♪ it's the hardest working muscle in the body.

beating on average 100,000 times per day. we're talking ak heart. this is "vital signs." i'm dr. sanjay gupta. the right side of the heart pumps blood to your lungs while the left side pumps it back to your body. it's the critical center of life in our bodies but it's also vulnerable to disease. in the united states, the american heart association says heart disease impacts someone every 42 seconds. in the middle east, it's the leading cause of death. that's why the focus on treating patients with heart disease is top priority. for surgeons in abu dhabi a robot is lending a helping hand. >> reporter: this doctor dedicates much of his life to treating the human heart. >> i knew i wanted to be a heart surgeon, because in heart surgery we seem excellence every day. and we're always pushing ourselves to advance the field of heart disease and heart care and heart surgery.

>> reporter: the doctor is the chief of cardiovascular surgery at the cleveland clinic in abu dhabi. a region where heart health is an increasing concern. cardiovascular disease accounts for 30% of deaths in the uae, and 45% of deaths in the overall gulf region. >> we're seeing exactly the same types of diseases we would see in the western world. we're seeing coronary artery disease, heart valve disease and heart muscle disease in roughly the same proportions. so when people assume that heart conditions are different here, that's probably not as true as we once imagined that to be. what is different here is that there's a tremendous underdiagnosis of heart disease. >> reporter: undiagnosed heart disease can leader major complications invoking procedures like open heart surgery. >> to access the heart, divide

the sternal bone for our eyes to see the structures on the heart and place our hands to fix it with a needle and thread and various devices that we sew on the heart. >> reporter: surgeons like this doctor are increasingly relying on robotic technology to change the way certain heart operations are performed. the team at the cleveland clinic agreed to give us a demonstration of the innovative equipment and techniques they use to perform closed chest heart surgeries. >> the unique thing about minimally invasive and finally robotic surge are you we're now able to accomplish these exact same things to deliver the most sophisticated therapies without ever looking at the heart itself, because we utilized ten times high definition magnification, or without ever touching the heart, because we utilize small instruments that have risk-like functions that slide between the ribs. having never to cut a rib, break a bone or -- or server a muscle

>> reporter: with robotically assisted heart surgery sometimes caused closed chest surgery, three small incisions are made between the ribs. surgical instruments and a camera are placed through those incisions allowing the surgeon to control the instruments using a computer consol. >> many assume the robot is an autonomous self-thinking being. that's simply not true. it's merely an extension of the surgeon's eyes, hands and arms. but with one significant difference. it's much easier to be able to climb inside of the heart, in virtual reality ten times high definition magnification. we're able to now repair those intricate structures of the human heart in ways that we were unable to before. and it's this saving of vital structures that allows patients to walk essentially to their rooms the night of surgery and

walk out of hospital three days later returning back to their normal lives. it's really a miraculous evolution in medicine. >> reporter: but these technological advancements aren't one size fits all. patients have to undergo diagnostic tests to determine if they're eligible for the operation. surgeons have to be properly trained to use the robotic equipment and the $2 million price tag for the robotic technology could mean increased costs for procedures and limiteded accessibility for hospitals. for this doctor and his team at the cleveland clinic, these robotic surgical tools aren't just advancements for the future of medicine. there a way to make their patients healthier, faster. >> when i see patients they simply can't believe we're able to repair their own broken heart valve right here in abu dhabi and this means they'll be able to enjoy many more years of life with they're friends, their families and their community, avoiding heart failure and living longer.

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transplant waiting list every ten minutes. that amounts to more than 120,000 men, women and children in need of a life-saving transplant. when a match does finally become available it can sometimes be all the way across the country. for heart transplants, the usual way of transporting the organ is on ice, in a cooler. similar to the one you take on a picnic. since the first heart transplarnt in the late 1960s, technology has come a long way, and now it might be catching up to organ preservation by keeping hearts alive outside the human body in a machine designed to function just like we do. >> reporter: this is the cornish coastline in england. 27-year-old lee hall leaves here with his wife and young son. surrounded by this beautiful landscape, he doesn't get out to enjoy it much. at least not yet. lee has spent much of his life

in hospitals. >> my lifestyle was okay until i was around 2 years old and was diagnosed with leukemia which went on for quite a long time, and luckily pulled through. by the time i was 14 i had a, an echo done on my heart, and came out that i had a problem with my heart then. >> reporter: the walls of lee's heart were too thin, and his heart was failing. it had to work even harder to pump blood through his body. doctors at the hospital in london implanted a mechanical pump. but these devices are not typically long-term solutions. lee would need a new heart. >> it was on the urgent waiting list for a heart transplant. >> reporter: this doctor is the director of transplantation at the hospital. in the united kingdom, the biggest issue is a shortage of suitable donor hearts and an aging population. >> the current situation in the

united kingdom is that we have only very, very few hearts. and you're only transplanted when you're on the urgent waiting list. no one really gets a heart on the normal waiting list unless you're very small or are in a specific grurp. >> reporter: getting the immune system to accept the donor unit instead of attacking about. what about before all that? what about the way the heart is preserved before it even reaches the recipient. >> the heart in many cultures and many parts of the world is really perceived at the most important organize than keeps every part of the body alive. >> reporter: while this man began his career as a heart surgeon, as a junior resident, he went on an organ retrieval getting a donor heart for transplant from another hospital. while lee was in charge of a cooler he realized how rudimentary the transportation of this vital organ can be.

>> it really upset me that at the time to become a cardiac surgeon still to today you need to spen, 10 to 11, to 12 years in training. i looked at this from a selfish standpoint i'm going to spend 12 years of my life learning ho you to protect this organ but when it comes to heart trnt plantation, which is the pinnacle of cardiac surgery, the heart is just going to be thrown in his igloo box. >> reporter: while lee left medicine to start a company called transmedics, the aim, change the way organs are preserved and delivered for transplant. the traditional way is called storage. dropping its temperature and putting it in a cooler on ice. this methods can have limitations due to organ decay, time and distance of retrieval. >> we're losing a lot of organs because of that time and distance limitation. this is why there are a lot of organs that go unutilized. in fact, we're only utilizing two off three out of every ten

organs every year. >> reporter: to improve that, transmedics developed a device called the organ care system. the machine is designed to replicate our human functions as closely as possible by keeping the organs alive outside the body. this is video of a heart transplant from the university of washington in seattle. one of seven hospitals in the united states participating in a clinical trial of the organ care system. now, we want to warn you, the beating heart in the device may be graphic for some viewers. unlike the cold storage in a cooler, this heart is still warm. it's beating, and it's being fed by a steady stream of oxygenated blood and newt 2r50e answtree a the while, nooutrients. >> as the technology evolved, as we gained experience, as we generate evidence, the obviously

resistance becomes lower and lower. >> reporter: the organ care system is still experimental in the united states, but it's always approved for use in other countries, like australia and the united kingdom. in the uk, this hospital now uses it for all of their heart transplants. including the one for lee hall. last summer, lee received a heart transplant. doctor simon was his surgeon. >> i think we will see a significant change in technique and technology. the last step that we've taken is we now have taken hearts from donors who have died from heart arrest. we now have been able to take those hearts and restart them outside of the body in that system. so that's another revolutionary step. >> reporter: with cold storage, the heart is ideally transplanted in under four hours. it has a low tolerance to the cold because it has to function immediately upon transplantation. in the organ care system, the time window has tripled, which

has led to an increase in viable donor hearts. >> the time, again, between stopping the heart in the donor and starting the heart in the recipients, we have up to 12 hours now. >> for lee hall, it's a second chance. less than a year after his transplant, he still is not 100%, and has frequent checkups at the hospital. but he went from being on borrowed time to making long-term plans with his son. >> it did feel weird at first, you know, someone's passed away and given something to me to stay alive, but without their passing i wouldn't be there now. so i thank them for changing my life. ♪ plaque psoriasis. be the you who shows up in that dress. who hugs a friend. who is done with treatments that don't give you clearer skin. be the you who controls your psoriasis with stelara® just 4 doses a year after 2 starter doses. stelara® may lower your ability to fight infections

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in the world of pediatric cardiology there's a saying.

baby's heart are like snowflakes. no two are exactly the same meaning imaging is especially important before surgery. traditional images like c.t.s and mris offered a two dimensional look. now 3d printer are bringing those to life allowing surgeons to hold the hearts in their hands before setting foot in an operating room. ♪ two, three, four >> reporter: time for dance class at spotlight academy in miami, florida. >> very good, molly. one more. >> reporter: these young girls are tumbling across the room. >> push! all the way over. there we go. >> reporter: and right in the middle of it all is 5-year-old miya gonzalez. >> there we go. yes! >> miya is like a ray of sunshine. she's a happy girl. everybody that meets her loves her. she's very active. she loves playing sports, a girly and a tomboy at the same

time. >> reporter: for miya, that wasn't always the case. in fact, right from the start miya's mother katherine knew something wasn't quite right with her little girl. >> from the second miya was born she basically had like a strider noise, just sounded like a gurgling noise when she was born, and i noticed it right away. i asked the doctors. they thought maybe some typeiot away. as weeks went by it continued. >> reporter: for the first four years of her life, miya was hospitalized. she kept getting sick but no one had answers for miya's family. doctors thought her breathing issues were from asthma. >> it was just, really just torturing. from the time she was 3 months old, she was just always sick with one thing or the next. and everywhere we went, either they couldn't find something, or they thought she had something

which she really didn't have. just kept being misdiagnosed. >> reporter: doctors prescribed asthma medication, but it wasn't working. asthma treatments target inflammation of the airwaves from the inside, but miya's trachea wasn't enflamed. her aorta was wrapped around it and as she grew, the pressure tightened on her windpipe. essentially being choked by her own body. it's a rare congenital anomaly of her aortic arch. >> bittersweet. scary. when you realize it's something to do with the heart, it's always, of course, very scary, but at the same time, we're like, we finally know what's wrong. >> reporter: doctors at nicholas children's hospital in miami had solved miya's mystery, but it meant heart surgery would be required as soon as possible. dr. redman burke is the chief of pediatric surgery at nicholas. >> what frequently happens to us is, patients will be sent to us who are deemed inoperable, and

that's a terrible word for a parent to hear. that means they're going to lose their child, because no one thinks that anything can be done for them, and we don't want people to feel that hopelessness. >> reporter: the doctor has always been fascinated with technology. he'd been keeping an eye on 3d printer. instead of printing ink, he print using plastic that can harden into three dimensional shapes. as the technology improved, he decided to get one for the hospital. dr. juan carlos munez runs the cardiac imaging center where you will find the hospital's 3d printer. >> the images that we use to figure out the structure of these hearts are all two dimensional techniques. having the technology to let you hold one of these hearts in your hands or the exact replica of it and feel that tactile feel to it

is a great thing. >> reporter: hospitals are starting to use 3d printers for everything, from prosthetics to sprints. miya's heart was only the second model printed here. being educated about the procedure before operating was important for the surgeons, and also for miya's family. >> remember, 4.5 years thinking she had asthma to one day to the next, she needs heart surgery. so we were freaking out a little bit and we asked to speak to dr. burke. he showed us a picture of the heart, and talked about the 3d modeling. >> so this is miya's heart, and particularly, this is miya's aorta. so all of us have an aorta that comes out of our heart, carries blood to every part of our body. now most of us have one main arch. miya has two. >> reporter: there are challenges with the system, like the material used to make the model. it's a hard, brittle plastic that can easily break. and obviously feels differ than a real human heart.

it's also critical that the images used to build the model of clear for accuracy. the lives of young patients depend on it. >> we work together as a team to make sure that these images are as accurate as possible, because if there are errors in the model that don't necessarily reflect exactly what the anatomy of the heart is, that could lead us down the wrong path. >> reporter: in miya's case, dr. burke knew exactly what he wanted to do before he operated on her. the operation was a success and the pressure on miya's trachea ealleviated. for the first time her life she 0 could breathe normally t. literally brought tears to my eyes to see how it actually alleviated here, what was there before is not there now and her trachea is now like a normal person. >> reporter: the doctor estimates his team made 40 heart models so far. without the model of miya's heart before surgery, he says there may have been a different outcome. >> i know that in miya's case i

was able to make a much smaller incision, because i had total confidence i could go into her left chest, find the part of her aorta that needed to be divided and not dissect her whole heart. i already had her whole heart in my hand. so inside her chest i could leave all the other tissues untouched and go to the exact spot that needed to the divided and i could divide it with confidence and safety and know i wasn't going to hurt her. because if you divide the wrong part of her aorta, which could easily happen, you change her life. you create a problem. you don't solve the problem. so for miya, it might have been the difference between -- a very good outcome and a terribly bad outcome. >> reporter: dr. burke says his less invasive approach also cut down on miya's recovery time and pain. just three weeks after her open heart surgery she performed in a dance recital, and today a common cold no longer means a visit to the hospital. >> it's been drastically different since the surgery.

we don't have to worry anymore. even when she had her surgery in may, and she still remembers everything, and if you ask her who dr. burke is, she'll say, he fixed my heart. >> ready? >> yes. >> reporter: technology continues to evolve and improve, but heart health starts with each of us and the choices we make. proper nutrition and exercise will help combat issues like obesity, diabetes, high cholesterol, all risk factors for cardiovascular disease. so take care of your heart, and it will take care of you. for "vital signs," i'm dr. sanjay gupta. -- captions by vitac -- www.vitac.com

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it's 3:00 eastern time. you're live in the "cnn newsroom." i'm suzanne malveaux in for poppy harlow. the world's most complicated divorce is getting messier by the hour. britain's vote to ditch the european union is churning harsh words, bitter feelings on both sides, and it's the pace of this unprecedented breakup that is becoming a major problem. after a meeting the eu president says he wants the split to happen immediately. yet britain signalled it will wait until october before even starting these negotiations. many people in the uk are now voicing doubt over the referendum outcome, feelings of regretices, if you will.