Medical Innovation That Transforms Surgery and Saves Lives
By Romina Andreani
Generally, we assume that a startup bases its business on some type of technological application that makes our lives more comfortable or more entertaining. But we don't usually think that a startup can directly save our lives. In a nutshell, that's what AVaTAR is all about, the medical venture launched by two Argentines, Ignacio Lugones and Tomás Armendáriz, which aims to revolutionize an area of complex surgery through highly creative engineering.
What was your path like until the birth of AVaTAR?
Ignacio Lugones: I am a doctor from the University of La Plata, I specialized in pediatric cardiovascular surgery. I have always liked innovation and, among the papers I have published, I invented a surgical technique, for a rare pathology, that bears my name. I had never gotten into “medical devices” until AVaTAR came up.
That's where the key partner appears, right?
Tomás Armendáriz: I am from Mendoza, an accountant and I studied economic sciences at the National University of Cuyo. I came to the entrepreneurial world through self-motivation, I always participated in activities parallel to my career and I identified with the entrepreneurial profile. I worked at Accenture as a business analyst. We met Ignacio through GridX, the technology-based business accelerator.
Why did you choose the name AVaTAR?
IL: It's an acronym. It has several meanings: Aortic Valve Trileaflet Autologous Replacement, and also in Sanskrit it means “reincarnation”, which is what we do with the valve, we take it out and do it again. The problem is that when you search for AVaTAR online the movie comes up. (Laughs.)
What is the AVaTAR team like?
IL: I am the ideator of the method. In the closest circle is my brother, who is the co-creator of this idea, he is a physicist and astronomer. The valve has a lot of mathematics and physics, it is a process by which the valve opens and closes depending on different pressure changes, it is not an active mechanism. Perfect and exact understanding of the shape and space arrangement of that valve is what makes it work. One Saturday night and a few beers, I told him a problem and we started drawing, doing beads and using latex gloves, a tube of toilet paper, tape and polenta we put together the first prototype.
How was it transformed into a product?
IL: What we came up with that night was what the valve should be like, but to make it you need certain instruments. We tested it in Denmark and we realized that, for this to work, the surgeon has to have the device that solves it, so that he does not have to do the math. There the idea of making the device began to mature. I began to move into the world of entrepreneurship (INCUBATE, from CABA). I started to conceive the idea of a medical device that would make this semi-automatic. The device allows you to take the valve pieces and, with a series of specific movements and instruments, build the valve inside the patient.
After the development period, a patient appeared in a critical situation, a child with a non-functioning valve, and we offered the family the procedure. It worked perfect. This proof of concept led us to gradually improve the device, we published the experience, and the idea of a medical device and a scalable solution was consolidated.
What is the proven effectiveness?
IL: We did it in 12 patients and in all of them we reconstructed the aortic valve, and it works well. Throughout the research we have added important elements: in a child, the root of the aorta grows and that is the main problem, because we cannot change the valve. We think about oversizing, a valve is placed that is larger than what the patient needs at that moment and as the patient grows it adapts.
Is it a forever valve?
IL: No. The problem is getting the child out of pediatric age. Later in adulthood there are other alternatives, which are suboptimal, but quite acceptable. Our valve lasts a few years because the tissue we use (the patient's own) does not have the same structure as the normal native valve. The normal native valve has a million years of evolution and we cannot reproduce that tissue, it is so perfect that it has an accordion shape and special cells that stretch throughout the cardiac cycle and we cannot reconstruct it today. Yes, we were able to imitate the structure and we understood how it works. We use a tissue that surrounds the heart, the pericardium, it is a resistant membrane specific to the patient that does not offer rejection to the patient and fulfills its function for a few years until the patient becomes an adult.
What do they need to completely rebuild it?
IL: Achieving the perfect valve tissue with tissue bioengineering, bioprinting. We are talking with bioprinting specialists. It is a path that, as I always tell Tomy, if we manage to achieve it, rather than aiming for a Unicorn we are going to aim for a Nobel (Laughter). We are traveling this path. We already have the geometry and morphology resolved; the Achilles heel is the tissue.
What other products or services will you provide in the future?
IL: The training. The idea is that AVaTAR provides the valve, the device that makes it, and the training so that the surgeon can do it more quickly and efficiently. It's a simulator.
TA: A simulator, which is a 3D printed plastic/rubber toy, a heart where surgeons can sew the valve there.
IL: It is a reconstruction of the heart with the characteristics of a diseased valve through which it is trained and the learning curve is reduced.
Can this be done remotely?
IL: Yes, I teach courses on an Argentine platform called MIRAI 3D, which manufactures simulators. We train surgeons remotely in other surgical techniques. We send the simulator, which has an embedded camera and I can zoom in on even the smallest movement that each surgeon makes and I train them remotely.
How is the investment sustained?
TA: Today it is all 3D investment, the cost is low because the material is plastic. Our idea is to use some type of bioplastic.
IL: Then the matrices will be made for mass production. It does not have electronics nor a very high production cost.
TA: The great advantage is that we can modify and improve the device, we can move forward. Even in the development process we are not going to assume the cost of capital (machines), we are going to outsource it because they also provide you with the eye and judgment of the design and the material.
How many people work at AVaTAR?
IL: It's just the two of us and two employees in the UK; We are evaluating candidates to do Project Management.
They're not profitable yet, right?
TA: We are an R&D company, developing a product. We target investors, people who understand the industry and regulatory processes.
IL: The time to market of a medical device is between 8 and 10 years. We have advanced in vitro studies, in pigs and in operated patients.
How is AVaTAR's growth continuing?
TA: The projection is to do the device kit well, our vision is that the AVaTAR device for valve reconstruction is the spearhead to incorporate more innovation in the future and add more medical devices and offer a medical portfolio for medical problems not only cardiac.
