Enhancing Interventional Cardiology Training: A Porcine Heart-Based Coronary Intervention Simulator

IntroductionAccess to simulators for interventional cardiology is currently limited. High acuity, low occurrence procedures (HALO), such as coronary perforation or iatrogenic dissection, are not trained in currently available simulators. We developed a cost-effective coronary intervention simulator designed to enhance the training of both novice and experienced interventionalists. MethodsPorcine hearts from 6-month-old Yorkshire pigs (heart weight: 300-500g) were obtained from a large animal research laboratory. Guide catheters were inserted into the coronary artery ostia and secured with superglue. To maintain shape and rigidity, commercially available polyurethane insulation foam was injected into the ventricles. The guide catheter was then connected to a Tuohy valve linked to a 3-way stopcock. One connection led to a pressure infusion bag filled with tap water (inflated at > 300 mmHg); the other was used for contrast injection. The heart was set on a radiolucent box with a fluid collector underneath. Clinical scenarios were simulated using 3D-printed stenoses and occlusions, blood clots for occlusive myocardial infarction, balloon oversizing for dissections, and needle trauma for perforations. ResultsThe simulator was used to practice coronary angiography, managing perforations, bifurcations, dissections, and acute coronary occlusions. Assembly, set-up, and simulation time until refilling the perfusion bag was required were 50, 25, and 30 minutes, respectively. Intravascular imaging with Optical Coherence Tomography was successfully used to guide interventions. The simulator was frozen and reused more than three times without notable deterioration. ConclusionA wide range of clinical scenarios can be trained with our model. Its preparatory flexibility, including the ability to be frozen for on-demand training, enhances its utility. Limitations include the absence of pulsatile flow, heart movement, and the inability to train guide catheter intubation.