World-first cardiac procedure at St. Michael’s Hospital offers new treatment for high-risk patients

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World-first cardiac procedure at St. Michael’s Hospital offers new treatment for high-risk patients

Toronto, September 8, 2020

By Selma Al-Samarrai

Mir Hasan Ali and Dr. Neil Fam shake hands.
Mir Hasan Ali, the patient to undergo the world-first procedure at St. Michael’s Hospital (left) with Dr. Neil Fam. Enlarge photo

A world-first occurred at St. Michael’s Hospital of Unity Health Toronto when Drs. Neil Fam, Mark Peterson and Géraldine Ong performed a catheter-based tricuspid valve replacement through the femoral vein in a patient’s leg.

The first patient to undergo this procedure, 76-year-old Mir Hasan Ali, says his health improved within 48 hours. One year later, his health remains markedly improved.

The team used the EVOQUE tricuspid valve replacement system. Prior to using the femoral approach, tricuspid valve replacement procedures were done through open heart surgery or a thoracotomy, meaning the incision occurred through the patient’s ribs. The surgery was effective but invasive, so it posed a greater risk of complications for older patients.

“Going through the femoral vein means the risk of complications is dramatically lower. 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,” explained Dr. Fam, an interventional cardiologist and the Director of Interventional Cardiology and Cardiac Catheterization Labs at St. Michael’s.

Prior to the procedure, which occurred on May 23, 2019, Ali explained that low-effort tasks such as getting out of the car or making the short walk from the bedroom to the bathroom proved too difficult. After the procedure, he could resume these tasks and many other daily activities with great ease.

“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,” explained Ali.

“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.”

Photo of the team that performed the tricuspid valve replacement on Mir Hasan Ali on the day of the procedure in May 2019.
Taken on the day of the world-first procedure in May 2019. click/tap for photo caption

(From L to R)

Back: Dr. Edwin Ho, Cardiologist, St. Michael’s; two Edwards EVOQUE team members; Henry Gehrs, Cardiac Catheterization Lab Technologist; Edwards EVOQUE team member; Dr. Mark Peterson, Medical Director, Walter and Maria Schroeder BRAIN&HEART Centre; Dr. John Webb, Director, Interventional Cardiology, St. Paul’s Hospital; Dr. Neil Fam, Director of Interventional Cardiology and Cardiac Catheterization Labs at St. Michael’s; Dr. Janine Eckstein, Cardiologist, St. Michael’s; two Edwards EVOQUE team members; Dr. Han Kim, Anesthesiologist, St. Michael’s.

Middle: Dr. Géraldine Ong, Cardiologist, St. Michael’s; Edwards EVOQUE Tricuspid team member; Debby Law, Cardiac Catheterization Lab Registered Nurse.

Front: Two Edwards EVOQUE team members; Tony Hong, Cardiac Catheterization Lab Technologist. Enlarge photo

The St. Michael's Structural Heart Team has since performed several more tricuspid valve replacement procedures using the femoral approach, with the patients reporting significant improvements in their health. To date, 25 patients worldwide have undergone the EVOQUE tricuspid valve replacement, and the results are very encouraging. With further studies planned.

The EVOQUE heart valve was first used for mitral valve replacements only. Just over two years ago, Dr. Fam approached the manufacturer Edwards to discuss if EVOQUE might be effective for tricuspid valve replacements as well, and this led to a great partnership to bring this idea to reality.

For the past five years, St. Michael’s has been a world leader in transcatheter tricuspid valve interventions, where tricuspid valves are repaired using MitraClip and PASCAL repair systems. However, some patients’ tricuspid valves were irreparable, and the challenge was to then develop a safe and effective procedure to entirely replace the tricuspid valve.

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

“Fourteen 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, and I am taking all the precautions to maintain my healthy lifestyle.”

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit

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