Towards Alternative Approaches for Coupling of a Soft Robotic Sleeve to the Heart

Abstract

Efficient coupling of soft robotic cardiac assist devices to the external surface of the heart is crucial to augment cardiac function and represents a hurdle to translation of this technology. In this work, we compare various fixation strategies for local and global coupling of a direct cardiac compression sleeve to the heart. For basal fixation, we find that a sutured Velcro band adheres the strongest to the epicardium. Next, we demonstrate that a mesh-based sleeve coupled to the myocardium improves function in an acute porcine heart failure model. Then, we analyze the biological integration of global interface material candidates (medical mesh and silicone) in a healthy and infarcted murine model and show that a mesh interface yields superior mechanical coupling via pull-off force, histology, and microcomputed tomography. These results can inform the design of a therapeutic approach where a mesh-based soft robotic DCC is implanted, allowed to biologically integrate with the epicardium, and actuated for active assistance at a later timepoint. This strategy may result in more efficient coupling of extracardiac sleeves to heart tissue, and lead to increased augmentation of heart function in end-stage heart failure patients.

Wearable and Implantable Devices for Cardiovascular Healthcare: from Monitoring to Therapy Based on Flexible and Stretchable Electronics

“…h) Optical image of soft‐robotic‐sleeve biointegration using medical mesh. Reproduced with permission . Copyright 2018, Springer Nature.…”

“…For efficient assistance by a sleeve, coupling of the sleeve to the epicardium is important, and various coupling methods were deployed, including sutures, suction, and surgical adhesives. Recently, a new concept of biointegration has been suggested to couple a sleeve to the epicardium, in which cell migration into interface materials enhances adhesion . In this strategy, a soft robotic sleeve using medical mesh as an interface material was fabricated, implanted on the heart, left over for tissue integration into the medical mesh, and then actuated for cardiac assistance (Figure h).…”

Hydrogels in adipose tissue engineering—Potential application in post‐mastectomy breast regeneration

“…Silicone is impervious to cell ingrowth, and as such a fibrous capsule (FC) grows around the implant (Horvath et al, ). Like silicone implants, hydrogel biomaterials also generate inflammation within tissue when injected, and each biomaterial generates its own inflammatory pattern.…”

An injectable alginate/extra cellular matrix (ECM) hydrogel towards acellular treatment of heart failure

“…Samples were then sliced to 7 μm thickness and mounted on slides. This was followed by staining with H& E (Hematoxylin and Eosin, Sigma Aldrich, Ireland), and slides were observed under an Olympus BX41 microscope, as previously described 41,42…”