We proudly presented our simulator at the Focus-Roll-Out last week. After nine months of hard work,
it is now possible to carry out a whole MitraClip intervention on our Cardex Simulator. Have a look
at the video below to find out how the inside of our simulated patient looks like and where the
simulated fluoroscopy and echocardiography views come from:
At our stand at the Roll-Out, the visitors could have a look at the simulator and collect
further informations on the technical details and the implemented procedure. Some could even
try out their skills at the Cardex simulator.
Some impressions can be found below:
29 April 2019
Only one month left! On May 28th we will present our Cardex-Simulator together with the other
at the Focus Roll-Out 2019. From 12.00 to 17.30, you will have the opportunity to pay us a visit
stand in the CLA building, ETH Zentrum and even try out your skills at a MitraClip intervention.
will also be a presentation of the project "Cardex" at 2 pm in the
Audi Max (HG F30), followed by the presentations of the other focus projects. We are looking
forward to seeing you!
16 March 2019
We are working on our third prototype, that now combines all the different subsystem elaborated
the last few months.
A key challenge for this prototype is the imaging. With the combination of all subsystems, we
understand, which parts need
to be removed or printed from transpartent material in order to allow a good view on the
The prototype will be tested at the “Simulator-Day” on Thursday, march 21, where we
can collect feedback from different surgeons as well as get an overview about the current state
in the medical area. With this informations, we will then further improve our simulator to get
This week, we presented our current state to Professor Meboldt, who was performing a first
intervention on the Cardex Simulator.
Professor Meboldt performing an intervention
The window allows a look inside the simulator to orientate the instruments inside
heart as long
as not all fluoroscopy and echocardiography views are implemented. It will be closed
the final simulator
and serves only for exchanging parts before or after the simulation.
On the screens, a simulation of echocardiography can be seen.
Inside the Simulator
The simulator will be placed inside a closed box with LED-panels as light-sources to
enable a constant and
homogeneous lighting. This is used for the image processing done for the real-time
of fluoroscopy and echocardiography.
18 December 2018
Our second prototype is focused on a realistic movement of the mitral valve and a modular anatomy
We were also working on a solution for the echocardiography,
that is the one of the imaging methods used during minimally invasive interventions at the
Since we will
use a fluid in
our simulator, the question how to handle this was another key point of the second prototype.
The current state of our project can be seen in the CAD-model below. Via the user
interface similar to
the one in a real operating theatre, the user can interact with the simulator. On
two screens, the
echocardiography and fluoroscopy can be seen.
On the second image, you can have a look behind the casing and see what there
inside the simulator.
Fossa Ovalis and Right Atrium
On the image below, you can see a silicon phantom consisting of the vena cava (on
left) and the right
atrium of the heart.
Integrated into the right atrium is the intratrial septum with the fossa ovalis.
fossa ovalis is a
spot, where the septum
separating the two atria is only a thin membrane. This is where the surgeon
gain access to the
The key part of this phantom is the fossa ovalis. In the image below you can see
it evolved over
Mitral Valve and Left Atrium
What would be a simulator for left atrial interventions without a mitral valve?
The mitral valve is passed by a blood flow of five liters every minute - can you
consequences of a malfunction?
Our simulator will enable surgeons to practice interventions to repair improperly
We present you our new silicone valve attached to the left atrium of the heart.
The complexity of the mold has increased with our unterstanding of the real
of the mitral valve.
We started with a two-part-mold and ended up now with six parts. Moreover, the
need to be molded
To make this anatomies visible to the surgeon, we implemented a simulation of
ultrasound in the region of the heart. In the image below, you can see the actual
of the simulation. Here
you can see the so called bicaval view, where the tenting at the fossa ovalis is
visible. The tenting is caused
catheter pressing against the thin membrane of the fossa ovalis.
The set up can be seen in the lower picture. A camera is looking from the side
the model of the
fossa ovalis. Behind the fossa ovalis is the catheter, that causes a small tenting
The subsystem fluid handling is responsible for a waterproof tank, that contains the
and a reservoir system to easily refill the simulator.
A key point was the insertion area, where the catheter is inserted to gain access to
The insertion area is seen in the image below.
Another solved challenge is the corner element. Since the vena from the groin to
heart is not
one straight line, there needs to be an angle in the tank.
05 November 2018
We are working on several subsystems of our simulator in order to find satisfying solutions. In a
first step, we
are focusing on the anatomy of the mitral valve and a realistic simulation of fluoroscopy.
In order to extend our simulator to include intervention in the left atrium, we also
need realistic models
these anatomies. These should not be static models, because during a minimally
heart operation, the
heart keeps beating all the time, meaning the valve moves during the procedure. This
should also be
displayed on the simulator, which is why we have already created the first silicone
models of the mitral
A focus was placed on the realistic movement of the valve. Above you can see the
silicone models below.
Since the surgeon does not have a direct view at the heart during a minimally
techniques are available; on the one hand ultrasound and on the other fluoroscopy,
works with X-rays.
In a first step, we focused on the simulation of fluoroscopy. The catheter is tracked
the model with two
such that the exact position of the catheter can be determined and displayed in a
This can be seen in
The obtained data on the position of the catheter are then inserted into a real
fluoroscopy image. On the
side, a real fluoroscopy image (including catheter) and our simulation of it can be
as a comparison.
Our goal is to reduce commonly occurring errors during minimally invasive cardiovascular
interventions. While gaining experience on simulators has become standard practice in the
aviation industry there is no satisfying equivalent for surgeons to train for upcoming challenges
in their professional life. We are working on filling this gap by introducing a new generation of
the Cardex simulator.
The number of patients suffering from cardiovascular diseases continues to increase. Many of the
interventions, such as mitral insufficiency and atrial fibrillation, require access to the left
atrium by transseptal puncture procedure.
Such interventions have not yet reached the level of standardization they should have regarding their
mere frequency. This is due to the peculiarity of each anatomy, the complications that occur and the
lack of training possibilities for surgeons which would prepare them to overcome such challenges.
Different simulators are already available but none of them combine haptic feedback with
in a satisfying way leading to unreasonably high ongoing expenses.
Using the knowhow gathered by last year’s team we will develop a second generation of the Cardex
cardiovascular intervention simulator which will enable the surgeon to train for a variety of
heart anatomies and complications. An instantaneous performance feedback will assess the quality of
In context of our studies in engineering, we have the opportunity to conduct ‘Focus’-projects during
year of our bachelor’s
degree, giving us the opportunity to realize a venture from the idea up to completion. This way, we
gain a unique
insight into product
development and engineering.
During the next eight months, our team of seven mechanical and one electrical engineering students
into the development of a simulator for
complex minimally invasive heart surgeries, aiming to present a new interactive possibility for
surgeons to train
We acquire our knowledge through self-study, dialogue with specialists and by attending lectures
biomedical engineering. The cooperation with
the University Hospital of Zurich allows us to develop an in-depth understanding of surgical
interventions and to
receive feedback from experienced surgeons.
The highlight will be the rollout on May, 28th 2019 at the ETH Zürich, where all Focus project teams
opportunity to present the result
of their effort to the public and the media.
Prof. Dr. Mirko Meboldt Head pd|z
“The capability to innovate is closely related to the ability to test and validate
in the application under real world conditions.
A realistic hardware based simulator for cardiovascular interventions will be a game
Prof. Dr. Francesco Maisano Project Partner
“With the availability of novel technologies, the development of innovative
to replicate various cardiovascular interventions, can help clinicians to advance
education and training.”
In the next eight months, our team of seven mechanical engineering students and one electrical
engineering student will delve into the development of a simulator for complex minimally invasive
heart surgery including different anatomies. We thank the last year’s team for the great
which we can take now as a basis for our project. In the end, we present a novel, reliable solution
allows safe training of surgeons.
We will master this challenge through a structured and flexible course of action.
We will use our maximal potential by splitting up workloads on one hand and tackling big problems as
a team on the
Development Mitral Valve, Sponsoring & Communication
When Werner Theodor Otto Forssmann performed the first catheterization of the right heart in 1929
self-experimentation, he surely did not consider
setting the foundation for modern minimally invasive heart surgery.
Its promising field of applications is constantly growing, thanks to extensive research.
In contrast, there is a notable lack of well-trained and experienced heart surgeons for certain
medical education is risky and expensive.
Cardex offers an innovative solution to secure a safe and target-aimed training.
Many catheter-based procedures on the heart require access to the left atrium. While being still
birth, this passage closes off in later stages of growth.
To re-establish this connection, a needle of approx. 90cm length is inserted at the groin.
The device is advanced through the inferior vena cava up to the right atrium, to puncture the
The surgeon has no direct vision but guides the needle using fluoroscopy and echocardiography as
This whole procedure is called ”Transseptal Puncture Procedure”.
Penetration of the atrial septum in the Fossa Ovalis and insertion of a Mitraclip® into
Our project is funded by sponsors, with all revenues going into production.
In order for the project to be successfully implemented, we depend on strong partners.
How to support our project:
Sponsor from 1000 CHF
Main sponsor from 5000 CHF
Premium sponsor from 15000 CHF
Mention on social media
Logo and link on website
Logo on banner at the official rollout
Logo on team shirts
Attendance at reviews
short description of the company on website
Presentation of the project at a company event
Logo on prototype
Please feel free to contact us anytime with personal offers.
We certainly find a solution that suits your expectations.
For further information we happily draw your attention to our brochure.