28/11/18 – Peter Mac Research – Page 3 The Age
Strategy of organising Lancet paper publication with opening of a new centre in Melbourne by Health Minister Greg Hunt led to syndication to more than 2 million print audience; across 60 radio stations and coverage on all five TV news stations with syndication. Internationally: BBC UK and NBC TV in US
Why Victorian Heart Hospital headhunted German engineer Ulrich Steinseifer
by Robert Bolton
Ulrich Steinseifer is a professor of mechanical and aerospace engineering at Monash University, according to the uni website. Which is a bit of a puzzle because he was hired to steer the university’s cardiovascular engineering activities. He’s already waiting for AFR Weekend at Cafe Sydney, on a table looking right at that legendary view: harbour bridge, Circular Quay, opera house.
“I don’t really eat lunch.”
No worries, neither do I. Main dish and salad?
“Just the fish.”
“No, it makes me sleep.”
“No, no bread.”
It’s the choice you expect from a cardio specialist. Lean, like him. It turns out he had hoped for a career as a soccer player, but drifted into mechanical engineering and had an epiphany at the University of Utah in the early 1980s. He was working with the “father of artificial organs” Willem Kolff and treating people with renal failure. The primitive dialysis machines needed gallons and gallons of fresh water so the patients were treated on houseboats on a lake and all the specialists came to the patient. That’s where he realised the importance of proximity.
Come forward four decades and Steinseifer has been headhunted by Monash University to be part of the team planning the new Victorian Heart Hospital. The VHH will be built on the uni’s Clayton campus about 20 kilometres south-east of central Melbourne.
He says he works 80/20. That’s 80 per cent at Monash, and 20 per cent at the Helmholtz Institute at the RWTH University hospital at Aachen in western Germany. His work is designing heart pumps and valves. Unlike a car – “Mercedes pumps, you know they were designed in Aachen” – the pumps and valves that go into a body are continuously evolving as science produces new surfaces and electronics gets smaller.
Steinseifer pulls out a heart pump the size of a peach.
“The gold standard is a heart transplant. But as you know we have a lack of donor organs. That’s when you come with these pumps. The patient is dying; you put in a pump.”
But the conjunction of medicine and engineering is fraught. Engineers like measurements, standards, long lead times and big production batches. Surgeons work with one-offs – every patient is different and time frames are always short.
Sharing same space
At Aachen, Steinseifer developed a model where clinicians (ie doctors) and researchers (ie engineers) work side by side in the same space. You would have thought that was so logical it happened everywhere in the world.
“Yes, it happens. No, not everywhere in the world. When it comes to the operating room and these devices, that’s not so common. At Aachen we are engineers in the hospital and we work closely with the clinicians. The hospitals that do that are on the forefront of international research. Like the Medical University of Vienna, like Louisville (Kentucky) or Texas Heart Institute. These are institutions that have a very close relationship between engineers and clinicians.”
So is that what physical proximity is about?
“The clinician will never go very far. So that means the engineer must be next to or even in his office – or wherever. A surgeon goes down to the operating room, he has his green or blue stuff on. But when he goes to a meeting and has to go upstairs and change clothes and then walk to some other place, he will think about it three times. Because if it takes him two hours he loses two hours of his time. And don’t forget cardiology is also the cash cow of the hospital. So this meeting has to be in the hospital … where the surgeons don’t even have to change clothing.”
The snapper arrives. The table gets rearranged. It’s getting noisy and hot. I move his glass of water; would he like a clean glass? People who work in hospitals obsess about infection control.
“No. I don’t believe in all that too much. I think it’s important to wash your hands, but all our children, we keep them absolutely sterile, and what do we have? Children with allergies all over. But where were we?”
Getting engineers and heart surgeons to understand each other.
“Yes. A surgeon comes in in the morning and he solves a crisis. He has a patient who is deadly ill and he has to do a surgery to get him off the table. He gets the patient off the table and the next day he says ‘I did a great job’. But the engineer says, ‘I have to make a pump like that? It’s a development that takes five years, costs €50 million. I have to make the URS, the ERS vectors and so on.
“We have it often that a surgeon says, ‘look at this, I took a knife and I cut a bit out of the ventricle, and I put in here a silicon tube and I made a bypass and look it’s fine. You can make a bypass from the ventricle to the aorta. It works. So you just have to do that.’
“And the engineers, well, you would go back and start to make your plans. And he would call a day later and say, ‘where is it?’ And you would say, ‘wait a sec, we’re planning it’. And he would say, ‘what are you doing? I did that yesterday with a piece of tube and it works. What are you doing?’
“But if the engineer tries to explain they want to do that in the longer run and make 100 tubes like that and make sure they’re safe, and approved and so on, that’s where you have this miscommunication. And that’s what you learn if the engineer is standing in the operating room. Communication is what you get when you put the people in a room together.
“By the way, and you can put this in your story. The fish is very good.”
Maybe a touch creamy? There’s a bit of cream in there. Does that worry you?
“No, not all. It’s spicy. It’s very good.”
Specialist hospital a national first
VHH will be a specialist heart hospital attached to a university. That’s a first for Australia. It’ll be jointly run by the state government through Monash Health, a service provider, and the university. The state government is tipping in $470 million, and the university $64.5 million. When it’s finished in 2022 it will have 112 public beds, 72 private and 20 intensive care.
Steinseifer is co-director of the Monash Institute for Medical Engineering, which is part of the uni and co-ordinates about 400 researchers, scientists and engineers. The university has an existing connection with the Alfred Hospital just south of Melbourne CBD. The idea of the VHH is to get as many disciplines as possible under one roof at the Clayton campus.
Steinseifer says he’s not interested in academic papers. He likes to work with patients and see if they are getting a benefit. Not every function in the new hospital will be literally under one roof. The uni has a “platform” that does additive manufacturing or 3D printing. Steinseifer says the VHH will have its own 3D printers, including some that can handle human cells, but if more complex devices are needed, the 3D platform will only be 50 metres away in a next door building.
Time for the bill. Or would you like some dessert?
“No, no, no. If I may make a comment? When you asked before what is in the future for the VHH?”
He picks up the mechanical heart and rotates it.
“This is the pump. And there are surfaces in there. If there is a foreign surface the blood says, ‘This doesn’t belong here and I’ll try to repair it. So I’ll put some platelets there to repair it’, and then it clots – and you don’t want that.”
The bill arrives. (How do you add a tip to a tap-and-go machine?)
“In our blood vessels we have a layer of cells that the blood likes. Called endothelial cells. So what we would like to do is to make bio-hybrid devices. So here is a pump chamber which has lots of surfaces where the blood has contact. We would try to put a layer of endothelial cells on the surfaces, which the blood would like. So it doesn’t clot.
“But then we get into very difficult logistics. How do we get this pump surface put it together with the cells in some kind of mesh, and keep it all sterile, and then put into the patient?”
Tissue engineering such as this is one of the projects Steinseifer wants researchers and clinicians to work on together.
“It’s not just engineers. It’s multi-disciplinary. It’s engineers and clinicians, biologists and materials scientists. And have them all around you. And that’s not really happening in most hospitals. Very often, even in engineering, you see someone sitting in an office and you go to the next office and you ask him what his neighbour is doing and he says ‘I don’t know’. What matters is communication.”
So what is it with the “aeronautical” reference on the uni website? It turns out that’s a throw back to the silo structure of universities that Steinseifer militates against. Engineers come in different colours and each type likes to have a defined status. Electrical, mechanical, chemical, civil and materials. Each with their own department. Mechanical deals with things such as flow: liquid flow, air flow and so on – which includes having a wind tunnel. So in the great Australian bureaucratic tradition, when Steinseifer arrived he found he was technically in a department that included aerospace engineering.
Did he always think he would be a bio-mechanical engineer?
“Not at all. I even came into mechanical engineering and didn’t know what I wanted to do.
“Actually my real love is soccer. When I was younger I played for a team in the Netherlands. Lemiersia it was. OK that was in the fourth division. I was a centre forward.”
Were you talented?
“Well maybe I was talented. But I wasn’t ambitious enough to beat others. There was a second league team that wanted me. But my father said to me, ‘No, you need to go to school’.”
The cashier fixes up the issue with the tip and the card-reading machine and it’s time to go.
Steinseifer has organised another meeting in the restaurant starting right after lunch. A designer from Sydney uni is coming to discuss the tactile qualities of controllers for heart pumps. Collaboration never ends.
Read more: http://www.afr.com/business/health/proximity-between-engineers-and-surgeons-is-the-key-behind-a-new-heart-hospital-20180209-h0vv07?login_token=KIvIOjtXJxOf6QJi7xucdwQUXKoCWHDBfI1l8V5we0V02yh-EQBrkPRiXFLKW1LsMdx_VW-Gx71ZN28luKq3BQ&expiry=1519421525&single_use_token=bMW-2ZoFYQxU1q7DRDfgKUO3v1x8qrWx2MnwNtD_z9LHOvFH7a8_l8cbUXYqylfXeky7Nq3Jw9NZZ2u5J3gyew#ixzz57y96o0T3
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