Robotic catheter paves the way for combo valve procedures

A novel robotic catheter could simplify valve procedures while allowing cardiac surgeons to complete multiple interventions within the same time frame, according to research presented at TVT 2019 in Chicago.

The implantation of transcatheter heart valves (THVs) has become canon in the world of valvular heart disease, presenter Gagan D. Singh, MD, MS, of UC Davis Health in Sacramento, Calif., said at the conference, but increasingly, today’s solutions are falling short. The bulk of current THV therapies involve manual manipulation, are relatively imprecise and carry a fairly steep learning curve, especially for physicians newer to the process.

“There’s this rapid innovation and evolution in both valve- and non-valve-based technologies,” Singh said. “Now, that being said, if you look overall at the catheters that are used for delivering these therapies, they’ve remained static for the last 20 years.”

Singh and his team are attempting to change that paradigm with what they call the “Project Moray Solution”—a robotic catheter system that allows physicians more freedom in the operating room. Singh et al. developed the catheter itself by assembling linear multi-lumen balloon arrays and stacking like segments on top of one another, permitting the kind of meticulous movement current systems aren’t capable of. It’s compact and self-contained, with a reusable drive system and the ability for wireless communication.

The catheter is controlled by the Coral brick, a self-contained fluidic drive that’s free of gantries, pull wires, magnets or motors. Singh said he and his colleagues toyed around with a number of interface options for the project—from a simple joystick to a more complex Playstation controller—but opted for the Coral’s quick-disconnect interface and integrated processor. The brick is powered by a battery and a gas canister that shuttles gas similarly to cryoablation, but at 1/100th of the dose.

Singh said there have been some in vivo investigations using the Project Moray technology, and to date his team has been able to demonstrate reliable catheter movement for tricuspid valve maneuvering with both medial to lateral annulus.

“In terms of where the future is for this technology, I think targeting valve-based therapies is going to be important for this catheter,” he said. “But I think probably one of the biggest things that I see for this therapy is combo therapies. A surgeon goes in and does a mitral valve repair/replacement, tricuspid valve annuloplasty, left atrial appendage closure all at the same time. If we can get over the reimbursement hurdles, that’s something that’s potential with this technology.”

In addition to combined procedures, the physician said a lot of non-valve-based therapies are sure to benefit from the technology, as well.

“It’s still very early,” Singh said. “I think it shows promise and I think we have a long way to go here, as well.”