known as or even decades before patients Family Hearts and Minds Clinic neatly tucked away. Add some DiGeorge Syndrome or velo- and their families are given a Energy Structural Mechanical Energy Structuralfor adults, at the Peter Munk Mechanicalwarmth with wood accents, and cardio-facial syndrome, and it’s diagnosis of 22q. For adults with Cardiac Centre (PMCC). the Dalglish Clinic feels more like caused by a missing piece (the 22q, there was a desperate need Unlike traditional clinic decor, a comfortable, well-appointed “deletion” in 22q11.2 Deletion for a centralized place to work there is very little metal. Instead, condo than a medical clinic. Syndrome) on chromosome with patients and families. when you walk in, the foyer looks The first of its kind in the 22. As a result of this deletion, Camilla Dalglish, who www.weldedtube.comwww.weldedtube.com more like the entranceway of world, this integrated clinic is patients with 22q can have spearheaded the donation

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DM161656_Pg01-57_PMCC_FALL_2015.indd 15 15-10-05 12:24 PM DM161656_Pg14_PMCC_FALL_2015.indd 14 15-10-05 3:28 PM symptoms, even in the same often 17 years old, get to see the other [from SickKids], which, I here, after they leave SickKids, McFarlane and colleague Lisa family, which can make it very clinic, are welcomed by Radhika think, is a benefit because they because they’ve met the person Palmer will e-mail and speak difficult to detect and treat. Sivanandan, the Patient Flow know they’re not alone, and that who is going to talk to them on with patients, sometimes on a “We think this is because of the Co-ordinator, and are offered a is really good,” says Dr. Bassett. the phone.” daily basis. Registered dietitian complexity of the condition and healthy snack. They are examined “For their next visit, they know The clinic also provides social Samantha Cooper works with the the variability of the condition by Dr. Erik Boot, a clinical where to come, they've seen workers, a registered dietitian, family and patients on dietary and the lack of recognition by and research Fellow from the everyone once and there’s some psychiatrists, endocrinologists, plans, part of the preventative doctors,” says Dr. Bassett. Netherlands and a physician for development of familiarity. It’s neurologists and genetics treatment of 22q. This includes This lack of knowledge can harm people with intellectual disability. much more likely they’re going expertise for the patient and ensuring patients have enough undiagnosed patients. Christine “They get a chance to know each to come to their appointments their family. Everyone is able to calcium and vitamin D (calcium Grant knows this first-hand. talk with each other face to face, deficiency is a symptom of 22q) to Her older brother, Henry*, now and all the patient files are under prevent seizures. 51, spent 20 years in and out one roof. This creates a holistic For Ms. Dalglish, the experience of hospitals. He was diagnosed “We’ve developed a wonderful approach to treatment, not just has been positive. “It’s less with schizophrenia, had corneal for the patient, but also for the stressful. I can make friends. I transplants and intermittent transition program with caregivers. met my best friend at the clinic.” stuttering and dragged his left “Families are overwhelmed,” There is still a lot of work to be foot. Ms. Grant said that in the 20 the Hospital for Sick Children. says Pam McFarlane, a social done, says Dr. Bassett. “To this years of trying to get a diagnosis worker with the clinic. “It’s hard day, we just don’t have a ‘What is for her brother, many doctors They start out over there, and our to do your own research, and we 22q’ message for the public. And a thought her brother’s symptoms sta members go over there and can help with developmental and lot of education is still needed for were behavioural versus medical. financial resources.” This personal doctors and trainees. It’s better “It took a long time to get walk them across the street to touch extends beyond the than it was 20 years ago, but it’s specialist treatment,” she says. monthly or yearly appointments still an uphill battle.” “Some physicians were completely Toronto General.” and family meetings. It’s not ignoring his needs.” It wasn't Dr. Anne Bassett, unusual for patients to e-mail *Name changed upon request. until she met Dr. Bassett at a Director of the Dalglish Family Hearts and Minds Clinic or call the clinic to check in. Ms. conference in 2010 that Henry got a genetic workup, with Dr. Bassett, that revealed a diagnosis of 22q. Henry became a patient © 2015 Ernst & Young LLP. All Rights Reserved. ED00 when the clinic opened at Toronto General Hospital. Ms. Grant has seen improvement and feels the 02 clinic, the team and the treatment may have saved her brother’s life. “I truly believe he would have to create the clinic, knows died by now.” No sick days. this first-hand. Her daughter While the Dalglishes were on Genevieve was diagnosed with their personal journey with their 22q 14 years ago by Dr. Bassett. daughter, Mrs. Dalglish asked That would be better. The Dalglishes had been on that Dr. Bassett what they did at There’s nothing more important than good diagnostic odyssey, testing Ms. the Hospital for Sick Children Dalglish’s hearing, adjusting her (SickKids). Dr. Bassett replied health. At EY, we’re proud to support the medications, getting on the right that while SickKids diagnosed Peter Munk Cardiac Centre and their efforts diet and exercise plan, all to help and worked with children and to make sick days a thing of the past. her. Mrs. Dalglish says, “It was their families with 22q, there Because helping people live healthier lives just endless, going to different was a need for an adult clinic. means helping to build a better working world. specialists.” Ms. Dalglish had two Thanks to the Dalglish family, the heart operations and was seeing clinic officially opened two years Visit ey.com/ca/pmm. a psychiatrist weekly. “She was so ago. What makes the clinic the ill, she must have been through first of its kind is the integrated 15 types of meds to try to find the treatment it provides to its right one, and the public doesn’t patients and the ability for them 03 realize that the families and the to transition from children to poor patients are going through adults without loss of care. this endless in and out, in and out “We’ve developed a wonderful 01 Genevieve Dalglish 02 Christine Grant holds 03 Dr. Anne Bassett, of hospitals.” transition program with the (left) and her mom a picture of her brother seated at the right and The reason for these medical Hospital for Sick Children. They Camilla praise the Henry. She says the pictured here with her odysseys is because it’s not an start out over there, and our staff positive, friendly clinic may have saved team, saw the need for easily recognized syndrome members go over there and walk atmosphere at the clinic. his life. a centralized place to among medical staff, much them across the street to Toronto work with families and less the public, and no two General,” explains Dr. Bassett. patients with 22q. patients with 22q have the same The new patients, who are

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DM161656_Pg02-56_PMCC_FALL_2015.indd 16 15-10-05 11:35 AM DM161656_Pg02-56_PMCC_FALL_2015.indd 17 15-10-05 11:35 AM radiation dose even below the low level it had been at before, so Striking gold in in some patients by 20 to 30 per cent,” says Dr. Paul. He believes research and clinical tools like the twin CT platform Twin state-of-the- cardiac care also help empower patients. “The art CT scanners old idea of the patient coming have allowed the into hospital and having their Peter Munk Cardiac How state-of-the-art twin CT scanners are revolutionizing treatment without any meaningful Centre to “rapidly put the treatment and management of heart patients interaction with the medical cutting-edge research team is gone. We very much protocols into clinical embrace patients being involved By Marlene Habib care as soon as they in their management, so anything are validated,” says that we can use to help them Dr. Narinder Paul. understand their disease more He calls it a “huge” A world-first project involving adjacent suite. The JDMI carries separate CT scanners. The CT fully, particularly through use of advancement in the twin state-of-the-art CT scanners out some 1,800 cardiac CT scans a scanners are not necessarily the CT images, is golden.” study and care of has only been in gear at Toronto year, Dr. Paul says. same age or model, or from the For patients like Amy Shannon, patients with heart General Hospital (TGH) since Researchers have conventionally same manufacturer, and they whose family has a history of disease. April 2015, but this novel used CT scans to evaluate the are usually located in different heart disease, waiting weeks for approach to conducting research anatomy or structure of organs areas, with different imaging research and diagnostic results that can be used immediately to such as the heart, lungs and brain. protocols. In this scenario, can be stressful and, possibly, life- help patients is already striking But the focus has progressed once a CT research protocol threatening. cardiac care “gold,” according to to developing techniques that is validated, it would require Ms. Shannon, a 51-year-old TGH’s head of cardiothoracic demonstrate how these organs further modification to be used Lindsay, Ont., resident, has imaging. function and, more recently, on the clinical CT scanner. This benefited from other forms of This “research-to-clinical to investigating how they are process could take days or weeks diagnostic and clinical care at platform” using two special perfused. The aim of analyzing to translate those protocols from the centre since November 2012, identical scanners – operated organ perfusion (blood flow) is the research scanner to the clinical when it was determined she has from a single control room – has “to pick up disease before it would scanner, Dr. Paul says. ALCAPA, a congenital heart proved to be “huge” in advancing otherwise be detected and to In the case of the twin CT defect whereby the left coronary the study and care of heart earlier detect the disease response scanners, if the new CT protocol artery, which carries blood to patients in the short time it has to various treatments,” Dr. Paul developed in the research scanner the heart, is attached to the been in place at the Peter Munk adds. does not need to be peer reviewed, pulmonary artery, instead of to Cardiac Centre (PMCC) at TGH, ‘These CT scanners allow us to then it can be transferred to the the aorta. Since having open heart says Dr. Narinder Paul, Division look at disease in a different way clinical scanner and put to work surgery in March 2013 at TGH Chief, Cardiothoracic Radiology, to traditional methods, and the on patients – almost instantly, he to repair the defect, Ms. Shannon University Health Network partnership between the Peter says. has made frequent follow-up (UHN), and a world-renowned, Munk Cardiac Centre and the Since April, when the project visits to the adult congenital heart partnership with the JDMI and pushing the envelope of how able to give much greater accuracy Mr. Dettmann. British-educated radiologist. Joint Department of Medical got underway, “we’ve reduced the clinic. Although she hasn’t needed the centre that aims to make quickly we are able to capture and speed, so you can assess But the company is also looking The centre specializes in Imaging has ensured that the to get involved in the twin CT imaging procedures more “patient an anatomic picture of the things now you absolutely couldn’t at preparing for future health-care scientific research and innovative TGH is the only place in the world project , she sees it as an exciting friendly.” human body, and that’s of critical do five years ago,” says Dr. White. needs, and that’s where important patient care carried out by that has this particular set-up,” development from a patient This is what a patient with a importance in cardiac imaging. Dr. Paul adds: “With a cardiac medical partnerships – multidisciplinary teams. The joint, he says. perspective. possible heart condition can Imagine the heart as a piece CT, because patients may be such as the one with the Joint multiyear project was unveiled “Having these advanced CT “These new “I think it’s excellent,” says the expect to experience as part of of muscle beating and moving nervous, the heart rate can be Department of Medical Imaging this spring within the Joint units side by side allows us to machines are former teacher. “With something the joint CT imaging project: rapidly in three dimensions, quite fast. Therefore, we often and the Peter Munk Cardiac Department of Medical Imaging rapidly put cutting-edge research like my congenital heart defect, The patient undergoes a CT scan, and the inherent challenges in have to temporarily slow the heart Centre – come into play, he says, (JDMI) at the University Health protocols into clinical care as soon able to give for instance, because it is so rare, during which the dye injected capturing anatomic details of this down to 60 beats per minute adding that there currently are Network (UHN). as they are validated – boom! it would put the information out into a vein will go to wherever the complex anatomic structure in a using medication. With these no plans to put this research-to- Dr. Paul believes that, over time, And that’s huge. As we research, much greater there more quickly and can be blood goes – if there’s a restriction single snapshot in time,” says Dr. new machines, because the X-ray clinical platform anywhere but the what’s being done through the evaluate and validate performing linked worldwide, which would to blood going into a certain area, Lawrence White, Radiologist-in- tube and detector spin that much PMCC. project – a collaboration between cardiac CT scans at very low accuracy and be amazing because they [the that dye will not highlight as well Chief of the Joint Department of faster, the heart rate can be as “What you need is the physicians the Peter Munk Cardiac Centre, radiation doses, the technique speed, so you researchers and clinicians] can as it would in areas where there Medical Imaging, a joint program high as 80 beats per minute, and telling you: what the headaches JDMI at the UHN and Toshiba becomes more available for at-risk compare their information,” she is no restriction. The image data of radiology at Mount Sinai we can still obtain wonderful are you have now; what the Medical Systems, Japan – will people. Imagine a person whose can assess notes. then goes to a powerful computer Hospital, the University Health images at a fraction of the solutions are you’re looking for; lead to a “fundamental change father and brothers died at a “Now they can check anybody and a software program, where Network and Women’s College radiation dose that is used in older what things we need to do in in patient care and patient young age of a heart attack, and things now with families with congenital the heart can be turned in three Hospital. CT scan units.” five to 10 years; and what kinds management.” every time they get a squeeze in you absolutely heart defects, see it right away and dimensions to look at every vessel, “When trying to assess So where does the future lie for of diseases are increasing,” Mr. The project involves using two their heart they are wondering, fix it right away.” no matter how small – both in and something as small as the imaging? Dettmann says. “Definitely, heart Aquilion ONE ViSION Edition ‘Am I next?’ Now we have a CT couldn’t do Jens Dettmann, general manager around the heart. This determines coronary arteries, the vessels that Toshiba of Canada, for one, is disease is one of the top two CT scanners, which Toshiba of scan-based test that can tell with and vice-president of Toshiba how blood is flowing into that supply blood to the heart muscle, focusing on “volume” scanners – diseases in the world [along with Canada Limited installed in a a very high degree of accuracy
ve years ago.” of Canada, Medical Systems area, thus seeing if there’s any to be able to see and assess these ones that capture 3-D and even cancer], so having a solution to single setting. One suite houses whether or not someone has Division, says the total cost of the disease, the extent of the disease structures you need a certain 4-D images that cover more area the variety of heart diseases, and a clinical CT scanner, the middle coronary artery disease.” Dr. Lawrence White, two CT scanner project is about and whether it requires any amount of resolution to your and in less time than conventional developing them together with Radiologist-in-Chief, area acts as a joint control room Traditionally, research and Joint Department of Medical Imaging, $3.6-million. He says the project intervention. images; they need to be sharp and scanners, meaning less radiation clinicians, is a very important part and the research scanner is in the clinical work is performed on University Health Network is a continuation of a decade-long “These new scanners are accurate. These new machines are exposure and quicker results, says of our business.”

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DM161656_Pg01-57_PMCC_FALL_2015.indd 18 15-10-05 12:25 PM DM161656_Pg01-57_PMCC_FALL_2015.indd 19 15-10-05 12:26 PM Why is philanthropy so What’s your opinion of just able to help create something – multiples of that have come in important to you? Canada’s health-care system? outstanding for Canada and for from other individuals. Friends Once you’ve made money, you You may think I’m just saying Toronto and, at the same time, of mine, not friends of mine, old have to make a decision within this, but the more you travel, help the maximum amount of patients, and I say, ‘Wow!’ So we yourself around what you and the more you meet friends Canadians. started something, but it’s really intend to do with that money. from Europe and from America now a self-generating process. I didn’t want to create a bunch and Latin America – and in my In 2010, you gave $18-million to But anyone can write a cheque of rich and spoiled children and business and in my life I do an fund five chairs in the hopes of when they’re wealthy. It’s what grandchildren with lots of cars awful lot of travel – the more you keeping Canadian talent here is done with that cheque that and big homes. It gives you more appreciate how spectacular the and attracting global talent to matters. I didn’t select [Dr.] satisfaction when you look back health system is in Canada. So Toronto. Why is curbing “brain Tirone David or Dr. Bob Bell Inside at the end of your life and see that became my main motivating drain” something you wanted [former UHN CEO] or Dr. what you accomplished in the force – to contribute to the to take on? Barry Rubin [Medical Director community and in society. health-care system. Before 1993, That was actually an important of the PMCC]. I didn’t select the As well, I came here as an there was no cardiac centre, so part of our initial presentation equipment that’s been bought. the immigrant. I went through my initial gift helped establish it. years ago. Dr. Tirone David, who I didn’t design the layout of the the war and was taken in by is now a world-recognized leader fantastic operating facility they Canada. I have enormous Has heart disease aected your in valve replacement, would have have. What the money has done appreciation for what Canada own life? been forced to go to America to is allow all of the people who mind of as a country has to offer the My uncle, who brought me to do his work. However, 15 years work on cardiac cases to focus in world. Canadians are respected Canada, died of heart failure. I ago we gave him $5-million to this area because it had funding as human beings, mostly because had a procedure several months do the research that led to his that other departments didn’t we have a tradition of self-help ago – I had blocked valves. life-saving work. He said to me have. Munk and civic responsibility to a It was an operation with a that he would have been forced much greater extent than any brand-new methodology called to move himself and his wife and What does the future hold for In this Q&A, the Peter other community. I came here, Transcatheter Aortic Valve kids to the Cleveland Clinic if it the PMCC? and I was given it all, with all Implantation (TAVI). It’s a major weren’t for these funds. I can see the Cardiac Centre Munk Cardiac Centre’s of the fantastic benefits and breakthrough. You can now do You can’t expect public health becoming the symbol of namesake talks about inclusiveness and opportunities valve repair operations without to do this. It looks after you when excellence. People will think of it to create a fulfilled life. So I want open heart surgery. That saves you break your leg. New research when they think of Toronto, just why he’s given so much to to try and reciprocate. an enormous amount of money is costly; it needs lab space and like people think of Rochester cardiac research, his own and reduces the time people have travel and access to information [, Minn.,] when they think of Why did you make health to spend in intensive care. I got and many other things. That’s the Mayo Clinic or they think heart surgery and how his care, and specifically cardiac out in two or three days. It was a where private funding can come Houston when they think of the support for the centre will medicine, a focus of your spectacular thing. in. Here’s another example. [Dr.] [MD] Anderson Cancer Center. giving? Peter Pisters is the new President There’s no question that as the continue after he’s gone When I made money, I selected What other innovations are you and CEO of the University population increases, health three priorities [for giving], excited about? Health Network. He was born issues will become a bigger By Bryan Borzykowski but No. 1 was the one I thought I have to be frank: I’m not and educated in Canada and and bigger priority, and I think would be most universally helpful a medical man, and I’m not then went off to America. He’s that every institution, whether When Peter Munk donated $5-million to Canadians, regardless of that familiar with specific a brilliant guy and became a it’s a university, a business or a to Toronto General Hospital for nationality, ethnicity, age, religion breakthroughs. All I know is real big shot at the Memorial hospital, has to identify an area of heart-related research in 1993, the and culture. That’s health. We that whether I’m in Quebec, Sloan Kettering Cancer Center priority where they want to excel. legendary Canadian businessman all have health issues, so this is Vancouver, New York or and at the University of Texas You can’t excel across the field, never thought he’d need to avail the something really meaningful. In wherever, people talk quite a MD Anderson Cancer Center. but you can excel if you focus. services of the cardiac centre that now the early 1990s, I sat down with bit about health. It used to be, Now’s he’s back in Toronto. So bears his name. But there he was, in the chair of the hospital and the ‘How is your skiing?’ or, ‘How we’re now able to recapture lost Will you continue to fund the November 2014, at the Peter Munk board and I looked at various was the cocktail party?’ But now talent, and that’s entirely due to Centre? Cardiac Centre (PMCC), undergoing options, and I was told that it’s health. I am excited about what they see as the large influx There’s no doubt that we’ll be a procedure to unblock the main valve cardiac issues were the largest Toronto and how the city is of funds that enable them to do here. I said that when I made my in his heart. If this were a few years cause of death. They felt that with excelling and becoming known things here. first speech. This is priority No. ago, Mr. Munk would have had to new facilities and new increasingly globally for its 1, and we’re not going to walk have open heart surgery and stay in equipment – and funds outstanding contribution Do you see other successful away. Our support for the [Peter the hospital for weeks, but, thanks to that could attract to health care and in Canadians donating funds to Munk] Cardiac Centre is going to the $65-million or so he’s donated to global talent – the field of cardiac health care in the same way be there in perpetuity. After my the centre over the last 22 years, a new that they could research. It’s people that you have? death, when I’m not around to procedure was developed that allowed make a major like Dr. Tirone I can only tell you that every time make decisions, my foundation, him to leave the hospital within three improvement. David and others I go into a meeting at the Peter which is the main beneficiary days. It remains an who are developing Munk Cardiac Centre, I look at of my estate, will continue this. The founder and chairman emeritus issue today. new methodologies, the wall of donors. I sit down It’s already negotiating with the of Barrick Gold Corporation shares who are doing the with the head of the foundations, [Peter Munk] Cardiac Centre for his perspective on philanthropy, heart work. I’m and I see that because of what ongoing support. disease and what will happen to his we’ve done, starting in 1993 –

donations after he dies. THE CANADIAN PRESS/Chris Young we’ve put out around $65-million

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DM161656_Pg02-56_PMCC_FALL_2015.indd 20 15-10-05 11:36 AM DM161656_Pg02-56_PMCC_FALL_2015.indd 21 15-10-05 11:36 AM Heart surgery in Though TAVI procedures had few years ago, so I thought to all,” he says. “I was surprised it been happening at the centre myself, ‘There’s no more risk was over in about half an hour. and elsewhere for a few years, to that than getting a stent I heard that, normally, the way awake patients: says Dr. Rakowski, at the time it put in,’” says Mr. McCallum. they were doing it before, you was not yet approved or funded Even though he would be the had tubes down your throat, by the Ministry of Health and first patient in Ontario to undergo all kinds of things. It seemed Long-Term Care in Ontario, the procedure while awake, Mr. much less invasive to me. I the new frontier and “we felt we needed to do McCallum says that didn’t bother never felt a thing,” he admits. some implants to prove to the him. “I took it all in stride. You “To be honest with you, I was ministry there were Canadian put your faith in the people who lying there, looking around A leading-edge procedure backed by the Peter Munk Cardiac Centre centres capable of doing it are going to do the job,” he says. and thinking, ‘All this damned Innovation Committee is a lifesaver for high-risk patients like David McCallum well, with good outcomes.” “Dr. Horlick asked me, ‘What equipment for me?’ And the But Mr. McCallum’s TAVI do you expect from this?’ nurses and doctors – it was quite By Shelley White procedure would be particularly And I said, ‘I expect to come an experience to see what they groundbreaking – he would out the other side,’” says Mr. were all doing, you know?” be the first patient in Ontario McCallum with a chuckle. In the years since the Innovation Last year, David McCallum was require intervention, not only to the leg. It’s a life-saving option to undergo an “awake TAVI,” Mr. McCallum’s historic awake Committee first voted to support far from living life to the fullest. improve his quality of life, but for patients who are too sick or without general anesthetic. By TAVI procedure took place and fund the TAVI project, more “I was feeling pretty sick,” also to prevent degeneration high-risk for open heart surgery. using only local anesthetic at on January 16, 2015. Because than 420 patients at UHN have says the 88-year-old resident of his heart muscle that could TAVI was one of the first the site of the catheter insertion, there would be no general benefited from the procedure. of Scarborough, Ont. “I become life-threatening. projects approved by the Peter as well as “conscious sedation,” anesthetic, there was no need It was partly due to this success couldn’t function properly “It affected me all the Munk Cardiac Centre Innovation awake TAVIs result in decreased for a breathing tube or a urinary that Ontario’s Ministry of Health while walking, breathing; way round,” he says. Committee back in 2012, says Dr. procedure time and are less catheter. An anesthesiologist and Long-Term Care approved there was pain, everything.” Mr. McCallum was referred Harry Rakowski, cardiologist, invasive, allowing patients administered sedation, and Mr. and began funding TAVI in 2013, A visit to the doctor and an to the cardiologists at the Peter who leads the Innovation a faster recovery and earlier McCallum says the procedure and it’s now currently being angiogram revealed that Mr. Munk Cardiac Centre (PMCC), Fund program. “We thought it discharge from the hospital. that followed was painless. used in several key hospitals McCallum suffered from severe and the team decided that he was was important for the PMCC When PMCC cardiologist “There was no discomfort at across the province that have aortic stenosis (narrowing of a candidate for a leading-edge and UHN [University Health Dr. Eric Horlick explained the demonstrated excellence in the aortic valve in the heart), procedure called Transcatheter Network] to help lead this procedure to Mr. McCallum, he the field, says Dr. Rakowski. siemens.com/cardiology which was the cause of his Aortic Valve Implantation, or innovative device that would says he felt quite comfortable 01 David McCallum, caregiver for As for Mr. McCallum, he stayed debilitating symptoms. Mr. TAVI, which involves inserting a help people for whom there going forward with it. “I’d wife Annie, had the life-saving, on for three days in the hospital McCallum’s condition would new valve through a catheter in was little alternative hope.” had a couple of stents put in a leading-edge TAVI procedure for after his awake TAVI and went those too high-risk for open heart home feeling “really good.” More cardiology, surgery. And he says that good feeling has continued to this day. 02 Interventional cardiologists, Dr. “I would recommend less heartache. Lee Benson (left), Dr. Mark Osten this procedure anytime at (middle) and Dr. Eric Horlick (right), all. I wouldn’t have one examine a 3-D printed model of hesitation,” he says. “It was Sustainable solutions that advance the heart. very, very well done.” cardiovascular care.

It is amazing what cardiovascular medicine can accomplish today. And how challenging it can be to accomplish it. At Siemens, sustainable cardiovascular care is all about pushing back clinical boundaries and pulling down operational barriers. In other words, it’s about helping you deliver more cardiology with less heartache. Less heartache means improving patient outcomes by reducing time-to-diagnosis, offering new therapeutic options, and getting better guidance during advanced procedures. Less heartache also means performing safer procedures with higher operational efficiency – on the way to a more personalized care. Innovation brought us here. At Siemens, innovation continues. Advancing cardiovascular care, with less heartache, sustainably. 01 02

22 Peter Munk Cardiac Centre Winter 2016

DM161656_Pg01-57_PMCC_FALL_2015.indd 22 15-10-05 12:27 PM DM161656_Pg01-57_PMCC_FALL_2015.indd 23 15-10-05 12:27 PM Graham Nie sat down better-than-fighting chance when for the patient, says Dr. Tan, because with his doctor at the a large aneurysm caused a tear in X-ray dye can be toxic to the kidneys. Peter Munk Cardiac his aorta. In February 2013, doctors With the PMCC’s advanced Centre (PMCC) to look at at the PMCC implanted a stent (an imaging technology, a CT scan is expandable tube made with fabric used to generate a 3-D picture of the a CT scan of his heart, and alloy materials) into the affected aorta, which is then fused with an rendered in 3-D on a artery using a tube inserted through a X-ray of the same area. The result computer screen, a year small slit in the groin. Once the stent is a complete and detailed digital was in place, a balloon tip at one end representation of the artery, allowing after he had surgery to of the tube inflated it to its full size, for precise placement of the stent implant a stent in a enabling it to reinforce the weakened without further injections of X-ray diseased artery. artery and prevent further swelling. dye. “Advanced EVAR is one of the most “What is unique here is our ability to “It was amazing. He could flip this significant developments in aortic offer advanced EVAR in an advanced image around, so I could see where surgery, developed elsewhere, but imaging environment,” says Dr. the stent and its branches were put refined at UHN,” says Dr. Kong Teng Tan, referring to the image-guided in,” recalls Mr. Nie, who was first Tan, Division Head, Interventional operating rooms (OR), which feature diagnosed in 1997 with an abdominal Radiology, Toronto General Hospital. large computer screens that give OR aortic aneurysm – a balloon-like bulge “The conventional way is open teams access to CT, X-ray and other that can cause parts of the body’s surgery, with an incision practically images during a surgical procedure. largest blood vessel, the aorta, to swell from the top of the chest to the groin,” “We are one of the few pioneering and, in some cases, rupture. “It was adds Dr. Tan, noting that the PMCC places to do it.” the first time in many years that I was leads the country in the number of The use of CT scans in cardiology is, clear of aneurysms.” advanced EVARs performed each in itself, a pioneering strategy that the Today, Mr. Nie, a 75-year-old retired year. “It’s very invasive, so not all PMCC continues to advance through school principal, remains aneurysm- patients can go through the operation research. Aside from minimizing free and continues to recover. He’s because you have to have a certain X-ray dye injections, CT scans provide active, albeit slower in his everyday level of health to tolerate it.” deeper insight into the anatomy of tasks such as mowing the lawn around With advanced EVAR, the PMCC the heart, all the way down to the his property in Peterborough, Ont. can give more patients a chance to cellular level. This allows doctors to Mr. Nie’s successful treatment and get a potentially life-saving stent – an see physiological clues and diagnose recovery can be attributed directly avenue that used to be closed off to disease sooner and more precisely. to leading-edge innovations at the about 80 per cent of patients with For example, the amount of blood PMCC, particularly in advanced aortic aneurysms, says Dr. Tan. But flow to muscles in the heart might medical imaging. From the increased what sets the PMCC apart from many indicate that certain arteries are use of CT scans to diagnose and other hospitals that offer advanced likely to continue narrowing and will address heart and vascular disease EVAR is its use of advanced imaging eventually stop functioning. to multimodal practitioners with during the procedure. “By looking at the physiology, we can combined expertise in cardiology, In the past, doctors had to keep pick up disease early and characterize vascular surgery and radiology, the injecting patients undergoing EVAR the disease to help with decision PMCC is driving advances in medical with X-ray dye to ensure the stent was making,” says Dr. Paul. “This type of methods and technology to improve positioned properly. This isn't good insight also helps us determine later if patient outcomes. the treatment is working.” CUTTING-EDGECUTTING-EDGE Located at Toronto General Hospital – one of four hospitals that make up Ontario’s University Health Network (UHN) – the PMCC has a Advanced uses and research with history of innovations that goes back CT scans aren’t the only imaging INNOVATIONSINNOVATIONS ININ 75 years. It boasts many world firsts, innovations at the PMCC. Dr. Danna from the first pacemaker implant in Spears, Clinical Director of the 1950 to the first installation and use Heritable Arrhythmia Program at of the Carto 3 heart monitor recorder the PMCC, uses catheter-guiding system, which uses electromagnetic technologies to map patients’ cardiac CARDIOVASCULARCARDIOVASCULAR technology to create three- electrical systems by picking up From 3-D imaging of the heart to multimodal practitioners, dimensional images of the heart. signals from an the Peter Munk Cardiac Centre is driving medical advances in “Everything we do is based around ultrasound probe Dr. Kong how to make things better for patients or by sensing both methods and technology Teng Tan and for the health-care system,” says and Dr. Elsie changes in CARECARE Dr. Narinder Paul, Division Chief, electrical resistance. Nguyen are BY MARJO JOHNE Cardiothoracic Radiology, University members of Electrode patches Health Network. The medical imaging the innovative applied on the team that also serves Toronto’s Mount medical body generate a Sinai and Women’s College hospitals. imaging team. magnetic field that “This means exploring and embracing communicates new technologies, as well as The work of with an electrode innovating through new applications Dr. Danna tip on the catheter Spears (near of existing technology.” to produce 3-D left) focuses In Mr. Nie’s case, the marriage of two on patients images of the heart’s innovations – advanced endovascular with irregular electrical system. aneurysm repair (EVAR) and heartbeats. “The conventional advanced imaging – gave him a way of imaging is

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DM161656_Pg01-57_PMCC_FALL_2015.indd 24 15-10-05 12:27 PMDM161656_Pg01-57_PMCC_FALL_2015.indd 25 15-10-05 12:27 PM by guiding catheters with an X-ray,” Peter Munk Cardiac Centre is now “Everything says Dr. Spears, whose work focuses building an education centre to house on patients with irregular heartbeats. its Program for Inter-Professional we do is based “For simple X-rays, we’re not talking Competency Optimization (PICO). about a huge amount of radiation Plans for the centre include around how to exposure, but, for serious cases, a simulation and observation spaces make things patient could easily spend an hour where health-care professionals in getting X-rays, and that means a Canada and from around the world better for much greater exposure to radiation.” can learn and practise the innovations Imaging innovations also extend developed at the PMCC. patients and to how the centre’s health-care “The idea is for health-care professionals hone and apply their professionals to have a dedicated for the health- expertise. The PMCC is one of the few program for learning new skills, care system. sites in the world where cardiology, incorporating four essential elements: vascular surgery and radiology are a workstation-based teaching This means practised by multimodal professionals laboratory for advanced image working in fully integrated teams. analysis; a simulation space where exploring and The centre has two cardiologists who they can perform diagnostic and embracing new work in the the Joint Department interventional procedures, including of Medical Imaging (JDMI) - one use of life-like phantoms; a period of technologies, reports magnetic resonance imaging clinical attachment where they can go (MRIs) and CT scans, while another and observe how things are done and as well as reports MRI scans. The PMCC also gain knowledge at a deeper level; and has one radiologist, Dr. Elsie Nguyen, a dedicated, state-of-the-art education innovating who does echocardiography reporting, center where they can have time for through new which uses sound waves to create reflective learning” says Dr. Paul. “To moving pictures of the heart. my knowledge, when this is built, it applications “I’m the only Level III certified will be the only place of its kind in radiologist in Canada who does the world.” of existing both cardiac MRI, CT and technology.” echocardiography,” says Dr. Nguyen. “Multimodality imagers are a Dr. Narinder Paul, feature that’s unique to the PMCC. Retired school Division Chief, We’re swapping roles and blurring For patients, this blending of Cardiothoracic Radiology, principal University Health Network boundaries, so radiology and traditionally separate roles often Graham cardiology are less separated.” means faster diagnosis and less Nie (left) additional testing. A multimodal reads to his professional can usually speed up granddaughter. the process, if further investigation is His successful needed. treatment and “I can actually arrange for an MRI recovery is based on identifying an abnormality the result of on the echocardiogram (heart leading-edge innovations in ST. HELEN’S MEAT ultrasound),” says Dr. Nguyen, “so the imaging and patient doesn’t have to wait weeks or care at Peter months.” Munk Cardiac Today, the PMCC continues to Centre. lead the way with a wide range of PACKERS LIMITED innovations in cardiology. Through Embracing new the work of Dr. Spears and Dr. technologies Michael Gollob – who is Chair of and innovating is the goal, IS PROUD TO SUPPORT the PMCC’s Centre of Excellence in Cardiovascular Molecular Medicine – says Dr. Narinder Paul, the PMCC is using novel technologies Division Chief, in genetic research to determine the Cardiothoracic cause of atrial fibrillation, the most Radiology, common form of arrhythmia, as well University THE PETER MUNK as the underlying genetic factors that Health predispose to sudden death in some Network. people with irregular heartbeats. “In the last 10 years, my group CARDIAC CENTRE discovered some genes that cause atrial fibrillation,” says Dr. Gollob. “The benefit of identifying the genes that cause a condition is that it allows you to know the protein that can be targeted in developing drug therapy.” In collaboration with the Joint Department of Medical Imaging: the

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How the Peter Munk Cardiac It’s a busy Tuesday morning at Centre Innovation Fund is Toronto’s Peter Munk Cardiac Centre improving patient outcomes, (PMCC). ¶ A middle-aged male patient one project at a time is guided slowly into the rounded opening of a CT scanner in the Joint BY SHELLEY WHITE Department of Medical Imaging (JDMI), while technicians on the other side of the glass study glowing images of the chest cavity on monitors. Nurses closely monitor the progress of the hospital’s most acutely ill patients in the Coronary Intensive Care Unit (CICU), while family members anxiously wait on couches located around the corner to see their loved ones. A group of medical residents and international fellows, along with a staff doctor, cluster in the hallway of the Cardiovascular Intensive Care Unit (CVICU), discussing the care of an elderly patient who had open heart surgery the day before.

In the operating room (OR) down the hall, it’s that critical time after a bypass operation, when surgeons must determine whether or not a patient will require a blood transfusion. It can be tricky thing to predict. Traditionally, doctors had to make that determination by eyeballing the situation, and if a patient looked “wet” (that is, still bleeding), he or she would be given blood. But today, the OR team is utilizing a leading-edge testing process that is saving blood, saving money and improving patient outcomes. It’s just one of the pioneering innovations that have been generated through the PMCC’s trailblazing Innovation Fund. The blood-conservation project was conceived three years ago by Dr. Keyvan Karkouti, Deputy-Anesthesiologist-in- Chief at Toronto General Hospital. It works in a two-part approach: First, during heart surgery, a nurse takes a sample of the patient’s blood and tests it in a machine (in a down- the-hall lab) that immediately indicates how well the blood is coagulating. Second, surgeons pack sponges around the heart and then weigh the sponges after exactly five minutes. If the sponges weigh more than 60 grams, the coagulation tests dictate if a patient needs blood. No guesswork required. Since adopting the blood-conservation project, “our red blood cell transfusions have dropped by about 20 per cent, our plasma Dr. Thomas transfusions have dropped by 60 per cent and platelets by about 40 Lindsay, per cent,” says Dr. Karkouti. (It’s also saved the hospital more than centre, $1-million this year.) “But, more importantly, it’s changing how we Division Head manage bleeding patients, with improvement in patient outcomes.” of Vascular Dr. Karkouti says kidney damage has been reduced, as Surgery, well as the need for re-exploration after surgery. “Before the performing program, 7 per cent of patients would finish surgery, go to life-saving the [Intensive Care Unit] and then either start bleeding or aneurysm surgery. continue to bleed and would have to come back to the OR. That’s dropped in half, from 7 to 3 per cent,” he says.

28 Peter Munk Cardiac Centre Winter 2016 29

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File Name: SPONS_AD_Globe and Mail Insert_0915-FIN Publication: The Globe and Mail Canadian Marketing Trim: 9” x 11.25” Material deadline: September 2015 100 Yonge Street, 16th Floor Bleed: 0.25" Safety: 0.4375” Mech Res: 300dpi Toronto, ON M5C 2W1 Colours: CMYK

Dr. Barry, Dr. Barry including physicians, surgeons, Rubin, approached scientists, a nurse practitioner, cardiologist Dr. Harry a psychologist, administrators, Rakowski to create a entrepreneurs and real estate new program to fund developers. Everybody gets an equal innovation, they both vote – thumbs-up or thumbs-down. agreed that they wanted “Usually, I try to pair a medical person to do things differently. and a business person to evaluate Dr. Rubin thought proposals, so that somebody can always that Innovation Fund explain the science, and the other committee members can look at it from a business point of should include health- view,” says Dr. Rakowski. “Does the care providers, who idea make sense? Can they achieve would assess if proposals what they want to achieve with the made sense from a funds they will have? Is it sustainable, medical point of view, so they can likely get more funding for and people from the a larger-scale study that will impact business world who care? And, from a personal patient might not have significant perspective, is this just a good idea?” medical knowledge, but Because of the mix of medical and who “know a winner business committee members, the when they see it.” Innovation Committee had been dubbed “If we’re going to “the Dragons’ Den of health care.” Jordan support innovation, Dermer, co-founder and managing let’s do it in an partner at Capital Developments, a innovative way,” says Toronto-based real estate development Dr. Rakowski, lead for firm, is one of the business leaders on the PMCC’s Innovation the Innovation Committee, and he says Fund program. “We there is some truth to the comparison. see ourselves as being “The debates are healthy, but, unlike thought leaders for Dragons’ Den, we’re not trying to the country and make money on their ideas,” says internationally, we try Mr. Dermer. “It’s interesting when to lead the development you get two doctors debating on two of projects and we have different sides of an issue, and it gets people who are capable a little hot in the kitchen. But, in The Innovation Fund provided the of doing that. But the questions are: the end, we all walk away smiling, Dr. Barry $150,000 needed to pilot the blood- ‘How do you bring those ideas forward? and there are no hard feelings.” Rubin (left) conservation project at the PMCC, And how do we vet those ideas?’” Another unique part of the program is and Dr. Harry Heartfelt thanks to the Rakowski and Dr. Karkouti says that funding Generous donors had supplied that, while most funding bodies reject (right) are the was essential to make the project a $5-million to get the program off the unsuccessful applicants without so much architects reality. “It not only made it fast, [but] ground. Dr. Rubin and Dr. Rakowski as an explanation, the PMCC Innovation of the Peter it also made it possible,” he says. decided that the new Innovation Fund gives constructive input, both Peter Munk Cardiac Centre. Munk Cardiac “Within a year, we had a permanent Fund would be open to all 1,000 before and after the submission process. Centre’s new program, and that’s unheard people working at the PMCC, from “If you submit something, and we think unique and of,” says Dr. Karkouti. In addition, cardiac surgeons to physiotherapists. you could do it better, cheaper, whatever, successful the pilot project’s positive results Unlike typical granting bodies that we’re going to give you that constructive For more than 75 years you’ve helped countless people Innovation helped Dr. Karkouti get a Canadian require pages of detailed proposals, input,” says Dr. Rakowski. “We’ll let Fund, a vehicle Institutes of Health Research (CIHR) applicants would only need to answer you resubmit or put you in touch with receive world renowned cardiac care. for staƒ to submit and grant to run a multicentre study 10 questions about their project, people who can make it better.” test innovative of the blood-conservation project with submissions accepted quarterly. Since the Innovation Fund program You stand out as much for your commitment to cardiac ideas. in 12 hospitals across Canada. It’s That makes the Innovation Fund started three years ago, they’ve awarded only been three years from the pilot nimble and able to rapidly support $1-million per year to a total of 31 innovation as for your compassion and respect for patients. project’s inception, and results of the evaluation of new ideas and medical recipients, with approximately 80 per larger study are almost finalized. devices, says Dr. Rubin. The fund cent of applications being funded, in “Based on my experience, similar would also change the way proposals comparison with the 15% funding rate projects would normally take at least are typically assessed in a hospital. for projects submitted to the Canadian five to 10 years to get through,” says Dr. “Rather than [vetting ideas] in the Institutes of Health Research. For Karkouti. “If the multicentre results are traditional way – a physician and example, the Transcatheter Aortic Valve positive, it’s going to change practice an executive sit down and make Implantation (TAVI) procedure – a across North America by next year.” the decision – we would make the non-invasive surgical technique that It’s the kind of success story for which process more broad-based, with both can be performed while the patient the Innovation Fund was created. physicians and non-physicians on a is awake – has become a viable way committee that reflect diverse interests to replace failing valves for patients www.scotiabank.com A Dragons’ Den approach and skill sets,” says Dr. Rakowski. who are too unwell for open heart The Innovation Committee is surgery. Other successes include When the PMCC’s Medical Director, currently made up of 14 people, iHeartChange.org, a website for young ® Registered trademark of The Bank of Nova Scotia.

Winter 2015 31

DM161656_Pg30_PMCC_FALL_2015.indd 30 15-10-05 12:14 PM DM161656_Pg01-57_PMCC_FALL_2015.indd 31 15-10-05 12:28 PM Creating a healthier tomorrow

people with congenital heart disease of a patient’s hip bone the morning you’re often going to be surprised.” Operating room nurse Sarah Lo who are transitioning to adult cardiac of the operation. While the patient In addition to being a successful (pictured in red care, and an antioxidant cocktail is undergoing heart bypass surgery, applicant, Dr. Yau is also a member of cap) prepares made up of beta carotene, ascorbic the cells are taken to a lab right the Innovation Committee (members a catheter that acid and red apple skin that prevents in the operating room and put can pitch ideas themselves, but is used by a radiation damage during X-rays. through a process to isolate “a very have to excuse themselves from multidisciplinary One requirement of the Innovation particular kind of stem cell that’s the decision-making for their own surgical team Fund process is that projects must good at improving blood flow and projects). Despite the fact that the (right) to repair be submitted to the Ontario Health heart function,” says Dr. Yau. renal denervation procedure didn’t an abdominal Technology Assessment Committee “During heart bypass surgery, and work, Dr. Yau says he’s glad the aortic aneurysm. (OHTAC), which decides if new before we take the patient off the committee funded it, “because, frankly, treatments are safe and effective. If bypass machine, we inject the stem otherwise we wouldn’t have known.” OHTAC supports the use of a new cells directly into the heart,” he “If you’re batting a thousand, then device or drug, the Ministry of Health says, to strengthen areas that have you’re probably not funding a lot of stuff will usually provide funding. been damaged by a heart attack. that you should have funded,” says Dr. It’s another example of how the After receiving $90,000 from the Yau. “If you only go for the short bets, Innovation Fund helps to get leading- Innovation Fund, a pilot study was you’ll miss out on a lot of opportunities.” edge devices and drugs into the system, conducted with 20 patients at the says Dr. Rakowski. For example, the PMCC and 20 more at Maisonneuve- Funding the future OHTAC has given the PMCC about Rosemont Hospital in Montreal. $2-million to fund the valves and stents The procedure was found to be The unique approach of the Innovation used during the TAVI procedure. safe and feasible, says Dr. Yau, but Committee has drawn interest from One of the Innovation Fund’s did it improve heart function? the wider medical community, says Dr. latest successes has to do with “In some of the outcomes assessing Rakowski, and he’s been approached what many believe is the next how well the heart squeezes, the by organizations who are hoping to frontier in treating cardiovascular improvement is so dramatic, to the create an innovation fund of their own. disease – regenerative medicine. point where even I said, ‘Really?’” “We are in the process of writing says Dr. Yau. “We will be doing up our experience for a scientific Hits and misses more studies to confirm that, but publication as a potential model it’s a surprisingly positive result.” for others to emulate,” he says. Can stem cells really repair a broken While results like this show just how When it comes to funding, Dr. heart? beneficial the Innovation Fund can Rakowski says he hopes the Innovation That’s the question Dr. Terence be, failure can sometimes be equally Fund will be around for the long haul. Rogers is proud to contribute to the Peter Munk Cardiac Centre, Yau was looking to answer when he important, points out Dr. Rakowski. With an 80-20 success rate, they are proposed his next-generation stem An early example of an Innovation proving their ability to recognize true cell therapy project to the Peter Munk Fund project that failed was a renal innovation and help bring it to fruition. and to share its pioneering spirit of pursuing new technology Cardiac Centre Innovation Committee. denervation procedure, where you “We’d like to have three to five years As a cardiovascular surgeon at the “burn the nerve around the artery to of sustainable funding,” says Dr. for the betterment of Canadian lives. PMCC, Dr. Yau had come up with a new the kidney for people with severe high Rakowski. “And I think the success way to utilize a patient’s own stem cells blood pressure,” says Dr. Rakowski. we’ve had so far is important for donors to improve the patient’s heart function “Of everything we funded, this was because they like to see there is benefit after bypass surgery. And it could the no-brainer. We knew it was going for the money they give,” he says. happen right in the operating room. to work,” he says. “And it didn’t. That is “If you look at that bang--the-buck With this therapy, stem cells are what’s so interesting about innovation. concept, I think we’ve done pretty “The best is yet to come.” harvested from the bone marrow If you go in with a preconceived idea, well.”

32 Peter Munk Cardiac Centre

DM161656_Pg01-57_PMCC_FALL_2015.indd 32 15-10-05 12:29 PM DM161656_Pg33_PMCC_FALL_2015.indd 33 15-10-05 12:14 PM Dr. Phyllis Billia’s unique research into heart regeneration holds great promise UNLOCKING THE SECRETS OF THE HEART WITH GENETIC REPROGRAMMING

BY JUDY GERSTEL

34 Peter Munk Cardiac Centre

DM161656_Pg01-57_PMCC_FALL_2015.indd 34 15-10-05 12:44 PM DM161656_Pg01-57_PMCC_FALL_2015.indd 35 15-10-05 12:44 PM similarities between cancer and heart to establish her own lab If the failure.” bearing her name. Untangling the spider’s web of genes “I’ve had great title implicated in both diseases led to Dr. mentorship,” she says, Billia’s elegant and potentially game- giving credit to both Dr. “Heart changing hypothesis. Tak Mak and to PMCC Whisperer” “I started thinking about tumour cardiologist Dr. Heather suppressor genes,” explains Dr. Billia, Ross. “I have a grant. existed, “especially the master regulator: p53. And we’re getting past When it mutates, it’s one of those some of the conventional it would permissive signals that allows cancer thinking to get to the cells to divide. I wondered what would next great leap. It’s not belong to happen if you knocked it out, just in the that the ideas aren’t there Dr. Phyllis heart.” and the know-how – it’s Would permitting heart muscle cells the money to get the Billia. to divide create new healthy cells that work done.” could compensate for damaged ones? Having her own While most physicians only listen to She tested the theory on mice, lab – her name is the heart, Dr. Billia is unlocking its knocking out p53 and one of its master prominently displayed secrets, modifying its behaviour and regulators from their hearts. “The – is a significant persuading the heart to regenerate. result,” she says, “was astounding.” achievement, physical It’s not that the physician needs yet What she found was that, when the evidence of the Canadian another title. genes were knocked out in the mice’s research establishment’s Dr. Phyllis Billia and She’s a clinical cardiologist, caring hearts, the mice died within 10 days. confidence in the her research team for patients at the Peter Munk Cardiac “Looking into the microscope, I could woman, the scientist, at the Peter Munk Centre (PMCC). see that the cardiomyocytes” – the the potential and the Cardiac Centre She’s Co-Director of the Peter Munk heart muscle cells – “were tiny. ‘Could commitment. are focused on Cardiovascular Biobank, which provides this be happening because they were She’s especially proud reversing heart living tissue and blood for research. dividing?’” she wondered. of her team, six women, failure by coaxing She’s the mother of a 13-year old The mice were dying because “when including a summer the heart to heal daughter and the wife of a physician you let the whole heart proliferate, it student, and the feeling itself with genetic with a private practice. fails,” she explains. is mutual. reprogramming. She’s a medical volunteer, travelling “So the next step was, ‘How do we Technician Daniela with her husband and daughter every target this at a site of injury?’ You Grothe has worked with year to British Guyana, where she works may still have damage, but you get Dr. Billia since they were at a heart function clinic, tending to surrounding cells to regenerate and together in Dr. Tak Mak’s patients with heart failure. compensate.” lab at Princess Margaret. And she is a scientist, a PhD in Dr. Billia acknowledges that her “If she wants something, she works biochemistry, researching the genetic approach to healing hearts through hard for it,” says Ms. Grothe, about pathway to heart regeneration though regeneration is different than the path Dr. Billia. “She works her ass off. We heart cell proliferation, which, until being followed by most heart research worked six years to set this up. This lab recently, was regarded as almost colleagues. was a dream. Now a lot of our ideas are THE MODERN GOLF ADVANTAGE impossible, and the Director of They’re trying to grow stem cells into coming to fruition,” says Ms. Grothe, Research at the PMCC. heart cells to replace those that have who adds: “Most people who have labs, Working in the cardiac clinic, Dr. been damaged. that’s their only job. Phyllis is always a Regardless of skill and level, custom club fitting Billia is acutely aware of the toll of “There’s a lot of work being done on doctor at the same time. She’s 100 per heart failure. It’s the leading cause that around the world,” explains Dr. cent research scientist and 100 per cent assists in hitting the ball longer and straighter of morbidity and mortality in North Billia, “but there are a lot of questions doctor. There’s never anything lacking with improved consistency and accuracy. This America. Heart failure patients about what cell to use, how to deliver on either end.” gives an overall higher level of performance have poor quality of life and a poor it, what’s the best timing and for what “My patients are used to seeing me in prognosis. condition.” jeans,” says Dr. Billia. “They know I’m and increases your enjoyment of the game. “Heart failure is an epidemic and it’s What Dr. Billia is attempting, she says, running back and forth between the lab on the rise,” says the cardiologist. “There “is more complex. We’re tweaking the and the clinic.” are about 50,000 new cases a year in genome, getting rid of the roadblock, And there could be no greater 100% of golfers are happy 95% of golfers experience improvement in distance with Canada, and a million Canadians have the p53 gene pathway.” motivation for commitment and success it. It’s just as common in women as in There are a lot of downstream targets in the lab than seeing her clinic patients with their new clubs their new driver. 30% saw an increase up to 30 yards. men as women get older.” in her sights: other proteins that suffer from heart failure. In her lab, on the third floor of the interact with the p53, other tumour “My gut says it will work,” she says Max Bell Research Centre, affiliated suppressors, injury models and then, about the genomic approach to healing with the PMCC, Dr. Billia and her team the Holy Grail, localized regeneration hearts. “You can never be 100 per cent are intent on reversing heart failure. in the heart and other organs, including positive about research, but what we’re of golfers are likely to improve their scoring average They are seeking to turn the almost the lungs and kidneys, that were long finding is quite striking.” 95% recommend our services 83% up to 6 strokes impossible into the possible, coaxing thought to be resistant to regeneration. The next step is testing in larger the heart to heal itself with genetic But when asked about the biggest animals and developing what is known reprogramming. challenge she faces in her work, Dr. as “preclinical proof of concept.” Having worked on a postdoctoral Billia doesn’t hesitate. Pressed for a timeline, Dr. Billia fellowship with cancer researcher Dr. “Money,” she replies. predicts that in five to 10 years, Book your next fitting at moderngolf.ca or call Tak Mak at the Princess Margaret The funding she’s received so far, genomic research will result in the heart 1 844 629 1003 and join the many golfers who Cancer Centre after completing medical mainly from the Canadian Institutes repairing itself. have taken the next step to improve their game. school and specializing in cardiology, of Health Research and the Canadian Genes, she believes, are the key to Dr. Billia recognized “a lot of genomic Cardiovascular Society, has allowed her heart failure. We guarantee that you will be 100% satisfied with your new clubs.

36 Peter Munk Cardiac Centre

DM161656_Pg01-57_PMCC_FALL_2015.indd 36 15-10-05 12:44 PM his heart wasn’t pumping properly, resulting the world-class care he received in 1991. “We’re trying to understand, at the than one gene, and it runs in her family Touching in a buildup of fluid around the organ. Mr. Allan has Marfan syndrome, a genetic molecular level, the cascade of events – she made up her mind to lose 50 “The doctors at [the] PMCC got rid of 25 disorder that causes problems with connective that lead to the heart muscle failing. But pounds when she turned 50 this year. Unique lives from pounds of fluid, and during the two weeks I tissue throughout the body. In Mr. Allan’s we’re just at the tip of understanding She walked at a fast pace on the was in the hospital, the congenital cardiac team case, the disorder had led to a dilated aorta, every pathway and exactly why the treadmill at home for 55 minutes international was in constant touch, explaining what they which was stretching to the point where it heart fails and why some people recover most days at maximum incline while coast to coast were doing and why,” recalls Mr. Wilkinson, might rupture. To address this problem, Dr. and some don’t. There are so many watching episodes of Game of Thrones, collaboration who is 37 years old. “I was discharged July Tirone David removed the enlarged valve, unanswered questions.” limited her calories to 1,000 per day on The circle of care at the Peter Munk Cardiac 25, and two days later I got married.” inserted it into artificial tubing and attached The heart, she suggests, for all that it is days when she didn’t exercise and lost poised for Centre (PMCC) extends far beyond the Mr. Wilkinson and his wife have relocated the entire assembly back to Mr. Allan’s heart. part of us, is as mysterious to us as the the 50 pounds in six months. boundaries of Toronto. Each year, thousands of to Toronto to be near the PMCC, where “I have not had any problems related solar system. “I feel better, sleep better and stopped patients from communities across the country Mr. Wilkinson was recently implanted to the surgery and have not needed to One of the unknowns, Dr. Billia snoring,” she says. breakthroughs in come to Canada's leading cardiac care centre. with a pacemaker, a defibrillator and a go back,” says Mr. Allan. “When I hit explains, is that, while there may be a She reads a lot to relax – Robert Jamie Wilkinson, a music teacher from ventricular assist device, which helps his the 20-year anniversary of my surgery, genetic predisposition to developing Sanderson is a new favourite author. “I cardiovascular Flatrock near St. John’s, Nfld., was flown by heart pump blood to all parts of the body. I compiled a little video for Dr. David heart disease, it’s not clear whether read every night before I go to bed,” she air ambulance to the PMCC in July 2012, just “The doctors have done such a wonderful basically saying, ‘Here I am. Life is good.’” improved lifestyle at an early age can says. “It helps me shut down at night. therapy two weeks before he and his fiancée were set to job in improving my quality of life,” says Life is definitely better for Katjana Biljan, an prevent onset of the disease. It’s a necessary part of my routine.” tie the knot. Born with a defective heart, Mr. Mr. Wilkinson. “They’re the best group of Ottawa psychotherapist with congenital heart But no matter what our genes dictate, She has a small, close group of friends Wilkinson was struggling to breathe because doctors I’ve encountered, that’s for sure. disease. By 2013, after four decades of heart she says, “we can improve longevity and – “a ladies’ club. We meet once a month They’re not making whole new Dr. Keller explains They’re so knowledgeable problems, she was a palliative care patient quality of life. There are things that you and catch up. I’m the only physician.” hearts yet, but the collaboration the importance of that and intelligent, and whose day-to-day survival depended on an of the Peter Munk Cardiac di‹erentiation: “There’s no can do.” But she also admits to waking up in they treat us like we’re oxygen machine, which kept her homebound. Centre (PMCC) and the McEwen point making ventricular cells If you do only one thing, it’s to stop the middle of the night and thinking Centre for Regenerative if the problem is atrial,” he part of the team.” She was referred to the PMCC that year, smoking, she advises. about work – “because the work is so Medicine with the Technion says. “What was absolutely It’s been 24 years since where doctors performed tissue implant Dr. Billia is her own example for exciting. We have a lot on the go. You Israel Institute of Technology crucial was that Lior came Jeff Allan travelled to the surgery to fix a hole in her heart. lowering risks of disease that can lead to worry about keeping it all going.” is making advances in heart with his clinical and heart cell PMCC for valve-sparing “They gave me my life back,” says Ms. heart failure. Asked whether she worries that her research and heart care that no expertise and stayed for a year’s surgery, a technique Biljan, who is 42 years old. “I’m a really “I decided not to get diabetes,” she research will bring the results she’s one could have imagined even sabbatical. It’s an example of developed at the hospital complex patient, and this is one of the says. looking for, she replies, “We’ll make it five years ago. how synergy and international to save the defective valve, top centres in the world that specializes Because “diabetes is thought to be work somehow.” “I never dreamed that collaboration really move the instead of replacing it with in complex cardiac cases like mine.” polygenic” – that is, caused by more Who could possibly doubt it? someday I’d be sitting with field forward.” an artificial or porcine Ms. Biljan says she no longer needs daily clinicians and cardiologists, and There’s also the challenge of valve. The 53-year-old doses of oxygen from a machine. She’s looking at taking cells from a developing medical devices to petri dish and putting them in a deliver the cells to a patient’s software developer and looking forward to resuming her career patient’s heart,” says biochemist heart. Technion is a world-leader Newfoundland resident Jamie Wilkson (left) and Je Allan from Calgary resident of Cochrane, after more than two years of not working. Dr. Gordon Keller, Director of the in biomedical engineering and (right) are among PMCC patients from across Canada. Alta., still remembers –   McEwen Centre. commercialization of devices, What has made that possible and Dr. Rubin would like Canada is the synergy of having world- to become more competitive in renowned researchers and that area. clinicians working together But there’s another reason why here in Toronto, where some of this research is so valuable that the sickest heart patients are has nothing to do with putting treated, says Dr. Barry Rubin, new cells in patients’ hearts. Medical Director of the PMCC. It’s the perfect example of “We’re used to trying new personalized medicine. things.” We can take cells from a The scientists and cardiologists patient’s blood, make them are taking the breakthrough into stem cells and transform of growing heart cells from a those cells into beating heart patient’s own blood or tissue to cells growing in a petri dish. the next level and beyond. These cells have the exact same “The first application is to try to genetic makeup as the patient’s Internationally- treat patients with heart failure,” own heart cells, and they are renowned says Dr. Rubin. “There are more the ideal model for assessing cardiologist hospitalizations for heart failure the disease and trying di‹erent and scientist, than for all forms of cancer, drugs to see what works Dr. Michael and the average life span from best without harming or even Gollob, and diagnosis of heart failure to involving the patient beyond his research death is only 2.1 years. That is a blood test or a simple tissue assistant Qiuju worse than most cancers” sample. Li, conduct But the challenge is growing Dr. Rubin explains: “We could experiments the right cells for the right part recapitulate the patient’s heart to better of the heart and determining disease in a dish before treating understand when and how to deliver them. the patient. Now, when we give 2145 Avenue Road how gene That’s where Dr. Lior Gepstein patients drugs for a condition, mutations comes in, literally, all the way say, arrhythmia, often the first change how from Israel. Working with choice of drug doesn’t work, 416.441.2888 heart cells biochemist Dr. Keller at the and may have side e‹ects. function and McEwen Centre, Dr. Gepstein “Rather than trying the drug for HARVEYKALLES.COM make them and the Keller team discovered the first time in the patient, we prone to how to make di‹erent types of take a sample of blood, make arrythmias heart cells. stem cells, make them into heart (irregular “Last year, when I came here cells, put the cells in 10 di‹erent heartbeats). to Gord’s lab,” says Dr. Gepstein, dishes, squirt in 10 di‹erent “we didn’t have any idea of how drugs and see which works to make di‹erent cells.” best,” he explains.

38 Peter Munk Cardiac Centre Invest in your dreams.

DM161656_Pg01-57_PMCC_FALL_2015.indd 38 15-10-05 12:45 PM DM161656_Pg02-56_PMCC_FALL_2015.indd 39 15-10-05 11:36 AM From the heart. For the heart.

Gluskin Sheff congratulates Peter Munk Cardiac Centre and The Globe & Mail for creating a stage to showcase the accomplishments of Canada’s premier cardiac centre. 01

invasive approaches, in some cases not using the heart-lung From science ction to machine, for example, or making smaller incisions and enlisting robots to do coronary bypass surgery. “almost routine” “Those innovations and technologies are still evolving,” says Dr. Rao, who is a professor Heart surgery techniques and technologies once considered futuristic of surgery at the University are now closer to reality of Toronto, noting that improvements in anaesthesia and surgery developed or By Renee Sylvestre-Williams validated at PMCC mean that complex cardiac procedures on high-risk patients once deemed Permanent artificial hearts, Dr. Rao, a recognized expert in of heart disease and “a flood “inoperable,” such as those holographic image-guided end-stage heart disease who has of people who needed bypass into their 80s, are now “almost surgery, “incisionless” operations helped build Canada’s largest surgery. There were few routine.” and reviving dead hearts to use in advanced heart failure program alternatives.” Meanwhile, in valve transplant recipients may sound at PMCC, has already seen new In the 1990s, a group of surgery, catheter-based valve like the stuff of science fiction. technologies and techniques anti-cholesterol drugs called replacements have proven to be But they’re all expected in the flourish through discoveries made statins significantly lowered the equal, if not better, in high-risk cardiac surgery of the future there over the last two decades. progression of the disease, while patients, he points out. Among at the Peter Munk Cardiac “The future of cardiac surgery percutaneous or minimally- the centre’s research is a study to Centre (PMCC). Supported by is changing in terms of what we invasive therapies, such as show whether the same is true in generous benefactors, a culture traditionally do day-to-day.” angioplasty and stenting, low-risk patients. of innovation and a visionary Born in India, Dr. Rao provided alternatives to Diseases of the aorta, the biggest team that spans disciplines and immigrated to Canada at the opening up the chest. The new blood vessel in the body, are is dedicated to cutting-edge age of three. He was drawn to medications and techniques another major focus of PMCC, research, even the most futuristic medicine, having come from a stabilized the amount of bypass one of the largest aortic centres cardiovascular therapies don’t long line of physicians, and was surgery being performed, in the country. This is an example seem so far off. particularly inspired to pursue especially relative to the growing of its multidisciplinary approach. “The field is changing cardiac surgery by a character on and aging population. Someone who needs surgical dramatically,” says Vivek Rao, 48, the 1980s TV show St. Elsewhere, Today, many patients opt for treatment for his or her aorta Chief of Cardiovascular Surgery Dr. Mark Craig, who devoted angioplasty and stenting, Dr. Rao will meet with a geneticist, an at PMCC, who holds the Munk himself to developing an artificial says; although, studies show that imaging specialist, a cardiologist Wealth & Risk Management Chair in Advanced Cardiac heart. traditional open heart surgery and the aortic surgeon, among Invested in your prosperity Therapeutics and is Surgical Back then, open heart surgery is often superior in terms of others, he says. “In one clinic visit, www.gluskinsheff.com Director of the centre’s artificial “was in its heyday,” Dr. Rao outcomes. Surgeons are adapting you’re covered from head to toe.” @GluskinSheffInc heart program. recalls, with the prevalence by trying more minimally- The PMCC’s multidisciplinary –

Winter 2016 41

DM161656_Pg40_PMCC_FALL_2015.indd 40 15-10-05 3:46 PM DM161656_Pg01-57_PMCC_FALL_2015.indd 41 15-10-05 12:49 PM and pioneering – ethos extend to 01 Dr. Vivek Rao (centre), its nurses, dietitians, pharmacists, cardiac surgeon, is an international occupational therapists, expert in mechanical physiotherapists and more, says heart technology. Lindsay Love, 31, an Advanced Practice Nurse Educator in the 02 Tubes carrying Coronary Intensive Care Unit blood to and from the (CICU). heart-lung machine The emphasis on research keep patients alive and record of world “firsts” during bypass surgery. there fosters a spirit of curiosity among nurses and a “desire 03 One area of focus to keep learning,” she says. for cardiac surgeon, Indeed, each year nurses from Dr. Mitesh Badiwala PMCC have been awarded (immediate left), is prestigious fellowships under reviving “dead” hearts the Collaborative Academic so that they can be used Practice Innovation and Research 02 03 for a future transplant. Fellowship Program offered by the University Health Network (UHN). Ms. Love says that ours to go to our benefactors and can be used to transplant into therapies are increasingly through the six-month pay- launch an investigation into the patients. blurred. “If you’re doing protected positions, nurses “are efficacy and safety of a certain Dr. Badiwala thinks that minimally- invasive surgery, are leading innovation themselves.” technique or procedure or device,” someday ex-vivo and artificial you an interventional cardiologist Dr. Rao focuses on heart he explains. The PMCC has done hearts could be used temporarily or are you a minimally-invasive failure, the inability of the that on a number of occasions, while a patient’s defective heart is heart surgeon?” he asks. “We’re heart to effectively pump blood for example, in groundbreaking removed, repaired and then sewn going to be trained in doing both, throughout the body. Improving research on minimally-invasive back in. “That’s thinking into the with teams that focus on heart the survival and the quality of life procedures to replace aortic future, but it might not be so far failure, teams that focus on valve of heart failure patients through valves. “There are also times away.” disease and teams that focus on new technologies, processes and when we evaluate technology, In other advances, PMCC aortic disease. That’s how the strategies is a key focus of the and we don’t recommend going is launching a program in patient gets the best care.” new Ted Rogers Centre for Heart forward with it.” surgery for arrhythmia using a He’s currently involved in Research, he stresses. This can There have been tremendous minimally-invasive approach clinical research, evaluating include artificial hearts, state- advances in artificial hearts where a videoscope can be new surgical technologies and of-the-art medications, ways from the first such device he inserted through a small hole in procedures, “so can we do the to monitor patients wirelessly introduced in 2001, called the the side of the chest. This way, the same thing, but do it better,” and and Web portals that provide HeartMate I, which was “huge” “tracks” inside and outside of the he has a basic science laboratory education to them, as well as and designed to last only 18 heart that cause arrhythmia can where PhD and master’s students to families and health-care months. Some nine different be ablated or burned. are trained to do molecular providers. versions followed; Dr. Rao is now Advanced imaging is biology research, looking into the The PMCC’s model of evaluating doing the first Canadian clinical particularly helpful to surgeons effect of transplants on the heart new technology through trial of the HeartMate III. using minimally-invasive and blood vessels. philanthropy is critical, says Dr. The pumps, now implanted techniques. Dr. Rao expects that While transplantation remains Rao, who launched the centre’s alongside the patient’s own soon with just the tiniest incision, “the well-accepted gold standard,” artificial heart program in 2001, heart, are ever-smaller and more a perfect life-sized or magnified he sees artificial hearts as the gathering data to show the durable. But they’re still powered image of the beating heart will be way of the future. “We’re going to Ontario Ministry of Health and by large external batteries, projected holographically outside see a patient with heart failure, Long-Term Care that outcomes which have to be charged twice of the body to guide surgeons and we’re going to say: ‘Do you with mechanical heart pumps a day and cannot get wet, he using microscopic instruments want to go on the waiting list for were good enough to offer says. “Clearly, what patients inside. a transplant – which you may the technology to Ontarians. and surgeons want is to make He says it may also be possible or may not get within the next Limited government funding everything implantable.” to do surgery with no incision of year or two – or do you want to is now available for mechanical Making a heart that is not any kind, akin to the way Star schedule your surgery for next heart pumps in the transplant beating at all viable for transplant Trek chief medical officer Dr. Tuesday, and we’ll put in an population. is the focus of cardiac surgeon Leonard McCoy used a focused artificial heart, and you’ll have a Dr. Rao says there is still an Mitesh Badiwala, 37, one of beam of energy to sew off a vessel normal life expectancy?’” “unmet need” for mechanical PMCC’s newest recruits. Dr. or cut out a lesion. “Certainly, the Dr. Rao has won numerous hearts in the many patients who Badiwala, surgical director of the technology exists where you can awards for his dedication to are not transplant candidates. heart transplant program, says focus a laser internally and not finding answers in such areas. Today, philanthropic money is the use of such “ex-vivo” hearts make any puncture on the skin, He says he would have never supporting four to five artificial would “increase the donor pool” and if something’s bleeding we dreamed 30 years ago that he heart transplants a year in these beyond those who are brain-dead can stop it from bleeding. We would be leading the Canadian non-transplant patients to to include “donation after cardiac can probably also burn vessels research on each new generation show whether outcomes justify death.” The hearts are removed, or burn tracks that are causing of artificial hearts, as Dr. Mark financing the program. resuscitated, reanimated and arrhythmias.” Craig did on St. Elsewhere. “I am “It’s incumbent on centres like then evaluated to see if they He notes that lines in heart living the dream, so to speak.”

42 Peter Munk Cardiac Centre

DM161656_Pg01-57_PMCC_FALL_2015.indd 42 15-10-05 12:49 PM DM161656_Pg43_PMCC_FALL_2015.indd 43 15-10-05 12:15 PM DM161656_Pg01-57_PMCC_FALL_2015.indd 44 © 2015Medtronic. All rightsreserved. www.medtronic.ca places around theworld. the rightpatient,attimeinmore healthcare—to gettherighttreatment, to systems andproviders to helpimprove Together, we willcollaborate withhealth IN MIND PROVIDERS PATIENTS AND INNOVATING WITH

Sharing Excellence Peter MunkCardiac Centre 357 Street, Bay Suite 500, Toronto, ONM5H2T7 and Further Capital: Further Capital Partners Ltd. CANADA’S PLACEMENT AGENT

15-10-05 12:57 PM DM161656_Pg01-57_PMCC_FALL_2015.indd 45

Illustrations by Brent Phillips Winter 2016 every day trying to marry research research tomarry day trying every researchers andclinicians are talent, thebest and retaining centre that pridesitselfonhiring other disciplines. medicine approachbeingusedin the samekindofpersonalized treatments andmovetoward researchers istoindividualize challenge forcliniciansand used inthemajority ofcases. minimally-invasive is method surgery, needopenheart still this aneurysm. andsealsoffis expanded the Onceinplace, thestent arteries. throughthe stents with steel fabric containing atubeofstrong room toguideacatheter X-ray imagingintheoperating weeks. versussix overnight recovery Lindsay’s work,itmeansan which makes upthebulkofDr. aneurysms, abdominal aortic Health Network (UHN). ofToronto’sand part University based at Toronto Hospital General Munk CardiacCentre(PMCC), of Vascular at thePeter Surgery Lindsay,Thomas Division Head practice,”vascular says Dr. radically changed technology ofhowdisruptive example successful isthemost graft, stent and remotelypositionanarotic a smallincisioninthegroin –wherebywecanmake surgery –endovascular invasive surgery within. from aneurysms and repairaortic surgeons toenterbloodvessels allowed technology when new olutionized intheearly1990s, Vascular wasrev- surgery By Jennifer Hough individualized treatmentsandpersonalizedmedicine A leaderinthefield,PMCCpromotesbigideasandmovetowardless-invasivesurgeries, surgery ofvascular the course changed Disruptive technology At the PMCC, a leading cardiac At thePMCC,aleadingcardiac Now, says Dr. Lindsay, the cases While somemorecomplex techniqueusesfluorscopic The When itcomestotreating adventofminimally- “The

University ofToronto, bigideas of Vascular at the Surgery who for11yearsheldtheChair problems toadvance thefield. and sciencewithreal-lifemedical According toDr. Lindsay, better?’ Webetter?’ are think like that, think like that, encouraged to encouraged to the challenges the challenges and to always and toalways Division HeadofVascular Surgery, questioning, questioning, solutions to to solutions clinicians.” be looking looking be Peter MunkCardiacCentre day we are day we are we do this we dothis we face as as we face ‘How can ‘How can Dr. ThomasLindsay, for new for new “Every “Every solutions to the challenges we face solutions tothechallenges weface and toalways belookingfornew are encouraged tothinklike that, ‘How canwedothisbetter?’ We “Every day we are questioning, are encouraged andnurtured. drew me here – mehere– drew and to educate and toeducate the ability and and the ability discovery and and discovery numbers and and numbers “There is real isreal “There tomorrow’s innovation, innovation, potential to potential to That’s what be aworld- be DivisionofVascular Surgery, strength in strength in expertise. expertise. leader in in leader leaders.” Dr. ThomasForbes, University ofToronto Professor andChair,

out in developing much better muchbetter out indeveloping so nowwearelookingfurther problems, some ofthebigger sophisticated and have solved aliveandwell. is still Lindsay says. toexist,”cardiac surgery Dr. build on,that allowsmodern thegroundworkotherscan sets during bypasssurgery. transplant thecellsintoheart a patient’s bone marrowand cellsfrom stem world toharvest PMCC becamethefirst inthe more recently, in2012, whenthe first pacemaker usedin1950,to as abloodthinnerin1935,tothe the first clinicaluseofheparin ofmedical“firsts,”history from as clinicians.” “We have becomealittle more Today, thepromiseofdiscovery “It’s thiskindof researchthat Indeed, thePMCChasalong VASCULAR SYSTEM INSIDE THE interventions. advanced diagnostic andsurgical highly complexcasesthrough renowned fordeliveringcareto a world-classacademicunit at Toronto GeneralHospitalis the abdominalaorta. blood vesselsmostcommonin aneurysms, whichareenlarged mainly blockagesinarteriesor outside oftheheartandhead– disorders ofthebloodvessels systems arealsoatriskoffailing. compromised, majororgan rely. which allsystemsinthebody essentially theplumbingupon the body, thevascularsystemis to andfromallmajororgansin Responsible forcarryingblood The DivisionofVascular Surgery Vascular surgeonstreat If theplumbingfailsoris 15-10-05 12:57 PM 45 The S-ICDTM System Protection Without Touching the Heart A team of cardiac surgeons, vascular surgeons and interventional radiologists meet regularly to discuss the best way to get a CT scan,” Dr. cases that benefit Forbes says. from a multi- “Normally, when you get a CT disciplinary approach to patient care. scan you are lying down. In their daily lives, people are standing up for two-thirds of the day, so we Fieldgate Homes and the are looking at whether or not it’s better to get a CT scan standing up.” Peter Munk Cardiac Centre Yet another area of research is the push to harness big data. “We have the epidemiological share a commitment to data of thousands of patients and The World’s First and Only Subcutaneous outcomes. The challenge is taking deliver the very best! numbers and applying them to Implantable Cardioverter Defibrillator one person, finding out if there are any rules you can apply at an The S-ICD System represents an exciting therapeutic solution individual level,” he explains. for patients at risk of sudden cardiac arrest (SCA) that leaves the STEM CELL RESEARCH But aside from the forward heart and vasculature untouched. march in terms of science and Canadian, innovative & world-leading Researchers at the Peter Munk innovation, both Dr. Lindsay and Learn more at www.SICDsystem.com. Cardiac Centre are attempting Dr. Forbes are clear that first-class to restore circulation using stem therapies.” don’t and why they are different patient care, delivered through Refer to product labeling for licensed indications, contraindications, warnings/precautions and adverse events. www.fieldgatehomes.com cells to alleviate the symptoms Dr. Lindsay’s colleague, and the – and be able to treat patients multidisciplinary teams, is the No. For professional use only. www.bostonscientific.com/sicd of peripheral vascular disease, current University of Toronto accordingly. Research projects at 1 way that the PMCC stays ahead © 2015 Boston Scientific Corporation or its affiliates. All rights reserved. CRM-106015-AC DEC2015 a condition that develops when Vascular Chair, Dr. Thomas the PMCC are ongoing; some are of the curve. arteries that supply blood to Forbes, agrees that the PMCC in their infancy, others are more “One of the fundamental things internal organs, arms and legs provides an ideal environment developed,” he says. we have tried to overcome here become blocked. for innovation: strong leadership, The second part to this is the is getting specialists to work in Dr. Thomas Lindsay, Division Head of Vascular Surgery at support and investment, state- hardware, such as stents and complementary multidisciplinary the PMCC, based at Toronto of-the-art equipment and critical other devices that go into the body teams,” says Dr. Lindsay. General Hospital, is the principal mass. to open up arteries and improve “We work together with investigator on the Hemostemix Speaking about his role as blood flow. surgeons, interventional trial, which involves targeting chair, he points out the “unique “Increasingly, we will have radiologists, anesthetists” and in For us, every diseased tissue with new cells situation” in vascular surgery devices that are customized to complex cases with other highly grown from the patient’s own in Toronto, because all of the the individual patient’s anatomy,” trained health-care professionals, innovation blood. hospitals fall under the umbrella Dr. Forbes says. One ongoing such as cardiac surgeons. “We are taking the patient’s of one university, unlike other project is a collaboration with Dr. Forbes concurs. “Our first own cells, putting them in the cities where they are divided. engineering to see if aortic stent obligation is to our patients. We starts with right environment and with the right stimuli, trying to grow “There is real strength in grafts (endografts) can be made to get referrals from all over Canada new cells to inject them back numbers and expertise. That’s last longer, and how they can best as we specialize in certain areas a human into the leg to regenerate the what drew me here – the ability be tailored to suit individuals. that are not available in other circulation,” explains Dr. Lindsay, and potential to be a world-leader “Sometimes, it can take a month places. Very often, we see patients a world-renowned vascular in discovery and innovation, and or two to get a stent made. In a who don’t have just one disease. inspiration surgeon with more than 25 years to educate tomorrow’s leaders.” serious situation, that’s a problem, It’s very important they don’t get of experience. Looking to the future, Dr. Forbes but with the advent of 3-D siloed into one area.” At Edwards Lifesciences, everything we do comes from a very human “We know stem cells are believes the next transformation printing, that will all change.” In other words, the PMCC place. We’re driven by a passion to help restore patients’ lives. And important; they still have not in vascular surgery is combining Work is ongoing at the PMCC ensures that patients and their reached their full potential. In the empower the caring clinicians who treat them. Together, they high-tech hardware with to create new types of stents, and illnesses come ahead of hospital vascular field, it’s about getting inspire us to create medical technologies that transform care growth to happen in someone biologics. they have been used in animal administration that likes to in structural heart disease and critical care monitoring. who is 70, not 7, and finding out Essentially, this means clinicians models, but not yet in a patient, pigeonhole people under one what the conditions are that will decide on customized Dr. Forbes adds. discipline. Innovation is what we do. allow for that to happen.” treatments based on what’s found It’s this kind of cutting-edge “It sounds simple, but Humanity is why we do it. A breakthrough in this field in a patient’s genes. research that keeps the PMCC on operationally it’s sometimes would be greatly beneficial for “This is precision or personalized the global stage. difficult to do across a hospital To learn more about Edwards Lifesciences people suŽering from critical limb medicine,” explains Dr. Forbes. Another study is imaging-based with different divisions. That is visit us at www.edwards.com ischemia (CLI), a severe form of “It’s taking the human genome and uses advanced MR imaging a great strength of the PMCC – peripheral artery disease (PAD) and deciding on a therapy, based to get a visual description of what the way people can flow easily Edwards, Edwards Lifesciences, and the stylized E logo are that can result in limb loss, Dr. trademarks of Edwards Lifesciences Corporation. on what you see. If you take 100 a blockage looks like. Based on through the system because of Lindsay says. Amputation or death occurs in people with aneurysms, they will this information, doctors will this multidisciplinary approach © 2015 Edwards Lifesciences Corporation. All rights reserved. AR10345/CAN approximately 50% of patients not behave the same way. We need make a more informed decision that is one of the hallmarks with CLI over 5 years, which is to explore the reasons why some on how to proceed. of [the] Peter Munk [Cardiac caused by reduced blood flow to aneurysms grow and some don’t, “We are also developing new Centre],” adds Dr. Forbes. the legs. why some rupture and some imaging models. For example, “Global success starts locally.” Edwards Lifesciences (Canada) Inc. | edwards.com 6750 Century Avenue, Suite 303 | Mississauga, ON, L5N 2V8 CANADA USA | Switzerland | Japan | China | Brazil | Australia | India 46 Peter Munk Cardiac Centre

DM161656_Pg01-57_PMCC_FALL_2015.indd 46 15-10-06 2:15 PM DM161656_Pg01-57_PMCC_FALL_2015.indd 47 15-10-06 2:15 PM Cardiac rehab “They wheeled me up for the prevailing attitude and grandkids, getting back to work Continuing with some sort of surgery. I was fully conscious challenged the medical norm or doing the grocery shopping. exercise regime after the program while they installed three “We want to at that point. But now, in Everyone leaves a very different ends is crucial, and for those programs are stents in the blocked artery, many areas of medicine, we person. There is definitely a who see it through –70 per cent and the symptoms immediately induce changes are embracing the fact that psychological component to the of participants do – there are disappeared.” eating, stopping smoking and program,” she says. a variety of options available, Mr. Hamayda was then referred in the physiology being active play a huge role in The nuts and bolts of the including a free three-month “critically important” to the cardiac rehab program at of the heart. determining what happens to us program incorporate stationary membership at GoodLife Fitness the Peter Munk Cardiac Centre long term – whether we live or bikes, treadmills and arm bikes. gyms across the city. (PMCC). This time, he decided We want to die,” he says. There’s even a 200-metre track In 2012, GoodLife committed A therapeutic approach builds on a unique program launched in the 1960s, to at least investigate what it The PMCC program, available (inside and outside) at the airy, $5-million to the PMCC in a when doctors prescribed getting active as the key to recovering entailed. change how at two sites in Toronto – Toronto impressive Rumsey site. first-of-its-kind, public-private from a heart attack “I went and got a stress test, but well the heart Western Hospital and Toronto “Everyone starts off with a collaboration to advance cardiac I told the kinesiologist that I was Rehab’s Rumsey Centre – has walking program based on their care and preventative programs. reluctant about the program. She performs and been established for decades, fitness level,” Ms. Skeffington The collaboration led to the By Jennifer Hough said she thought I could really and it is one of largest and most explains. appointment of Dr. Oh as the benefit, and get my heart rate up improve central comprehensive of about 55 in the “We do weight training, inaugural GoodLife Chair in in a supervised manner.” province. stretching and take an cardiovascular rehabilitation and In his mid-40s and working active. I was a set dresser, uncomfortable foggy feeling, and Now, having completed the tness, speed “We see people across the interdisciplinary approach, and prevention. in a physically demanding job, decorating movie and TV sets, he had difficulty breathing. program, Mr. Hamayda says up metabolism age spectrum and also see an we have mindfulness, eating, “A tenet of the cardiac program Nathan Hamayda thought he was so I was always lifting, and I At age 60, he was having it was much better than he expanded population of people nutrition and stress-management is that people can carry on in pretty good shape. That was felt strong. I thought it [rehab] another attack. expected. and change a with stroke, cancer and diabetes education.” afterward,” Dr. Oh says. until his heart attack in 2001, a would be a bunch of old men on “I lay down, hoping the feeling “I started walking on the who have the same risk factors,” The social aspect to the program “Not only does this offer silent coronary, after which he treadmills,” he says wryly. “And I would pass,” he says. treadmill and began adjusting the person’s outlook Dr. Oh explains. cannot be underestimated. a continuum for people to underwent bypass surgery. wasn’t having an easy time after It didn’t, and he asked his speed, setting targets. It doesn’t long term.” “We want to induce changes “Peer support is very important. transition from hospital to His recovery was difficult, so my operation.” landlord to take him to the take long to notice a difference. in the physiology of the heart. That person sitting beside you community, but also the PMCC he didn’t take up a cardiac rehab Fast forward to 2014: Mr. hospital. Over the course of a few weeks, I Dr. Paul Oh, We want to change how may have been your roommate trains GoodLife instructors in program that was offered to him Hamayda was at home one After some tests, doctors noticed it took longer to get my Medical Director and GoodLife Chair well the heart performs and and knows your situation,” she how to deal with cardiac recovery at the time. day, when he got that feeling determined that one of his bypass heart rate up.” of the Cardiovascular Prevention and improve central fitness, speed says. customers.” Rehabilitation Program at the Peter Munk “My job was very physically again. Not pain, just a really grafts was blocked. The difference a cardiac rehab Cardiac Centre and Toronto Rehab up metabolism and change a The sessions take place in a person’s outlook long term,” he group format once a week for 90 says. minutes, but participants should program can make is “critically The program is tailored to each also exercise on their own four REHAB BY important” for people recovering individual, but “the commonality times a week. THE NUMBERS from a wide range of heart between everyone in the program This can be a new concept for episodes, says Dr. Paul Oh, is that they are learning how many, Ms. Skeffington notes. More than 1.4 million Canadians Medical Director and GoodLife to get active and manage their “We see a lot of women who have heart disease. Chair of the Cardiovascular condition in a safe, progressive were never involved in physical Prevention and Rehabilitation and effective manner,” Dr. Oh activities; it’s a very new thing to Heart disease is one of the Program at the Peter Munk adds. ask them to exercise, so what we leading causes of death in Cardiac Centre and Toronto Being supervised and having the are asking has to be reasonable Canada, claiming more than Rehab. safety net of a multidisciplinary and realistic. For older people – 33,600 lives each year. “It’s as important as anything team of we have an 88-year-old at the we can do in medicine. We can experts – a psychologist, moment – they go at their own Cardiac rehab can prevent death by 25 to 50% and reduce cut the chance of dying by 25 dietitian, nurse, kinesiologist, pace. We are not asking them to hospitalization by 25%. to 50 per cent and reduce re- physiotherapist and occupational run a marathon, just asking them hospitalization by 25 per cent. therapist – is what makes the to get stronger within their own The Peter Munk Cardiac Centre It’s as powerful as taking meds or cardiac rehab program so limitations. For some, the goal is has two rehab sites: Toronto stopping smoking,” says Dr. Oh. appealing and so important, says just to live to see another day.” Western Hospital and the Rumsey The therapeutic approach Valerie Skeffington, Manager of Some people do end up running Centre, which has a 200-metre embodied by the Peter Munk the Cardiovascular Prevention marathons, though, says Dr. Oh. track, inside and out. Cardiac Centre program goes and Rehabilitation Program at “People tell us they not only back to the 1960s, when doctors the University Health Network recover from the heart condition, The program sees about 2,600 presented the notion that the key (UHN). but also get to a state where they people annually. to recovering from a heart attack “Our patients come here directly are as strong as they have been Group sessions last for was to get active, says Dr. Oh. after hospital, typically within in years, or ever, so it’s a very 90 minutes, one day per week: “This was very different to three weeks of an event. They exciting transition,” he says. 30 minutes of education and aren’t sure what they are in for, “People get to the stage where 60 minutes of exercise. and there is always hesitancy and we can say, without being Participants are expected to Nathan Haymada, left, and a bit of anxiety. But they start to facetious, ‘Congratulations! complete four sessions on Dr. Paul Oh discuss the build confidence and competency. You’ve had a heart attack. Now their own. importance of being active It’s about getting people back to there’s a chance to regain your in the PMCC prevention and being active, back to themselves, life in a way that’s under your A full 70% of participants rehabilitation program. whether that means playing with control.’” complete the program.

48 Peter Munk Cardiac Centre Winter 2016 49

DM161656_Pg01-57_PMCC_FALL_2015.indd 48 15-10-05 1:04 PM DM161656_Pg01-57_PMCC_FALL_2015.indd 49 15-10-05 1:04 PM 01 Dr. Heather Ross, left, and Stella Kozuszko, Nurse Practitioner in the PMCC Heart Transplant Program, are constanly communicating about major and minor A life saving adjustments to a patient’s care, sometimes minute by minute.

02 Just over a year after he transplant put received a heart transplant, Thunder Bay firefighter Dale Shippam was back on the job.

a re ghter 03 Dr. Ross also leads TestYourLimits expeditions for transplant patients, going to place such as Antarctica, back on Bhutan and the North Pole. The first Canadian trek took place in the Northwest the job Territories in July 2015.

Round-the-clock expert attention, care and month. He got fit again. “I was getting very strong,” he says. support kept Dale Shippam going until a new A year after the transplant, heart showed up he asked Dr. Ross whether there was any chance he could go back to firefighting. By Judy Gerstel 01 “She didn’t say no,” he recalls. “She said, ‘If the fire department okays it, you can Growing up, Dale Shippam always easily, breathed harder, felt weak. get. They can’t be manufactured good. It’s very nerve-racking.” go back,’” says Mr. Shippam. knew what his future His family doctor with 3-D printers. They can’t be The business of transferring “I knew I’d have to pass was going to be. diagnosed heart failure. ordered from Amazon. And they a beating heart from one body certain tests. I did a lot more He was going to be a firefighter. “I had to get a pacemaker,” can’t be created whole from stem that has expired to another body fitness work, and a year after But during six weeks in the Mr. Shippam explains. “Then cells or other living tissues – at that is on the brink is more than the transplant I went back to Coronary Intensive Care Unit a defibrillator. Every time they least, not yet; although, a short just a delicate operation – or, firefighting on the truck.” (CICU) at the Peter Munk tried to control it, something distance from Mr. Shippam’s room rather, two operations – with the But his new heart took him far Cardiac Centre (PMCC), else would happen.” were labs, where scientists were added challenge of transportation beyond the fires of Thunder Bay. the firefighter’s future, any Mr. Shippam was referred to working to make that happen. in between. It’s something of He joined his cardiologist, Dr. future, was in grave doubt. the PMCC because of problems But in Mr. Shippam’s room, it a miracle when it works. Ross, on her “TestYourLimits” “There were so many sirens with the defibrillator. He was told was the applied science of keeping And sometimes, it doesn’t. expeditions for transplant outside,” he recalls, “and I was he’d contracted a heart virus. a diseased heart beating that was ”People have false alarms,” patients. lying in a bed, thinking, ‘I’m never A few days later, transferring happening, hour by hour, second Mr. Shippam explains. “You’re The first trip was to Antarctica. going to ride a fire truck again.’” between units with his wife, by second, a race against the clock. taken to the operating room, “That first one, I didn’t know The best he could hope for, and Peggy, a former nurse, at his “We worked very hard to put under and can wake what would happen,” he recalls. it was a long shot, was to live. side, he suffered a cardiac maintain what little heart up with no new heart.” “But I quickly found that I could If you’d told him at the time that arrest and was rushed to the function there was,” explains 03 In Mr. Shippam’s case, he woke keep up with everybody.” he’d be riding the truck again, CICU, where Dr. Heather Ross veteran CICU nurse Stella up a week after the transplant, Another expedition went trekking in Bhutan, climbing in worked hard to keep him alive. Kozuszko, “constantly making after being kept in a medical to the North Pole. Nepal, skiing to the North Pole “Dale was critically ill,” recalls adjustments, minor, minor little hold on until a heart showed up.” his life could only be saved by coma to allow the new heart “That was brutal,” recalls Dr. and the South Pole, he’d have Dr. Ross, Dr. Heather Ross, changes, minute by minute.” 02 Mr. Shippam knew he was in the death of someone else. and his other organs to adapt. Ross, “the worst journey in thought he was hallucinating from Cardiologist, Peter Munk Cardiac The heart, says Ms. Kozuszko, danger of another cardiac arrest, “You never really know where “I certainly realized right the world. But on all the trips all the drugs dripping into him. Centre, and Medical Director, is responsible for what all the a fatal one, at any moment. And you are on the list,” he says. away that I had another heart, we’ve done, Dale has been the Mr. Shippam had been a Cardiac Transplant Program, organs are doing – the kidneys, “We had to get to the point where he knew that having a heart show “You can spend a lot of time that it was changed, but it strongest person on the trip. fit 47-year old firefighter Toronto General Hospital. “He the lungs, the brain. A slight he was well enough and strong up was not a simple matter, even contemplating where you are does take a while to sink in.” When we went to Bhutan, in Thunder Bay. had a very prolonged arrest, and drop in urinary output or blood enough to have a transplant,” once he was on the transplant list. on the list, but sometimes it’s As with all transplant patients, another trekker said about Dale, “I was incredibly healthy,” we had to return circulation. pressure needs to be attended explains Ms. Kozuszko. “You have to be optimistic,” he better not to. It’s a very tough Mr. Shippam was told nothing ‘That man is a machine!’” he says. “I ran the Boston We got it, we lost it; it was a to instantly. Monitoring fluids As critically ill as he was, says, “but also realistic because business, holding on every day, about the donor. “I think every Dr. Ross adds, “He’s also Marathon. I never smoked. I real battle. Dale’s body had and devices is a priority. hovering between life and there is a shortage of hearts in just waiting, knowing that if I transplant patient wonders about a very gentle soul.” controlled for risk factors.” tried to actively die through “It’s a fine line, at that point, death, Mr. Shippam was aware this country for transplants. It got a cold or something went that, but it’s probably better The most recent journey There was no history of cardiac arrest,” she says. in terms of monitoring,” says of what was happening. needs to be a certain body size wrong, I’d be off the list,” he says. that you don’t know,” he says. was a whitewater canoeing cardiovascular disease “At that stage, I was incredibly Ms. Kozuszko, “because in “They were so attentive round- and a special blood type. You “They don’t do that many heart “It’s hard even after all this time expedition on the Nahanni River in his family. sick,” Mr. Shippam says. “I was seconds they could pass.” the-clock,” he recalls, “and have to be realistic that one transplants. It’s still an event. And to talk about it because there’s in the Northwest Territories. But his body began to fail him. told I would never be able to But there was a challenge friendly, on top of everything else.” may not show up in time.” you see people passing away in a sad story at the other end.” “Five-foot standing waves, What was happening to all the leave the hospital without a heart for the highly trained, highly He strongly believes, and tells And always, behind the waiting the ICU while they’re waiting.” Mr. Shippam started walking big water, big holes,” says Dr. energy and stamina that had transplant. I would either get skilled nurses and doctors everyone who will listen, that “it and the hoping and the holding Then, he says, when the heart within a few day of waking Ross, with evident relish. fuelled this powerful six-foot a new heart or die waiting.” in the CICU beyond just was because of the care I received on for another day, there was does show up, “you don’t always from the coma, and he was “Dale and I, in a athlete in his prime? He tired But new hearts are not easy to keeping Mr. Shippam alive. in this hospital that I was able to the terrible knowledge that know if the heart’s going to be walking long distances within a canoe together.”

50 Peter Munk Cardiac Centre Winter 2016 51

DM161656_Pg01-57_PMCC_FALL_2015.indd 50 15-10-05 1:04 PM DM161656_Pg01-57_PMCC_FALL_2015.indd 51 15-10-05 1:04 PM Volunteering for and, at that point, once you’ve done your contacts and created an ambiance that may work, it’s, the greater good ‘Over to you, guys.’” Beyond their interest in health-care philanthropy, Dr. Board members are making a world of dierence in patients’ lives Gosevitz and Ms. Rogers also share a passion for protecting the By Shelley White environment. Dr. Gosevitz is the Chair of the Canadian Wildlife Foundation, and, over the Serving on the board of the much of their efforts for the “The thing I really like about years, he and Ms. Rogers have Toronto General & Western TGWHF board on supporting the PMCC and the Ted Rogers teamed up to produce a series Hospital Foundation (TGWHF) the innovative work of the Peter initiative is that it’s patient- of children’s books through Ms. is a combined effort for long-time Munk Cardiac Centre (PMCC) focused, and, to me, that’s the Rogers’s organization, Children’s friends Loretta Rogers and Dr. and the recently launched whole reason we’re here,” says Books for Charity. Bernard Gosevitz. Ted Rogers Centre for Heart Dr. Gosevitz, who is the only Their latest book is called “We work as a really close team,” Research. This cutting-edge community-based physician on Under Your Nose: A Book About says Dr. Gosevitz, sitting with Ms. initiative, which will combine the TGWHF board. Nature’s Gifts, featuring artists Rogers in the sun-filled atrium the forces of the UHN, the “For me, it’s been very like renowned naturalist painter of her home in Old Forest Hill, Hospital for Sick Children and rewarding as a physician, and Robert Bateman, D.A. Dunford Toronto. “Loretta’s been involved the University of Toronto, was I’ve seen the benefit to my and Ms. Rogers herself. (“It’s a in philanthropy for a long time, established in 2014, thanks to patients. It’s catapulting Toronto story about kids who are forced particularly with schools, so she a landmark donation by the as a world-leader in heart and to go without technology for puts a different spin on it, and Rogers family of $130-million – vascular disease, and it’s saving a while,” says Dr. Gosevitz.) I’ve got the spin of a primary the largest ever single donation lives every day.” Proceeds from the book will physician, as well. So we come up to a health-care institution in When asked what initiatives be split between the Bateman with ideas that are maybe a little Canada. she is proud of, Ms. Rogers Foundation and the Canadian to the right or to the left, but points to the Ted Rogers and Wildlife Foundation. maybe that’s good.” Family Centre of Excellence in But while the two friends Dr. Gosevitz, Vice-President Heart Function, a program that have accomplished a great deal and Chief Medical Officer specializes in improving clinical through their philanthropic at Rogers Communications, outcomes for patients who have endeavours, Ms. Rogers says recruited Ms. Rogers 10 years “Volunteer experienced heart failure. “It’s that there is still much work to ago to join him on the TGWHF board doing a great deal of good,” she be done. What’s ahead for the board, knowing she shared his notes. TGWHF board? “More money to interest in cardiac care and members serve Ms. Rogers and Dr. Gosevitz do more,” says Ms. Rogers. research. Dr. Gosevitz had been are two of 36 members on Dr. Gosevitz concurs. “One of the Rogers family’s physician a major role in the TGWHF board, which the ways Canada is the best in the since 1974 and treated Ms. is comprised of leaders in world is health care, but you’re Rogers’s husband – the late the success of medicine, business, media not going to get the funding communications magnate Ted fundraising… and philanthropy. Linda through tax dollars; it’s just not Rogers – for an ongoing heart Goldsack, chair of the PMCC going to be there,” he says. “I condition that plagued him for They source Campaign, says that volunteers think it’s incumbent on private years. are instrumental in providing industry and on private donors Ms. Rogers says she felt potential new guidance and direction in to step up. And I think we need compelled to join the board donors, make fundraising efforts. to get our foundation out there a because she had always been “Volunteer board members little more and encourage people impressed with the care her direct asks serve a major role in the to donate. We have world-class husband had received as a success of fundraising,” says Ms. things here, but, being Canadian, patient at the University Health to potential Goldsack. “They source potential we don’t talk about it.” Network (UHN). new donors, make direct asks “The Americans blow their horn “Ted had quite a few rounds supporters to potential supporters and – Canadians do not,” adds Ms. of surgeries, so you start to get and also also open doors to provide Rogers. to know people and see that it’s opportunities for donations.” She points out that it’s also a really good place to go,” says open doors A lot of the donations that have important to encourage everyone Ms. Rogers. “It’s a very nice, come through his practice are to donate, no matter who you are. caring atmosphere. The doctors, to provide grateful patients coming to him “One thing [the foundation] tries surgeons and nurses – you are opportunities and asking, “What can I do?”, to get across is, we want your looked after very well, with a says Dr. Gosevitz. small donations. If you can’t do a smile.” for donations.” “We’ve got a superb foundation big one, fine. Enough small ones Because of their shared interest – the people who work there,” add up to be a big one,” she says. in cardiac health, Dr. Gosevitz Linda Goldsack, he says. “We can open the doors, “And, well, just think: You may Chair, Peter Munk Cardiac Centre and Ms. Rogers have focused Campaign but they know how to finish, need it one day.”

52 Peter Munk Cardiac Centre Winter 2016 53

DM161656_Pg01-57_PMCC_FALL_2015.indd 52 15-10-05 1:04 PM DM161656_Pg01-57_PMCC_FALL_2015.indd 53 15-10-05 1:04 PM Have a since 1987 complete picture of your health It’s more than which, when you’re waiting for to the PMCC. After successful soliciting donations. “Most people a heart transplant, could be the surgery, Mr. Bank wanted to do understand and become excited difference between life and death. something to show his gratitude. and want to know more about writing a cheque David Prince knows this first- “I can give some money to show it. We encourage people to come hand. Lean, relaxed and enjoying how thankful I am,” he says. “It down and visit with us,” she the good weather over coffee, it’s can be used to help someone else.” says. “To speak with the doctors, For the donors to the Peter Munk Cardiac Centre, the money is a small part. hard to believe that he suffered Mr. Bank and his doctor, Robert nurses and researchers, and The relationships and trust in the team also make them give a catastrophic heart attack James (R.J.) Cusimano, are also learn first-hand the difference eight years ago, when he and friends. “After an event like that, they are making in pushing the his wife, Susan, were in Brazil. you become connected with these boundaries in understanding By Renee Sylvestre-Williams They spent a nerve-racking people.” When he decided to and treating cardiac disease and The Comprehensive Health Assessment from Medcan is a two months in Brazil before Mr. donate to the PMCC, he didn’t in improving patient care. Once thorough head-to-toe evaluation that gives you insights on Prince could be flown back to dictate how it should be spent. they meet the doctors and take your current health and future risks, so you can reach your Don and Carol Pennycook hold Goldsack and her team ensure applied the funds raised through Canada to continue treatment Instead, he completely trusted a behind-the-scenes tour of the a polo match for charity every that their donors know and a golf tournament to purchase at the PMCC. He was put on Dr. Cusimano. “A donation hospital, most people say, ‘How health goals. August in Hudson, Que., located are supportive of exactly where an echocardiography machine,” the heart transplant list and should have some impact.” can I help? What can I do?’” between Ottawa and Montreal. their donations are directed. says Ms. Goldsack. “We needed received a mechanical heart Showing impact is part of The funds raised from donations Medcan has over 65 physicians and specialists on site, alongside It’s an opportunity to enjoy The Peter Munk Cardiac a new, state-of-the art unit. (LVAD) while he was waiting. provide another benefit; they lead a broad roster of complementary health-care disciplines. We the weather and watch two Centre was created in 1997 There was no money left in the He received his new heart and to more money from the Ministry provide an innovative range of diagnostic assessments, health exhibition games. It’s also an with donations from Peter and operating budget to buy one, immediately got involved with of Health, which, in turn, goes 01 Grateful patient Don improvement programs and year-round care for individuals, opportunity for the Pennycook’s Melanie Munk. Since then, the and it was going to be a huge the PMCC via education and toward research and care. Pennycook and his to raise funds for the Peter centre has become internationally benefit to the specialists to talking with patients who were “Philanthropy can greatly families and organizations. cardiologist, Dr. Vijay Munk Cardiac Centre (PMCC). renowned, with 1,500 open have this new equipment with going in for transplants. impact ministry funding,” says Chauhan, during an annual Mr. Pennycook, a patient at heart surgeries performed a the extra capability of a new Henry Bank also began his Ms. Goldsack. “For example, polo fundraising event in 150 York Street, Suite 1500 Toronto, Ontario M5H 3S5 • 416.350.5900 • medcan.com the PMCC, was approached by year, 1,800 minimally-invasive echo probe. With a price tag of donor relationship with the Quebec, to support research the mechanical heart hardware a member of the Peter Munk heart procedures and 55,000 roughly $300,000, it’s not always PMCC in 1999, thanks to a high into abnormal heart rhythms, was funded by donations for 10 Cardiac Centre Campaign of annual patient visits. In 2008, in the operating budget of the blood pressure diagnosis. He such as atrial fibrillation. years, at $100,000 per heart. the Toronto General & Western the Ontario Ministry of Health hospital to buy this equipment.” tried to lower it with diet and An application to the Ontario Hospital Foundation. “They and Long-Term Care found These dollars make a difference, exercise, but “all hell broke loose 02 Dr. Narinder Paul (left), Health Technology Advisory were looking for some help to that the PMCC had the best whether they’re going to on a Sunday.” He had severe Linda Goldsack, Chair of the Committee (OHTAC), with fund the project on afib [atrial surgical outcomes for patients research or to the purchase intermittent pain down his leg. 10 years of data proving cost Peter Munk Cardiac Centre MEDCAN_quarter pg Ad.indd 1 2015-08-26 8:49 AM fibrillation, where a patient has with heart-related issues. A lot of machines and tools to help When he went to the hospital, Campaign (center), and Dr. savings to the ministry, quality an irregular rapid heart rhythm of this is a result of the PMCC’s people live longer. Some of he found out that there was Patricia Murphy (right), pictured of life for patients awaiting causing the atria to quiver or ongoing fundraising campaign. the money raised has gone no pulse in his leg. He had an beside an echocardiography heart transplants and the fibrillate] research.” He agreed as “One year a group of golfers toward mechanical hearts, echocardiogram and was sent machine with echo probe, saving of lives while waiting for he had become a patient due to made possible through heart transplants, resulted in afib. Mr. Pennycook had donated philanthropy. Ministry of Health support.” to charities before, but he wanted to do something on an ongoing basis like an event; hence, the polo match every August. IMPACT For both the PMCC and the University Health Network (UHN), donors and their Your donation will help us financial and educational contributions are a very achieve more breakthroughs. important part of their ability to provide top health care and carry out cutting-edge research in the field of cardiac care. “It’s philanthropic giving that has really set the bar in the institution,” says Linda Goldsack, Chair of the Peter Munk Cardiac Centre Campaign. “My team and I are successful in our campaign by building relationships with existing, donors and with new donors, as evidenced by recently achieving the goal of raising $100-million for the centre.” Every nickel Make your donation: counts, and while some donors 01 02 can give more than others, 416 -340 -3935

54 Peter Munk Cardiac Centre Winter 2016 www.inaheartbeat.ca

DM161656_Pg02-56_PMCC_FALL_2015.indd 54 15-10-05 11:36 AM DM161656_Pg01-57_PMCC_FALL_2015.indd 55 15-10-05 1:22 PM Grateful donors help fund innovation

By David Israelson

Everything is “so far, so good” Mr. Rubenstein’s own heart and is leading its four-year Je Rubenstein (right) and his a dozen years after his heart skips a beat when he talks about campaign to raise $100-million father, Max, who has been a transplant at Toronto’s Peter the importance of supporting for the centre, which treats patient at the Peter Munk Cardiac Centre. Munk Cardiac Centre (PMCC), the centre’s work, if only from 55,000 patients a year with says Frank Lavorato. And enthusiasm and excitement. cardiac or vascular disease. This that’s an understatement. “There’s a saying, ‘Saving one goal was achieved in October “I couldn’t be happier with life is like saving the world,’” 2014, capping in at $139-million. Munk Cardiac Centre Innovation the way I’ve been treated,” notes Mr. Rubenstein, CEO The foundation is considering Committee with medical experts, says Mr. Lavorato, a 65-year- of Export Packers Company whether to launch another which evaluates research old Woodbridge, Ont., Limited in Brampton, Ont. mega-campaign for the centre. proposals to determine which resident whose family has a After his father was helped, Regardless, the need for funding ones are most ready to be history of cardiac disease. Mr. Rubenstein was given a is always there, says Linda funded. “It’s like going back Jeff Rubenstein thinks it’s tour of the centre’s facilities, Goldsack, Chair of the Peter to school for me. I learn so wonderful that Mr. Lavorato’s and “I felt compelled to Munk Cardiac Centre Campaign. much all the time,” he jokes. transplant in 2003 was do something,” he says. The foundation and PMCC People in the Greater successful, but his goal is more Now it’s practically impossible work in “gift teams,” so that Toronto Area have a strong expansive – less surgery, more to get Mr. Rubenstein to stop donors can apply their funds understanding of the importance non-invasive treatment and advocating for the Peter Munk either to general hospital of being generous toward state- ever better knowledge, care and Cardiac Centre, for the new programs or specific areas of-the-art facilities like the Peter understanding of the heart. related Ted Rogers Centre for such as heart research Munk Cardiac Centre and the Mr. Rubenstein is a Toronto Heart Research and for the and cardiac care. Ted Rogers Centre for Heart businessman whose father, work they’re doing to treat This enables people whose Research, Ms. Goldsack says. now 95, also had his life patients today and to develop family members have been “Philanthropy is what allows saved at the centre. new treatments for tomorrow. treated by PMCC to make this institution to take that “He was 65 years old and “Cardiac care has come a long specific gifts, and it also lets next step,” she explains. “It had a heart attack right in the way in the last 25 years. We’ve the world-leading heart experts allows for the establishment of middle of a stress test. He had made a lot of inroads in cardiac who work there seek funding for academic chairs [for medical a quadruple bypass, and the surgery, cardiology,” says Mr. new types of treatment, which research]. We have 24 at the doctor saved him. Our family has Rubenstein, who is on the are often still experimental Peter Munk Cardiac Centre, all always been philanthropic. When board of the Toronto General & and, therefore, wouldn’t be funded through philanthropy.” someone saves your life, you want Western Hospital Foundation. funded by government. Each chair requires about to become a bit more involved, He is the Board Champion for In an additional role, Mr. $3-million in funding, say, ‘Thank you,’” he says. the Peter Munk Cardiac Centre Rubenstein sits on the Peter Ms. Goldsack says.

56 Peter Munk Cardiac Centre

DM161656_Pg01-57_PMCC_FALL_2015.indd 56 15-10-05 1:22 PM DM161656_PgOBC_PMCC_FALL_2015.indd 1 15-10-05 12:13 PM RioCan is a proud supporter of the Toronto General & Western Hospital Foundation and the Peter Munk Cardiac Centre

2300 Yonge Street, Suite 500 Toronto, Ontario M4P 1E4 www.riocan.com

DM161656_PgIFC_PMCC_FALL_2015.indd 1 15-10-05 3:18 PM