Story by Elizabeth Chorney-Booth | Photograph by Jared Synch
How Calgary’s Mitral Valve Interventions Program is revolutionizing cardiac care in Calgary
Most people recognize the sudden and often dramatic symptoms of a heart attack. But fewer of us are aware of heart-valve-related symptoms that can come on slowly in someone who is otherwise healthy and physically fit: periodic palpitations or fluttering of the heart, irregular heartbeat, and shortness of breath that worsens when lying down. These symptoms usually begin gradually and may even be possible to ignore for years. But as time marches on, sufferers may feel like they’re struggling to breathe or worse, drowning.
Heart valve problems may not seem as pressing or life-threatening as a stroke or heart attack, but they can greatly affect a patient’s quality of life. Calgary-based heart surgeons Drs. William Kent and Corey Adams have dedicated themselves to improving heart valve care for Calgarians through the Mitral Valve Interventions Program (MVIP), which provides tailored and innovative surgical care to patients with mitral valve issues. Through the development of a comprehensive all-hands-on-deck program, the surgeons raise awareness about valve health while also providing minimally invasive surgical options, often with the use of innovative new technology.
Valves: doors to a healthy heart
So, what does the mitral valve and its cousin the tricuspid valve do? These two valves essentially consist of flaps or doors that control the flow of blood between the chambers of the heart. Valves form a regurgitation or become “leaky” when the flaps do not close completely, causing blood to flow in the wrong direction. An estimated 1.5 million Canadians over the age of 65 will develop some form of heart valve disease by 2040 with mitral valve regurgitation (MVR) being the most common. MVR can be the result of stress on the heart caused by heart disease or another illness, or a natural or genetic degeneration of the cords that pull the flaps open and shut. It can affect anyone including generally healthy individuals in their 30s or 40s who show no other signs of heart disease. Left untreated, MVR can lead to lifelong complications, including heart failure.
Typically, surgeons treat MVR with open-heart surgery to repair or replace either the valve or the cords around it. While traditional open-heart surgery is still the best option in many MVR cases, Kent and Adams’s mission is to offer minimally invasive surgery whenever possible. Since conventional surgery comes with risks, especially for elderly or medically compromised patients, as well as lengthy hospital stays and recovery times, MVIP focuses on alternative treatments. Instead of opening up the chest, Kent and Adams typically enter the heart through an artery with a transcatheter via a small incision often on the side of the patient’s torso, allowing for procedures that not only improve patient recovery, but also free up beds and take pressure off the busy healthcare system.
When asked if the MVIP approach really provides more benefit over conventional surgery, Kent is confident in his response. “We always say it’s about the subtle things, like how quickly patients are getting out to the mountains with their family after surgery or how early they’re getting back to work. That quality-of-life piece is important.”
The art of valve surgery
Kent and Adams share an infectious energy — when they’re together talking about their work, their passion for the possibilities of modern mitral valve surgery is palpable. As part of Calgary’s relatively small community of cardiac surgeons, both doctors perform all kinds of heart surgeries on an emergency basis, but they developed a partnership through a shared fascination with valves. While neither surgeon entered medical school with an existing fervor for valve work, Kent says he came to appreciate the nuances involved with treating these delicate aspects of the heart as he learned about the technical aspects of valve procedures.
“What appeals to me personally is there’s an art in this kind of medicine,” Kent says. “You get to be creative with valve surgery.”
After completing medical school in Ontario in 2010, Kent moved to Calgary, where his wife is originally from. He completed his cardiac surgery training at the University of Calgary where he formed a bond with now-retired cardiologist Dr. Andrew Maitland. Maitland became a mentor and got Kent excited about valve surgery — minimally invasive procedures in particular — a program Maitland pioneered at the Foothills Medical Centre. As Maitland neared retirement, Kent sought out a new collaborator to help lead MVIP. He had run into Adams — who was then practicing cardiac surgery in his hometown of St. Johns, Newfoundland — on the conference circuit and found he shared a similar enthusiasm for valve surgery. Adams moved to Calgary in 2020 and the two have spent the last five years working to bring new surgical solutions to Calgarians through MVIP.
“It’s nice to come together with people who are pulling in the same direction,” Adams says of his partnership with Kent and the rest of the MVIP team. “Our goals here are to provide the best care we can to a big population and make a difference to a whole lot of people.”
Creating a toolbox for heart valve care
At the heart of MVIP’s approach is a toolbox philosophy. Kent, Adams, and their team carefully examine each patient’s needs before deciding which tools will make up the best course of action and ensure each patient gets the best possible care. In 2023, Kent and Adams started working with a tool called MitraClip, a dime-sized synthetic device implanted within the heart through a catheter to control the mitral valve. It acts as a minimally invasive substitution for repairing the cords that open and close the valve, and patients typically only have to spend a couple of days in hospital post-surgery before returning to their normal lives.
Even though MitraClip has been prescribed by surgeons around the world since 2003, the technology was previously unavailable in Calgary. Patients who were good candidates would either have to travel out of province for the device or opt for less ideal open-heart surgery. But now, thanks to Calgary Health Foundation funding commitment, MitraClip is available through MVIP. While MitraClip isn’t right for all patients, the surgeons say having every tool available in their arsenal improves the overall picture of valve health in Calgary.
And MitraClip is only one tool; others are now under development. “The number of new techniques coming along is immense,” says Kent. “We want to be the best valve centre in the world and do great heart surgery. But we realized if we want to expand and be the best, we have to have more of these tools.”
Building a comprehensive program
The toolbox mentality illustrates why it’s essential that MVIP is structured as a program rather than a series of flashy valve-related techniques and technologies. Not only does the program champion and make MitraClip and other minimally invasive surgeries possible for Calgarians, it also gives Kent and Adams the opportunity to take a relatively unique team approach. They work with interventional cardiologists, researchers, nurse specialists, anesthesiologists, and other medical professionals to not only offer the best patient care, but also to organize data to track patient outcomes and measure their success rate. As the program develops different ways to meet individual patient needs, outcomes will improve for all cardiac surgical patients — including those receiving traditional open-heart surgery — as the entire department works more efficiently.
“We’re using innovation to provide more care, even for conventional surgery,” Adams says. “Since the Foundation is funding our program as opposed to a single technique, we can fund a researcher to study how patients are doing. That’s the part of the program. We get feedback and then we can accurately tell people what to expect with these new surgeries.”
Kent and Adams’s program-centric approach has captured the attention of other surgeons who have reached out for training and opportunities to collaborate or share ideas. As MVIP’s reputation for forward-thinking valve surgery continues to grow, Kent and Adams expect more device manufacturers to reach out and help to expand their toolbox, giving Calgarians even more options as new technologies emerge.
“We have this vision to build a centre of excellence in valve surgery,” Kent says. “We want to serve the patients in southern Alberta and Calgary and provide them with the best care they can get in the world. Funding from Calgary Health Foundation triggers a commitment and really gets that ball rolling.”
With these innovative techniques, they’re not just restoring heart function, but also giving patients back their health and their lives, which is the ultimate goal. “With these operations, when we nail it, we can say to patients, ‘Go live your life, go chase your grandkids,’” Adams says, noting that a successful surgery gives patients a similar life expectancy to someone who has never had a valve problem. “Potentially, it’s a fixed-for-life solution.”
Symptoms of a mitral valve regurgitation
- Shortness of breath especially when exercising or lying down
- Palpitations: a feeling of a rapid, fluttering, or pounding heartbeat
- Swelling in your hands, feet, ankles, abdomen, or the veins in your neck
- Fatigue or tiring easily, especially during physical exertion
- Irregular heartbeat, also called an arrhythmia
- Chest pain (less common)
If you experience these symptoms, discuss them with your healthcare professional.
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