{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T15:31:31Z","timestamp":1762183891353,"version":"build-2065373602"},"reference-count":42,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004440","name":"Wellcome\/EPSRC Centre for Medical Engineering","doi-asserted-by":"publisher","award":["WT203148\/Z\/16\/Z"],"award-info":[{"award-number":["WT203148\/Z\/16\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"name":"the British Heart Foundation (BHF) Centre of Excellence"},{"name":"the Department of Health and Social Care"},{"name":"the China Scholarship Council","award":["202208440109"],"award-info":[{"award-number":["202208440109"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Robotics"],"abstract":"<jats:p>Structural heart interventions require precise navigation through tortuous and dynamic cardiac anatomies. However, current guide sheaths often lack sufficient maneuverability for positioning additional catheters. To address these limitations, this paper presents the design and evaluation of a robotic guide sheath with a dual-bendable, compressible tip. The sheath is capable of navigating complex cardiac anatomies for multiple valve interventions. The system consists of a soft continuum sheath tip driven by tendons, a laser-cut compact motorized actuation bed, and a joystick-controlled tendon actuation mechanism. A constant-curvature kinematic model maps actuation inputs to tip bending in 3D, while a custom software interface enables real-time control. Mechanical evaluation (tension, maximum bending, and contraction tests) demonstrated low actuation tension requirements (0.78 N), a wide bending range (from 80\u00b0 to 90\u00b0), and promising tip compressibility (average 5 mm). Trajectory-following tests showed good accuracy, with an average error of 3.34 mm. Catheter guidance trials further validated the sheath\u2019s ability to navigate to the right atrium and guide additional catheters effectively. This work presents a proof-of-concept robotic guide sheath with enhanced maneuverability and adaptability, establishing a foundation for future integration of sensing, automation, and clinical applications.<\/jats:p>","DOI":"10.3390\/robotics14110162","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T13:47:58Z","timestamp":1762177678000},"page":"162","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Design and Evaluation of a Dual-Bendable, Compressible Robotic Guide Sheath for Heart Valve Interventions"],"prefix":"10.3390","volume":"14","author":[{"given":"Matteo","family":"Arena","sequence":"first","affiliation":[{"name":"Department of Surgical & Interventional Engineering, School of Biomedical Engineering & Imaging Sciences, King\u2019s College London, London SE1 7EH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0643-1496","authenticated-orcid":false,"given":"Weizhao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Surgical & Interventional Engineering, School of Biomedical Engineering & Imaging Sciences, King\u2019s College London, London SE1 7EH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2288-700X","authenticated-orcid":false,"given":"Carlo","family":"Saija","sequence":"additional","affiliation":[{"name":"Department of Surgical & Interventional Engineering, School of Biomedical Engineering & Imaging Sciences, King\u2019s College London, London SE1 7EH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9611-6514","authenticated-orcid":false,"given":"Zhouyang","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Surgical & Interventional Engineering, School of Biomedical Engineering & Imaging Sciences, King\u2019s College London, London SE1 7EH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1594-1594","authenticated-orcid":false,"given":"Aya Mutaz","family":"Zeidan","sequence":"additional","affiliation":[{"name":"Department of Surgical & Interventional Engineering, School of Biomedical Engineering & Imaging Sciences, King\u2019s College London, London SE1 7EH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8798-407X","authenticated-orcid":false,"given":"Yixuan","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Surgical & Interventional Engineering, School of Biomedical Engineering & Imaging Sciences, King\u2019s College London, London SE1 7EH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1673-5728","authenticated-orcid":false,"given":"Richard James","family":"Housden","sequence":"additional","affiliation":[{"name":"Department of Surgical & Interventional Engineering, School of Biomedical Engineering & Imaging Sciences, King\u2019s College London, London SE1 7EH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4707-7318","authenticated-orcid":false,"given":"Kawal","family":"Rhode","sequence":"additional","affiliation":[{"name":"Department of Surgical & Interventional Engineering, School of Biomedical Engineering & Imaging Sciences, King\u2019s College London, London SE1 7EH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.1016\/S0140-6736(23)02755-1","article-title":"Valvular heart disease: From mechanisms to management","volume":"403","author":"Praz","year":"2024","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1146\/annurev-med-042921-122533","article-title":"Valvular heart disease: New concepts in pathophysiology and therapeutic approaches","volume":"74","author":"Eleid","year":"2023","journal-title":"Annu. Rev. Med."},{"key":"ref_3","first-page":"1070","article-title":"Aortic valve disease, transcatheter aortic valve replacement, and the heart failure patient: A state-of-the-art review","volume":"11","author":"Okumus","year":"2023","journal-title":"Heart Fail."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Castro, M.d.L., Alves, M., Papoila, A.L., Botelho, A., and Fragata, J. (2023). One-year survival after cardiac surgery in frail older people\u2014Social support matters: A prospective cohort study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12144702"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2480","DOI":"10.1001\/jama.2021.2133","article-title":"Transcatheter treatment of valvular heart disease: A review","volume":"325","author":"Davidson","year":"2021","journal-title":"J. Am. Med. Assoc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1093\/eurheartj\/ehy668","article-title":"Transcatheter heart valve interventions: Where are we? Where are we going?","volume":"40","author":"Prendergast","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.4244\/EIJ-D-22-00070","article-title":"Transcatheter interventions for heart failure","volume":"18","author":"Latib","year":"2023","journal-title":"EuroIntervention"},{"key":"ref_8","first-page":"100454","article-title":"Use of steerable guide catheter to improve intracardiac ultrasound in transcatheter tricuspid valve edge-to-edge repair","volume":"1","author":"Gleason","year":"2022","journal-title":"J. Soc. Cardiovasc. Angiogr. Interv."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e002030","DOI":"10.1136\/openhrt-2022-002030","article-title":"Transcatheter tricuspid valve intervention techniques and procedural steps for the treatment of tricuspid regurgitation: A review of the literature","volume":"9","author":"Matli","year":"2022","journal-title":"Open Heart"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"96","DOI":"10.21037\/acs-2019-mv-169","article-title":"Mitral valve-in-valve and valve-in-ring: Tips, tricks, and outcomes","volume":"10","author":"Pirelli","year":"2021","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.jacc.2024.10.071","article-title":"Transcatheter tricuspid valve replacement","volume":"85","author":"Hausleiter","year":"2025","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1177\/0954411919877709","article-title":"Catheter steering in interventional cardiology: Mechanical analysis and novel solution","volume":"233","author":"Ali","year":"2019","journal-title":"Proc. Inst. Mech. Eng. Part H J. Eng. Med."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Qiu, M.Y., Chandrasekaran, V., Hartquist, C.M., Lowe, H.R., Suskin, C.B., Lee, S., Becerra-Garcia, J., Lee, J.V., Rucker, D.B., and Connor, M.R. (2025). Dynamic Rigidity Control for Supportive Sheaths in Endovascular Procedures. J. Biomech. Eng., 147.","DOI":"10.1115\/1.4068225"},{"key":"ref_14","first-page":"679","article-title":"Steerable catheters in cardiology: Classifying steerability and assessing future challenges","volume":"63","author":"Ali","year":"2016","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"516","DOI":"10.21037\/acs.2017.07.02","article-title":"Transcatheter aortic valve implantation economics: A grisly reality","volume":"6","author":"Manolis","year":"2017","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_16","first-page":"1045","article-title":"Remotely controlled steerable sheath improves result and procedural parameters of atrial fibrillation ablation with magnetic navigation","volume":"17","author":"Errahmouni","year":"2015","journal-title":"EP Eur."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1038\/nrcardio.2014.23","article-title":"Robotic technology in cardiovascular medicine","volume":"11","author":"Bonatti","year":"2014","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2200367","DOI":"10.1002\/aisy.202200367","article-title":"Continuum robots: An overview","volume":"5","author":"Russo","year":"2023","journal-title":"Adv. Intell. Syst."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2123","DOI":"10.1109\/LRA.2018.2809546","article-title":"Design and evaluation of a steerable magnetic sheath for cardiac ablations","volume":"3","author":"Chautems","year":"2018","journal-title":"IEEE Robot. Autom. Lett."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s44182-024-00017-w","article-title":"Development of a single port dual arm robotically steerable endoscope for neurosurgical applications","volume":"3","author":"Qi","year":"2025","journal-title":"npj Robot."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2816","DOI":"10.1109\/TBME.2025.3553014","article-title":"Development and Evaluation of a Robotic System for Safe Cardiac Sheath Delivery","volume":"72","author":"Wang","year":"2025","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1109\/TMECH.2024.3401757","article-title":"Concentric Wire-Driven Robots With In Situ Torsion for Transnasal Surgery","volume":"30","author":"Kong","year":"2024","journal-title":"IEEE\/ASME Trans. Mechatron."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1109\/TRO.2021.3080659","article-title":"Eccentric tube robots as multiarmed steerable sheaths","volume":"38","author":"Wang","year":"2021","journal-title":"IEEE Trans. Robot."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Sridhar, A., Ourak, M., Valdivielso, I., and Vander Poorten, E. (2021, January 6\u201310). Design and Preliminary Characterisation of a New Soft Steerable Sheath for Cardiovascular Interventions. Proceedings of the 2021 20th International Conference on Advanced Robotics (ICAR), Ljubljana, Slovenia.","DOI":"10.1109\/ICAR53236.2021.9659442"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3263","DOI":"10.1177\/0142331216685607","article-title":"Design and control of a tendon-driven continuum robot","volume":"40","author":"Li","year":"2018","journal-title":"Trans. Inst. Meas. Control"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1109\/TMRB.2022.3215522","article-title":"Toward the design and development of a robotic transcatheter delivery system for mitral valve implant","volume":"4","author":"Nayar","year":"2022","journal-title":"IEEE Trans. Med. Robot. Bionics"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"102054","DOI":"10.1016\/j.rcim.2020.102054","article-title":"Design, modelling and validation of a novel extra slender continuum robot for in-situ inspection and repair in aeroengine","volume":"67","author":"Wang","year":"2021","journal-title":"Robot. Comput.-Integr. Manuf."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"942","DOI":"10.3390\/applmech2040055","article-title":"Effects of curing on photosensitive resins in SLA additive manufacturing","volume":"2","author":"Riccio","year":"2021","journal-title":"Appl. Mech."},{"key":"ref_29","first-page":"435","article-title":"Flexible 3D-printable materials for application in medical research: A comprehensive comparison of commercially available materials","volume":"12","author":"Grab","year":"2024","journal-title":"3D Print. Addit. Manuf."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2308","DOI":"10.1364\/BOE.518967","article-title":"Tissue mimicking materials and finger phantom design for pulse oximetry","volume":"15","author":"Rodriguez","year":"2024","journal-title":"Biomed. Opt. Express"},{"key":"ref_31","unstructured":"(2020). Biological Evaluation of Medical Devices\u2014Part 1: Evaluation and Testing within a Risk Management Process (Standard No. ISO 10993-1)."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"33","DOI":"10.5114\/jcb.2025.147780","article-title":"Auxetic solution for enhanced esophageal brachytherapy applicator","volume":"17","author":"Balagiannis","year":"2025","journal-title":"J. Contemp. Brachyther."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2006","DOI":"10.1109\/COMST.2024.3444051","article-title":"A survey on haptics: Communication, sensing and feedback","volume":"27","author":"Emami","year":"2025","journal-title":"IEEE Commun. Surv. Tutor."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Nankaku, A., Tokunaga, M., Yonezawa, H., Kanno, T., Kawashima, K., Hakamada, K., Hirano, S., Oki, E., Mori, M., and Kinugasa, Y. (2022). Maximum acceptable communication delay for the realization of telesurgery. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0274328"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1728","DOI":"10.1109\/TRO.2022.3231360","article-title":"Soft robots modeling: A structured overview","volume":"39","author":"Armanini","year":"2023","journal-title":"IEEE Trans. Robot."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"011010","DOI":"10.1115\/1.4041739","article-title":"Kinematics of continuum robots with constant curvature bending and extension capabilities","volume":"11","year":"2019","journal-title":"J. Mech. Robot."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1007\/s11548-015-1310-2","article-title":"Tendon-driven continuum robot for neuroendoscopy: Validation of extended kinematic mapping for hysteresis operation","volume":"11","author":"Kato","year":"2016","journal-title":"Int. J. Comput. Assist. Radiol. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"454.e7","DOI":"10.1016\/j.avsg.2020.07.019","article-title":"EVAR with Aortic Placement of a Single JOTEC E-iliac Stent-graft System in a Patient with Poliomyelitis Aortoiliac Deformities","volume":"69","author":"Orrico","year":"2020","journal-title":"Ann. Vasc. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.carrev.2025.06.034","article-title":"The SAPIEN M3 system for transcatheter mitral valve replacement: A new era begins","volume":"79","author":"Penteris","year":"2025","journal-title":"Cardiovasc. Revascularization Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1109\/TMRB.2025.3550674","article-title":"Model-Based Position Control of a Tendon-Driven Variable-Length Continuum Robot for Minimally Invasive Mitral Valve Repair","volume":"7","author":"Bicchi","year":"2025","journal-title":"IEEE Trans. Med. Robot. Bionics"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Wang, W., Xu, Z., Zeidan, A.M., Saija, C., Zheng, Y., Arena, M., Wang, S., Housden, R.J., and Rhode, K. (IEEE\/ASME Trans. Mechatron., 2025). Compact Design and Image-Space Pose Control of a Robot for Tendon-Driven Concentric Catheters in Mitral Repair Interventions, IEEE\/ASME Trans. Mechatron., in press.","DOI":"10.1109\/TMECH.2025.3602061"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1109\/TMRB.2022.3216026","article-title":"Kinematic modeling and jacobian-based control of the coast guidewire robot","volume":"4","author":"Sarma","year":"2022","journal-title":"IEEE Trans. Med. Robot. Bionics"}],"container-title":["Robotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2218-6581\/14\/11\/162\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T14:44:15Z","timestamp":1762181055000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2218-6581\/14\/11\/162"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,3]]},"references-count":42,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["robotics14110162"],"URL":"https:\/\/doi.org\/10.3390\/robotics14110162","relation":{},"ISSN":["2218-6581"],"issn-type":[{"value":"2218-6581","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,3]]}}}