Frugal innovation in cardiac surgery

The development of a tilting disc heart valve in full compliance with ISO standards and affordable for low-income patients in India was undertaken in the early 1980s at the Sree Chitra Institute, Trivandrum. The constraint on resources and emphasis on self-reliance made frugal innovation obligatory for valve development. After the failure of three initial models, the fourth model succeeded and was used clinically in December 1990. Equally successful in a multi-centric trial in India, it has been implanted in over 100,000 patients to date. In overcoming problems in relation to the choice of materials and tests for performance during valve development, several innovations were employed in the low-resource setting of Chitra Institute, which anticipated the advent of "Frugal Innovation" by three decades.