Some embodiments of the present invention relate to a mechanical circulatory support device, for assisting or replacing native heart function in cases of congestive heart failure. Some embodiments also relate to percutaneously implantable cardiovascular support and percutaneously implantable temporary mechanical circulatory support device. The methods have far-reaching implications for implantation and removal of implantable devices. The methods may be applied to other industrial applications, where shape memory alloys may be installed and removed at different temperatures.
Shape memory alloys are used in aerospace structures, orthodontics, cardiovascular prosthetic devices, sensors and controllers, and many other engineering, technology, science, and other fields. Solar panels used in space may be folded and unfolded at two different temperatures on ground, and folded and unfolded at a third colder temperature in space. Orthotic, orthodontic and cardiovascular devices experience operating room ambient temperature about 20 degree C., may be folded at 0 degree C., and unfolded and folded at body temperature about 37 degree C. Other literature in these fields describes the use of differences in stress-strain curves in shape-memory alloys with transition from martensite to austenite at two different temperatures. The subject of this disclosure is when three or more different temperatures are used in the practical application. This disclosure expands the field of application from two to three or more different temperatures. The use of the method is described in the case of a temporary heart assist pump to illustrate the concepts, but the method applies to many other fields.
It is an object of the invention to provide a device that can be installed and removed with less risk to the patient.
In some embodiments, a method to use the temperature versus stress versus strain properties of shape-memory alloys to ensure that the device stays in the elastic regime in at least three different temperatures used for different temperature conditions is provided.
In some embodiments, the temperatures are selected from a collapsed cold temperature, an expanded hot temperature, a collapsed hot temperature, and an environmental temperature.
In some embodiments, a method to use the temperature versus stress versus strain properties of shape memory alloys to ensure that the device, when deformed, stays in the elastic regime in at least three different temperatures used for different temperature conditions is provided.
In some embodiments, a method to use the temperature versus stress versus strain properties of shape-memory alloys to ensure that the device, when deformed, stays below a targeted permanent strain level when deformed in any of at least three different temperatures used for different temperature conditions is provided.
In some embodiments, a method to use the temperature versus stress versus strain properties of shape-memory alloys to ensure that the device, when deformed, stays above the elastic, but in the plastic regime below fracture, in at least three different temperatures used for different temperature conditions is provided.
In some embodiments, a method to use the temperature versus stress versus strain properties of shape-memory alloys to ensure that the device, when deformed, stays anywhere below the fracture point in at least three different temperatures used for different temperature conditions is provided.
In some embodiments, a method to use the temperature versus stress versus strain properties of shape-memory alloys to ensure that the device is able to recover its shape without deformation in at least three different temperatures used for different temperature conditions is provided.
In some embodiments, the temperatures are selected from a collapsed cold temperature, an expanded hot temperature, a collapsed hot temperature, and an environmental temperature.
In some embodiments, a method to use the temperature versus stress versus strain properties of shape-memory alloys to ensure that the device stays below fracture limits in at least three different temperatures used for three different conditions is provided.
In some embodiments, the temperatures are selected from a collapsed cold temperature, an expanded hot temperature, a collapsed hot temperature, and an environmental temperature.
In some embodiments, a method to use the temperature versus stress versus strain properties of shape-memory alloys to ensure that implanted devices stay in the shape-recovering regime at temperatures between T2 and T8, thus facilitating removal of the implanted devices after use is provided.
In some embodiments, T2 and T8 are environmental and body temperature. In some embodiments, T2 and T8 are related to aerospace applications. In some embodiments, T2 and T8 are related to aerospace applications temperatures. In some embodiments, T2 and T8 are higher and lower than environmental temperatures. In some embodiments, the method includes facilitating collapse, implantation, and removal after use, at two or more temperatures different than environmental. In some embodiments, the method includes facilitating collapse, implantation, and removal after use, at three or more temperatures, wherein the third temperature is environmental. In some embodiments, T2 and T8 are a cold collapsed temperature and a body temperature.
In some embodiments, a method to use the temperature versus stress versus strain properties of shape-memory alloys to ensure that implanted devices stay within elastic deformation limits at temperatures between the highest and lowest of three temperatures is provided.
In some embodiments, highest and lowest of three temperatures are higher and lower than environmental temperatures. In some embodiments, the method includes facilitating collapse, implantation, and removal after use, at two or more temperatures different than environmental.
In some embodiments, a method to use the temperature versus stress versus strain properties of shape-memory alloys to ensure that implanted devices stay below the fracture strain at temperatures between the maximum and minimum of three temperatures is provided.
In some embodiments, the maximum and minimum of three temperatures are higher and lower than environmental temperatures. In some embodiments, the method includes facilitating collapse, implantation, and removal after use, at two or more temperatures different than environmental. In some embodiments, the method includes facilitating collapse, implantation, and removal after use, at three or more temperatures.
In some embodiments, a method to use the temperature versus stress versus strain properties of shape-memory alloys to ensure that, after implantation, highly-stressed portions of the devices deform while staying in the elastic regime in the body at body temperature T8, thus facilitating explantation of the implanted devices after use is provided.
In some embodiments, a method to use the temperature versus stress versus strain properties of shape-memory alloys to ensure that, after implantation, highly-stressed portions of the devices deform without breaking (without reaching breaking stress) in the body at body temperature T8, thus facilitating removal of the implanted devices after use is provided. In some embodiments, a method to use the temperature versus stress versus strain properties of shape-memory alloys to ensure that, after implantation, highly-stressed portions of the devices deform without breaking (without reaching breaking strain) in the body at body temperature T8, thus facilitating removal of the implanted devices after use is provided.
In some embodiments, the device is initially at zero stress, zero strain, at room temperature in austenitic phase. In some embodiments, the device is cooled to below the temperature at which martensitic phase has finished forming. In some embodiments, the device is then collapsed for implantation at this temperature experiencing finite stress and strain. In some embodiments, the device is then inserted into the body where it reaches body temperature and austenitic state with positive stress and strain but below breaking stress. In some embodiments, the device is then inserted into the body where it reaches body temperature and austenitic state with positive stress and strain but below breaking strain. In some embodiments, the device is removed from the body without breaking after some period of use. In some embodiments, the device where after some period of use the device is removed without breaking from the body. In some embodiments, after implantation and removal of a constraining device at body temperature, the implanted device is returned to austenitic state and zero-stress zero strain. In some embodiments, after implantation and removal of a constraining device at body temperature, the implanted device is returned to the zero stress, positive strain. In some embodiments, after a period of use the implanted device is collapsed again at body temperature and austenitic phase without reaching breaking stress. In some embodiments, after a period of use the implanted device is collapsed again at body temperature and austenitic phase without reaching breaking strain. In some embodiments, after some period of use the implanted device is removed without breaking inside the body. In some embodiments, the collapsing components of the device reach specific dimensions of the impeller tip to inner diameter of waist after one cycle, thus optimizing this dimension for maximum efficiency. In some embodiments, the collapsing components of the device reach specific dimensions of the impeller tip to inner diameter of waist after a series of cycles, thus optimizing this dimension for maximum efficiency. In some embodiments, the collapsing components of the device reach specific dimensions of the impeller tip to inner diameter of waist after one cycle, thus optimizing this dimension for minimum hemolysis. In some embodiments, the collapsing components of the device reach specific dimensions of the impeller tip to inner diameter of waist after a series of cycles, thus optimizing this dimension for minimum hemolysis. In some embodiments, the physical size or geometry of the bending components has been optimized with finite element calculations to remain below the upper stress plateau at body temperature. In some embodiments, the physical size or geometry of the bending components has been optimized with finite element calculations to remain below the breaking strain point at body temperature. In some embodiments, the physical size or geometry of the bending components has been optimized with theoretical calculations to remain below the upper stress plateau at body temperature. In some embodiments, the physical size or geometry of the bending components has been optimized with theoretical calculations to remain below permanent deformation at body temperature. In some embodiments, the physical size or geometry of the bending components has been optimized with theoretical calculations to remain below permanent deformation at targeted removal temperature. In some embodiments, the physical size or geometry of the bending components has been optimized with theoretical calculations to remain below permanent deformation stress. In some embodiments, the physical size or geometry of the bending components has been optimized with theoretical calculations to remain below permanent deformation strain. In some embodiments, the physical size or geometry of the bending components has been optimized with finite theoretical calculations to remain below the breaking strain point at body temperature. In some embodiments, the physical size or geometry of the bending components has been optimized with manufactured prototype experiments to remain below the upper stress plateau at body temperature. In some embodiments, the physical size or geometry of the bending components has been optimized with manufactured prototype experiments to remain below permanent deformation at body temperature. In some embodiments, the physical size or geometry of the bending components has been optimized with manufactured prototype experiments to remain below permanent deformation at targeted removal temperature. In some embodiments, the physical size or geometry of the bending components has been optimized with manufactured prototype experiments to remain below permanent deformation stress. In some embodiments, the physical size or geometry of the bending components has been optimized with manufactured prototype experiments to remain below the breaking strain point at body temperature. In some embodiments, the geometric shape is optimized by removing alloy material. In some embodiments, the geometric shape is optimized by adding alloy material. In some embodiments, the geometric shape is optimized by removing alloy material or adding alloy material, thus implementing changes in the stiffness of highly-stressed bending portions to facilitate bending into the desirable state while keeping the stress below the upper stress plateau. In some embodiments, the geometric shape is optimized by removing alloy material, or adding alloy material, thus implementing changes in the stiffness of highly-stressed twisting portions to facilitate twisting into the desirable state while keeping the stress below the upper stress plateau. In some embodiments, the geometric shape is optimized by removing alloy material, or adding alloy material, thus implementing changes in the stiffness of highly-stressed bending portions to facilitate bending into the desirable state while keeping the strain below the breaking strain. In some embodiments, the geometric shape is optimized by removing alloy material, or adding alloy material, thus implementing changes in the stiffness of highly-stressed twisting portions to facilitate twisting into the desirable state while keeping the strain below the breaking strain. In some embodiments, the geometric shape of the medical device is optimized to allow inserting guiding shapes of a biocompatible material to collapse the device, thus implementing changes in the stiffness of highly-stressed bending portions to facilitate bending into the desirable state while keeping the stress below the upper stress plateau. In some embodiments, the geometric shape of the medical device is optimized to allow inserting guiding shapes of a biocompatible material such as a catheter to collapse the device, thus implementing changes in the strain of highly-stressed twisting portions to facilitate twisting into the desirable state while keeping the stress below the upper stress plateau. In some embodiments, the geometric shape of the medical device is optimized to allow inserting guiding shapes of a biocompatible material such as a catheter to collapse the device, thus implementing changes in the stiffness of highly-stressed twisting portions to facilitate twisting into the desirable state while keeping the stress below the upper stress plateau. In some embodiments, the geometric shape of the medical device is optimized to allow inserting guiding shapes of a biocompatible material to facilitate collapsing the device into a catheter, thus implementing changes in the strain of highly-stressed bending portions to facilitate bending of the medical device into the desirable state while keeping the strain below the breaking strain. In some embodiments, the geometric shape of the medical device is optimized to allow inserting guiding shapes of a biocompatible material to facilitate collapsing the device into a catheter, thus implementing changes in the strain of highly-stressed bending portions to facilitate bending of the medical device into the desirable state while keeping the strain within recoverable elastic limits. In some embodiments, the geometric shape of the medical device is optimized to allow inserting guiding shapes of a biocompatible material such as a catheter to collapse the device, thus implementing changes in the stiffness of highly-stressed bending portions to facilitate bending of the medical device into the desirable state while keeping the strain below the breaking strain. In some embodiments, the geometric shape of the medical device is optimized to allow inserting guiding shapes of a biocompatible material such as supporting structures 1780 allow collapsing in a catheter, thus implementing changes in the stiffness of highly-stressed twisting portions to facilitate twisting of the medical device into the desirable state while keeping the strain below the breaking strain. In some embodiments, the geometric shape of the medical device is optimized to allow inserting guiding shapes of a biocompatible material such as a catheter to collapse the device, thus implementing changes in the stiffness of highly-stressed twisting portions to facilitate twisting of the medical device into the desirable state while keeping the strain below the breaking strain.
In some embodiments, wherein the method is applied to the components of collapsible heart assist pumps, prosthetic heart valves, or stents. In some embodiments, wherein the method is applied to different industries and uses. In some embodiments, the environmental temperature is room temperature. In some embodiments, the environmental temperature is body temperature. In some embodiments, the environmental temperature is ice bath temperature. In some embodiments, the method is limited to the biomedical field. In some embodiments, the method is limited to the mechanical circulatory support field. In some embodiments, a curvature controller comprises a varying radius distribution to accommodate stress or strain levels below a desired point along the length of a blade-hub interconnect of a blade of the implanted device. In some embodiments, a curvature controller comprises a changing radius to control the rate of distribution of stress, or strain, along the bending shape of a blade-hub interconnect of a blade of the implanted device. In some embodiments, a curvature controller comprises a changing radius to keep the combined bending and torsional stresses below a target level. In some embodiments, a curvature controller comprises a changing radius to keep the combined bending and torsional strain below a target level. In some embodiments, a curvature controller comprises a changing radius to keep the combined multi-dimensional strain below a target level. In some embodiments, a curvature controller comprises a changing radius to keep the resultant strain below a target level for deformation control. In some embodiments, a curvature controller comprises a changing radius to keep the combined bending and torsional stresses below a target level. In some embodiments, a curvature controller comprises a changing radius to keep the resultant combined strain below a target level for deformation control.
Embodiments of the invention will now be described, by way of example only, with reference to the accompanying drawings in which corresponding reference symbols indicate corresponding parts, and in which:
The properties of shape memory alloys are used to fold or collapse a device. The device can be used to implant in the human body. The properties of shape memory alloys are used to fold or collapse the device without breaking the device as the device reaches body temperature. In some embodiments, the shape memory alloys comprises nitinol.
The properties of nitinol are also used to describe intended explantation or removal of the device, at body temperature, from the vasculature without breaking the device. The planned removal may be needed in cases where the device is designed for temporary use, such as mechanical circulatory support devices intended for temporary use and then removal of all components of the device from the body. The same method can be used for devices that have not been initially designed for removal, such as stents or valves, that must later be explanted for reasons unanticipated when they were installed.
The methods ensure that the devices stay within stress-strain-temperature conditions so they remain elastic, or under the upper stress plateau, or remain plastic, but always under the breaking strain, of shape memory alloys at the following temperatures: environmental conditions, cooler than environmental conditions, and at a higher than environmental conditions. The methods ensure that the devices stay within stress-strain-temperature conditions so they remain elastic, or under the upper stress plateau, or remain plastic, but always under the breaking strain, of shape memory alloys at the following temperatures: room temperature, cooler than room temperature, and higher than room temperature. The methods ensure that the devices stay within stress-strain-temperature conditions so they remain elastic, or under the upper stress plateau, or remain plastic, but always under the breaking strain, of shape memory alloys at the following temperatures: cooler than body temperature such as room temperature and at body temperature. The environmental conditions can be room temperature. The environmental conditions can be body temperature. The environmental conditions can be ice bath temperature. The environmental conditions can be conditions in which the device reaches 0 degrees Celsius. The environmental conditions can be temperatures achieved with the use of cold sprays. The environmental conditions can be conditions in which the device reaches temperatures below 0 degrees Celsius. The environmental conditions can be conditions in which the device reaches temperatures between −10 degrees Celsius and −20 degrees Celsius.
In aerospace applications, the method may be used to fold and unfold solar panels in space, to modify the shape of airfoils and wings to achieve variations in lift and drag in airplanes, to modify the shape of flying objects in order to control observable reflections of optical, acoustic, electrical or magnetic reflections for stealth operations, among other uses. In civil engineering applications, the method may be used to control deflections of structures at different ambient temperatures. In automation and controls, the method may be used to modulate signal amplitude and control function with dependence on ambient or operating temperature. Without loss of generality, the method is described with the example of a heart-assist pump implanted for temporary use, then removed at a third operating temperature without breaking the device inside the human body. The biomedical field is just now beginning to realize the need to fold and explant Nitinol heart valves to implant a new one, for instance after use of the first valve implanted for some years in young people. Similarly but less frequently, implanted stents may need to be explanted. Such requirements for removal without breakage at a different temperature are addressed herein. The methods described may also be applied to other industrial applications, where shape memory alloys may be installed and removed at different temperatures. The methods can provide coverage for biomedical field. The methods can provide coverage for industrial processes in different fields. The methods can provide coverage for stents or valves. The methods can provide coverage for mechanical circulatory supports.
Without loss of generality, as an example of where the method may be used, shape memory alloys can be used in cardiovascular stents, prosthetic heart valves, and removable heart-assist pumps for temporary use. The method has application in many industrial fields where the shape memory alloys need to be collapsed in different temperatures.
A small portion of cardiovascular stents may need to be explanted because they may get infected, stenose, rupture, migrate, or exhibit internal or external leaks not suitable for endoluminal therapy, or limb thrombosis. The methods described below can be used to ensure that the stent is flexible enough to be collapsed into a catheter for explantation without fracturing inside the patient's body.
Another portion of cardiovascular prosthetic devices, such as heart valves, have a limited life. In cases where the life expectancy of the patient exceeds the life expectancy of the valve, the valve must be replaced. In other cases, the valves exhibit regurgitation, thrombose, cause infective endocarditis, or structural valve failure, or manifest other complications so that the valves must be removed or replaced. It would be most desirable if there were ways to collapse these prosthetic valves to the minimal volume again to be captured, explanted, and replaced with a new one after some years of use, with minimally invasive procedures. The methods described herein can be used to ensure that removable portions of the heart valve, either the whole valve or the ring of leaflets of the valve, is flexible enough to be collapsed into a catheter without fracturing inside the patient's body.
In recent years there has been increased interest in miniature heart-assist pumps that are fully-removed after a period of use, which, which can be called temporary Mechanical Circulatory Support Devices (MCSD). MCSD are designed for implantation with minimally invasive surgery. As described herein, VADs have their inlet cannulated to the (usually left or infrequently right) ventricle. MCSD are implanted elsewhere in the vasculature. Permanent MCSD are MCSD with some of their components permanently implanted in the body. Temporary MCSD have all their components permanently removed after use.
Miniature heart-assist pumps may be used for smaller periods, varying from a few hours to a few weeks to a few months. Some of these miniature heart-assist pumps have foldable components, and after a period of use, it is desirable that they collapse again to the minimal volume state in order to be captured and removed. This is intended, planned, designed explantation. As these pumps are used in recurring conditions, in most instances a second pump may be used again after a period of time, similarly collapsed, deployed, used for some time, and then collapsed again for explantation. The patient may not need assistance from a blood pump until the next episode.
A removable heart assist pump is described in a nonprovisional utility patent application entitled COLLAPSING MECHANICAL CIRCULATORY SUPPORT DEVICE FOR TEMPORARY USE, filed on the same day herewith and U.S. Provisional Application No. 63/279,826, filed Nov. 16, 2021, which are incorporated by reference herein in their entirety. This corresponding application describes a method to remove many biocompatible devices, using this pump as an example. The method described herein may be used in other cases in engineering industry, where shape memory alloys may need to be collapsed and/or removed at a different temperature (T8) than the initial temperature (T1) or the temperature (T2) at which the device is initially collapsed to minimum shape before implantation.
In current medical practice, heart assist valves are not designed for intentional explant, and in many cases their life exceeds the expected life of older patients. The way the valves are designed, many of them endothelialize with tissue around them after a period of use. Thus, explants of heart valves and stents have a time period after which the structure around the valve leaflets cannot be removed without surgery. However, as these heart valves are implanted in younger people, and as complications occur with a small number of patients of all ages, there is a small but growing number of cases where the valves must be explanted. There are some, but even fewer than valves cases, where stents need to be explanted.
Therefore, there exists a need for unintended explantation of heart valves and stents, and there may also be a need for future new designs of heart valves and stents where they may need to be explanted. For instance, the ring of leaflets of a heart valve described herein may be designed to be part of an inner ring that does not endothelialize, and be part of the intentionally or unintentionally expandable structure of the valve, which may or may not be attached to another part of the valve that is allowed to endothelialize.
The methods designed herein may be used for all the above medical applications, and may also be used in other cases in broader industry, whenever the shape memory alloy structure needs to be collapsed at two or more different temperatures.
Gold-cadmium (Au—Cd) shape-memory alloys (SMA), also frequently called smart materials, were discovered in the 1930s. The unique properties of Nickel-Titanium (Ni—Ti) alloys were first observed in 1960s. Today there are two basic families of shape memory alloys in use: copper-aluminium based (Cu—Al with Zn, Ni, Be etc.) and nickel titanium based (Ni—Ti with Fe, Cu, Co etc). Nitinol alloys used in biomedical applications may contain fractional percentages of Cr, Cu, Fe, Nb, Co, ppm of C and O etc. Theoretical and experimental data related to the properties, manufacturing and uses of shape memory materials are disclosed.
The materials have memory in that they have different stress-strain curves at different temperatures, so the materials can have distinct shapes at different temperatures. This is a continuously-varying relation to temperature as described herein. This is achieved by the transformation of their crystalline structure from austenite (A) at a higher temperature to martensite (M) at a lower temperature. The austenite phase has a simple cubic B2(CsCl) crystal structure. The martensite phase has a monoclinic B19 crystal structure. The transition between austenite and martensite occurs by energy exchange affected either thermally or by inducing stress.
The effects of chemistry composition in the alloy and heat treatment on transformation temperature can be described. The transformation temperature is very sensitive and can vary from −100 deg C. at 48.5% Ti to +100 deg C. at 51% Ti, or even over a wider range. The other constituents in the alloy also affect transformation temperature and stress-strain properties. For instance, depending on alloy composition, the pseudo-elastic hysteresis effect may be exhibited up to strains of 6% to 8% or more. The deformation processing of hot worked and cold worked Nitinol and heating durations, temperatures, and aging treatments are known to influence transformation temperatures and the shape of stress-strain curves. Thermal processing is used to tailor these properties for optimal performance. Thus, the effects of alloy atomic concentrations, and of thermal processing, for instance temperature and duration of heat treatment, affect the transformation behaviour and mechanical behaviour of Nitinol by changing the transformation temperature, the stress levels of the Upper Stress Plateau and Lower Stress Plateau, and the Ultimate stress and strain. Understanding these aspects is essential for successful application of Nitinol shape memory alloys in all fields of application.
The temperature dependence of the pseudo-elastic stress-strain curve shown in
It is assumed that the device starts from zero-stress and zero-strain large-volume shape from temperature TO above Af; then cooled to TA below Mf, still at large volume zero stress and zero strain; then compressed at temperature TA (e.g. inside a catheter) to a positive stress, positive strain, smaller volume shape along the Upper Stress Plateau side of the curve to point B, and the device implanted in the body. At that point it is explained that if the catheter is removed at temperature TA, and if the device has reached the Upper Stress Plateau strain levels, the device will assume a deformed intermediate volume shape at point C, with zero stress (as it is outside the catheter) and positive strain (smaller volume than it started at points O and A, but larger volume than the higher-strain point B). Then, as the device is heated, it returns to its initial shape (zero stress, zero strain, large volume shape) at point O. In some cases, stents are expanded with balloons into a desired shape while implanted. In some instances, it is assumed that from point B at temperature TA it returns to point E at temperature TO before the catheter is removed with the device installed in the body. With the catheter removed, the implanted device would return to point O, at zero stress, zero strain and large volume configuration. Thus the properties of nitinol have been used to implant a large-volume device (point O) by using the properties of nitinol to cool it (point A), then compress it into a small volume (point B), then implant it into the body where it returns to the large volume at point O.
“Assuming Nitinol initially is in an austenitic state at the origin point O. With no applied stress as Nitinol is cooled along path O-A below martensite finish temperature (Mf), complete transformation from austenite to martensite (twinned) will occur. The material is deformed through reorientation and detwinning of martensite along path A-B. Then, load releasing on path B-C will cause elastic unloading of the reoriented detwinned martensite and the material stays deformed. On heating above the austenite finish temperature (Af), the material transforms from martensite to austenite and recovers the pseudo-plastic deformation ‘remembering’ its former shape. The austenitic Nitinol can be loaded along the path O-E above the austenite finish temperature (Af) through a stress-induced transformation to martensitic state. A large elastic strain up to 11% can be achieved. Upon unloading along the path E-O, the material will transform back to austenitic state and the superelastic deformation will be recovered, demonstrating a hysteresis loop in the stress-strain diagram.” Y Guo, A Klink, C Fu, J Snyder. Machinability and surface integrity of Nitinol shape memory alloy. CIRP Annals—Manufacturing Technology 62 (2013) 83-86.
There is infrequent mention of the difference between room temperature in the operating room, about 20 deg C., and body temperature, typically around 36.7 or 37 deg C., or how these may affect implantation of the device. Despite the recognition of the effect of temperature MD in relation to the maximum temperature of the crystalline transformation process, it is assumed that the properties will work for implantation. This means the device is considered from room temperature TO to colder TA, collapsing to point B for implantation, then heating to body temperature. In some instances, e.g. stents, expanding balloons are used to bring the stent to the desired large-volume state in situ. There is seldom consideration of what may be needed to re-collapse the medical device for explantation. “For example, alloys which are intended to be superelastic at room temperature are generally produced with their active AF temperatures just below room temperature, say in the range of 0-20° C. Such a material will also exhibit good superelastic properties at body temperature (37° C.).” D. Kapoor. Nitinol for Medical Applications: A Brief Introduction to the Properties and Processing of Nickel Titanium Shape Memory Alloys and their Use in Stents. Johnson Matthey Technol. Rev., 2017, 61, (1), 66-76.
It is currently not frequent to consider the process of explantation of expanded nitinol cardiovascular devices, such stents, valves, or heart-assist pumps. As cardiovascular valves are increasingly installed in younger patients, there have been a few cases or explantation reported. In one case, a valve was cooled with water for minimally-invasive removal. Other cases describe sternotomy and surgical explantation. As the field evolves, there will be increased demand to explant valves, or stents, and miniature cardiovascular heart-assist pumps intended for temporary use (temporary Mechanical Circulatory Support Devices, or temporary MCSD). For these explantation cases to be performed with minimally-invasive procedures, the implanted device needs to be collapsed to small-volume shape at 37 deg C. This body temperature is above the atmospheric temperature TO at which the device entered the operating room. The Upper Stress Plateau (USP) and Lower Stress Plateau (LSP) levels have been displaced upwards as illustrated in
While the process is described herein using the example of collapsing the blades of and axial turbomachine pump, the process can be used in all other cases of explantation of cardiovascular prosthetic devices, and all other biomedical devices that need collapsing for explantation, or need collapsing at two or more different temperatures. While the process is described below using the example of collapsing the blades of and axial turbomachine pump, the process can be used in all other industrial cases of shape memory alloys that need to be collapsed at two or more different temperatures. In some applications, devices may need to just change shape, not just fully collapse and expand, at more than 2 different temperatures. In aerospace and control applications, the shape of the device may need to be continuously variable as a function of changing temperature.
The method can be described in stress-strain-temperature terms.
Without loss of generality, as a representative example, the method is described in relation to using the folding blades of a miniature heart assist pump with axial turbomachine blades secured in a stent-like hourglass shape, illustrated in
The blades can be manufactured from sheets of material. The three blade impeller portion shape 1750 can be cut out of sheets of shape-memory alloy. A pair of these impeller portions 1750 can be placed together. The impeller portions 1750 can be rotated azimuthally 60 degrees. The impeller portions 1750 can be connected to two cylindrical half shafts or hubs 1778, one upstream and one downstream of the blades. These shafts can be considered the upstream hub and the downstream hub. The flat-plate circles 1779 of impeller portions 1750 and the hubs 1778 can be welded together to form the impeller 1710. The flat-plate circles 1779 of impeller portions 1750 and the hubs 1778 can be connected together by adhesive, glue, fasteners, weld, and other means. The impeller portions 1750 and the hubs 1778 can be heat treated to achieve the three dimensional flat-plate blade shape. Additional features of the device 1700 are described in a nonprovisional utility patent application entitled COLLAPSING MECHANICAL CIRCULATORY SUPPORT DEVICE FOR TEMPORARY USE, filed as on the same day herewith, and U.S. Provisional Application No. 63/279,826, filed Nov. 16, 2021, which are incorporated by reference herein in their entirety. The hubs 1778 may also be secured azimuthally without welds with methods described in these related applications. For instance, the hubs 1778 may be secured by fixing the location with indexing components and avoiding the weld. In some embodiments, the weld weakens the structure and alters the metal properties. The transformation from austenite to martensite can be less predictable after weld. The indexing mechanism addresses this issue by avoiding welds.
In device 1700 the hydrodynamic efficiency of the pump is determined by the amount of regurgitant flow (backflow), from higher pressure downstream, to lower pressure upstream, occurs at the gap between the impeller tip and the waist. Flow shear in the same gap causes hemolysis, the size of the gap determining to a large degree the level of hemolysis of the pump. It is crucial to control this gap using processes described in
The device 1700 can include a miniature heart-assist pump. The device 1700 is brought to the operating room at room temperature. The device 1700 is expanded in its geometry as shown
Subsequently, the device 1700 can be inserted in an ice bath. The device 1700 reaches in its expanded geometry, the large-volume zero stress zero-strain shape shown at the
In the process of collapsing the device 1700 at cooler temperature T2, the stress and strain may reach up to any point in the elastic region between Point 2, Point 3a, Point 3, and Point 3b in
At this point, conventional teachings suggest that the shape memory alloy is reheated to a higher temperature, such as room temperature T1. The reheating can reach Point 6 between Point 6a and Point 6b on the red line if constrained. The reheating can reach Point 5 at zero stress and zero strain if unconstrained. The reheating can cause the device 1700 to recover the initial large-volume state at Point 5. Conventional teaching describe how the device goes from Point 3 to Point 4, and then from Point 4 at zero stress along the green dotted line to Point 5.
It is important to recognize that this does not happen to cardiovascular devices implanted in the human body. Instead, starting from Point 3 between Point 3a and Point 3b, or any point on the elastic regime along this green line, subsequently the device 1700 is inserted in the human body, at the small-volume, positive stress and positive strain state. The device can be represented in our example by the shape shown in
The implanted device 1700 reaches the fuchsia line
Upon being implanted, the device 1700 reaches temperature T8 while loaded via the catheter 1716 inside the body of the patient. Contrary to conventional teachings, if the device 1700 reaches body temperature T8 while inside the catheter 1716, then the device 1700 still has deformation (positive strain), and therefore it moves from Point 3 at temperature T2 to Point 7 at temperature T8. It is important to design the shape of the deforming device 1700 so that stresses and strains for temperature T8 are anywhere along Point 7a to Point 7 to Point 7b, below fracture at Point X, or in elastic regime if that is the target, as in the case of the heart pump. When the device 1700 is unloaded from the catheter 1716 in the body of the patient, the device will reach its original large-volume state (shown in
Depending on how rapidly the device 1700 is installed in the body of the patient and unloaded from the catheter 1716, and how rapidly the device 1700 is heated from temperature T2 to T8, it is also possible that the device follows any path on the three dimensional stress-strain temperature curve from Point 3 (where it is in the low-volume configuration illustrated on the
Most such devices are not usually explanted, e.g. by the reverse procedure from implantation. In the case of the device 1700, the pump can operate at some rpm inside the body for a period of time. At the end of this period of time, the pump must be explanted from the body without breaking. This removal is harder to do at body temperature T8 than the loading process at T2, because the Upper Stress Plateau (USP) curves at temperature T8 are higher than at temperature T1 and which are higher than temperature T2, and the breaking stresses at these temperatures are also different. Similarly, for the device not to fracture, while collapsing at temperature T8, it must stay below the corresponding fracture strain at Point X.
In order to explant the device, the device 1700 at temperature T8 is collapsed into a catheter 1716, and then removed. In the vast majority of cases, it is not feasible to cool the device 1700 to temperature T1 or temperature T2 inside the human body, in order to follow the reverse process of implantation for explantation. It is therefore required to collapse the device at temperature T8 inside a catheter to Point 9, between Points 9a and Point 9b, in
The teal line corresponds to temperatures higher than the martensite deformation temperature Ma in
Therefore, it is important to recognize that the method of design of such device 1700 for explantation is at the higher Upper Stress Plateau (USP) curves of temperature T8 (fuchsia line), and not those at temperature T5 or T1 (red line) or T2 (green line). Therefore, it is important to consider the corresponding breaking strain levels. It is important to consider the corresponding breaking strain levels at temperature T8 (fuchsia line) which is lower than the breaking strain levels at T5 or T1 (red line) or T2 (green line). The methods of calculating the stresses, strains and forces for the design of these devices 1700 may be numerical (e.g. Finite Element Methods (FEM) programs allow modelling the Upper Stress Plateau (USP) and Lower Stress Plateau (LSP) in the calculations), or theoretical, or experimental. Some examples are provided herein.
With respect to the shape memory alloy folding and unfolding methods described herein, in this example, the likely most critical component of the temporary-use explantable device 1700 is the segment 1788 connecting the impeller portion shape 1750 to the flat plate circle 1779 and the hub 1778. This segment 1788 is a small flat horizontal plate, connecting the hub 1778 via the flat-plate circle 1779 to the three dimensional impeller portion shape 1750 of the blade 1758. This flat plate of the segment 1788 must be stiff enough to minimize blade deflection. The blade 1758 is subjected to forces that the blade 1758 experiences upstream from the fluid pressure that the blade 1758 generates. The blade 1758 is subjected to forces by the action-reaction principle. The impeller 1710 must reasonably maintain its shape under these forces. The blade 1758 must not deflect too far upstream under these forces. The flat plate of the segment 1788 needs to be stiff enough so it does not deflect with this force, yet flexible enough to allow the blade 1758 to fold upstream into the catheter as shown in
One way to meet the conflicting requirements is to introduce slits into this vertical plate of the segment 1788 as shown in the middle part of
From Equation C, for a given deflection angle (Θmax), of a given material (E), in order to reduce the maximum stress, either the length (L) must increase (and therefore also the catheter diameter), or the flat-plate thickness (c) must decrease. The moment of inertia (I), including the effect of geometrical stiffness would not have any impact on the maximum stress.
According to the equations above, for a given deflection angle, the reduced moment of inertia by adding one or more slits leads to a reduced force, but does not have any effect on the stress level.
Maximum surface stress is affected by plate thickness of the segment 1788. To reduce maximum surface stress, the plate thickness of the segment 1788 can be reduced. By adding slits to the segment 1788, this reduces the force to bend the blades, but does not affect stress on the material surface. The slits may be placed closer to the hub, or closer to the blade, or be made in a variety of configurations such as those shown in
Computations for flat-plate supporting structure 1788 and blade thickness of 0.1 mm and 0.08 mm are compared, without considering the effect of the slits. We consider the effect of plate thickness on deflection for a given force on the blade (caused by 30 mm Hg pressure rise), and surface stress for folding the blade (modelled as a flat plate) into a 6 mm restriction (where the catheter is also modelled as infinite flat plate into the paper).
The computed results verify the theoretical calculations above. Among the folded plates the thicker 0.1 mm plate exhibits maximum stress 1,275 MPa at the plate bend, and the thinner 0.08 mm plate exhibits lower maximum stress 1,140 MPa at the same point. Both of these values are above the Upper Stress Plateau (USP), but in the elastic regime for the shape memory alloy stress-strain-temperature relation, and below the ultimate tensile stress of 1,400 MPa. Correspondingly, when subjected to the same upward force generated from a pump pressure rise of 30 mmHg, the thinner blade of 0.08 mm deflects about 2 mm upstream, and the thicker blade of 0.1 mm deflects 1 mm upstream. The computed results assist in determining acceptable compromises between undesirable blade deflection and stress levels, so the shape memory alloy does not enter into plastic deformation when loaded into the catheter at T2 for implantation, and does not fracture when re-loaded into the catheter at T8 for explantation. The 0.1 mm folded blade reaches 1275 MPa. This is higher than the folded 0.08 mm blade, which reaches 1140 MPa. As a thicker plate is used to minimize deflection during unfolded 30 mmHg operation, a stiffness can be reached in excess of 1400 MPa at the folded blade condition, beyond which plastic deformation will form. For even thicker plates reaching even higher stress-strain points in the folded blade condition, the strain fracture can be reached at point X.
The impeller 1710 can include one or more supporting structures 1780 near the hub 1778 of the blades. The supporting structures 1780 can improve shaft rigidity near the blades. The supporting structures 1780 can eliminate or reduce the slow-flow regions near the blades. The supporting structures 1780 can improve hydrodynamic performance. The contra-rotating blades 1710 can be the result of improved manufacturing process for the folding blades. Each impeller can include two, three, four, five, six blades or any range of blades. Each impeller can have shaped blades. The number and shape of blades can facilitate smooth folding. The blades 1710, 1712 are made from flat plates formed into impeller portions 1750. The blades 1710, 1712 are shaped into three-dimensional objects with varying blade angle from hub to tip. The supporting structures 1780 can be o-ring shapes or similar shapes. The supporting structures 1780 can be configured to eliminate slow flow regions near the hubs 1778.
The curvature controller of the supporting structures 1780 may have varying radius distribution as shown in
In some embodiments, a nitinol bending method is provided. The application of the method is described in relation to embodiments of a medical device, but other devices are contemplated. The method can be used with different devices. The method can be used with different industries.
Although the present invention has been described in terms of certain preferred embodiments, it may be incorporated into other embodiments by persons of skill in the art in view of the disclosure herein. The scope of the invention is therefore not intended to be limited by the specific embodiments disclosed herein, but is intended to be defined by the full scope of the following claims. It is understood that this disclosure, in many respects, is only illustrative of the numerous alternative device embodiments of the present invention. Changes may be made in the details, particularly in matters of shape, size, material and arrangement of various device components without exceeding the scope of the various embodiments of the invention. Those skilled in the art will appreciate that the exemplary embodiments and descriptions thereof are merely illustrative of the invention as a whole. While several principles of the invention are made clear in the exemplary embodiments described above, those skilled in the art will appreciate that modifications of the structure, arrangement, proportions, elements, materials and methods of use, may be utilized in the practice of the invention, and otherwise, which are particularly adapted to specific environments and operative requirements without departing from the scope of the invention. In addition, while certain features and elements have been described in connection with particular embodiments, those skilled in the art will appreciate that those features and elements can be combined with the other embodiments disclosed herein.
When a feature or element is herein referred to as being “on” another feature or element, it can be directly on the other feature or element or intervening features and/or elements may also be present. In contrast, when a feature or element is referred to as being “directly on” another feature or element, there are no intervening features or elements present. It will also be understood that when a feature or element is referred to as being “connected”, “attached” or “coupled” to another feature or element, it can be directly connected, attached or coupled to the other feature or element or intervening features or elements may be present. In contrast, when a feature or element is referred to as being “directly connected”, “directly attached” or “directly coupled” to another feature or element, there are no intervening features or elements present. Although described or shown with respect to one embodiment, the features and elements so described or shown can apply to other embodiments. It will also be appreciated by those of skill in the art that references to a structure or feature that is disposed “adjacent” another feature may have portions that overlap or underlie the adjacent feature.
Terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. For example, as used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprises” and/or “comprising,” when used in this specification, specify the presence of stated features, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, and/or groups thereof. As used herein, the term “and/or” includes any and all combinations of one or more of the associated listed items and may be abbreviated as “/”.
Spatially relative terms, such as “under”, “below”, “lower”, “over”, “upper” and the like, may be used herein for ease of description to describe one element or feature's relationship to another element(s) or feature(s) as illustrated in the figures. It will be understood that the spatially relative terms are intended to encompass different orientations of the device in use or operation in addition to the orientation depicted in the figures. For example, if a device in the figures is inverted, elements described as “under” or “beneath” other elements or features would then be oriented “over” the other elements or features. Thus, the exemplary term “under” can encompass both an orientation of over and under. The device may be otherwise oriented (rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein interpreted accordingly. Similarly, the terms “upwardly”, “downwardly”, “vertical”, “horizontal” and the like are used herein for the purpose of explanation only unless specifically indicated otherwise.
Although the terms “first” and “second” may be used herein to describe various features/elements (including steps), these features/elements should not be limited by these terms, unless the context indicates otherwise. These terms may be used to distinguish one feature/element from another feature/element. Thus, a first feature/element discussed below could be termed a second feature/element, and similarly, a second feature/element discussed below could be termed a first feature/element without departing from the teachings of the present invention.
Throughout this specification and the claims which follow, unless the context requires otherwise, the word “comprise”, and variations such as “comprises” and “comprising” means various components can be co-jointly employed in the methods and articles (e.g., compositions and apparatuses including device and methods). For example, the term “comprising” will be understood to imply the inclusion of any stated elements or steps but not the exclusion of any other elements or steps.
As used herein in the specification and claims, including as used in the examples and unless otherwise expressly specified, all numbers may be read as if prefaced by the word “about” or “approximately,” even if the term does not expressly appear. The phrase “about” or “approximately” may be used when describing magnitude and/or position to indicate that the value and/or position described is within a reasonable expected range of values and/or positions. For example, a numeric value may have a value that is +/−0.1% of the stated value (or range of values), +/−1% of the stated value (or range of values), +/−2% of the stated value (or range of values), +/−5% of the stated value (or range of values), +/−10% of the stated value (or range of values), etc. Any numerical values given herein should also be understood to include about or approximately that value, unless the context indicates otherwise. For example, if the value “10” is disclosed, then “about 10” is also disclosed. Any numerical range recited herein is intended to include all sub-ranges subsumed therein. It is also understood that when a value is disclosed that “less than or equal to” the value, “greater than or equal to the value” and possible ranges between values are also disclosed, as appropriately understood by the skilled artisan. For example, if the value “X” is disclosed the “less than or equal to X” as well as “greater than or equal to X” (e.g., where X is a numerical value) is also disclosed. It is also understood that the throughout the application, data is provided in a number of different formats, and that this data, represents endpoints and starting points, and ranges for any combination of the data points. For example, if a particular data point “10” and a particular data point “15” are disclosed, it is understood that greater than, greater than or equal to, less than, less than or equal to, and equal to 10 and 15 are considered disclosed as well as between 10 and 15. It is also understood that each unit between two particular units are also disclosed. For example, if 10 and 15 are disclosed, then 11, 12, 13, and 14 are also disclosed.
The examples and illustrations included herein show, by way of illustration and not of limitation, specific embodiments in which the subject matter may be practiced. As mentioned, other embodiments may be utilized and derived there from, such that structural and logical substitutions and changes may be made without departing from the scope of this disclosure. Such embodiments of the inventive subject matter may be referred to herein individually or collectively by the term “invention” merely for convenience and without intending to voluntarily limit the scope of this application to any single invention or inventive concept, if more than one is, in fact, disclosed. Thus, although specific embodiments have been illustrated and described herein, any arrangement calculated to achieve the same purpose may be substituted for the specific embodiments shown. This disclosure is intended to cover any and all adaptations or variations of various embodiments. Combinations of the above embodiments, and other embodiments not specifically described herein, will be apparent to those of skill in the art upon reviewing the above description. The claims below are representative claims, and may be restructured and combined with other features described in the embodiments herein.
This application claims priority benefit of U.S. Provisional Patent Application No. 63/279,924 filed Nov. 16, 2021, which is incorporated herein by reference in its entirety for all purposes. Any and all applications related thereto by way of priority thereto or therefrom are hereby incorporated by reference in their entirety. Systems and methods as disclosed herein can include any combination of features disclosed, for example, in PCT/US2019/025667 filed Apr. 3, 2019, PCT/US2020/039978 filed Jun. 26, 2020, U.S. Provisional Patent Application No. 63/279,826 filed Nov. 16, 2021, a nonprovisional utility patent application entitled COLLAPSING MECHANICAL CIRCULATORY SUPPORT DEVICE FOR TEMPORARY USE, filed on the same day herewith, which are hereby incorporated by reference in their entireties.
Number | Date | Country | |
---|---|---|---|
63279924 | Nov 2021 | US |