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Tamadon I, Sadati SMH, Mamone V, Ferrari V, Bergeles C, Menciassi A. Semiautonomous Robotic Manipulator for Minimally Invasive Aortic Valve Replacement. IEEE T ROBOT 2023; 39:4500-4519. [PMID: 38249319 PMCID: PMC7615540 DOI: 10.1109/tro.2023.3315966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Aortic valve surgery is the preferred procedure for replacing a damaged valve with an artificial one. The ValveTech robotic platform comprises a flexible articulated manipulator and surgical interface supporting the effective delivery of an artificial valve by teleoperation and endoscopic vision. This article presents our recent work on force-perceptive, safe, semiautonomous navigation of the ValveTech platform prior to valve implantation. First, we present a force observer that transfers forces from the manipulator body and tip to a haptic interface. Second, we demonstrate how hybrid forward/inverse mechanics, together with endoscopic visual servoing, lead to autonomous valve positioning. Benchtop experiments and an artificial phantom quantify the performance of the developed robot controller and navigator. Valves can be autonomously delivered with a 2.0±0.5 mm position error and a minimal misalignment of 3.4±0.9°. The hybrid force/shape observer (FSO) algorithm was able to predict distributed external forces on the articulated manipulator body with an average error of 0.09 N. FSO can also estimate loads on the tip with an average accuracy of 3.3%. The presented system can lead to better patient care, delivery outcome, and surgeon comfort during aortic valve surgery, without requiring sensorization of the robot tip, and therefore obviating miniaturization constraints.
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Affiliation(s)
- Izadyar Tamadon
- Faculty of Engineering Technology, University of Twente, 7522 NB Enschede, The Netherlands, and also with the BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pontedera, Italy
| | - S. M. Hadi Sadati
- Robotics and Vision Department in Medicine Lab, School of Biomedical Engineering & Imaging Sciences, King’s College London, SE17EU London, U.K
| | - Virginia Mamone
- Department of Computer Science and the EndoCAS Center for Computer-Assisted Surgery, University of Pisa, 56124 Pisa, Italy
| | - Vincenzo Ferrari
- Department of Computer Science and the EndoCAS Center for Computer-Assisted Surgery, University of Pisa, 56124 Pisa, Italy
| | - Christos Bergeles
- Robotics and Vision Department in Medicine Lab, School of Biomedical Engineering & Imaging Sciences, King’s College London, SE17EU London, U.K
| | - Arianna Menciassi
- BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pontedera, Italy
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Tamadon I, Mamone V, Huan Y, Condino S, Quaglia C, Ferrari V, Ferrari M, Menciassi A. ValveTech: A Novel Robotic Approach for Minimally Invasive Aortic Valve Replacement. IEEE Trans Biomed Eng 2020; 68:1238-1249. [PMID: 32931426 DOI: 10.1109/tbme.2020.3024184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Aortic valve disease is the most common heart disease in the elderly calling for replacement with an artificial valve. The presented surgical robot aims to provide a highly controllable instrument for efficient delivery of an artificial valve by the help of integrated endoscopic vision. METHODS A robot (called ValveTech), intended for minimally invasive surgery (MIS) and consisting of a flexible cable driven manipulator, a passive arm, and a control unit has been designed and prototyped. The flexible manipulator has several features (e.g., stabilizing flaps, tiny cameras, dexterous introducer and custom cartridge) to help the proper valve placement. It provides 5 degrees of freedom for reaching the operative site via mini-thoracotomy; it adjusts the valve and expands it at the optimal position. The robot was evaluated by ten cardiac surgeons following a real surgical scenario in artificial chest simulator with an aortic mockup. Moreover, after each delivery, the expanded valve was evaluated objectively in comparison with the ideal position. RESULTS The robot performances were evaluated positively by surgeons. The trials resulted in faster delivery and an average misalignment distance of 3.8 mm along the aorta axis; 16.3 degrees rotational angle around aorta axis and 8.8 degrees misalignment of the valve commissure plane to the ideal plane were measured. CONCLUSION The trials successfully proved the proposed system for valve delivery under endoscopic vision. SIGNIFICANCE The ValveTech robot can be an alternative solution for minimally invasive aortic valve surgery and improve the quality of the operation both for surgeons and patients.
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Blanken CPS, Farag ES, Boekholdt SM, Leiner T, Kluin J, Nederveen AJ, van Ooij P, Planken RN. Advanced cardiac MRI techniques for evaluation of left-sided valvular heart disease. J Magn Reson Imaging 2019; 48:318-329. [PMID: 30134000 PMCID: PMC6667896 DOI: 10.1002/jmri.26204] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/19/2018] [Indexed: 01/06/2023] Open
Abstract
The most common types of left‐sided valvular heart disease (VHD) in the Western world are aortic valve stenosis, aortic valve regurgitation, and mitral valve regurgitation. Comprehensive clinical evaluation entails both hemodynamic analysis and structural as well as functional characterization of the left ventricle. Cardiac magnetic resonance imaging (MRI) is an established diagnostic modality for assessment of left‐sided VHD and is progressively gaining ground in modern‐day clinical practice. Detailed flow visualization and quantification of flow‐related biomarkers in VHD can be obtained using 4D flow MRI, an imaging technique capable of measuring blood flow in three orthogonal directions over time. In addition, recent MRI sequences enable myocardial tissue characterization and strain analysis. In this review we discuss the emerging potential of state‐of‐the‐art MRI including 4D flow MRI, tissue mapping, and strain quantification for the diagnosis and prognosis of left‐sided VHD. Level of Evidence: 1 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2018. J. MAGN. RESON. IMAGING 2018;48:318–329.
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Affiliation(s)
- Carmen P S Blanken
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Emile S Farag
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Tim Leiner
- Department of Radiology, University Medical Center, Utrecht, the Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Aart J Nederveen
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Pim van Ooij
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - R Nils Planken
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands
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Farag ES, Schade EL, van Ooij P, Boekholdt SM, Planken RN, van Kimmenade R, Nederveen AJ, de Mol BAJM, Kluin J. Bileaflet mechanical aortic valves do not alter ascending aortic wall shear stress. Int J Cardiovasc Imaging 2019; 35:703-710. [PMID: 30741363 PMCID: PMC6482125 DOI: 10.1007/s10554-018-1508-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 11/22/2018] [Indexed: 01/12/2023]
Abstract
Progressive ascending aortic dilatation has been observed after mechanical aortic valve replacement (mAVR), possibly due to altered blood flow and wall shear stress (WSS) patterns induced by their bileaflet design. We examined the effect of mAVR on WSS in the ascending aorta using time-resolved 4D flow MRI. Fifteen patients with mechanical aortic valve prostheses, 10 patients with bicuspid aortic valve disease and 10 healthy individuals underwent thoracic 4D flow MRI. Peak systolic hemodynamic parameters (velocity and WSS) and vessel diameters were assessed in the ascending aorta. In addition, three-dimensional per-voxel analysis was used to compare velocity and WSS between patient groups and healthy controls. Peak aortic diameters were significantly higher in mAVR and BAV patients compared to healthy controls (p = 0.011). Mean aortic diameters were comparable between mAVR and BAV patients. No differences in 4D flow MRI-derived mean blood flow velocity and peak WSS were found between the three groups. Compared to healthy controls, mean WSS was significantly lower in mAVR patients (p = 0.031). Per-voxel analysis revealed no increased WSS in the ascending aortic wall and significantly lower velocity and WSS values in mAVR patients compared to healthy controls. In contrast, regions of significantly increased outer lumen velocities and WSS in BAV patients compared to healthy controls were found. This study shows that there is no increased ascending aortic WSS after mAVR. Our results suggest that, in contrast to BAV patients, there is no indication for intensified follow-up of the ascending aorta after mAVR.
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Affiliation(s)
- Emile S Farag
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands.
| | - Emilio L Schade
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Pim van Ooij
- Department of Radiology and nuclear medicine, Academic Medical Center, Amsterdam, The Netherlands
| | | | - R Nils Planken
- Department of Radiology and nuclear medicine, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Aart J Nederveen
- Department of Radiology and nuclear medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Bas A J M de Mol
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Capelli C, Corsini C, Biscarini D, Ruffini F, Migliavacca F, Kocher A, Laufer G, Taylor AM, Schievano S, Andreas M, Burriesci G, Rath C. Pledget-Armed Sutures Affect the Haemodynamic Performance of Biologic Aortic Valve Substitutes: A Preliminary Experimental and Computational Study. Cardiovasc Eng Technol 2016; 8:17-29. [PMID: 27873180 PMCID: PMC5320018 DOI: 10.1007/s13239-016-0284-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 10/27/2016] [Indexed: 11/28/2022]
Abstract
Surgical aortic valve replacement is the most common procedure of choice for the treatment of severe aortic stenosis. Bioprosthetic valves are traditionally sewed-in the aortic root by means of pledget-armed sutures during open-heart surgery. Recently, novel bioprostheses which include a stent-based anchoring system have been introduced to allow rapid implantation, therefore reducing the duration and invasiveness of the intervention. Different effects on the hemodynamics were clinically reported associated with the two technologies. The aim of this study was therefore to investigate whether the differences in hemodynamic performances are an effect of different anchoring systems. Two commercially available bio-prosthetic aortic valves, one sewed-in with pledget-armed sutures and one rapid-deployment, were thus tested in this study by means of a combined approach of experimental and computational tools. In vitro experiments were performed to evaluate the overall hydrodynamic performance under identical standard conditions; computational fluid dynamics analyses were set-up to explore local flow variations due to different design of the anchoring system. The results showed how the performance of cardiac valve substitutes is negatively affected by the presence of pledget-armed sutures. These are causing flow disturbances, which in turn increase the mean pressure gradient and decrease the effective orifice area. The combined approach of experiments and numerical simulations can be effectively used to quantify the detailed relationship between local fluid-dynamics and overall performances associated with different valve technologies.
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Affiliation(s)
- Claudio Capelli
- UCL Institute of Cardiovascular Science, and Great Ormond Street Hospital for Children, NHS Foundation Trust, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Chiara Corsini
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
| | - Dario Biscarini
- UCL Institute of Cardiovascular Science, and Great Ormond Street Hospital for Children, NHS Foundation Trust, 30 Guilford Street, London, WC1N 1EH, UK.,Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
| | - Francesco Ruffini
- UCL Institute of Cardiovascular Science, and Great Ormond Street Hospital for Children, NHS Foundation Trust, 30 Guilford Street, London, WC1N 1EH, UK.,Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
| | - Alfred Kocher
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Guenther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Andrew M Taylor
- UCL Institute of Cardiovascular Science, and Great Ormond Street Hospital for Children, NHS Foundation Trust, 30 Guilford Street, London, WC1N 1EH, UK
| | - Silvia Schievano
- UCL Institute of Cardiovascular Science, and Great Ormond Street Hospital for Children, NHS Foundation Trust, 30 Guilford Street, London, WC1N 1EH, UK
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Gaetano Burriesci
- Department of Mechanical Engineering, UCL, London, UK.,Fondazione Ri.MED, Bioengineering Group, Palermo, Italy
| | - Claus Rath
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.,Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
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