Tal Golesworthy: How I repaired my own heart
October 11, 2011
Tal Golesworthy is a boiler engineer -- he knows piping and plumbing. When he needed surgery to repair a life-threatening problem with his aorta, he mixed his engineering skills with his doctors' medical knowledge to design a better repair job.Tal Golesworthy
- Engineer and artist
Tal Golesworthy is an engineer and entrepreneur, working in research and development of combustion and air pollution control -- until he decided to innovate in his own health. Full bio
Double-click the English subtitles below to play the video.
I'm a process engineer.
I know all about boilers and incinerators
and fabric filters and cyclones and things like that,
but I also have Marfan syndrome.
This is an inherited disorder.
And in 1992
I participated in a genetic study
and found to my horror, as you can see from the slide,
that my ascending aorta was not in the normal range,
the green line at the bottom.
Everyone in here will be between 3.2 and 3.6 cm.
I was already up at 4.4.
And as you can see,
my aorta dilated progressively,
and I got closer and closer
to the point where surgery was going to be necessary.
The surgery on offer was pretty gruesome --
anesthetize you, open your chest,
put you on an artificial heart and lung machine,
drop your body temperature to about 18 centigrade,
stop your heart, cut the aorta out,
replace it with a plastic valve and a plastic aorta,
and, most importantly,
commit you to a lifetime of anticoagulation therapy,
The thought of the surgery was not attractive.
The thought of the warfarin
was really quite frightening.
So I said to myself, I'm an engineer, I'm in R and D,
this is just a plumbing problem.
I can do this. I can change this.
So I set out
to change the entire treatment
for aortic dilation.
The project aim is really quite simple.
The only real problem with the ascending aorta
in people with Marfan syndrome
is it lacks some tensile strength.
So the possibility exists
to simply externally wrap the pipe.
And it would remain stable and operate quite happily.
If your high-pressure hose pipe,
or your high-pressure hydraulic line, bulges a little,
you just wrap some tape around the outside of it.
It really is that simple in concept,
though not in execution.
The great advantage of an external support for me
was that I could retain all of my own bits,
all of my own endothelium and valves,
and not need any anticoagulation therapy.
So where do we start?
Well this is a sagittal slice through me.
You could see in the middle
that device, that little structure, squeezing out.
Now that's a left ventricle
pushing blood up through the aortic valve --
you can see two of the leaflets of the aortic valve working there --
up into the ascending aorta.
And it's that part, the ascending aorta,
which dilates and ultimately bursts,
which, of course, is fatal.
We started by organizing image acquisition
from magnetic resonance imaging machines
and CT imaging machines
from which to make a model
of the patient's aorta.
This is a model of my aorta.
I've got a real one in my pocket,
if anyone would like to look at it and play with it.
You can see, it's quite a complex structure.
It has a funny trilobal shape at the bottom,
which contains the aortic valve.
It then comes back into a round form
and then tapers and curves off.
So it's quite a difficult structure
This, like I say, is a CAD model of me,
and this is one of the later CAD models.
We went through an iterative process
of producing better and better models.
When we produced that model
we turn it into a solid plastic model,
as you can see,
using a rapid prototyping technique,
another engineering technique.
We then use that former
to manufacture a perfectly bespoke
porous textile mesh,
which takes the shape of the former
and perfectly fits the aorta.
So this is absolutely personalized medicine
at its best really.
Every patient we do
has an absolutely bespoke implant.
Once you've made it, the installation's quite easy.
John Pepper, bless his heart,
professor of cardiothoracic surgery --
never done it before in his life --
he put the first one in, didn't like it, took it out, put the second one in.
Happy, away I went.
Four and a half hours on the table and everything was done.
So the surgical implantation actually was the easiest part.
If you compare our new treatment to the existing alternative,
the so-called composite aortic root graft,
there are one of two startling comparisons,
which I'm sure will be clear to all of you.
Two hours to install one of our devices
compared to six hours
for the existing treatment.
The existing treatment requires, as I've said,
the heart and lung bypass machine
and it requires a total body cooling.
We don't need any of that; we work on a beating heart.
He opens you up, he accesses the aorta while your heart is beating,
all at the right temperature.
No breaking into your circulatory system.
So it really is great.
But for me, absolutely the best point
is there is no anticoagulation therapy required.
I don't take any drugs at all
other than recreational ones that I would choose to take.
And in fact, if you speak to people who are on long-term warfarin,
it is a serious compromise to your quality of life.
And even worse,
it inevitably foreshortens your life.
Likewise, if you have the artificial valve option,
you're committed to antibiotic therapy
whenever you have any intrusive medical treatment at all.
Even trips to the dentist require that you take antibiotics,
in case you get an internal infection on the valve.
Again, I don't have any of that, so I'm entirely free.
My aorta is fixed, I haven't got to worry about it,
which is a rebirth for me.
Back to the theme of the presentation:
In multidisciplinary research,
how on earth does a process engineer used to working with boilers
end up producing a medical device
which transforms his own life?
Well the answer to that is a multidisciplinary team.
This is a list of the core team.
And as you can see,
there are not only two principal technical disciplines there,
medicine and engineering,
but also there are various specialists
from within those two disciplines.
John Pepper there
was the cardiac surgeon who did the actual work on me,
but everyone else there had to contribute one way or another.
Raad Mohiaddin, medical radiologist:
We had to get good quality images
from which to make the CAD model.
Warren Thornton, who still does all our CAD models for us,
had to write a bespoke piece of CAD code
to produce this model
from this really rather difficult input data set.
There are some barriers to this though. There are some problems with it.
Jargon is a big one.
I would think no one in this room understands
those four first jargon points there.
The engineers amongst you
will recognize rapid prototyping and CAD.
The medics amongst you, if there are any, will recognize the first two.
But there will be nobody else in this room
that understands all of those four words.
Taking the jargon out was very important
to ensure that everyone in the team
understood exactly what was meant
when a particular phrase was used.
Our disciplinary conventions were funny as well.
We took a lot of horizontal slice images through me,
produced those slices and then used those to build a CAD model.
And the very first CAD model we made,
the surgeons were playing with the plastic model,
couldn't quite figure it out.
And then we realized that it was actually a mirror image
of the real aorta.
And it was a mirror image
because in the real world we always look down on plans,
plans of houses or streets or maps.
In the medical world they look up at plans.
So the horizontal images were all an inversion.
So one needs to be careful with disciplinary conventions.
Everyone needs to understand
what is assumed and what is not assumed.
were another serious headache in the project.
The Brompton Hospital was taken over
by Imperial College's School of Medicine,
and there are some seriously bad relationship problems
between the two organizations.
I was working with Imperial and the Brompton,
and this generated some serious problems with the project,
really problems that shouldn't exist.
Research and ethics committee: If you want to do anything new in surgery,
you have to get a license from your local research and ethics.
I'm sure it's the same in Poland.
There will be some form of equivalent,
which licenses new types of surgery.
We didn't only have the bureaucratic problems associated with that,
was also had professional jealousies.
There were people on the research and ethics committee
who really didn't want to see John Pepper succeed again,
because he's so successful.
And they made extra problems for us.
Ultimately when you have a new treatment
you have to have a guidance note going out
for all of the hospitals in the country.
In the U.K. we have the National Institute for Clinical Excellence, NICE.
You'll have an equivalent in Poland, no doubt.
We had to get past the NICE problem.
We now have a great clinical guidance out on the Net.
So any of the hospitals interested
can come along, read the NICE report
get in touch with us and then get doing it themselves.
Another big area to be concerned with.
A big problem with understanding one of those perspectives:
When we first approached
one of the big U.K. charitable organizations that funds this kind of stuff,
what they were looking at was essentially an engineering proposal.
They didn't understand it; they were doctors, they were next to God.
It must be rubbish. They binned it.
So in the end I went to private investors
and I just gave up on it.
But most R and D is going to be institutionally funded,
by the Polish Academy of Sciences
or the Engineering and Physical Sciences Research Council or whatever,
and you need to get past those people.
Jargon is a huge problem when you're trying to work across disciplines,
because in an engineering world,
we all understand CAD and R.P. --
not in the medical world.
I suppose ultimately the funding bureaucrats have really got to get their act together.
They've really got to start talking to each other,
and they've got to exercise a bit of imagination,
if that's not too much to ask --
which it probably is.
I've coined a phrase "obstructive conservatism."
So many people in the medical world don't want to change,
particularly not when some jumped-up engineer has come along with the answer.
They don't want to change.
They simply want to do whatever they've done before.
And in fact, there are many surgeons in the U.K.
still waiting for one of our patients
to have some sort of episode,
so that they can say, "Ah, I told you that was no good."
We've actually got 30 patients.
I'm at seven and a half years.
We've got 90 post-op patient years between us,
and we haven't had a single problem.
And still, there are people in the U.K. saying,
"Yeah, that external aortic root, yeah, it'll never work, you know."
It really is a problem. It really is a problem.
I'm sure everyone in this room has come across arrogance
amongst medics, doctors, surgeons at some point.
The middle point is simply
the way that the doctors protect themselves.
"Yeah, well of course, I'm looking after my patient."
I think it's not good, but there you are, that's my view.
Egos, of course, again, a huge problem
If you're working in a multidisciplinary team,
you've got to give your guys the benefit of the doubt.
You've got to express support for them.
Tom Treasure, professor of cardiothoracic surgery:
Dead easy to give him respect.
Him giving me respect? Slightly different.
That's all the bad news.
The good news is the benefits are stonkingly huge.
Translate that one. I bet they can't.
When you have a group of people
who have had a different professional training, a different professional experience,
they not only have a different knowledge base,
but they have a different perspective on everything.
And if you can bring those guys together
and you can get them talking and understanding each other,
the results can be spectacular.
You can find novel solutions, really novel solutions,
that have never been looked at before
very, very quickly and easily.
You can shortcut huge amounts of work
simply by using the extended knowledge base you have.
And as a result,
it's an entirely different use of the technology
and the knowledge around you.
The result of all this
is that you can get incredibly quick progress
on incredibly small budgets.
I'm so embarrassed at how cheap it was
to get from my idea to me being implanted
that I'm not prepared to tell you what it cost.
Because I suspect there are
absolutely standard surgical treatments
probably in the USA
which cost more
for a one-off patient
than the cost of us getting from my dream
to my reality.
That's all I want to say, and I've got three minutes left.
So Heather's going to like me.
If you have any questions, please come up and talk to me later on.
It would be a pleasure to speak with you. Many thanks.
- Engineer and artist
Tal Golesworthy is an engineer and entrepreneur, working in research and development of combustion and air pollution control -- until he decided to innovate in his own health.Why you should listen
Tal Golesworthy is an experienced engineer and entrepreneur who branched out into bio-engineering in response to his own dilated aorta. His company now funds the research and development of devices that will help people with aortic dilation avoid major surgery and lifelong drug therapy.
He also has considerable expertise over a wide range of combustion and process plant including conventional and novel combustion systems, and his background has also included several years as an information scientist, and hot gas cleaning.
The original video is available on TED.com