A serious heart problem inspired a man with Marfan syndrome to develop a device that offers hope not just for himself but for thousands of other patients with the same condition.
In 2000, Tal Golesworthy, a process engineer from the UK, was told that the aortic root in his heart had expanded and was in danger of splitting. He had two choices; undergo surgery to insert a mechanical valve or risk a sudden and fatal heart attack.
The first option filled him with almost as much dread as the second. Surgery would involve cutting out the damaged section of the artery and replacing it with a piece of tubing. It would also mean that he would be placed on warfarin, a blood-thinning drug, also used as rat poison, which carries the risk of severe bleeding. “That’s not something I wanted to rely on for the rest of my life,” said Golesworthy. “The thought of that dismayed me more so than the surgery.”
Golesworthy thought he could engineer a better solution. What excited him was the use of. He believed that by combining magnetic resonance imaging (MRI) and computer-aided design (CAD) with rapid prototyping (RP) techniques he could manufacture a tailor-made support that would act as an internal bandage to keep his aorta in place.
The concept, he hoped, would reduce the risk of harmful clots forming due to the mechanical valve and importantly, eliminate the need to take warfarin. Time was crucial if Golesworthy was to save himself. So he enlisted the help of Prof Tom Treasure, a cardiothoracic surgeon at Guy’s Hospital, and Prof John Pepper, a surgeon from the Royal Brompton Hospital.
“Although conceptually, it was very simple to do, the actual engineering was significantly more complex.” explained Golesworthy.
He set about devising a means of wrapping the aorta in a sleeve to prevent it expanding, and came up with a solution called Ears — external aortic root support — which is now being marketed through his firm, Exstent. The team looked at a number of different processes, such as 3D embroidery, but ended up using a standard medical polymer, polyethylene terephthalate (PET) in a textile solution. The mesh weighed less than 5g, was an exact fit for the ascending aorta and could be sutured into place by the surgeon. Each sleeve is created using scans of the individual patient’s aorta and computer-assisted drawing to produce a bespoke device.
The process, from proposal to final product, took just under two years. “My aorta was dilating all through that period,’”said Golesworthy.
Golesworthy believes that projects such as this demonstrate that the interface between engineers and the rest of the world isn’t functioning in the way it should. “When it does function, huge advances can be made in a very short time period, on very little money,” he said. “We have changed the world for people with aortic dilation and we have done it on a fraction of the cost.”
In May 2004, Golesworthy became the first recipient of his own invention. Since then, 23 patients have successfully had the implant fitted and another seven are hoping to undergo the procedure.
Word on Health is continually amazed at what people can do when their life is on the line. Although as Golesworthy himself says “When you’ve got the scalpel of Damocles hanging over your sternum, it motivates you into making things happen.”