Polyurethane: material for the next generation of heart valve prostheses?

Design, manufacturing and testing of a green non-isocyanate polyurethane prosthetic heart valve

The sole effective treatment for most patients with heart valve disease is valve replacement by implantation of mechanical or biological prostheses. However, mechanical valves represent high risk of thromboembolism, and biological prostheses are prone to early degeneration. In this work, we aim to determine the potential of novel environmentally-friendly non-isocyanate polyurethanes (NIPUs) for manufacturing synthetic prosthetic heart valves. Polyhydroxyurethane (PHU) NIPUs are synthesized via an isocyanate-free route, tested in vitro, and used to produce aortic valves. PHU elastomers reinforced with a polyester mesh show mechanical properties similar to native valve leaflets. These NIPUs do not cause hemolysis. Interestingly, both platelet adhesion and contact activation-induced coagulation are strongly reduced on NIPU surfaces, indicating low thrombogenicity. Fibroblasts and endothelial cells maintain normal growth and shape after indirect contact with NIPUs. Fluid-structure interaction (FSI) allows modeling of the ideal valve design, with minimal shear stress on the leaflets. Injection-molded valves are tested in a pulse duplicator and show ISO-compliant hydrodynamic performance, comparable to clinically-used bioprostheses. Poly(tetrahydrofuran) (PTHF)-NIPU patches do not show any evidence of calcification over a period of 8 weeks. NIPUs are promising sustainable biomaterials for the manufacturing of improved prosthetic valves with low thrombogenicity.

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.

Thermoplastic polyurethane/POSS nanohybrids: Synthesis, morphology, and biological properties

Recent studies show good osteoinductive properties of polyurethanes modified with polyhedral oligomeric silsesquioxanes (POSS). In this work, three types of POSS; propanediolisobutyl-POSS (PHI-POSS), disilanolisobutyl-POSS (DSI-POSS), and octahydroxybutyl-POSS (OCTA-POSS) were chemically incorporated into linear polyurethane based on an aliphatic isocyanate, hexamethylene diisocyanate (HDI), to obtain new nanohybrid PU-POSS materials. The full conversion of POSS was confirmed by Fourier transform infrared spectroscopy (FTIR-ATR) spectra of the model reactions with pure HDI. The materials obtained were investigated by FTIR, SEM-EDS, and DSC. The DSC studies showed the thermoplasticity of the obtained materials and apparently good recovery. 30-day immersion in SBF (simulated body fluid) revealed an increase in the rate of deposition of hydroxyapatite (HAp) for the highest POSS loadings, resulting in thick layers of hydroxyapatite (~60-40 μm), and the Ca/P ratio 1.67 (even 1.785). The structure and properties of the inorganic layer depend on the type of POSS, the number of hard segments, and those containing POSS, which can be tailored by changing the HDI/poly(tetramethylene glycol) (PTMG) ratio. Furthermore, the obtained composites revealed good biocompatibility, as confirmed by cytotoxicity tests conducted on two cell lines; normal human dermal fibroblasts (NHDF) and primary human osteoblasts (HOB). Adherent cells seeded on the tested materials showed viability even after a 48-h incubation. After this time, the population of viable, and proliferating cells exceeded 90%. Bioimaging studies have shown the fibroblast and osteoblast cells were well attached to the surface of the tested materials.

Progress on a Novel, 3D-Printable Heart Valve Prosthesis

(1) Background: Polymeric heart valves are prostheses constructed out of flexible, synthetic materials to combine the advantageous hemodynamics of biological valves with the longevity of mechanical valves. This idea from the early days of heart valve prosthetics has experienced a renaissance in recent years due to advances in polymer science. Here, we present progress on a novel, 3D-printable aortic valve prosthesis, the TIPI valve, removing the foldable metal leaflet restrictor structure in its center. Our aim is to create a competitive alternative to current valve prostheses made from flexible polymers. (2) Methods: Three-dimensional (3D) prototypes were designed and subsequently printed in silicone. Hemodynamic performance was measured with an HKP 2.0 hemodynamic testing device using an aortic valve bioprosthesis (BP), a mechanical prosthesis (MP), and the previously published prototype (TIPI 2.2) as benchmarks. (3) Results: The latest prototype (TIPI 3.4) showed improved performance in terms of regurgitation fraction (TIPI 3.4: 15.2 ± 3.7%, TIPI 2.2: 36.6 ± 5.0%, BP: 8.8 ± 0.3%, MP: 13.2 ± 0.7%), systolic pressure gradient (TIPI 3.4: 11.0 ± 2.7 mmHg, TIPI 2.2: 12.8 ± 2.2 mmHg, BP: 8.2 ± 0.9 mmHg, MP: 10.5 ± 0.6 mmHg), and effective orifice area (EOA, TIPI 3.4: 1.39 cm2, TIPI 2.2: 1.28 cm2, BP: 1.58 cm2, MP: 1.38 cm2), which was equivalent to currently used aortic valve prostheses. (4) Conclusions: Removal of the central restrictor structure alleviated previous concerns about its potential thrombogenicity and significantly increased the area of unobstructed opening. The prototypes showed unidirectional leaflet movement and very promising performance characteristics within our testing setup. The resulting simplicity of the shape compared to other approaches for polymeric heart valves could be suitable not only for 3D printing, but also for fast and easy mass production using molds and modern, highly biocompatible polymers.

Strategies for Development of Synthetic Heart Valve Tissue Engineering Scaffolds

The current clinical solutions, including mechanical and bioprosthetic valves for valvular heart diseases, are plagued by coagulation, calcification, nondurability, and the inability to grow with patients. The tissue engineering approach attempts to resolve these shortcomings by producing heart valve scaffolds that may deliver patients a life-long solution. Heart valve scaffolds serve as a three-dimensional support structure made of biocompatible materials that provide adequate porosity for cell infiltration, and nutrient and waste transport, sponsor cell adhesion, proliferation, and differentiation, and allow for extracellular matrix production that together contributes to the generation of functional neotissue. The foundation of successful heart valve tissue engineering is replicating native heart valve architecture, mechanics, and cellular attributes through appropriate biomaterials and scaffold designs. This article reviews biomaterials, the fabrication of heart valve scaffolds, and their in-vitro and in-vivo evaluations applied for heart valve tissue engineering.

Scientific Evolution of Artificial Heart Valves: A Narrative Review

Cardiovascular disorders have always been the top contributors to the number of mortality occurring worldwide. But the last few decades have seen a drop in those numbers as the lives of millions of people have been saved due to ground-breaking advances in both therapeutic and surgical treatment modalities. Achieving this level of scientific glory in cardiology was a challenging feat. The credit goes to the scientists and physicians of the previous century who, despite their time's technological limitations, made discoveries and laid a solid foundation for modern medicine. Valvular complications are a major part of the global burden of cardiac diseases. The ongoing development of heart valve replacements remains a fascinating subject, as it continues to progress. Valve replacements comprise either mechanical heart valves or bioprosthetic heart valves. Both types of valves have their merits and demerits; their usage depends mostly on individual patient requirements. This article aims to review the evolution of the implantation of heart valves, and it is the objective of this article to give credit to scientists and physicians for their contributions. The article highlights the research gaps in finding more durable materials and the scope of further research in creating a heart valve that can be universally used for better patient outcomes.

Pediatric pulmonary valve replacements: Clinical challenges and emerging technologies

Congenital heart diseases (CHDs) frequently impact the right ventricular outflow tract, resulting in a significant incidence of pulmonary valve replacement in the pediatric population. While contemporary pediatric pulmonary valve replacements (PPVRs) allow satisfactory patient survival, their biocompatibility and durability remain suboptimal and repeat operations are commonplace, especially for very young patients. This places enormous physical, financial, and psychological burdens on patients and their parents, highlighting an urgent clinical need for better PPVRs. An important reason for the clinical failure of PPVRs is biofouling, which instigates various adverse biological responses such as thrombosis and infection, promoting research into various antifouling chemistries that may find utility in PPVR materials. Another significant contributor is the inevitability of somatic growth in pediatric patients, causing structural discrepancies between the patient and PPVR, stimulating the development of various growth-accommodating heart valve prototypes. This review offers an interdisciplinary perspective on these challenges by exploring clinical experiences, physiological understandings, and bioengineering technologies that may contribute to device development. It thus aims to provide an insight into the design requirements of next-generation PPVRs to advance clinical outcomes and promote patient quality of life.

Preclinical Large Animal In-Vivo Experiments for Surgically Implanted Atrioventricular Valve: Reappraisal and Systematic Review

BACKGROUND

The development of atrioventricular bioprosthesis has witnessed an increasing drive toward clinical translation over the last few decades. A significant challenge in the clinical translation of an atrioventricular bioprosthesis from bench to bedside is the appropriate choice of a large animal model to test the safety and effectiveness of the device.

METHODS

We conducted a systematic review of pre-clinical in vivo studies that would enable us to synthesize a recommended framework. PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) guidelines were followed to identify and extract relevant articles.

RESULTS

Sheep was the most common choice of animal, with nine out of the 12 included studies being conducted on sheep. There were acute and chronic studies based on our search criteria. An average of ~20 and 5 animals were used for chronic and acute studies. One out of three acute studies and eight out of nine chronic studies were on stented heart valve bioprosthesis. All analyses were conducted on the implantation of atrioventricular valves with trileaflet, except for one chronic study on unileaflet valves and one chronic and acute study on bileaflet valves.

CONCLUSION

Understanding the variance in past pre-clinical study designs may increase the appropriate utilization of large animal models. This synthesized evidence provides a pre-clinical in vivo studies framework for future research on an atrioventricular bioprosthesis.

Development of Innovative Biomaterials and Devices for the Treatment of Cardiovascular Diseases

Cardiovascular diseases have become the leading cause of death worldwide. The increasing burden of cardiovascular diseases has become a major public health problem and how to carry out efficient and reliable treatment of cardiovascular diseases has become an urgent global problem to be solved. Recently, implantable biomaterials and devices, especially minimally invasive interventional ones, such as vascular stents, artificial heart valves, bioprosthetic cardiac occluders, artificial graft cardiac patches, atrial shunts, and injectable hydrogels against heart failure, have become the most effective means in the treatment of cardiovascular diseases. Herein, an overview of the challenges and research frontier of innovative biomaterials and devices for the treatment of cardiovascular diseases is provided, and their future development directions are discussed.

Regularization of a Mathematical Model of the Wheatley Heart Valve

This note considers the mathematical model published in the Journal of Biomechanical Engineering by McKee et al. [1]. The model presented there suffers from the fact that there is a line discontinuity in the first derivative producing what appears to be a kink in each of the leaflets. This note is concerned with regularizing the shape of the valve while holding to Wheatley's essential idea [2].

In Vivo Biocompatibility of an Innovative Elastomer for Heart Assist Devices

Cardiac surgical approaches require the development of new materials regardless of the polyurethanes used for pulsatile blood pumps; therefore, an innovative biomaterial, a copolymer of poly(ethylene terephthalate) and dimer fatty acid (dilinoleic acid) modified with D-glucitol, hereafter referred to as PET/DLA, has been developed, showing non-hemolytic and atrombogenic properties and resistance to biodegradation. The aim of this work was to evaluate in vivo inflammatory responses to intramuscular implantation of PET/DLA biomaterials of different compositions (hard to soft segments). Two copolymers containing 70 and 65 wt.% of hard segments, as in poly(ethylene terephthalate) and dilinoleic acid in soft segments modified with D-glucitol, were used for implantation tests to monitor tissue response. Medical grade polyurethanes Bionate II 90A and Bionate II 55 were used as reference materials. After euthanasia of animals (New Zealand White rabbits, n = 49), internal organs and tissues that contacted the material were collected for histopathological examination. The following parameters were determined: peripheral blood count, blood smear with May Grunwald–Giemsa staining, and serum C-reactive protein (CRPP). The healing process observed at the implantation site of the new materials after 12 weeks indicated normal progressive collagenization of the scar, with an indication of the inflammatory–resorptive process. The analysis of the chemical structure of explants 12 weeks after implantation showed good stability of the tested copolymers in contact with living tissues. Overall, the obtained results indicate great potential for PET/DLA in medical applications; however, final verification of its applicability as a structural material in prostheses is needed.

A Mathematical Representation of the Wheatley Heart Valve

Starting from a hand-drawn contour plot, this note develops a set of intersecting and contiguous circles whose perimeter, upon extending appropriately to three dimensions, can be seen to be a natural mathematical representation of the Wheatley heart valve.

Structural stability of novel composite heart valve prostheses - Fatigue and wear performance

Heart valve replacement is a very effective method to treat severe valvular stenosis or valvular insufficiency. The valve can be divided into the mechanical valve and biological valve according to the main materials of the valve leaflets. The former has good durability, but the patients need to take anticoagulants all their lives, otherwise, thrombosis will occur; the latter has good blood compatibility, and only 3-6 months of postoperative anticoagulation is required, but its durability is lower than the former. Compared with a traditional valve used materials, the fabric composite valve leaflets have both mechanical valve and biological valve advantages, i.e. it can have both good blood compatibility and excellent fatigue resistance. This material is comprised of the internal fabric layer and bilateral external polyurethane layers jointed with adhesive, and it can adjust the flexibility, wear-resistance and fatigue resistance of the valve leaflet through adjusting the thickness of the outer polyurethane protective layer, the weaving method, the fiber diameter and the surface density of the inner ultra-high molecular weight polyethylene (UHMWPE) fabric. In this article, we tested the long-term durability of a fabric composite with its property close to the valve leaflet made of bovine pericardium, to evaluate the material performance loss under long-term fatigue and the wear degree of this material with different polyurethane layer thicknesses. As many as two hundred million cycles of fatigue test and the hydrodynamic performance test before and after the fatigue test proved that the material could withstand a service life of at least five years without structural failure or functional degradation. According to the SEM images after the experiment, it can be predicted that this material can achieve a longer fatigue life.

Design, Manufacturing Technology and In-Vitro Evaluation of Original, Polyurethane, Petal Valves for Application in Pulsating Ventricular Assist Devices

Minimizing of the life-threatening thrombo-emboli formation in pulsatile heart assist devices by a new biomimetic heart valve design is presently one of the most important problems in medicine. As part of this work, an original valve structure was proposed intended for pneumatic, extracorporeal ventricular assist devices. The valve design allows for direct integration with other parts of the pulsating blood pump. Strengthening in the form of the titanium or steel frame has been introduced into the polyurethane lagging, which allows for maintaining material continuity and eliminating the risk of blood clotting. The prototype of the valve was made by the injection molding method assisted by numerical simulation of this process. The prototype was introduced into a modified pulsating, extracorporeal heart assist pump ReligaHeart EXT (developed for tilting disc valves) and examined in-vitro using the “artificial patient” model in order to determine hydrodynamic properties of the valve in the environment similar to physiological conditions. Fundamental blood tests, like hemolysis and thrombogenicity have been carried out. Very low backflow through the closed valve was observed despite their slight distortion due to pressure. On the basis of immunofluorescence tests, only slight activation of platelets was found on the inlet valve and slight increased risk of clotting of the outlet valve commissures as a result of poor valve leaflets assembling in the prototype device. No blood hemolysis was observed. Few of the clots formed only in places where the valve surfaces were not smooth enough.

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.

An Insight into the Structural Diversity and Clinical Applicability of Polyurethanes in Biomedicine

Due to their mechanical properties, ranging from flexible to hard materials, polyurethanes (PUs) have been widely used in many industrial and biomedical applications. PUs' characteristics, along with their biocompatibility, make them successful biomaterials for short and medium-duration applications. The morphology of PUs includes two structural phases: hard and soft segments. Their high mechanical resistance featuresare determined by the hard segment, while the elastomeric behaviour is established by the soft segment. The most important biomedical applications of PUs include antibacterial surfaces and catheters, blood oxygenators, dialysis devices, stents, cardiac valves, vascular prostheses, bioadhesives/surgical dressings/pressure-sensitive adhesives, drug delivery systems, tissue engineering scaffolds and electrospinning, nerve generation, pacemaker lead insulation and coatings for breast implants. The diversity of polyurethane properties, due to the ease of bulk and surface modification, plays a vital role in their applications.

Recent advances in heparinization of polymeric membranes for enhanced continuous blood purification

Continuous blood purification technology such as hemodiafiltration has been used worldwide for saving patients suffering from severe diseases or organ function failure, especially in the intensive care unit and emergency setting. The filters as core devices are commonly made of polymer materials as hollow fiber membranes. However, the membrane is often inductively blocked by blood clot formation due to its interactions with blood components. Heparin is the anticoagulant often used in clinical practice for anti-coagulation. Recently, heparin is also employed to modify the hollow fiber membranes either chemically or physically to improve the filtration performance. This review summarizes recent advances in methodology for surface heparinization of such hollow fiber membranes, and their filtration performance improvement. The review also provides expert opinions for further research in this rapidly expanding field.

Materials and manufacturing perspectives in engineering heart valves: a review

Valvular heart diseases (VHD) are a major health burden, affecting millions of people worldwide. The treatments for such diseases rely on medicine, valve repair, and artificial heart valves including mechanical and bioprosthetic valves. Yet, there are countless reports on possible alternatives noting long-term stability and biocompatibility issues and highlighting the need for fabrication of more durable and effective replacements. This review discusses the current and potential materials that can be used for developing such valves along with existing and developing fabrication methods. With this perspective, we quantitatively compare mechanical properties of various materials that are currently used or proposed for heart valves along with their fabrication processes to identify challenges we face in creating new materials and manufacturing techniques to better mimick ​the performance of native heart valves.

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.

Short-term evaluation of thromboresistance of a poly(ether ether ketone) (PEEK) mechanical heart valve with poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC)-grafted surface in a porcine aortic valve replacement model

Improved thromboresistance of mechanical valves is desired to decrease the risk of thromboembolism and thrombosis and reduce the dosage of anticoagulation with a vitamin K antagonist (e.g., warfarin). For several mechanical valves, design-related features are responsible for their improved thromboresistance. However, it remains unclear whether material-related features provide a practical level of thromboresistance to mechanical valves. Here, we studied the effect of a bileaflet valve made of poly(ether ether ketone) (PEEK) with a poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC)-grafted surface (PEEK-g-PMPC). PMPC is a well-known thromboresistant polymeric material. A short-term (<26 h) porcine aortic valve replacement model using neither an anticoagulant nor an antiplatelet agent showed that the PEEK-g-PMPC valve opened and closed normally with an allowable transvalvular gradient. Unlike an untreated PEEK valve, no thrombus formed on the PEEK-g-PMPC valves on gross anatomy examination in addition to the absence of traveled thrombi in the kidney and lung tissues. Material (PEEK-g-PMPC)-related thromboresistance appeared to decrease the risk of thromboembolism and thrombosis for patients with mechanical valves. However, thromboresistance of the PEEK-g-PMPC valve requires improvement because fibrous fouling was still observed on the leaflet. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 1052-1063, 2019.

Effect of chemical structure on properties of polyurethanes: Temperature responsiveness and biocompatibility

Polyurethanes are known as one of the most biocompatible and inherently blood-compatible materials and have a wide range of applications in the medical field due to their controllable structure and properties. Durability, elasticity, elastomeric structure, fatigue resistance, versatility, and easy acceptance by the biological media after the application makes these polymers preferable in medical area. In this study, polyurethane films were prepared using poly(propylene-ethylene glycol) and either toluene-2,4-diisocyanate or 4,4′-methylenediphenyl diisocyanate without adding any other ingredients such as solvent, catalyst, or chain extender to prevent negative effects of leachable molecules. Mechanical tests were performed at room temperature while swelling tests were conducted in water and phosphate-buffered saline at 4°C, 25°C, and 37°C. Temperature responsiveness was observed for the samples synthesized using toluene-2,4-diisocyanate and poly(propylene-ethylene glycol). These samples had more than 100% swelling at 4°C and about 4% swelling at 25°C and 37°C. Cytocompatibility tests were performed by culturing the samples and their extracts with mouse fibroblast cells (L929). Viability of human umbilical vein endothelial cells was studied to examine the compatibility of the films for blood contacting devices. Both toluene-2,4-diisocyanate and 4,4-methylenediphenyl diisocyanate–based polyurethane films showed no cytotoxic effect and good biocompatibility. Oxygen plasma treatment enhanced hydrophilicity of the films. After plasma treatment, human umbilical vein endothelial cell attachment on toluene-2,4-diisocyanate–based polyurethane films improved and 4,4-methylenediphenyl diisocyanate–based polyurethane films maintained their high cell affinity. Polyurethanes presenting temperature responsiveness, high biocompatibility, and high affinity for human umbilical vein endothelial cells were synthesized in medical purity and in a reaction media involving only diisocyanate and diol components without addition of any solvent, chain extender, or catalyst. Polyurethanes with these properties and as produced in this study are reported for the first time in the literature.

Hydrodynamic Function of a Biostable Polyurethane Flexible Heart Valve after Six Months in Sheep

Survival to six months for sheep with a non-biostable polyurethane mitral heart valve prosthesis has been reported previously, however, with surface degradation and accumulation of calcified fibrin/thrombus that impaired leaflet motion and compromised hydrodynamic function. Newly available biostable polyurethanes may overcome this problem.

Six adult sheep with biostable polyurethane trileaflet heart valve prostheses of documented hydrodynamic performance, implanted in the mitral position, were allowed to survive for 6 months. Explanted valves were photographed, resubmitted to hydrodynamic function testing, and studied by light and electron microscopy.

Explanted valves were structurally intact and differed little in appearance from their preimplant state. Hydrodynamic testing showed no deterioration in pressure gradient or energy losses compared with pre-implant values.

Biostable polyurethanes demonstrated improved blood compatibility leaving leaflets flexible and valve function unimpaired. Biostable polyurethanes may thus improve prospects for prolonged function of synthetic heart valve prostheses.

Morphology and surface properties of high strength siloxane poly(urethane-urea)s developed for heart valve application

A series of siloxane poly(urethane-urea) (SiPUU) were developed by incorporating a macrodiol linked with a diisocyanate to enhance mixing of hard and soft segments (SS). The effect of this modification on morphology, surface properties, surface elemental composition, and creep resistance was investigated. The linked macrodiol was prepared by reacting α,ω-bis(6-hydroxyethoxypropyl) poly(dimethylsiloxane)(PDMS) or poly(hexamethylene oxide) (PHMO) with either 4,4'-methylenediphenyl diisocyanate (MDI), hexamethylene diisocyanate (HDI), or isophorone diisocyanate (IPDI). SiPUU with PHMO-MDI-PHMO and PHMO-IPDI-PHMO linked macrodiols showed enhanced creep resistance and recovery when compared with a commercial biostable polyurethane, Elast-Eon™ 2A. Small and wide-angle X-ray scattering data were consistent with significant increase of hydrogen bonding between hard and SS with linked-macrodiols, which improved SiPUU's tensile stress and tear strengths. These SiPUU were hydrophobic with contact angle higher than 101° and they had low water uptake (0.7%·w/w of dry mass). They also had much higher siloxane concentration on the surface compared to that in the bulk. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 107B: 112-121, 2019.

Development of a New Combined Test Setup for Accelerated Dynamic pH-Controlled in vitro Calcification of Porcine Heart Valves

Fifty years after their first implantation, bioprosthetic heart valves still suffer from tissue rupture and calcification. Since new bioprostheses exhibit a lower risk of calcification, fast and reliable in vitro methods need to be evaluated for testing the application of new anti-calcification techniques. This report describes a modification of the well-known in vitro dynamic calcification test method (Glasmacher et al, Leibniz University Hannover (LUH)), combined with the pH-controlled, constant solution supersaturation (CSS) method (University of Patras (UP)). The CSS method is based on monitoring the pH of the solution and the addition of calcium and phosphate ion solutions through the implementation of two syringe pumps. The pH and the activities of all ions in the solutions are thus kept constant, resulting in higher calcification rates compared to conventional in vitro methods in which solution supersaturation is allowed to decrease without any further control. To verify this hypothesis, five glutaraldehyde preserved porcine aortic valves were tested. Three of the valves were tested according to a free-drift methodology: the valves were immersed in a supersaturated calcification solution, with an initial total calcium times total phosphate product of (CaxP)=10.5 (mmol/L)2 renewed weekly. Two valves were tested by the new pH-controlled loop system, implementing the CSS methodology. All valves were tested for a 4-week period, loaded at 300 cycles per minute, resulting in a total of 12 million cycles at the end of the testing period. The degree of calcification was determined weekly by means of μx-ray, and by conventional, clinical and micro-computer tomography (CT, μCT). The results showed that the valves mineralizing at constant solution supersaturation in vitro yielded higher rates of calcification compared to the valves tested at conditions of decreasing solution supersaturation without any control, indicating the development of a new, accelerated, controllable in vitro calcification method.

Off-the-shelf tissue engineered heart valves for in situ regeneration: current state, challenges and future directions

INTRODUCTION

Transcatheter aortic valve replacement (TAVR) is continuously evolving and is expected to surpass surgical valve implantation in the near future. Combining durable valve substitutes with minimally invasive implantation techniques might increase the clinical relevance of this therapeutic option for younger patient populations. Tissue engineering offers the possibility to create tissue engineered heart valves (TEHVs) with regenerative and self-repair capacities which may overcome the pitfalls of current TAVR prostheses.

AREAS COVERED

This review focuses on off-the-shelf TEHVs which rely on a clinically-relevant in situ tissue engineering approach and which have already advanced into preclinical or first-in-human investigation.

EXPERT COMMENTARY

Among the off-the-shelf in situ TEHVs reported in literature, the vast majority covers pulmonary valve substitutes, and only few are combined with transcatheter implantation technologies. Hence, further innovations should include the development of transcatheter tissue engineered aortic valve substitutes, which would considerably increase the clinical relevance of such prostheses.

2-methoxyethylacrylate modified polyurethane membrane and its blood compatibility

Hydrophilic material 2-methoxyethylacrylate (MEA) was grafted onto polyurethane (PU) membrane via Michael addition reaction. Fourier transform infrared spectroscope (FTIR) and X-ray photoelectron spectroscopy (XPS) characterizations of the modified membrane proved that MEA was successfully grafted onto PU membrane surface. The water contact angle of the modified PU membrane decreased from 86° to 48° compared with unmodified PU membrane, which means that the hydrophilicity of the modified membrane was greatly improved. A series of blood compatibility tests including bovine serum protein adsorption, platelet adhesion, hemolysis assay, plasma recalacification time, prothrombin time (PT), partial thromboplastin time (APTT) and thrombin time (TT) were carried out on PU membrane and the modified PU membrane with highest grafted density of MEA. The combined results indicate that MEA plays an important role in improving the blood compatibility of PU membrane.

Development of high strength siloxane poly(urethane-urea) elastomers based on linked macrodiols for heart valve application

Mixed macrodiol based siloxane poly(urethane-urea)s (SiPUU) having number average molecular weights in the range 87-129 kDa/mol were synthesized to give elastomers with high tensile and tear strengths required to fabricate artificial heart valves. Polar functional groups were introduced into the soft segment to improve the poor segmental compatibility of siloxane polyurethanes. This was achieved by linking α,ω-bis(6-hydroxyethoxypropyl) poly(dimethylsiloxane) (PDMS) or poly(hexamethylene oxide) (PHMO) macrodiols with either 4,4'-methylenediphenyl diisocyanate (MDI), hexamethylene diisocyanate (HDI) or isophorone diisocyanate (IPDI) prior to polyurethane synthesis. The hard segment was composed of MDI, and a 1:1 mixture of 1,3-bis(4-hydroxybutyl)-1,1,3,3-tetramethyldisiloxane and 1,2-ethylene diamine. We report the effect of urethane linkers in soft segments on properties of the SiPUU. PHMO linked with either MDI or IPDI produced SiPUU with the highest tensile and tear strengths. Linking PDMS hardly affected the tensile strength; however, the tear strength was improved. The stress-strain curves showed no plastic deformation region typically observed for conventional polyurethanes indicating good creep resistance. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1712-1720, 2018.

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.

Biodegradable and biomimetic elastomeric scaffolds for tissue-engineered heart valves

Valvular heart diseases are the third leading cause of cardiovascular disease, resulting in more than 25,000 deaths annually in the United States. Heart valve tissue engineering (HVTE) has emerged as a putative treatment strategy such that the designed construct would ideally withstand native dynamic mechanical environment, guide regeneration of the diseased tissue and more importantly, have the ability to grow with the patient. These desired functions could be achieved by biomimetic design of tissue-engineered constructs that recapitulate in vivo heart valve microenvironment with biomimetic architecture, optimal mechanical properties and possess suitable biodegradability and biocompatibility. Synthetic biodegradable elastomers have gained interest in HVTE due to their excellent mechanical compliance, controllable chemical structure and tunable degradability. This review focuses on the state-of-art strategies to engineer biomimetic elastomeric scaffolds for HVTE. We first discuss the various types of biodegradable synthetic elastomers and their key properties. We then highlight tissue engineering approaches to recreate some of the features in the heart valve microenvironment such as anisotropic and hierarchical tri-layered architecture, mechanical anisotropy and biocompatibility.

STATEMENT OF SIGNIFICANCE

Heart valve tissue engineering (HVTE) is of special significance to overcome the drawbacks of current valve replacements. Although biodegradable synthetic elastomers have emerged as promising materials for HVTE, a mature HVTE construct made from synthetic elastomers for clinical use remains to be developed. Hence, this review summarized various types of biodegradable synthetic elastomers and their key properties. The major focus that distinguishes this review from the current literature is the thorough discussion on the key features of native valve microenvironments and various up-and-coming approaches to engineer synthetic elastomers to recreate these features such as anisotropic tri-layered architecture, mechanical anisotropy, biodegradability and biocompatibility. This review is envisioned to inspire and instruct the design of functional HVTE constructs and facilitate their clinical translation.

Tailored poly(ethylene) glycol dimethacrylate based shape memory polymer for orthopedic applications

Shape-memory polymers (SMPs) are stimuli-responsive materials known for their outstanding ability to be actuated from temporary shape into original shape. Because of this unique functionality SMPs are promising materials for diverse technological applications including smart biomedical devices. In this article, the work has been focused towards tailoring the SMP precursor and crosslinker wt% to obtain biocompatible acrylate based shape memory polymer with glass transition temperature (T_g) close to human body temperature. Methacrylate based shape memory polymer networks are synthesized via free radical polymerization by varying the wt% of t-butyl acrylate (tBA) and poly(ethylene glycol) dimethacrylate (PEGDMA) as crosslinker. The T_g is found to increase from 28 to 45°C with increasing tBA amount. The SMP synthesized from 70wt% of tBA and 30wt% of PEGDMA possess Tg close to human body temperature and is tested for cytotoxicity with two different cell lineages, osteosarcoma (MG-63) cells, and human keratinocyte (HaCaT) cells. The synthesized SMP is found to be non-cytotoxic. Thus the investigated biocompatible shape memory polymer network can be a promising soft substrate for passive thermomechanical stimulation which can adapt and meet specific needs of in vitro or in vivo orthopedic Superior Labrum Anterior and Posterior (SLAP) medical devices.

Sensing surface mechanical deformation using active probes driven by motor proteins

Studying mechanical deformation at the surface of soft materials has been challenging due to the difficulty in separating surface deformation from the bulk elasticity of the materials. Here, we introduce a new approach for studying the surface mechanical deformation of a soft material by utilizing a large number of self-propelled microprobes driven by motor proteins on the surface of the material. Information about the surface mechanical deformation of the soft material is obtained through changes in mobility of the microprobes wandering across the surface of the soft material. The active microprobes respond to mechanical deformation of the surface and readily change their velocity and direction depending on the extent and mode of surface deformation. This highly parallel and reliable method of sensing mechanical deformation at the surface of soft materials is expected to find applications that explore surface mechanics of soft materials and consequently would greatly benefit the surface science.

Micro and nanotechnologies in heart valve tissue engineering

Due to the increased morbidity and mortality resulting from heart valve diseases, there is a growing demand for off-the-shelf implantable tissue engineered heart valves (TEHVs). Despite the significant progress in recent years in improving the design and performance of TEHV constructs, viable and functional human implantable TEHV constructs have remained elusive. The recent advances in micro and nanoscale technologies including the microfabrication, nano-microfiber based scaffolds preparation, 3D cell encapsulated hydrogels preparation, microfluidic, micro-bioreactors, nano-microscale biosensors as well as the computational methods and models for simulation of biological tissues have increased the potential for realizing viable, functional and implantable TEHV constructs. In this review, we aim to present an overview of the importance and recent advances in micro and nano-scale technologies for the development of TEHV constructs.

Nucleated nanocomposites of TPU–PDMS blends based on spherical nanohydroxyapatite

The present investigation gives a profound insight into the preparation of nucleated nanocomposites of TPU–PDMS blends based on uniquely synthesized PPG-wrapped spherical nanohydroxyapatite (nHap).

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.

Electrospun/electrosprayed polyurethane biomembranes with ciprofloxacin and clove oil extract for urinary devices

Polyurethane–eugenol solutions in N,N-dimethyl formamide were electrospun/electrosprayed onto polyurethane–ciprofloxacin biomembranes to obtain drug delivery systems for urinary devices. Following electrospinning/electrospraying, particle-fiber morphology was evidenced by scanning electronic microscope analysis. Contact angle determinations along with surface free energy calculations, moisture diffusion test, and diffusion coefficient determinations were done for polyurethane–ciprofloxacin biomembranes. Determination of bioactive ciprofloxacin release kinetics evidences non-Fickian/anomalous/diffusion mechanism, coupling Fickian diffusion with the relaxation of the polymeric chains within the matrix network. A slight increase in n values for electrospun/electrosprayed coated samples evidenced a behavior closer to a case II transport mechanism with zero-order kinetics. The biological activity of the electrospun/electrosprayed polyurethane membrane samples tested against Staphylococcus aureus, Sarcina lutea, Bacillus cereus, Bacillus subtilis, Escherichia coli, and Pseudomonas aeruginosa showed comparable antibacterial activity with standard ciprofloxacin.

The aortic valve: structure, complications and implications for transcatheter aortic valve replacement

The aortic valve operates in a complex haemodynamic environment, opening and closing over 100,000 times a day. When complications arise, such as aortic stenosis, prognosis can be very poor, leading to death within the first few years. Surgical valve replacement is currently the standard treatment for aortic stenosis. A thorough understanding of the anatomy and function of the native valve is imperative when developing a prosthetic replacement that can withstand the complex demands of the heart. This review focuses on the anatomy, structure and disease of the aortic valve and the implications for a transcatheter aortic valve replacement (TAVR). Current complications with TAVR, such as major vascular bleeding, conduction disturbances and patient-prosthesis mismatch (PPM), can be overcome by reducing the delivery profile and through the use of more accurate imaging technologies to work towards a fully functional and durable prosthesis.

Reduced platelets and bacteria adhesion on poly(ether ether ketone) by photoinduced and self-initiated graft polymerization of 2-methacryloyloxyethyl phosphorylcholine

Aromatic poly(ether ether ketone) (PEEK) is a super engineering plastic, which has good mechanical properties and is resistant to physical and chemical stimuli. We have, therefore, attempted to use PEEK in cardiovascular devices. Synthetic cardiovascular devices require both high hemocompatibility and anti-inflammatory activity in addition to the mechanical properties. We modified the PEEK surface by photoinduced and self-initiated graft polymerization with 2-methacryloyloxyethyl phosphorylcholine (MPC; PMPC-grafted PEEK) for obtaining good antithrombogenicity. Polymerization was carried out on the surface of PEEK under radiation of ultraviolet (UV) light during which we controlled monomer concentrations, temperatures, and UV intensities. The biological performance of the PMPC-grafted PEEK was examined and compared with that of unmodified PEEK. With increase in the thickness of the PMPC layer, the amount of fibrinogen adsorption decreased significantly in comparison to that in the case of unmodified PEEK. When placed in contact with human platelet-rich plasma, surface of the PMPC-grafted PEEK clearly showed inhibition of platelet adhesion and activation. Also, bacterial adhesion was reduced dramatically on the PMPC-grafted PEEK. Thus, the PMPC grafting on PEEK improved the antithrombogenicity.