Medical Design Briefs - February 2024 - 57

Shape-Shifting Robotic Catheter Could Make Heart
Surgery Safer
The catheter inflates once
inside the heart.
Boston University
Boston, MA
A beating heart makes for a formidable
surgical arena, but a new robotic
catheter could someday equip surgeons
to operate in the cardiac environment
with greater ease.
The device, designed by a team of physicians
and engineers at Boston University,
possesses shape-shifting capabilities
that allow it to be maneuvered through
complex anatomy while maintaining
enough stability to accomplish surgical
objectives within the heart. In a study
published in Science Advances, the authors
demonstrated the robot's ability to
assist with two mock cardiac procedures
using animal tissue. The study authors
suggest that, with further development,
the robotic catheter could make many
common heart surgeries far safer and
less taxing on the body.
" The authors carefully consider patient
safety in their design, which creatively
integrates several robotic features
to navigate an environment that can be
complicated and risky to operate in, "
says Moria Bittmann, PhD, director of
the NIBIB Robotics Program.
Today, a significant share of cardiac
procedures performed in the United
States are open-heart surgeries, which
grant surgeons a high degree of control,
but also entail extensive recovery
periods and are not an option for some
high-risk patients.
Less-invasive methods, wherein surgeons
thread catheters through the
body's vasculature to reach the heart,
are available but come with serious drawbacks.
These instruments, while small
enough to fit through peripheral veins,
are easily pushed aside by beating heart
tissue due to their size. And in general,
they lack dexterity, making it difficult for
surgeons to reach the target tissue.
This application has stumped researchers
working on new solutions as it
seemingly calls for an instrument with diametrically
opposed properties - such
as being both small and large and being
both rigid and maneuverable.
Medical Design Briefs, February 2024
The new robotic catheter features both a deployable stabilization mechanism and a flexible manipulator tip. (Credit:
Rogatinsky et al.)
To solve the puzzle, senior author
Tommaso Ranzani, PhD, a professor of
mechanical engineering at Boston University,
and his colleagues created a robotic
system that exhibits specific qualities
as needed during a procedure.
The team's robotic catheter features a
flexible, air pressure-operated tip, thin
enough to fit inside veins but also capable
of inflating once inside the heart.
For added stability, they incorporated
an expandable ring that, once deployed,
would push up against the walls of the
vein near the entrance of the heart, anchoring
the catheter in place.
With the stabilizing mechanism and
an inflatable tip, the authors reasoned
the tool would be able to exert enough
force to pierce beating heart tissue without
being knocked back, Ranzani says.
Then, the catheter could collapse both
its stabilizer and tip to make an easy exit.
To test the device in a setting with realistic
anatomy, the researchers used it to
take on two different cardiac procedures
within an ex vivo pig heart's right atrium,
one of the heart's four chambers.
The first was a common procedure
called a pacemaker lead placement,
wherein a guidewire for a pacemaker
lead is inserted into the wall of the
right atrium.
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Five different inexperienced operators
used the robotic catheter to perform the
procedure several times using hearts extracted
from adult pigs. For comparison,
an experienced physician using a standard
catheter carried out the same task.
All five inexperienced operators were
able to complete the procedure, and, on
average, did so in a similar length of time
as the expert.
The next trial for the robotic tool was
the first step of a tricuspid valve repair
procedure - a much more challenging
operation usually conducted through
open-heart surgery. The procedure normally
involves fastening a ring around an
opening and closing heart valve.
Since the researchers were not experimenting
on living, beating hearts, they
connected a tricuspid valve taken from
a pig to a small motor, causing the valve
to pulse. With the beating valve as their
target, a researcher simulated the procedure's
initial step of anchoring the ring by
puncturing the valve in a predetermined
spot, repeating the process three times.
The test was successful as the instrument
was able to maintain contact with
and apply force to its moving target
throughout.
Next up, the authors plan to bring
the technology into live subjects and
57
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Medical Design Briefs - February 2024

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