UCL helps engineer to heal his own heart
19 May 2011
Professors at UCL have helped an engineer develop and evaluate a device to repair a defect in his own heart.
The extraordinary collaboration has proved so successful that a further 19 people have undergone the same pioneering operation.
Engineer Tal Golesworthy was suffering from a defect in his
aorta — the main artery for carrying oxygenated blood — that left it in
danger of splitting.
The genetic condition, known as Marfan syndrome, can cause
instant death, but Mr Golesworthy was so unimpressed by standard
techniques for treating it that he decided to devise his own.
He approached Tom Treasure, now at UCL's Clinical
Operational Research Unit (CORU), who helped him recruit further support
for his idea from the UCL Institute of Child Health and the Royal
The results of the decade-long collaboration – published
this month in the European Association for Cardiothoracic Surgery’s
interactive journal – were so good that Mr Golesworthy has set up a
company, Exstent, to market the device.
In the following piece, Tom Treasure describes how he first met Mr Golesworthy and CORU's involvement in the development of his lifesaving ExoVasc External Aortic Root Support.
"It is ten years since I first met the engineer Tal
Golesworthy. At that first meeting the challenge he put to me, a cardiac
surgeon, was to work with him towards a better form of operation on the
aorta for people who have inherited Marfan’s syndrome. Two thirds of
them suffer from a very well described and consistent mode of structural
failure of the aorta which results in sudden death.
The nub of Golesworthy’s proposal was to use sophisticated
medical imaging to gain a reliable three-dimensional map of the aorta
and to employ these data in computer-aided design and rapid prototyping
to make a bespoke supporting device. The surgeon could then implant this
custom-made support at a planned pre-emptive operation.
At that first encounter at a lecture to the Marfan
Association in 2000, I thought Tal Golesworthy was on to something
important. The idea was already well developed in his mind; he’d had
many years to think about it. The standard approach is to measure the
aorta in the at-risk group of patients, typically over a period of
years, in essence to monitor its expansion towards bursting point. Our
research contribution thus far was to put some science into the
monitoring phase, work done in collaboration with Steve Gallivan, CORU’s
director at the time.
If the aorta is well over size or expands between
measurements the surgeon intervenes with a radical operation replacing
the entire root of the aorta, including the valve, re-implanting the
coronary arteries, and all of this during a period of one to two hours
of cardiopulmonary bypass and hypothermia. Tal was not enjoying the
nerve-racking brinkmanship, the prospect of such surgery, or of the
ensuing lifelong dependency on anticoagulant drugs to prevent blood
With Tal we recruited support, notably from Professor
Robert Anderson, cardiac anatomist at the UCL Institute of Child Health,
and Professor John Pepper at the Royal Brompton Hospital. By 2005 we
were ready for the first operation and Tal was himself the first
recipient of his own innovation. Now 20 such operations have been
performed, all by John Pepper.
The first 10 patients are the subject of the recent report.
All patients were at least a year after surgery and we had at least one
and up to four magnetic resonance images of the aorta to compare with
the one taken preoperatively. For all its "high tech” reputation, the
reading of the grey scale cross-sectional magnetic resonance images
allows for quite a lot of leeway in the eye of the beholder, so a
critical part of the evaluation was to get an independent radiologist to
make the before and after measurements in a random sequence amongst
other Marfan patients images to eliminate any unconscious bias. This
part of the study was led from CORU by its present director, Professor
The summary line is that the primary technical objective of
the surgery, to resist further expansion of the aortic root, was
achieved in all 10 patients and in 8/10 there was a marked reduction in
the aortic size bringing it back towards the normal range."
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