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Shi D, Kang Y, Wang W, Liu R, Tang Q, Li Z, Jiang H, Ding J. Biodegradable polymeric occluder with controllable locking structure for closure of atrial septal defect via interventional treatment. Regen Biomater 2025; 12:rbaf016. [PMID: 40248504 PMCID: PMC12005900 DOI: 10.1093/rb/rbaf016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2025] [Revised: 02/24/2025] [Accepted: 03/17/2025] [Indexed: 04/19/2025] Open
Abstract
Atrial septal defect (ASD) is one of the major congenital heart diseases, and transcatheter closure with a cardiac occluder is a modern method to treat ASD with the advantage of mini-invasiveness over traditional surgical closure. While current occlusion devices are mainly made of non-degradable nitinol with superelasticity, the permanent existence of a metal in vivo may trigger potential complications and especially has an adverse effect on the heart development for children. However, it is challenging to invent a superelasticity-free occluder that can be delivered through a catheter but firmly locked after being opened at the target site; it is also much desired for research and development to quickly assess the feasibility of a superelasticity-free occluder in vitro. Herein, a biodegradable poly(L-lactide) (PLLA) occluder composed of a braided PLLA frame as the skeleton and a nonwoven PLLA fabric as the flow-blocking membrane is developed, and a controllable locking structure is designed to enable firm closure for a device even without superelasticity. We also suggest and justify a series of in vitro methods to assess the efficacy of the biodegradable occluder, and the results confirm the reliability of locking, water-blocking, mechanical strength and degradability. It is found that the PLLA fabric with moderate fiber density is optimal for surface endothelialization. We also carry out biological assessments; significant endothelialization and alleviated inflammation response are observed after 6 months of subcutaneous implantation into rabbits. The porcine model illustrates that the biodegradable polymeric occluder can be successfully implanted into the atrial septum via transcatheter intervention; the follow-ups have confirmed the safety and efficacy of this biodegradable polymeric occluder with the controllable locking structure.
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Affiliation(s)
- Daokun Shi
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai 200438, China
| | - Yahong Kang
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai 200438, China
- Shanghai Key Laboratory of Interventional Medical Devices and Equipment, Shanghai MicroPort Medical Group Co, Ltd, Shanghai 201203, China
- AccuPath Group Co., Ltd, Jiaxing 314000, China
| | - Weijie Wang
- Shanghai Key Laboratory of Interventional Medical Devices and Equipment, Shanghai MicroPort Medical Group Co, Ltd, Shanghai 201203, China
- AccuPath Group Co., Ltd, Jiaxing 314000, China
| | - Ruili Liu
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai 200438, China
| | - Quansheng Tang
- Shanghai Key Laboratory of Interventional Medical Devices and Equipment, Shanghai MicroPort Medical Group Co, Ltd, Shanghai 201203, China
- AccuPath Group Co., Ltd, Jiaxing 314000, China
| | - Zhaomin Li
- Shanghai Key Laboratory of Interventional Medical Devices and Equipment, Shanghai MicroPort Medical Group Co, Ltd, Shanghai 201203, China
- AccuPath Group Co., Ltd, Jiaxing 314000, China
| | - Hongyan Jiang
- Shanghai Key Laboratory of Interventional Medical Devices and Equipment, Shanghai MicroPort Medical Group Co, Ltd, Shanghai 201203, China
| | - Jiandong Ding
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai 200438, China
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2
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Frager MR, Frishman WH, Aronow WS. Advances in Atrial Septal Defect Closure: Managing Pulmonary Hypertension and Expanding Treatment Criteria Applicability. Cardiol Rev 2025:00045415-990000000-00443. [PMID: 40096632 DOI: 10.1097/crd.0000000000000896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2025]
Abstract
Atrial septal defects (ASDs) are common congenital heart anomalies that can have significant long-term implications, particularly in the presence of pulmonary hypertension (PH). If left untreated, there is an increased risk of heart failure and Eisenmenger syndrome leading to a subsequent increase in patient morbidity and mortality. Advances in surgical and transcatheter closure techniques have improved outcomes, though challenges remain, particularly in patients with severe PH. This review highlights current secundum ASD closure methods, including open heart and transcatheter approaches, and explores the potential of biodegradable devices under development. Furthermore, recent guidelines for closure are discussed with an emphasis on PH management. In addition, the treat-and-repair strategy is discussed in the context of a meta-analysis and case reports, which show promise in expanding eligibility for closure in patients when used in conjunction with PH reversibility testing. The importance of multidisciplinary care in optimizing patient outcomes is emphasized and the need for further research is noted to refine strategies, improve device safety, and extend ASD closure guidelines to a broader patient population.
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Affiliation(s)
- Malkiel R Frager
- From the Department of Medicine, New York Medical College, Valhalla, NY
| | | | - Wilbert S Aronow
- From the Department of Medicine, New York Medical College, Valhalla, NY
- Departments of Cardiology and Medicine, Westchester Medical Center, Valhalla, NY
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3
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Graczyk S, Grzeczka A, Pasławska U. A Comprehensive Review of Canine and Feline Ventricular Septal Defects-From Pathogenesis to Long-Term Follow-Up. Animals (Basel) 2025; 15:850. [PMID: 40150379 PMCID: PMC11939684 DOI: 10.3390/ani15060850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2025] [Revised: 03/11/2025] [Accepted: 03/13/2025] [Indexed: 03/29/2025] Open
Abstract
Congenital heart defects (CHDs) in dogs and cats represent a definite minority of cardiac patients. One of the most commonly diagnosed is ventricular septal defects (VSDs). These are associated with abnormal ventricular septation during the prenatal period; however, the mutations of the genes responsible for this phenomenon are not fully understood. VSDs pose a significant diagnostic challenge due to the multitude of locations in the ventricular septum where they are likely to occur. Therefore, there are many phenotypes of the defect causing many problems in terms of a common nomenclature. Among the various classifications, the latest terminology issued by The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD) considers both electrical conduction pathways and adjacent structures to standardize nomenclature. Further, defects located at different sites can alter both prognosis and subsequent management for the patient; thus, taking accurate measurements is crucial. Among these, the Qp:Qs and VSD:Ao ratios, the direction of blood flow through the defect, its location, the diameter and maximum flow velocity, and the pressure difference between the RV and LV are indicated. Emerging technologies such as 3D echocardiography and cardiac magnetic resonance may provide additional diagnostic value. Altogether, along with clinical symptoms, we should determine further management, involving the monitoring of the patient, the implementation of pharmacological treatment, or referral for surgical closure of the VSD. This review summarizes current knowledge on VSD, where the pathogenesis of the condition, diagnosis, and management, including conventional and surgical methods as well as long-term follow-up, are described, providing a complete overview of the issue.
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Affiliation(s)
- Szymon Graczyk
- Department of Diagnostics and Clinical Sciences, Institute of Veterinary Medicine, Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland;
| | | | - Urszula Pasławska
- Department of Diagnostics and Clinical Sciences, Institute of Veterinary Medicine, Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland;
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Wang XW, Ye CQ, Tang Q, Yu HM, Wang J, Fu GS, Ren KF, Yu L, Ji J. Drop-shaped microgrooves guide unidirectional cell migration for enhanced endothelialization. Nat Commun 2025; 16:1928. [PMID: 39994203 PMCID: PMC11850906 DOI: 10.1038/s41467-025-57146-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 02/11/2025] [Indexed: 02/26/2025] Open
Abstract
Atrial fibrillation (AF) significantly increases the risk of ischemic stroke, and in non-valvular AF, 90% of stroke-causing thrombi arise from the left atrial appendage (LAA). Percutaneous LAA occlusion using an occluder is a crucial clinical intervention. However, occluder materials could provoke thrombi, termed device-related thrombosis (DRT), leading to treatment failure. Rapid endothelialization is essential to address the DRT but the occluder's large surface area and irregular cell migration on the surface impede this process. Here, we report a continuous drop-shaped microgroove, which has a drop-shaped unit structure similar to endothelial cells. The microgrooves polarize the cytoskeleton, guiding cell unidirectional migration within the grooves, and increase cell migration efficiency. We show that drop-shaped microgrooves accelerate wound healing in a rat model, and that occluder discs with drop-shaped microgrooves promote endothelialization in a canine model. Together, our results show that integrating microgrooves with medical devices is a promising approach for addressing DRT.
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Affiliation(s)
- Xing-Wang Wang
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, China
| | - Cheng-Qiang Ye
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, China
| | - Qian Tang
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
- Engineering Research Center for Cardiovascular Innovative Devices of Zhejiang Province, Hangzhou, China
| | - Hong-Mei Yu
- Department of Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Jing Wang
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Guo-Sheng Fu
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
- Engineering Research Center for Cardiovascular Innovative Devices of Zhejiang Province, Hangzhou, China
| | - Ke-Feng Ren
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, China.
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China.
- Engineering Research Center for Cardiovascular Innovative Devices of Zhejiang Province, Hangzhou, China.
| | - Lu Yu
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China.
- Engineering Research Center for Cardiovascular Innovative Devices of Zhejiang Province, Hangzhou, China.
| | - Jian Ji
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, China.
- State Key Laboratory of Transvascular Implantation Devices, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.
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Cheng M, Wang J, Liu X, Wang Y, Wu Q, Wang F, Li P, Wang B, Zhang X, Xie W. Development and Validation of a Deep-Learning Network for Detecting Congenital Heart Disease from Multi-View Multi-Modal Transthoracic Echocardiograms. RESEARCH (WASHINGTON, D.C.) 2024; 7:0319. [PMID: 38455153 PMCID: PMC10919123 DOI: 10.34133/research.0319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/26/2024] [Indexed: 03/09/2024]
Abstract
Early detection and treatment of congenital heart disease (CHD) can significantly improve the prognosis of children. However, inexperienced sonographers often face difficulties in recognizing CHD through transthoracic echocardiogram (TTE) images. In this study, 2-dimensional (2D) and Doppler TTEs of children collected from 2 clinical groups from Beijing Children's Hospital between 2018 and 2022 were analyzed, including views of apical 4 chamber, subxiphoid long-axis view of 2 atria, parasternal long-axis view of the left ventricle, parasternal short-axis view of aorta, and suprasternal long-axis view. A deep learning (DL) framework was developed to identify cardiac views, integrate information from various views and modalities, visualize the high-risk region, and predict the probability of the subject being normal or having an atrial septal defect (ASD) or a ventricular septaldefect (VSD). A total of 1,932 children (1,255 healthy controls, 292 ASDs, and 385 VSDs) were collected from 2 clinical groups. For view classification, the DL model reached a mean [SD] accuracy of 0.989 [0.001]. For CHD screening, the model using both 2D and Doppler TTEs with 5 views achieved a mean [SD] area under the receiver operating characteristic curve (AUC) of 0.996 [0.000] and an accuracy of 0.994 [0.002] for within-center evaluation while reaching a mean [SD] AUC of 0.990 [0.003] and an accuracy of 0.993 [0.001] for cross-center test set. For the classification of healthy, ASD, and VSD, the model reached the mean [SD] accuracy of 0.991 [0.002] and 0.986 [0.001] for within- and cross-center evaluation, respectively. The DL models aggregating TTEs with more modalities and scanning views attained superior performance to approximate that of experienced sonographers. The incorporation of multiple views and modalities of TTEs in the model enables accurate identification of children with CHD in a noninvasive manner, suggesting the potential to enhance CHD detection performance and simplify the screening process.
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Affiliation(s)
- Mingmei Cheng
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Department of Psychology, School of Mental Health and Psychological Sciences,
Anhui Medical University, Hefei 230011, China
| | - Jing Wang
- Heart Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 10045, China
- School of Basic Medical Sciences, Capital Medical University, Beijing 10069, China
| | - Xiaofeng Liu
- Gordon Center for Medical Imaging, Harvard Medical School, and Massachusetts General Hospital, Boston, MA 02114, USA
| | - Yanzhong Wang
- School of Life Course and Population Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - Qun Wu
- Heart Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 10045, China
| | - Fangyun Wang
- Heart Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 10045, China
| | - Pei Li
- Heart Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 10045, China
| | - Binbin Wang
- Center for Genetics,
National Research Institute for Family Planning, Beijing 100730, China
- Graduated School,
Peking Union Medical College, Beijing 100730, China
| | - Xin Zhang
- Heart Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 10045, China
| | - Wanqing Xie
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Department of Psychology, School of Mental Health and Psychological Sciences,
Anhui Medical University, Hefei 230011, China
- Beth Israel Deaconess Medical Center, Harvard Medical School,
Harvard University, Boston, MA 02215, USA
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Xu Q, Fa H, Yang P, Wang Q, Xing Q. Progress of biodegradable polymer application in cardiac occluders. J Biomed Mater Res B Appl Biomater 2024; 112:e35351. [PMID: 37974558 DOI: 10.1002/jbm.b.35351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 09/08/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
Cardiac septal defect is the most prevalent congenital heart disease and is typically treated with open-heart surgery under cardiopulmonary bypass. Since the 1990s, with the advancement of interventional techniques and minimally invasive transthoracic closure techniques, cardiac occluder implantation represented by the Amplazter products has been the preferred treatment option. Currently, most occlusion devices used in clinical settings are primarily composed of Nitinol as the skeleton. Nevertheless, long-term follow-up studies have revealed various complications related to metal skeletons, including hemolysis, thrombus, metal allergy, cardiac erosion, and even severe atrioventricular block. Thus, occlusion devices made of biodegradable materials have become the focus of research. Over the past two decades, several bioabsorbable cardiac occluders for ventricular septal defect and atrial septal defect have been designed and trialed on animals or humans. This review summarizes the research progress of bioabsorbable cardiac occluders, the advantages and disadvantages of different biodegradable polymers used to fabricate occluders, and discusses future research directions concerning the structures and materials of bioabsorbable cardiac occluders.
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Affiliation(s)
- Qiteng Xu
- Medical College, Qingdao University, Qingdao, China
| | - Hongge Fa
- Qingdao Women and Children's Hospital, QingdaoUniversity, Qingdao, China
| | - Ping Yang
- Medical College, Qingdao University, Qingdao, China
| | | | - Quansheng Xing
- Qingdao Women and Children's Hospital, QingdaoUniversity, Qingdao, China
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7
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Kong P, Liu X, Li Z, Wang J, Gao R, Feng S, Li H, Zhang F, Feng Z, Huang P, Wang S, Zhuang D, Ouyang W, Wang W, Pan X. Biodegradable Cardiac Occluder with Surface Modification by Gelatin-Peptide Conjugate to Promote Endogenous Tissue Regeneration. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2305967. [PMID: 37984880 PMCID: PMC10787076 DOI: 10.1002/advs.202305967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/20/2023] [Indexed: 11/22/2023]
Abstract
Transcatheter intervention has been the preferred treatment for congenital structural heart diseases by implanting occluders into the heart defect site through minimally invasive access. Biodegradable polymers provide a promising alternative for cardiovascular implants by conferring therapeutic function and eliminating long-term complications, but inducing in situ cardiac tissue regeneration remains a substantial clinical challenge. PGAG (polydioxanone/poly (l-lactic acid)-gelatin-A5G81) occluders are prepared by covalently conjugating biomolecules composed of gelatin and layer adhesive protein-derived peptides (A5G81) to the surface of polydioxanone and poly (l-lactic acid) fibers. The polymer microfiber-biomacromolecule-peptide frame with biophysical and biochemical cues could orchestrate the biomaterial-host cell interactions, by recruiting endogenous endothelial cells, promoting their adhesion and proliferation, and polarizing immune cells into anti-inflammatory phenotypes and augmenting the release of reparative cytokines. In a porcine atrial septal defect (ASD) model, PGAG occluders promote in situ tissue regeneration by accelerating surface endothelialization and regulating immune response, which mitigate inflammation and fibrosis formation, and facilitate the fusion of occluder with surrounding heart tissue. Collectively, this work highlights the modulation of cell-biomaterial interactions for tissue regeneration in cardiac defect models, ensuring endothelialization and extracellular matrix remodeling on polymeric scaffolds. Bioinspired cell-material interface offers a highly efficient and generalized approach for constructing bioactive coatings on medical devices.
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Affiliation(s)
- Pengxu Kong
- Department of Structural Heart DiseaseNational Center for Cardiovascular DiseaseChina & State Key Laboratory of Cardiovascular DiseaseFuwai HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeNational Health Commission Key Laboratory of Cardiovascular Regeneration MedicineNational Clinical Research Center for Cardiovascular DiseasesBeijing100037China
| | - Xiang Liu
- Tianjin Key Laboratory of Biomaterial ResearchInstitute of Biomedical EngineeringChinese Academy of Medical Sciences and Peking Union Medical CollegeTianjin300192China
| | - Zefu Li
- Department of Structural Heart DiseaseNational Center for Cardiovascular DiseaseChina & State Key Laboratory of Cardiovascular DiseaseFuwai HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeNational Health Commission Key Laboratory of Cardiovascular Regeneration MedicineNational Clinical Research Center for Cardiovascular DiseasesBeijing100037China
| | - Jingrong Wang
- Tianjin Key Laboratory of Biomaterial ResearchInstitute of Biomedical EngineeringChinese Academy of Medical Sciences and Peking Union Medical CollegeTianjin300192China
| | - Rui Gao
- Tianjin Key Laboratory of Biomaterial ResearchInstitute of Biomedical EngineeringChinese Academy of Medical Sciences and Peking Union Medical CollegeTianjin300192China
| | - Shuyi Feng
- Department of Structural Heart DiseaseNational Center for Cardiovascular DiseaseChina & State Key Laboratory of Cardiovascular DiseaseFuwai HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeNational Health Commission Key Laboratory of Cardiovascular Regeneration MedicineNational Clinical Research Center for Cardiovascular DiseasesBeijing100037China
| | - Hang Li
- Department of Structural Heart DiseaseNational Center for Cardiovascular DiseaseChina & State Key Laboratory of Cardiovascular DiseaseFuwai HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeNational Health Commission Key Laboratory of Cardiovascular Regeneration MedicineNational Clinical Research Center for Cardiovascular DiseasesBeijing100037China
| | - Fengwen Zhang
- Department of Structural Heart DiseaseNational Center for Cardiovascular DiseaseChina & State Key Laboratory of Cardiovascular DiseaseFuwai HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeNational Health Commission Key Laboratory of Cardiovascular Regeneration MedicineNational Clinical Research Center for Cardiovascular DiseasesBeijing100037China
| | - Zujian Feng
- Tianjin Key Laboratory of Biomaterial ResearchInstitute of Biomedical EngineeringChinese Academy of Medical Sciences and Peking Union Medical CollegeTianjin300192China
| | - Pingsheng Huang
- Tianjin Key Laboratory of Biomaterial ResearchInstitute of Biomedical EngineeringChinese Academy of Medical Sciences and Peking Union Medical CollegeTianjin300192China
| | - Shouzheng Wang
- Department of Structural Heart DiseaseNational Center for Cardiovascular DiseaseChina & State Key Laboratory of Cardiovascular DiseaseFuwai HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeNational Health Commission Key Laboratory of Cardiovascular Regeneration MedicineNational Clinical Research Center for Cardiovascular DiseasesBeijing100037China
- Key Laboratory of Innovative Cardiovascular DevicesChinese Academy of Medical SciencesBeijing100037China
| | - Donglin Zhuang
- Department of Structural Heart DiseaseNational Center for Cardiovascular DiseaseChina & State Key Laboratory of Cardiovascular DiseaseFuwai HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeNational Health Commission Key Laboratory of Cardiovascular Regeneration MedicineNational Clinical Research Center for Cardiovascular DiseasesBeijing100037China
| | - Wenbin Ouyang
- Department of Structural Heart DiseaseNational Center for Cardiovascular DiseaseChina & State Key Laboratory of Cardiovascular DiseaseFuwai HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeNational Health Commission Key Laboratory of Cardiovascular Regeneration MedicineNational Clinical Research Center for Cardiovascular DiseasesBeijing100037China
- Key Laboratory of Innovative Cardiovascular DevicesChinese Academy of Medical SciencesBeijing100037China
| | - Weiwei Wang
- Tianjin Key Laboratory of Biomaterial ResearchInstitute of Biomedical EngineeringChinese Academy of Medical Sciences and Peking Union Medical CollegeTianjin300192China
- Key Laboratory of Innovative Cardiovascular DevicesChinese Academy of Medical SciencesBeijing100037China
| | - Xiangbin Pan
- Department of Structural Heart DiseaseNational Center for Cardiovascular DiseaseChina & State Key Laboratory of Cardiovascular DiseaseFuwai HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeNational Health Commission Key Laboratory of Cardiovascular Regeneration MedicineNational Clinical Research Center for Cardiovascular DiseasesBeijing100037China
- Key Laboratory of Innovative Cardiovascular DevicesChinese Academy of Medical SciencesBeijing100037China
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Chen J, Xie Y, Li Y, Chen X, Fu M, Liu Y, Zhang Z. Assessment of degradability and endothelialization of modified poly L-lactic acid (PLLA) atrial septal defect (ASD) occluders over time in vivo. J Cardiothorac Surg 2023; 18:283. [PMID: 37817186 PMCID: PMC10566106 DOI: 10.1186/s13019-023-02401-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/30/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVE To evaluate the fiber-degradation and endothelialization of a modified poly L-lactic acid (PLLA) atrial septal defect (ASD) occluder for a long time in vivo. METHODS A total of 57 New Zealand rabbits were selected to establish the vasculature implantation model, which would be used to characterize the mechanical properties and pathological reaction of PLLA filaments (a raw polymer of ASD occluder). In total, 27 Experimental piglets were used to create the ASD model for the catheter implantation of PLLA ASD occluders. Then, X-ray imaging, transthoracic echocardiography, histopathology, and scanning electron microscope (SEM) were performed in the experimental animals at 3, 6, 12, and 24 months after implantation. RESULTS In the rabbit models, the fibrocystic grade was 0 and the inflammatory response was grade 2 at 6 months after vasculature implantation of the PLLA filaments. The mass loss of PLLA filaments increased appreciably with the increasing duration of implantation, but their mechanical strength was decreased without broken. In the porcine models, the cardiac gross anatomy showed that all PLLA ASD occluders were stable in the interatrial septum without any vegetation or thrombus formation. At 24 months, the occluders had been embedded into endogenous host tissue nearly. Pathological observations suggested that the occluders degraded gradually without complications at different periods. SEM showed that the occluders were endothelialized completely and essentially became an integral part of the body over time. CONCLUSION In the animal model, the modified PLLA ASD occluders exhibited good degradability and endothelialization in this long-term follow-up study.
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Affiliation(s)
- Jun Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, No. 106 Zhongshan Second Road, Yuexiu District, Guangzhou, 510100, Guangdong, China
- Danzhou People's Hospital, Danzhou, 571700, Hainan, China
| | - Yumei Xie
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, No. 106 Zhongshan Second Road, Yuexiu District, Guangzhou, 510100, Guangdong, China
| | - Yifan Li
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, No. 106 Zhongshan Second Road, Yuexiu District, Guangzhou, 510100, Guangdong, China
| | - Xianmiao Chen
- Lifetech Scientific (Shenzhen) Co., Ltd., Shenzhen, 518057, Guangdong, China
| | - Mingjuan Fu
- Lifetech Scientific (Shenzhen) Co., Ltd., Shenzhen, 518057, Guangdong, China
| | - Yanfen Liu
- Lifetech Scientific (Shenzhen) Co., Ltd., Shenzhen, 518057, Guangdong, China
| | - Zhiwei Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China.
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, No. 106 Zhongshan Second Road, Yuexiu District, Guangzhou, 510100, Guangdong, China.
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9
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Xiang Z, Zhang J, Zhou C, Zhang B, Chen N, Li M, Fu D, Wang Y. Near-Infrared Remotely Controllable Shape Memory Biodegradable Occluder Based on Poly(l-lactide- co-ε-caprolactone)/Gold Nanorod Composite. ACS APPLIED MATERIALS & INTERFACES 2023; 15:42341-42353. [PMID: 37647023 DOI: 10.1021/acsami.3c09852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Biodegradable occluders, which can efficiently eliminate the complications caused by permanent foreign implants, are considered to be the next-generation devices for the interventional treatment of congenital heart disease. However, the controllability of the deployment process of degradable occluders remains a challenge. In this work, a near-infrared (NIR) remotely controllable biodegradable occluder is explored by integrating poly(l-lactide-co-ε-caprolactone) (PLCL) with poly(ethylene glycol)-modified gold nanorods (GNR/PEG). The caprolactone structural units can effectively increase the toughness of poly(l-lactide) and reduce the shape-memory transition temperature of the occluder to a more tissue-friendly temperature. Gold nanorods endow the PLCL-GNR/PEG composite with an excellent photothermal effect. The obtained occluder can be easily loaded into a catheter for transport and spatiotemporally expanded under irradiation with near-infrared light to block the defect site. Both in vitro and in vivo biological experiments showed that PLCL-GNR/PEG composites have good biocompatibility, and the PEGylated gold nanorods could improve the hemocompatibility of the composites to a certain extent by enhancing their hydrophilicity. As a thermoplastic shape-memory polymer, PLCL-GNR/PEG can be easily processed into various forms and structures for different patients and lesions. Therefore, PLCL-GNR/PEG has the potential to be considered as a competitive biodegradable material not only for occluders but also for other biodegradable implants.
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Affiliation(s)
- Zhen Xiang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Jiayi Zhang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Chen Zhou
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Bo Zhang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Nuoya Chen
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Mingyu Li
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Daihua Fu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
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Jiang H, Cao S, Wang R, Wang S, He Z, Xu X, Yang C, Liu X. In vivo study of a reserved atrial septal puncture area patent foramen ovale occluder. Cardiol Young 2023; 33:1581-1586. [PMID: 36065734 DOI: 10.1017/s1047951122002827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE After patent foramen ovale interventional closure, puncture of the interatrial septum through the occluder is difficult but sometimes needed for further interventional treatment. This paper presents findings from an in vivo experimental study of a reserved atrial septal puncture area patent foramen ovale occluder. MATERIALS AND METHODS A patent foramen ovale model was established in canines using trans-septal puncture of the fossa ovale and high-pressure balloon dilation. Then, patent foramen ovale closure was performed with a reserved atrial septal puncture area and all canines were raised for 3 months. Then, the occluder was crossed and left atrial angiography was performed on the septal area with the occluder. Finally, DSA angiography, echocardiography, and histology were used to evaluate the performance and feasibility of the reserved atrial septal puncture area. RESULTS A patent foramen ovale model was successfully established in 10 canines using the atrial septal puncture method. The average diameter of the patent foramen ovale was 3.77 ±0.19 mm, and the patent foramen ovale was successfully closed in all canines using a reserved atrial septal puncture area. As assessed using transoesophageal echocardiography, the new occluder exhibited an ideal position and was occluded entirely without a residual shunt intraoperatively and postoperatively. A 100% success rate of atrial septum puncture was achieved across the new occluder. The occluders were completely endothelialised 3 months post-implantation. CONCLUSIONS The reserved atrial septal puncture area was effective in patent foramen ovale closure and exhibited positive sealing performance and biological compatibility. Trans-septal puncture was feasible and effective after reserved atrial septal puncture area patent foramen ovale closure.
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Affiliation(s)
- Haibin Jiang
- Department of Cardiology, Wuxi NO. 2 People's Hospital, Nanjing Medical University, Wuxi 214000, Jiangsu, China
| | - Suyan Cao
- Department of Cardiology, Wuxi NO. 2 People's Hospital, Nanjing Medical University, Wuxi 214000, Jiangsu, China
| | - Renrong Wang
- Department of Cardiology, Wuxi NO. 2 People's Hospital, Nanjing Medical University, Wuxi 214000, Jiangsu, China
| | - Shuya Wang
- Department of Cardiology, Wuxi NO. 2 People's Hospital, Nanjing Medical University, Wuxi 214000, Jiangsu, China
| | - Ziqian He
- Department of Cardiology, Wuxi NO. 2 People's Hospital, Nanjing Medical University, Wuxi 214000, Jiangsu, China
| | - Xin Xu
- Department of Cardiology, Wuxi NO. 2 People's Hospital, Nanjing Medical University, Wuxi 214000, Jiangsu, China
| | - Chengjian Yang
- Department of Cardiology, Wuxi NO. 2 People's Hospital, Nanjing Medical University, Wuxi 214000, Jiangsu, China
| | - Xiaoxiao Liu
- Department of Cardiology, Wuxi NO. 2 People's Hospital, Nanjing Medical University, Wuxi 214000, Jiangsu, China
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11
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Moura D, Pereira AT, Ferreira HP, Barrias CC, Magalhães FD, Bergmeister H, Gonçalves IC. Poly(2-hydroxyethyl methacrylate) hydrogels containing graphene-based materials for blood-contact applications: from soft inert to strong degradable material. Acta Biomater 2023; 164:253-268. [PMID: 37121371 DOI: 10.1016/j.actbio.2023.04.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/02/2023]
Abstract
Degradable biomaterials for blood-contacting devices (BCDs) are associated with weak mechanical properties, high molecular weight of the degradation products and poor hemocompatibility. Herein, the inert and biocompatible FDA approved poly(2-hydroxyethyl methacrylate) (pHEMA) hydrogel was turned into a degradable material by incorporation of different amounts of a hydrolytically labile crosslinking agent, pentaerythritol tetrakis(3-mercaptopropionate). In situ addition of 1wt.% of oxidized graphene-based materials (GBMs) with different lateral sizes/thicknesses (single-layer graphene oxide, and oxidized forms of few-layer graphene materials) was performed to enhance the mechanical properties of hydrogels. An ultimate tensile strength increases up to 0.2 MPa (293% higher than degradable pHEMA) was obtained using oxidized few-layer graphene with 5 μm lateral size. Moreover, the incorporation of GBMs has demonstrated to simultaneously tune the degradation time, which ranged from 2 to 4 months. Notably, these features were achieved keeping not only the intrinsic properties of inert pHEMA regarding water uptake, wettability and cytocompatibility (short and long term), but also the non-fouling behavior towards human cells, platelets and bacteria. This new pHEMA hydrogel with degradation and biomechanical performance tuned by GBMs, can therefore be envisioned for different applications in tissue engineering, particularly for BCDs where non-fouling character is essential. STATEMENT OF SIGNIFICANCE: Suitable mechanical properties, low molecular weight of the degradation products and hemocompatibility are key features in degradable blood contacting devices (BCDs), and pave the way for significant improvement in the field. In here, a hydrogel with outstanding anti-adhesiveness (pHEMA) provides hemocompatibility, the presence of a degradable crosslinker provides degradability, and incorporation of graphene oxide reestablishes its strength, allowing tuning of both degradation and mechanical properties. Notably, these hydrogels simultaneously provide suitable water uptake, wettability, cytocompatibility (short and long term), no acute inflammatory response, and non-fouling behavior towards endothelial cells, platelets and bacteria. Such results highlight the potential of these hydrogels to be envisioned for applications in tissue engineered BCDs, namely as small diameter vascular grafts.
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Affiliation(s)
- Duarte Moura
- INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200-180 Porto, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200-180 Porto, Portugal; FEUP - Faculdade de Engenharia, Departamento de Engenharia Metalúrgica e de Materiais, Universidade do Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Andreia T Pereira
- INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200-180 Porto, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200-180 Porto, Portugal
| | - Helena P Ferreira
- INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200-180 Porto, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200-180 Porto, Portugal; ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, 4050-313, Portugal
| | - Cristina C Barrias
- INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200-180 Porto, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200-180 Porto, Portugal; ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, 4050-313, Portugal
| | - Fernão D Magalhães
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Helga Bergmeister
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Cardiovascular Research, Austria
| | - Inês C Gonçalves
- INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200-180 Porto, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200-180 Porto, Portugal.
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12
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Lin C, Huang Z, Wang Q, Zou Z, Wang W, Liu L, Liu Y, Leng J. 4D Printing of Overall Radiopaque Customized Bionic Occlusion Devices. Adv Healthc Mater 2023; 12:e2201999. [PMID: 36337009 DOI: 10.1002/adhm.202201999] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/28/2022] [Indexed: 11/09/2022]
Abstract
Percutaneous closure of ventricular septal defect (VSD) can effectively occlude abnormal blood flow between ventricles. However, commonly used Nitinol occlusion devices have non-negligible limitations, such as nondegradability leading to life-threatening embolization; limited device size predisposing to displacement and wear; only a few radiopaque markers resulting in inaccurate positioning. Nevertheless, the exploration of customized, biodegradable, and overall radiopaque occluders is still vacant. Here, overall radiopaque, biodegradable, and dynamic reconfigurable 4D printed VSD occluders are developed. Based on wavy bionic structures, various VSD occluders are designed and manufactured to adapt to the position diversity of VSD. The customized configuration, biocompatibility, and biodegradability of the developed 4D printed bionic occluders can eliminate the series of complications caused by traditional occluders. The overall radiopacity of 4D printed VSD occluders is validated ex vivo and in vivo, whereby accurate positioning can be assured. Notably, the preparation strategies for 4D printed occluders are scalable, eliminating the barriers to mass production, and marking a meaningful step in bridging the gap between modeling and clinical application of 4D printed occlusion devices. This work opens attractive perspectives for the rapid manufacturing of customized intelligent medical devices for which overall radiopacity, dynamic reconfigurability, biocompatibility, and biodegradability are sought.
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Affiliation(s)
- Cheng Lin
- Centre for Composite Materials and Structures, Harbin Institute of Technology, No. 2 Yikuang Street, Harbin, 150001, P. R. China
| | - Zhipeng Huang
- Tangdu Hospital of the Air Force Military Medical University, No. 1, Xinsi Road, Xi'an, 710038, P. R. China
| | - Qinglong Wang
- Tangdu Hospital of the Air Force Military Medical University, No. 1, Xinsi Road, Xi'an, 710038, P. R. China
| | - Zhichen Zou
- The First Affiliated Hospital of Harbin Medical University, No. 23 Youzheng Street, Nangang District, Harbin, 150001, P. R. China
| | - Wenbo Wang
- The First Affiliated Hospital of Harbin Medical University, No. 23 Youzheng Street, Nangang District, Harbin, 150001, P. R. China
| | - Liwu Liu
- Department of Astronautical Science and Mechanics, Harbin Institute of Technology, No. 92 West Dazhi Street, Harbin, 150001, P. R. China
| | - Yanju Liu
- Department of Astronautical Science and Mechanics, Harbin Institute of Technology, No. 92 West Dazhi Street, Harbin, 150001, P. R. China
| | - Jinsong Leng
- Centre for Composite Materials and Structures, Harbin Institute of Technology, No. 2 Yikuang Street, Harbin, 150001, P. R. China
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13
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Zhao W, Yue C, Liu L, Liu Y, Leng J. Research Progress of Shape Memory Polymer and 4D Printing in Biomedical Application. Adv Healthc Mater 2022:e2201975. [PMID: 36520058 DOI: 10.1002/adhm.202201975] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/06/2022] [Indexed: 12/23/2022]
Abstract
As a kind of smart material, shape memory polymer (SMP) shows great application potential in the biomedical field. Compared with traditional metal-based medical devices, SMP-based devices have the following characteristics: 1) The adaptive ability allows the biomedical device to better match the surrounding tissue after being implanted into the body by minimally invasive implantation; 2) it has better biocompatibility and adjustable biodegradability; 3) mechanical properties can be regulated in a large range to better match with the surrounding tissue. 4D printing technology is a comprehensive technology based on smart materials and 3D printing, which has great application value in the biomedical field. 4D printing technology breaks through the technical bottleneck of personalized customization and provides a new opportunity for the further development of the biomedical field. This paper summarizes the application of SMP and 4D printing technology in the field of bone tissue scaffolds, tracheal scaffolds, and drug release, etc. Moreover, this paper analyzes the existing problems and prospects, hoping to provide a preliminary discussion and useful reference for the application of SMP in biomedical engineering.
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Affiliation(s)
- Wei Zhao
- Department of Astronautical Science and Mechanics, Harbin Institute of Technology (HIT), P.O. Box 301, No. 92 West Dazhi Street, Harbin, 150001, P. R. China
| | - Chengbin Yue
- Department of Astronautical Science and Mechanics, Harbin Institute of Technology (HIT), P.O. Box 301, No. 92 West Dazhi Street, Harbin, 150001, P. R. China
| | - Liwu Liu
- Department of Astronautical Science and Mechanics, Harbin Institute of Technology (HIT), P.O. Box 301, No. 92 West Dazhi Street, Harbin, 150001, P. R. China
| | - Yanju Liu
- Department of Astronautical Science and Mechanics, Harbin Institute of Technology (HIT), P.O. Box 301, No. 92 West Dazhi Street, Harbin, 150001, P. R. China
| | - Jinsong Leng
- Center for Composite Materials and Structures, Harbin Institute of Technology (HIT), P.O. Box 3011, No. 2 Yikuang Street, Harbin, 150080, P. R. China
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A fully degradable transcatheter ventricular septal defect occluder: Towards rapid occlusion and post-regeneration absorption. Biomaterials 2022; 291:121909. [DOI: 10.1016/j.biomaterials.2022.121909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/26/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022]
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Zhang Z, Xiong Y, Hu J, Guo X, Xu X, Chen J, Wang Y, Chen Y. A Finite Element Investigation on Material and Design Parameters of Ventricular Septal Defect Occluder Devices. J Funct Biomater 2022; 13:jfb13040182. [PMID: 36278651 PMCID: PMC9590015 DOI: 10.3390/jfb13040182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/26/2022] [Accepted: 10/01/2022] [Indexed: 12/01/2022] Open
Abstract
Background and Objective: Ventricular septal defects (VSDs) are the most common form of congenital heart defects. The incidence of VSD accounts for 40% of all congenital heart defects (CHDs). With the development of interventional therapy technology, transcatheter VSD closure was introduced as an alternative to open heart surgery. Clinical trials of VSD occluders have yielded promising results, and with the development of new material technologies, biodegradable materials have been introduced into the application of occluders. At present, the research on the mechanical properties of occluders is focused on experimental and clinical trials, and numerical simulation is still a considerable challenge due to the braided nature of the VSD occluder. Finite element analysis (FEA) has proven to be a valid and efficient method to virtually investigate and optimize the mechanical behavior of minimally invasive devices. The objective of this study is to explore the axial resistive performance through experimental and computational testing, and to present the systematic evaluation of the effect of various material and braid parameters by FEA. Methods: In this study, an experimental test was used to investigate the axial resistive force (ARF) of VSD Nitinol occluders under axial displacement loading (ADL), then the corresponding numerical simulation was developed and compared with the experimental results to verify the effectiveness. Based on the above validation, numerical simulations of VSD occluders with different materials (polydioxanone (PDO) and Nitinol with different austenite moduli) and braid parameters (wire density, wire diameter, and angle between left and right discs) provided a clear presentation of mechanical behaviors that included the maximal axial resistive force (MARF), maximal axial displacement (MAD) and initial axial stiffness (IAS), the stress distribution and the maximum principal strain distribution of the device under ADL. Results: The results showed that: (1) In the experimental testing, the axial resistive force (ARF) of the tested occluder, caused by axial displacement loading (ADL), was recorded and it increased linearly from 0 to 4.91 N before reducing. Subsequent computational testing showed that a similar performance in the ARF was experienced, albeit that the peak value of ARF was smaller. (2) The investigated design parameters of wire density, wire diameter and the angle between the left and right discs demonstrated an effective improvement (7.59%, 9.48%, 1.28%, respectively, for MARF, and 1.28%, 1.80%, 3.07%, respectively, for IAS) for the mechanical performance for Nitinol occluders. (3) The most influencing factor was the material; the performance rose by 30% as the Nitinol austenite modulus (EA) increased by 10,000 MPa. The performance of Nitinol was better than that of PDO for certain wire diameters, and the performance improved more obviously (1.80% for Nitinol and 0.64% for PDO in IAS, 9.48% for Nitinol and 2.00% for PDO in MARF) with the increase in wire diameter. (4) For all of the models, the maximum stresses under ADL were distributed at the edge of the disc on the loaded side of the occluders. Conclusions: The experimental testing presented in the study showed that the mechanical performance of the Nitinol occluder and the MARF prove that it has sufficient ability to resist falling out from its intended placement. This study also represents the first experimentally validated computational model of braided occluders, and provides a perception of the influence of geometrical and material parameters in these systems. The results could further provide meaningful suggestions for the design of biodegradable VSD closure devices and to realize a series of applications for biodegradable materials in VSD.
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Affiliation(s)
- Zhuo Zhang
- School of Mechanical Engineering, Sichuan University, Chengdu 610000, China
| | - Yan Xiong
- School of Mechanical Engineering, Sichuan University, Chengdu 610000, China
- Correspondence: (Y.X.); (Y.W.)
| | - Jinpeng Hu
- Shanghai Shape Memory Alloy Co., Ltd., Shanghai 200000, China
| | - Xuying Guo
- Shanghai Shape Memory Alloy Co., Ltd., Shanghai 200000, China
| | - Xianchun Xu
- Shanghai Shape Memory Alloy Co., Ltd., Shanghai 200000, China
| | - Juan Chen
- Shanghai Shape Memory Alloy Co., Ltd., Shanghai 200000, China
| | - Yunbing Wang
- College of Biomedical Engineering, Sichuan University, Chengdu 610000, China
- Correspondence: (Y.X.); (Y.W.)
| | - Yu Chen
- Department of Applied Mechanics, Sichuan University, Chengdu 610000, China
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Song L, Shi P, Zheng X, Hongxin L, Li Z, Lv M, Wang H. Echocardiographic characteristics of transcatheter closure of patent foramen ovale with mallow biodegradable occluder: A single-center, phase III clinical study. Front Cardiovasc Med 2022; 9:945275. [PMID: 36035958 PMCID: PMC9411996 DOI: 10.3389/fcvm.2022.945275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/18/2022] [Indexed: 12/03/2022] Open
Abstract
Background Transcatheter occlusion of patent foramen ovale (PFO) has become a recognized treatment option for high-risk PFO-related diseases. However, traditional metal occluders have some disadvantages, such as permanent retention in the body, abrasion of tissues, and obstruction of access to the left side of the heart for interventional procedures. With biodegradable occluders that release non-toxic degradation products and are absorbable by the body, the risk of long-term complications could be greatly reduced. The experimental results of using a PFO-degradable occluder in beagle dogs in early stages, independently developed by Shanghai Mallow Medical Instrument Co., Ltd., showed that the occluding umbrella disc network was degraded 6 months after occlusion. The occluder also showed good memory, biocompatibility, and mechanical properties. Methods As one of the multi-center research units, this prospective Phase III clinical trial study included 16 patients with PFO-related complications who were treated with a degradable occluder. The follow-up period lasted for 12 months to analyze the echocardiographic characteristics and procedural feasibility. Results The immediate success rate of the procedure was 100% with no serious complications. Postoperative color Doppler transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) at 12 months showed that one patient with atrial septal aneurysm (ASA) had a residual shunt at the edge of the occluder, and contrast transcranial Doppler (cTCD) showed that all patients were grade I or 0 right-to-left shunts (RLS), indicating that the occlusion success rate was 100%. The occluder gradually degraded after the procedure, particularly when the umbrella disc structure became vague, and the size of the occluder decreased significantly 6 months after occlusion. Conclusions PFO closure with a Mallow degradable occluder has a high plugging success rate, is safe and effective, and has no serious complications. However, for PFO closure with special anatomical features, further research with a larger sample size is required. TTE can dynamically, conveniently, and accurately observe the entire degradation process of the occluder. Clinical Trial Registration ChiCTR1900024036.
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Affiliation(s)
- Lin Song
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Peixuan Shi
- Department of Medical Ultrasound, Shandong Provincial Qianfoshan Hospital, Shandong First Medical University, Jinan, China
| | - Xiaozhou Zheng
- Department of Cardiovascular Surgery, Shandong Engineering Research Center for Health Transplant and Material, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Li Hongxin
- Department of Cardiovascular Surgery, Shandong Engineering Research Center for Health Transplant and Material, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Ziang Li
- Department of Cardiovascular Surgery, Shandong Engineering Research Center for Health Transplant and Material, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Meng Lv
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Haiyan Wang
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- *Correspondence: Haiyan Wang
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Jiang N, Jia B. WITHDRAWN: Progress of biodegradable materials for occlusion devices. Ann Med Surg (Lond) 2022. [DOI: 10.1016/j.amsu.2022.103745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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