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By reducing actuator volume and enhancing energy transfer, LIMO enables a more compact and efficient design. We developed a soft ventricle prototype using thin-walled pouch actuators that achieve transmission ratios above one via circumferential shrinkage. A fast, cost-effective prototyping method accelerated testing. Experimental results showed high energy transfer efficiency (82 to 91%), and in vitro tests demonstrated promising cardiac outputs of 5.9\u00a0liters per minute against aortic pressure and 7.6\u00a0liters per minute against pulmonary pressure. These findings represent a step toward a more broadly applicable biventricular soft robotic TAH for treating end-stage heart failure.<\/jats:p>","DOI":"10.1126\/sciadv.adv4854","type":"journal-article","created":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T13:59:13Z","timestamp":1751464753000},"update-policy":"https:\/\/doi.org\/10.34133\/aaas_crossmark","source":"Crossref","is-referenced-by-count":13,"title":["Toward developing a compact total artificial heart using a soft robotic fluidic transmission system"],"prefix":"10.1126","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4459-5582","authenticated-orcid":true,"given":"Maziar","family":"Arfaee","sequence":"first","affiliation":[{"name":"Cardiothoracic Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands."},{"name":"Department of Cardiothoracic Surgery, Thorax Center, Erasmus MC, Rotterdam, Netherlands."},{"name":"Autonomous Matter Department, AMOLF, Amsterdam, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1366-8969","authenticated-orcid":true,"given":"Lucas C.","family":"van Laake","sequence":"additional","affiliation":[{"name":"Autonomous Matter Department, AMOLF, Amsterdam, Netherlands."},{"name":"Mechanical Engineering Department, Eindhoven University of Technology, Eindhoven, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9154-0058","authenticated-orcid":true,"given":"Shibo","family":"Zou","sequence":"additional","affiliation":[{"name":"Autonomous Matter Department, AMOLF, Amsterdam, Netherlands."},{"name":"Department of BioMechanical Engineering, Delft University of Technology, Delft, Netherlands."},{"name":"School of Mechanical and Aerospace Engineering, Queen\u2019s University Belfast, Belfast, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Bording","sequence":"additional","affiliation":[{"name":"Autonomous Matter Department, AMOLF, Amsterdam, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5942-4727","authenticated-orcid":true,"given":"Jolanda","family":"Kluin","sequence":"additional","affiliation":[{"name":"Cardiothoracic Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands."},{"name":"Department of Cardiothoracic Surgery, Thorax Center, Erasmus MC, Rotterdam, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0253-0147","authenticated-orcid":true,"given":"Johannes T. 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