Within the further discussion on engineering matters we should mention one delicate point. It is generally thought that the true features of a person’s character are mostly revealed in the most extreme situations for them – when they are hanging between life and death. But the same refers to the mind – facing a difficult choice a person makes a decision or reasons based on the type of mind that prevails. So if we consider an engineer as not just a holder of an appropriate diploma, but as a person who has this specific type of mind, it is obvious that a true engineer will always stay an engineer, be it at work, in their household, health care etc. In any situation, decisions made will be based on an engineering logic. Therefore, the main task in the process of creating an engineer is to develop an engineering mind. If this task is completed, we most probably get a person who can solve extraordinary and super-complex engineering problems.
Tal Golesworthy, a 54-year-old British engineer from Gloucestershire, is a case history for everything said before. “Engineer to the backbone” and “a person evoking true respect” are the first things that come to mind after one has got to know one of the stories of his life.
Together with medical personnel and engineers Golesworthy has developed an invention and tested it on himself – “EARS” (External Aortic Root Support). The reason for the beginning of the research was Golesworthy diagnosis. He had Marfan syndrome – a genetic disorder of the connective tissue, associated with mutations and failures in synthesis and desintegration of collagens, resulting in changes in locomotor system, visual organs and pathologies in cardiovascular system. In 1992 it turned out, that Golesworthy had the most serious type of this disease – pathological aorta opening distention (aorta aneurysm) and dissection of aortic walls.
A usual treatment prescribed with such a diagnosis is surgery, involving partial resection of the aorta and replacing it with an artificial (plastic) prosthesis. This is a long and complicated operation, held under general anesthesia with chest opening, cardioplegia and temporary connection to a heart-lung machine. During the operation the body temperature is reduced to 18 degrees. Further life extension of the patients is connected with life-long treatment with medicines (mostly Warfarin) that reduce blood coagulation (anticoagulant therapy) but have lots of undesirable side effects. Moreover, the smallest infection can lead to very serious problems – heart and artificial aorta failures and finally death.
Golesworthy was not happy with this – he did not want to take unsafe medicine for the rest of his life and also to be permanently afraid of a smallest cut. Thus, being an engineer he started thinking over the possible ways to solve the problem. His professional activities were mostly connected with boilers, incinerators, cloth and cyclone filters; he looked abstractively at the problem of recovering the normal functions of the circulatory system, as if it were an engineering task of repairing a plumbing mechanism. He said for himself: “I am an engineer and I do scientific research. My problem is just a solitary defect. I can conquer this; I am able to change this”.
From the engineering point of view, Golesworthy’s problem was a very simple one – how to produce additional external tension of the ascending aorta, as Marfan syndrom reduces its tensile strength (the aorta cannot withstand the pressure from liquid blood the system, that leads to its rupture) – and this is the only thing to be done in this situation. Golesworthy considered the aorta to be nothing but a tube, and it should be simply swathed from the outside; it should stay strong then and continue functioning. This is like a swelling rubber tube, whose problem is solved by swathing it with friction tape.
External fixation of the aorta would at least let him save his own organs, tissues and valves. This became a major impetus for Golesworthy. Moreover, he would not then have to take anticoagulant medicine for the rest of his life.
But the circulatory system is not a plumbing, of course, and making an external supporting covering is a much more difficult task to achieve than attaching a socket to a pipe. The first essential difference is a complicated form of aortic root, which is not easy to imitate as it has branches, narrowings, curves, sections and even an internal valve, which makes the blood move from the heart to ascending aorta. The ascending aorta takes the biggest pressures and this is where aneurisms usually appear, causing a life-threatening condition. If the dilatated aorta ruptures, a fatal bleeding occurs, which rapidly leads to death.
The first reasearch stage was to collect tomographic data for producing an aorta model. Then, based on CAD systems (computer-aided design systems) a model was produced, which was further updated during the working process.
A for producing a device, Golesworthy did not have enough professional knowledge in medicine and some specific areas of engineering. That is why he brought together focused specialists and formed a team including a heart surgeon, a radiologist, designers and others. But as in every multidisciplinary team, the specialists faced the problem of understanding the various specific fields of knowledge of each other. When producing the first plastic aorta model it turned out that it did not correspond to a human organ.The problem was in the different understanding of horizontal planes of the object. When making a project, engineers rely on planes and a top view as well, when you look at the object from above. Cardiologists look at top and bottom relative to the heart. As the aorta is situated above the heart its upper part is actually the bottom in common parlance. So the engineers produced something which was not a direct dopy, but in fact a mirrir image, with everything upside down.
The other problem was raising funds. When the team turned to a large British charity fund that financed operations, the project – because of the lack of engineering competention of this company staff – was not understood clearly and did not get the money. But it was supported by private investors and in the end it turned out that the costs for all stages of developing and testing a new device was comparable to the cost of one standard surgery opearation of medium complexity.
When all problems connected with funds and professional terminology were solved, the engineers using fast prototyping, produced a plastic blank, which considered all individual particularities of a patient’s body, in this case Golesworthy’s. The blank was produced in layers of corresponding material until it was complete. This technology eliminated restrictions in the internal form of the model produced, it did not need any additionally drilling, skivering, bending or rolling. After this, an implant - a net made out of sponge material and based on a polyethylene network - was produced. The complete blank was used to make the implant take the ideal form of the aorta. It’s clear that the implant, as well as the blank, idealy considered all particularities of Golesworthy’s body.
After producing a supporting net, one could just perform the surgery to implant it. But the team faced one more unpleasant surprise – they had to overcome burocratic barriers to get a license for a new type of surgery and to produce all necessary paperwork (instructions, etc.). Moreover, it turned out that doctors suffer from professional envy and conservatism – many of them are vocal opponents of any modernisations and successes of other people. They’d better keep on doing what they already do, letting no changes happen. So they tried to make the life of Golesworthy’s team as hard as they could.
But they still managed to get approving documentation and the surgery was done. This is how Golesworthy describes the procedure: “When the implant is ready it is relatively easy to install it. John Pepper, Professor and cardithoraic surgeon, did it for the first time; he installed one implant and did not like it, then he changed it to another one – and soon I was happy and on my way home. Four and a half hours on the operation table – and it’s done. Implantation turned out to be the easiest part of the whole process. If you compare our new method with a traditional one – the so called complex transplantation of the aortic root – you will see essential differences. Two hours for initiating one of our devices instead of six hours for traditional treatment, when the patient must be connected to a heart-and-lungs machine and his body must be cooled. We do not need anything like that. A surgeon just cuts you and gets access to the aorta – the heart goes on beating and the temperature stays normal. No interference with the circulatory system. So everything’s great. But I am personally especially happy that no anticoagulant therapy is required. I do not take anything at all, only if I want to, for a better mood. And people who take Warfarin have a much lower quality of life. And what is even worse is their lifespan decreases. Moreover, if you have an artificial valve you must take antibiotics in case of any invasive reaction. You must take antibiotics even after a visit to a dentist – just in case that infection gets into the valve. I do not have anything like that, I am absolutely free. My aorta is safe and I do not have to care about it. I am like reborn”.
Thus, Tal Golesworthy was the first one to test his own invention and avoided partial resection of his aorta. By 2013, in the eight following years, 30 patients were operated on the same way, including a 16-year-old girl. On the whole, they lived 90 postsurgical years and none of them had any complications. And we are eager to thank Tal for his courage, insistence and devotion to engineering and wish him a long and happy life!
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