Zain Moin

Background:  Heart failure (HF) remains a major global health challenge, marked by high mortality, hospitalizations, and limited treatment options¹. While pharmacologic therapies and mechanical devices like ventricular assist devices (VADs) provide some benefit, they are often invasive, high-risk, and are not well-suited to the heart’s dynamic function^1–3. Soft robotics—using flexible, tissue-like actuators—offers a promising, less invasive alternative for mechanical cardiac support⁴. Recent research has demonstrated their potential to improve heart function through external compression or ventricular assistance. However, comprehensive comparisons with VADs and a unified understanding of the diverse clinical applications of soft robotics are still lacking. This work aims to (i) categorize the key applications of soft robotic systems in HF care and (ii) evaluate their effectiveness relative to traditional VADs.

Methods:  Initial literature review consisted of PubMed searches of terms including “soft robotics,” “soft robotics for cardiac interventions”, “heart failure robotic augmentation”, and “soft robotics in interventional cardiology.”

Results:  Soft robotic tools show strong promise in HF care, with advancements in mechanical augmentation, disease modeling, intervention guidance, and targeted therapy. For example, the silicone-nylon construct by Phan et al. achieved radial, axial, and torsional heart motion with a cardiac output of 1.05 L/min². Since this is below the 4–8 L/min needed to sustain life, it suggests the device can support but not fully replace ventricular function^1,2. The Harvard–Boston Children’s pneumatic sleeve offered direct compressive support, maintaining heart rates of 73–84 bpm with high cardiac output in porcine models, supporting this conclusion⁴. Additionally, multifunctional systems by Rogatinsky et al. demonstrate applications in catheter steering and cardiac pathology modeling for training³. Their device, built from semirigid spring steel and flexible polyimide film, showed success in ICD lead implantation in porcine models^3,5. These examples highlight how soft robotics may offer a less invasive, physiologically supportive alternative to VADs by preserving native cardiac function and lowering infection and thrombosis risks⁵. However, they remain best suited for milder HF, as material cardiotoxicity and poor synchronization may raise the risk of arrhythmia-related injury².

Conclusions:  Emerging research highlights the potential of soft robotics as an adjunct to standard HF treatment. These devices offer mechanical support and conform closely to the heart, improving patient outcomes and recovery. Their compressibility enables use in minimally invasive, catheter-based procedures, reducing reliance on high-risk surgeries and medications. Future research efforts should focus on exploring how soft robotics respond to physiological signals and methods for improving their synchronization with cardiac muscle.

Works Cited

1. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Vol 145.; 2022. doi:10.1161/CIR.0000000000001063
2. Phan PT, Davies J, Hoang TT, et al. Robotic Cardiac Compression Device Using Artificial Muscle Filaments for the Treatment of Heart Failure. Adv Intell Syst. 2024;6(3). doi:10.1002/aisy.202300464
3. Rogatinsky J, Recco D, Feichtmeier J, et al. A multifunctional soft robot for cardiac interventions. Sci Adv. 2023;9(43). doi:10.1126/SCIADV.ADI5559
4. Payne CJ, Wamala I, Abah C, et al. An Implantable Extracardiac Soft Robotic Device for the Failing Heart: Mechanical Coupling and Synchronization. Soft Robot. 2017;4(3):241-250. doi:10.1089/soro.2016.0076
5. Rosalia L, Ozturk C, Goswami D, et al. Soft robotic patient-specific hydrodynamic model of aortic stenosis and ventricular remodeling. Sci Robot. 2023;8(75). doi:10.1126/SCIROBOTICS.ADE2184