Better access to care for mitral valve patients in Saskatchewan thanks to champion efforts by local cardiologist

April 22, 2023

“Until 2023, patients in Saskatchewan who needed a mitral valve repair would undergo open heart surgery,” says Dr. Janine Eckstein, an assistant professor at the University of Saskatchewan and interventional cardiologist at the Royal University Hospital (RUH), Saskatoon, Saskatchewan, who advocated for her province to approve the program.

“Patients who weren’t candidates for open heart surgery had no other less invasive options available in the province,” explains Dr. Eckstein—options that could improve their quality of life or in some cases, save their life. When possible, they were offered to travel to Ontario or BC to undergo a less invasive procedure to repair or replace their heart valve.

The impact of travelling out of the province on patients and caregivers could be significant. For some, it would require either a long drive or flight and the support of a family member or friend who would need to take time away from work. For others, the high cost of travel and hotel made the trip unaffordable.

By 2018, the impact on patients was evident to Dr. Eckstein. While pursuing subspecialty training in interventional cardiology at St. Michael’s Hospital in Toronto, she continued to see Saskatchewan-based patients on her trips home to Saskatchewan. If a patient was a candidate for the less invasive procedure, she would refer the patient to the Ontario or BC team.  

In July 2019, while training in Toronto, Dr. Eckstein worked with the Cardiosciences team at RUH to submit a proposal to the Saskatchewan Ministry of Health for a transcatheter program to be housed at RUH. The transcatheter aortic valve implantation (TAVI) program started at RUH in August 2019, but the mitral valve procedure was not yet approved.

Every year, the request to treat mitral valve patients was edited and resubmitted. The team added new data and insights, strengthened the case for support and highlighted the burden on the patients who couldn’t get treated in their home province, and the burden on the health care system. Meanwhile, patients who were considered for transcatheter mitral valve repair continued to be referred out of province.

After completing her Fellowship, Dr. Eckstein returned to Saskatchewan. She kept her medical license in Ontario and Saskatchewan, paving the way for a collaboration between the two institutions and new options for heart valve patients in her home province.

When the circumstances allowed, she even travelled with the patient and their caregiver to Toronto where she worked with the St. Michael’s team to perform the transcatheter mitral valve repair, paying for her own travel and accommodations.

“Flying these patients is not ideal when we can do them in Saskatchewan,” says Eckstein. Making the trip with her patients gave her a unique perspective that would later help strengthen their case to the Ministry in 2021.

“The reason I traveled with my patients was to make a point. I knew we could do the mitral valve procedure here in Saskatchewan,” says Eckstein.  By traveling to Toronto, she got to keep up her skills, oversee their care and share her patients’ journey.

Their case was further strengthened when in 2022, RUH hired Dr. Max Buchko, a cardiac surgeon with training in transcatheter procedures. His arrival made for a well-rounded, multi disciplinary team.  

That same year, thanks to the persistent advocacy work of Dr. Eckstein and her colleagues, the Ministry of Health agreed to the program and the team was ready to go! Patients who are candidates for mitral valve repair can now be treated at home, which is better for the patients and their caregivers.

On January 12, 2023, Dr. Eckstein and Dr. Buchko performed the first minimally invasive mitral valve repair in Saskatchewan, on Virgina, an 83-year-old heart valve patient from Saskatoon.

For Virginia and the patients who followed, the news that their procedure was going to be done in their home province was truly unbelievable. “The patients were thrilled they didn’t have to travel,” says Dr. Eckstein.  

For Dr. Eckstein, the cardiology team assembled at RUH has been the key, bringing a spirit of collaboration which is helping them become even more multi-disciplinary, working with physicians from multiple specialties, nurses, technicians and many others. “Disease management has become so specialized that we do need multi-disciplinary teams to help us treat the patient as a whole,” she says.

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