Getting to the Heart of the Matter

UWI develops Cardiovascular Surgery Simulator

Article courtesy the Marketing & Communications Office, UWI Mona

The pig’s contributory role to medical research and improvements in public health and patient care has been largely downplayed.

However, recent ground-breaking work by a multi-disciplinary team of researchers at The University of the West Indies, Mona has put the pig’s heart at the centre of cutting-edge technology with the innovation of the cardiac surgery simulator.

Anatomically similar to that of humans, the pig’s heart is a valuable model in developing treatment in cardiovascular health management. Former lecturer in the Department of Surgery Dr. Paul Ramphal recognised this from back in the 1990s when as a surgical trainee in Glasgow, Scotland, he bought pig hearts from the local butcher to practice on.

“The idea of using a pig’s heart to simulate a human one is not original to me, as the similarities between the porcine and human hearts have been known for years,” Dr. Ramphal said in a 2011 interview from the UWI Bahamas School of Clinical Medicine, where he is now an associate lecturer.

On returning to Jamaica in 1998, Dr. Ramphal was appointed Consultant Cardiothoracic Surgeon at UWI with the task of training three new cardiothoracic surgeons. Because only few open heart procedures were done locally, Dr. Ramphal faced a challenge in providing his trainees with the experience they needed to operate in high-volume centres in North America and the United Kingdom. This was when he came up with the idea of animating a pig’s heart by inserting balloons inside it and using a pump to inflate and deflate the balloon to mimic a beating heart..

“What is unique about my simulator is that the heart is made to look as though it is still alive and beating inside an artificial human chest cavity and has artificial blood flowing through it and is connected by computer to a simulated vital signs monitor and can be made to react to actions taken by the trainee,” he said.

He took the mechanical prototype to the then Department of Mathematics and Computer Science at Mona where computer scientist Dr. Daniel Coore created the software that allowed the pumping device to move causing the heart to beat in synchrony with the vital sign traces being displayed on a monitor.

Dr. Michael Craven of the Engineering Department at the University of Technology who was on sabbatical from  Nottingham University in the UK, and his assistant Mr. Somara Newman, did engineering work in the early phases  of the project.

Not long thereafter Professor Richard Feins of the University of North Carolina at Chapel Hill, then Chairman of the American Board of Thoracic Surgery, contacted Dr. Ramphal. And the pioneering trio of Ramphal, Craven and Coore went to Chapel Hill to show off the simulator.

“Over the last four years we have been demonstrating the capabilities and properties of the simulator to hundreds of surgical residents and Thoracic Surgical Programme Directors at special symposia and meetings all over the USA, and even as far as Melbourne, Australia. The response of those who have seen it and used it has been uniformly positive,” said Dr. Ramphal.

Strongest arguments in favour of the simulator are that it provides a highly realistic training environment for surgical residents, enabling routine and unusual surgical procedures or situations, without exposing the patient to danger. The  simulator uses porcine hearts of animals slaughtered for consumption, so animals are not sacrificed to provide material.

By April 2009, Dr Feins had begun to muster tangible support for the simulator among prominent US teaching  hospitals. Up until this time, there was only one prototype in existence, and Dr. Ramphal was the only person who could proficiently operate it. So, using specifications provided by Dr. Ramphal, Dr. Coore set about re-engineering the entire simulator from within the Department of Computing, UWI, Mona. The electronic components that already existed were repackaged, and new components were introduced to automate the activities that Dr. Ramphal would perform during a simulation run. New software was developed to control the entire simulator, and to make operating the simulator easier to learn. By mid-2010 the second generation prototype was completed.

Agreements were signed between The UWI and eight US institutions to allow each to own and use a prototype in their cardiac training programmes. By September 2011, eight prototypes had been delivered and installed at: University of North Carolina (Chapel Hill), University of Rochester, Massachusetts General Hospital, Johns Hopkins Medical Centre, Vanderbilt University, Mayo Clinic, University of Washington, and Stanford University. These institutions are, together, investigating how to systematically use simulation to improve cardiac surgical training in the US. The UWI Cardiac Surgery Simulator is currently their highest fidelity simulator, and stands at the centre of the study.

A US patent has also been granted for the simulator thereby raising UWI’s international research reputation.

The Simulator innovation is an important manifestation of the UWI’s research thrust and points to an interest in addressing national, regional and global needs through research conducted by its best minds.