How can you tell the difference between a good surgeon and an exceptional one?
You could start by looking for the one who has the rare ability to visualize a human organ in three dimensions from little more than a scan.
“The handful of the top surgeons in the world are like sculptors,” said Dr. Deepak Srivastava, a director at the Gladstone Institute of Cardiovascular Disease in San Francisco.
“When cardiovascular surgeons go in to repair a defect in the heart, their success is so often dependent on an ability to see the anatomy in 3-D in their minds,” said Srivastava. “That’s more difficult for younger, less experienced surgeons.”
But recent advancements in the field of computer-based modeling may make it easier someday for good surgeons to be great.
One such technology comes from Dassault Systèmes, a French company that specializes in 3-D software to help engineers who design cars and planes avoid potentially fatal outcomes.
Earlier this week, Dassault released its highly realistic digital model of the human heart, which it calls the “Living Heart Project.” Doctors wear 3-D glasses and use a joystick to zoom in to a ventricle or valve, while listening to every heartbeat.
“We take a [patient’s] scan, reconstruct it into a 3-D model, and test all the possibilities before a heart surgery,” said Dr. Steve Levine, chief strategy officer and director for the Living Heart Project.
The technology hasn’t received regulatory approval for doctors to use it in making medical decisions. But hospitals can buy it for research and educational purposes, such as exploring triggers that cause heart attacks.
Dassault hopes that medical device makers will also use the Living Heart Project’s technology for research and development. The software is free to organizations that agree to conduct research and share their findings with the project. Otherwise, licenses start at $15,000 a year for commercial use, with educational licenses starting at $500 per year.
Recruiting Partners in Health Care
For the Living Heart Project, Levine has so far recruited 45 partners, including the Mayo Clinic, Stanford University and the University of Oxford.
Levine said the Food and Drug Administration initially wanted to take a “watch and wait” approach when told about the project. “I told them, you can’t sit on the sidelines as nonparticipants. You have to get involved.”
In 2014, the agency agreed to work with Dassault on a five-year research project that will focus on the reliability of pacemaker leads (the thin wires that carry an electrical impulse from the device to the heart.) But the agency said that it won’t necessarily endorse any of the computational models that are developed as part of the research.
“Challenges to greater adoption of computer-modeling include a lack of data for some medical conditions, which makes realistic predictions difficult,” said Donna Lochner, a senior scientific advisor in the FDA’s Office of Science and Engineering Laboratories.
A Hammer Looking for a Nail?
At the University of California, San Francisco, a team of researchers in the cardiology division are hoping to use the Living Heart Project to figure out the best time to replace patients’ heart valves.
Surgeons have to strike the right balance between swapping out too early, when a valve is still working reasonably well, or waiting too long, when heart function has already deteriorated.
Dr. Jeffrey Olgin, the division’s chief, has been following the project’s progress. But he isn’t convinced it will transform how are surgeries are performed. “Is this a hammer looking for a nail?” he asked. “Or will this change how we practice medicine?”
He said he hopes advanced technology can fill some gaps, where surgeons are still making educated guesses, such as the timing of valve replacements. But he also said he hasn’t seen a convincing study yet that proves the simulation can improve patient outcomes.
Unlike simulations involving manmade objects such as cars and planes, it’s very difficult to predict how the human heart will respond to stress in the real world. Olgin said he fears that doctors could come to rely too heavily on this technology and medical device makers could pull the plug on promising research if the simulation shows a negative result.
“The technology doesn’t offer the same level of evidence as [medical research on] animals or small pilot human trials,” he said.