20th anniversary of the Cardiac Surgery Program at THP

Cardiac Surgery is proud to celebrate its 20th anniversary within the regional Cardiac Health program at Trillium Health Partners (THP). For two decades now, our cardiac surgeons have performed the delicate, complex procedures needed to save the lives of patients with failing hearts, establishing one of the most respected, high-volume cardiac surgery programs in the province.

Successful programs like the Cardiac Health Program are made possible with the essential support of donors like you in our community. Please give generously.

THP Foundation connected with Dr. Joseph Noora, Head of Cardiac Surgery to learn more about the history of the program – and what to expect in the next 20 years and beyond.

Interview with Dr. Joseph Noora

Q: What prompted the creation of the Division of Cardiac Surgery in 2000?

A: In the 1990s, significant waitlists for cardiac surgery were common. To address the need for timely care for at-risk heart patients, the province expanded care to support the needs of growing communities, including Mississauga.

Dr. Gopal Bhatnagar was hired as chief of cardiac surgery to build the program with surgeons Dr. Shaf Ahmed and Dr. Charles Cutrara.

Now, we’re a team of five including Dr. Ting Zhang, who came on staff after her Fellowship here and Dr. Steve Singh, who came back to Canada from a senior role at the renowned Brigham and Women’s Hospital at Harvard Medical School.

Q: I understand we do some 1,500 cardiac surgeries annually. Can you talk about the range and complexity of procedure your team performs?

A: Correct. Cardiac surgeries steadily grew annually over the last 20 years. When I came on 10 years ago we were at about 1,000 cases and last year we did 1,472 to be exact.

The group of surgeons we have are diverse, experienced and very able. We work collaboratively with our broader clinical team of cardiologists, radiologists, nursing staff and anesthesiologists. Together we do valve repairs, valve replacements, complicated aortic and combined procedures and catheter-based valve structural heart procedures, but we specialize – and originally made our name in – beating heart surgery. We remain the only centre in English Canada that can boast the volume of beating heart surgery we have at THP.

We are also one of the select few hospitals in Ontario to offer TAVI, or transcatheter aortic valve implantation, and performed over 100 of these procedures in 2018/2019 with that number climbing each year. Our cooperative venture with interventional cardiology in structural heart disease, including TAVI and mitral clips, has become the envy of the province. We are proud to offer a successful program in minimally invasive valve procedures to high risk patients. Our adoption of newer techniques have made us the centre of last resort for many high risk patients.

Q: What kind of impact does a rapidly growing and aging population with more complex conditions have on your patient population?

A: This conversation started in cardiac surgery before it started anywhere else. No doubt our population is ageing: our average patient age is 72 to 73 years old and we now operate patients in their 80s who, 20 years ago, wouldn’t have been candidates but now we are able to do very complicated, high-risk surgeries for these patients.

Q: How do we compare to other centres? What should we be known for?

A: I think the group has established themselves as an efficient surgical centre with expertise in beating heart coronary bypass surgery able to participate in some very complex surgical procedures involving all aspects of the heart. We continue to be a high volume referral centre through CritiCall, the provincial referral service for urgent care, tending to life threatening emergencies day and night.

As far as volumes and efficiency goes, we are amongst the top tier – there are only 11 centres in the province and we are for volume in the province. The efficiency of the group, the administrative staff, the nursing staff, and the collaborative environment I have found second to none and I am very proud of that.

Q: Given COVID-19, are you back to doing elective procedures?

A: While heart procedures are somewhat elective, they’re still time-sensitive. We are still not back to our pre-COVID volumes because we have to maintain capacity for a potential surge in COVID cases. Despite the pandemic, we never shut down our total volumes, continuing to provide a high level of care, while keeping our patients and staff safe.

Q: Where do you see the program going in the next few years?

A: I think there’s a lot happening at THP and our community that will affect us. Population growth and demand of the community will necessitate growth for our program and the introduction of newer technologies, whether its volume growth or minimally invasive procedures. We may need to take on advancements in devices as demand grows. When people ask me, I say the sky’s the limit.

Q: What makes you most proud about the program?

A: The ability of the entire program to continue to work together to do what’s best for patients. It definitely has an impact, especially in a high-stress environment like cardiac surgery. Everyone works well together – the whole group with administration comes together to advance care for the community.

Obviously I’m proud of the clinical work we do, the very difficult procedures we take on. None of that is possible without collective support. Everyone from the clinical staff to the administration is proud of the work we do here and that’s been made abundantly clear during COVID. Over the last 20 years and the last nine months we have managed things very well for the community.

Q: Can you share an example of innovation at THP that is improving patient care and efficiency?

A: PPATH (Putting Patients At The Heart) is a program that was tested out here by the province. Heart surgery patients receive 24-hour support as needed from SE Health so they can recover at home. Dr. Cutrara won several awards for his leadership there. The collaborative effort at THP allowed the program to thrive, reducing hospital stay times and improving patient satisfaction. I think it’s been a great asset to the community and patients.

Q: Can you elaborate on teaching and research efforts? Any other programs upcoming?

A: We are working on developing more research to use our volumes to help medical care in general. We also have a great relationship with the U of T medical school teaching and our program is an asset to the residency program. Our surgeons have already won teaching awards and I think students have a great experience in the operating room.

Q: What are your closing thoughts?

A: My pride is the collaborative spirit of the team. Team approach has ensured our world class status. Our trajectory of growth and excellence has been made possible by the generosity of our community, and we are most thankful for that support.

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Successful programs like the Cardiac Health Program are made possible with the essential support of donors like you in our community. Please give generously.



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