A novel polymer for potential use in a trileaflet heart valve

Aortic Valve Engineering Advancements: Precision Tuning with Laser Sintering Additive Manufacturing of TPU/TPE Submillimeter Membranes

Synthetic biomaterials play a crucial role in developing tissue-engineered heart valves (TEHVs) due to their versatile mechanical properties. Achieving the right balance between mechanical strength and manufacturability is essential. Thermoplastic polyurethanes (TPUs) and elastomers (TPEs) garner significant attention for TEHV applications due to their notable stability, fatigue resistance, and customizable properties such as shear strength and elasticity. This study explores the additive manufacturing technique of selective laser sintering (SLS) for TPUs and TPEs to optimize process parameters to balance flexibility and strength, mimicking aortic valve tissue properties. Additionally, it aims to assess the feasibility of printing aortic valve models with submillimeter membranes. The results demonstrate that the SLS-TPU/TPE technique can produce micrometric valve structures with soft shape memory properties, resembling aortic tissue in strength, flexibility, and fineness. These models show promise for surgical training and manipulation, display intriguing echogenicity properties, and can potentially be personalized to shape biocompatible valve substitutes.

Research on fatigue optimization simulation of polymeric heart valve based on the iterative sub-regional thickened method

Prosthetic polymeric heart valves (PHVs) have the potential to overcome the inherent material and design limitations of traditional valves in the treatment of valvular heart disease; however, their durability remains limited. Optimal design of the valve structure is necessary to improve their durability. This study aimed to enhance the fatigue resistance of PHVs by improving the stress distribution. Iterative subregional thickening of the leaflets was used, and the mechanical stress distribution and hemodynamics of these polymeric tri-leaflet valves were characterized using a fluid-structure interaction approach. Subregional thickening led to a reduction in stress concentration on the leaflet, with the effective orifice area still meeting ISO 5840-3 and the regurgitant volume achieving a similar value to those in previous studies. The maximum stress in the final iteration was reduced by 28% compared with that of the prototype. The proposed method shows potential for analyzing the stress distribution and hemodynamic performance of subregional thickened valves and can further improve the durability of PHVs.

Polymeric Heart Valves Will Displace Mechanical and Tissue Heart Valves: A New Era for the Medical Devices

The development of a novel artificial heart valve with outstanding durability and safety has remained a challenge since the first mechanical heart valve entered the market 65 years ago. Recent progress in high-molecular compounds opened new horizons in overcoming major drawbacks of mechanical and tissue heart valves (dysfunction and failure, tissue degradation, calcification, high immunogenic potential, and high risk of thrombosis), providing new insights into the development of an ideal artificial heart valve. Polymeric heart valves can best mimic the tissue-level mechanical behavior of the native valves. This review summarizes the evolution of polymeric heart valves and the state-of-the-art approaches to their development, fabrication, and manufacturing. The review discusses the biocompatibility and durability testing of previously investigated polymeric materials and presents the most recent developments, including the first human clinical trials of LifePolymer. New promising functional polymers, nanocomposite biomaterials, and valve designs are discussed in terms of their potential application in the development of an ideal polymeric heart valve. The superiority and inferiority of nanocomposite and hybrid materials to non-modified polymers are reported. The review proposes several concepts potentially suitable to address the above-mentioned challenges arising in the R&D of polymeric heart valves from the properties, structure, and surface of polymeric materials. Additive manufacturing, nanotechnology, anisotropy control, machine learning, and advanced modeling tools have given the green light to set new directions for polymeric heart valves.

Adhesive and Self-Healing Polyurethanes with Tunable Multifunctionality

Many polyurethanes (PUs) are blood-contacting materials due to their good mechanical properties, fatigue resistance, cytocompatibility, biosafety, and relatively good hemocompatibility. Further functionalization of the PUs using chemical synthetic methods is especially attractive for expanding their applications. Herein, a series of catechol functionalized PU (C-PU-PTMEG) elastomers containing variable molecular weight of polytetramethylene ether glycol (PTMEG) soft segment are reported by stepwise polymerization and further introduction of catechol. Tailoring the molecular weight of PTMEG fragment enables a regulable catechol content, mobility of the chain segment, hydrogen bond and microphase separation of the C-PU-PTMEG elastomers, thus offering tunability of mechanical strength (such as breaking strength from 1.3 MPa to 5.7 MPa), adhesion, self-healing efficiency (from 14.9% to 96.7% within 2 hours), anticoagulant, antioxidation, anti-inflammatory properties and cellular growth behavior. As cardiovascular stent coatings, the C-PU-PTMEGs demonstrate enough flexibility to withstand deformation during the balloon dilation procedure. Of special importance is that the C-PU-PTMEG-coated surfaces show the ability to rapidly scavenge free radicals to maintain normal growth of endothelial cells, inhibit smooth muscle cell proliferation, mediate inflammatory response, and reduce thrombus formation. With the universality of surface adhesion and tunable multifunctionality, these novel C-PU-PTMEG elastomers should find potential usage in artificial heart valves and surface engineering of stents.

Transcatheter Heart Valves: A Biomaterials Perspective

Heart valve disease is prevalent throughout the world, and the number of heart valve replacements is expected to increase rapidly in the coming years. Transcatheter heart valve replacement (THVR) provides a safe and minimally invasive means for heart valve replacement in high-risk patients. The latest clinical data demonstrates that THVR is a practical solution for low-risk patients. Despite these promising results, there is no long-term (>20 years) durability data on transcatheter heart valves (THVs), raising concerns about material degeneration and long-term performance. This review presents a detailed account of the materials development for THVRs. It provides a brief overview of THVR, the native valve properties, the criteria for an ideal THV, and how these devices are tested. A comprehensive review of materials and their applications in THVR, including how these materials are fabricated, prepared, and assembled into THVs is presented, followed by a discussion of current and future THVR biomaterial trends. The field of THVR is proliferating, and this review serves as a guide for understanding the development of THVs from a materials science and engineering perspective.

Suppression of hydrolytic degradation in labile polymer networks via integrated styrenic nanogels

OBJECTIVE

The objective of this study was to demonstrate an approach with potential to increase the life of dental restorative polymers in water, by maintaining their strength and toughness with varied content of inert or reactive styrenic pre-polymeric additives. It was hypothesized that addition of styrene-co-divinylbenzene nanogels to a conventional dimethacrylate resin (e.g. TEGDMA) would reduce its susceptibility towards hydrolytic degradation, while maintaining equivalent mechanical properties.

METHODS

Polymerization kinetics and functional group conversions were determined by Fourier transform infrared spectroscopy. Triple-detection gel permeation chromatography was used for nanogel particle characterization. A goniometer was used to measure water contact angle on experimental and control photocured polymers. Hydrolytic degradation and mass loss evaluation was performed after extended water storage of an intentionally hydrolytically degradable polymer. Resin viscosity was determined rheometrically and polymer mechanical properties were evaluated using three-point flexural testing with TEGDMA-nanogel formulations.

RESULTS

The polymer network with highest level of nanogel loading (50 wt%) and the highest level of internal nanogel crosslinking (50 mol%) had the lowest degree of equilibrium swelling ratio and mass loss. The flexural modulus and ultimate strength of polymerized TEGDMA and styrenic nanogel-modified TEGDMA were not statistically different (p > 0.05).

SIGNIFICANCE

Due to improved shielding throughout the bulk of methacrylate-based polymers, including an example with an intentionally hydrolytically labile network structure, and a dramatic decrease of water uptake while maintaining equivalent mechanical properties, styrenic nanogel additives especially in high loading levels provide an excellent alternative to eliminate the adverse effects of water and presumably salivary fluids.

Biomaterials in Valvular Heart Diseases

Valvular heart disease (VHD) occurs as the result of valvular malfunction, which can greatly reduce patient's quality of life and if left untreated may lead to death. Different treatment regiments are available for management of this defect, which can be helpful in reducing the symptoms. The global commitment to reduce VHD-related mortality rates has enhanced the need for new therapeutic approaches. During the past decade, development of innovative pharmacological and surgical approaches have dramatically improved the quality of life for VHD patients, yet the search for low cost, more effective, and less invasive approaches is ongoing. The gold standard approach for VHD management is to replace or repair the injured valvular tissue with natural or synthetic biomaterials. Application of these biomaterials for cardiac valve regeneration and repair holds a great promise for treatment of this type of heart disease. The focus of the present review is the current use of different types of biomaterials in treatment of valvular heart diseases.

Extracellular matrix coating improves the biocompatibility of polymeric heart valves

Prosthetic heart valve replacement is an effective therapy for patients with valvular heart disease. New-type polymer materials provide potential choices of material for preparing prosthetic heart valves. In this study, we focused on enhancing the biocompatibility of polystyrene-block-isobutylene-block-styrene (SIBS) by surface modification with an extracellular matrix (ECM). Experimental results demonstrated that the ECM coating increased the adsorption resistance against protein and platelets. SIBS coated with an ECM adsorbed much less bovine serum albumin and fibrinogen (5.38 μg cm-2 and 31.53 μg cm-2, respectively) than the original material (90.84 μg cm-2 and 132.38 μg cm-2, respectively). The relative platelet adsorption of the ECM-modified SIBS was lower than that of SIBS (0.04 versus 0.10). Moreover, the surface coating could also reduce endothelial cytotoxicity, suppress the immune response, and potentially induce tissue regeneration. In conclusion, ECM coating improved the biocompatibility of SIBS effectively.

Mechanical considerations for polymeric heart valve development: Biomechanics, materials, design and manufacturing

The native human heart valve leaflet contains a layered microstructure comprising a hierarchical arrangement of collagen, elastin, proteoglycans and various cell types. Here, we review the various experimental methods that have been employed to probe this intricate microstructure and which attempt to elucidate the mechanisms that govern the leaflet's mechanical properties. These methods include uniaxial, biaxial, and flexural tests, coupled with microstructural characterization techniques such as small angle X-ray scattering (SAXS), small angle light scattering (SALS), and polarized light microscopy. These experiments have revealed complex elastic and viscoelastic mechanisms that are highly directional and dependent upon loading conditions and biochemistry. Of all engineering materials, polymers and polymer-based composites are best able to mimic the tissue-level mechanical behavior of the native leaflet. This similarity to native tissue permits the fabrication of polymeric valves with physiological flow patterns, reducing the risk of thrombosis compared to mechanical valves and in some cases surpassing the in vivo durability of bioprosthetic valves. Earlier work on polymeric valves simply assumed the mechanical properties of the polymer material to be linear elastic, while more recent studies have considered the full hyperelastic stress-strain response. These material models have been incorporated into computational models for the optimization of valve geometry, with the goal of minimizing internal stresses and improving durability. The latter portion of this review recounts these developments in polymeric heart valves, with a focus on mechanical testing of polymers, valve geometry, and manufacturing methods.

Impermeable and Compliant: SIBS as a Promising Encapsulant for Ionically Electroactive Devices

Metals and glass are excellent for containing electrolytes and liquids in general, but their rigid mechanics limits their application for mechanically active ionic actuators or flexible/ stretchable electrochemical devices such as batteries and supercapacitors. In this study, we evaluate the performance of spray-coated poly (styrene-block-isobutylene-block-styrene) (SIBS) as a stretchable encapsulant, which suggests that it offers a better combination of compliance and impermeability than any other barrier. We examined the drying time of 360-µm thick encapsulated tri-layer conducting polymer (CP) actuators, comprised of poly(3,4-Ethylenedioxythiophene) (PEDOT) as the CP electrode and an interpenetrated polymer network of polyethylene oxide (PEO) and nitrile butadiene rubber (NBR) as the separator layer, which operates with a 1 M solution of Lithium bis(trifluoromethanesulfonyl)imide (Li+TFSI−) in propylene carbonate (PC). A 100-µm thick SIBS encapsulation layer is anticipated to help these devices to retain 80% of stored PC for more than 1000 times longer compared to when there is no encapsulation (from less than 0.5 days to over 1.5 years). This low permeability combined with the low Young’s modulus of the SIBS film, its biocompatibility, biostability, and FDA approval, as well as ease of fabrication, make this thermoplastic elastomer a promising candidate as an encapsulant for flexible ionic devices such as flexible batteries and supercapacitors, ionic-electrode capacitive sensors, and ionically electroactive actuators. This paves the way for using these devices in implantable and in vivo applications.

Clinically advancing and promising polymer-based therapeutics

In this review article, we will examine the history of polymers and their evolution from provisional World War II materials to medical therapeutics. To provide a comprehensive look at the current state of polymer-based therapeutics, we will classify technologies according to targeted areas of interest, including central nervous system-based and intraocular-, gastrointestinal-, cardiovascular-, dermal-, reproductive-, skeletal-, and neoplastic-based systems. Within each of these areas, we will consider several examples of novel, clinically available polymer-based therapeutics; in addition, this review will also include a discussion of developing therapies, ranging from the in vivo to clinical trial stage, for each targeted area of treatment. Finally, we will emphasize areas of patient care in need of more effective, accessible, and targeted treatment approaches where polymer-based therapeutics may offer potential solutions.

Investigating the Suitability of Carbon Nanotube Reinforced Polymer in Transcatheter Valve Applications

The current delivery size of transcatheter aortic valves, limited by the thickness of their pericardial leaflets, correlates with a high prevalence of major vascular complications. Polyurethane valves can be developed to a fraction of the thickness of pericardial valves through the addition of carbon nanotubes to reinforce their leaflets. This study investigates the suitability of a novel carbon nanotube reinforced leaflet to reduce the delivery profile of transcatheter aortic valves. Carbon nanotube polyurethane composites were developed with thicknesses of 50 μm and their mechanical properties were determined in relation to various environmental effects. The composites demonstrated improvements to the material stiffness, particularly at increasing strain rates compared to the neat polymer. However, increasing nanotube concentrations significantly decreased the fatigue life of the composites. Key findings highlighted a potential for carbon nanotube reinforcement in valve replacement which experience very high strain rates during the cardiac cycle. Further testing is needed to achieve a strong nanotube-matrix interface which will prolong the cyclic fatigue life and further strengthen tensile properties. Testing on the durability and haemocompatibility of these composite heart valves are ongoing.

A Computational Tool for the Microstructure Optimization of a Polymeric Heart Valve Prosthesis

Styrene-based block copolymers are promising materials for the development of a polymeric heart valve prosthesis (PHV), and the mechanical properties of these polymers can be tuned via the manufacturing process, orienting the cylindrical domains to achieve material anisotropy. The aim of this work is the development of a computational tool for the optimization of the material microstructure in a new PHV intended for aortic valve replacement to enhance the mechanical performance of the device. An iterative procedure was implemented to orient the cylinders along the maximum principal stress direction of the leaflet. A numerical model of the leaflet was developed, and the polymer mechanical behavior was described by a hyperelastic anisotropic constitutive law. A custom routine was implemented to align the cylinders with the maximum principal stress direction in the leaflet for each iteration. The study was focused on valve closure, since during this phase the fibrous structure of the leaflets must bear the greatest load. The optimal microstructure obtained by our procedure is characterized by mainly circumferential orientation of the cylinders within the valve leaflet. An increase in the radial strain and a decrease in the circumferential strain due to the microstructure optimization were observed. Also, a decrease in the maximum value of the strain energy density was found in the case of optimized orientation; since the strain energy density is a widely used criterion to predict elastomer's lifetime, this result suggests a possible increase of the device durability if the polymer microstructure is optimized. The present method represents a valuable tool for the design of a new anisotropic PHV, allowing the investigation of different designs, materials, and loading conditions.

Lipid diffusion and swelling in a phase separated biocompatible thermoplastic elastomer

Lipid uptake was analyzed via gravimetric measurements in a biocompatible poly(styrene-block-isobutylene-block-styrene) (SIBS) copolymer. Absorption followed Fickian diffusion behavior very closely, although some deviation was noticed once saturation was reached. Diffusion parameters of three different SIBS formulations were calculated and used to predict the behavior of a fourth type based on molecular weight and relative polystyrene content. SIBS with lower polystyrene content and molecular weight showed lower physical stability and developed surface cracks that propagated with exposure to the lipid medium. Saturation lipid content varied from 45% to 63% by weight and was inversely related to polystyrene content, suggesting most of the plasticization is occurring in the isobutylene phase of SIBS. Moreover, swelling of specimens was monitored throughout the immersion in the lipid medium and ranged from 32% to 58%. Swelling in formulations with lower hard phase (polystyrene) was significantly higher than the swelling in SIBS with higher hard phase content. This is consistent with lipid-induced plasticization occurring in the soft (polyisobutylene) segments, relaxing the polymer network and leading to increased swelling and lipid uptake. The biocompatibility and tailorability of SIBS through control of hard/soft phase ratio offer significant advantages for in vivo applications. However, the lipophilic nature of the material and the associated degradation may render the polymer unusable in certain applications. The predictive model of lipid uptake introduced here will allow more accurate evaluation of lipid susceptibility during the preliminary design phase of SIBS-based in vivo structures.

Hemocompatibility of styrenic block copolymers for use in prosthetic heart valves

Certain styrenic thermoplastic block copolymer elastomers can be processed to exhibit anisotropic mechanical properties which may be desirable for imitating biological tissues. The ex-vivo hemocompatibility of four triblock (hard-soft-hard) copolymers with polystyrene hard blocks and polyethylene, polypropylene, polyisoprene, polybutadiene or polyisobutylene soft blocks are tested using the modified Chandler loop method using fresh human blood and direct contact cell proliferation of fibroblasts upon the materials. The hemocompatibility and durability performance of a heparin coating is also evaluated. Measures of platelet and coagulation cascade activation indicate that the test materials are superior to polyester but inferior to expanded polytetrafluoroethylene and bovine pericardium reference materials. Against inflammatory measures the test materials are superior to polyester and bovine pericardium. The addition of a heparin coating results in reduced protein adsorption and ex-vivo hemocompatibility performance superior to all reference materials, in all measures. The tested styrenic thermoplastic block copolymers demonstrate adequate performance for blood contacting applications.

Fluid dynamic characterization of a polymeric heart valve prototype (Poli-Valve) tested under continuous and pulsatile flow conditions

PURPOSE

Only mechanical and biological heart valve prostheses are currently commercially available. The former show longer durability but require anticoagulant therapy; the latter display better fluid dynamic behavior but do not have adequate durability. New Polymeric Heart Valves (PHVs) could potentially combine the hemodynamic properties of biological valves with the durability of mechanical valves. This work presents a hydrodynamic evaluation of 2 groups of newly developed supra-annular, trileaflet prosthetic heart valves made from styrenic block copolymers (SBC): Poli-Valves.

METHODS

2 types of Poli-Valves made of SBC and differing in polystyrene fraction content were tested under continuous and pulsatile flow conditions as prescribed by ISO 5840 Standard. A pulse duplicator designed ad hoc allowed the valve prototypes to be tested at different flow rates and frequencies. Pressure and flow were recorded; pressure drops, effective orifice area (EOA), and regurgitant volume were computed to assess the behavior of the valve.

RESULTS

Both types of Poli-Valves met the minimum requirements in terms of regurgitation and EOA as specified by the ISO 5840 Standard. Results were compared with 5 mechanical heart valves (MHVs) and 5 tissue heart valves (THVs), currently available on the market.

CONCLUSIONS

Based on these results, PHVs based on styrenic block copolymers, as are Poli-Valves, can be considered a promising alternative for heart valve replacement in the near future.

Physical Characterization and Platelet Interactions under Shear Flows of a Novel Thermoset Polyisobutylene-based Co-polymer

Over the years, several polymers have been developed for use in prosthetic heart valves as alternatives to xenografts. However, most of these materials are beset with a variety of issues, including low material strength, biodegradation, high dynamic creep, calcification, and poor hemocompatibility. We studied the mechanical, surface, and flow-mediated thrombogenic response of poly(styrene-coblock-4-vinylbenzocyclobutene)-polyisobutylene-poly(styrene-coblock-4-vinylbenzocylcobutene) (xSIBS), a thermoset version of the thermoplastic elastomeric polyolefin poly(styrene-block-isobutylene-block-styrene) (SIBS), which has been shown to be resistant to in vivo hydrolysis, oxidation, and enzymolysis. Uniaxial tensile testing yielded an ultimate tensile strength of 35 MPa, 24.5 times greater than that of SIBS. Surface analysis yielded a mean contact angle of 82.05° and surface roughness of 144 nm, which was greater than for poly(ε-caprolactone) (PCL) and poly(methyl methacrylate) (PMMA). However, the change in platelet activation state, a predictor of thrombogenicity, was not significantly different from PCL and PMMA after fluid exposure to 1 dyn/cm(2) and 20 dyn/cm(2). In addition, the number of adherent platelets after 10 dyn/cm(2) flow exposure was on the same order of magnitude as PCL and PMMA. The mechanical strength and low thrombogenicity of xSIBS therefore suggest it as a viable polymeric substrate for fabrication of prosthetic heart valves and other cardiovascular devices.

Tangible nanocomposites with diverse properties for heart valve application

Cardiovascular disease claims millions of lives every year throughout the world. Biomaterials are used widely for the treatment of this fatal disease. With the advent of nanotechnology, the use of nanocomposites has become almost inevitable in the field of biomaterials. The versatile properties of nanocomposites, such as improved durability and biocompatibility, make them an ideal choice for various biomedical applications. Among the various nanocomposites, polyhedral oligomeric silsesquioxane-poly(carbonate-urea)urethane, bacterial cellulose with polyvinyl alcohol, carbon nanotubes, graphene oxide and nano-hydroxyapatite nanocomposites have gained popularity as putative choices for biomaterials in cardiovascular applications owing to their superior properties. In this review, various studies performed utilizing these nanocomposites for improving the mechanical strength, anti-calcification potential and hemocompatibility of heart valves are reviewed and summarized. The primary motive of this work is to shed light on the emerging nanocomposites for heart valve applications. Furthermore, we aim to promote the prospects of these nanocomposites in the campaign against cardiovascular diseases.

Polymeric trileaflet prosthetic heart valves: evolution and path to clinical reality

Present prosthetic heart valves, while hemodynamically effective, remain limited by progressive structural deterioration of tissue valves or the burden of chronic anticoagulation for mechanical valves. An idealized valve prosthesis would eliminate these limitations. Polymeric heart valves (PHVs), fabricated from advanced polymeric materials, offer the potential of durability and hemocompatibility. Unfortunately, the clinical realization of PHVs to date has been hampered by findings of in vivo calcification, degradation and thrombosis. Here, the authors review the evolution of PHVs, evaluate the state of the art of this technology and propose a pathway towards clinical reality. In particular, the authors discuss the development of a novel aortic PHV that may be deployed via transcatheter implantation, as well as its optimization via device thrombogenicity emulation.

In vitro evaluation of a novel hemodynamically optimized trileaflet polymeric prosthetic heart valve

Calcific aortic valve disease is the most common and life threatening form of valvular heart disease, characterized by stenosis and regurgitation, which is currently treated at the symptomatic end-stages via open-heart surgical replacement of the diseased valve with, typically, either a xenograft tissue valve or a pyrolytic carbon mechanical heart valve. These options offer the clinician a choice between structural valve deterioration and chronic anticoagulant therapy, respectively, effectively replacing one disease with another. Polymeric prosthetic heart valves (PHV) offer the promise of reducing or eliminating these complications, and they may be better suited for the new transcatheter aortic valve replacement (TAVR) procedure, which currently utilizes tissue valves. New evidence indicates that the latter may incur damage during implantation. Polymer PHVs may also be incorporated into pulsatile circulatory support devices such as total artificial heart and ventricular assist devices that currently employ mechanical PHVs. Development of polymer PHVs, however, has been slow due to the lack of sufficiently durable and biocompatible polymers. We have designed a new trileaflet polymer PHV for surgical implantation employing a novel polymer-xSIBS-that offers superior bio-stability and durability. The design of this polymer PHV was optimized for reduced stresses, improved hemodynamic performance, and reduced thrombogenicity using our device thrombogenicity emulation (DTE) methodology, the results of which have been published separately. Here we present our new design, prototype fabrication methods, hydrodynamics performance testing, and platelet activation measurements performed in the optimized valve prototype and compare it to the performance of a gold standard tissue valve. The hydrodynamic performance of the two valves was comparable in all measures, with a certain advantage to our valve during regurgitation. There was no significant difference between the platelet activation rates of our polymer valve and the tissue valve, indicating that similar to the latter, its recipients may not require anticoagulation. This work proves the feasibility of our optimized polymer PHV design and brings polymeric valves closer to clinical viability.

Toward optimization of a novel trileaflet polymeric prosthetic heart valve via device thrombogenicity emulation

Aortic stenosis is the most prevalent and life-threatening form of valvular heart disease. It is primarily treated via open-heart surgical valve replacement with either a tissue or a mechanical prosthetic heart valve (PHV), each prone to degradation and thrombosis, respectively. Polymeric PHVs may be optimized to eliminate these complications, and they may be more suitable for the new transcatheter aortic valve replacement procedure and in devices like the total artificial heart. However, the development of polymer PHVs has been hampered by persistent in vivo calcification, degradation, and thrombosis. To address these issues, we have developed a novel surgically implantable polymer PHV composed of a new thermoset polyolefin called cross-linked poly(styrene-block-isobutylene-block-styrene), or xSIBS, in which key parameters were optimized for superior functionality via our device thrombogenicity emulation methodology. In this parametric study, we compared our homogeneous optimized polcymer PHV to a prior composite polymer PHV and to a benchmark tissue valve. Our results show significantly improved hemodynamics and reduced thrombogenicity in the optimized polymer PHV compared to the other valves. These results indicate that our new design may not require anticoagulants and may be more durable than its predecessor, and validate the improvement, toward optimization, of this novel polymeric PHV design.

Synthesis of HMDI-based segmented polyurethanes and their use in the manufacture of elastomeric composites for cardiovascular applications

For short-term cardiovascular application, segmented polyurethanes (SPUs) based on 4,4-methylenebis(cyclohexyl isocyanate) (HMDI), polytetramethylenglycol (PTMG) and 1,4-butanediol (BD) were synthesized and characterized by spectroscopy (FT-IR, (1)H-NMR) and thermal (TGA, DMA, DSC) and mechanical techniques. The segmented nature of the SPUs was not easily established by spectroscopic means; however, TGA allowed the quantification of the rigid segments content by the significant mass loss between 348 and 356 degrees C. The alpha transition was detected by DMA and related to the T(g) of the soft segments at -50 degrees C, while DSC showed the presence of an endothermic transition above 80 degrees C attributed to the melting of rigid segments. Two types of composites were prepared using the synthesized SPUs and Lycra (either T162B or T162C). The first one consisted of a two layers casting laminated while the second one was a classic unidirectional fibre-reinforced material. Laminate composites prepared with SPU containing 23.9% and 33.9% of rigid segments and Lycra T162C exhibited a higher tensile modulus but lower tensile strength than composites prepared with Tecoflex SG-80A (39.7% of rigid segments). The energy of adhesion between layers on these composites ranged from 475 to 2150 J. Fibre-reinforced SPUs exhibited higher moduli than the two layer laminated composites with increasing amounts of rigid segments in the matrix and by increasing Lycra T162C content (up to 10%). This behaviour was explained by SEM, which showed a good fibre-matrix bonding.

Nanocomposite biomaterial mimicking aortic heart valve leaflet mechanical behaviour

The main problem with polymeric heart valves (which are already biocompatible) is that they usually fail in the long term owing to tearing and calcification of the leaflets under high dynamic tensile bending stress and oxidative reactions with blood. To overcome this shortcoming, it is hypothesized that synthetic valve leaflets which mimic native valve leaflet structure fabricated from fibre-reinforced composite material will optimize leaflet stresses and decrease tears and perforations. The objective of this study is to develop a PVA-BC (polyvinyl alcohol-bacterial cellulose)-based hydrogel that mimics not only the non-linear mechanical properties displayed by porcine heart valves, but also their anisotropic behaviour. By applying a controlled strain to the PVA samples, while undergoing low-temperature thermal cycling, it was possible to create oriented mechanical properties in PVA hydrogels. The oriented stress–strain properties of porcine aortic valves were matched simultaneously by a PVA hydrogel (15 per cent PVA, 0.5 BC cycle 4, 75 per cent initial tensile strain). This novel technique allows the control of anisotropy to PVA hydrogel, and gives a broad range of control of its mechanical properties, for specific medical device applications.

Thrombogenic potential of Innovia polymer valves versus Carpentier-Edwards Perimount Magna aortic bioprosthetic valves

Trileaflet polymeric prosthetic aortic valves (AVs) produce hemodynamic characteristics akin to the natural AV and may be most suitable for applications such as transcatheter implantation and mechanical circulatory support (MCS) devices. Their success has not yet been realized due to problems of calcification, durability, and thrombosis. We address the latter by comparing the platelet activation rates (PARs) of an improved polymer valve design (Innovia LLC) made from poly(styrene-block-isobutylene-block-styrene) (SIBS) with the commercially available Carpentier-Edwards Perimount Magna Aortic Bioprosthetic Valve. We used our modified prothrombinase platelet activity state (PAS) assay and flow cytometry methods to measure platelet activation of a pair of 19 mm valves mounted inside a pulsatile Berlin left ventricular assist device (LVAD). The PAR of the polymer valve measured with the PAS assay was fivefold lower than that of the tissue valve (p = 0.005) and fourfold lower with flow cytometry measurements (p = 0.007). In vitro hydrodynamic tests showed clinically similar performance of the Innovia and Magna valves. These results demonstrate a significant improvement in thrombogenic performance of the polymer valve compared with our previous study of the former valve design and encourage further development of SIBS for use in heart valve prostheses.

Recent Advances in Polymeric Heart Valves Research

Heart valve replacement is fast becoming a routine surgery worldwide, and heart valve prostheses are today considered among the most widely used cardiovascular devices. Mechanical and bioprostheses have been the traditional choices to the replacement surgeries. However, such valves continue to expose patients to risks including thrombosis, infection and limited valve durability. In recent years, advances in polymer science give rise to an important new class of artificial heart valve made predominantly of polyurethane-based materials, which show improved biocompatibility and biostability. These polymeric heart valves have demonstrated excellent hemodynamic performance and good durability with excellent fatigue stress resistance. Advancements in the designs and manufacturing methods also suggested improved in the durability of polymeric heart valves. Animal studies with these valves have also shown good biocompatibility with minimal calcification of the valve leaflets. With these promising progresses, polymeric heart valves could be a viable alternative in the heart valve replacement surgeries in the near future.

Prosthetic aortic heart valves: modeling and design

Although heart valve replacement is among the most common cardiovascular surgical procedures, their outcome is often difficult to predict. One of the reasons is the design and choice of the materials used for the fabrication of the prostheses. This review paper describes the use of modeling techniques in prosthetic heart valve (HV) design and aims at the justification and development of a polymer based trileaflet mechanical heart valve (MHV). The closing/opening phase behavior of the bileaflet MHV was investigated. The potential problem of valve failure due to crack propagation in the brittle pyrolytic carbon leaflet was also discussed. These studies suggest that although bileaflet MHV performs satisfactorily, there are justifications for improvement. Since the native aortic HV is trileaflet and made of anisotropic and hyperelastic tissue, one possible approach to a better MHV design is based on our ability to closely mimic the natural geometry and biomaterial properties.

A novel small animal model for biocompatibility assessment of polymeric materials for use in prosthetic heart valves

A composite polymeric material, poly(styrene-block-isobutylene-block-styrene) (SIBS) with an embedded reinforcement polyethylene terephthalate (PET) fabric, is undergoing investigation for potential use in a novel heart valve. The purpose of this study was to develop and implement a small animal model to assess the biocompatibility of composite samples in a cardiovascular tissue and blood-contacting environment. Composite samples were manufactured using dip coating and solvent casting with two coating thicknesses (25 and 50 microm). A novel rat abdominal aorta model was developed to test the dip-coated samples in a similar pulsatile flow condition to its intended use, and both dip-coated and solvent-cast samples were tested using a rat subcutaneous model. Tissue response, defined by degree of cellular infiltration and encapsulation, was minimized when a smooth coating of SIBS shielded the PET fabric from exposure to blood and tissue, and the degree of tissue response was directly correlated with the degree of surface roughness. Surface modification using phospholipid further reduces the tissue response. We have demonstrated the applicability of using a novel rat abdominal aorta model for biocompatibility assessment of polymeric materials that will be used in cardiovascular implants. For the purpose of this study, our results indicate that solvent casting with a 25-microm SIBS coating thickness will provide optimal biocompatibility for the SIBS valve.

Development and evaluation of a novel artificial catheter-deliverable prosthetic heart valve and method for in vitro testing

BACKGROUND

This work presents a novel artificial prosthetic heart valve designed to be catheter or percutaneously deliverable, and a method for in vitro testing of the device. The device is intended to create superior characteristics in comparison to tissue-based percutaneous valves.

METHODS

The percutaneous heart valve (PhV) was constructed from state-of-the-art polymers, metals and fabrics. It was tested hydrodynamically using a modified left heart simulator (Lhs) and statically using a tensile testing device.

RESULTS

The PhV exhibited a mean transvalvular pressure gradient of less than 15 mmhg and a mean regurgitant fraction of less than 5 percent. It also demonstrated a resistance to migration of up to 6 N and a resistance to crushing of up to 25 N at a diameter of 19 mm. The PhV was crimpable to less than 24 F and was delivered into the operating Lhs via a 24 F catheter.

CONCLUSION

An artificial PhV was designed and optimized, and an in vitro methodology was developed for testing the valve. The artificial PhV compared favorably to existing tissue-based PhVs. The in vitro test methods proved to be reliable and reproducible. The PhV design proved the feasibility of an artificial alternative to tissue based PhVs, which in their traditional open-heart implantable form are known to have limited in vivo durability.

Polymeric heart valves: new materials, emerging hopes

Heart valve (HV) replacements are among the most widely used cardiovascular devices and are in rising demand. Currently, clinically available devices are restricted to slightly modified mechanical and bioprosthetic valves. Polymeric HVs could represent an attractive alternative to the existing prostheses, merging the superior durability of mechanical valves and the enhanced haemodynamic function of bioprosthetic valves. After early unsatisfactory clinical results, polymeric HVs did not reach commercialization, mainly owing to their limited durability. Recent advances in polymers, nanomaterials and surface modification techniques together with the emergence of novel biomaterials have resulted in improved biocompatibility and biostability. Advances in HV design and fabrication methods could also lead to polymeric HVs that are suitable for long-lasting implantation. Considering all these progresses, it is likely that the new generation of polymeric HVs will find successful long-term clinical applications in future.

A Phospholipid-modified Polystyrene—Polyisobutylene— Polystyrene (SIBS) Triblock Polymer for Enhanced Hemocompatibility and Potential Use in Artificial Heart Valves

Poly(styrene-block-isobutylene-block-styrene) (`SIBS') is selected for a novel trileaflet heart valve due to its high resistance to oxidation, hydrolysis, and enzyme attack. SIBS is modified using six different phospholipids and its mechanical properties characterized by tensile stress, peel strength, shear strength, contact angle, and surface energy, and then for hemocompatibility by studying the adhesion of fluorescently labeled platelets in a parallel plate chamber under physiological flow conditions. Phospholipid modification decreases SIBS tensile stress (at 45% strain) by 30% and reduces platelet adhesion by a factor of 10, thereby improving its hemocompatibility and its potential use as a synthetic heart valve.

Biocompatibility: meeting a key functional requirement of next-generation medical devices

The array of polymeric, biologic, metallic, and ceramic biomaterials will be reviewed with respect to their biocompatibility, which has traditionally been viewed as a requirement to develop a safe medical device. With the emergence of combination products, a paradigm shift is occurring that now requires biocompatibility to be designed into the device. In fact, next-generation medical devices will require enhanced biocompatibility by using, for example, pharmacological agents, bioactive coatings, nano-textures, or hybrid systems containing cells that control biologic interactions to have desirable biologic outcomes. The concept of biocompatibility is moving from a "do no harm" mission (i.e., nontoxic, nonantigenic, nonmutagenic, etc.) to one of doing "good," that is, encouraging positive healing responses. These new devices will promote the formation of normal healthy tissue as well as the integration of the device into adjacent tissue. In some contexts, biocompatibility can become a disruptive technology that can change therapeutic paradigms (e.g., drug-coated stents). New database tools to access biocompatibility data of the materials of construction in existing medical devices will facilitate the use of existing and new biomaterials for new medical device designs.