Current and future applications of robotics in structural heart interventions

Robotics entered the cardiovascular field in the late 1990s with a robot-assisted coronary artery bypass graft. Since then, the use of robots has become a common part of cardiovascular surgery in several types of interventions. The experience in transcatheter interventions has been slower, and the application of robotics to percutaneous coronary interventions has shown some encouraging results but also some technical limitations. Following the growth of structural heart interventions, attention has recently switched to the potential application of robotics in this field. So far, several cases have been performed in animal models and only a few cases in humans. The opportunity to perform a procedure (almost) without any X-ray exposure or lead garments is extremely attractive, especially for operators. Alongside these, there are several further potential advantages, but there are also many challenges to overcome. The integration of artificial intelligence and machine learning in the near future might further contribute to improve the performance of future generations of robots. In this review, the current and future applications of robotics in structural heart interventions and transoesophageal echocardiography will be discussed, together with the potential advantages, challenges and future perspectives.