The influence of textile vascular prosthesis crimping on graft longitudinal elasticity and flexibility

Effect of molar mass and alkyl chain length on the surface properties and biocompatibility of poly(alkylene terephthalate)s for potential cardiovascular applications

Cardiovascular diseases are the leading cause of death worldwide. Treatments for occluded arteries include balloon angioplasty with or without stenting and bypass grafting surgery. Poly(ethylene terephthalate) is frequently used as a vascular graft material, but its high stiffness leads to compliance mismatch with the human blood vessels, resulting in altered hemodynamics, thrombus formation and graft failure. Poly(alkylene terephthalate)s (PATs) with longer alkyl chain lengths hold great potential for improving the compliance. In this work, the effect of the polymer molar mass and the alkyl chain length on the surface roughness and wettability of spin-coated PAT films was investigated, as well as the endothelial cell adhesion and proliferation on these samples. We found that surface roughness generally increases with increasing molar mass and alkyl chain length, while no trend for the wettability could be observed. All investigated PATs are non-cytotoxic and support endothelial cell adhesion and growth. For some PATs, the endothelial cells even reorganized into a tubular-like structure, suggesting angiogenic maturation. In conclusion, this research demonstrates the biocompatibility of PATs and their potential to be applied as materials serving cardiovascular applications.

Tri-Layered Vascular Grafts Guide Vascular Cells’ Native-like Arrangement

Bionic grafts hold great promise for directing tissue regeneration. In vascular tissue engineering, although a large number of synthetic grafts have been constructed, these substitutes only partially recapitulated the tri-layered structure of native arteries. Synthetic polymers such as poly(l-lactide-co-ε-caprolactone) (PLCL) possess good biocompatibility, controllable degradation, remarkable processability, and sufficient mechanical strength. These properties of PLCL show great promise for fabricating synthetic vascular substitutes. Here, tri-layered PLCL vascular grafts (TVGs) composed of a smooth inner layer, circumferentially aligned fibrous middle layer, and randomly distributed fibrous outer layer were prepared by sequentially using ink printing, wet spinning, and electrospinning techniques. TVGs possessed kink resistance and sufficient mechanical properties (tensile strength, elastic modulus, suture retention strength, and burst pressure) equivalent to the gold standard conduits of clinical application, i.e., human saphenous veins and human internal mammary arteries. The stratified structure of TVGs exhibited a visible guiding effect on specific vascular cells including enhancing endothelial cell (EC) monolayer formation, favoring vascular smooth muscle cells’ (VSMCs) arrangement and elongation, and facilitating fibroblasts’ proliferation and junction establishment. Our research provides a new avenue for designing synthetic vascular grafts with polymers.

Medical Textiles as Vascular Implants and Their Success to Mimic Natural Arteries

Vascular implants belong to a specialised class of medical textiles. The basic purpose of a vascular implant (graft and stent) is to act as an artificial conduit or substitute for a diseased artery. However, the long-term healing function depends on its ability to mimic the mechanical and biological behaviour of the artery. This requires a thorough understanding of the structure and function of an artery, which can then be translated into a synthetic structure based on the capabilities of the manufacturing method utilised. Common textile manufacturing techniques, such as weaving, knitting, braiding, and electrospinning, are frequently used to design vascular implants for research and commercial purposes for the past decades. However, the ability to match attributes of a vascular substitute to those of a native artery still remains a challenge. The synthetic implants have been found to cause disturbance in biological, biomechanical, and hemodynamic parameters at the implant site, which has been widely attributed to their structural design. In this work, we reviewed the design aspect of textile vascular implants and compared them to the structure of a natural artery as a basis for assessing the level of success as an implant. The outcome of this work is expected to encourage future design strategies for developing improved long lasting vascular implants.

Attachment of human endothelial cells to polyester vascular grafts: pre-coating with adhesive protein assemblies and resistance to short-term shear stress

Cardiovascular prosthetic bypass grafts do not endothelialize spontaneously in humans, and so they pose a thrombotic risk. Seeding with cells improves their performance, particularly in small-caliber applications. Knitted tubular polyethylene-terephthalate (PET) vascular prostheses (6 mm) with commercial type I collagen (PET/Co) were modified in the lumen by the adsorption of laminin (LM), by coating with a fibrin network (Fb) or a combination of Fb and fibronectin (Fb/FN). Primary human saphenous vein endothelial cells were seeded (1.50 × 10(5)/cm2), cultured for 72 h and exposed to laminar shear stress 15 dyn/cm(2) for 40 and 120 min. The control static grafts were excluded from shearing. The cell adherence after 4 h on PET/Co, PET/Co +LM, PET/Co +Fb and PET/Co +Fb/FN was 22%, 30%, 19% and 27% of seeding, respectively. Compared to the static grafts, the cell density on PET/Co and PET/Co +LM dropped to 61% and 50%, respectively, after 120 min of flow. The cells on PET/Co +Fb and PET/Co +Fb/FN did not show any detachment during 2 h of shear stress. Pre-coating the clinically-used PET/Co vascular prosthesis with LM or Fb/FN adhesive protein assemblies promotes the adherence of endothelium. Cell retention under flow is improved particularly on fibrin-containing (Fb and Fb/FN) surfaces.

A biomimetic approach for designing stent-graft structures: Caterpillar cuticle as design model

Stent-graft (SG) induced biomechanical mismatch at the aortic repair site forms the major reason behind postoperative hemodynamic complications. These complications arise from mismatched radial compliance and stiffness property of repair device relative to native aortic mechanics. The inability of an exoskeleton SG design (an externally stented rigid polyester graft) to achieve optimum balance between structural robustness and flexibility constrains its biomechanical performance limits. Therefore, a new SG design capable of dynamically controlling its stiffness and flexibility has been proposed in this study. The new design is adopted from the segmented hydroskeleton structure of a caterpillar cuticle and comprises of high performance polymeric filaments constructed in a segmented knit architecture. Initially, conceptual design models of caterpillar and SG were developed and later translated into an experimental SG prototype. The in-vitro biomechanical evaluation (compliance, bending moment, migration intensity, and viscoelasticity) revealed significantly better performance of hydroskeleton structure than a commercial SG device (Zenith(™) Flex SG) and woven Dacron(®) graft-prosthesis. Structural segmentation improved the biomechanical behaviour of new SG by inducing a three dimensional volumetric expansion property when the SG was subjected to hoop stresses. Interestingly, this behaviour matches the orthotropic elastic property of native aorta and hence proposes segmented hydroskeleton structures as promising design approach for future aortic repair devices.