3D Printing Helps you to Implant Dangerous Transcatheter Mitral Valves

Transcatheter aortic valve implantations are actually routine at numerous high-finish hospitals all over the world. Non-invasive mitral valve replacements, however, are much harder and vulnerable to publish-op complications, and they are still a rarity. Yet, 60% of patients over 75 have mitral valve disease, and it is a level bigger problem than aortic valves. We visited the Henry Ford Hospital in Detroit to discover a cutting-edge program where clinicians use 3D printing and computer simulations to assist install substitute mitral valves without getting to turn to open surgery.

The Middle for Structural Cardiovascular Disease at Henry Ford Hospital is headed by Dr. William O’Neill, a master within the field, who came back to Detroit carrying out a sting at College of Miami School Of Medicine. Dr. O’Neill and the team created a process and compiled the various tools and devices essential to pre-plan transcatheter mitral valve replacements (TMVR). They labored with Materialise, a 3D printer located in Plymouth, Michigan, so that you can consistently convert CT scans of hearts into computer simulations and 3D printed hearts that may be examined and manipulated to determine what valves to implant where to put them.

Though each one of the bits of this method, for example CT checking and 3D printing, aren’t uncommon, tying them together continues to be challenging. We spoken with Bryan Crutchfield, a VP and GM of Materialise’s United States operations, who described that converting CT scan data into 3D printer files is itself an elaborate process. To create helpful models, the organization developed software that cleans up many of the noise and physiological fragments, after which clinicians with the aid of Materialise’s specialists perform some manual computer try to define the ultimate model. These models will be printed immediately in the hospital and could be examined and evaluated for various valves. Once that’s done, the process turns into a lot simpler and could be performed with greater confidence, resulting in much improved clinical outcomes. And also the figures show this.

We spoken with Dr. Dee Dee Wang, a cardiologist who’s Director of Structural Heart Imaging at Henry Ford Hospital and Medical Director of 3D Printing at Henry Ford Innovation Institute concerning the challenges of mitral valve implantation and just how she overcomes these challenges using today’s technology. The mitral anatomy is much more complex compared to aortic one, requiring significantly more intending to make certain an implant is positioned properly and fits the patient’s anatomy. One of the most common complications of non-invasive mitral valve implantations remains output tract obstruction. This occurs once the new valve protrudes in to the ventricular output tract, creating one other issue altogether. Sometimes the valve embolizes since it detaches from its implant site and floats away, creating an urgent situation that may simply be worked with open heart surgery. Since patients receiving transcatheter mitral valves happen to be high-risk for open heart surgery, this really is clearly a vital problem.

Dr. Wang described to all of us that about 20% of TMVR procedures using conventional imaging and sizing result in left ventricle output tract (LVOT) obstructions, that are also hard to reverse and wish open heart surgery. CT scans don’t supply the intuitive depth perception required to size new valves properly and calcified regions are poorly defined, which makes it a lot more of a guessing game. During open mitral valve procedures surgeons really stick types of valves in to the anatomy to determine what will be a good fit, however this doesn’t seem possible inside a non-invasive procedure. Top quality 3D prints, however, reproduce this method making it clear to see the anatomy and different challenges of positioning a valve inside a difficult place without them protruding an excessive amount of in to the left ventricle output tract.

The printed models are within one millimeter precision from the patient’s own hearts and also have the necessary depth and handling to have an interventional cardiologist so that you can alter to determine what valve to insert where to deploy it. Dr. Wang appears proud the manufacturing and prototype approach that they’ve taken at Henry Ford for repairing hearts mirrors Detroit and it is auto industry. She’s developed quite an accumulation of 3D printed patient hearts, that is beginning to appear enjoy it may eventually be considered a museum collection. They are still helpful devices, as they possibly can be referred to when similar patient cases are available in.

Our trip to Henry Ford was exciting and academic so we were quite astounded by we’ve got the technology that’s used in challenging transcatheter mitral valve procedures.

Finally, here’s a relevant video story in regards to a 16 year-old with a number of heart disease which was helped by doctors by 3D printing his heart when preparing for that procedure:

Links: Materialise homepage and the company’s Products for Cardiologists and Cardiac Surgeons…

Related study in JACC: Cardiovascular Imaging: Predicting LVOT Obstruction After TMVR…

Stratasys Releases Type of Custom Made 3D Printed Anatomy Models

Stratasys, among the big 3D printing companies, has announced the discharge of their new BioMimics type of 3D printed human body models. These products are created to be utilized in clinical training and also to help design and test new medical devices.

The organization is first releasing bone and heart models, with vascular structures expected to be shown early the coming year. The models might have simulated disease areas that may further assist in testing new items as well as for training clinicians how you can do delicate surgical treatments. The organization hopes the printed BioMimics models can help alleviate the requirement of animal and cadaver models, and will be offering an simpler-to-use products which may be just like effective oftentimes.

The models can be found like a service, with companies and research institutions ordering the key they need for his or her applications. Stratasys consequently returns multi-material prints that may be both soft and hard, have different feel and textures, which mimic many of the characteristics from the anatomy they’re copying.

“BioMimics is really a revolution in medical modeling, taking advantage of advanced 3D printing approaches for clinically accurate representations of complex human anatomies – from microscopic patterns of tissue to replicating soft to hard texture of body structures,” said Scott Rader, GM of Healthcare Solutions at Stratasys. “Armed with unmatched realism of BioMimics, researchers, educators and manufacturers can finally make use of the tools to demonstrate out new ideas lengthy before numerous studies, and demonstrate innovations towards the skilled physicians who depend in it.Inches

Link: Stratasys homepage…

Via: Stratasys…


At Medgadget, we set of the most recent medical technology news, interview leaders within the field, and file dispatches from medical occasions from around the globe.

Edwards buys medical technology firm Harpoon Medical

MDBR Staff Author Printed 07 December 2017

Edwards Lifesciences has acquired medical technology firm Harpoon Medical for $100m in cash.

According to the deal, Harpoon Medical may also receive as much as $150m pre-specified milestone-driven payments within the next 10 years.

In 2015, Edwards guaranteed a unique choice to acquire Harpoon Medical having a structured advanced budgeting.

Harpoon Medical is promoting a singular system for repair of degenerative mitral regurgitation (DMR). 

Harpoon system continues to be made to facilitate echo-led repair of mitral valve regurgitation through stabilizing the prolapsed mitral valve leaflet to revive proper coaptation and valve function.

Based on the organization, the unit is under evaluation and never yet readily available for commercial applications. The firm will quickly obtain a CE mark for that system.

Edwards surgical heart valve therapy corporate v . p . Bernard Zovighian stated: “We feel adding Harpoon Medical’s technology and gifted team will enable much more possibilities to assist patients with degenerative mitral regurgitation.

“The unique beating-heart repair technique of mitral valve patients complements Edwards’ comprehensive portfolio of treating structural cardiovascular disease, and reinforces our dedication to innovation in cardiac surgery.”

Captured, Edwards acquired Israel-based Valtech Cardio for around $690m.

Valtech produces Cardioband system, which is often used for transcatheter repair from the mitral and tricuspid valves.

The machine, which utilizes a catheter placed in to the femoral vein, is delivered via a transseptal approach over the septum from the heart. It aggregates a renovation implant that resembles a surgical annuloplasty mitral valve repair device.

Edwards Lifesciences is active in the growth and development of novel medical solutions for structural cardiovascular disease, in addition to critical care and surgical monitoring.

Image: Edwards Lifesciences has acquired Harpoon Medical. Photo: thanks to adamr / FreeDigitalPhotos.internet.

LivaNova to purchase remaining stake in ImThera Medical for $225m

MDBR Staff Author Printed 06 December 2017

United kingdom-based medical technology firm LivaNova has decided to buy the remaining stake in US firm ImThera Medical for approximately $225m.

The offer includes up-front costs as high as $78m, in addition to payment of balance amount according to regulatory and purchasers milestone achievements.

Located in North Park of California, ImThera is promoting a completely implanted neurostimulation device to deal with osa (OSA).

The implantable device will stimulate multiple tongue muscles with the hypoglossal nerve, which enables to spread out the airway while someone is sleeping.

This Year, ImThera’s implantable device guaranteed CE mark approval to deal with patients with moderate to severe OSA who’re not able or reluctant to make use of continuous positive airway pressure (CPAP) therapy.

The firm’s sleep therapy product includes an implanted small generator and multi-funnel electrode lead, additionally for an exterior handheld handheld remote control that may start, stop or pause therapy

LivaNova Chief executive officer Damien McDonald stated: “The ImThera system is highly aligned with this existing Neuromodulation business, and we’re very looking forward to the chance to optimize we’ve got the technology and fold it into our universal platform.

“In the near term, we’ll concentrate on expanding ImThera’s current commercial presence within the European market, while evolving enrollment inside a U.S. Fda (Food and drug administration) pivotal trial.”

ImThera founder, president and Chief executive officer Marcelo Lima stated: “We be proud of the accomplishments we’ve produced in developing a highly effective CPAP alternative for people struggling with OSA.”

LivaNova operates three business franchises, including cardiac surgery, neuromodulation and cardiac rhythm management.

In November, MicroPort Scientific decided to acquire LivaNova’s cardiac rhythm management (CRM) business franchise for approximately $190m.

LivaNova’s CRM business franchise is involved in the event, manufacturing and marketing of merchandise for that diagnosis, treatment and control over heart rhythm disorders and heart failures.

Image: LivaNova to get the remaining stake in ImThera Medical. Photo: thanks to adamr / FreeDigitalPhotos.internet.

Ultrasound Imaging Needle Set to change Heart Surgery

Researchers working in london have printed information on an innovative new cardiology needle able to imaging the heart’s soft tissues from inside. They from College College London (UCL) and Queen Mary College based in london (QMUL) used the brand new all-optical ultrasound imaging system for heart surgery in pigs, effectively recording high-resolution images as much as 2.5cm from the needle tip.

An exciting-optical ultrasound device may seem as an oxymoron, however the imaging needle depends on an embedded miniature optical fiber that transmits brief pulses of sunshine, which generate ultrasound pulses. These ultrasound pulses propagate from the needle, reflecting off soft tissues prior to being detected with a second optical fiber within the needle housing.

The very first time live imaging is now able to taken directly from the heart during keyhole surgery, which can offer vast enhancements over current practice, where surgeons depend on preoperative imaging coupled with exterior ultrasound probes.

“The optical ultrasound needle is ideal for procedures where there’s a little tissue target that’s difficult to see during keyhole surgery using current methods and missing it might have disastrous effects,” stated Dr Malcolm Finlay, study co-lead and consultant cardiologist at QMUL and Barts Heart Center.

The needle system can emit ultrasound because of the growth and development of a singular composite material composed of the mesh of carbon nanotubes encased in silicone and on the tip from the optical fiber. The pulsed light in the fiber is absorbed through the carbon nanotubes and produces an ultrasound wave because of the photoacoustic effect. Another innovation underpins the recognition from the reflected ultrasound waves at this type of small-scale, the invention of highly sensitive optical fibers incorporating polymer optical microresonators.

The incredibly high-speed from the ultrasound emission and recognition process leads to unparalleled temporal and spatial resolution from the images. The present system can offer live imaging having a resolution as fine as 64 microns, which is one of the width of nine red bloodstream cells. The movement from the heart walls and valves may also be tracked instantly.

Outdoors of cardiology, the imaging system has numerous potential uses in a number of non-invasive procedures, also it even opens-up the potential of advanced applications for example in-womb surgery.

They of researchers behind we’ve got the technology are actually planning towards converting the machine for clinical use within patients.

Open access study in journal Light: Science & Applications: Through-needle all-optical ultrasound imaging in vivo: a preclinical swine study…

Via: College College London…

Duke College Heart Patch Shows Promise in Repairing Cardiac Injury

Researchers at Duke College allow us an artificially-engineered patch composed of completely functional human heart muscle tissues you can use to correct broken regions of the center. While it isn’t the very first cardiac tissue to become artificially engineered, it’s significant for the reason that it’s the very first that’s big enough to become clinically helpful to pay for an affected part of the heart while being sufficiently strong so that as electrically active as native heart tissue.

The Duke heart patch is produced much like other artificially-engineered cardiac tissues: human pluripotent stem cells are injected right into a support structure and therefore are provided with nutrients and growth factors. Under specific conditions, the stem cells can differentiate into cardiomyocytes and other kinds of tissues based in the heart. Researchers were effective in growing an area 2.5 square inches (16 square cm) and five to eight cells thick in dimensions that was similar to native cardiac tissue in structure and it was completely functional both electrically and robotically.

Furthermore, after implanting the center patches onto rat and mouse hearts, they saw the patches maintained their function and grew to become vascularized and integrated using the heart’s native tissues.

Here’s a brief video revealing the brand new heart patch:

Journal abstract in Nature Communications: Cardiopatch platform enables maturation and scale-from human pluripotent stem cell-derived engineered heart tissues…

Via Duke: Beating Heart Patch is big Enough to correct a persons Heart…

Scott Jung

Scott Jung (@scottjung) is really a Plastic Valley-based health and medical technology journalist and advocate. He is a guest cause of Intel’s iQ e-magazine and Rock Health’s corporate blog and it has provided live, on-site coverage from the Worldwide CES and Digital Health Summit, TEDMED, and Stanford Medicine X conference for Medgadget. Most lately, he’s been appearing on TWiT.tv’s The Brand New Screen Savers like a semi-regular health and medical technology correspondent. Scott holds a b -.Utes. degree in Biomedical Engineering in the College of Los Angeles. Scott is definitely searching for the following big factor in medical technology and digital health. Thinking about helping him transform lives? Make contact with him at http://scottjung.internet

Soft Automatic Cardiac Assist Device for just one-sided Heart Failure

Researchers at Boston Children’s Hospital allow us a singular automatic cardiac assist device made to assist patients with one-sided heart failure. The unit combines soft actuators having a rigid brace that penetrates in to the heart’s intraventricular septum, to supply gentle but robust pumping help only one side from the heart, without disturbing the game of sleep issues.

Soft automatic components have significant potential in non-invasive cardiac assist devices which help the failing heart to function by squeezing it in the outdoors. Unlike conventional ventricular assist devices, this method doesn’t need the unit to possess significant connection with the bloodstream, reducing the chance of clotting and the requirement for anticoagulant therapy.

Medgadget lately reported on the soft sleeve that may envelope the failing heart and squeeze it, augmenting cardiac output. What about one-sided heart failure, where only one ventricle is battling to function enough bloodstream? This kind of heart failure is much more common in certain pediatric patients, where a hereditary condition may cause failure of either the left or right ventricle, although not both.

For the reason that instance, squeezing the whole heart could really hinder the pumping from the healthy ventricle, along with a wraparound sleeve may not be appropriate. To deal with this, a few of the researchers behind the soft sleeve have think of a new device that targets only one ventricle.

“We’ve combined rigid bracing with soft automatic actuators to lightly but sturdily help a diseased heart chamber pump bloodstream effectively,” states Nikolay Vasilyev, a investigator active in the study. The rigid brace is implanted in to the intraventricular septum, and offers resistant against soft actuators that cup the top of affected ventricle.

Once the actuators expand, they push from the ventricular wall and pull from the septal brace, causing compression within the ventricular chamber, without having affected sleep issues from the heart. “As the actuators relax, specifically-designed elastic bands help return the heart’s wall to the original position, filling the chamber sufficiently with bloodstream,” states Vasilyev.

“With using classic left ventricular assist devices, you will find patients who notice a septum shift for the right side and subsequent ballooning from the right ventricle, which could cause secondary right heart failure,” states Vasilyev. “Here, the rigid brace keeps the septum in the original position, protecting the healthy right side from the heart in the mechanical load from the left ventricular assistance.”

The study team has tested the unit within an animal model also it considerably enhanced ale a diseased ventricle to eject bloodstream. Now, they is trying to customize the device that it is appropriate for human patients.

Study in Science Robotics: Soft automatic ventricular assist device with septal bracing for therapy of heart failure…

Via: Boston Children’s Hospital…

MicroPort Scientific to purchase LivaNova’s CRM business franchise for $190m

MDBR Staff Author Printed 21 November 2017

MicroPort Scientific has decided to acquire United kingdom-based LivaNova’s cardiac rhythm management (CRM) business franchise for approximately $190m.

LivaNova’s CRM business franchise is involved in the event, manufacturing and marketing of merchandise for that diagnosis, treatment and control over heart rhythm disorders and heart failures.

The CRM business produces products for example high-current defibrillators, cardiac resynchronization therapy devices and occasional-current pacemakers.

With around 900 employees, the CRM business performs operations in Clamart of France, Saluggia of Italia and Santo Domingo of Dominican Republic.

In 2014, LivaNova and MicroPort created a Chinese partnership (JV) MicroPort Sorin CRM (Shanghai) to market CRM devices for example implantable pacemakers, defibrillators and cardiac resynchronization devices in China.

In September this season, the JV guaranteed approval in the China Fda for that Rega pacemaker family.

Susceptible to regulatory approvals, the offer is anticipated to accomplish within the second quarter of 2018.

MicroPort chairman and Chief executive officer Dr Zhaohua Chang stated: “The CRM Business Franchise is really a global business and powerful regional player with attractive assets, a strong pipeline and growth potential.”

LivaNova Chief executive officer Damien McDonald stated: “The purchase will enable us to pay attention to LivaNova’s regions of strength and market leadership within our Cardiac Surgery and Neuromodulation companies.”

MicroPort operates various business segments, including cardiovascular, memory foam, endovascular, neurovascular, electrophysiology, surgical management, diabetes care and endocrinal management.

LivaNova operates three business franchises, including cardiac surgery, neuromodulation and cardiac rhythm management.

Image: MicroPort Scientific to get LivaNova’s CRM business franchise. Photo: thanks to adamr / FreeDigitalPhotos.internet.

Cheap, Simple to Integrate Technology Converts Any 2D Ultrasound Machine into 3D Scanner

Portable ultrasound technologies are improving and achieving less expensive, making it utilized in places formerly impossible because of size and price. Full-sized ultrasound imagers can perform some impressive stuff, for example creating 3D reconstructions acquired from 2D probes. Now researchers at Duke College are presenting incredibly easy and cheap to integrate technology that may convert any 2D ultrasound right into a 3D imaging system.

It really works because of a $10 sensor nick that detects the orientation of the ultrasound probe. Because the probe can be used to scan your body, the chip’s readings are combined with 2D data from the probe’s transducer to correctly stitch it together, producing a volumetric dataset. This data may then be observed similar to MRI and CT scans, letting physicians view 3D models in order to virtually slice with the volume.

The nick is built-into easy-on attachment that may be linked to any ultrasound probe. A pc can be used to seize the output video signal of the ultrasound machine and also the nick around the ultrasound probe is attached to the same computer. The pc then will the stitching and displays the output on its screen.

Since the technology doesn’t require any particular skills to do the imaging, they even picture patients themselves checking an appearance part they feel reaches discomfort. The doctor would then simply just consider the 3D scan to make use of within the diagnosis.

The brand new technologies are being proven off in the ongoing American College of Emergency Physicians (ACEP) Research Forum in Washington, D.C.

Via: Duke…


At Medgadget, we set of the most recent medical technology news, interview leaders within the field, and file dispatches from medical occasions from around the globe.

College of Michigan’s Hybrid OR: Hi-tech Surgical Gadgetry Inside One Room

The College of Michigan in Ann Arbor sports among the finest medical facilities in the usa. We won’t even mention the football team. A primary reason U of M’s clinics are the main thing on they since the college gives physicians the liberty to find new methods for doing things. Including building new facilities designed to handle type of medical practices which are likely to occur soon. One particular facility may be the lately built hybrid operating room in the Frankel Cardiovascular Center, an area which mixes a higher-finish cath lab having a traditional open-chest surgical atmosphere. The very first situation within the new OR was performed in This summer of the year.

Its genesis was the culmination of efforts brought by Dr. Stanley Frederick Chetcuti, an interventional cardiologist who also sees themself like a technology fanatic fortunate enough to combine the love and profession. I was fortunate to get an excursion from Dr. Chetcuti of his hybrid OR, that he displays a nearly fatherly affinity. We visited on the week day mid-day, in the end the procedures during the day were complete so when we could explore the area without disrupting anyone’s clinical work. We placed on a bunny suits and were brought inside.

Entering the hybrid OR, the immediate impression is a spacious area filled with completely new, high-tech gadgets. It might be the biggest facility of their enter in the U.S., otherwise the planet. The additional space assists you to wheel equipment rapidly back and forth from the individual, particularly significant whenever a catheter-based procedure goes awry along with a conversion for an open heart surgical treatment is all of a sudden needed. Furthermore, a bigger clinical staff, including surgical trainees, could be covered without crowding.

The imaging within the hybrid Or perhaps is supplied by a Siemens ARTIS pheno angiography system, a tool Dr. Chetcuti was particularly proud to possess become his on the job and something we excited to look at. Removed through the Food and drug administration only in March of the year, College of Michigan’s hybrid OR was the very first installing of the ARTIS pheno. The machine is really a floor-based automatic fluoroscope that gives top quality imaging while considerably lowering the radiation exposure from the nearby clinical staff. Since the device does not have cables reaching in to the ceiling, the leaded glass shields that safeguard clinicians working on the individual could be moved around freely out on another need to be considered when repositioning the fluoroscope.

A lot of rays reduction is a result of Siemens’ zen40HDR low noise lcd detector, GIGALIX X-ray tube, and pre-filtration, but additionally due to advanced software that facilitates the development of quality images while using the less radiation during each exposure. The right radiation dose can also be instantly selected through the apparatus with different quantity of factors, which enables the clinicians to start the process faster while lowering the exposure of everybody involved. As A Result , the quantity of contrast agent to inject may also be decreased in a number of cases because of the ARTIS pheno.

While working within the hybrid OR, clinicians put on dosimeter badges that measure everyone’s contact with X-ray radiation. Clinical personel can easily see their personal exposure in tangible-time, letting them change location and immediately begin to see the impact which makes. A radiation safety group meets regularly to judge the information and also to make suggestions regarding how to enhance the figures. To date, Dr. Chetcuti believes that exposure continues to be decreased by in regards to a factor of 4, a outstanding achievement within an industry constantly battling to do this. To help lower just how much radiation really strikes clinicians’ physiques, U of M now mandates even leaded glasses and mind protection.

Computer displays are apparently everywhere and also the large screens can be simply split to exhibit imaging, vitals, along with other live data. Furthermore, 3D digital fusions could be instantly produced that combine pre-op imaging scans, including transesophageal echocardiography, with live intra-op fluoroscopy data. These give physicians an in depth and intuitive look at the appropriate anatomy, in addition to depth perception, because they guide catheter-based tools and devices toward the center. Digital markers put on the ultrasound scans could be instantly used in the fluoro image, that is another regularly used tool to supply intuitive intra-op navigation.

Dr. Chetcuti demonstrated us a few of the implants he installs every day within the hybrid OR, including Medtronic and Edwards TAVRs (transcatheter aortic heart valves), Boston Scientific’s Watchman device, which will help to avoid strokes by occluding the left atrial appendage, and Abbott’s AMPLATZER Septal Occluder, accustomed to treat atrial septal defects. These units are impressive within their intricate detail, a large amount of the consequence of manual craftsmanship that’s made by anonymous weavers.

A few of these devices cost thousands of dollars, which can be surprising even thinking about the work which goes into them. However they are due to a significant quantity of research, testing, trialing, and focused attention that couple of similarly sized devices receive within the consumer world. Even simple things like the flaps inside a substitute heart valve are de-cellularized animal tissues that has to be created within an very controlled fashion to make sure that they work perfectly for a lot of a large number of heartbeats.

So when one views the entire hybrid Or perhaps is setup to implant these small devices that just work nicely when correctly delivered and positioned, it might be even clearer that everybody and all things have to operate together to make certain each patient will get the perfect outcome.

Dr. Chetcuti believes that soon we’ll be seeing the development of living tissue valves that gradually disintegrate as patient’s own tissue gets control, producing a fix that does not leave an implant behind. This might seem excessively positive, but Dr. Chetcuti themself wouldn’t have believed 5 years ago that he’d have the ability to do things he is doing now every day.

While optimal patient outcomes are its primary focus, U of M is another teaching hospital and many of the procedures involve students at various amounts of education. As a result, the control room at the back of the hybrid OR has space for around twelve individuals to witness the procedures happening. Since there are important details which are difficult to see from the rear of the control room, the operating room has cameras around the walls that the instructor may use to focus on main reasons. The pictures come through on the large screen TV hanging over the primary window searching in to the OR. Exactly the same TV can show output in the ARTIS pheno C-arm, clinical monitors, or any other devices getting used. Furthermore, exactly the same feed can be shown on screens to students outdoors the hybrid-OR, helpful when bigger groups need to be been trained in a specific procedure.

We’d prefer to thank Dr. Chetcuti for showing us the brand new hybrid OR and congratulate everybody at U of M for building this kind of impressive facility.

Link: Frankel Cardiovascular Center…