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Nascimbene A, Bark D, Smadja DM. Hemocompatibility and biophysical interface of left ventricular assist devices and total artificial hearts. Blood 2024; 143:661-672. [PMID: 37890145 PMCID: PMC10900168 DOI: 10.1182/blood.2022018096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
ABSTRACT Over the past 2 decades, there has been a significant increase in the utilization of long-term mechanical circulatory support (MCS) for the treatment of cardiac failure. Left ventricular assist devices (LVADs) and total artificial hearts (TAHs) have been developed in parallel to serve as bridge-to-transplant and destination therapy solutions. Despite the distinct hemodynamic characteristics introduced by LVADs and TAHs, a comparative evaluation of these devices regarding potential complications in supported patients, has not been undertaken. Such a study could provide valuable insights into the complications associated with these devices. Although MCS has shown substantial clinical benefits, significant complications related to hemocompatibility persist, including thrombosis, recurrent bleeding, and cerebrovascular accidents. This review focuses on the current understanding of hemostasis, specifically thrombotic and bleeding complications, and explores the influence of different shear stress regimens in long-term MCS. Furthermore, the role of endothelial cells in protecting against hemocompatibility-related complications of MCS is discussed. We also compared the diverse mechanisms contributing to the occurrence of hemocompatibility-related complications in currently used LVADs and TAHs. By applying the existing knowledge, we present, for the first time, a comprehensive comparison between long-term MCS options.
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Affiliation(s)
- Angelo Nascimbene
- Advanced Cardiopulmonary Therapies and Transplantation, University of Texas, Houston, TX
| | - David Bark
- Division of Hematology and Oncology, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO
| | - David M. Smadja
- Université de Paris-Cité, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Hematology Department, Assistance Publique–Hôpitaux de Paris, Georges Pompidou European Hospital, Paris, France
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2
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Malone G, Abdelsayed G, Bligh F, Al Qattan F, Syed S, Varatharajullu P, Msellati A, Mwipatayi D, Azhar M, Malone A, Fatimi SH, Conway C, Hameed A. Advancements in left ventricular assist devices to prevent pump thrombosis and blood coagulopathy. J Anat 2022; 242:29-49. [PMID: 35445389 PMCID: PMC9773170 DOI: 10.1111/joa.13675] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 12/25/2022] Open
Abstract
Mechanical circulatory support (MCS) devices, such as left ventricular assist devices (LVADs) are very useful in improving outcomes in patients with advanced-stage heart failure. Despite recent advances in LVAD development, pump thrombosis is one of the most severe adverse events caused by LVADs. The contact of blood with artificial materials of LVAD pumps and cannulas triggers the coagulation cascade. Heat spots, for example, produced by mechanical bearings are often subjected to thrombus build-up when low-flow situations impair washout and thus the necessary cooling does not happen. The formation of thrombus in an LVAD may compromise its function, causing a drop in flow and pumping power leading to failure of the LVAD, if left unattended. If a clot becomes dislodged and circulates in the bloodstream, it may disturb the flow or occlude the blood vessels in vital organs and cause internal damage that could be fatal, for example, ischemic stroke. That is why patients with LVADs are on anti-coagulant medication. However, the anti-coagulants can cause a set of issues for the patient-an example of gastrointestinal (GI) bleeding is given in illustration. On account of this, these devices are only used as a last resort in clinical practice. It is, therefore, necessary to develop devices with better mechanics of blood flow, performance and hemocompatibility. This paper discusses the development of LVADs through landmark clinical trials in detail and describes the evolution of device design to reduce the risk of pump thrombosis and achieve better hemocompatibility. Whilst driveline infection, right heart failure and arrhythmias have been recognised as LVAD-related complications, this paper focuses on complications related to pump thrombosis, especially blood coagulopathy in detail and potential strategies to mitigate this complication. Furthermore, it also discusses the LVAD implantation techniques and their anatomical challenges.
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Affiliation(s)
- Grainne Malone
- Tissue Engineering Research Group (TERG)Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin 2DublinIreland
| | - Gerges Abdelsayed
- School of MedicineRCSI University of Medicine and Health Sciences, Dublin 2DublinIreland
| | - Fianait Bligh
- School of MedicineRCSI University of Medicine and Health Sciences, Dublin 2DublinIreland
| | - Fatma Al Qattan
- Tissue Engineering Research Group (TERG)Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin 2DublinIreland,School of Pharmacy and Biomolecular SciencesRCSI University of Medicine and Health Sciences, Dublin 2DublinIreland
| | - Saifullah Syed
- School of MedicineRCSI University of Medicine and Health Sciences, Dublin 2DublinIreland
| | | | - Augustin Msellati
- School of MedicineRCSI University of Medicine and Health Sciences, Dublin 2DublinIreland
| | - Daniela Mwipatayi
- School of MedicineRCSI University of Medicine and Health Sciences, Dublin 2DublinIreland
| | - Maimoona Azhar
- Department of SurgerySt. Vincent's University Hospital, Dublin 4DublinIreland
| | - Andrew Malone
- Tissue Engineering Research Group (TERG)Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin 2DublinIreland
| | - Saulat H. Fatimi
- Department of Cardiothoracic SurgeryAga Khan University HospitalKarachiPakistan
| | - Claire Conway
- Tissue Engineering Research Group (TERG)Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin 2DublinIreland,Trinity Centre for Biomedical Engineering (TCBE)Trinity College Dublin (TCD)DublinIreland
| | - Aamir Hameed
- Tissue Engineering Research Group (TERG)Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin 2DublinIreland,Trinity Centre for Biomedical Engineering (TCBE)Trinity College Dublin (TCD)DublinIreland
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3
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Major R, Gawlikowski M, Plutecka H, Surmiak M, Kot M, Dyner M, Lackner JM, Major B. Biocompatibility testing of composite biomaterial designed for a new petal valve construction for pulsatile ventricular assist device. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:118. [PMID: 34459990 PMCID: PMC8405480 DOI: 10.1007/s10856-021-06576-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 06/16/2021] [Indexed: 06/13/2023]
Abstract
This paper presents the results of biocompatibility testing performed on several biomaterial variants for manufacturing a newly designed petal valve intended for use in a pulsatile ventricular assist device or blood pump. Both physical vapor deposition (PVD) and plasma-enhanced chemical vapor deposition (PECVD) were used to coat titanium-based substrates with hydrogenated tetrahedral amorphous carbon (ta-C:H) or amorphous hydrogenated carbon (a-C:H and a-C:H, N). Experiments were carried out using whole human blood under arterial shear stress conditions in a cone-plate analyzer (ap. 1800 1/s). In most cases, tested coatings showed good or very good haemocompatibility. Type a-C:H, N coating proved to be superior in terms of activation, risk of aggregation, and the effects of generating microparticles of apoptotic origin, and also demonstrated excellent mechanical properties. Therefore, a-C:H, N coatings were selected for further in vivo studies. In vivo animal studies were carried out according to the ISO 10993 standard. Intradermal reactivity was assessed in three rabbits and sub-acute toxicity and local effects after implantation were examined in 12 rabbits. Based on postmortem examination, no organ failure or wound tissue damage occurred during the required period of observation. In summary, our investigations demonstrated high biocompatibility of the biomaterials in relation to thrombogenicity, toxicity, and wound healing. Prototypes of the petal valves were manufactured and mounted on the pulsatile ventricular assist device. Hydrodynamic features and impact on red blood cells (hemolysis) as well as coagulation (systemic thrombogenicity) were assessed in whole blood.
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Affiliation(s)
- Roman Major
- Institute of Metallurgy and Materials Science, Polish Academy of Sciences, Reymonta Str. 25, Cracow, Poland.
| | - Maciej Gawlikowski
- Foundation for Cardiac Surgery Development, Artificial Heart Laboratory, Wolnosci Str. 345, Zabrze, Poland
- Department of Biosensors and Processing of Biomedical Signals, Faculty of Biomedical Engineering, Silesian University of Technology, Roosevelt Str. 40, Zabrze, Poland
| | - Hanna Plutecka
- Department of Medicine, Jagiellonian University Medical College, Skawinska Str. 8, Cracow, Poland
| | - Marcin Surmiak
- Department of Medicine, Jagiellonian University Medical College, Skawinska Str. 8, Cracow, Poland
| | - Marcin Kot
- Faculty of Mechanical Engineering and Robotics, AGH University of Science and Technology, Mickiewicza Str. 30, Cracow, Poland
| | - Marcin Dyner
- Faculty of Science and Technology, Jan Dlugosz University in Czestochowa, CHIRMED, 13/15 Armii Krajowej Av, Czestochowa, Poland
| | - Juergen M Lackner
- Joanneum Research Forschungsges.m.b.H., Institute of Surface Technologies and Photonics, Functional Surfaces, Leobner Str. 94, Niklasdorf, Austria
| | - Boguslaw Major
- Institute of Metallurgy and Materials Science, Polish Academy of Sciences, Reymonta Str. 25, Cracow, Poland
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4
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Reczyńska K, Major R, Kopernik M, Pamuła E, Imbir G, Plutecka H, Bruckert F, Surmiak M. Surface modification of polyurethane with eptifibatide-loaded degradable nanoparticles reducing risk of blood coagulation. Colloids Surf B Biointerfaces 2021; 201:111624. [PMID: 33621749 DOI: 10.1016/j.colsurfb.2021.111624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/03/2021] [Accepted: 02/08/2021] [Indexed: 11/18/2022]
Abstract
The main purpose of the work was to develop a drug releasing coatings on the surface of medical devices exposed to blood flow, what should enable effective inhibition of blood coagulation process. As a part of the work, the process of encapsulating the anticoagulant drug eptifibatide (EPT) in poly(DL-lactic-co-glycolic acid) (PLGA) nanoparticles was developed. EPT encapsulation efficiency was 29.1 ± 2.1%, while the EPT loading percentage in the nanoparticles was 4.2 ± 0.3%. The PLGA nanoparticles were suspended in a polyanion solution (hyaluronic acid (HA)) and deposited on the surface-treated thermoplastic polyurethane (TPU) by a layer-by-layer method. As a polycation poly-L-lysine (PLL) was used. The influence of released EPT on the activation of the coagulation system was analyzed using dynamic blood tester. Performed experiments show an effective delivery of the drug to the bloodstream and low risk of platelets (membrane receptor) activation. The dynamic blood test process, including its physical phenomenon, was described using numerical methods, i.e. a finite volume cone-and-plate test model as well as non-Newtonian blood models. The values of shear stress and blood flow velocity under the fast-rotating cone were computed applying boundary conditions of cylinder wall imitating blood-nanomaterial interaction. Implementing boundary conditions as initial shear stress values of bottom cylinder wall resulted in the increase of shear stress in blood under rotating cone. The developed system combining drug eluting polymeric nanoparticles with the polyelectrolyte "layer-by-layer" coating can be easily introduced to medical implants of various shape, with the advantages of resorbable drug carriers allowing for local and controllable delivery of anti-thrombogenic drugs.
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Affiliation(s)
- Katarzyna Reczyńska
- AGH University of Science and Technology, Faculty of Materials Science and Ceramics, Al. Mickiewicza 30, 30-059 Kraków, Poland
| | - Roman Major
- Institute of Metallurgy and Materials Science, Polish Academy of Sciences, 25 Reymonta st., 30-059 Cracow, Poland
| | - Magdalena Kopernik
- AGH University of Science and Technology, Faculty of Metals Engineering and Industrial Computer Science, Al. Mickiewicza 30, 30-059 Kraków, Poland.
| | - Elżbieta Pamuła
- AGH University of Science and Technology, Faculty of Materials Science and Ceramics, Al. Mickiewicza 30, 30-059 Kraków, Poland
| | - Gabriela Imbir
- Institute of Metallurgy and Materials Science, Polish Academy of Sciences, 25 Reymonta st., 30-059 Cracow, Poland
| | - Hanna Plutecka
- Department of Internal Medicine, Jagiellonian University Medical College, 8 Skawińska st., 31-066 Cracow, Poland
| | - Franz Bruckert
- Laboratoire des Matériaux et du Génie Physique - UMR 5628, 3 parvis Louis Néel, Grenoble Cedex 1, France
| | - Marcin Surmiak
- Department of Internal Medicine, Jagiellonian University Medical College, 8 Skawińska st., 31-066 Cracow, Poland
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5
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Klompas AM, Boswell MR, Plack DL, Smith MM. Thrombocytopenia: Perioperative Considerations for Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2021; 36:893-905. [PMID: 33707107 DOI: 10.1053/j.jvca.2021.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 11/11/2022]
Abstract
The etiologies of thrombocytopenia in patients presenting for cardiac surgery are extensive, but clinically relevant conditions generally can be categorized by those related to decreased platelet production or increased platelet destruction. Many causes require mere acknowledgment and availability of allogeneic platelet transfusion; others have unique considerations for which providers should be familiar. The purpose of this review is to provide an overview of the common causes of thrombocytopenia, summarize the literature, and discuss perioperative considerations for patients undergoing cardiac surgery.
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Affiliation(s)
- Allan M Klompas
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, 200 First St SW, Rochester, MN
| | - Michael R Boswell
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, 200 First St SW, Rochester, MN
| | - Daniel L Plack
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, 200 First St SW, Rochester, MN
| | - Mark M Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, 200 First St SW, Rochester, MN.
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6
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Trembecka-Wójciga K, Kopernik M, Surmiak M, Major R, Gawlikowski M, Bruckert F, Kot M, Lackner JM. Effect of the mechanical properties of carbon-based coatings on the mechanics of cell-material interactions. Colloids Surf B Biointerfaces 2020; 197:111359. [PMID: 33032179 DOI: 10.1016/j.colsurfb.2020.111359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 12/28/2022]
Abstract
The paper presents an influence of the surface mechanical properties of thin-film materials on blood cell adhesion under shear stress conditions. Physical vapour deposited (PVD) coatings i.e. hydrogenated amorphous carbon (a-C:H) doped with nitrogen or silicon have been investigated. The mechanical properties of materials, namely their microhardness and Young's modulus were measured using indentation test with Rockwell indenter. The adhesion efficiency of blood cells in dynamic conditions were analysed using a radial flow chamber. Red blood cells (RBC) were used as representative cells to analyse cell-material interactions. The biomaterial examinations were performed under physiological flow conditions at the single-cell level. The 3D FVM (finite volume method) model of multi-phase radial flow test was developed to reproduce the physical test and to predict distributions of shear stresses and velocity during blood washout with PBS. Cell-material interactions were found to be strongly associated with the mechanical properties of the thin-film material. The decrease in the hardness of the coatings translated into a weaker cell - material interactions.
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Affiliation(s)
- K Trembecka-Wójciga
- Institute of Metallurgy and Materials Science, Polish Academy of Sciences, Reymonta St. 25, Cracow, Poland
| | - M Kopernik
- AGH University of Science and Technology, Mickiewicza Str. 30, Cracow, Poland.
| | - M Surmiak
- Department of Internal Medicine, Jagiellonian University Medical College, Skawinska Str. 8, Cracow, Poland
| | - R Major
- Institute of Metallurgy and Materials Science, Polish Academy of Sciences, Reymonta St. 25, Cracow, Poland
| | - M Gawlikowski
- Silesian University of Technology, Faculty of Biomedical Engineering, Department of Biosensors and Processing of Biomedical Signals, Roosevelt Str. 40, Zabrze, Poland
| | - F Bruckert
- Laboratoire des Matériaux et du Génie Physique - UMR 5628, 3 parvis Louis Néel, Grenoble Cedex 1, France
| | - M Kot
- Faculty of Mechanical Engineering and Robotics, AGH University of Science and Technology, Mickiewicza Str. 30, Cracow, Poland
| | - J M Lackner
- Joanneum Research Forschungsges mbH, Institute of Surface Technologies and Photonics, Functional Surfaces, Leobner Strasse 94, A-8712, Niklasdorf, Austria
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8
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Hong JK, Gao L, Singh J, Goh T, Ruhoff AM, Neto C, Waterhouse A. Evaluating medical device and material thrombosis under flow: current and emerging technologies. Biomater Sci 2020; 8:5824-5845. [DOI: 10.1039/d0bm01284j] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This review highlights the importance of flow in medical device thrombosis and explores current and emerging technologies to evaluate dynamic biomaterial Thrombosis in vitro.
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Affiliation(s)
- Jun Ki Hong
- School of Chemistry
- The University of Sydney
- Australia
- School of Medical Sciences
- Faculty of Medicine and Health
| | - Lingzi Gao
- Heart Research Institute
- Newtown
- Australia
- The University of Sydney Nano Institute
- The University of Sydney
| | - Jasneil Singh
- Heart Research Institute
- Newtown
- Australia
- The Charles Perkins Centre
- The University of Sydney
| | - Tiffany Goh
- Heart Research Institute
- Newtown
- Australia
- The Charles Perkins Centre
- The University of Sydney
| | - Alexander M. Ruhoff
- Heart Research Institute
- Newtown
- Australia
- The Charles Perkins Centre
- The University of Sydney
| | - Chiara Neto
- School of Chemistry
- The University of Sydney
- Australia
- The University of Sydney Nano Institute
- The University of Sydney
| | - Anna Waterhouse
- School of Medical Sciences
- Faculty of Medicine and Health
- The University of Sydney
- Australia
- Heart Research Institute
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9
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Hilal T, Mudd J, DeLoughery TG. Hemostatic complications associated with ventricular assist devices. Res Pract Thromb Haemost 2019; 3:589-598. [PMID: 31624778 PMCID: PMC6781923 DOI: 10.1002/rth2.12226] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/08/2019] [Indexed: 01/03/2023] Open
Abstract
Hemostatic complications are common in patients with ventricular assist devices. The pathophysiologic mechanisms that lead to dysregulated hemostasis involve complex interactions between device surface, sheer stress, and blood flow. These factors lead to various manifestations that require a thorough understanding of the interplay among platelets, coagulation factors, and red cells. In this article, we review the pathophysiology of hematologic complications (bleeding, acquired von Willebrand disease, heparin-induced thrombocytopenia, hemolysis, stroke and pump thrombosis), the clinical manifestations, and the management of each. We summarize the evidence available for management of these entities and provide a pragmatic clinical review.
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Affiliation(s)
- Talal Hilal
- Division of Hematology/OncologyMayo Clinic Cancer CenterMayo ClinicPhoenixArizona
| | - James Mudd
- Center for Advanced Heart Disease and TransplantationProvidence Sacred Heart Medical CenterSpokaneWashington
| | - Thomas G. DeLoughery
- Division of Hematology/Medical OncologyKnight Cancer CenterOregon Health & Science UniversityPortlandOregon
- Division of Laboratory MedicineDepartment of PathologyOregon Health & Science UniversityPortlandOregon
- Division of Hematology/OncologyDepartment of PediatricsOregon Health & Science UniversityPortlandOregon
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10
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Jamiolkowski MA, Pedersen DD, Wu WT, Antaki JF, Wagner WR. Visualization and analysis of biomaterial-centered thrombus formation within a defined crevice under flow. Biomaterials 2016; 96:72-83. [PMID: 27156141 DOI: 10.1016/j.biomaterials.2016.04.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/08/2016] [Accepted: 04/20/2016] [Indexed: 01/14/2023]
Abstract
The blood flow pathway within a device, together with the biomaterial surfaces and status of the patient's blood, are well-recognized factors in the development of thrombotic deposition and subsequent embolization. Blood flow patterns are of particular concern for devices such as blood pumps (i.e. ventricular assist devices, VADs) where shearing forces can be high, volumes are relatively large, and the flow fields can be complex. However, few studies have examined the effect of geometric irregularities on thrombus formation on clinically relevant opaque materials under flow. The objective of this study was to quantify human platelet deposition onto Ti6Al4V alloys, as well as positive and negative control surfaces, in the region of defined crevices (∼50-150 μm in width) that might be encountered in many VADs or other cardiovascular devices. To achieve this, reconstituted fresh human blood with hemoglobin-depleted red blood cells (to achieve optical clarity while maintaining relevant rheology), long working optics, and a custom designed parallel plate flow chamber were employed. The results showed that the least amount of platelet deposition occurred in the largest crevice size examined, which was counterintuitive. The greatest levels of deposition occurred in the 90 μm and 53 μm crevices at the lower wall shear rate. The results suggest that while crevices may be unavoidable in device manufacturing, the crevice size might be tailored, depending on the flow conditions, to reduce the risk of thromboembolic events. Further, these data might be used to improve the accuracy of predictive models of thrombotic deposition in cardiovascular devices to help optimize the blood flow path and reduce device thrombogenicity.
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Affiliation(s)
- Megan A Jamiolkowski
- McGowan Institute for Regenerative Medicine, Pittsburgh, PA, USA; Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Drake D Pedersen
- McGowan Institute for Regenerative Medicine, Pittsburgh, PA, USA; Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wei-Tao Wu
- Dept. of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - James F Antaki
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Dept. of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - William R Wagner
- McGowan Institute for Regenerative Medicine, Pittsburgh, PA, USA; Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Dept. of Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Dept. of Chemical Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
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11
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Jamiolkowski MA, Woolley JR, Kameneva MV, Antaki JF, Wagner WR. Real time visualization and characterization of platelet deposition under flow onto clinically relevant opaque surfaces. J Biomed Mater Res A 2014; 103:1303-11. [PMID: 24753320 DOI: 10.1002/jbm.a.35202] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 03/31/2014] [Accepted: 04/18/2014] [Indexed: 11/07/2022]
Abstract
Although the thrombogenic nature of the surfaces of cardiovascular devices is an important aspect of blood biocompatibility, few studies have examined platelet deposition onto opaque materials used for these devices in real time. This is particularly true for the metallic surfaces used in current ventricular assist devices (VADs). Using hemoglobin depleted red blood cells (RBC ghosts) and long working distance optics to visualize platelet deposition, we sought to perform such an evaluation. Fluorescently labeled platelets mixed with human RBC ghosts were perfused across six opaque materials (a titanium alloy (Ti6Al4V), silicon carbide (SiC), alumina (Al2O3, 2-methacryloyloxyethyl phosphorylcholine polymer coated Ti6Al4V (MPC-Ti6Al4V), yttria partially stabilized zirconia (YZTP), and zirconia toughened alumina (ZTA)) for 5 min at wall shear rates of 400 and 1000 s(-1). Ti6Al4V had significantly increased platelet deposition relative to MPC-Ti6Al4V, Al2 O3 , YZTP, and ZTA at both wall shear rates (p < 0.01). For all test surfaces, increasing the wall shear rate produced a trend of decreased platelet adhesion. The described system can be a utilized as a tool for comparative analysis of candidate blood-contacting materials with acute blood contact.
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Affiliation(s)
- Megan A Jamiolkowski
- McGowan Institute for Regenerative Medicine, Pittsburgh, Pennsylvania; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
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12
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Evaluation of Blood–Materials Interactions. Biomater Sci 2013. [DOI: 10.1016/b978-0-08-087780-8.00055-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
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13
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Ye SH, Johnson CA, Woolley JR, Snyder TA, Gamble LJ, Wagner WR. Covalent surface modification of a titanium alloy with a phosphorylcholine-containing copolymer for reduced thrombogenicity in cardiovascular devices. J Biomed Mater Res A 2009; 91:18-28. [PMID: 18683221 PMCID: PMC3402171 DOI: 10.1002/jbm.a.32184] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Our objective was to develop a surface modification strategy for a titanium alloy (TiAl6V4) to provide thromboresistance for surfaces in rigorous blood-contacting cardiovascular applications, such as that found in ventricular assist devices. We hypothesized that this could be accomplished by the covalent attachment of a phospholipid polymer, poly(2-methacryloyloxyethylphosphorylcholine (MPC)-co-methacryl acid) (PMA). TiAl6V4 was H2O plasma treated by radio frequency glow discharge, silanated with 3-aminopropyltriethoxysilane (APS), and ammonia plasma treated to increase surface reactivity. The TiAl6V4 surface was then modified with PMA via a condensation reaction between the amino groups on the TiAl6V4 surface and the carboxyl groups on PMA. The surface composition was verified by X-ray photoelectron spectroscopy, confirming successful modification of the TiAl6V4 surfaces with APS and PMA as evidenced by increased Si and P. Plasma treatments with H2O and ammonia were effective at further increasing the surface reactivity of TiAl6V4 as evidenced by increased surface PMA. The adsorption of ovine fibrinogen onto PMA-modified surfaces was reduced relative to unmodified surfaces, and in vitro ovine blood contact through a rocking test revealed marked reductions in platelet deposition and bulk phase platelet activation relative to unmodified TiAl6V4 and polystyrene controls. The results indicate that the PMA-modification scheme for TiAl6V4 surfaces offers a potential pathway to improve the thromboresistance of the blood-contacting surfaces of cardiovascular devices.
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Affiliation(s)
- Sang-Ho Ye
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15219, USA
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14
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Abstract
This article focuses on the surface engineering of ventricular assist devices (VADs) for the treatment of heart failure patients, which involves the modification of surfaces contacting blood in order to improve the blood compatibility (hemocompatibility) of the VADs. Following an introduction to the categorization and the complications of VADs, this article pays attention on the hemocompatibility, applications and limitations of six types of surface coatings for VADs: titanium nitride coatings, diamond-like carbon coatings, 2-methacryloyloxyethyl phosphorylcholine polymer coatings, heparin coatings, textured surfaces and endothelial cell linings. In particular, diamond-like coatings and heparin coatings are the most commonly used for VADs owing to their excellent hemocompatibility, durability and technical maturity. For high performance and a long lifetime of VADs, surface modification with coatings to ensure hemocompatibility is as important as the mechanical design of the device.
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Affiliation(s)
- Dong-Choon Sin
- Institute of Health and Biomedical Innovation, Queensland University of Technology, 2 George Street, GPO Box 2434, Brisbane, QLD 4059, Australia.
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Kurotobi K, Yamamoto A, Kikuta A, Hanawa T. Short term evaluation of material blood compatibility using a microchannel array. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2007; 18:1175-84. [PMID: 17277985 DOI: 10.1007/s10856-007-0120-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Accepted: 03/03/2006] [Indexed: 05/13/2023]
Abstract
New short-term evaluation of material blood compatibility was attempted using a microchannel array with human blood under a flow condition. The microchannel array chips were made of silicon, having 8,736 microchannels of 10 microm-wide, 30 microm-long, and 4.5 microm-deep on the average, as the models of capillary blood vessels. Titanium, chromium, albumin and collagen were coated onto the chips to examine the difference of material blood compatibility and the effect of protein adsorption on it. The time for the first 100 microl portion of whole blood to pass through the channels (blood pass-through time, BPT) was measured under a pressure difference of 20 cmH2O. Simultaneously, the flow behavior of blood cells was observed by an optical microscope. The BPT tends to correlate well with the level of platelet adhesion. The highest BPT as well as platelet adhesion was observed on collagen, followed by titanium, chromium, silicon, and albumin. These results indicate that the BPT can detect the different levels of platelet adhesion and thrombus formation on microchannel surface and that the protein adsorption onto chip surface can influence BPT. We concluded that this method could be applied to evaluate initial blood compatibility of materials within several minutes in vitro.
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Affiliation(s)
- Kimi Kurotobi
- Biomaterials Center, National Institute for Materials Science (NIMS), 1-1, Namiki, Tsukuba, Ibaraki 305-0044, Japan
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Snyder TA, Tsukui H, Kihara S, Akimoto T, Litwak KN, Kameneva MV, Yamazaki K, Wagner WR. Preclinical biocompatibility assessment of the EVAHEART ventricular assist device: Coating comparison and platelet activation. J Biomed Mater Res A 2007; 81:85-92. [PMID: 17109415 DOI: 10.1002/jbm.a.31006] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Thromboembolism and bleeding remain significant complications of ventricular assist device (VAD) support. Increasing the amount of biocompatibility data collected during preclinical studies can provide additional criteria to evaluate device refinements, while design changes may be implemented before entering clinical use. Twenty bovines were implanted with the EVAHEART centrifugal VAD for durations from 30 to 196 days. Titanium alloy pumps were coated with either diamond-like carbon or 2-methoxyethyloylphosphoryl choline (MPC). Activated platelets and platelet microaggregates were quantified by flow cytometry, including two new assays to quantify bovine platelets expressing CD62P and CD63. Temporally, all assays were low preoperatively, then significantly increased following VAD implantation, before declining to a lower, but still elevated level over 2-3 weeks. MPC-coated VADs produced significantly fewer activated platelets after implant trauma effects diminished. Three animals receiving no postoperative anticoagulation had similar amounts of circulating activated platelets and platelet microaggregates as animals receiving warfarin anticoagulation. Two new methods to quantify bovine activated platelets using antibodies to CD62P and CD63 were characterized and applied. These measures, along with previously described assays, were able to differentiate between two biocompatible coatings and assess effects of anticoagulation regimen in VAD preclinical testing.
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Affiliation(s)
- Trevor A Snyder
- Bioengineering Department, University of Pittsburgh, 100 Technology Drive, Pittsburgh, PA 15219, USA
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Yamanaka H, Rosenberg G, Weiss WJ, Snyder AJ, Zapanta CM, Siedlecki CA. Short-term in vivo studies of surface thrombosis in a left ventricular assist system. ASAIO J 2006; 52:257-65. [PMID: 16760713 DOI: 10.1097/01.mat.0000219067.19482.1e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Thrombosis continues to be a major adverse and at times fatal event in patients with left ventricular assist systems (LVAS). To assess acute thrombosis in an LVAS, multiscale analysis of surface thrombosis was performed on LVAS blood sacs retrieved after implantation in seven calves for 3 days. Two study groups were evaluated: One group was given heparin and warfarin sodium throughout the study; the second received no postoperative anticoagulation. On explantation, the blood sacs were examined for macroscopic thrombi; microscale thrombosis was assessed with the use of scanning electron microscopy. Macroscopic thrombi about 1 mm in diameter were seen in all sacs from both groups. Although macroscopic thrombi occurred in all sac regions, scanning electron microscopy revealed differences in microscale topography between the port regions and the other sac regions. The primary structure was spherical particles approximately 400 nm in diameter, found to occur at a lower density in the ports. In contrast, the highest densities of proteinaceous rough topography and fibrillar structures consistent with fibrin clot were seen in the port regions. The density distribution of these structures was different in the eight sac regions, and anticoagulation therapy appeared to have no effect on surface thrombosis in these short-term LVAS implants.
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Affiliation(s)
- Hanako Yamanaka
- Department of Bioengineering, The Pennsylvania State University, Hershey, Pennsylvania 17033, USA
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Yamanaka H, Rosenberg G, Weiss WJ, Snyder AJ, Zapanta CM, Siedlecki CA. Multiscale analysis of surface thrombosis in vivo in a left ventricular assist system. ASAIO J 2006; 51:567-77. [PMID: 16322720 DOI: 10.1097/01.mat.0000181707.06225.a0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Thrombosis limits the success of ventricular assist devices as the demand for alternatives to heart transplants is increasing. This study mapped the occurrence of thrombosis in a left ventricular assist system (LVAS) to better understand the biologic response to these devices. Nine calves divided into two groups were implanted with LVAS for 28 to 30 days. One group was anticoagulated, whereas the second group received no long-term anticoagulation. The blood-contacting poly(urethane urea) surfaces of blood sacs in the LVAS were examined for macroscopic thrombi upon retrieval. The sac was partitioned into eight sections and imaged for thrombi by scanning electron microscopy. No difference in thrombosis was observed macroscopically between the groups. Anticoagulation appeared to result in reduction of platelet-like structures, but the presence of fibrin-like structures remained similar between groups. Regional differences correlating with high and low shear stress regions were observed. At the macroscale, fewer thrombi were recorded in the high shear stress ports. At the microscale, features resembling fibrin were observed primarily in the ports and platelet-like features were common in lower shear stress regions. These variations in thrombosis with anticoagulation and location are likely due to varied fluid dynamics within the LVAS blood sac.
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Affiliation(s)
- Hanako Yamanaka
- Department of Bioengineering, The Pennsylvania State University, Hershey, PA 17033, USA
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Bhargava B, Reddy NK, Karthikeyan G, Raju R, Mishra S, Singh S, Waksman R, Virmani R, Somaraju B. A novel paclitaxel-eluting porous carbon–carbon nanoparticle coated, nonpolymeric cobalt–chromium stent: Evaluation in a porcine model. Catheter Cardiovasc Interv 2006; 67:698-702. [PMID: 16575925 DOI: 10.1002/ccd.20698] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We aimed to evaluate the response of porcine coronary arteries to a novel paclitaxel-eluting porous carbon-carbon nanoparticle coated, nonpolymeric cobalt chromium stent. BACKGROUND Polymer based drug-eluting stents significantly reduce restenosis. However, the indefinite presence of polymer is thought to initiate and sustain inflammation and contribute to the occurrence of late complications. METHODS Sixteen carbon-carbon coated, nonpolymeric cobalt chromium stents with two different doses of paclitaxel (eight of each) were implanted in porcine coronary arteries. In addition, eight cobalt chromium stents coated with a biodegradable polymer were also studied. Animals were sacrificed 6 weeks after stent implantation and histomorphometric analysis was performed. Results were compared among the three groups of stents. RESULTS The cobalt chromium stents coated with carbon-carbon with low and medium doses of paclitaxel both showed acceptable performance characteristics, with respect to endothelialization, neointimal hyperplasia, percentage diameter stenosis, inflammatory response, and tendency to fibrin deposition, when compared to historical data with the Cypher stent. On the other hand, the stents coated with poly(lactide) and poly(lactide-co-glycolide) biodegradable polymers and 0.7 microg/mm2 paclitaxel showed poor performance. There was a significant tendency to poor endothelialization, greater neointimal hyperplasia, percentage diameter stenosis, greater inflammatory response, and tendency to fibrin deposition (P < 0.01 for all parameters). CONCLUSIONS This preclinical evaluation demonstrates the safety and efficacy of a novel cobalt chromium stent with a carbon-carbon coating and low and medium doses of paclitaxel.
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Affiliation(s)
- Balram Bhargava
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Perego G, Preda P, Pasquinelli G, Curti T, Freyrie A, Cenni E. Functionalization of poly-L-lactic-co-ε-caprolactone: effects of surface modification on endothelial cell proliferation and hemocompatibility. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2003; 14:1057-75. [PMID: 14661879 DOI: 10.1163/156856203769231565] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A copolymer of L-lactic acid and epsilon-caprolactone (PLLACL) was synthesized with the aim of preparing a bioartificial, small-diameter and partially resorbable vascular graft. The material was submitted to surface functionalizations (i.e. chemical modification by means of hydrolytic 'etching' and plasma discharge) to promote endothelial cell (EC) adhesion and growth avoiding platelet adhesion or coagulation factor absorption. Furthermore, the behaviour of human microvascular endothelial cells (HMVEC) seeded on the untreated and treated copolymer is described, as well as the platelet adhesion and the modifications of coagulation factors determined by the copolymer itself. PLLACL in its native state provided little support for EC adhesion. Improved EC adherence was obtained when functional groups were provided on the polymer surface by surface chemical hydrolysis. HMVEC seeded and cultured on the polymer surface did not show any ultrastructural alteration, thus demonstrating the absence of the polymer cytotoxicity. Moreover, SEM analysis performed on cold plasma modified specimens showed the presence of a subconfluent monolayer of EC, with an elongated spread morphology. Both the untreated and treated copolymers induced only slight variations of platelet number, but determined the activated partial thromboplastin time (APTT) increase, due to factor XI reduction. Finally, a prototype of partially biodegradable vascular prosthesis was prepared with NaOH/HCl-treated copolymer. Pre-cultured HMVEC seeding of the prosthesis by means of a rotation device resulted in an almost completely coverage of the graft inner surface.
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Wagner WR, Schaub RD, Sorensen EN, Snyder TA, Wilhelm CR, Winowich S, Borovetz HS, Kormos RL. Blood biocompatibility analysis in the setting of ventricular assist devices. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2001; 11:1239-59. [PMID: 11263811 DOI: 10.1163/156856200744183] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Ventricular assist devices (VADs) are increasingly applied to support patients with advanced cardiac failure. While the benefit of VADs in supporting this patient group is clear, substantial morbidity and mortality occur during the VAD implant period due to thromboembolic and infective complications. Efforts at the University of Pittsburgh aimed at evaluating the blood biocompatibility of VADs in the clinical, animal, and in vitro setting over the past decade are summarized. Emphasis is placed on understanding the mechanisms of thrombosis and thromboembolism associated with these devices.
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Affiliation(s)
- W R Wagner
- Department of Surgery, University of Pittsburgh, PA 15261, USA.
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Vorp DA, Gartner MJ, Keynton RS. Vascular Applications of Micro- and Nanotechnology. J Vasc Interv Radiol 2001. [DOI: 10.1016/s1051-0443(01)70132-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Anderson JM, Bianco RW, Grehan JF, Grubbs BC, Hanson SR, Hauch KD, Lahti M, Mrachek JP, Northup SJ, Ratner BD, Schoen FJ, Schroeder EL, Schumacher CW, Svendsen CA. Biological Testing of Biomaterials. Biomater Sci 1996. [DOI: 10.1016/b978-012582460-6/50008-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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