In the United States, the lifetime risk of developing heart failure is roughly 20%. The current clinical standard treatment is implantation of a ventricular assist device that contacts the patient’s blood and is associated with thromboembolic events, hemolysis, immune reactions and infections. We are developing biologically-inspired direct cardiac compression devices that can wrap around a failing heart and utilize soft robotic actuation to assist the native heart function without contacting the blood. This soft robotic sleeve not only emulates the contractile behavior of the heart ventricles but can also performing twisting actions that can restore blood flow from severe heart failure condition in large animal models (Roche et al, Sci. Trans. Med 2017). We have also investigated how such devices can be effectively coupled and synchronized with the native heart to maximize cardiac output (Payne et al, Soft Robotics 2017).