SOFT robotic cardiac sleeves could offer a new approach to heart failure management by providing non-blood-contact mechanical support, researchers suggest in a new review of preclinical data.
Heart failure affects more than 64 million people globally and remains associated with high mortality despite advances in medical therapy.
While heart transplantation remains the definitive treatment for end stage disease, donor shortages limit availability.
Mechanical circulatory support devices can provide lifesaving assistance, but their use is restricted by complications including thrombosis, infection, driveline failure, and the need for lifelong anticoagulation.
Soft robotic cardiac sleeves have emerged as an alternative strategy designed to avoid direct interaction with circulating blood.
Rather than pumping blood, these devices envelop the heart and provide synchronised external compression, torsion, and relaxation to support cardiac function.
According to the review, soft robotic cardiac sleeves have progressed from proof-of-concept systems to sophisticated preclinical platforms capable of reproducing physiological cardiac mechanics and improving haemodynamic performance.
Researchers reported that sleeve-based technologies may support a range of cardiac conditions, including systolic dysfunction, diastolic dysfunction, conduction disorders, and severe ventricular impairment.
By replicating natural myocardial motion, these systems aim to restore cardiac output while preserving more physiological heart mechanics than conventional assist devices.
Recent preclinical studies demonstrated restoration of cardiac output and ventricular performance in large animal models.
Researchers also explored adaptive systems that synchronise assistance with electrical activity or pressure signals, advancing the concept of closed loop cardiac support.
Despite these advances, most evidence remains limited to acute or short duration studies. Long-term data examining durability, biological integration, and safety are still lacking.
The review identified durable epicardial integration as one of the most significant barriers to clinical implementation.
Achieving effective force transmission while maintaining biological compatibility, coronary safety, and device reversibility remains an unresolved challenge.
Additional concerns include inflammatory responses, fibrotic encapsulation, thermal safety, long term mechanical reliability, and the development of implantable power and control systems.
The authors also highlighted the need for standardised surgical workflows and clearer regulatory pathways.
Future development is expected to focus on patient specific designs, regionally targeted actuation, wireless power delivery, integrated sensing technologies, and biologically informed interfaces.
The review concluded that successful clinical translation will depend on multidisciplinary collaboration across cardiology, cardiac surgery, biomaterials science, soft robotics, and bioelectronics engineering.
Reference
Foroughi J et al. Clinical translation and engineering challenges of soft robotic cardiac sleeves for heart failure. Nat Commun. 2026;DOI:10.1038/s41467-026-76596-z
Featured image: Chinnapong on Adobe Stock
Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.
