Totally implantable artificial hearts and left ventricular assist devices: selecting impermeable polycarbonate urethane to manufacture ventricles

Hybrid Materials for Vascular Applications: A Preliminary In Vitro Assessment

The production of biomedical devices able to appropriately interact with the biological environment is still a great challenge. Synthetic materials are often employed, but they fail to replicate the biological and functional properties of native tissues, leading to a variety of adverse effects. Several commercial products are based on chemically treated xenogeneic tissues: their principal drawback is due to weak mechanical stability and low durability. Recently, decellularization has been proposed to bypass the drawbacks of both synthetic and biological materials. Acellular materials can integrate with host tissues avoiding/mitigating any foreign body response, but they often lack sufficient patency and impermeability. The present paper investigates an innovative approach to the realization of hybrid materials that combine decellularized bovine pericardium with polycarbonate urethanes. These hybrid materials benefit from the superior biocompatibility of the biological tissue and the mechanical properties of the synthetic polymers. They were assessed from physicochemical, structural, mechanical, and biological points of view; their ability to promote cell growth was also investigated. The decellularized pericardium and the polymer appeared to well adhere to each other, and the two sides were distinguishable. The maximum elongation of hybrid materials was mainly affected by the pericardium, which allows for lower elongation than the polymer; this latter, in turn, influenced the maximum strength achieved. The results confirmed the promising features of hybrid materials for the production of vascular grafts able to be repopulated by circulating cells, thus, improving blood compatibility.

In Vitro Proof of Concept of a First-Generation Growth-Accommodating Heart Valved Conduit for Pediatric Use

Currently available heart valve prostheses have no growth potential, requiring children with heart valve diseases to endure multiple valve replacement surgeries with compounding risks. This study demonstrates the in vitro proof of concept of a biostable polymeric trileaflet valved conduit designed for surgical implantation and subsequent expansion via transcatheter balloon dilation to accommodate the growth of pediatric patients and delay or avoid repeated open-heart surgeries. The valved conduit is formed via dip molding using a polydimethylsiloxane-based polyurethane, a biocompatible material shown here to be capable of permanent stretching under mechanical loading. The valve leaflets are designed with an increased coaptation area to preserve valve competence at expanded diameters. Four 22 mm diameter valved conduits are tested in vitro for hydrodynamics, balloon dilated to new permanent diameters of 23.26 ± 0.38 mm, and then tested again. Upon further dilation, two valved conduits sustain leaflet tears, while the two surviving devices reach final diameters of 24.38 ± 0.19 mm. After each successful dilation, the valved conduits show increased effective orifice areas and decreased transvalvular pressure differentials while maintaining low regurgitation. These results demonstrate concept feasibility and motivate further development of a polymeric balloon-expandable device to replace valves in children and avoid reoperations.

Biomimetic materials based on zwitterionic polymers toward human-friendly medical devices

This review summarizes recent research on the design of polymer material systems based on biomimetic concepts and reports on the medical devices that implement these systems. Biomolecules such as proteins, nucleic acids, and phospholipids, present in living organisms, play important roles in biological activities. These molecules are characterized by heterogenic nature with hydrophilicity and hydrophobicity, and a balance of positive and negative charges, which provide unique reaction fields, interfaces, and functionality. Incorporating these molecules into artificial systems is expected to advance material science considerably. This approach to material design is exceptionally practical for medical devices that are in contact with living organisms. Here, it is focused on zwitterionic polymers with intramolecularly balanced charges and introduce examples of their applications in medical devices. Their unique properties make these polymers potential surface modification materials to enhance the performance and safety of conventional medical devices. This review discusses these devices; moreover, new surface technologies have been summarized for developing human-friendly medical devices using zwitterionic polymers in the cardiovascular, cerebrovascular, orthopedic, and ophthalmology fields.

Hybrid membranes for the production of blood contacting surfaces: physicochemical, structural and biomechanical characterization

Background

Due to the shortage of organs’ donors that limits biological heart transplantations, mechanical circulatory supports can be implanted in case of refractory end-stage heart failure to replace partially (Ventricular Assist Device, VAD) or completely (Total Artificial Heart, TAH) the cardiac function. The hemocompatibility of mechanical circulatory supports is a fundamental issue that has not yet been fully matched; it mostly depends on the nature of blood-contacting surfaces.

Methods

In order to obtain hemocompatible materials, a pool of hybrid membranes was fabricated by coupling a synthetic polymer (polycarbonate urethane, commercially available in two formulations) with a decellularized biological tissue (porcine pericardium). To test their potential suitability as candidate materials for realizing the blood-contacting surfaces of a novel artificial heart, hybrid membranes have been preliminarily characterized in terms of physicochemical, structural and mechanical properties.

Results

Our results ascertained that the hybrid membranes are properly stratified, thus allowing to expose their biological side to blood and their polymeric surface to the actuation system of the intended device. From the biomechanical point of view, the hybrid membranes can withstand deformations up to more than 70 % and stresses up to around 8 MPa.

Conclusions

The hybrid membranes are suitable for the construction of the ventricular chambers of innovative mechanical circulatory support devices.

Hard Block Degradable Polycarbonate Urethanes: Promising Biomaterials for Electrospun Vascular Prostheses

We report biodegradable thermoplastic polyurethanes for soft tissue engineering applications, where frequently used carboxylic acid ester degradation motifs were substituted with carbonate moieties to achieve superior degradation properties. While the use of carbonates in soft blocks has been reported, their use in hard blocks of thermoplastic polyurethanes is unprecedented. Soft blocks consist of poly(hexamethylene carbonate), and hard blocks combine hexamethylene diisocyanate with the newly synthesized cleavable carbonate chain extender bis(3-hydroxypropylene)carbonate (BHPC), mimicking the motif of poly(trimethylene carbonate) with highly regarded degradation properties. Simultaneously, the mechanical benefits of segmented polyurethanes are exploited. A lower hard block concentration in BHPC-based polymers was more suitable for vascular grafts. Nonacidic degradation products and hard block dependent degradation rates were found. Implantation of BHPC-based electrospun degradable vascular prostheses in a small animal model revealed high patency rates and no signs of aneurysm formations. Specific vascular graft remodeling and only minimal signs of inflammatory reactions were observed.

Recent developments in the field of barrier and permeability properties of segmented polyurethane elastomers

Polyurethane (PU) elastomers represent an important class of segmented copolymers. Thanks to many available chemical compositions, a rather broad range of chemical, physical, and biocompatible properties of PU can be obtained. These polymers are often characterized by high tensile and tear strength, elongation, fatigue life, and wear resistance. However, their relatively high permeability towards gases and water as well as their biocompatibility still limits the PU’s practical application, especially for biomedical use, for example, in implants and medical devices. In this review, the barrier and permeability properties of segmented PUs related to their chemical structure and physical and chemical properties have been discussed, including the latest developments and different approaches to improve the PU barrier properties.

Biodegradable polymer scaffolds

Tissue engineering aims to repair the damaged tissue by transplantation of cells or introducing bioactive factors in a biocompatible scaffold. In recent years, biodegradable polymer scaffolds mimicking the extracellular matrix have been developed to promote the cell proliferation and extracellular matrix deposition. The biodegradable polymer scaffolds thus act as templates for tissue repair and regeneration. This article reviews the updated information regarding various types of natural and synthetic biodegradable polymers as well as their functions, physico-chemical properties, and degradation mechanisms in the development of biodegradable scaffolds for tissue engineering applications, including their combination with 3D printing.

The use of polyurethane materials in the surgery of the spine: a review

BACKGROUND CONTEXT

The spine contains intervertebral discs and the interspinous and longitudinal ligaments. These structures are elastomeric or viscoelastic in their mechanical properties and serve to allow and control the movement of the bony elements of the spine. The use of metallic or hard polymeric devices to replace the intervertebral discs and the creation of fusion masses to replace discs and/or vertebral bodies changes the load transfer characteristics of the spine and the range of motion of segments of the spine.

PURPOSE

The purpose of the study was to survey the literature, regulatory information available on the Web, and industry-reported device development found on the Web to ascertain the usage and outcomes of the use of polyurethane polymers in the design and clinical use of devices for spine surgery.

STUDY DESIGN/SETTING

A systematic review of the available information from all sources concerning the subject materials' usage in spinal devices was conducted.

METHODS

A search of the peer-reviewed literature combining spinal surgery with polyurethane or specific types and trade names of medical polyurethanes was performed. Additionally, information available on the Food and Drug Administration Web site and for corporate Web sites was reviewed in an attempt to identify pertinent information.

RESULTS

The review captured devices that are in testing or have entered clinical practice that use elastomeric polyurethane polymers as disc replacements, dynamic stabilization of spinal movement, or motion limitation to relieve nerve root compression and pain and as complete a listing as possible of such devices that have been designed or tested but appear to no longer be pursued. This review summarizes the available information about the uses to which polyurethanes have been tested or are being used in spinal surgery.

CONCLUSIONS

The use of polyurethanes in medicine has expanded as modifications to the stability of the polymers in the physiological environment have been improved. The potential for the use of elastomeric materials to more closely match the mechanical properties of the structures being replaced and to maintain motion between spinal segments appears to hold promise. The published results from the use of the devices that are discussed show early success with these applications of elastomeric materials.

Imaging, spectroscopy, mechanical, alignment and biocompatibility studies of electrospun medical grade polyurethane (Carbothane™ 3575A) nanofibers and composite nanofibers containing multiwalled carbon nanotubes

In the present study, we discuss the electrospinning of medical grade polyurethane (Carbothane™ 3575A) nanofibers containing multi-walled-carbon-nanotubes (MWCNTs). A simple method that does not depend on additional foreign chemicals has been employed to disperse MWCNTs through high intensity sonication. Typically, a polymer solution consisting of polymer/MWCNTs has been electrospun to form nanofibers. Physiochemical aspects of prepared nanofibers were evaluated by SEM, TEM, FT-IR and Raman spectroscopy, confirming nanofibers containing MWCNTs. The biocompatibility and cell attachment of the produced nanofiber mats were investigated while culturing them in the presence of NIH 3T3 fibroblasts. The results from these tests indicated non-toxic behavior of the prepared nanofiber mats and had a significant attachment of cells towards nanofibers. The incorporation of MWCNTs into polymeric nanofibers led to an improvement in tensile stress from 11.40 ± 0.9 to 51.25 ± 5.5 MPa. Furthermore, complete alignment of the nanofibers resulted in an enhancement on tensile stress to 72.78 ± 5.5 MPa. Displaying these attributes of high mechanical properties and non-toxic nature of nanofibers are recommended for an ideal candidate for future tendon and ligament grafts.

The use of compliant layer prosthetic components in orthopedic joint repair and replacement: a review

The surgical repair or treatment of degenerative joint disease has traditionally involved the substitution of synthetic materials for one or both surfaces of the joint. Engineering thermoplastics, metals, and ceramics have either been widely accepted or experimentally evaluated for use as bearing surfaces in these prostheses. When engineering thermoplastics are used, the opposing surface is a metal or a ceramic, but metal-on-metal, metal-on-ceramic, and ceramic-on-ceramic have also been used or tested. Researchers have sought the opportunity to utilize materials with compressive mechanical properties more closely matching those of the natural articular cartilage. This review discusses the theory, testing, and application of elastomers for one bearing component of articular joint prostheses.

In-vivo degradation of poly(carbonate-urethane) based spine implants

Fourteen explanted Dynesys® spinal devices were analyzed for biostability and compared with a reference, never implanted, control. Both poly(carbonate-urethane) (PCU) spacers and polyethylene-terephthalate (PET) cords were analyzed. The effect of implantation was evaluated through the observation of physical alterations of the device surfaces, evaluation of the chemical degradation and fluids absorption on the devices and examination of the morphological and mechanical features. PCU spacers exhibited a variety of surface damage mechanisms, the most significant being abrasion and localized, microscopic surface cracks. Evidence of oxidation and chain scission were detected on PCU spacers ATR-FTIR. ATR-FTIR, DSC and hardness measurements also showed a slight heterogeneity in the composition of PCU. The extraction carried out on the PCU spacers revealed the presence of extractable polycarbonate segments. One spacer and all PET cords visually exhibited the presence of adherent biological material (proteins), confirmed by the ATR-FTIR results. GC/MS analyses of the extracts from PET cords revealed the presence of biological fluids residues, mainly cholesterol derivatives and fatty acids, probably trapped into the fiber network. No further chemical alterations were observed on the PET cords. Although the observed physical and chemical damage can be considered superficial, greater attention must be paid to the chemical degradation mechanisms of PCU and to the effect of byproducts on the body.

Evaluation of the wear performance of a polycarbonate-urethane acetabular component in a hip joint simulator and comparison with UHMWPE and cross-linked UHMWPE

Acetabular hip joint components manufactured from gamma-sterilized ultra high molecular weight polyethylene (UHMWPE), gamma cross-linked UHMWPE, or polycarbonate-urethane (PCU) polymers were evaluated in a hip joint simulator, using cobalt alloy femoral components, for at least 5 million cycles. The volume of material losses due to wear was calculated for each type of sample, based upon mass loss measurements, every 500,000 cycles. The loss of material for the conventional UHMWPE was much higher than for the cross-linked UHMWPE, showing about a 70% reduction in wear due to cross-linking. The material loss for the PCU samples appears to have been at least 24% lower than for the cross-linked UHMWPE. Based upon these results, the PCU material seems to have potential for use as an alternative bearing material to UHMWPE for total hip replacement surgeries.

Development of Biomedical Polymer-Silicate Nanocomposites: A Materials Science Perspective

Biomedical polymer-silicate nanocomposites have potential to become critically important to the development of biomedical applications, ranging from diagnostic and therapeutic devices, tissue regeneration and drug delivery matrixes to various bio-technologies that are inspired by biology but have only indirect biomedical relation. The fundamental understanding of polymer-nanoparticle interactions is absolutely necessary to control structure-property relationships of materials that need to work within the chemical, physical and biological constraints required by an application. This review summarizes the most recent published strategies to design and develop polymer-silicate nanocomposites (including clay based silicate nanoparticles and bioactive glass nanoparticles) for a variety of biomedical applications. Emerging trends in bio-technological and biomedical nanocomposites are highlighted and potential new fields of applications are examined.

Synthesis and characterisation of enhanced barrier polyurethane for encapsulation of implantable medical devices

Polymeric membranes have been used as interfaces between implantable devices and biological tissues to operate as a protective barrier from water exchanging and to enhance biocompatibility. Polyurethanes have been used as biocompatible membranes for decades. In this study, copolymers of polyether urethane (PEU) with polydimethylsiloxane (PDMS) were synthesised with the goal of creating materials with low water permeability and high elasticity. PDMS was incorporated into polymer backbone as a part of the soft segment during polyurethane synthesis and physical properties as well as water permeability of resulting copolymer were studied in regard to PDMS content. Increase in PDMS content led to increase of microphase separation of the copolymer and corresponding increase in elastic modulus. Surface energy of the polymer was decreased by incorporating PDMS compared to unmodified PEU. PDMS in copolymer formed a hydrophobic surface which caused reduction in water permeability and water uptake of the membranes. Thus, PDMS containing polyurethane with its potent water resistant properties demonstrated a great promise for use as an implantable encapsulation material.

Surface modification of medical-grade polyurethane by cyanurchloride-activated tetraether lipid (a new approach for bacterial antiadhesion)

The surface of high-grade medical polyurethane was chemically modified and coated with tetraether lipid, employing cyanurchloride as coupling agent. The surfaces were initially grafted with hexamethylene diisocyanate and subsequently treated with water or hexamethylene diamine to generate free amino groups on the surface. This provides a convenient way for covalent coupling of tetraether lipids. These lipid-coated surfaces were investigated for bacterial adhesion using Pseudomonas aeruginosa. All lipid-coated surfaces significantly reduced bacterial adhesion. Surface topology and individual modification steps were controlled by contact angle measurements, attenuated total reflectance infrared spectroscopy, X-ray photoelectron spectroscopy, confocal laser scanning microscopy, and environmental scanning electron microscopy. This new surface modification approach may reduce the adhesion of bacteria on biomaterials.

Modified polycarbonate urethane: synthesis, properties and biological investigation in vitro

A new polycarbonate urethane (PCU-I) was synthesized from aliphatic monomers, i.e. polyhexamethylene carbonate diol and 4,4'-methylene-bis cyclohexane diisocyanate, a mixture of low molecular diols, and castor oil (containing mainly the triglyceride of 12-hydroxyoleic acid). The second synthesized polymer (PCU-II) did not contain castor oil. Both PCUs had good tensile strength, i.e. 32.5 and 27.8 MPa for PCU-I and PCU-II, respectively. Modification by castor oil led to a decrease in glass transition temperature (T(g) = -14 degrees C for PCU-I and -6 degrees C for PCU-II) and an increase in the softening temperature (135 and 125 degrees C for PCU-I and PCU-II, respectively). Partial crosslinking of PCU-I increased the storage modulus of elasticity and provided better resistance to sterilization by ETO and gamma radiation. Both PCUs displayed good stability when subjected to sterilization by hydrogen peroxide plasma. Neither PCU caused cytotoxic effect in mouse fibroblasts (3T3 Balb C). They also had no toxic effects on the morphotic components and did not influence changes in the hematologic parameters or plasmatic coagulation system of human blood.

Cholesterol-derivatized polyurethane: characterization and endothelial cell adhesion

Endothelialization of synthetic surfaces has been challenging with limited success thus far. We investigated the hypothesis that covalent attachment of cholesterol to polyurethane via the urethane nitrogen groups would create a high-affinity surface for attachment and adhesion of endothelial cells. Cholesterol was covalently bound to the polyether polyurethane, Tecothane, by first derivatizing the polyurethane nitrogen groups with bromoalkyl side chains, followed by reacting mercapto-cholesterol to the bromoalkyl sites. Cholesterol-modified polyurethane demonstrated a qualitatively smoother surface per atomic force microscopy than nonmodified and increased surface energy (contact angle measurements) compared with unmodified polyurethane. Cell attachment assays showed a significantly greater number of attached bovine arterial endothelial cells (p = 0.0003) after 45 min of seeding on cholesterol-modified polyurethane versus unmodified polyurethane. Bovine arterial endothelial cells cultivated on cholesterol-modified Tecothane showed significantly greater levels of cell retention compared with unmodified Tecothane when exposed to arterial level shear stress for 2 h (25 dynes/cm2) with 90.0 +/- 6.23% cells remaining adherent compared with unmodified polyurethane, 41.4 +/- 11.7%, p = 0.0070. Furthermore, ovine endothelial precursors, obtained as blood outgrowth endothelial cells, were seeded on cholesterol-modified polyurethane and exposed to 25 dynes/cm2 shear conditions for 2 h, with the retention of 90.30 +/- 3.25% of seeded cells versus unmodified polyurethane, which retained only 4.56 +/- 0.85% (p < 0.001). It is concluded that covalently linking cholesterol to polyurethane results in improved material properties that permit increased endothelial cell retention compared with unmodified polyurethane.

Enzyme induced biodegradation of polycarbonate-polyurethanes: dose dependence effect of cholesterol esterase

The current study has investigated the influence of esterase activity (80-400units/ml) on the biodegradation of polycarbonate-urethanes (PCNUs) by cholesterol esterase (CE), with a particular interest in studying the influence of different hard segment structures and their contribution to sensitizing the polymer towards enzyme catalyzed hydrolysis. Polycarbonate based polyurethanes were synthesized with varying hard segment content as well as hard segment chemistry based on three different diisocyanates, 1,6-hexane diisocyanate (HDI), 4,4'-methylene bisphenyl diisocyanate (MDI) and 4,4-methylene biscyclohexyl diisocyanate (HMDI). The effect of different chemistry on surface contact angle was measured in order to define the relative chemical nature of the surfaces. The enzyme dose response was found to be lower when hard segment content in the polymer was high. There was a very strong dependence on enzyme concentration for polyurethanes with different hard segment chemistry, despite the fact that the nature of the hydrolysable polycarbonate segment remained the same. The PCNU which showed the most dramatic dependence on enzyme concentration was synthesized with HMDI. At low enzyme concentration (80units/ml) this material was the most stable of the polymers while at elevated CE concentration (400units/ml) the polymer underwent a catastrophic breakdown. The findings suggested that protein binding on the surfaces was saturated even though enzyme degradation did not achieve saturation on any of the surfaces. The role of protein binding in modulating the hydrolytic action of the enzymes at different activity levels highlights a need for further study in this area.

Low permeability biomedical polyurethane nanocomposites

In this article we describe our continuing research on a novel nanocomposite approach for reducing gas permeability through biomedical polyurethane membranes. Nanocomposites were prepared using commercially available poly(urethane urea)s (PUU) and two organically modified layered silicates (OLS). Wide-angle X-ray diffraction experiments showed that the silicate layer spacing in the nanocomposites increased significantly compared with the neat OLS, signifying the formation of intercalated PUU/OLS structures. The nanocomposite materials exhibit increased modulus with increasing OLS content, while maintaining polymer strength and ductility. Water vapor permeability was reduced by about fivefold at the highest OLS contents, as a result of PUU/inorganic composite formation.

Hydrolytic degradation of poly(carbonate)-urethanes by monocyte-derived macrophages

Polycarbonate (PCN)-based polyurethanes (PCNU) are rapidly becoming the chosen polyurethane (PU) for long-term implantation since they have shown decreased susceptibility to oxidation. However, monocyte-derived macrophages (MDM), the cell implicated in biodegradation, also contain hydrolytic activities. Hence, in this study, an activated human MDM cell system was used to assess the biostability of a PCNU, synthesized with 14C-hexane diisocyanate (HDI) and butanediol (BD), previously shown to be susceptible to hydrolysis by cholesterol esterase (CE). Monocytes, isolated from whole blood and cultured for 14 days on polystyrene (PS) to mature MDM, were gently trypsinized and seeded onto 14C-PCNU. Radiolabel release and esterase activity, as measured with p-nitrophenylbutyrate, increased for almost 2 weeks. At 1 week, the increase in radiolabel release and esterase activity were diminished by more than 50% when the protein synthesis inhibitor, cycloheximide, or the serine esterase/protease inhibitor, phenylmethylsulfonylfluoride was added to the medium. This strongly suggests that in part, it was MDM esterase activity which contributed to the PU degradation. In an effort to simulate the potential combination of oxidative and hydrolytic activities of inflammatory cells. 14C-PCNU was exposed to HOCl and then CE. Interestingly, the release of radiolabeled products by CE was significantly inhibited by the pre-treatment of PCNU with HOCl. The results of this study show that while the co-existing roles of oxidation and hydrolysis in the biodegradation of PCNUs remains to be elucidated, a clear relationship is drawn for PCNU degradation to the hydrolytic degradative activities which increase in MDM during differentiation from monocytes, and during activation in the chronic phase of the inflammatory response.

Assessing the resistance to calcification of polyurethane membranes used in the manufacture of ventricles for a totally implantable artificial heart

Ventricles made from segmented polyurethane membranes and used in the fabrication of a totally implantable artificial heart are known to undergo biomaterial-associated calcification. As there is no effective method currently available to prevent such biomaterials from calcifying, a practical solution is to use only materials with a relatively high resistance to calcification, to extend ventricular durability and ensure a longer functional life for the manufactured device. In the present study, an in vitro calcification protocol was used to determine the relative resistance to calcification of six different polyurethanes, namely, Carbothane PC3570A, Chronoflex AR, Corethane 80A, Corethane 55D, Tecoflex EG80A, and Tecothane TT1074A. The results demonstrated that all six polyurethanes did become calcified during the 60-day incubation period in the calcification solution. The degree of calcification was found to be associated with the surface chemistry of the particular polyurethane, with the Tecothane TT1074A exhibiting the highest level. The Corethane 80A and 55D polymers showed a relatively low propensity to calcify. These two membranes can, therefore, be considered as the most appropriate materials for the fabrication of ventricles for a totally implantable artificial heart. In addition, since the calcification occurred primarily at the surface of the membranes, without affecting the bulk microphase structure, the issue of modifying the surface chemistry to reduce the incidence of calcification is discussed.