Creating a collaborative Centre of Excellence in Cardiac Valve therapy that is program focused, rather than provider based, is a novel approach that will maintain and strengthen our valve program on the international stage, and will provide durable leadership in a core area of cardiovascular care. The Centre will focus on advancing the field of complex valve repair by multidisciplinary teams that include Cardiologists, Cardiac Surgeons, Vascular Surgeons, Medical Imaging Physicians and Cardiac Anaesthesiologists. The establishment of the Peter Munk Cardiac Centred Chair in Advanced Cardiac Therapeutics will continue the legacy of Dr. Tirone David. This Chair will allow the Peter Munk Cardiac Centre to attract an individual who will be at the forefront of the development and evaluation of new technologies that are used to repair cardiac valves. It is anticipated that the Peter Munk Cardiac Centre Chair in Advanced Cardiac Therapeutics will also be the Head of the Division of Cardiac Surgery at University Health Network.

To be used at the discretion of the Peter Munk Cardiac Centre Chair in Advanced Cardiac Therapeutics.

PMCC’s Adult Congenital Heart Disease Program is the first and still largest program of its kind in the world. Patients with valvular heart disease constitute a major focus of this program, which maintains international leadership in research, education, and clinical standards, and is a perfect example of the programmatic approach to patient care that the PMCC is based on, as this group includes Cardiologists, Cardiac Surgeons and Medical Imaging physicians. We need to foster this unique clinical program, because the ACHD patient population continues to grow rapidly as patients graduate from care at the Hospital for Sick Children when they turn 18 and turn to the PMCC for ongoing management. This support will enable continued expansion of this program, and will allow us to expand our investigations into the genetic underpinnings of congenital heart disease.

Funding will include a $3 million Chair in Adult Congenital Heart Disease that would be held by the Director of the Program, as well as $1 million for an Endowed Fellowship and $1 million in expendable funds to defray the cost of research initiatives.

The molecular origin of many diseases that lead to damage to cardiac valves remains unexplained. The pathologist’s role in patient care is to analyze tissue samples and establish a definitive diagnosis. To do this, the pathologist requires all contemporary tools, including light and electron microscopy, robot enhanced tissue staining and molecular diagnostics. Accurate diagnosis is essential to enable specific therapy that will minimize morbidity and mortality. The pathologist’s unrivaled understanding of the structural basis of disease makes that individual an essential member of the research team, as they work to unravel the basis of all valvular heart disease. The Chair in Cardiac Valve Pathology will enable the Peter Munk Centre of Excellence in Cardiac Valve Disease to coordinate research into the molecular origins of valvular heart disease, and to coordinate research efforts in valvular heart disease with other physicians in the PMCC.

This year, we completed construction of the multi-purpose operating room (the MPOR), the only operating room in Canada with a state of the art, integrated CT scan – flat panel, digital angiography unit. The demand for this room is rising exponentially, as surgeons continue to integrate intraoperative imaging and surgery. Therefore, we anticipate the need for a second MPOR, to accommodate the demand for percutaneous cardiac valves and endovascular aortic aneurysm repair by PMCC physicians.

This Fellowship recognizes the sustained and outstanding contribution that Dr. Lenkei-Kerwin has made to the PMCC, and will enable one Fellow per year to conduct research in cardiac disease.

The Centre of Excellence in Aortic Disease will be led by the Peter Munk Chair in Complex Aortic Therapy, who will be at the forefront of research in aortic diseases and the development and evaluation of new technologies for use in the treatment of aortic pathology. The Chair will develop a strong interdisciplinary team that includes Medical Imaging physicians, Cardiac Surgeons, Vascular Surgeons and Mechanical Engineers to improve the clinical care of those who suffer from diseases of the aorta, such as aneurysms and dissections. Advances in minimally invasive aneurysm surgery, including endovascular repair, robotic assisted repair and delivery of molecular therapies would be directed by the Chair, which may be held by a Vascular Surgeon, Cardiac Surgeon or Medical Imaging Physician.

To be used at the discretion of the Peter Munk Chair in Complex Aortic Therapy.

The Division of Cardiovascular Surgery cares for more patients with connective tissue disorders of the heart and great vessels than any other institution in Canada. This includes patients with aortic root aneurysms or dissections due to connective tissue disorders like Marfan’s Disease, and mitral regurgitation due to mitral valve prolapse. Numerous operative procedures have been developed in this hospital during the past two decades to treat these patients that are in use world wide, and several publications describing the clinical outcomes of these novel operations developed in the PMCC are published every year. The Peter Munk Chair in Cardiovascular Connective Tissue Disorders will lead expansion of this strong clinical program into a more comprehensive initiative that includes Pathologists, Basic Scientists and Cardiologists to study the morphologic and molecular abnormalities associated with these diseases.

Rupture of an abdominal aortic aneurysm is a leading cause of death in Canada, particularly in men over 65 years of age that smoke, and is fatal in 90% of cases. Despite the fact that the cause of aortic aneurysm growth and rupture has been studied extensively, an explanation for this lethal disease has not been identified. Dr. Lindsay’s basic science laboratory has studied the effect of simulated aneurysm rupture in mice, and has identified some of the causes of organ failure after aneurysm rupture. By combining the expertise that has been developed in their laboratories, teams led by Dr. Lindsay and Dr. Rubin will be able to study the causes of aortic aneurysm growth and rupture. Funding through an endowed Chair would ensure appropriate support for this basic science work, which has a high potential to be translated into novel, clinically applicable therapies that will prevent aortic aneurysm rupture.

Surgical simulation has emerged as an educational tool for trainees and students to practice and rehearse procedures in a safe, controlled, risk-free setting. Simulator-based endovascular skills’ training has been shown to measurably improve performance in catheter-based image-guided interventions. In addition to improving endovascular training, simulators may prove useful in determining procedural competency and credentialing standards for Endovascular Surgeons and Interventional Cardiologists and Medical Imaging physicians, thereby improving patient care.

Mentice VIST™ is a high fidelity endovascular simulator that provides relevant, realistic hands-on training for angiographic and interventional procedures. The cases available on the VIST™ facilitate the development of equipment handling skills and clinical decision making abilities. Multiple access options and a variety of patient scenarios challenge the learner’s procedural capabilities. With the Mentice VIST™ system, physicians can practice peripheral vascular, renal, carotid and coronary interventions, percutaneous heart valve replacement and endovascular stent graft repairs. This simulation centre will allow students, residents and staff to learn and practice the catheter based skills that will be necessary to deliver care for patients with cardiac and vascular disease. In the future, students will learn in a simulation centre before doing procedures in the operating room or cardiac catherization laboratory.

The Peter Munk Chair in Molecular Medicine will lead the Peter Munk Centre of Excellence in Molecular Medicine. The Peter Munk Chair in Molecular Medicine will ensure that the three other Peter Munk Centres of Excellence sustain global leadership in cardiac and vascular care by optimal targeting of innovative diagnostic and therapeutic technologies to the patients most likely to benefit from these advances. The Peter Munk Centre of Excellence in Molecular Medicine will focus on ‘personalizing’ patient care by integrating traditional clinical information, including imaging, with genetic, molecular, cellular and physiological data, and will be led by the Peter Munk Chair in Molecular Medicine. In the future, analysis of each individual patient’s genes will direct their therapy.

To be used at the discretion of the Peter Munk Chair in Molecular Medicine.

By collecting tissue samples from every patient that has a surgical procedure in the PMCC, we will build a repository of specimens that can be used for future research. Given the breadth of patients that are seen in the PMCC, including patients with adult congenital heart disease, ischemic heart disease, heart failure, valve disease, aortic aneurysm and aortic dissection, we can create a biobank of unparalleled scope. Furthermore, by integrating this biobank with a data base that captures the patient’s clinical history, blood work, imaging results, genetic, molecular, cellular and physiological data, the opportunities for discovery of new disease pathways and new treatments for those diseases will be limited only by our own imagination, creativity and drive.

Arrhythmias occur when the heart does not beat in a regular, rhythmic fashion, and are a leading cause of disability and death worldwide. Inherited arrhythmias are a growing problem in Ontario, and no centres in Toronto are currently equipped to manage and investigate the young patients that have this potentially devastating group of diseases. Patients with inherited arrhythmias are genetically predisposed to the development of arrhythmias, in the same way that some patients have genes that increase their risk of developing specific cancers. The Chair in Heritable Arrhythmias will lead a unique clinical and research program that will focus on understanding the genetics of cardiac arrhythmias, and will develop specific therapies for individual patients, based on their genetic profile. Work in the PMCC has already identified some genes that may play a key role in the development of some inherited arrhythmias. If we know what causes the arrhythmia, we can develop therapies to cure these abnormal heart rhythms.

Clinical trials are necessary to evaluate the safety and efficacy of new devices and therapies before they can be introduced into practice. The Peter Munk Centre of Excellence in Multinational Clinical Trials will build upon a foundation of research strengths, and will recruit cardiovascular scientists who are expert in clinical epidemiology, clinical trial design and health outcomes research. The Peter Munk Centre of Excellence in Multinational Clinical Trials will provide the infrastructure and resources that are essential for successful clinical trials research. The Peter Munk Centre of Excellence in Multinational Clinical Trials will be led by the Peter Munk Chair in Multinational Clinical Trials.

To be used at the discretion of the Peter Munk Chair in Multinational Clinical Trials.

This unit will allow simultaneous assessment of metabolic activity, blood flow and the structure of a beating heart. Only two of these units are currently in use world-wide (New York and Barcelona). By placing this unit next to a cyclotron, we will create a unique environment where radioactive chemicals which only last a few minutes could be made and directly injected into patients. The potential for clinical research and the assessment of new drugs in patients with cardiac diseases like heart failure is immense, and would attract significant support from the pharmacologic industry. Given the interest that the pharmaceutical industry has in doing clinical trials in Canada, having the unique infrastructure of a cyclotron adjacent to a PET – MRI would ensure that return on this investment, in terms of payment for enrollment of patients in clinical trials, would be very high. This system would allow us to simultaneously assess the structure and function of a beating heart, and to determine how the heart responds to specific therapies.

After a heart attack, some heart muscle cells die, and the ability of the heart to pump blood is compromised. By transplanting stem cells into areas of the heart that have died, it may be possible to grow new heart cells and recover heart function, thereby prolonging the life of patients that have had a heart attack. This funding will allow Dr. Terry Yau and his team to harvest stem cells from patients who have had a heart attack, grow these cells in a culture dish and then transplant them back into the patient’s damaged heart, thereby leading to recovery of heart function.

Most patients requiring cardiovascular surgery suffer from hardening of the arteries, or atherosclerosis. Patients with peripheral arterial disease – generally affecting the legs and causing severe pain or gangrene and limb loss – are known to have advanced atherosclerosis. While hundreds of thousands of Canadian have atherosclerosis and peripheral arterial disease, there is currently little research on the effect of treating factors that cause atherosclerosis, such as hypertension, high cholesterol, smoking and diabetes on the evolution of peripheral arterial disease. A Chair in Cardiovascular Epidemiology will lead programs that will develop and promote optimal treatment strategies for patients suffering with atherosclerosis and peripheral arterial disease.

This IT support, including high throughput servers and networks, will allow the PMCC to provide an integrated imaging framework that can efficiently manage the very large data sets that current imaging equipment in I3 generates. This IT support will also enable integration of current and future data management and data storage systems.

This fellowship will recognize the sustained excellence of Dr. Johnston in clinical research, and will allow one Vascular Surgery Fellow per year to continue this work.

Due to the severity of the disease process and the significant co-morbid conditions that patients with cardiovascular disorders have, and secondary to its inherently invasive nature, cardiovascular surgery has the highest incidence of major morbidity of any type of surgery. Outcomes of cardiac surgical patients treated in the PMCC compare very favorably with other major cardiac surgery centres around the world, due in part to the development and implementation of evidence-based guidelines for cardiovascular surgery in our Centre. However, even with these initiatives, we have failed to alter outcomes for standard cardiovascular surgery significantly over the last decade. Thus, there is a clear need for Patient Safety Research and Innovation to improve outcomes in this diverse patient population.

Over the last 5 years the UHN Department of Anaesthesia and Pain Management has developed a set of unique, world class Peri-operative Information Management tools, with a data base that currently has 15,000 patients. The Chair in Cardiovascular Peri-operative Patient Safety will build upon these recent advances in anaesthesia information technology, and capture in one place the totality of each patient’s peri-operative experience. Using these tools and data, the Chair will identify areas for improvement, and direct clinical trials, education and clinic decision support. The comprehensive peri-operative database will enable continued monitoring of outcomes and the evaluation of each intervention’s effectiveness in real time.

Care delivered by nurses and allied health professionals, including physiotherapists and occupational therapists, is a central and growing component of the scope of care provided to patients with cardiovascular disease in the PMCC. This fellowship will allow a nurse or allied health professional to do research in best practices for patients with cardiovascular disease, in both the in-patient and out-patient setting.

The mission of the Peter Munk Cardiac Centre includes leading the world in the development and evaluation of innovative cardiac and vascular therapies. These therapies, which are often based on medical devices that are smaller and less invasive than their predecessors, frequently allow physicians in the PMCC to treat patients that would otherwise not be candidates for any treatment. Examples of innovative cardiovascular therapies include percutaneous cardiac valves, which are used to treat patients with aortic, mitral and pulmonary valve disease that are too ill for open cardiac surgery, advanced aortic stent grafts, which are placed in patients too ill for open aortic aneurysm repair, and Impella turbine catheters, which can help patients with failing hearts maintain blood flow to vital organs. None of these devices are currently funded by the Ministry of Health and Long Term Care (MOHLTC).

The MOHLTC does not fund the cost of new medical devices, at least not in the early phase of their clinical assessment. The Peter Munk Innovation Fund will maintain and accelerate the development and evaluation of innovative cardiac and vascular therapies by Peter Munk Cardiac Centre physicians, by defraying the cost of advanced medical devices until these devices are funded by the MOHLTC. Simultaneously, the Peter Munk Cardiac Centre will coordinate applications for the evaluation of advanced devices by the Ontario Health Technology Advisory Committee (OHTAC), which advises the MOHLTC on the safety and efficacy of medical devices after they have been approved by Health Canada. Once approved by OHTAC, Peter Munk Cardiac Centre physicians, in conjunction with UHN, will aggressively lobby the MOHLTC to fund these devices. This is the protocol that was followed at UHN to realize $2.9 million in funding for left ventricular assist devices from the MOHLTC in 2010. In addition, last year PMCC Vascular Surgeons and Medical Imaging physicians submitted an application to OHTAC that led to a recommendation by this body to fund a particular kind of advanced endograft.

Innovation Funds will be allocated after consultation with the Innovation Fund Oversight Committee, which will prioritize innovation funding initiatives in the PMCC. Membership for this Committee will include individuals from outside of the PMCC who have experience funding and developing innovation in a commercial setting. Innovation Funds will be provided on the strict condition that the patients that receive devices supported by Innovation Funds be rigorously studied, and that the results of such studies be submitted to the Ontario Health Technology Assessment Committee.

The establishment of Peter Munk Cardiac Centre Integrated Fellowship Program will enable an environment where the training of physicians will be disease based and patient centered, as opposed to the specialty based and physician centered training that is currently practiced in most Centres. Through this program, physician trainees will learn how to deliver the full spectrum of care to the patients that they manage – this will include medical management, conventional and molecular imaging, catheter based endoluminal interventions and open surgical procedures in a team based environment.

To support the training of physicians across existing specialty designations, four integrated multi-disciplinary Fellowships are proposed:

Anaesthesia – Intraoperative Cardiac Imaging Fellowship
This Fellowship will enable future cardiac anaesthesiologists to gain expertise in intraoperative imaging of the heart by two and three-dimensional echocardiography, CT and MR techniques.

Cardiology – Medical Imaging Fellowship
This Fellowship will provide an opportunity for cardiologists to gain expertise in echocardiography, CT and MR, or for medical imaging physicians to increase their understanding of the management of patients with cardiac pathology.

Cardiac Surgery – Cardiology Fellowship
This Fellowship will enable the development of cardiac specialists that can provide the full spectrum of cardiac care through open surgical or catheter based techniques.

Vascular Surgery – Medical Imaging Fellowship
This Fellowship will strengthen the existing integration between Vascular Surgery and Vascular Interventional Radiology, and is consistent with our vision to train Vascular Specialists who can image patients and then carry out endoluminal therapies or open surgical procedures.

The Peter Munk Cardiac Center Medical Director Chair will oversee and manage the Peter Munk Cardiac Centre, promote a multi-disciplinary approach to patient care and fellowship training, support study of the basic mechanisms of cardiovascular disease and have primary responsibility for all of the activities in the PMCC, in conjunction with the Toronto General Hospital Vice President and site lead. The Peter Munk Cardiac Center Medical Director Chair will also ensure that the Centre recruits and retains the physicians necessary to fulfill the mission and vision of the Peter Munk Cardiac Centre, and will be responsible for making the Peter Munk Cardiac Centre a world wide leader in the diagnosis and management of cardiovascular disease, and the training of physicians that manage patients with cardiac and vascular disorders.

More information coming soon…

More information coming soon…

Heart failure treatments and investigations constitute a core strength of the PMCC. The group of Cardiologists and Cardiac Surgeons, with special expertise in heart failure has recently formed a comprehensive group, pooling their clinical and research talents. Dr. Heather Ross leads this group and was named the inaugural holder of the Ted Rogers and Family Chair in Heart Function. The goal of this group is to create one of the worlds leading research and educational programs in heart failure, with a focus on fellowship training and research in outcomes and mechanisms of disease.

Elements of this program include funding for a fellowship program ($2.25 million), ongoing funding for clinical delivery and research in left ventricular assist devices ($1.5 million), creation of a clinical trials program specific to early phase studies in heart failure ($750,000) and funding to explore E health solutions to improve heart failure patients self care ($500,000).

A donor has confirmed their intention to support the Centre of Excellence in Heart Failure.

Cardiac electrical disturbances span the entire spectrum of patients with heart disease. Investigation and treatment of heart rhythm disorders is changing dramatically based on ongoing research. The PMCC already has an internationally recognized research and clinical group in areas such as ablation treatment for ventricular arrhythmias, mechanisms of arrhythmias, and heart rhythm disorders in congenital heart disease. The establishment of a Chair in Heart Rhythm Disorders ($3 million), to be held by the Head of Electrophysiology, will provide clinical and research leadership.

A donor has confirmed their intention to support the Chair in Heart Rhythm Disorders.

Dramatic innovations are now occurring in medical devices and ablation that are used to treat a wide range of heart rhythm diseases. All of these new and evolving treatments are optimally carried out in dedicated electrophysiology procedure rooms, which include both radiology and electrophysiology equipment, and also have the functionality to enable the conduct of surgical procedures. Currently, patients receive treatment for heart rhythm disorders in the heart catheterization suites and in the main operating rooms. The equipment in our current single electrophysiology suite is well past its projected life span, and requires replacement at a cost of $3 million.

A heart catheterization laboratory is located next to the current electrophysiology suite, and will no longer be used when the four new heart catheterization laboratories, a component of the I3 project funded by Peter and Melanie Munk, open in February 2011. We plan to convert the decommissioned heart catheterization laboratory into a dedicated implantation suite for patients needing pacemakers or implantable defibrillators, at a cost of $2 million. With state of the art imaging and electrophysiology equipment in an operating room environment that will exist in the Invasive Electrophysiology Centre, we will be able to implant much more advanced devices, often in critically ill patients, far surpassing our current capacity.

Related news: Peter Munk Cardiac Centre expanding infrastructure to include two state-of-the-art Electrophysiology Suites.

Treatment of patients with coronary artery disease with medical management, percutaneous coronary intervention (angioplasty and stenting) or bypass surgery is central to any cardiac program. At the PMCC, the clinical and research focus is treating patients with complex and critical coronary artery disease in very high risk settings, such as during a heart attack. This builds on the established cardiac and surgical strengths of PMCC, and also complements the heart failure and transplant programs. This Centre of Excellence will be led by a Chair in advanced cardiac revascularization. The Chair will provide clinical leadership and will foster research focusing on revascularization and medical therapy in the setting of high risk revascularization and myocardial infarction. The request also includes operating funds for this Centre of Excellence, to be used at the discretion of the Chair in Advanced Cardiac Revascularization, which could be held by a Cardiologist or Cardiac Surgeon.

This is required to allow echocardiography, nuclear cardiology, CT and MRI to be located in close proximity to each other, which will centralize the area where patients requiring cardiovascular investigations go to have these investigations. Therefore, imaging will become patient centered, as opposed to the current situation, where patients must go to multiple different parts of the Hospital for imaging studies. In addition, this proximity of diagnostic modalities will create an environment that promotes collaboration between imaging specialists, and which will lead to integrated, multidisciplinary patient care.