Low Cost Simulator for Heart Surgery Training

Abstract

Objective: Introduce the low-cost and easy to purchase simulator without biological material so that any institution may promote extensive cardiovascular surgery training both in a hospital setting and at home without large budgets.

Methods: A transparent plastic box is placed in a wooden frame, which is held by the edges using elastic bands, with the bottom turned upwards, where an oval opening is made, "simulating" a thoracotomy. For basic exercises in the aorta, the model presented by our service in the 2015 Brazilian Congress of Cardiovascular Surgery: a silicone ice tray, where one can train to make aortic purse-string suture, aortotomy, aortorrhaphy and proximal and distal anastomoses. Simulators for the training of valve replacement and valvoplasty, atrial septal defect repair and aortic diseases were added. These simulators are based on sewage pipes obtained in construction material stores and the silicone trays and ethyl vinyl acetate tissue were obtained in utility stores, all of them at a very low cost.

Results: The models were manufactured using inert materials easily found in regular stores and do not present contamination risk. They may be used in any environment and maybe stored without any difficulties. This training enabled young surgeons to familiarize and train different surgical techniques, including procedures for aortic diseases. In a subjective assessment, these surgeons reported that the training period led to improved surgical techniques in the surgical field.

Conclusion: The model described in this protocol is effective and low-cost when compared to existing simulators, enabling a large array of cardiovascular surgery training.

Fig. 1

A. Transparent plastic box with rubberized fabric straps, smooth shelf with elastic band sand two sewage sleeves, simulating the mitral and aortic rings. B. Detailed fixation of the box on the shelf with the support of elastic bands. C. Sewer pipe connections simulating mitral and aortic rings with caps representing the prostheses, one of which shows the strap (arrow), which is the place for passing the “prosthesis” stitches. D. The same images seen from a different angle.

Fig. 2

A. Upper view of the silicone mold in tricuspid valvuloplasty exercise, ASD and proximal anastomosis. B. Upper view of the aortic prosthesis implantation exercise results. C. Upper view of the silicone mold in mitral valvuloplasty exercise. D. Lateral view of the silicone mold in a simulation practice for making the mitral valve neochordae (half the mold wall was removed to facilitate exposure).

Fig. 3

Removing the silicone mold bottom for an ascending aorta replacement exercise.

Fig. 4

A. Ice tray used to train aortotomy, aortorrhaphy, and preparation for aortic cannulation. B. The same aspect from a closer look. C. Details of coronary proximal suture using spaghetti balloon drain. D. The spaghetti balloon simulating a coronary artery bed, for the practice of distal sutures.

Fig. 5

The photos show four sequential steps of the aorta replacement exercise. A. Stitching of an inverted silicone mold onto sewer pipe connections. B. Suture of EVA pipe with fabric strap support simulating distal anastomosis. C. Resecting the excessive EVA pipe. D. EVA pipe end-to-end anastomosis.