The future of heart surgery is in something called a “snake robot,” at least according to the people at Newport, RI-based Cardiorobotics. We decided to check it out in more depth since Cardiorobotics just raised $11.6 million this week to see if it can demonstrate this is truly the next frontier in minimally invasive ways of fixing irregular heartbeats.
Cardiorobotics, a spinout from Carnegie Mellon University and the University of Pittsburgh, got its start in the nearby Pittsburgh Life Sciences Green House in 2005. The company now splits its operations between the Steel City and Newport. I got the update from the company’s president and CEO, Samuel Straface.
Like many medical device companies, Cardiorobotics has its sights on replacing a standard surgical procedure with something a lot less invasive. The company’s initial goal is to help patients avoid open-heart surgery for irregular heartbeats (arrhythmias), particularly atrial fibrillation. Instead of cracking open the chest with a breastplate incision, and forcing patients to shoulder the risk of going on a heart-lung machine, Cardiorobotics envisions doing a single tiny incision in the chest, that has an opportunity to improve patient recovery and reduce the risk of complications from surgery. Atrial fibrillation is the most frequently diagnosed type of arrhythmia, and affects an estimated 2.3 million people in the U.S.
Cardiorobotics is planning on starting clinical trials of its device in Europe by the end of the year, and if everything goes right, the technology could win its first regulatory approval for the market in two years, Straface says. Both cardiac surgeons and cardiologists, he predicts, are going to be quick to adopt this technology.
“The snake robot is plug-and-play,” Straface said, adding that getting certified to use the robot will not be too difficult or expensive. “If you’ve played on video games, it’s not too different,” he said.
How is it supposed to really work? Straface helped walk through this idea step by step. The snake, officially called the Articulated Robotic MedProbe (ARM), is inserted through a small hole under the breastbone, and then carefully curves around the tight, finely structured muscle of the heart. The snake has a camera with its eyes focused on the heart tissue responsible for the arrhythmia. And with a delicate, finely timed movement, the snake cuts small lesions into each of the upper heart chambers, or atria, using a narrowly focused microwave laser or other energy emitter to kill those cells that were keeping the heart from functioning normally. Its work complete, the snake then eases itself back through the chest, adjusting itself again to avoid harming the tissues it moved through before. When the procedure is done, the snake robot gets thrown away.
Cardiorobotics set up its headquarters in Newport in 2007, and Straface took over as president and CEO this year after he previously served as an Executive-in-Residence at the Pittsburgh Life Sciences Greenhouse.
Other companies have similar robotic devices for heart surgery, notably Sunnyvale, CA-based Intuitive Surgical (NASDAQ: ISRG), a company Straface calls “the mother of all robotic companies” for surgery. What makes the robots developed by Cardiorobotics different from Intuitive and others is that its snake robot has a multi-link design allowing it to maneuver in any direction and angle, Straface says. It is also self-supporting and doesn’t need to rest its weight on a surface in the body while it moves.
“It has an incredible degree of freedom of movement,” Straface says. Other robotic probes of its type can go only in a straight line, requiring surgeons to use several probes. The Cardiorobotics approach, which uses “serpentine robotics,” should be less invasive because it only needs one incision, Straface said.
Treating atrial fibrillation and other kinds of heart arrhythmia is done either by a cardiologist or a cardiac surgeon depending on the procedure, Straface says. The treatments are based around creating scar tissue that block unhealthy electric impulses—the cause of many irregular heartbeats. But the best success rate comes from using surgery to access the heart and apply the energy needed to make the lesions. Working outside the heart “has been demonstrated by cardiac surgeons to be highly effective, and the current gold standard in treatment, especially for patients with more chronic disease,” Straface said. The current cure rate is about 90 percent.
But, as mentioned above, this treatment requires opening the breastbone to get at the heart and comes with all the concerns associated with open-heart surgery. For that reason, the surgery is usually only done in conjunction with other necessary heart surgery rather than as a stand-alone procedure. For those atrial fibrillation sufferers who have an early, non-persistent version of the disease (about 22 percent), treatment usually comes from cardiac electrophysiologists, who try to create the necessary scar tissue, but that technique has a lower rate of success than the surgical approach, especially long-term, Straface says.
Using the snake robots from Cardiorobotics would ideally allow the more successful type of treatment to be done without having to crack open a patient’s chest or involve the heart-lung machine to keep the patient alive during surgery, he says.
Each disposable snake robot, which will come in different sizes, will be connected wirelessly to a feeder box that is plugged into a console that either a cardiac surgeon or cardiologist will use to look through the camera eyes of the snake as they guide it through the body and perform the procedure. Although he would not reveal the cost of manufacturing the device or its price, Straface did say the product will be market competitive. Cardiorobotics may lease some of the hardware to hospitals and sell the disposable robots, Straface says. The total potential market is between one and two million people a year just in the United States, Straface says, so there is a lot of potential for profit, he says. “We’re already in development on the commercial product,” he says.
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