Muscle-Mimicking Robotic Sleeve Could Treat Heart Failure According to New Research

in #health7 years ago (edited)


Introduction


I came across a fascinating paper in "Science Translational Medicine" today by Roche et al.
The paper describes their use of a soft "robotic" device that fits around the heart and is able to make up for any inadequacy of function that may arise due to heart failure.

Heart failure is a significant health problem around the world affecting an estimated 41 million people worldwide.

5 million people are affected in the US alone at an estimated cost of $32 billion per year.

It is a serious, life long condition that is generally progressive and can place serious restrictions on quality of life.

You can find a basic plain English explanation of heart failure here.

In the terminal stages of heart failure people may need heart transplantation.

Due to the shortage of organs there is a growing need for assistive devices to help keep people alive in the interim period.

This is very early research and involved testing the sleeve device both artificially for mechanical functionality as well as in pigs as a model for functioning in humans.

What Is New Here?


1) The Sleeve Uses Soft Material That is More Like Heart Tissue

Unlike most conventional heart assisting devices this one is made of structurally soft materials which are able to mimic an actual heart much more precisely.

The architecture of the native heart was the inspiration for our device, which comprises a fully conformable sleeve with two biomimetic layers of contractile elements embedded in an elastomeric matrix with mechanical properties similar to those of cardiac tissue. Inspired by our previous work on a three-dimensional (3D) structure designed to replicate ventricular twist (1), we used a multilayer design to simulate the two outer layers of the myocardial fibers of the heart

The movement conforms much more to the actual way a real heart moves which could make it more functionally effective at pumping.

This may also have implications in improving the likelihood of functional recovery within the damaged heart too.


2) Pneumatic Artificial Muscles (PAM) and Custom Fit

In keeping with replicating the heart more closely the device uses something called PAMs (pneumatic artificial muscles) to pump:

we exploited fabrication techniques that allowed the integration of custom-designed soft pneumatic artificial muscles (PAMs) into a soft matrix that approximated and conformed to the outer surface of the heart. The PAMs’ self-limiting load-length curves (27–29) provide a physiological, atraumatic strategy to assist and increase native cardiac muscle function.

They used tomography (an imaging technique) to customise the shape to the actual individual heart itself. Further a special type of gel was used to interface between the sleeve and the heart.

This both improves the function and reduces the likelihood of the actual heart being damaged.


3) Functionality Can Also Be Tailored to the Individual and Over Time

Each case of heart failure differs in the exact type of functional deficiency and the type of assistance desired.

Further there may be alterations to the needs over time.

This particular device allows regular adjustment and tailoring of the movement and type of assistance without having to reopen the chest.

4) No Blood Contact = No Anticoagulants Required

A further massive advantage is that it wraps around the outside of the heart and does not interact with blood.

This is a massive problem with current devices.

Coming into contact with blood confers a significant clotting risk.

Patients with existing devices need to be on anticoagulant medication with the associated risks of bleeding.


Results


Overall the sleeve seemed to work very well both from a simulated laboratory standpoint and also when used in pigs.

I think the results of the testing in pigs is most important here:

For the first part of the pig experiment, the pig's hearts were stopped using medication - in a sense the most extreme result of heart failure - this was done to isolate the effects of the device:

The device was used to temporarily reestablish cardiac output after drug-induced cardiac arrest. Data were collected for at least 15 min for baseline, asystole, and ventricular assist conditions. Ten representative cycles of aortic flow from each condition were converted to cardiac output per cycle and averaged.

Two slightly different designs were tested and gave the following results:

Design 1 could achieve ~48% restoration of cardiac output when actuated at its maximum operating pressure of 10 psi at 80 beats per minute (bpm) for a period of 200 ms per cycle.

Design 2 could achieve ~88% restoration of cardiac output when actuated at its maximum operating pressure of 21 psi at 80 bpm for a period of 200 ms per cycle.

Further testing was done in six pigs with partial drug induced heart failure:

The cardiac output was reduced to ~45% of baseline when acute heart failure was induced but recovered to ~97% of baseline when active assist was initiated, constituting an augmentation of 113%.

This shows that the device seems to be even more effective in a more realistic situation.

Encouragingly, histology (the microscopic study of cells) of the heart tissue did not indicate any damage or inflammation due to the device itself.

The gel was also tested separately in rats to assess it's safety and seemed to result in a reduced inflammatory response compared to a neutral control substance - the findings were not statistically significant though.

(N.B. Not statistically significant means that the results were not strong enough for us to be sure they didn't arise purely by chance. So further research would be required.)


Problems


This is an early "feasibility" study so one would not expect it to be perfect:
  1. Sample sizes were small. 2-6 pigs were used. 2 rats were used for another part of the study to assess the safety of the gel.
  2. Testing was over relatively short periods and more long term data for effectiveness as well as any complications or damage induced by the device need further research.
  3. The long term immunological effects/biocompatibility of the material used are unknown.
  4. Long term adhesion of the device is still a problem that needs to be resolved. The experimenters used a number of methods for testing which may not be appropriate in real life use.
  5. The device is still quiet bulky and needs further miniaturisation and refinement as the authors state: -

"The current version of the device is a tethered implantable system and uses wall-compressed air supply for actuation. Further development will need to miniaturise the entire system, so it can be implanted in the body or have the pump and system controller be worn around the waist of the patient, similar to other devices."


Conclusion


As I stated earlier this is preliminary research.

The results are very promising but we need to keep this in mind whilst assessing this paper.

If the findings continue to be replicated and the device can be further refined it would give us a useful tool in the fight against heart failure - something which we urgently need.

References


  1. Roche, Ellen T., Markus A. Horvath, Isaac Wamala, Ali Alazmani, Sang-Eun Song, William Whyte, Zurab Machaidze, et al. 2017. “Soft Robotic Sleeve Supports Heart Function.” Science Translational Medicine 9 (373). doi:10.1126/scitranslmed.aaf3925.
  2. Choices, Nhs. 2017. “Heart Failure - NHS Choices,” April. Department of Health. http://www.nhs.uk.



Thank you for reading



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Again, an excellent presentation @thecryptofiend! I was aware of soft tissue research but to see it pushed to the levels of robotics, especially in that context is a scientific treat. Thank you for sharing this new comer in technology and, I'm sure, a great hope for many. All for one and one for all! Namaste :)

You're welcome. Glad you liked it:)

Great post, I was reading about this yesterday it's pretty exciting. Our slow progression to man combined with machine begins! Joking aside this has the potential to improve and extend the lives of heart failure patients and seems great!

Yes for sure. I'm sure they will be able to shrink it down enough to make it viable beyond a hospital only setting.

I think I saw something about this yesterday, its amazing. :)

Cool. Heart failure is a huge problem and anything that can help is very useful. This might help to keep people alive long enough for new treatments or to get a donor heart.

I agree, the least it does is give people hope :)

Yes for sure. Eventually I think growing a new heart using a person's own stem cells will supersede things like this.

I think thats the way its heading :)

That is cool..will wait for our yearly HF symposium about it. For now, LVAD is more beneficial than transplant.

OK. It is a while since I have done any cardiology so I'm not in the loop about current practice guidelines.

LVADS are getting smaller and rarely used now as a bridge to transplant. It answers the lack of donors minus rejections. Also, lots of patients are back to their usual lifestyles with it.

Cool. I have also heard that they can in some cases allow the actual cardiac tissue to recover functionality.

If the heart muscles can still recover yes probably.Is that in UK?they're quiet strict with their criteria.

Yes UK. Yes they are!

Because he/she seems to think I stole their post. Pathetic.

How would you feel if your science scoop gets hijacked by someone with a higher rep who immediately gets more reward. Did you see my scoop or did you find it elsewhere? Pfff

I posted this 18 hours ago under different tags https://steemit.com/technology/@mithrilweed/we-live-in-an-age-of-wonder.... I did not go into such a thourough breakdown as @cryptofiend has done... A very well written post I might add. I've read both posts @technodanta and unfortunately both are similar in nature but delivered quite differently. I don't think you would feel it fair if I implied that you "scooped" me.

Not obvious from yr title. If this is the way in steemit, so be it. Would have preferred a kind of code of conduct. In this case you were the first to post it, so at least that should have been acknowledged. Didn't see that sorry. In scientific journals such a code does exist.

Unfortunately we all have great ideas to write about on steemit and some will be the same for sure. I like to think of it as all 3 of us had the same idea... Technically I was the first (but both of you made more $) than I did. That idea flourished and both you @technovedanta and @cryptofiend fared better than I. All 3 articles made steemit better for the simple reason... we all tried.

It doesn't make sense what you are saying, there is a code of conduct; But a requirement to ,find, read and credit every single similar topic is not in the code and would be ridiculous anyway! Just like you didn't have the time to find & read @mithrilweed, @cryptofiend didn't have time to find and read yours.

Next time just post a comment saying that you wrote something on the same topic with a smiley face, like this :)

I apologize. I have thought it over and indeed it is not fair to claim intellectual property of something that isn't mine.

That's OK we all get things wrong some times. I do it at least 100 times a day!

Thanks @mithrilweed - exactly my point. It has happened to me too where someone else has posted on the same issue or news - that is to be expected when there are lots of people with similar interests. I don't complain about it - it's just life. It would be like the BBC complaining that Sky News were stealing their stories because they covered the same news. That is why I always try to give my own analysis of things.

I apologize. I have thought it over and indeed it is not fair to claim intellectual property of something that isn't mine.

I didn't hijack your scoop. Further it is not your scoop - you got it from the BBC.

I saw it (the paper) myself and made my own post using the actual paper with my own analysis. The fact that you would even suggest that shows that you have not even read my post.

Listen, I didn't flag you. I got it indeed from the BBC. But I think it's not a good practice if we post on the same science novelties on the same day. I see you added some more information, but you could at least have acknowledged that this topic had already been posted on steemit and that you wanted to give some more detail. It doesn't feel friendly this way.

Listen, I didn't flag you.

You have no reason to flag me.

But I think it's not a good practice if we post on the same science novelties on the same day.

I don't have the time to ensure that I check every post before I make my own. It is illogical to assume that in the hours that I spent doing my own analysis of the paper someone would not post a short link and a paragraph.

That is why I do my own perspective and interpretation. You don't own the news or the paper any more than the BBC do.

I see you added some more information

Added some information? I spent hours doing my own reading and analysis of the actual paper. If you think that is the same as posting a paragraph and a picture taken from a BBC article you don't know what you are talking about.

but you could at least have acknowledged that this topic had already been posted on steemit and that you wanted to give some more detail

The irony of this is that you simply took some information from a BBC article and are somehow implying that I stole your idea. I could have done the same in 5 minutes but instead I chose to do a more detailed analysis.

It doesn't feel friendly this way.

What doesn't feel friendly is coming on my blog and belittling my personal effort which is what you are doing.

I spent a long time reading the actual ORIGINAL source and translating it into a more readable form for regular non medical readers.

If you don't see the value of that then it is YOUR problem NOT mine.

wow excellent and I really hope that this research continues and gets even better!

Thanks yes for sure:)

I was thinking about posting about this someday. You should give me half the payout! ;P

Upvote for content.
100% for the puppy!

Nice post, on an interesting subject. Technology always seems to progress in unexpected ways.
.



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Thanks. Yes for sure:)

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