July 18, 2014
Almost 15 years after James Poulias underwent successful double bypass cardiac surgery at London Health Sciences Centre (LHSC), he returned on May 12 to LHSC to receive North America’s first ACURATE TA™ transcatheter aortic valve implantation (TAVI).
“My surgeon told me 15 years ago that one day I may require another surgery because of a separate problem with one of my heart valves,” says 80 year old James Poulias, from Tecumseh Ontario. Earlier this year, Poulias began feeling severe fatigue, shortness of breath and a little pressure in his chest area. He could no longer mow the lawn without sitting down and had to stop playing golf, his favourite pastime. “Since my surgery, I already feel better but I look forward to longer walks with my wife and playing golf with my seniors club.”
When presented with Poulias’ case, LHSC cardiac physicians, Drs. Bob Kiaii, Michael Chu, Pantelis Diamantouros, and Patrick Teefy, agreed TAVI would be the best treatment option. The minimally invasive surgery would treat the critically narrowed heart valve to improve blood flow.
James Poulias, pictured here with his wife Lena Poulias and members of the cardiac surgery team at University Hospital, was the first patient in North America to received a new generation cardiac device. See more photos on LHSC's Facebook page.
A majority of patients who receive TAVI are 80 years of age or older, thus, open heart surgery is often not an option available to them given the risk of complications. However, further assessment revealed that currently available TAVI devices were not suitable due to Poulias’ anatomy, meaning the risk of serious leakage around an implanted valve was too high to perform the procedure.
Fortunately, LHSC’s cardiac team had very recently received training in Germany for the implantation of the ACURATE TA Aortic Bioprosthesis, a newer generation TAVI device that allows safer treatment of higher risk patients with fewer complications.
This new generation TAVI device proved to be an excellent solution for Poulias. “This device promises to reduce or eliminate significant leakage from around the implanted valve, which roughly 10 to 20 per cent of all previous generation TAVI patients experience, ranging from mild to severe,” says Dr. Kiaii. “In severe cases the risk of mortality is similar to not having the procedure at all.”
On May 12, the heart team, as well as a multidisciplinary team including anaesthesiologists, nurses, and clinical perfusionists, performed three TAVI implants using the new device, including Poulias’. “Our results have been excellent with our first cases,” adds Dr. Chu. “In fact, we completed five more cases in July, again with excellent results. At a minimum, we feel that at least 20 per cent of all TAVI patients could benefit from the new device. We can now expand TAVI treatment to higher risk patients who were otherwise deemed untreatable.”
The device, at present, is only available at LHSC in North America, has a short hour glass shape that self-seats and self-seals tightly within the old aortic valve while intuitively ensuring correct anatomic positioning.
Currently, special approval from Health Canada is required prior to proceeding with each individual patient. ACURATE TA was developed and is manufactured by Symetis SA in Switzerland.
“My children and grandchildren have told me they notice the colour has returned to my face,” says a jovial Poulias. “I already feel a significant improvement in my quality of life.”