The heart disease structural will affect 20 million people over 65 in the European Union between now and 2040, of which 2.5 million in Italy
. Aortic stenosis, mitral and tricuspid regurgitation are some examples of this type of disease, which mainly affect with advancing age and which could soon become a social emergency. Currently they concern about 12.5% of Italians. Among the research projects that deal with structural heart disease there is also ARTERY (Autonomous Robotics for Transcatheter dEliveRy sYstems), an H2020 officially launched last January which includes among others the Politecnico di Milano (lead partner), with the collaboration of the Politecnico di Milano Foundation and the IRCCSSan Raffaele Hospital
. The research project is funded by the European Commission under the Horizon 2020 program of innovation and enhancement of robotics applications.
A revolutionary ‘robot’
The focus of the project is on the non-invasive treatment of heart valve diseases and ARTERY’s goal is to create a revolutionary robotic platform that exploits artificial intelligence and augmented reality to develop new guidance and monitoring systems and systems capable of training and support operators by making interventions safer and more effective for the patient and eliminating the use of X-rays.
Let’s imagine a parallel between the surgeon and the pilot. In the aeronautical field, simulators have been used for a very long time to improve the flight experience, especially in critical situations. Implementing virtual reality solutions in the field of cardiovascular operations, as in the case of ARTERY, in which the operator in training seems to be in a real intervention and therefore also experiences stressful situations, means radically improving the approach of the interventions. Adding augmented reality to this also means integrating information on wearable systems. In this way the doctor will no longer learn about the patient but about the simulator without risk and with almost total safety.
How do you operate today?
Today these pathologies require surgery or with a traditional approach, that is, with an open heart, or percutaneous. In this second case, the diseased structures are repaired or replaced by implanting one or more devices in the heart through a catheter, which reaches the heart itself by advancing into the blood vessels after being inserted from a small peripheral access. Percutaneous intervention is therefore much less invasive than the classic one. However, percutaneous interventions are technically complex to learn and perform and require the use of fluoroscopy, a method that requires the use of X-rays, to indirectly view the catheter’s advancement in the vessels and its movements in the heart. Radiation is a cause of risk for the patient and, above all, for the operators present in the room.
How will you work with ARTERY?
A robotic platform will be created in the ARTERY project that will simplify percutaneous procedures and eliminate the use of intra-operative X-rays. The surgeon will be able to interface with the robotic system through augmented reality, select the target point that the catheter must reach and view the model of the catheter and the patient’s vascular tree. The system will be semi-autonomous and the decisions, guided by artificial intelligence, will always be shared and agreed with the human operator. In practice, an immersive and intuitive system will be created in which the responsibility and supervision will be of the operator while the cardiovascular procedure will be performed by a robot, which will be supported by control systems, automatic pilots that can perform repetitive tasks by replacing the operator who remains responsible for the intervention.
Emiliano Votta, Associate Professor at Politecnico di Milano states: “The Artery project will introduce two major innovations that will have an important impact on cardiac operations: the remote control of robots through artificial intelligence and augmented reality, and therefore the possibility of managing complex operations in a intuitive and potentially remote, and the use of sensorized catheters, which will allow more control and precision in the movements of the catheter inside the patient’s body. These innovations will make percutaneous heart interventions easier to learn and perform, and safer for patients and practitioners. “
Says Francesco Maisano, director of the Heart Valve Center of the IRCCS San Raffaele Hospital: «Simulation represents an essential step for the application of new technologies in clinical practice. Thanks to simulators, artificial intelligence and augmented reality you will work with higher safety standards and with better results. Also on the training side, thanks to the simulator, we will give back to trainees the opportunity to try without fear of making a mistake and without danger for patients ».
To achieve this ambitious goal, the Politecnico di Milano combines its skills with those of the IRCCS San Raffaele Hospital, which provides clinical guidance in the development, of the Scuola Superiore Sant’Anna of Pisa, which deals with the sensing of the system, the Catholic University of Leuven, which deals with the robotic implementation of catheters and three companies that will contribute to the translatability of the research: FBGS, expert in fiber optic sensors, Artiness, expert in augmented reality applied to the medical world, and Swissvortex, expert in transcatheter technologies.