Patient Stories

Spotlight on Evoque: St. Michael’s performs another world first-in-human cardiac procedure

Two days after surgery, Mr. Ali was ready to resume his daily activities.

A weak heart made simple tasks like getting out of the car or walking to the bathroom difficult for Mir Hasan Ali.

“In April and May of last year, I was terrible. Taking just a few steps meant I had to sit down. I was always so drowsy, tired and irritable,” says the 76-year-old retiree.

The problem: a leaking valve on the right side of his heart known as the tricuspid valve.

It’s a hard-to-treat condition that typically requires open heart surgery or a thoracotomy, which is an incision through the ribs. But that was too risky for Hasan, who also had several other heart issues.

His cardiologist, St. Michael’s Dr. Neil Fam, approached him with a novel idea: to replace the valve by inserting a catheter through the femoral vein in his leg and implanting a new valve within the old valve, effectively eliminating the leak and improving blood flow to the rest of the body.

“When Dr. Fam explained the procedure to me, my sixth sense said yes on the spot. I trusted completely that he could do it, and I was right,” says Hasan.

He agreed, becoming the first person in the world to undergo this procedure.

“Doing tricuspid valve replacements through the femoral approach is a game-changer as it opens up treatment options for patients with heart failure who are too sick to undergo surgery or are not good candidates for tricuspid clipping,” says Dr. Fam, the director of Interventional Cardiology and Cardiac Catheterization.

Drs. Neil Fam, Mark Peterson and Geraldine Ong performed the world-first procedure using the EVOQUE tricuspid valve replacement system on May 23, 2019.

And within two days, Mr. Ali was ready to resume his daily activities.

The St. Michael’s Structural Heart Team has since replicated the procedure several more times. Patients are noticing big improvements in their health. It was Dr. Fam’s idea to approach Edwards to see if EVOQUE, which was first used for mitral valve replacement, could work for tricuspid valve replacements as well. As a result, 50 more patients around the world so far have successfully undergone the procedure as part of a clinical trial. 

This less-invasive approach reduces the risk of complications, recovery time and medications. And that’s great news for the 60,000 Canadians with tricuspid regurgitation who don’t respond to medication.

“Often the symptoms of patients are vague, and don’t get diagnosed until later. But patients who have this problem really don’t feel well — they’re suffering and once they develop heart failure they’re in and out of the hospital. Now we have a solution,” says Dr. Fam. “And it all started with St. Michael’s donors giving to the tricuspid intervention fundraising project that allowed us to do tricuspid clips.”

Hasan says he is grateful to Dr. Fam and the Structural Heart Team at St. Michael’s for their care and attention.

“Every single day, I pray for two people: one is my son, and the other is Dr. Neil Fam. He’s like family to me now,” said Hasan.

“Fifteen months after the procedure and I’m still feeling great and trying my best to maintain my health. The pandemic was a challenge, my rehab was cancelled, but the procedure provided me the opportunity to live again.”

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