Implantable Soft Robotic Devices for Heart Failure

Implantable soft robotic devices to enhance cardiac function in left or right heart failure have been developed by a research team at Boston Children’s Hospital

Highlights:

Implantable robotic devices may offer new therapy for heart failure.
These devices help recover blood flow and pressure.
These devices also have artificial muscles to perform motions.

Soft robotic actuators, which are pneumatic artificial muscles designed and programmed to perform lifelike motions, have recently emerged as an attractive alternative to more rigid components that have conventionally been used in biomedical devices. A research team at the Boston Children's Hospital team revealed a proof-of-concept soft robotic sleeve that could support the function of a failing heart.

Despite this promising innovation, the team recognized that many pediatric heart patients have more one-sided heart conditions. These patients are not experiencing failure of the entire heart -- instead, congenital conditions have caused disease in either the heart's right or left ventricle, but not both.

Congestive Heart Failure (Congestive Cardiac Failure) Current Management
Congestive heart failure (CHF) is a condition in which the heart fails to work adequately as a pump that can deliver oxygen rich blood to the body.

‘Implantable robotic devices help recover blood flow and pressure from the baseline heart failure conditions.’

"We set out to develop new technology that would help one diseased ventricle, when the patient is in isolated left or right heart failure, pull blood into the chamber and then effectively pump it into the circulatory system," says Nikolay Vasilyev, MD, a researcher in cardiac surgery at Boston Children's.

The heart of the challenge - pumping blood efficiently
Although other existing mechanical pumps can help propel blood through the heart, they are designed so that blood must run through the pump itself, exposing blood to its unnatural surface.

"Running blood through a pump always requires a patient to be placed, permanently, on anticoagulant medication to prevent blood clotting," Vasilyev says, who is a co-senior author on the paper. "It can be very difficult to keep the right balance of medication, especially in pediatric patients, who are therefore at risk of excessive bleeding or dangerous clotting."

Cardiogenic Shock - Causes, Symptoms, Diagnosis, Treatment & Prevention
Cardiogenic shock is defined as reduced cardiac output due to inability of the heart to pump adequate blood in the presence of a normal blood volume.

So, using external actuators to help squeeze blood through the heart's own chamber, the team has designed a system that could theoretically work with minimal use of anticoagulants.

"We've combined rigid bracing with soft robotic actuators to gently but sturdily help a diseased heart chamber pump blood effectively," Vasilyev says.

Drugs Causing Low Blood Sodium Levels / Hyponatremia
Many drugs can lower your blood sodium levels or hyponatremia. Low blood sodium symptoms are associated with salt level in blood and causes of hyponatremia are decrease in sodium and water content.

The rigid brace component is deployed via a needle into the heart's intraventricular septum, the wall of tissue between the heart's chambers, to prevent the septum from shifting under the pressure of the artificial "muscle" of the soft actuator.

"With the use of classic left ventricular assist devices, there are patients who experience a septum shift towards the right side and subsequent ballooning of the right ventricle, which can cause secondary right heart failure," Vasilyev says. "Here, the rigid brace keeps the septum in its original position, protecting the healthy right side of the heart from the mechanical load of the left ventricular assistance."

Pulmonary Edema - Causes, Symptoms, Signs, Diagnosis, Treatment, Prevention
Pulmonary edema or fluid in the lungs is caused by congestive heart failure and several other conditions, including pneumonia, exposure to certain toxins etc.

In contrast, existing ventricular assist devices (VAD) don't involve the septum at all.

Tailoring the concept for future translation
Altogether, the system involves a septal anchor, a bracing bar and sealing sleeve that pass through the ventricle wall, and a frame embedded with soft actuators that is mounted around the ventricle. The researchers designed two distinct versions of the system for the right and left ventricle.

In animal studies, the soft robotic system contributed significantly to the diseased ventricle's ability to eject blood. The researchers speculate that the system's effectiveness is due in part to its integration with the septum, which plays a key role in the heart's ability to pump blood.

The system also made significant improvement in its ability to draw blood into the ventricles, which is just as important as the heart's ability to pump it out.

"As the actuators relax, specially-designed elastic bands help return the heart's wall to its original position, filling the chamber sufficiently with blood," Vasilyev says.

Based on these initial proof-of-concept results, Vasilyev and his team are working on key design modifications that can bring this system closer to use in humans, such as portability and miniaturization of the components. They also need to do longer tests in animals to see how the system impacts the heart over prolonged periods of time.

References:

Christopher J. Payne, Isaac Wamala et al. Soft Robotic Ventricular Assist Device with Septal Bracing for Therapy of Heart Failure, Science RoboticsDOI: 10.1126/scirobotics.aan6736

Source-Eurekalert