biomaterials lecture final.ppt [read-only]
TRANSCRIPT
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Cardiovascular Biomaterials
Karyn S. Kunzelman, Ph.D.
Division of Cardiothoracic SurgeryDepartment of Biomedical Engineering
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Overview
History
Specific Applications
Future Directions
Blood Material Interactions
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History ofCardiovascular
Intervention
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Historical
1628 - William Harvey, English Physician, describes blood circulation.
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Historical
1706 - Raymond de Vieussens, French anatomy professor, firstdescribes the structure of the heart's chambers and vessels.
1733 - Stephen Hales, English clergyman and scientist, first measuresblood pressure.
1816 - Rene Laennec, French physician, invents the stethoscope.
1903 - Willem Einthoven, Dutch physiologist, develops theelectrocardiograph.
1912 - James Herrick, American physician, first describes heart diseaseresulting from hardening of the arteries.
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Historical
1948 - Dwight Harken, American surgeon, performs first closed mitralcommisurotomy.
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Historical
1951 - Charles Hufnagel,American surgeon, developsa plastic valve to repair anaortic valve.
1952 - F. John Lewis, W.Lillehei, American surgeons,perform first successful openheart surgery (VSD repair).
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Historical
1953 - John H. Gibbon, American surgeon, first uses a mechanicalheart and blood purifier.
1965 - Michael DeBakey and Adrian Kantrowitz, Americansurgeons, implant mechanical devices to help a diseased heart.
1967 - Christiaan Barnard, a South African surgeon, performs thefirst whole heart transplant from one person to another.
1982 - Willem DeVries, an American surgeon, implants apermanent artificial heart, designed by Robert Jarvik, anAmerican physician, into a patient.
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Cardiovascular System
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Devices
Heart Valves 52,000Mechanical (32,000)Bioprosthetic (20,000)
Pacemakers 144,000
Vascular grafts 160,000
Oxygenators (CPB) 260,000
Heart Assist 31,717
IABP (31,300)
VAD (400)
TAH (17)
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Blood Material Interactions
Detrimental effects on blood/tissue/organ
Detrimental effects on material/device
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Effect on Materials/Device
Adsorption of plasma proteins, lipids, calcium
Formation of pseudointima or capsule
Adhesion of platelets, leukocytes, erythrocytes
Alteration of mechanical properties
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Effect on Subject
Anemia, hemolysis, leukopenia,thrombocytopenia, altered RBC function
Formation of thrombi and/or embolization
Cell and/or tissue injury
Intimal hyperplasia, capsule affecting function
Activation of coagulation, fibrinolytic,or immunologic pathways
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Platelets / Thrombosis
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Platelets / Thrombosis
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Specific Applications
Heart surgery
Heart Assist
Other
Vascular surgery
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Heart Surgery
Heart valves
Cardiopulmonarybypass
Coronary arteryinterventions
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Cardiac anatomy / circulation
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Cardiopulmonary Bypass
Allows open heartsurgery, ECMO, ARDStreatment
Pumps unoxygenatedvenous blood throughoxygenator, and back toarterial system
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CPB components (1)
Blood pumps (roller head, vortex)
Oxygenators (membrane, bubbler)
Tubing, connectors
Suction
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CPB components (2)
Arterial filter Bubble trap
Cardioplegia
Heat exchanger
Resevoirs (hard shell, membrane)
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CPB
Materials used:Silicone elastomersMicroporous polypropylenePolyester (mesh in filter)Acrylonite-styrene polymersPolyurethanePolycarbonateStainless steel
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CPB
Clinical benefits:Allows open heart surgery, complex repairsAllows recovery from RDS, trauma
Problems to overcome: Major activation of coagulation and complement
Requires systemic anticoagulation
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Oxygenators
-Complement activation (contact, coagulation,fibrinolytic pathways activated)
-Platelet function abnormalities, bleeding, transfusions
-Post perfusion lung syndrome, neuropsychcomplications (due to platelet or leukocyte aggregates,or microbubbles)
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Oxygenator comparisonBubble oxygenators
Respiratory gas in contact with bloodRequires defoamer + bubble trap
Increased blood trauma
Membrane oxygenatorsBlood and gas separatedhollow fiber (polypropylene, polyurethane epoxy)Coated aluminum tubes (heat exchangers)Less hemolysis, less protein denaturationBetter preservation of platelet count and function
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Coronary Artery Intervention
Catheters/Cannula
CABG (coronary artery bypass graft)
PTCA (percutaneous transluminalcoronary angioplasty)
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Coronary anatomy
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CABG
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Catheters, Cannulas
Placed in virtuallyevery portion ofarterial+venouscirculation
Administering fluids,withdrawing bloodspecimens, pressuremonitoring, otherdata monitoring
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Catheters, cannulas
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Catheters/CannulasMaterials used:
Polyurethane, etc.Silicone elastomers
Problems to overcome (few):Vascular endothelium injury Thromboembolism
Clinical benefits:Widespread appliacations for administeringfluids, monitoring patient conditions
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PTCA / DCA
Directcoronaryatherectomy
Rotoblader
Percutaneoustransluminal
coronary angioplasty
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PTCA
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PTCA / DCA
Materials used:PolyurethaneSilicone elastomersStainless steel
Problems to overcomeVascular endothelium injuryRestenosis rate
Clinical benefits:Allows correction of stenosis without surgery
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Heart Valves
Mechanical Valves
Valve repair
Bioprosthetic Valves
Homografts
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Valve Replacement Procedures
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Valve Replacement Procedure
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Mechanical Valves
Tilting disk Bileaflet valveBall and cage
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Mechanical valves
Materials:Silicone elastomerCobalt-chrome alloysPyrolytic carbon TitaniumDacron
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Mechanical valves
Clinical benefits:Correct significant symptoms
Problems to overcome:ThromboembolismBleedingStructural failureEndocarditis
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Mechanical valves
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Bioprosthetic Valves
Stented Porcine Stentless Porcine Stented Pericardial
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Bioprosthetic valves
Materials:Porcine cross-linked valve tissuePericardial cross-linked tissueTitanium strutsDacron covering
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Bioprosthetic valves
Problems to overcome:CalcificationStructural deteriorationAntigenic reactionsEndocarditis
Clinical benefits:Correct significant symptoms
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Valve repair
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Homografts
Aortic MitralPulmonary
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Vascular Surgery
Stents
Grafts
Vascular access
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Biologic Grafts
IMA Femoral veinSaphenous vein
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Biologic grafts
Materials used:Arterial conduitsSaphenous vein
Clinical benefits:Replace blocked arteries, no anti-coagulation
Problems to overcome:Availability, quality, spasmThrombosis, neointimal hyperplasia
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Synthetic Grafts
Large diameter
Small diameter
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Sythethtic grafts
Materials used:DacronePTFE
Clinical Benefits:Replace blocked arteries, readily available
Problems to overcome:Thrombosis, neointimal hyperplasia
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Material treatment
Treatment methodsHeparin (-coagulation)Prostacylcin, or dipyriadomole (-platelets)Urokinase (+fibrinolysis)Heparin fraction (-intimal hyperplasia)Seeding / sodding endothelial cellsCompliance matching
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EC adherence
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EC adherence
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EC adherence
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Vascular access
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Vascular access
Materials used:Polyurethane
Clinical benefits:Access for chronic IV therapy, dialysis
Problems to overcome:Epithelial downgrowth, expulsion
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Stents
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Stents
Materials used:Nitinol (memory metal)Biodegradable polymers
Clinical benefits:Open blocked arteries
Problems to overcome:EC injury due to insertionThrombus, intimal hyperplasia, restenosis
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Heart Assist
Pacemakers
Ventricular assist devices
Artificial hearts
Intra-aortic balloon pump
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Pacemakers
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Pacemaker
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Materials used:Leads: platinum, silver, titanium, steel, cobaltLead sheaths: silicone rubber, polyurethaneLead connector: polyether urethaneCasing: titanium
Clinical benefits:Overcome abnormalities in heart rhythm
Problems to overcome:Rare complications, (localized inury)
Pacemaker
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IABP
Increase coronary arteryperfusion
Reduce workload
Principle ofcounterpulsation
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IABP
Materials used:Polyurethane balloon
Clinical benefit:Reduces workload on heartIncreases coronary and systemic flow
Problems to overcome:Surgical complications, gas leak
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Ventricular Assist Devices (VADs)
Pneumatic
AbiomedRotary
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Pneumatic
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Rotary
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Abiomed
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Total Artificial Heart (TAH)
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VADs / TAHMaterials used:
Blood pump sac Segmented polyether/polyurethaneValves Mechanical, bioprostheticCasing Titanium + siliconeConduits Dacron vascular graftsPower unit TitaniumBelt transformer Silicone covering, silver contactsConnecting leads SiliconePump drive unit Titanium, copper coilsVolume compensator Structural compositeEnergy control unit Ni-Cad2nd skin transformer Silver, copper
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VADs / TAH
Clinical benefit:Can function as heart
Problems to overcome:ThrombosisMechanical failureLimited battery life / power issuesInfectionComplications can be fatal
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Other
Drug Delivery
Blood Substitutes
Hemostatic agents
Tissue Engineering
Hybrid organs
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Drug delivery
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Drug delivery
Materials used:Titanium caseSilicone elastomer delivery catheter
Clinical benefit:Programmed, responsive drug delivery
Problems to overcome:Thrombosis, encapsulation
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Blood substitutes / oxygen carriers
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Blood substitutes / O2 carriers
Materials used:PerfluorocarbonsEncapsulated hemoglobin
Clinical benefit:Increase oxygen delivery
Problems to overcome:Safety, efficacy not determined
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Tissue Engineering
Application of engineering principles to createdevices for the study, restoration, modification,and assembly of functional tissues from native orsynthetic sources.
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Ischemia / Angiogenesis
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Ischemia / Angiogenesis
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Hybrid organs
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Tissue engineering / hybridsMaterials used:
Polystyrenes, PMMA, PDMSCollagen matrices
Clinical benefits:Possibly better incorporation?Increased longevity?
Problems to overcome:Large scale productionAntigenicity issues
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Hemostatic agents
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Hemostatic agents
Materials used:Collagen, gelatinOxidized regenerated cellulose
Clinical benefits:Control bleeding, reoperationsAneurysms, dissections
Problems to overcome:Antigenicity issuesProof of benefit
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Peptide binding, stimulate EC adherence
Genetic engineering, tPA activity
Seeding with EC, fibroblasts
Binding, controlled release of heparin
Resorbable materials
Better hemodynamic design
Approaches to overcomethrombosis, hyperplasia
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Seeding with ECs
Genetic engineering, antimicrobial activity
Modify receptors on surface
Binding, controlled release of antibacterials
Approaches to overcomeinfection
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Tissue engineering
Target integration with environment
More emphasis on long term interfacial events
Future directions
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Thanks for yourattention!