An Implantable Extracardiac Soft Robotic Device for the Failing Heart: Mechanical Coupling and Synchronization

Bio-SHARPE: Bioinspired Soft and High Aspect Ratio Pumping Element for Robotic and Medical Applications

The advent of soft robots has solved many issues posed by their rigid counterparts, including safer interactions with humans and the capability to work in narrow and complex environments. While much work has been devoted to developing soft actuators and bioinspired mechatronic systems, comparatively little has been done to improve the methods of actuation. Hydraulically soft actuators (HSAs) are emerging candidates to control soft robots due to their fast responses, low noise, and low hysteresis compared to compressible pneumatic ones. Despite advances, current hydraulic sources for large HSAs are still bulky and require high power availability to drive the pumping plant. To overcome these challenges, this work presents a new bioinspired soft and high aspect ratio pumping element (Bio-SHARPE) for use in soft robotic and medical applications. This new soft pumping element can amplify its input volume to at least 8.6 times with a peak pressure of at least 40 kPa. The element can be integrated into existing hydraulic pumping systems like a hydraulic gearbox. Naturally, an amplification of fluid volume can only come at the sacrifice of pumping pressure, which was observed as a 19.1:1 reduction from input to output pressure. The new concept enables a large soft robotic body to be actuated by smaller fluid reservoirs and pumping plant, potentially reducing their power and weight, and thus facilitating drive source miniaturization. The high amplification ratio also makes soft robotic systems more applicable for human-centric applications such as rehabilitation aids, bioinspired untethered soft robots, medical devices, and soft artificial organs. Details of the fabrication and experimental characterization of the Bio-SHARPE and its associated components are given. A soft robotic squid and an artificial heart ventricle are introduced and experimentally validated.

Stretching-Induced 2D-to-3D Shape Transformation of an Elastic Composite for Sensitivity-Tailorable Soft Electronics

The shapes of rubbers and elastomers are challenging to alter, and current methods relying on permanent plasticity and dynamic cross-linking strategies are usually laborious and can inevitably compromise the network elasticity. Here, we report a photoresponsive elastic composite that can be programmed into 3D shapes by first UV light irradiation and then stretching. The composite comprises ethylene propylene rubber as the elastic substrate and photoliquefiable azobenzene small molecules as the responsive filler. Upon UV light irradiation, the liquefication of the filler induces the destruction of the crystalline aggregates near the irradiated surface, and after stretching and subsequent stress release, the irradiated part bends to the irradiated side based on a gradient network orientation mechanism. The position and amplitude of bending deformation can be controlled to realize a 2D-to-3D shape transformation. We further show that the resulting 3D-shaped elastomer can integrate with silver conductive paste to develop soft conductive lines with tailorable strain-sensitive conductivities. This study may open a new door for the development of shape-tailorable elastomers and soft electronics with designable strain-sensitive conductivities.

Optimal assist strategy exploration for a direct assist device under stress‒strain dynamics

OBJECTIVES

The aim of this paper is to introduce a new assist strategy for a direct assist device that can enhance the heart's pumping efficiency and decrease the chances of myocardial injury in contrast to the conventional assist strategy.

METHODS

We established a finite element model of a biventricular heart, divided the ventricles into several regions, and applied pressure to each region separately in order to identify the primary and secondary assist areas. Then combined and tested these areas to obtain the optimal assist strategy.

RESULTS

The results indicate that our method exhibits an assist efficiency approximately ten times higher than that of the traditional assist method. Additionally, the stress distribution in the ventricles is more uniform after assistance.

CONCLUSIONS

In summary, this approach can result in a more homogenous stress distribution within the heart while also minimizing the contact area with it, which can reduce the incidence of allergic reactions and the likelihood of myocardial injury.

Artificial Muscles and Soft Robotic Devices for Treatment of End-Stage Heart Failure

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.

Recent Advances in Cardiovascular Disease Biosensors and Monitoring Technologies

Cardiovascular disease (CVD) causes significant mortality and remains the leading cause of death globally. Thus, to reduce mortality, early diagnosis by measurement of cardiac biomarkers and heartbeat signals presents fundamental importance. Traditional CVD examination requires bulky hospital instruments to conduct electrocardiography recording and immunoassay analysis, which are both time-consuming and inconvenient. Recently, development of biosensing technologies for rapid CVD marker screening attracted great attention. Thanks to the advancement in nanotechnology and bioelectronics, novel biosensor platforms are developed to achieve rapid detection, accurate quantification, and continuous monitoring throughout disease progression. A variety of sensing methodologies using chemical, electrochemical, optical, and electromechanical means are explored. This review first discusses the prevalence and common categories of CVD. Then, heartbeat signals and cardiac blood-based biomarkers that are widely employed in clinic, as well as their utilizations for disease prognosis, are summarized. Emerging CVD wearable and implantable biosensors and monitoring bioelectronics, allowing these cardiac markers to be continuously measured are introduced. Finally, comparisons of the pros and cons of these biosensing devices along with perspectives on future CVD biosensor research are presented.

An implantable soft robotic ventilator augments inspiration in a pig model of respiratory insufficiency

Severe diaphragm dysfunction can lead to respiratory failure and to the need for permanent mechanical ventilation. Yet permanent tethering to a mechanical ventilator through the mouth or via tracheostomy can hinder a patient's speech, swallowing ability and mobility. Here we show, in a porcine model of varied respiratory insufficiency, that a contractile soft robotic actuator implanted above the diaphragm augments its motion during inspiration. Synchronized actuation of the diaphragm-assist implant with the native respiratory effort increased tidal volumes and maintained ventilation flow rates within the normal range. Robotic implants that intervene at the diaphragm rather than at the upper airway and that augment physiological metrics of ventilation may restore respiratory performance without sacrificing quality of life.

Actuators for Implantable Devices: A Broad View

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.

Fluidic enabled bioelectronic implants: opportunities and challenges

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.

Reciprocity of Cell Mechanics with Extracellular Stimuli: Emerging Opportunities for Translational Medicine

Human cells encounter dynamic mechanical cues in healthy and diseased tissues, which regulate their molecular and biophysical phenotype, including intracellular mechanics as well as force generation. Recent developments in bio/nanomaterials and microfluidics permit exquisitely sensitive measurements of cell mechanics, as well as spatiotemporal control over external mechanical stimuli to regulate cell behavior. In this review, the mechanobiology of cells interacting bidirectionally with their surrounding microenvironment, and the potential relevance for translational medicine are considered. Key fundamental concepts underlying the mechanics of living cells as well as the extracelluar matrix are first introduced. Then the authors consider case studies based on 1) microfluidic measurements of nonadherent cell deformability, 2) cell migration on micro/nano-topographies, 3) traction measurements of cells in three-dimensional (3D) matrix, 4) mechanical programming of organoid morphogenesis, as well as 5) active mechanical stimuli for potential therapeutics. These examples highlight the promise of disease diagnosis using mechanical measurements, a systems-level understanding linking molecular with biophysical phenotype, as well as therapies based on mechanical perturbations. This review concludes with a critical discussion of these emerging technologies and future directions at the interface of engineering, biology, and medicine.

Hydraulic Detrusor for Artificial Bladder Active Voiding

The gold standard treatment for bladder cancer is radical cystectomy that implies bladder removal coupled to urinary diversions. Despite the serious complications and the impossibility of controlled active voiding, bladder substitution with artificial systems is a challenge and cannot represent a real option, yet. In this article, we present hydraulic artificial detrusor prototypes to control and drive the voiding of an artificial bladder (AB). These prototypes rely on two actuator designs (origami and bellows) based either on negative or positive operating pressure, to be combined with an AB structure. Based on the bladder geometry and size, we optimized the actuators in terms of contraction/expansion performances, minimizing the liquid volume required for actuation and exploring different actuator arrangements to maximize the voiding efficiency. To operate the actuators, an ad hoc electrohydraulic circuit was developed for transferring liquid between the actuators and a reservoir, both of them intended to be implanted. The AB, actuators, and reservoir were fabricated with biocompatible flexible thermoplastic materials by a heat-sealing process. We assessed the voiding efficiency with benchtop experiments by varying the actuator type and arrangement at different simulated patient positions (horizontal, 45° tilted, and vertical) to identify the optimal configuration and actuation strategy. The most efficient solution relies on two bellows actuators anchored to the AB. This artificial detrusor design resulted in a voiding efficiency of about 99%, 99%, and 89%, in the vertical, 45° tilted, and horizontal positions, respectively. The relative voiding time was reduced by about 17, 24, and 55 s compared with the unactuated bladder.

Direct Cardiac Compression Devices to Augment Heart Biomechanics and Function

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.

Damian D. Hyperelastic Membrane Actuators: Analysis of Toroidal and Helical Multifunctional Configurations

Technologies that provide mechanical assistance are required in the medical field, such as implants that regenerate tissue through elongation and stimulation. One of the challenges is to develop actuators that combine the benefits of high axial extension at low pressures, modularity, multifunction, and load-bearing capabilities into one design while maintaining their shape and softness. Overcoming such a challenge will provide implants with enhanced capacity for mechanical assistance to induce tissue regeneration. We introduce two novel actuators (M2H) built of stacked Hyperelastic Ballooning Membrane Actuators (HBMAs) that can be realized using helical and toroidal configurations. By restraining the HBMA expansion deterministically using a semisoft exoskeleton, the actuators are endowed with axial extension and radial expansion capabilities. These actuators are thus built of modules that can be configured to different therapeutical needs and multifunctionality, to provide anatomically congruent stimulation. We present the design, fabrication, testing, and numerical and experimental validation of the M2H-HBMAs. They can axially extend up to 41% and 32% in their helical and toroidal configurations at input pressures as low as 26 and 24 kPa, respectively. If the axial extension module is used separately, its extension capacity reaches >170%. The M2H-HBMAs can perform independent and simultaneous expansion and extension motions with negligible intraluminal deformation as well as stand at least 1 kg of axial force without collapsing. The M2H-HBMAs overcome the limitations of hyperexpanding machines that show low resistance to load. We envisage M2H-HBMAs as promising tools to perform tissue regeneration procedures.

Embedded Computational Heart Model for External Ventricular Assist Device Investigations

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.

The Role of Soft Robotic Micromachines in the Future of Medical Devices and Personalized Medicine

Developments in medical device design result in advances in wearable technologies, minimally invasive surgical techniques, and patient-specific approaches to medicine. In this review, we analyze the trajectory of biomedical and engineering approaches to soft robotics for healthcare applications. We review current literature across spatial scales and biocompatibility, focusing on engineering done at the biotic-abiotic interface. From traditional techniques for robot design to advances in tunable material chemistry, we look broadly at the field for opportunities to advance healthcare solutions in the future. We present an extracellular matrix-based robotic actuator and propose how biomaterials and proteins may influence the future of medical device design.

A decade retrospective of medical robotics research from 2010 to 2020

[Figure: see text].

MotorSkins-a bio-inspired design approach towards an interactive soft-robotic exosuit

The work presents a bio-inspired design approach to a soft-robotic solution for assisting the knee-bending in users with reduced mobility in lower limbs. Exosuits and fluid-driven actuators are fabric-based devices that are gaining increasing relevance as alternatives assistive technologies that can provide simpler, more flexible solutions in comparison with the rigid exoskeletons. These devices, however, commonly require an external energy supply or a pressurized-fluid reservoir, which considerably constrain the autonomy of such solutions. In this work, we introduce an event-based energy cycle (EBEC) design concept, that can harvest, store, and release the required energy for assisting the knee-bending, in a synchronised interaction with the user and the environment, thus eliminating any need for external energy or control input. Ice-plant hydro-actuation system served as the source of inspiration to address the specific requirements of such interactive exosuit through a fluid-driven material system. Based on the EBEC design concepts and the abstracted bio-inspired principles, a series of (material and process driven) design experimentations helped to address the challenges of realising various functionalities of the harvest, storage, actuation and control instances within a closed hydraulic circuit. Sealing and defining various areas of water-tight seam made out of thermoplastic elastomers provided the base material system to program various chambers, channels, flow-check valves etc of such EBEC system. The resulting fluid-driven EBEC-skin served as a proof of concept for such active exosuit, that brings these functionalities into an integrated 'sense-acting' material system, realising an auto-synchronised energy and information cycles. The proposed design concept can serve as a model for development of similar fluid-driven EBEC soft-machines for further applications. On the more general scheme, the work presents an interdisciplinary design-science approach to bio-inspiration and showcases how biological material solutions can be looked at from a design/designer perspective to bridge the bottom-up and top-down approach to bio-inspiration.

Cardiac mechanostructure: Using mechanics and anisotropy as inspiration for developing epicardial therapies in treating myocardial infarction

The mechanical environment and anisotropic structure of the heart modulate cardiac function at the cellular, tissue and organ levels. During myocardial infarction (MI) and subsequent healing, however, this landscape changes significantly. In order to engineer cardiac biomaterials with the appropriate properties to enhance function after MI, the changes in the myocardium induced by MI must be clearly identified. In this review, we focus on the mechanical and structural properties of the healthy and infarcted myocardium in order to gain insight about the environment in which biomaterial-based cardiac therapies are expected to perform and the functional deficiencies caused by MI that the therapy must address. From this understanding, we discuss epicardial therapies for MI inspired by the mechanics and anisotropy of the heart focusing on passive devices, which feature a biomaterials approach, and active devices, which feature robotic and cellular components. Through this review, a detailed analysis is provided in order to inspire further development and translation of epicardial therapies for MI.

Physical Human-Robot Collaboration: Robotic Systems, Learning Methods, Collaborative Strategies, Sensors, and Actuators

This article presents a state-of-the-art survey on the robotic systems, sensors, actuators, and collaborative strategies for physical human-robot collaboration (pHRC). This article starts with an overview of some robotic systems with cutting-edge technologies (sensors and actuators) suitable for pHRC operations and the intelligent assist devices employed in pHRC. Sensors being among the essential components to establish communication between a human and a robotic system are surveyed. The sensor supplies the signal needed to drive the robotic actuators. The survey reveals that the design of new generation collaborative robots and other intelligent robotic systems has paved the way for sophisticated learning techniques and control algorithms to be deployed in pHRC. Furthermore, it revealed the relevant components needed to be considered for effective pHRC to be accomplished. Finally, a discussion of the major advances is made, some research directions, and future challenges are presented.

An organosynthetic soft robotic respiratory simulator

In this work, we describe a benchtop model that recreates the motion and function of the diaphragm using a combination of advanced robotic and organic tissue. First, we build a high-fidelity anthropomorphic model of the diaphragm using thermoplastic and elastomeric material based on clinical imaging data. We then attach pneumatic artificial muscles to this elastomeric diaphragm, pre-programmed to move in a clinically relevant manner when pressurized. By inserting this diaphragm as the divider between two chambers in a benchtop model—one representing the thorax and the other the abdomen—and subsequently activating the diaphragm, we can recreate the pressure changes that cause lungs to inflate and deflate during regular breathing. Insertion of organic lungs in the thoracic cavity demonstrates this inflation and deflation in response to the pressures generated by our robotic diaphragm. By tailoring the input pressures and timing, we can represent different breathing motions and disease states. We instrument the model with multiple sensors to measure pressures, volumes, and flows and display these data in real-time, allowing the user to vary inputs such as the breathing rate and compliance of various components, and so they can observe and measure the downstream effect of changing these parameters. In this way, the model elucidates fundamental physiological concepts and can demonstrate pathology and the interplay of components of the respiratory system. This model will serve as an innovative and effective pedagogical tool for educating students on respiratory physiology and pathology in a user-controlled, interactive manner. It will also serve as an anatomically and physiologically accurate testbed for devices or pleural sealants that reside in the thoracic cavity, representing a vast improvement over existing models and ultimately reducing the requirement for testing these technologies in animal models. Finally, it will act as an impactful visualization tool for educating and engaging the broader community.

Synchronization of a Soft Robotic Ventricular Assist Device to the Native Cardiac Rhythm Using an Epicardial Electrogram

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.

Dynamic Augmentation of Left Ventricle and Mitral Valve Function With an Implantable Soft Robotic Device

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.

Design and Control of Foam Hands for Dexterous Manipulation

There has been great progress in soft robot design, manufacture, and control in recent years, and soft robots are a tool of choice for safe and robust handling of objects in conditions of uncertainty. Still, dexterous in-hand manipulation using soft robots remains a challenge. This paper introduces foam robot hands actuated by tendons sewn through a fabric glove. The flexibility of tendon actuation allows for high competence in utilizing deformation for robust in-hand manipulation. We discuss manufacturing, control, and design optimization for foam robots and demonstrate robust grasping and in-hand manipulation on a variety of different physical hand prototypes.

Self-Powered Direct Muscle Stimulation Using a Triboelectric Nanogenerator (TENG) Integrated with a Flexible Multiple-Channel Intramuscular Electrode

Muscle function loss can result from multiple nervous system diseases including spinal cord injury (SCI), stroke, and multiple sclerosis (MS). Electrical muscle stimulation is clinically employed for rehabilitative and therapeutic purpose and typically requires mA-level stimulation current. Here, we report electrical muscle stimulation, which is directly powered by a stacked-layer triboelectric nanogenerator (TENG) through a flexible multiple-channel intramuscular electrode. This multiple-channel intramuscular electrode allows mapping of motoneurons that is sparsely distributed in the muscle tissue and thus enables high efficiency TENG muscle stimulation, although the short-circuit current of the TENG is only 35 μA. With a stimulation efficiency matrix, we find the electrical muscle stimulation efficiency is affected by two factors, namely, the electrode-motoneuron position, and the stimulation waveform polarity. To test whether it is a universal phenomenon for electrical stimulation, we then further investigate with the conventional square wave current stimulation and confirm that the stimulation efficiency is also affected by these two factors. Thus, we develop a self-powered direct muscle stimulation system with a TENG as power source and waveform generator, and a multiple-channel intramuscular electrode to allow motoneuron mapping for stimulation efficiency optimization. We believe such self-powered system could be potentially used for rehabilitative and therapeutic purpose to treat muscle function loss.

Optimizing Epicardial Restraint and Reinforcement Following Myocardial Infarction: Moving Towards Localized, Biomimetic, and Multitherapeutic Options

The mechanical reinforcement of the ventricular wall after a myocardial infarction has been shown to modulate and attenuate negative remodeling that can lead to heart failure. Strategies include wraps, meshes, cardiac patches, or fluid-filled bladders. Here, we review the literature describing these strategies in the two broad categories of global restraint and local reinforcement. We further subdivide the global restraint category into biventricular and univentricular support. We discuss efforts to optimize devices in each of these categories, particularly in the last five years. These include adding functionality, biomimicry, and adjustability. We also discuss computational models of these strategies, and how they can be used to predict the reduction of stresses in the heart muscle wall. We discuss the range of timing of intervention that has been reported. Finally, we give a perspective on how novel fabrication technologies, imaging techniques, and computational models could potentially enhance these therapeutic strategies.

Evaluation of the CorInnova Heart Assist Device in an Acute Heart Failure Model

While the number of patients supported with temporary cardiac assist is growing, the existing devices are limited by a multitude of complications, mostly related to contact with the blood. The CorInnova epicardial compressive heart assist device was tested in six sheep using an acute heart failure model. High esmolol dose, targeting a 50% reduction in CO from healthy baseline, resulted in a failure state with mean CO 1.9 L/min. Heart assist with the device during failure state resulted in an average absolute increase in CO of 1.0 L/min, along with a decline in ventricular work to 67.5% of the total LV SW. Combined with repeated success of minimally invasive device implant, the resulting increases in cardiac hemodynamics achieved while still unloading the heart demonstrate the potential of the CorInnova device for temporary heart assist.

Modular force approximating soft robotic pneumatic actuator

PURPOSE

Soft robots are highly flexible and adaptable instruments that have proven extremely useful, especially in the surgical environment where compliance allows for improved maneuverability throughout the body. Endoscopic devices are a primary example of an instrument that physicians use to navigate to difficult-to-reach areas inside the body. This paper presents a modular soft robotic pneumatic actuator as a proof of concept for a compliant endoscopic device.

METHODS

The actuator is 3D printed using an FDM printer. Maximum bending angle is measured using image processing in MATLAB at a gauge pressure level of 35 psi. End-effector displacement is measured using electromagnetic tracking as gauge pressure ranges from 10 to 35 psi, and uniaxial tensile loading ranges from 0 to 120 g.

RESULTS

The actuator achieves a maximum bending angle of 145°. Fourth-order polynomial regression is used to model the actuator displacement upon inflation and tensile loading with an average coefficient of correlation value of 0.998. We also develop a feedforward neural network as a robust computer-assisted method for controlling the actuator that achieves a coefficient of correlation value of 0.996.

CONCLUSION

We propose a novel modular soft robotic pneumatic actuator that is developed via rapid prototyping and evaluated using image processing and machine learning models. The curled resting shape allows for simple manufacturing and achieves a greater range of bending than other actuators of its kind. A feedforward neural network provides accurate prediction of end-effector displacement upon inflation and loading to deliver precise manipulation and control.

Soft robotic ventricular assist device with septal bracing for therapy of heart failure

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.

The use of soft robotics in cardiovascular therapy

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.