Doctors unsure why Williams would go to U.S. for heart surgery

All but very rare and specialized heart surgery that is done in the United States is also available in Canada, doctors said Tuesday about the decision by Premier Danny Williams of Newfoundland and Labrador to have heart surgery later this week in the U.S.

"The vast majority of heart procedures are available all across Canada, in most centres," says Dr. Christopher Feindel, a cardiac surgeon at the Peter Munk Cardiac Centre at the University Health Network in Toronto. That would include the "whole gamut" of heart surgery, from coronary bypass, to all forms of valve procedures, heart transplants and operations to restore abnormal muscle inside the heart.

While some of the more specialized procedures are concentrated in larger centres, "for the most part as far as I can tell everything is available in Canada," Feindel said.

The one significant exception would be surgery to the thoracic aorta, the giant blood vessel that carries blood that's pumped out of the heart to other organs. If a person develops a swelling or aneurysm, an abnormal bulging, in the thoracic aorta, and needs surgery to open the chest cavity, "that's a very extensive operation," Feindel said.

"It's generally very rarely done. It's done in Quebec but it's also so rare, certainly in Ontario, when we run across these cases we tend to send them to one of the heart centres in Texas."

The Baylor University Medical Center in Dallas, Texas, "has tremendous expertise in this. They're doing almost one or two of these cases a day, whereas in Ontario we might get two or three cases a year," Feindel said.

Someone with a thoracic aortic aneurysm is followed for many years.

"It's usually a fairly elective procedure and we usually have lots of warning to determine what should be done," Feindel says.

People develop symptoms of the aneurysm expanding inside their chest. They may get pressure against their vocal chords, and become hoarse. They may get pressure against their esophagus, causing difficulty swallowing.

Often it's picked up by a chest X-ray. "Or often they've had some previous problem with the aorta that's gone on to develop this over the years, and it's picked up because they're followed on a regular basis over many years," Feindel says. "It's not something that happens overnight."

It's the only procedure Feindel has come across "that we would specifically refer to the states."

For years, Americans travelled to Canada for valve repair surgery, to avoid having to replace a diseased or defective valve with an artificial one. Valve repair, or valve-sparing techniques were developed in Canada, "and in particular here, at the Peter Munk Cardiac Centre. So, it's been a reverse," Feindel said. "We've had people come from other countries and the U.S. for surgery."

He said well known people, politicians or otherwise, sometimes go elsewhere to have surgery. "I'm not sure it's such a terrible thing. I think sometimes anonymity can be beneficial," he said.

"But I have a lot of trust in the Canadian health care system. If I needed surgery, I would go to some centre in Canada — hopefully my own — but certainly any centre that provides the same service."

A spokesman for the University of Ottawa Heart Institute said he was "hard pressed" to think of why Williams would need treatment in the U.S., unless it were for something "exceptionally rare."

Every patient is unique, said Jacques Guerette, vice president, communications for the heart institute. "It's more a question about the individual patient, and what factors are at play, than it is about what expertise is available," he said. "You have to look at the patient in totality, and that might influence how treatment is administered."

"I can say the Heart Institute is certainly second to none in North America. We're here if he (Williams) needs us."

Guerette said the Heart Institute is the Ontario centre for a rare surgical procedure called pulmonary thromboendarterectomy, an operation that removes clotted blood from the arteries, and is a leader in mitral valve surgery in the country. "We have the most advanced electrophysiology labs in North America," he said. "We have the most advanced catheterization lab in the country, and probably North America."

"At the end of the day it's up to the individual patient to decide what's best for them, under their particular circumstances. We can try to have the best experts and the latest equipment and the most advanced research. But people may still choose to get treatment elsewhere for personal reasons. And that's absolutely fair and that's the way the system should be."