University Health Network (Toronto General Hospital) is located in the heart of downtown Toronto and home to a team of 19 Perfusionists. The Perfusion scope of practice at UHN is very diverse. Yearly the team is involved in over 1500 cardiac cases, as well as over 1700 cell saver procedures which include cardiac, liver and lung transplants (along with some placenta percreta cases at Mount Sinai). We continue to see a rise in heart failure and do over 40 heart transplants a year as well as over 40 VAD insertions using the Centrimag, Heartware, Heartmate II & III and Impella.
UHN is the world’s leading lung transplant center performing the first successful lung transplant in 1983 and now does 130 lung transplants annually (plus or minus intraoperative ECMO). UHN was the first to use XVIVO lung perfusion to improve high-risk donor lungs extending the utilization of donor lungs from 15% (worldwide) to 40 per cent here at TGH. As a result the perfusion department is involved with over 100 of these cases a year. The Xvivo program has extended to other organs as well. We have currently done 18 Xvivo liver perfusion cases which, unlike the lungs, require the Perfusionist to travel to the donor site to perfuse the organ (using the OrganOx device).
Our Extracorporeal Life Support program continues to grow and evolve each year, reaching +85 ECMO cases. 26 of these cases were a part of our external retrieval program across southern Ontario (accepting patients within a 400 km radius). In the past we have held two very successful ECLS centered symposiums and expect to hold similar educational meetings in the near future. Our main ECLS circuit is the Centrimag pump with the Quadrox oxygenator, however, we also use the NOVA lung and A-lung on occasion.
Other procedures we are involved in are intra-op veno-veno bypass for hepatectomies and CPB for Pulmonary Thrombo Endarectomies (40 cases a year). We also recently started an InVivo Lung Perfusion study for patients with lung cancer.
We currently use the Sorin S3 heart lung machines, Spectrum in-line monitoring and electronic perfusion records, Maquet HCU-40, Sorin Xtra Blood Recovery Systems, Hemochron Signature Elite ACT machines, Seimens Rapid Point 500 blood gas analyzers and iSTAT ACT/blood gas analyzer for transports.
Our Perfusion department is also associated with the Perfusion Program at the Michener Institute of Education at UHN. We help with lectures and labs and have students come in for observational day visits throughout the program along with taking on students for their clinical placements.
In the near future our center we will be involved with the Tandem Heart percutaneous VAD system, AngioVac used for the removal of soft, fresh thrombi or emboli in the venous system, Xvivo kidney perfusion clinical trials.
We are always open and excited to bring in new technologies as we continue to expand our scope of practice at TGH.