Enhancing interventional cardiology training: a porcine heart-based coronary intervention simulator

Abstract Introduction Access to simulators for percutaneous coronary interventions is limited by cost and availability and is not part of most interventional fellowship programs. We developed a cost-effective coronary intervention simulator to enhance the training of interventionalists. Methods Porcine hearts from 6-month-old Yorkshire pigs (heart weight 300–500 g) were obtained from a large animal research laboratory. Guide catheters were inserted into the coronary artery ostia and secured with superglue. Polyurethane insulation foam was injected into the ventricles to maintain shape and rigidity. The guide catheter was then connected to a Tuohy valve connected 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. Results The simulator was used to practice managing perforations, bifurcation-stenting, dissections, and acute coronary occlusions. Assembly, setup, and simulation times until refilling were 50, 25, and 30 min, respectively. Intravascular imaging with Optical Coherence Tomography was successfully used to guide interventions. The simulator was frozen and reused three times without notable deterioration. Conclusion Our model can train a wide range of scenarios. The ability to be frozen for on-demand training enhances its utility. Limitations include the absence of pulsatile flow, heart movement, and the lack of guide catheter manipulation.