The Professor, The Problem & Moving The Bullseye

People were dying from their bad hearts. So doctors used a device to help save their lives. But, there were problems with the device, and improvements needed to be made.

Maybe the answer will be immediately apparent to you. Like most things, the answer is simple once you see it. Though honestly, even if I hadn’t seen the simple solution, I’m not sure that it would have been apparent to me.

Throughout my career, I’ve been lucky to work with some really smart people. The two key people related to this innovation were John Lucas and Bob Schock. Bob has a PhD, and I call him “the Professor.” It just seems to fit. There were other people involved of course, but those two wizards led the effort.

There were a lot of limitations, physical restrictions on what could be done. As it turned out, the problem was solved by thinking about it from an entirely new perspective. But, I’m getting ahead of myself.

Let me give you a little background and show you an illustration. Then you can solve the problem perhaps just by thinking about it, or maybe scribbling a bit on a napkin. In any event, you won’t need a calculator or even math.

As mentioned at the outset, people were dying. In fact, every year, thousands and thousands of people come to hospitals with a weak or damaged heart. These weak hearts aren’t able to pump sufficient amounts of blood through the bodies of these folks. Not good.

To help these troubled hearts, doctors sometimes insert an Intraaortic Balloon to help the heart pump blood through the body. An Intraaortic Balloon (known as an IAB in medical parlance) is actually pretty simple to describe.

Think of it like a tube (called a catheter) that’s about a meter in length (and about twice the diameter of an iPhone earpod wire), and at the front end, there’s a hot dog sized balloon. If you looked at a cross section of the catheter, you’d see it’s actually a tube inside of another tube. The inside tube is used to insert a wire for guiding the catheter up through the artery and to the aorta, and the thin space between the two tubes is where gas is pumped back and forth to inflate and deflate the balloon.

Figure 1: Cross-Section of a Typical Intraaortic Balloon Catheter (IAB)

The way it’s used can be explained pretty simple too. I purposely say “explained simply,” because reading and doing are two different things – especially when it comes to inserting something near the heart! But basically, the catheter is inserted into the patient in the groin area, and the length is snaked up through the artery until the end with the hot dog sized balloon is inside the patient’s aorta. The end that’s outside the patient is hooked up to a pump that inflates and deflates the hot dog sized balloon.

By inflating and deflating the balloon in the aorta, and synching the inflation to a patient’s beating heart, the blood flow through the body is significantly improved. It’s a lifesaver. Sometimes IABs remain in a patient for days or weeks, while waiting for the patient’s heart to get stronger.

When you insert a catheter into an artery, you’re also obstructing the blood flow through that artery. That’s not good, especially if the person already has a weak or damaged heart. We also needed to increase the area for the gas to shuttle back and forth (that thin area around the perimeter). More area would allow the balloon to inflate/deflate faster, and that would improve pumping more blood.

So there are two necessary goals

1. Reduce the outside diameter of the catheter (so the artery is less obstructed)
2. Increase the area for the shuttle gas (to move more gas)

Easy, right?

Hold on, there were also a few major limitations at the time, basically due to the existing material science. These also need to be the ground rules for your thinking.

1. The inner catheter had to remain round and the same size
2. The wall thicknesses couldn’t be made any thinner
3. The large catheter had to remain round

So with those goals and limitations in mind – you can go ahead and solve the problem.

Before I show you the answer, let me make a few suggestions that may be helpful when approaching a problem where a solution is not obvious.

1. Start With Blank Paper

Sometimes it helps to consider the problem, without being overly fixated on the existing design. Existing designs often end up hitting a wall due to inherent limitations, and a new approach needs to be considered. Two blades on a razor may be better than one, but at some point adding more blades doesn’t help. A propeller can only move a plane so fast, so a jet engine had to be invented to go faster.

This is the “blank paper” thinking that resulted in the world’s largest taxi company owning no vehicles (Uber), and the word’s largest accommodation provider owning no real estate (Airbnb).

2. Break the Problem Into It’s Simplest Definition

It’s a good idea to describe the problem (or need) very simply. And don’t include what you presume to know are the associated problems with a particular solution.

It’s like when the team at Apple worked for weeks to prepare a presentation to show Steve Jobs, which included many pages of prototype screen shots showing the new program’s functions as to how the app would work. According to Mike Evangelist who was on the team responsible for coming up with ideas for a DVD-burning program, “Steve Jobs comes into the meeting, doesn’t look at the prepared work. Goes over to a whiteboard and draws a rectangle. ‘Here’s the new application,’ he says. ‘It’s got one window. You drag your video into the window. Then you click the button that says BURN. That’s it. That’s what we’re going to make.’’”

3. Ask For Ideas

The reason we’ve all heard that “ideas can come from anywhere” is because it’s true. Ask for ideas.

4. Involve an Outsider

I was thinking of titling this point as “Be an Outsider,” and that’s a good mindset to apply sometimes. Though it can be difficult to forget what you know. It’s easier to involve others with a unique perspective. That’s an advantage people have from other industries. It’s why Nike has no issues hiring people outside of the shoe and apparel industry. Innovators bring what they’ve learned from across the continuum of their experiences, and apply it to the situation at hand.

Before I show you how John Lucas and the Professor cleverly solved the problem, and assuming you haven’t figured it out yet – go ahead review the two problems (and the restrictions).

What would you do?

Now, back to John Lucas and the Professor.

I will tell you this. John Lucas and the Professor cleverly reduced the overall diameter, thereby providing less obstruction in the artery and simultaneously increased the area for the gas flow thereby providing greater volume for the balloon to inflate/deflate more efficiently. The new design went on to generate over a billion dollars. More importantly, their work impacted many lives. It was a pleasure to have these guys as colleagues.

Alright, shown below is how John Lucas and the Professor solved the problem.

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Spoiler Alert Below

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The original design is shown on the left, the new design is shown on the right. The breakthrough was realizing they could essentially combine the two catheters – and actually share a common wall. Simple. Clever. Ingenious. (I gave a little hint in the title of the article)

Note, the illustrations are representational only – in reality, the outer diameter of the new design was smaller than the outer diameter of the old design so it provided less of an obstruction to blood flow in the artery. At the same time, the “inflation lumen” of the new design had significantly more area, which allowed the balloon to inflate/deflate faster, therefore increasing blood pumping efficiency.

Figure 2: Cross-Section of a Traditional Catheter Design on Left, and the New Co-Lumen Design on Right

That’s a win-win, that resulted in countless dub dubs. The tin man would be proud.

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Tom loves building meaningful businesses and technology (with people who care). Reach him on Twitter @thomastriumph or tomtriumph.com. 

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