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Cardiac Team Achieves Surgical First in Ontario

Southlake Regional Health Centre is first in Ontario to use an endoaortic balloon,  a novel approach to stopping the heart during minimally invasive surgery

Newmarket, Ontario – June 30, 2010 – The cardiac surgical team at Newmarket-based Southlake Regional Health Centre is the first in Ontario to perform a completely minimally invasive heart surgery procedure using an endoclamp aortic catheter – a cutting-edge approach to stopping a patient’s heart that is fed through an artery in the groin. This approach eliminates the need to use an external aortic cross clamp, a surgical instrument that must be applied through an incision in the chest in order to arrest the heart.

The milestone is significant because it means Canadians can receive leading edge treatment right here at home rather than travelling to the U.S., said Dr. Zlatko Pozeg, the Southlake cardiac surgeon who led the procedure and who was trained at the University of Pennsylvania in Philadelphia. Earlier this year, Danny Williams, premier of Newfoundland, made headline news when he travelled to the U.S. for a similar cardiac procedure.

“This is an important step forward in the evolution of truly minimally invasive surgery related to valve repair,” said Dr. Pozeg. “With the aid of minimally invasive surgical techniques and the use of the endoclamp aortic balloon, we are able to perform the entire operation through a small, two-inch incision under the patient’s right breast which means recovery is quicker, with less pain.”

The novel approach is rare in Canada and required special training for the entire Southlake surgical team, including the nursing staff, operating room assistants, perfusionists and anesthesiologists. The only other Canadian physicians who recently began using this method are based in Quebec cardiac centres.

The endoaortic balloon is inserted into a patient’s femoral artery in the groin area through a very small incision or “port” and guided to the aorta using an echocardiogram or heart ultrasound machine. Once it is in place, it is inflated and a potassium chloride solution is delivered to stop the heart, providing a still surgical field so surgeons can operate. The balloon is used in conjunction with a coronary sinus catheter to ensure the heart does not continue to beat during the procedure.

“To see the endoaortic balloon in place was quite impressive,” noted cardiac anesthesiologist Dr. Daniel Kim. “It’s a much more controlled approach than traditional cross-clamping that is safer for the patient and reduces the risk of hemorrhaging.”

The cardiac first at Southlake – with equipment supplied by Edwards Healthsciences – was performed on Colombe Parker, a female patient suffering from heart valve disease. By applying advanced minimally invasive surgery techniques, the cardiac team successfully performed mitral and tricuspid valve repairs, leaving only small incision scars and avoiding the need for a sternotomy – a cut through the sternum.

“There was no happier day than when I found out that they could perform the operation this way,” said Parker, who still wears a bikini at 56. “Thanks to Dr. Pozeg and the cardiac team at Southlake, the scar is small and hidden underneath the breast, and I really have to make an effort to see it,” she said. Currently recovering at home, Parker is also amazed at how quickly her breathing is improving. She’s already walking 30 minutes a day and is looking forward to getting on with her retirement, which includes plans to do a lot of travelling with her husband.

In addition to the obvious cosmetic advantage of a small incision on the side as opposed to a large one down the centre of the chest, patients who undergo the minimally invasive procedure also enjoy the benefit of a shorter hospital and a quicker return to their normal lives without compromising surgical outcome. Moving forward, Dr. Pozeg expects to regularly perform similar valve replacements or repairs using the endoaortic balloon in response to high demand for the procedure.

 “More and more cardiac centres are grasping onto this technology and are being trained for it,” he says, noting that every member of his surgical team received special training in Philadelphia in order to learn exactly what was expected and how to be successful with the new device. “It’s important because it means our patients are getting the best possible minimally invasive procedure they can get.”

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