Integrative Design of Biomedical Products

Assignments (2)

General background
These 2 assignments have to do with the main pump of the body, the heart. This pump gets its
energy supply from oxygen and nutrients that enter the heart muscle via small blood vessel
around the heart, the coronary arteries. Blockage of these blood vessels could occur which impairs
the oxygen supply of the heart muscle what could cause a heart attack. A method to this is
bypassing the blockage with a graft vessel. This surgical procedure can be done on a silenced
heart, where an external pump takes over the function of the heart (On pump Coronary Artery
Bypass - ONCAB). Another way is making the bypass on the blood vessels while the heart
continues beating (Off Pump Coronary Artery Bypass - OPCAB).
This OPCAB procedure is highly challenging to learn, because vessels of around 2mm diameter
need to be stitched together while the surface area is constantly moving. Another challenge is to
manipulate the heart without endangering it’s vital function.
The complexity of this OPCAB surgery and the risks that are associated with it can be considered
equivalent to flying for a pilot. However, learning to fly includes lots of hours in an advanced flight
simulator, while learning the OPCAB procedure does only consist of increasingly assisting master
surgeons with the OPCAB procedure on real patients.
This highlights the need to include a simulator in training surgeons for OPCAB surgery.

Assignment 1 – Heart simulator – Realistic moving heart

A complicated heart-surgery is an off pump coronary artery bypass (OPCAB). For this surgery,
surgeons need to train making blood vessel grafts on a beating heart. To do so a beating heart
simulator could improve training and decrease the risks of complications for patients.
Can you design a realistic looking and moving physical beating heart?

Assignment 2 – Heart simulator – Sense heart manipulations on a beating heart

During Off-pump coronary artery bypass (OPCAB) surgery, the heart need to be displaced to
reach blood vessels on the back side of the heart. Both the altered heart orientation and the
manipulations of the flexible heart by the surgeon are the most important risk factors for
insufficient blood flow (hemodynamics) through the body. Insufficient blood flow causes lack of
oxygen to tissue and organs, which can ultimately cause tissue death. It is a serious challenge
during OPCAB surgery to keep a stable hemodynamic state for the patient, and surgeons should
train to manipulate the heart without causing hemodynamic instability. For this, a sensor system
should be included in the simulator that senses and locates the pressures that a surgeon exerts
on the flexible beating heart simulator and indicates the consequences for both cardiac and
coronary output.

Can you design a system that senses heart manipulations on a beating heart?