Catheter-integrated soft multilayer electronic arrays for multiplexed sensing and actuation during cardiac surgery

Abstract

The rigidity and relatively primitive modes of operation of catheters equipped with sensing or actuation elements impede their conformal contact with soft-tissue surfaces, limit the scope of their uses, lengthen surgical times and increase the need for advanced surgical skills. Here, we report materials, device designs and fabrication approaches for integrating advanced electronic functionality with catheters for minimally invasive forms of cardiac surgery. By using multiphysics modelling, plastic heart models and Langendorff animal and human hearts, we show that soft electronic arrays in multilayer configurations on endocardial balloon catheters can establish conformal contact with curved tissue surfaces, support high-density spatiotemporal mapping of temperature, pressure and electrophysiological parameters and allow for programmable electrical stimulation, radiofrequency ablation and irreversible electroporation. Integrating multimodal and multiplexing capabilities into minimally invasive surgical instruments may improve surgical performance and patient outcomes.Minimally invasive surgeries involve the insertion of advanced diagnostic and therapeutic tools through small percutaneous incisions for treatment of cardiovascular diseases, cancers and other health conditions, with fast recovery times and low risks compared with those of conventional procedures 1,2 . Catheters represent one of the most compelling devices for such purposes due to their capabilities in deploying medical devices (for example, intravascular stents or heart-valve prostheses), capturing information during surgical procedures (for example, force, temperature or electrograms) and/or delivering forces, electromagnetic energy, thermal stimuli and/or biomaterials (for example, drugs, cells or nanoparticles) to targeted sites on or within soft tissues 3,4 . Although these catheter-based approaches have widespread uses in modern medicine, they suffer from (1) mechanical rigidity or insufficient compliance, leading to non-ideal interfaces with soft tissues and low coupling efficiency 5 , Han et al.

Wearable, Implantable, and Interventional Medical Devices Based on Smart Electronic Skins

“…For these sensors, we describe in detail their applications in the medical field (such as wearable, Implantable, and Interventional medical devices) ( Figure ). [ 111–114 ]…”

“…Interventional medical devices image (Scale bars: 2 mm): Reproduced with permission. [ 114 ] Copyright 2020, Springer Nature Limited.…”

“…Reproduced with permission. [ 114 ] Copyright 2020, Springer Nature Limited. f) Optical image of a sensor web without substrate attached on the surface of tissue and optical image of a sensor with the silk substrate.…”

“…[ 158 ] Recently, Rogers and his group reported on materials, device design and manufacturing methods that combine advanced electronic functions with catheters for minimally invasive forms of heart surgery (Figure 12d). [ 114 ] The integration of this system with commercial and/or custom catheters results in complex systems with multimodal sensing and actuation capabilities, high‐density and conformality. In vitro experiments, as well as computational studies and evaluations on human hearts and rabbits, have demonstrated that these systems are superior to traditional heart devices in shape factor, function and programmability.…”

Scalable Microfabrication of Folded Parylene‐Based Conductors for Stretchable Electronics

“…[ 10 ] Those concepts are often based on serpentine‐shaped conductors [ 11 ] that connect rigid islands that host complex electronic devices or chips. [ 12,13 ] While this approach allows a high degree of miniaturization through microfabrication, serpentine‐shaped interconnects usually consume the majority of the device area, hampering efficient use of available space. Mesh‐type electronics based on Kirigami‐structures suffer from similar problems yet excel with high stretchability and simple fabrication processes.…”