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Li P, Chang Y, Song J. Advances in preclinical surgical therapy of cardiovascular diseases. Int J Surg 2024; 110:4965-4975. [PMID: 38701509 PMCID: PMC11326035 DOI: 10.1097/js9.0000000000001534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
Cardiovascular disease is the most common cause of death worldwide, resulting in millions of deaths annually. Currently, there are still some deficiencies in the treatment of cardiovascular diseases. Innovative surgical treatments are currently being developed and tested in response to this situation. Large animal models, which are similar to humans in terms of anatomy, physiology, and genetics, play a crucial role in connecting basic research and clinical applications. This article reviews recent preclinical studies and the latest clinical advancements in cardiovascular disease based on large animal models, with a focus on targeted delivery, neural regulation, cardiac remodeling, and hemodynamic regulation. It provides new perspectives and ideas for clinical translation and offers new methods for clinical treatment.
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Affiliation(s)
- Peiyuan Li
- Department of Cardiac Surgery, Beijing Key Laboratory of Preclinical Research and Evaluation for Cardiovascular Implant Materials, Animal Experimental Centre, National Centre for Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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2
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Weymann A, Foroughi J, Vardanyan R, Punjabi PP, Schmack B, Aloko S, Spinks GM, Wang CH, Arjomandi Rad A, Ruhparwar A. Artificial Muscles and Soft Robotic Devices for Treatment of End-Stage Heart Failure. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023; 35:e2207390. [PMID: 36269015 DOI: 10.1002/adma.202207390] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/19/2022] [Indexed: 05/12/2023]
Abstract
Medical soft robotics constitutes a rapidly developing field in the treatment of cardiovascular diseases, with a promising future for millions of patients suffering from heart failure worldwide. Herein, the present state and future direction of artificial muscle-based soft robotic biomedical devices in supporting the inotropic function of the heart are reviewed, focusing on the emerging electrothermally artificial heart muscles (AHMs). Artificial muscle powered soft robotic devices can mimic the action of complex biological systems such as heart compression and twisting. These artificial muscles possess the ability to undergo complex deformations, aiding cardiac function while maintaining a limited weight and use of space. Two very promising candidates for artificial muscles are electrothermally actuated AHMs and biohybrid actuators using living cells or tissue embedded with artificial structures. Electrothermally actuated AHMs have demonstrated superior force generation while creating the prospect for fully soft robotic actuated ventricular assist devices. This review will critically analyze the limitations of currently available devices and discuss opportunities and directions for future research. Last, the properties of the cardiac muscle are reviewed and compared with those of different materials suitable for mechanical cardiac compression.
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Affiliation(s)
- Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Javad Foroughi
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
- Faculty of Engineering and Information Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Library Rd, Kensington, NSW, 2052, Australia
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, Imperial College Road, London, SW7 2AZ, UK
| | - Prakash P Punjabi
- Department of Cardiothoracic Surgery, Hammersmith Hospital, National Heart and Lung Institute, Imperial College London, 72 Du Cane Rd, London, W12 0HS, UK
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Sinmisola Aloko
- Faculty of Engineering and Information Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Geoffrey M Spinks
- Faculty of Engineering and Information Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Chun H Wang
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Library Rd, Kensington, NSW, 2052, Australia
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, Imperial College Road, London, SW7 2AZ, UK
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
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3
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Yan B. Actuators for Implantable Devices: A Broad View. MICROMACHINES 2022; 13:1756. [PMID: 36296109 PMCID: PMC9610948 DOI: 10.3390/mi13101756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/12/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
The choice of actuators dictates how an implantable biomedical device moves. Specifically, the concept of implantable robots consists of the three pillars: actuators, sensors, and powering. Robotic devices that require active motion are driven by a biocompatible actuator. Depending on the actuating mechanism, different types of actuators vary remarkably in strain/stress output, frequency, power consumption, and durability. Most reviews to date focus on specific type of actuating mechanism (electric, photonic, electrothermal, etc.) for biomedical applications. With a rapidly expanding library of novel actuators, however, the granular boundaries between subcategories turns the selection of actuators a laborious task, which can be particularly time-consuming to those unfamiliar with actuation. To offer a broad view, this study (1) showcases the recent advances in various types of actuating technologies that can be potentially implemented in vivo, (2) outlines technical advantages and the limitations of each type, and (3) provides use-specific suggestions on actuator choice for applications such as drug delivery, cardiovascular, and endoscopy implants.
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Affiliation(s)
- Bingxi Yan
- Department of Electrical and Computer Engineering, Ohio State University, Columbus, OH 43210, USA
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Coles L, Oluwasanya PW, Karam N, Proctor CM. Fluidic enabled bioelectronic implants: opportunities and challenges. J Mater Chem B 2022; 10:7122-7131. [PMID: 35959561 PMCID: PMC9518646 DOI: 10.1039/d2tb00942k] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/26/2022] [Indexed: 11/21/2022]
Abstract
Bioelectronic implants are increasingly facilitating novel strategies for clinical diagnosis and treatment. The integration of fluidic technologies into such implants enables new complementary routes for sensing and therapy alongside electrical interaction. Indeed, these two technologies, electrical and fluidic, can work synergistically in a bioelectronics implant towards the fabrication of a complete therapeutic platform. In this perspective article, the leading applications of fluidic enabled bioelectronic implants are highlighted and methods of operation and material choices are discussed. Furthermore, a forward-looking perspective is offered on emerging opportunities as well as critical materials and technological challenges.
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Affiliation(s)
- Lawrence Coles
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, UK.
| | - Pelumi W Oluwasanya
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, UK.
| | - Nuzli Karam
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, UK.
| | - Christopher M Proctor
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, UK.
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5
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Bonnemain J, Del Nido PJ, Roche ET. Direct Cardiac Compression Devices to Augment Heart Biomechanics and Function. Annu Rev Biomed Eng 2022; 24:137-156. [PMID: 35395165 DOI: 10.1146/annurev-bioeng-110220-025309] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The treatment of end-stage heart failure has evolved substantially with advances in medical treatment, cardiac transplantation, and mechanical circulatory support (MCS) devices such as left ventricular assist devices and total artificial hearts. However, current MCS devices are inherently blood contacting and can lead to potential complications including pump thrombosis, hemorrhage, stroke, and hemolysis. Attempts to address these issues and avoid blood contact led to the concept of compressing the failing heart from the epicardial surface and the design of direct cardiac compression (DCC) devices. We review the fundamental concepts related to DCC, present the foundational devices and recent devices in the research and commercialization stages, and discuss the milestones required for clinical translation and adoption of this technology. Expected final online publication date for the Annual Review of Biomedical Engineering, Volume 24 is June 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Jean Bonnemain
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.,Department of Adult Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland;
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA;
| | - Ellen T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.,Department of Mechanical Engineering and Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA;
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6
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Kummer T, Rossi S, Vandenberghe S, Demertzis S, Jenny P. Embedded Computational Heart Model for External Ventricular Assist Device Investigations. Cardiovasc Eng Technol 2022; 13:764-782. [PMID: 35292915 PMCID: PMC9616791 DOI: 10.1007/s13239-022-00610-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 01/26/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE External cardiac assist devices are based on a promising and simple concept for treating heart failure, but they are surprisingly difficult to design. Thus, a structured approach combining experiments with computer-based optimization is essential. The latter provides the motivation for the work presented in this paper. METHODS We present a computational modeling framework for realistic representation of the heart's tissue structure, electrophysiology and actuation. The passive heart tissue is described by a nonlinear anisotropic material law, considering fiber and sheetlet directions. For muscle contraction, an orthotropic active-strain model is employed, initiated by a periodically propagating electrical potential. The model allows for boundary conditions at the epicardium accounting for external assist devices, and it is coupled to a circulation network providing appropriate pressure boundary conditions inside the ventricles. RESULTS Simulated results from an unsupported healthy and a pathological heart model are presented and reproduce accurate deformations compared to phenomenological measurements. Moreover, cardiac output and ventricular pressure signals are in good agreement too. By investigating the impact of applying an exemplary external actuation to the pathological heart model, it shows that cardiac patches can restore a healthy blood flow. CONCLUSION We demonstrate that the devised computational modeling framework is capable of predicting characteristic trends (e.g. apex shortening, wall thickening and apex twisting) of a healthy heart, and that it can be used to study pathological hearts and external activation thereof.
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Affiliation(s)
- Thomas Kummer
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Simone Rossi
- Mathematics Department, University of North Carolina, Chapel Hill, NC USA
| | - Stijn Vandenberghe
- Cardiovascular Engineering, Cardiocentro Ticino, Lugano, Switzerland ,Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Stefanos Demertzis
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland ,Cardiac Surgery & Cardiovascular Engineering, Cardiocentro Ticino, Lugano, Switzerland
| | - Patrick Jenny
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
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Jin L, Forte AE, Bertoldi K. Mechanical Valves for On-Board Flow Control of Inflatable Robots. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:e2101941. [PMID: 34494725 PMCID: PMC8564437 DOI: 10.1002/advs.202101941] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/03/2021] [Indexed: 06/13/2023]
Abstract
Inflatable robots are becoming increasingly popular, especially in applications where safe interactions are a priority. However, designing multifunctional robots that can operate with a single pressure input is challenging. A potential solution is to couple inflatables with passive valves that can harness the flow characteristics to create functionality. In this study, simple, easy to fabricate, lightweight, and inexpensive mechanical valves are presented that harness viscous flow and snapping arch principles. The mechanical valves can be fully integrated on-board, enabling the control of the incoming airflow to realize multifunctional robots that operate with a single pressure input, with no need for electronic components, cables, or wires. By means of three robotic demos and guided by a numerical model, the capabilities of the valves are demonstrated and optimal input profiles are identified to achieve prescribed functionalities. The study enriches the array of available mechanical valves for inflatable robots and enables new strategies to realize multifunctional robots with on-board flow control.
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Affiliation(s)
- Lishuai Jin
- John A. Paulson School of Engineering and Applied SciencesHarvard UniversityCambridgeMA02138USA
| | - Antonio Elia Forte
- John A. Paulson School of Engineering and Applied SciencesHarvard UniversityCambridgeMA02138USA
- Department of ElectronicsInformation and Bioengineering, Politecnico di MilanoMilan20133Italy
| | - Katia Bertoldi
- John A. Paulson School of Engineering and Applied SciencesHarvard UniversityCambridgeMA02138USA
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Bautista-Salinas D, Hammer PE, Payne CJ, Wamala I, Saeed M, Thalhofer T, del Nido PJ, Walsh CJ, Vasilyev NV. Synchronization of a Soft Robotic Ventricular Assist Device to the Native Cardiac Rhythm Using an Epicardial Electrogram. J Med Device 2020. [DOI: 10.1115/1.4047114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Soft robotic devices have been proposed as an alternative solution for ventricular assistance. Unlike conventional ventricular assist devices (VADs) that pump blood through an artificial lumen, soft robotic VADs (SRVADs) use pneumatic artificial muscles (PAM) to assist native contraction and relaxation of the ventricle. Synchronization of SRVADs is critical to ensure maximized and physiologic cardiac output. We developed a proof-of-concept synchronization algorithm that uses an epicardial electrogram as an input signal and evaluated the approach on adult Yorkshire pigs (n = 2). An SRVAD previously developed by our group was implanted on the right ventricle (RV). We demonstrated an improvement in the synchronization of the SRVAD using an epicardial electrogram signal versus a RV pressure signal of 4 ± 0.5% in heart failure and 3.2 ± 0.5% during actuation for animal 1 and 7.4 ± 0.6% in heart failure and 8.2% ± 0.8% during actuation for animal 2. Results suggest that improved synchronization is translated in greater cardiac output. The pulmonary artery (PA) flow was restored to a 107% and 106% of the healthy baseline during RV electrogram actuation and RV pressure actuation, respectively, in animal 1, and to a 100% and 87% in animal 2. Therefore, the presented system using the RV electrogram signal as a control input has shown to be superior in comparison with the use of the RV pressure signal.
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Affiliation(s)
| | - Peter E. Hammer
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, MA 02115
| | - Christopher J. Payne
- John A. Paulson Harvard School of Engineering and Applied Sciences, Wyss Institute for Biologically Inspired Engineering, Harvard University, MA 02138
| | - Isaac Wamala
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, MA 02115
| | - Mossab Saeed
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, MA 02115
| | - Thomas Thalhofer
- John A. Paulson Harvard School of Engineering and Applied Sciences, Wyss Institute for Biologically Inspired Engineering, Harvard University, MA 02138
| | - Pedro J. del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, MA 02115
| | - Conor J. Walsh
- John A. Paulson Harvard School of Engineering and Applied Sciences, Wyss Institute for Biologically Inspired Engineering, Harvard University, MA 02138
| | - Nikolay V. Vasilyev
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Enders 1330, 300 Longwood Avenue, Boston, MA 02115
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9
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Saeed MY, Van Story D, Payne CJ, Wamala I, Shin B, Bautista-Salinas D, Zurakowski D, del Nido PJ, Walsh CJ, Vasilyev NV. Dynamic Augmentation of Left Ventricle and Mitral Valve Function With an Implantable Soft Robotic Device. JACC Basic Transl Sci 2020; 5:229-242. [PMID: 32215347 PMCID: PMC7091510 DOI: 10.1016/j.jacbts.2019.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 01/18/2023]
Abstract
Left ventricular failure is strongly associated with secondary mitral valve regurgitation. Implantable soft robotic devices are an emerging technology that enables augmentation of a native function of a target tissue. We demonstrate the ability of a novel soft robotic ventricular assist device to dynamically augment left ventricular contraction, provide native pulsatile flow, simultaneously reshape the mitral valve apparatus, and eliminate the associated regurgitation in an Short-term large animal model of acute left ventricular systolic dysfunction.
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Key Words
- FS, fractional shortening
- HF, heart failure
- IQR, interquartile range
- IVS, interventricular septum
- LHF, left heart failure
- LV, left ventricular
- LVEDP, left ventricular end-diastolic pressure
- LVSD, left ventricular systolic dysfunction
- MV, mitral valve
- MVR, mitral valve regurgitation
- RV, right ventricle
- SRVAD, soft robotic ventricular assist device
- left ventricular systolic dysfunction
- mitral valve
- secondary mitral regurgitation
- soft robotic
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Affiliation(s)
- Mossab Y. Saeed
- Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Van Story
- Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher J. Payne
- Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts
- John A. Paulson Harvard School of Engineering and Applied Sciences, Harvard University, Boston, Massachusetts
| | - Isaac Wamala
- Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Borami Shin
- Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel Bautista-Salinas
- Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
- School of Industrial Engineering, Technical University of Cartagena, Cartagena, Spain
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pedro J. del Nido
- Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Conor J. Walsh
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts
- John A. Paulson Harvard School of Engineering and Applied Sciences, Harvard University, Boston, Massachusetts
| | - Nikolay V. Vasilyev
- Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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10
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Gu H, Bertrand T, Boehler Q, Chautems C, Vasilyev NV, Nelson BJ. Magnetically Active Cardiac Patches as an Untethered, Non-Blood Contacting Ventricular Assist Device. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2020; 8:2000726. [PMID: 33437567 PMCID: PMC7788498 DOI: 10.1002/advs.202000726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/20/2020] [Indexed: 05/03/2023]
Abstract
Patients suffering from heart failure often require circulatory support using ventricular assist devices (VADs). However, most existing VADs provide nonpulsatile flow, involve direct contact between the blood flow and the device's lumen and moving components, and require a driveline to connect to an external power source. These design features often lead to complications such as gastrointestinal bleeding, device thrombosis, and driveline infections. Here, a concept of magnetically active cardiac patches (MACPs) that can potentially function as non-blood contacting, untethered pulsatile VADs inside a magnetic actuationsystem is reported. The MACPs, which are composed of permanent magnets and 3D-printed patches, are attached to the epicardial surfaces, thus avoiding direct contact with the blood flow. They provide powerful actuation assisting native heart pumping inside a magnetic actuation system. In ex vivo experiments on a healthy pig's heart, it is shown that the ventricular ejection fractions are as high as 37% in the left ventricle and 63% in the right ventricle. Non-blood contacting, untethered VADs can eliminate the risk of serious complications associated with existing devices, and provide an alternative solution for myocardial training and therapy for patients with heart failure.
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Affiliation(s)
- Hongri Gu
- Institute of Robotics and Intelligent SystemsETH ZurichZurichCH‐8092Switzerland
| | - Thibaud Bertrand
- Institute of Robotics and Intelligent SystemsETH ZurichZurichCH‐8092Switzerland
| | - Quentin Boehler
- Institute of Robotics and Intelligent SystemsETH ZurichZurichCH‐8092Switzerland
| | - Christophe Chautems
- Institute of Robotics and Intelligent SystemsETH ZurichZurichCH‐8092Switzerland
| | - Nikolay V. Vasilyev
- Department of Cardiac SurgeryBoston Children's HospitalHarvard Medical SchoolBostonMA02115USA
| | - Bradley J. Nelson
- Institute of Robotics and Intelligent SystemsETH ZurichZurichCH‐8092Switzerland
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11
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Hsiao JH, Chang JY(J, Cheng CM. Soft medical robotics: clinical and biomedical applications, challenges, and future directions. Adv Robot 2019. [DOI: 10.1080/01691864.2019.1679251] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Jen-Hsuan Hsiao
- Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Jen-Yuan (James) Chang
- Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
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12
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Dolan EB, Varela CE, Mendez K, Whyte W, Levey RE, Robinson ST, Maye E, O'Dwyer J, Beatty R, Rothman A, Fan Y, Hochstein J, Rothenbucher SE, Wylie R, Starr JR, Monaghan M, Dockery P, Duffy GP, Roche ET. An actuatable soft reservoir modulates host foreign body response. Sci Robot 2019; 4:4/33/eaax7043. [PMID: 33137787 DOI: 10.1126/scirobotics.aax7043] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/01/2019] [Indexed: 12/18/2022]
Abstract
The performance of indwelling medical devices that depend on an interface with soft tissue is plagued by complex, unpredictable foreign body responses. Such devices-including breast implants, biosensors, and drug delivery devices-are often subject to a collection of biological host responses, including fibrosis, which can impair device functionality. This work describes a milliscale dynamic soft reservoir (DSR) that actively modulates the biomechanics of the biotic-abiotic interface by altering strain, fluid flow, and cellular activity in the peri-implant tissue. We performed cyclical actuation of the DSR in a preclinical rodent model. Evaluation of the resulting host response showed a significant reduction in fibrous capsule thickness (P = 0.0005) in the actuated DSR compared with non-actuated controls, whereas the collagen density and orientation were not changed. We also show a significant reduction in myofibroblasts (P = 0.0036) in the actuated group and propose that actuation-mediated strain reduces differentiation and proliferation of myofibroblasts and therefore extracellular matrix production. Computational models quantified the effect of actuation on the reservoir and surrounding fluid. By adding a porous membrane and a therapy reservoir to the DSR, we demonstrate that, with actuation, we could (i) increase transport of a therapy analog and (ii) enhance pharmacokinetics and time to functional effect of an inotropic agent. The dynamic reservoirs presented here may act as a versatile tool to further understand, and ultimately to ameliorate, the host response to implantable biomaterials.
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Affiliation(s)
- E B Dolan
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Biomedical Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway, Ireland.,Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - C E Varela
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - K Mendez
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - W Whyte
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.,Advanced Materials and BioEngineering Research Centre (AMBER), Trinity College Dublin, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - R E Levey
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - S T Robinson
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland.,Advanced Materials and BioEngineering Research Centre (AMBER), Trinity College Dublin, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - E Maye
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - J O'Dwyer
- Biomedical Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway, Ireland.,Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - R Beatty
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - A Rothman
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Y Fan
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - J Hochstein
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - S E Rothenbucher
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - R Wylie
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - J R Starr
- Epidemiology and Biostatistics Core, The Forsyth Institute, 245 First Street, Cambridge, MA, USA
| | - M Monaghan
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.,CÚRAM, Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - P Dockery
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland.,CÚRAM, Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - G P Duffy
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland. .,Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.,Advanced Materials and BioEngineering Research Centre (AMBER), Trinity College Dublin, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland.,CÚRAM, Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - E T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
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13
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Boone AC, Gregory SD, Wu EL, Stephens A, Liao S, Pauls JP, Salamonsen R, Fraser J, Tansley GD. Evaluation of an intraventricular balloon pump for short-term support of patients with heart failure. Artif Organs 2019; 43:860-869. [PMID: 30868602 DOI: 10.1111/aor.13454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 12/22/2022]
Abstract
The high cost of ventricular assist devices results in poor cost-effectiveness when used as a short-term bridging solution, thus a low-cost alternative is desirable. The present study aimed to develop an intraventricular balloon pump (IVBP) for short-term circulatory support, and to evaluate the effect of balloon actuation timing on the degree of cardiac support provided to a simulated in vitro severe heart failure (SHF) patient. A silicone IVBP was designed to avoid contact with internal left ventricular (LV) features (ie, papillary muscles, chordae, aortic, and mitral valves) based on LV computed tomography data of 10 SHF patients with dilated cardiomyopathy. The hemodynamic effects of varying balloon inflation and deflation timing parameters (inflation duty [D] and end-inflation point [σ]) were evaluated in a purpose-built systemic mock circulatory loop. Three IVBP actuation timing categories were defined: co-, transitional, and counterpulsation. Compared to the SHF baseline, co-pulsation increased aortic flow from 3.5 to 5.2 L/min, mean arterial pressure from 72.1 to 94.8 mmHg and ejection fraction from 14.4% to 21.5%, while mean left atrial pressure decreased from 14.6 to 10 mmHg. Transitional and counterpulsation resulted in a double ventricular pulse and extended the duration of increased ventricular pressure, potentially impeding diastolic filling and coronary perfusion. This in vitro study showed the IVBP could restore the hemodynamic balance of a simulated SHF patient with dilated cardiomyopathy to healthy levels.
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Affiliation(s)
- Alice C Boone
- School of Engineering and Built Environment, Griffith University, Queensland, Australia.,Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Shaun D Gregory
- School of Engineering and Built Environment, Griffith University, Queensland, Australia.,Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia.,Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, Australia
| | - Eric L Wu
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
| | - Andrew Stephens
- School of Engineering and Built Environment, Griffith University, Queensland, Australia.,Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, Australia
| | - Sam Liao
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Jo P Pauls
- School of Engineering and Built Environment, Griffith University, Queensland, Australia.,Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Robert Salamonsen
- Department of Epidemiology and Preventative Medicine, Monash University.,Intensive Care Unit, Alfred Hospital, Melbourne, Australia
| | - John Fraser
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
| | - Geoff D Tansley
- School of Engineering and Built Environment, Griffith University, Queensland, Australia.,Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
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14
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Terentjev AB, Perrin DP, Settlemier SH, Zurakowski D, Smirnov PO, del Nido PJ, Shturts IV, Vasilyev NV. Temporal enhancement of 2D color Doppler echocardiography sequences by fragment-based frame reordering and refinement. Int J Comput Assist Radiol Surg 2019; 14:577-586. [DOI: 10.1007/s11548-019-01926-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 02/15/2019] [Indexed: 10/27/2022]
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15
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Towards Alternative Approaches for Coupling of a Soft Robotic Sleeve to the Heart. Ann Biomed Eng 2018; 46:1534-1547. [DOI: 10.1007/s10439-018-2046-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/08/2018] [Indexed: 01/03/2023]
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16
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Danilov VV, Skirnevskiy IP, Gerget OM, Shelomentcev EE, Kolpashchikov DY, Vasilyev NV. Efficient workflow for automatic segmentation of the right heart based on 2D echocardiography. Int J Cardiovasc Imaging 2018; 34:1041-1055. [PMID: 29428969 DOI: 10.1007/s10554-018-1314-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 02/02/2018] [Indexed: 12/01/2022]
Abstract
The present study aimed to present a workflow algorithm for automatic processing of 2D echocardiography images. The workflow was based on several sequential steps. For each step, we compared different approaches. Epicardial 2D echocardiography datasets were acquired during various open-chest beating-heart surgical procedures in three porcine hearts. We proposed a metric called the global index that is a weighted average of several accuracy coefficients, indices and the mean processing time. This metric allows the estimation of the speed and accuracy for processing each image. The global index ranges from 0 to 1, which facilitates comparison between different approaches. The second step involved comparison among filtering, sharpening and segmentation techniques. During the noise reduction step, we compared the median filter, total variation filter, bilateral filter, curvature flow filter, non-local means filter and mean shift filter. To clarify the endocardium borders of the right heart, we used the linear sharpen. Lastly, we applied watershed segmentation, clusterisation, region-growing, morphological segmentation, image foresting segmentation and isoline delineation. We assessed all the techniques and identified the most appropriate workflow for echocardiography image segmentation of the right heart. For successful processing and segmentation of echocardiography images with minimal error, we found that the workflow should include the total variation filter/bilateral filter, linear sharpen technique, isoline delineation/region-growing segmentation and morphological post-processing. We presented an efficient and accurate workflow for the precise diagnosis of cardiovascular diseases. We introduced the global index metric for image pre-processing and segmentation estimation.
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Affiliation(s)
- Viacheslav V Danilov
- Medical Devices Design Laboratory, RASA Center in Tomsk, Tomsk Polytechnic University, Tomsk, Russia
| | - Igor P Skirnevskiy
- Medical Devices Design Laboratory, RASA Center in Tomsk, Tomsk Polytechnic University, Tomsk, Russia
| | - Olga M Gerget
- Medical Devices Design Laboratory, RASA Center in Tomsk, Tomsk Polytechnic University, Tomsk, Russia
| | - Egor E Shelomentcev
- Medical Devices Design Laboratory, RASA Center in Tomsk, Tomsk Polytechnic University, Tomsk, Russia
| | - Dmitrii Yu Kolpashchikov
- Medical Devices Design Laboratory, RASA Center in Tomsk, Tomsk Polytechnic University, Tomsk, Russia
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17
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Payne CJ, Wamala I, Bautista-Salinas D, Saeed M, Van Story D, Thalhofer T, Horvath MA, Abah C, Del Nido PJ, Walsh CJ, Vasilyev NV. Soft robotic ventricular assist device with septal bracing for therapy of heart failure. Sci Robot 2017; 2:2/12/eaan6736. [PMID: 33157903 DOI: 10.1126/scirobotics.aan6736] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 10/30/2017] [Indexed: 01/25/2023]
Abstract
Previous soft robotic ventricular assist devices have generally targeted biventricular heart failure and have not engaged the interventricular septum that plays a critical role in blood ejection from the ventricle. We propose implantable soft robotic devices to augment cardiac function in isolated left or right heart failure by applying rhythmic loading to either ventricle. Our devices anchor to the interventricular septum and apply forces to the free wall of the ventricle to cause approximation of the septum and free wall in systole and assist with recoil in diastole. Physiological sensing of the native hemodynamics enables organ-in-the-loop control of these robotic implants for fully autonomous augmentation of heart function. The devices are implanted on the beating heart under echocardiography guidance. We demonstrate the concept on both the right and the left ventricles through in vivo studies in a porcine model. Different heart failure models were used to demonstrate device function across a spectrum of hemodynamic conditions associated with right and left heart failure. These acute in vivo studies demonstrate recovery of blood flow and pressure from the baseline heart failure conditions. Significant reductions in diastolic ventricle pressure were also observed, demonstrating improved filling of the ventricles during diastole, which enables sustainable cardiac output.
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Affiliation(s)
- Christopher J Payne
- Wyss Institute for Biologically Inspired Engineering, 3 Blackfan Circle, Longwood, Boston, MA 02115, USA.,Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 29 Oxford Street, Cambridge, MA 02138, USA
| | - Isaac Wamala
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.,Department of Cardiovascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Daniel Bautista-Salinas
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Mossab Saeed
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - David Van Story
- Wyss Institute for Biologically Inspired Engineering, 3 Blackfan Circle, Longwood, Boston, MA 02115, USA.,Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 29 Oxford Street, Cambridge, MA 02138, USA.,Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Thomas Thalhofer
- Wyss Institute for Biologically Inspired Engineering, 3 Blackfan Circle, Longwood, Boston, MA 02115, USA.,Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 29 Oxford Street, Cambridge, MA 02138, USA.,Department of Mechanical Engineering, Technical University of Munich, Munich, Germany
| | - Markus A Horvath
- Wyss Institute for Biologically Inspired Engineering, 3 Blackfan Circle, Longwood, Boston, MA 02115, USA.,Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 29 Oxford Street, Cambridge, MA 02138, USA.,Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
| | - Colette Abah
- Wyss Institute for Biologically Inspired Engineering, 3 Blackfan Circle, Longwood, Boston, MA 02115, USA.,Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 29 Oxford Street, Cambridge, MA 02138, USA
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Conor J Walsh
- Wyss Institute for Biologically Inspired Engineering, 3 Blackfan Circle, Longwood, Boston, MA 02115, USA. .,Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 29 Oxford Street, Cambridge, MA 02138, USA
| | - Nikolay V Vasilyev
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
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18
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Abstract
INTRODUCTION Robots have been employed in cardiovascular therapy as surgical tools and for automation of hospital systems. Soft robots are a new kind of robot made of soft deformable materials, that are uniquely suited for biomedical applications because they are inherently less likely to injure body tissues and more likely to adapt to biological environments. Awareness of the soft robotic systems under development will help promote clinician involvement in their successful clinical translation. Areas covered: The most advanced soft robotic systems, across the size scale from nano to macro, that have shown the most promise for clinical application in cardiovascular therapy because they offer solutions where a clear therapeutic need still exists. We discuss nano and micro scale technology that could help improve targeted therapy for cardiac regeneration in ischemic heart disease, and soft robots for mechanical circulatory support. Additionally, we suggest where the gaps in the technology currently lie. Expert commentary: Soft robotic technology has now matured from the proof-of-concept phase to successful animal testing. With further refinement in materials and clinician guided application, they will be a useful complement for cardiovascular therapy.
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Affiliation(s)
- Isaac Wamala
- a Klinik für Herz- , Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin , Berlin , Germany
| | - Ellen T Roche
- b Discipline of Biomedical Engineering , College of Engineering and Informatics, National University of Ireland , Galway , Ireland
| | - Frank A Pigula
- c Rudd Heart and Lung Center , University of Louisville - Jewish Hospital , Louisville , USA
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