Accurate positioning for intervention on the beating heart using a crawling robot

Abstract

Heart failure resulting from myocardial infarct, oxygen-deprived tissue death, is a serious disease that affects over 20 million patients in the world. The precise injection of tissue-engineered materials into the infarct site is emerging as a treatment strategy to improve cardiac function for patients with heart failure. We have developed a novel miniature robotic device (HeartLander) that can act as a manipulator for precise and stable interaction with the epicardial surface of the beating heart by mounting directly to the organ. The robot can be delivered to and operate within the intrapericardial space with the chest closed, through a single small incision below the sternum. The tethered crawling device uses vacuum pressure to maintain prehension of the epicardium, and a drive wire transmission motors for actuation. An onboard electromagnetic tracking sensor enables the display of the robot location on the heart surface to the surgeon, and closed-loop control of the robot positioning to targets. In a closed-chest animal study with the pericardium intact, HeartLander demonstrated the ability to acquire a pattern of targets located on the posterior surface of the beating heart within an average of 1.7 ± 1.0 mm. Dye injections were performed following the target acquisitions to simulate injection therapy for heart failure. HeartLander may prove useful in the delivery of intrapericardial treatments, like myocardial injection therapy, in a precise and stable manner, which could be performed on an outpatient basis.