Structural intervention cardiology (SIC) interventions are crucial procedures for correcting heart valves, walls, and muscle form defects. However, the possibility of embolization or perforation, as well as the lack of transparent vision and autonomous surgical equipment, make it difficult for the clinician. This paper proposes a robot-assisted tendon-driven catheter and machine learning-based path planner to overcome these challenges. Firstly, an analytical inverse kinematic model is constructed to convert the tip location in the Cartesian space to the tendons' displacement. Then inverse reinforcement learning algorithm is employed to calculate the optimal path to avoid possible collisions between the catheter tip and the atrial wall. Moreover, a closed-loop feedback controller is adopted to improve positioning accuracy in a direct distal position measurement manner. Simulation and experiments are designed and conducted to demonstrate the feasibility and performance of the proposed system.

OBJECTIVES Commissural orientation <160° is a recognized risk factor for bicuspid aortic valve repair failure. Based on this observation, repairing this subtype of aortic valve by reorienting the 2 commissures at 180° has recently been proposed. METHODS Nine porcine hearts with aortic annulus diameters of 25 mm were selected. A pathological model of a Sievers 1 bicuspid aortic valve was obtained by suturing the coaptation line between the left and right leaflets. Each heart underwent reimplantation procedures both in the native (120°) and the reoriented (180°) configuration. After the operation, each sample was tested on a pulse duplicator at rest (heart rate 60 beats per min) and with mild exercise (heart rate 90 beats per min) conditions. RESULTS No statistically significant difference was noted in mean and peak transvalvular aortic gradients between the 2 configurations at rest (18.6 ± 5 vs 17.5 ± 4 for the mean aortic gradient; 42.8 ± 12.7 vs 36.3 ± 5.8 for the peak aortic gradient) but the group with the 120°-oriented commissures had significantly higher mean transaortic gradients compared to the group with the 180°-oriented commissures at initial exercise stress conditions (30.1 ± 9.1 vs 24.9 ± 3.8; p value 0.002). CONCLUSIONS The 180° commissural reorientation of the asymmetrical bicuspid aortic valve does not improve the transvalvular aortic gradient in an acute model at rest conditions, but it could do so under stress situations. Even if it is surgically more complex and time-consuming, this approach could be a good strategy to improve long-term results, particularly in young patients.