Question: Dr. Berreklouw can you tell us about your work and why you started Daidalos Solutions B.V.?
Answer: I have been working in heart surgery from 1976, when I was 24 years old. My father was one of the first cardiologists in The Netherlands. I have been involved in all the major developments within our profession, like the developments in coronary bypass (CABG) surgery, valve surgery, cardiac protection, off pump surgery, arrhytmia surgery, cardiac assist devices, and so on. I have written a thesis on the use of arterial grafts in CABG surgery. In the nineteen eighties we as heart surgeons encountered for the first time competition from invasive cardiologists when Dr. Gruentzig started with his PTCA’s, and then others came with coronary stenting (PCI). PCI became rapidly very popular all over the world and the numbers have surpassed CABG in all countries. Based on our own research in the nineteen eighties, we became already very early aware that PCI was less cost effective than CABG, in particular when arterial grafts are used in bypass surgery. PCI became more popular than CABG not because it has been more effective, but because it was less invasive than heart surgery. That knowledge has changed my vision on the future of cardiac surgery dramatically. Heart surgery is offering a superior product, but to remain in business it needs to become minimal invasive in all its domains.
Question: When did you start your Daidalos activities and what was your first project?
Answer: After I have written my thesis in 1996, I was on a meeting about arterial grafting in Rome. Italy. I started to make simple drawings of devices to make bypass surgery sutureless by mechanical means. I was aware of memory metals, like Nitinol, and I started to make drawings from scratch how such devices could look like. I was actually sitting at the grounds of the Coloseum in Rome where I felt myself inspired by the classic enviroment. Since that time I often combine visiting museums with creative design work. My first Patents were all in the field of making sutureless vascular connectors for coronary bypass surgery. I still see a great future for such devices in heart and vascular surgery in general. The heart surgery community has been offset by the early failures of the first generation of such devices, like the Symmetry® device of St Jude Medical. We are still working on such devices, but with another less damaging technology, that for sure will prove to be superior to these early failures. Mechanical vascular connectors are the only way to make robotization of our profession a reality.
Question: What is your opinion about using robots in heart surgery?
Answer: Robots are great in performing relative simple tasks, like navigating a device or tool to a certain spot, and to fire it there. But I do not see a great future for suture-robots as are currently on the market. They seem me too complicated, time consuming, and expensive, and that is why not many surgeons are using them currently. But in the future robots will have their role, and patients will benefit from the automated production quality improvement as we have seen in other industries where robots are used.
Question: How do you see the future of heart surgery and how does your work fit into this future?
Answer: Heart surgery and invasive cardiology will grow towards each other. Both professions will perform intracardiac procedures on a beating heart. Cardiologists tend to think only by the catheter, while cardiac surgeons think about everything else but catheters. Daidalos is and will provide the necessary tools, not only the sutureless devices to be implanted within or on the heart, but also the necessary working ports and channels. The Nitinol devices we are and will be providing make intracardiac surgery on a beating heart fully feasible, unrelated to which medical specialist is employing the technology. I have a background as heart surgeon and a preference for heart surgeons, as they are better trained and experienced in cardiac anatomy. But once we are able to do introduce our technology in heart surgery, similar technology can be applied by other surgical or invasive medical specialists, as long as hollow organs are involved.
Question: What do you see as the most important technological improvements to reach your goals?
Answer: The main improvement of the current era of cardiac surgery is the use of image guided surgery. We now can look inside the blood filled beating heart, while in the past we needed to arrest and empty the heart to do so. The technology of image guided surgery will further improve dramatically over the coming years, particularly with help of virtual reality technologies, and adding sensors and MEMS technologies to our instruments and devices. In our devices we will use more and more smart materials like Nitinol memory metals and memory elastomers. All these technologies together will cause a complete change of our medical professions, that in the end will benefit our patients enormously.
Interview with Dr. Berreklouw at Medtronic’s Eureka website