The Personal Health Navigator is available to all Canadian patients. Questions about your doctor, hospital or how to navigate the health care system can be sent to AskLisa@Sunnybrook.ca
The Question: Does OHIP cover all of the costs associated with valve replacement surgery?
The Answer: The short answer is yes, the Ontario Health Insurance Plan does cover the cost of all aortic valve replacement surgery – something that is true across Canada. The operation is typically done on those with narrowed or leaking aortic valves, due to a congenital condition or a disease acquired in later life. The valves can be mechanical or bio-prosthetic and made of porcine, equine or bovine material.
“The mechanical valves require lifelong anticoagulation [treatment with so-called blood thinners] while bio prosthetic valves typically don’t. On the other hand bioprosthetic valves typically wear out in the 10 to 20 year range, requiring a repeat surgical procedure,” said Dr. Sam Radhakrishnan, director of Sunnybrook’s catheterization laboratory.
There’s a newer type of minimally invasive valve replacement available, called transcatheter aortic valve implantation [TAVI], now being funded by the Ontario government. It is offered to patients who are ineligible for open-heart surgery because their risk of death or developing severe disability post surgery is deemed too high.
Patients eligible for TAVI suffer from severe aortic stenosis, an increasingly prevalent disease among the elderly. With the onset of significant symptoms, particularly progressive shortness of breath, severe uncorrected aortic stenosis carries with it a death rate of up to 50 per cent over the next two years. The average age for the TAVI procedure at Sunnybrook has been 83.
In addition to Sunnybrook, five other hospitals in Ontario – University Health Network, Hamilton Health Sciences Centre, St. Michael’s Health Sciences Centre, the University of Ottawa Heart Institute and London Health Sciences Centre – are being funded to perform the minimally invasive operation on a pilot basis over the next three years, according to Ontario health ministry spokesman David Jensen.
To cover the cost of the new operation, Ontario is providing an additional $15,000 per case, bringing the total reimbursement for the TAVI procedure to $35,000 – the same amount funded by the British Columbia Ministry of Health, said Mr. Jensen.
The procedure involves inserting a replacement valve made of porcine or bovine tissue mounted on a metal frame, into the diseased aortic valve. The procedure is done with fluoroscopic (X-ray) guidance and often can be accomplished through an incision in the groin that is less than half an inch.
According to results of the Placement of Aortic Transcatheter Valves trial [PARTNERS], in patients who were not candidates for conventional open-heart surgery, TAVI provided a survival benefit over medical therapies. “In this trial, for patients who were deemed inoperable, performing TAVI led to a substantial reduction in the one year rate of dying or being rehospitalized for heart failure. Indeed, for just about every three patients treated with TAVI compared to medical therapies alone, one life was saved or repeat hospitalization prevented.” In patients who were deemed high risk for a conventional operation (but operable) those who underwent TAVI had virtually the same survival rates at one year as compared to patients who had open-heart surgical repair. However, in this trial the stroke rate was higher for the TAVI patients at 30 days and again at one year compared to those that underwent open-heart surgery.
“There’s no doubt the recovery with TAVI is a lot faster,” said Dr. Radhakrishnan, noting that patients spend seven to eight days in hospital compared to almost two weeks for open-valve replacement in these higher risk patients.
Lisa Priest is Sunnybrook’s Manager of Community Engagement & Patient Navigation. Her blog Personal Health Navigator provides advice and answers questions from patients and their families, relying heavily on medical and health experts. Her blog is reprinted on healthydebate.ca with the kind permission of Sunnybrook Health Sciences Centre. Send questions to AskLisa@sunnybrook.ca.
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Heart failure cannot be cured though there is a range of treatment options available to manage and improve quality of life.
Hi.I leave in Greater Vancouver bc.I am seventy years old and on the waiting list for tricuspid heart valve repair and and a leaking mitral valve replacement.I have no other medical issues.I do Not want a mechanical valve.I am looking for a surgeon who can perform a non invasive surgery and install a bio prosthetic valve.
Can you help me?
I was diagnosed with aortic stenosis. The surgeon I talked with in January recommended a mechanical replacement which included taking Warfarin for the remainder of my life. I am in my mid 50’s and wonder if it would be better to have a bio replacement instead. Unfortunately no discussion of change in diet or CACS was discussed. Also, what do you know of the carotid intima media thickness? Would that be done before or after?
I am 69 years old and I have had an Aortic Valve Replacement at age 64. It was a bovine Valve and was replaced with open heart surgery . In the event I need a second replacement would TAVR be an option for me or would I have to have open heart surgery again.
Where would be the best place in Ontario for mitral valve repair with experienced surgeons
Which city is the best for the aortic heart surgery
I am male 80 years old in fair medical condition and have (moderate) aortic stenosis.I have been told I do not qualify for a valve repair(tavi).I am petrified at having open heart surgery.Could I please have your opinion.Could I wait until my condition deteriorates??????
I am on waiting list tor TAVI @ UOttawa Heart Institute and want to know more about TAVI.
I just had an aortic valve replacement done at the University of Ottawa Heart Institute on January 28th with a tissue valve and I am feeling great. I would highly recommend this Hospital, very professional, highly trained staff just go to their web site and read all about them and their established procedures. Don’t waist time you must be as fit as possible to recover quickly and without further complications. Oh yes, leave a donation with the foundation. All the Best!!
Is The Tavi procedure contraindicated in the presence of mitral stenosis?
Yours is a very informative website, thank you very much!
My Toronto daughter says you run a very competent agency, and she wishes I too were living in Toronto, so that my 12-year-old aortic porcine valve could be replaced. But I’m in the Fredericton area of New Brunswick, not Ontario.
Would you know if your procedures are being practiced in New Brunswick, probably Saint John?