Vital Signs: The Heart
PREMIERS MARCH 16, 2020 AT 6PM
Mia Gonzalez didn’t know what it was like to be a normal child. She had breathing problems and was constantly in the hospital, even just for a common cold. By the time she was four years old, doctors had solved the mystery – it was a rare heart condition that was choking Mia from the inside.
Heart surgery on this little girl was necessary, yet risky. But a 3D printer would provide some clarity in a complex situation. With the heart in particular, no two are ever the same.
Having an exact model of Mia’s heart printed before the operation allowed the surgeons in Miami to create a plan long before they operated on Mia. It’s just another way heart surgery is changing today. From robotic heart surgery in Abu Dhabi, to a transplant system that keeps the heart warm and beating outside the body, technology is changing the way we save hearts around the world
Vital Sings: The Heart
Premieres: March 16, 2020.
DR. SANJAY GUPTA, CNN Chief Medical Correspondent
00:25 Sanjay Gupta:
It’s the hardest working muscle in the body, beating on average 100,000 per day. We’re talking about the heart. This is Vital Signs. I’m Dr Sanjay Gupta.
The right side of the heart pumps blood to your lungs, while the left side pumps it back to your body. It’s the critical centre of life in our bodies, but it’s also vulnerable to disease. In the United States, the American Heart Association says heart disease impacts someone every 42 seconds. In the Middle East, it’s the leading cause of death. That’s why the focus on treating patients with heart disease is top priority. For surgeons in Abu Dhabi, a robot is lending a helping hand.
01:06 Dr Rakesh Suri dedicates much of his life to treating the human heart.
DR RAKESH SURI, Chief of Cardiovascular Surgery, Cleveland Clinic Abu Dhabi
01.11 Dr Rakesh Suri:
When you hear about people who are immediately attracted to a career, it’s almost a spiritual thing that happens, so you see the clouds parting and the light coming down.
I knew I wanted to be a heart surgeon because in heart surgery we seek excellence every day and we’re always pushing ourselves to advance the field of heart disease and heart care and heart surgery.
01:37 Sanjay Gupta:
Dr Suri is the Chief of Cardiovascular Surgery at the Cleveland clinic in Abu Dhabi, a region where heart health is an increasing concern. Cardiovascular disease accounts for 30% of deaths in the UAE and 45% of deaths in the overall Gulf region.
01.56 Dr Rakesh Suri:
We’re seeing exactly the same types of diseases we would see in the Western world. We’re seeing coronary artery disease, heart valve disease, and heart muscle disease in roughly the same proportions, so when people assume that heart conditions are different here, that’s probably not as true as we once imagined that to be.
02:17 What is different here is that there’s a tremendous under-diagnosis of heart disease.
Undiagnosed heart disease can lead to major complications, requiring some patients to undergo invasive treatments, like open-heart surgery.
02.32Dr Rakesh Suri:
To access the heart, we need to divide the sternal bone in order for our eyes to see the structures on the heart and place our hands to fix it with a needle and thread and various devices that we sow on the heart.
02:45 Sanjay Gupta:
But surgeons like Dr Suri are increasingly relying on robotic technology to change the way certain heart operations are performed. The team at the Cleveland Clinic agreed to give us a demonstration of the innovative equipment and techniques they use to perform closed chest heart surgeries.
03:02 Dr Rakesh Suri:
The unique thing about minimal invasive and finally robotic surgery is that we’re now able to accomplish these exact same things, to deliver the most sophisticated therapies, without ever looking at the heart itself, because we utilise ten times high definition magnification, or without ever touching the heart, because we utilise small instruments that have wrist-like functions that slide between the ribs, having never to cut a rib, break a bone or sever a muscle.
03:36 Sanjay Gupta:
With robotically-assisted heart surgery, again, sometimes called ‘closed-chest surgery’, three small incisions are made in spaces between the ribs. Surgical instruments and a camera are placed through those incisions, allowing the surgeon to control the instruments using a computer console.
03.52 Dr Rakesh Suri:
So, at the end of the day, heart surgery can be accomplished via an open chest or via a minimal invasive approach. For a heart surgeon, being able to get there in the slickest, most innovative manner possible, is really the pinnacle of our profession.
04:09 Many people assume that the robot is an autonomous, self-thinking, being. That’s simply not true. The robot is merely an extension of the surgeon’s eyes, hands and arms, but with one significant difference: it’s much easier to be able to climb inside of the heart in virtual reality, ten times high definition magnification.
04:35 We’re able to now repair those intricate structures of the human heart in ways that we were unable to before, and it’s this saving of vital structures that allows patients to walk, essentially, to their rooms the night of surgery and walk out of hospital three days later, returning back to their normal lives. It’s really a miraculous evolution in medicine.
05:00 Sanjay Gupta:
But these technological advancements aren’t one size fits all. Patients have to undergo diagnostic tests to determine if they are eligible for the operation. Surgeons have to be properly trained to use the robotic equipment. And the $2 million price tag for the robotic technology could mean increased costs for procedures and limited accessibility for hospitals.
For Dr Suri and his team at the Cleveland Clinic, these robotic surgical tools aren’t just advancements for the future of medicine; they’re a way to make their patients healthier faster.
05:34 Dr Rakesh Suri:
When I see patients in the clinic, they simply can’t believe that we’re able to repair their own broken heart valve, right here in Abu Dhabi, and that this means that they’ll be able to enjoy many more years of life with their friends, their families and their community, avoiding heart failure and living longer.
05.54 Sanjay Gupta:
In the United States, someone’s name is added to the national organ transplant waiting list every ten minutes. That amounts to more than 120,000 men, women and children in need of a life-saving transplant. And when a match does finally become available, it can sometimes be all the way across the country.
06.11 For heart transplants, the usual way of transporting the organ is on ice, in a cooler similar to the one you take on a picnic. And since the first heart transplant in the late 1960s, technology has come a long way. And now, it might be catching up to organ preservation, by keeping hearts alive outside the human body, in a machine designed to function just like we do.
06.37 This is the Cornish coastline in England. 27-year-old Lee Hall lives here with his wife and young son. Surrounded by this beautiful landscape, he doesn’t get out to enjoy it much. At least, not yet. Lee has spent much of his life in hospitals.
06.58 Lee Hall:
My life started off ok, until I was around two years’ old and was diagnosed with leukaemia, which went on for quite a long time and luckily pulled through. When I was 14 I had an echo done on my heart and it came out that that I had a problem with my heart then.
07.22 Sanjay Gupta:
The walls of Lee’s heart were too thin and his heart was failing. It had to work even harder to pump blood through his body. Doctors in Harefield Hospital in London implanted a mechanical pump, but these devices are not typically long-term solutions. Lee would need a new heart.
07.40 Dr Andre Simon:
He was on the ‘urgent’ waiting list for a heart transplant.
07.45 Sanjay Gupta:
Dr Andre Simon is the director of transplantation at Harefield Hospital. In the United Kingdom, the biggest issue is a shortage of suitable donor hearts and an ageing population.
Dr Andre Simon, Director of Transplantation, Harefield Hospital
07.56 Dr Andre Simon:
The current situation in the United Kingdom is that we have only very, very few hearts, and you’re only transplanted when you’re on the urgent waiting list. No one really gets a heart who’s on the normal waiting list unless you’re very small and have a specific blood group.
08.11 Sanjay Gupta:
There’s been a lot of focus on helping transplants succeed after they are complete. For instance, getting the immune system to accept the donor organ instead of attacking it. But what about before all that? What about the way the heart is preserved before it even reaches the recipient?
The heart, in many cultures and many parts of the world is really perceived as the most important organ that keeps every part of the body alive.
08.38 Sanjay Gupta:
Waleed Hassaneii began his career as a heart surgeon. As a junior resident, he went on an organ retrieval: getting a donor heart for transplant from another hospital. Waleed was in charge of a cooler, and that’s when he realised just how rudimentary the transportation of this vital organ can be.
WALEED HASSANEII, CEO, TransMedics
08.56 Waleed Hassaneii:
It really upset me that, at the time, to become a cardio surgeon – still till today – you need to spend 10 to 11 or 12 years in training. And I looked at this and I said – from a selfish standpoint – I’m going to spend 12 years of my life learning how to protect this organ, but when it comes to heart transplantation, which is the pinnacle of cardiac surgery, the heart is just going to be thrown in this igloo box?
09.23 Sanjay Gupta:
Waleed left medicine to start a company called TransMedics. The aim? To change the way organs are preserved and delivered for transplant. The traditional way is cold storage: flushing the heart with a solution that drops its core temperature and putting it in a cooler on ice. This method can have limitations due to organ decay, time and distance of retrieval.
09.46 Waleed Hassaneii:
We’re losing a lot of organs because of that time and distance limitation. This is why there are a lot of organs go unutilised. In fact, we’re only utilising two or three out of every ten organs every year.
09.59 Sanjay Gupta:
To improve that, TransMedics developed a device called the Organ Care System. The machine is designed to replicate our human functions as closely as possible, by keeping the organs alive outside the body.
10:13 This is video of a heart transplant from the University of Washington in Seattle, one of seven hospitals in the United States participating in a clinical trial of the Organ Care System. Now, we want to warn you: the beating heart in the device may be graphic for some viewers. Unlike the cold storage in a cooler, this heart is still warm. It’s beating and it’s being fed by a steady stream of oxygenated blood and nutrients. All the while, the organ’s vitals are monitored.
10.43 Waleed Hassaneii:
In the early days it was really a paradigm shift. But as the technology evolved, as we gain experience, as we generate evidence, the resistance becomes lower and lower so, in the beginning, of course, it was really trailblazing, trying to convince transplant surgeons that cold is not your friend, and actually we can change things.
11:11 Sanjay Gupta:
The organ care system is still experimental in the United States, but it’s already approved for use in other countries, like Australia and the United Kingdom.
In the UK, Harefield Hospital now uses it for all their heart transplants, including the one for Lee Hall. Last summer, Lee received a heart transplant. Dr Simon was his surgeon.
11:32 Dr Andre Simon:
I think we will see a significant change in technique and technology. The last step that we’ve taken is we’ve now taken hearts from donors who have died from heart arrest. We now have been able to take those hearts and restart them outside of the body in that system, so that’s another revolutionary step.
11.56 Sanjay Gupta:
With cold storage, the heart is ideally transplanted in under four hours. It has a low tolerance to the cold because it has to function immediately upon transplantation. In the organ care system, the time window has tripled, which has led to an increase in viable donor hearts.
12.13 Dr Andre Simon:
The time between stopping the heart in the donor and starting the heart in the recipient… we have up to 12 hours now.
12.22 Sanjay Gupta:
For Lee Hall, it’s a second chance. Less than a year after his transplant, he’s still not 100% and has frequent check-ups at Harefield, but he went from being on borrowed time to making long-term plans with his son.
12.36 Lee Hall:
Now my goals are to actually strengthen my body up and get myself back to a normal life again. It did feel weird at first, to know that someone’s passed away and given something to me to stay alive, but without that person I wouldn’t be here now, so I thank them for changing my life.
12.55 Sanjay Gupta:
In the world of paediatric cardiology there is a saying: ‘babies’ hearts are like snowflakes: no two are exactly the same’. That means imaging is especially important before surgery. Traditional imaging, like CTs and MRIs, they’ve offered more of a two-dimensional look.
But now, 3D printers are bringing those images to life, enabling surgeons to hold these hearts in their hands before setting foot in an operating room.
13.32 It’s time for dance class at Spotlight Academy in Miami, Florida. These young girls are tumbling across the room, and right in the middle of it all is five year-old Mía González.
Mía is like a ray of sunshine. She’s a happy girl, everybody that meets her loves her. She’s very active. She loves playing sports, she’s girly but a tomboy at the same time.
14:02 Sanjay Gupta:
But for Mía, that wasn’t always the case.
In fact, right from the start, Mía’s mother, Katherine, knew something wasn’t quite right with her little girl.
14.15 Katherine González:
From the second that Mía was born, she basically had a stridor noise, a sound like a gurgling noise, when she was born, and I noticed it right away. I asked the doctors if that maybe was just some type of amniotic fluid that she had in her lungs, and they said it would go away eventually. But as weeks went by it continued.
14.35 Sanjay Gupta:
For the first four and a half years of her life, Mía was hospitalised ten different times for at least a week each time. Their little girl kept getting sick, but no one had any answers for Mía’s family. Doctors thought her breathing issues were from asthma.
14.50 Katherine González:
It was really just torturing. From the time that she was three months’ old, she was just always sick with one thing or the next, and everywhere we went, either they couldn’t find something or they thought she had something which she really didn’t have. She kept being misdiagnosed.
15:09 On her first year, on Christmas Eve, she choked and she turned blue, she passed out and we thought we had lost her.
15.25 Sanjay Gupta:
Doctors prescribed asthma medication, but it wasn’t working. Asthma treatments target inflammation of the airway from the inside. But Mía’s trachea wasn’t inflamed. Her aorta was wrapped around it, and as she grew, the pressure tightened on her windpipe. Essentially, she was being choked by her own body. It’s a rare congenital anomaly of her aortic arch.
15.50 Katherine González:
It was bittersweet. It was scary, because when you realise it’s something to do with the heart it’s always, of course, very scary, but at the same time, we were like ‘well, we finally know what’s wrong’.
16.03 Sanjay Gupta:
Doctors at Nicklaus Children’s Hospital in Miami had solved Mía’s mystery, but it meant heart surgery would be required as soon as possible. Dr Redmond Burke is the Chief of Paediatric Cardiac Surgery at Nicklaus.
DR REDMOND BURKE, Director of Cardiovascular Surgery, Nicklaus Children’s Hospital
16.15 Dr Redmond Burke:
What frequently happens to us is, patients will be sent to us who are deemed ‘inoperable’. And that’s a terrible word for a parent to hear. That means they’re going to lose their child because no-one thinks that anything can be done for them, and we don’t want people to feel that hopelessness.
16.34 Sanjay Gupta:
Dr Burke has always been fascinated with technology. He’d been keeping an eye on 3D printers. Instead of printing ink, they print using plastic that can harden into three-dimensional shapes. As the technology improved, he decided to get one for the hospital.
16.52 Dr Juan Carlos Muniz runs the cardiac imaging centre here, where you will find the hospital’s 3D printer.
DR JUAN CARLOS MUNIZ, Director of Cardiac MRI Imaging, Nicklaus Children’s Hospital
16.59 Dr Juan Carlos Muniz:
The imaging that we use to figure out the structure of these hearts are all two-dimensional techniques so, having a technology that actually lets you hold one of these hearts in your hand, or an exact replica of it, and really get that three-dimensional tactile feel to it, is really a great method of communication.
17.20 Dr Redmond Burke:
In the past we’ve always had models of generic hearts. I want that actual heart of the baby that I’m operating on, that really gives me power.
17.30 Sanjay Gupta:
Hospitals around the United States are starting to use 3D printers for everything, from prosthetics to splints. Mía’s heart was only the second model printed here. Being educated about the procedure before operating was important for the surgeons, and also, for Mía’s family.
17.48 Katherine González:
We went from four and a half years of thinking she had asthma to, one day to the next, she needs heart surgery so, we were freaking out a little bit and we asked to speak to Dr Burke. He showed us a picture of the heart and talked about the 3D modelling.
18.04 Dr Redmond Burke:
So, this is Mía’s heart and, particularly, this is Mía’s aorta. So, all of us have an aorta that comes out of our heart, carries blood to every part of our body. Most of us have one main arch. Mía has two, and so, if that arch squeezes down on the baby’s breathing tube and feeding tube they can’t breathe and they can’t eat and that’s not compatible with life.
18.30 Sanjay Gupta:
There are challenges with the system, like the material used to make the model. It’s a hard, brittle plastic that can easily break, and obviously feels different than a real human heart. It’s also critical that the images used to build the model are clear, for accuracy. The lives of young patients depend on it.
18.48 Dr Juan Carlos Muniz:
We work together as a team to make sure that these images are as accurate as possible, because if there are errors in the model that don’t necessarily reflect exactly what the anatomy of the heart is, then that could lead us down the wrong path.
1902 Sanjay Gupta:
In Mía’s case, Dr Burke knew exactly what he wanted to do before he operated on her. The operation was a success, and the pressure on Mía’s trachea was alleviated. For the first time in her life, she could breathe normally.
19.18 Katherine González:
It literally brought tears to my eyes to see how it actually alleviated her, to actually see what was there before and how her trachea is now, like a normal person’s.
19.28 Sanjay Gupta:
Dr Burke estimates his team has made 40 heart models so far. Without the model of Mía’s heart before surgery he says there may have been a different outcome.
19.38Dr Redmond Burke:
I know that, in Mía’s case, I was able to make a much smaller incision because I had total confidence that I could go into her left chest, find the part of her aorta that needed to be divided, and not dissect out her whole heart – I already had her whole heart in my hand. So, inside her chest I could leave all the other tissues untouched and go to the exact spot that needed to be divided and I could divide it with confidence and safety and know that I wasn’t going to hurt her, because if you divide the wrong part of her aorta, which could easily happen, you change her life. You create a problem; you don’t solve a problem.
20.14 So, for Mía, it might have been the difference between a very good outcome and a terribly bad outcome.
20.23 Sanjay Gupta:
Dr Burke says his less invasive approach also cut down on Mía’s recovery time and pain. Just three weeks after her open-heart surgery, she performed in a dance recital. And today, a common cold no longer needs a visit to the hospital.
20.38 Katherine González:
It’s been drastically different since the surgery. We don’t have to worry anymore. Even though she had her surgery in May, and she still remembers everything, and if you ask her who Dr Burke is, she’ll say ‘he fixed my heart’.
20.54 Sanjay Gupta:
Technology continues to evolve and improve, but heart health starts with each of us, and the choices we make. Proper nutrition and exercise will help combat issues like obesity, diabetes, high cholesterol – all risk factors for cardiovascular disease. So take care of your heart, and it will take care of you. For Vital Signs, I’m Dr Sanjay Gupta.