Soft robotic patient-specific hydrodynamic model of aortic stenosis and ventricular remodeling

Abstract

Aortic stenosis (AS) affects about 1.5 million people in the United States and is associated with a 5-year survival rate of 20% if untreated. In these patients, aortic valve replacement is performed to restore adequate hemodynamics and alleviate symptoms. The development of next-generation prosthetic aortic valves seeks to provide enhanced hemodynamic performance, durability, and long-term safety, emphasizing the need for high-fidelity testing platforms for these devices. We propose a soft robotic model that recapitulates patient-specific hemodynamics of AS and secondary ventricular remodeling which we validated against clinical data. The model leverages 3D-printed replicas of each patient’s cardiac anatomy and patient-specific soft robotic sleeves to recreate the patients’ hemodynamics. An aortic sleeve allows mimicry of AS lesions due to degenerative or congenital disease, whereas a left ventricular sleeve recapitulates loss of ventricular compliance and diastolic dysfunction (DD) associated with AS. Through a combination of echocardiographic and catheterization techniques, this system is shown to recreate clinical metrics of AS with greater controllability compared with methods based on image-guided aortic root reconstruction and parameters of cardiac function that rigid systems fail to mimic physiologically. Last, we leverage this model to evaluate the hemodynamic benefit of transcatheter aortic valves in a subset of patients with diverse anatomies, etiologies, and disease states. Through the development of a high-fidelity model of AS and DD, this work demonstrates the use of soft robotics to recreate cardiovascular disease, with potential applications in device development, procedural planning, and outcome prediction in industrial and clinical settings.

A patient-specific echogenic soft robotic left ventricle embedded into a closed-loop cardiovascular simulator for advanced device testing

“…The soft robotic left ventricle is implemented and controlled to represent patient-specific data in a high-fidelity anatomical model. The integration of a controllable soft robotic left ventricle into a cardiovascular simulator is a critical step forward toward the development of clinically relevant hemodynamic and biomechanical models personalizable to patient-specific conditions 27 ranging from stiff left ventricles with a small cavity and a restrictive pattern of diastolic function, as in the HFpEF patient, to large ventricles with a predominately systolic dysfunction, as in dilated cardiomyopathy.…”

“…While this setup achieves a good level of realism, the use of an animal heart restricts the simulation to non-patient-specific scenarios. Rosalia et al 27 used a silicon left ventricle with a soft robotic sleeve to replicate systolic contraction by compressing the element externally. Such a method could reproduce waveforms in agreement with in vivo experiments.…”

The Application of Precision Medicine in Structural Heart Diseases: A Step towards the Future

“…Validated through echocardiographic and catheterization techniques, this model offers superior controllability compared to rigid systems, ensuring a physiological representation of cardiac function. In addition, this model was tested in different backgrounds, presenting consistent results in the assessment of the hemodynamic efficacy of TAVI [52].…”

Modulating Cardiac Hemodynamics Using Tunable Soft Robotic Sleeves in a Porcine Model of HFpEF Physiology for Device Testing Applications

“…[51] In previous studies, we demonstrated the ability of the LV sleeve to limit cardiac filling in an in vitro model of aortic stenosis and that of the aortic sleeve to recreate the hemodynamics of pressure overload in vitro and in vivo. [52,53] Here, we redesign the LV sleeve for the development of a porcine model of HFpEF capable of tuning pressure overload and ventricular compliance independently, in a facile, immediate, tunable manner, which allows us to re-create a broad spectrum of HFpEF hemodynamics. By investigating the hemodynamic response of the model postimplantation of an interatrial shunt device, we then demonstrate the applicability of this model for in vivo evaluation of devicebased solutions for HFpEF (Figure 1B).…”