The present disclosure relates generally to the field of stents, and in particular, to stents for use in transcatheter prosthetic heart valves. More particularly, the present disclosure is directed to improved methods for manufacturing such stents.
Prosthetic heart valves, including surgical heart valves and expandable heart valves intended for transcatheter aortic valve replacement (“TAVR”) or transcatheter mitral valve replacement (“TMVR”), are well known in the patent literature. (See U.S. Pat. Nos. 3,657,744; 4,056,854; 5,411,552; 5,545,214; 5,855,601; 5,957,948; 6,458,153; 6,540,782; 7,510,575; 7,585,321; 7,682,390; and 9,326,856; and U.S. Pub. No. 2015/0320556.) Surgical or mechanical heart valves may be sutured into a native heart valve annulus of a patient during an open-heart surgical procedure, for example. Expandable heart valves may be delivered into a patient via a tube-like delivery apparatus such as a catheter, a trocar, a laparoscopic instrument, or the like to avoid a more invasive procedure such as full open chest, open heart surgery. As used herein, reference to an “expandable” heart valve includes those that are self-expending and those that are mechanically expandable via, for example, a balloon. Often the term “collapsible/expandable” heart valve is used herein and unless the text or the context dictate otherwise, this term is meant to include heart valves that may be collapsed to a small cross-section that enables them to be delivered into a patient through a tube-like delivery apparatus in a minimally invasive procedure, and then self-expanded or mechanically expanded to an operable size once in place.
Prosthetic heart valves typically take the form of a one way valve structure (often referred to herein as a valve assembly) mounted to/within a stent. In general, expandable heart valves include a self-expanding or balloon expandable stent, often made of a metal, such as Nitinol or stainless steel. The one way valve assembly mounted to/within the stent includes one or more leaflets, and may also include a cuff or skirt. The cuff may be disposed on the stent's interior or luminal surface, its exterior or abluminal surface, and/or on both surfaces. (See U.S. Pat. Nos. 6,458,153; 7,585,321; 8,992,608; 9,241,794; and 9,289,296; and U.S. Pub. No. 2015/0320556.) The cuff ensures that blood does not just flow around the valve leaflets if the valve or valve assembly are not optimally seated in a valve annulus. A cuff, or a portion of a cuff, disposed on the exterior of the stent can help retard leakage around the outside of the valve (the latter known as paravalvular or “PV” leakage).
Leaflets, cuffs and valve assemblies for prosthetic heart valves may be derived from various natural tissues or synthetic materials. Commercial natural tissues that have been chemically treated or “fixed” are often used. For example, leaflets could be made of bovine pericardium and cuffs could be made of porcine pericardium. (See, e.g., U.S. Pat. No. 5,957,949 at 6:23 33; U.S. Pat. No. 6,458,153 at 8:28 40; U.S. Pat. No. 5,855,601 at 6:21 30; and U.S. Pat. No. 7,585,321 at 13:5 36.) Other materials that may be used to form valve components include various synthetic polymers including, without limitation, polytetrafluoroethylene (PTFE) or polyester (see U.S. Pat. No. 5,855,601 at 6:29-31; U.S. Pat. Nos. 10,039,640; 10,022,211; 9,056,006; and 10,299,915; and U.S. Pub. Nos. 2018/0055632; 2017/0258585; 2018/0078368; and 2019/0201190), and elastic materials including silicone rubber and polyurethanes. (See U.S. Pat. No. 6,540,782 at 6:2-5.) These materials have been used in the form of continuous sheets, porous felts (U.S. Pat. No. 6,540,782 at 6:17-23) or woven fabrics. (See also U.S. Pat. Nos. 10,039,640; 10,299,915; 10,022,211; and 4,610,688; and U.S. Pub. Nos. 2018/0055632; 2017/0258585; and 2018/0078368; see also Basir et al., “Flexible mechanoprosthesis made from woven ultra-high-molecular-weight polyethylene fibers; proof of concept in a chronic sheep model”; Interactive CardioVascular and Thoracic Surgery, 25(2017) 942-949; and Yamagishi and Kurosawa, “Outflow Reconstruction of Tetralogy of Fallot Using a Gore-Tex Valve”; Ann. Thorac Surg. 1993; 56:1414-17.) Valve components and valve assemblies may be attached to a collapsible/expandable stent or frame by sutures or may be molded, glued, or soldered to the stent. (See U.S. Pat. No. 7,585,321 at 13:30-31.)
Current methods of manufacturing expandable stents used in prosthetic heart valves involve laser cutting a desired shape from a round tube of metal. The cut tube can then be expanded to a desired shape, and the expanded shape can then be shape set by, for example, being placed within a molten salt bath.
This manufacturing process requires a large amount of precision and care given the size and delicate structure of the stent. Even minor deviations from the desired expanded shape of the stent can have disastrous consequences for a patient after implantation. As such, any inaccuracies during manufacturing can have an outsized effect on the structure of the stent and its efficacy within a patient.
One aspect of the disclosure provides a stent comprising a body portion having a first configuration and a second configuration, the body portion in the first configuration lying substantially in a plane and having a first end, a second end, a first attachment point at the first end, and a second attachment point at the second end, the body portion in the first configuration being curved about an axis substantially perpendicular to the plane.
Another aspect of the disclosure provides a method of forming a stent, the method comprising cutting a body portion of the stent from a substantially planar plate, the body portion in a first configuration being substantially planar and having a first end, a second end, a first attachment point at the first end, and a second attachment point at the second end, and connecting the first attachment point to the second attachment point to transform the body portion from the first configuration to a second configuration that is nonplanar.
Cutting an expandable stent from a round tube requires extremely precise control of the linear and rotational movement of the tube, as well as the cutter, during the cutting process. As such, cutting a stent from a round tube requires more moving parts and is more complex than cutting the stent from a flat plate. Such increases in complexity increase inefficiencies and decrease accuracy during manufacture of the stent. This disclosure is directed to methods of manufacturing a stent that minimize such difficulties.
Stent 100 may be formed from one or more of a variety of suitable biocompatible materials. For example, in some embodiments, stent 100 may be made of polyethylene, or other hard or semi-hard polymer, and may be covered with a polyester velour to promote ingrowth. In other examples, stent 100 may be made of metal, such as, for example, Nitinol, stainless steel, titanium and other biocompatible metals.
Stent 100 includes a number of cells each having an opening 101 therein. This enables stent 100 to be flexible such that the stent in the final configuration can be collapsed from an expanded condition, as depicted in
Body portion 110 may also have a number of cells each having an opening 101 therein that is smaller than those of cuff portion 120. In such embodiments, cuff portion 120 may encompass a larger surface area than body portion 110. This may be particularly helpful as cuff portion 120 can be in more direct contact with a patient's anatomy, such as a native valve annulus of the patient's heart, to ensure that stent 100 is secured within the heart. In other embodiments, the openings 101 of cuff portion 120 may be equal or smaller in size than the openings of body portion 110.
Body portion 110 includes engagement portions 112 that may extend from an end of the body portion opposite cuff portion 120 and within the planar profile of stent 100. In some embodiments, each engagement portion 112 may have an aperture therein. This aperture can allow an additional component (not shown) to be assembled to stent 100. For example, a suture, tether, inner frame, or covering can be assembled to engagement portions 112. In other embodiments, the engagement portions may not include an aperture. Engagement portions 112 may remain at the same radial distance from a central longitudinal axis of stent 100 when the stent is in the final non-planar configuration. In other embodiments, engagement portions 112 may extend from body portion 110 in any direction, such as in radial directions relative to the central longitudinal axis of the stent when in the final non-planar configuration.
Body portion 110 may be curved about axis A so as to have a curved length defined between ends 113 and 114 of the body portion. Cuff portion 120 may be curved about axis A so as to have a curved length defined between ends 123 and 124 of the cuff portion. The curved length in cuff portion 120 is greater than the curved length in body portion 110 so that, when manipulated into the final expanded configuration, stent 100 has a frustoconical profile, as discussed further below.
Body portion 110 includes a first attachment point 111 at end 113 and a second attachment point 115 at end 114, while cuff portion 120 includes a third attachment point 121 at end 123 and a fourth attachment point 125 at end 124. However, stent 100 may include any number of pairs of attachment points, such as one, two, three, four or more pairs of attachment points.
Attachment points 111, 115, 121, 125 are depicted simply as abstract representations in
A method of manufacturing stent 100 will now be described. A substantially planar plate will first be received within a cutting machine (e.g., a laser cutting machine or the like). The cutting machine may cut the plate to form stent 100 in an initial configuration. Stent 100 in the initial configuration may be in either an expanded condition, or it may be in a compressed condition and subsequently expanded. Stent 100 may be cut from the plate so as to include attachment points 111, 115, 121, 125, or, in other methods, the stent may be cut from the plate without the attachment points, and the attachment points may later be secured to the stent, such as, for example, by suturing, welding or another attachment method. As noted, when stent 100 is cut from the plate in the compressed condition, it may subsequently be expanded. While maintaining a substantially planar profile, stent 100 may be expanded by pulling end 113 away from end 114, and end 123 away from end 124. Expansion may also be accomplished through the use of dies or other processes known in the art to change the shape of a stent. While being expanded, and while maintaining the substantially planar profile, stent 100 may also be curved about an axis perpendicular to the plane (i.e., axis A) to achieve the expanded shape shown in
While stent 100 is in the initial expanded configuration, additional components may be assembled to the stent. In this planar configuration, it is far easier to assemble certain components to stent 100 than it is when the stent is in a non-planar configuration, such as when the stent is in a frustoconical configuration. For example, a skirt or cuff (either a “covering”) (not shown) may be assembled to the interior surface, the exterior surface or both surfaces of stent 100. The covering may be formed from one or more synthetic materials, such as polyester, from organic tissue, or from a combination of synthetic materials and tissue to provide adequate sealing of the stent and to promote tissue ingrowth once the stent has been implanted. For example, the tissue could be at least one of bovine pericardium or porcine pericardium. The synthetic materials could be at least one of PTFE, polyester, silicone rubber, or polyurethanes. Moreover, the coverings can be in the form of continuous sheets, porous felts, or woven fabrics. One end of a length of the covering may be attached to stent 100 at or near attachment points 111, 121, while the other end of the covering may be attached to the stent at or near attachment points 115, 125. Attachment of the covering or other components to the stent may be accomplished by any known expedient, such as, for example, sutures, adhesives, ultrasonic or heat bonds, and the like.
In an alternative embodiment, an excess portion of the length of the covering may be left over once the covering has been attached to stent 100. For example, a portion spaced from one of the ends of the covering may be attached to or near the attachment points at that end, leaving a free end of the covering extending away from the stent. This free end can overlap with the opposite end of the covering to ensure that the covering fully encircles the surface of the stent when the stent is in a final expanded configuration. In some embodiments, a free end may be formed at both ends of the covering, and those free ends may overlap with one another in the final expanded configuration of the stent. In a further alternative, one type of covering material may be attached to body portion 110 (e.g., tissue material) and another type of covering material may be attached to cuff portion 120 (e.g., synthetic material). One or both of these coverings may be attached to the stent so as to provide a free end portion at one or both ends.
Since stent 100 is substantially planar in the initial configuration (whether expanded or compressed), the covering requires significantly less manipulation and coordination to be assembled in the desired manner to the stent. Moreover, any points on the stent or the covering at which attachment is to be made are readily accessible by hand or by attachment tools. This provides an improvement over prior methods of manufacturing stents in which the stents were in a non-planar (e.g., frustoconical) configuration, as manipulating the covering relative to the stent would be much more difficult, as would accessing all of the points of attachment, leading to an increased chance of error, poorer quality, as well as a lengthier manufacturing process.
Once stent 100 in the initial expanded configuration has been fully processed, the stent may be transformed to a final expanded configuration shown in
Once stent 100 is in the final expanded configuration, the stent may be shape set using a molten salt bath or other process known in the art for shape setting certain heat sensitive materials, such as Nitinol. This final expanded configuration is the configuration toward which stent 100 expands when deployed from a delivery device within the patient. The stent may then be collapsed to a compressed condition, such as that depicted in
Stent 100 may have various sizes and/or shapes in the initial and final configurations. For example, stent 100 may have a substantially straight initial configuration, rather than the curved configuration shown in
In a further example, the stent may be formed so as to not need attachment points 111, 115, 121, 125.
Stent 200 is cut from the plate so that body portion 210 and cuff portion 220 are both continuous without free ends that would require attachment to one another. Once stent 200 has been fully processed, the stent may be transformed to its final expanded configuration by manipulating certain portions of the stent in a direction transverse to the substantially planar profile of the stent in its initial expanded configuration. For example, engagement portions 212 may all be pulled or pushed in a direction perpendicular to the initial plane of the stent, converting the stent to a three-dimensional, generally tubular profile having a central axis B.
In a variant of the foregoing processes, other components configured to be assembled to stent 100, 200 such as an inner frame, can be manufactured in a manner similar to one of the methods described above for manufacturing the stent. For example, an inner frame configured to be assembled within stent 100, 200 may also be cut from a flat plate in an initial configuration with a planar profile and attachment points. In an alternative example, the inner frame can be cut from the plate without any attachment points so as to have a continuous elliptical shape, similar to stent 200. The inner frame may be assembled to stent 100 before the attachment points of the stent are joined together to form an implant in a final configuration or may be assembled to stent 200 in its initial, planar configuration after being cut from the plate. In another example, a valve assembly having a cuff or skirt and one or more valve leaflets may be assembled within stent 100 or stent 200 to form a prosthetic heart valve.
The manufacturing processes of this disclosure enables a stent to be manufactured with greater efficiency while minimizing inaccuracies and errors posed by cutting a stent from a round tube rather than from a substantially planar plate. For example, the planar profile of the stent in the initial configuration may enable the covering to be more easily and efficiently attached to the stent, particularly where the covering is to be positioned on the inner surface of the stent. Further, the planar profile of stent 100 in the initial configuration may allow a thinner covering material to be used. In such event, stent 100 may be compressible to a smaller diameter, allowing for smaller catheter sizes (e.g., from 36 Fr to 18 Fr) to be inserted into a patient without reducing the surface area covered by the stent when in the final expanded configuration. Moreover, cutting a stent from a plate so that the stent is already in an expanded configuration induces less strain in the stent than prior forming processes which require the stent structure to be expanded.
To summarize the foregoing, a stent includes a body portion having a first configuration and a second configuration, the body portion in the first configuration lying substantially in a plane and having a first end, a second end, a first attachment point at the first end, and a second attachment point at the second end, the body portion in the first configuration being curved about an axis substantially perpendicular to the plane; and/or
According to another aspect of the disclosure, a method of forming a stent includes cutting a body portion of the stent from a substantially planar plate, the body portion in a first configuration being substantially planar and having a first end, a second end, a first attachment point at the first end, and a second attachment point at the second end, and connecting the first attachment point to the second attachment point to transform the body portion from the first configuration to a second configuration that is nonplanar; and/or
According to another aspect of the disclosure, a stent includes a body portion having a first configuration and a second configuration, the body portion in the first configuration lying substantially in a plane and having a continuous elliptical shape about an axis substantially perpendicular to the plane.
According to another aspect of the disclosure, a method of forming a stent includes cutting a body portion of the stent from a substantially planar plate, the body portion in a first configuration defining a plane and having an elliptical shape about an axis substantially perpendicular to the plane, and transforming the body portion from the first configuration to a second configuration by manipulating the body portion about the axis.
Although the subject matter herein has been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the principles and applications of the subject matter described. It is therefore to be understood that numerous modifications may be made and that other arrangements may be devised without departing from the spirit and scope of the described subject matter as defined by the appended claims.
The present application claims the benefit of the filing date of U.S. Provisional Patent Application No. 63/158,576 filed Mar. 9, 2021, the disclosure of which is hereby incorporated by reference herein.
Number | Date | Country | |
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63158576 | Mar 2021 | US |