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

Abstract

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.

Fluidic enabled bioelectronic implants: opportunities and challenges

“…These types of ventricular assistance can also be triggered with electrical feedback via electrocardiogram signals, or pressure driven feedback measured within the blood vessels Please do not adjust margins Please do not adjust margins to produce a closed-loop assist system to provide tailored therapy to the patient. 97…”

“…These types of ventricular assistance can also be triggered with electrical feedback via electrocardiogram signals, or pressure-driven feedback measured within the blood vessels to produce a closed-loop assist system to provide tailored therapy to the patient. 97 Fig. 3 Implants with fluidic shape actuation (a) Minimally invasive spinal cord stimulator using shape actuation to enable deployment using a Tuohy needle before expansion to conform to the spinal.…”

Magnetically Active Cardiac Patches as an Untethered, Non‐Blood Contacting Ventricular Assist Device

“…We can use the real-time heart beat signals from the surface electrogram to synchronize with the native ventricular actuation patterns. [40] Phase differences could be explored to optimize the volumetric output of the heart. With…”

“…We can use the real‐time heart beat signals from the surface electrogram to synchronize with the native ventricular actuation patterns. [ 40 ] Phase differences could be explored to optimize the volumetric output of the heart. With improved field strength, the weight and volume of the MACP could be reduced, and the development of advanced tissue adhesives would eliminate the need for manual sutures during the experiments.…”

Importance of Preserved Tricuspid Valve Function for Effective Soft Robotic Augmentation of the Right Ventricle in Cases of Elevated Pulmonary Artery Pressure

“…2,5,9 In recent work, our group has suggested the concept of soft robotic ventricular assist devices. 1,10 Taking advantage of recent advances in soft robotics, we have shown that septally braced soft epicardial actuators can be precisely actuated in synchrony with the failing heart, to augment function. 10 Light, compact, and with minimal blood contact, these devices provide pulsatile augmentation of the native ventricular ejection by mechanically approximating the septum and ventricular free wall, making use of the native cardiovascular chambers without the requirement to reroute blood flow.…”