Novel mitral clipping technique overcoming extreme atrial dilatation

Tiroch, Klaus; Vorpahl, Marc; Seyfarth, Melchior

doi:10.1002/ccd.25269

Cited by 6 publications

(4 citation statements)

References 1 publication

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“…The steerable sheath with adjustable curve allowed for easy positioning of the guiding catheter and resulted in a successful procedure. More recently, Tiroch et al 18 reported a case in which a novel mitral clipping technique was combined with the steerable guide sheath that is part of the MitraClip system. The procedure relied on two alternating 90° bends of the steerable sheath, allowing the clinicians to advance the clip delivery system further in the steerable guide and position and align it into an adequate grasping position.…”

Section: Introductionmentioning

confidence: 99%

Catheter steering in interventional cardiology: Mechanical analysis and novel solution

Ali

Sakes

Arkenbout

et al. 2019

Proc Inst Mech Eng H

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In recent years, steerable catheters have been developed to combat the effects of the dynamic cardiac environment. Mechanically actuated steerable catheters appear the most in the clinical setting; however, they are bound to a number of mechanical limitations. The aim of this research is to gain insight in these limitations and use this information to develop a new prototype of a catheter with increased steerability. The main limitations in mechanically steerable catheters are identified and analysed, after which requirements and solutions are defined to design a multi-steerable catheter. Finally, a prototype is built and a proof-of-concept test is carried out to analyse the steering functions. The mechanical analysis results in the identification of five limitations: (1) low torsion, (2) shaft shortening, (3) high unpredictable friction, (4) coupled tip-shaft movements, and (5) complex cardiac environment. Solutions are found to each of the limitations and result in the design of a novel multi-steerable catheter with four degrees of freedom. A prototype is developed which allows the dual-segmented tip to be steered over multiple planes and in multiple directions, allowing a range of complex motions including S-shaped curves and circular movements. A detailed analysis of limitations underlying mechanically steerable catheters has led to a new design for a multi-steerable catheter for complex cardiac interventions. The four integrated degrees of freedom provide a high variability of tip directions, and repetition of the bending angle is relatively simple and reliable. The ability to steer inside the heart with a variety of complex shaped curves may potentially change conventional approaches in interventional cardiology towards more patient-specific and lower complexity procedures. Future directions are headed towards further design optimizations and the experimental validation of the prototype.

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Section: Introductionmentioning

confidence: 99%

Catheter steering in interventional cardiology: Mechanical analysis and novel solution

Ali

Sakes

Arkenbout

et al. 2019

Proc Inst Mech Eng H

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“…Comparative studies between steerable and nonsteerable catheters have demonstrated reductions in procedure time and improvements in patient safety (109)(110)(111). Steerable catheters are known to enable better positioning of sophisticated implants (112,113) and successful treatment in patients who would otherwise be precluded from endovascular treatment with a standard nonsteerable catheter (46,114).…”

Section: Discussionmentioning

confidence: 99%

Soft robotic steerable microcatheter for the endovascular treatment of cerebral disorders

et al. 2021

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Catheters used for endovascular navigation in interventional procedures lack dexterity at the distal tip. Neurointerventionists, in particular, encounter challenges in up to 25% of aneurysm cases largely due to the inability to steer and navigate the tip of the microcatheters through tortuous vasculature to access aneurysms. We overcome this problem with submillimeter diameter, hydraulically actuated hyperelastic polymer devices at the distal tip of microcatheters to enable active steerability. Controlled by hand, the devices offer complete 3D orientation of the tip. Using saline as a working fluid, we demonstrate guidewire-free navigation, access, and coil deployment in vivo, offering safety, ease of use, and design flexibility absent in other approaches to endovascular intervention. We demonstrate the ability of our device to navigate through vessels and to deliver embolization coils to the cerebral vessels in a live porcine model. This indicates the potential for microhydraulic soft robotics to solve difficult access and treatment problems in endovascular intervention.

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“…Comparative studies between steerable and non-steerable catheters have demonstrated significant reductions in procedure time and improvements in patient safety [114,42,70]. Steerable catheters are known to enable better positioning of sophisticated implants [82,113] and successful treatment in patients who would otherwise be precluded from endovascular treatment with a standard non-steerable catheter [51,94].…”

Section: Discussionmentioning

confidence: 99%

Soft robotic steerable micro-catheter for the endovascular treatment of cerebral disorders

Tilvawala

Wen

Santiago-Dieppa

et al. 2021

Preprint

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Catheters used for endovascular navigation in interventional procedures lack dexterity at the distal tip. Neurointerventionists, in particular, encounter challenges in up to 25% of aneurysm cases largely due to the inability to steer and navigate the tip of the micro-catheters through tortuous vasculature to access aneurysms. We overcome this problem with sub-millimeter diameter, hydraulically-actuated hyperelastic polymer devices at the distal tip of micro-catheters to enable active steerability. Controlled by hand, the devices offer complete 3D orientation of the tip. Using pressures up to 400 kPa (4 atm) we demonstrate guidewire-free navigation, access, and coil deployment in vivo, offering safety, ease of use, and design flexibility absent in other approaches to endovascular intervention. We demonstrate the ability of our device to navigate through vessels and to deliver embolization coils to the cerebral vessels in a live porcine model. This indicates the potential for microhydraulic soft robotics to solve difficult access and treatment problems in endovascular intervention.

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Novel mitral clipping technique overcoming extreme atrial dilatation

Cited by 6 publications

References 1 publication

Catheter steering in interventional cardiology: Mechanical analysis and novel solution

Catheter steering in interventional cardiology: Mechanical analysis and novel solution

Soft robotic steerable microcatheter for the endovascular treatment of cerebral disorders

Soft robotic steerable micro-catheter for the endovascular treatment of cerebral disorders

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