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Using Robotics to Improve Transcatheter Edge-to-Edge Repair of the Mitral Valve

Léa Pistorius, Namrata U. Nayar, Phillip Tran, Sammy Elmariah, Pierre E. Dupont

TL;DR

Transcatheter edge-to-edge repair (TEER) of the mitral valve presents a steep learning curve due to complex, multi-DOF catheter manipulation. The authors introduce a robotics-based TEER system that replaces manual handles with robotic cartridges and uses joint-space control mapped from a game controller, covering $8$ DOF across three nested catheters within a stepwise control paradigm aligned to standard imaging views. In a silicone phantom, the system significantly reduced motion errors and improved clip placement accuracy compared to manual delivery, while also decreasing overall procedure time in key steps. The results suggest that robotic assistance can lower operator burden and extend robotic navigation strategies to other transcatheter valve procedures, offering a more reliable platform for complex transcatheter interventions.

Abstract

Transcatheter valve repair presents significant challenges due to the mechanical limitations and steep learning curve associated with manual catheter systems. This paper investigates the use of robotics to facilitate transcatheter procedures in the context of mitral valve edge-to-edge repair. The complex handle-based control of a clinical repair device is replaced by intuitive robotic joint-based control via a game controller. Manual versus robotic performance is analyzed by decomposing the overall device delivery task into motion-specific steps and comparing capabilities on a step-by-step basis in a phantom model of the heart and vasculature. Metrics include procedure duration and clip placement accuracy. Results demonstrate that the robotic system can reduce procedural time and motion errors while also improving accuracy of clip placement. These findings suggest that robotic assistance can address key limitations of manual systems, offering a more reliable and user-friendly platform for complex transcatheter procedures.

Using Robotics to Improve Transcatheter Edge-to-Edge Repair of the Mitral Valve

TL;DR

Transcatheter edge-to-edge repair (TEER) of the mitral valve presents a steep learning curve due to complex, multi-DOF catheter manipulation. The authors introduce a robotics-based TEER system that replaces manual handles with robotic cartridges and uses joint-space control mapped from a game controller, covering DOF across three nested catheters within a stepwise control paradigm aligned to standard imaging views. In a silicone phantom, the system significantly reduced motion errors and improved clip placement accuracy compared to manual delivery, while also decreasing overall procedure time in key steps. The results suggest that robotic assistance can lower operator burden and extend robotic navigation strategies to other transcatheter valve procedures, offering a more reliable platform for complex transcatheter interventions.

Abstract

Transcatheter valve repair presents significant challenges due to the mechanical limitations and steep learning curve associated with manual catheter systems. This paper investigates the use of robotics to facilitate transcatheter procedures in the context of mitral valve edge-to-edge repair. The complex handle-based control of a clinical repair device is replaced by intuitive robotic joint-based control via a game controller. Manual versus robotic performance is analyzed by decomposing the overall device delivery task into motion-specific steps and comparing capabilities on a step-by-step basis in a phantom model of the heart and vasculature. Metrics include procedure duration and clip placement accuracy. Results demonstrate that the robotic system can reduce procedural time and motion errors while also improving accuracy of clip placement. These findings suggest that robotic assistance can address key limitations of manual systems, offering a more reliable and user-friendly platform for complex transcatheter procedures.

Paper Structure

This paper contains 11 sections, 9 figures, 1 table.

Table of Contents

  1. Introduction
  2. Stepwise Decomposition of TEER
  3. Robotic TEER System
  4. Conversion of Manual Handles to Robotic Cartridges
  5. Catheter Control
  6. Experiments
  7. Comparison of Motion Problems Identified in Table I
  8. Comparison of Manual and Robotic Clip Delivery
  9. Procedure time
  10. Clip Placement Accuracy
  11. Conclusion

Figures (9)

  • Figure 1: TEER system for correcting mitral valve regurgitation. (a) Delivery steps. (b) Sheath control handles mounted in stabilizer. Adapted from MitraClip.
  • Figure 2: Conversion to robotic system. (a) Manual handles of TEER system. (b) Robotic cartridges. (c) Cartridges mounted in drive system.
  • Figure 3: Catheter control. (a) Manual handle system, (b) Game controller, (c) Sheath motions from 3D en-face view of mitral valve.
  • Figure 4: Experimental TEER system. (a) Manual system. (b) Robotic system.
  • Figure 5: Mitral valve phantom model and camera views. (a) Phantom heart model. (b) En face camera view of mitral valve from left atrium. (c) En face camera view of mitral valve from left ventricle.
  • ...and 4 more figures