Patent Application
20230089253
The present disclosure relates to synthetic fabric materials that can be used in various medical devices and the medical devices including the synthetic fabric materials. For purposes of discussing the state of the art, however, prosthetic heart valves, and particularly collapsible/expandable prosthetic heart valves useful for delivery through a catheter or trocar, will be exemplified.
Prosthetic heart valves, including surgical heart valves and collapsible/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 annulus of a patient during an open-heart surgical procedure, for example. Collapsible/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 a “collapsible/expandable” heart valve includes heart valves that are formed with 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 expanded to an operable once in place, as well as heart valves that, after construction, are first collapsed to a small cross-section for delivery into a patient and then expanded to an operable size once in place.
Collapsible/expandable prosthetic heart valves typically take the form of a one-way valve structure (often referred to herein as a valve assembly) mounted to/within an expandable stent. In general, these collapsible/expandable heart valves include a self-expanding or balloon-expandable stent, often made of nitinol or 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.) A 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 leakage 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 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; 2019/0201190; 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; Yamagishi and Kurosawa, “Outflow Reconstruction of Tetralogy of Fallot Using a Gore-Tex Valve; ” Ann. Thorac Surg. 1993;56:1414-17), 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. Patent No. 6,540,782 at 6:17-23) or woven fabrics. (See also U.S. Patent 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.) 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. Patent No. 7,585,321 at 13:30-31.)
Mesh has been used in various surgical applications and in intravascular procedures as well. U.S. Pat. Nos. 6,974,586 and 6,375,670 describe the use of a mesh made from, inter alia, woven or interlaced wires, fibers or filaments.
Despite the disclosure of various natural tissues and synthetic materials for possible uses in various medical devices, little is often disclosed about the specifics of the structure and compositions of such elements beyond illustrations of their general structure and a generic identification of polymers that can be used. Those generalized disclosures show that, while the concept of polymer-based implantable medical devices, and in particular valves, is known, actually successfully taking the broad concept to working solutions is far more challenging. Therefore, there exists a need for further improvements in the materials for these devices and the devices made therefrom.
Another problem that may be encountered with medical devices formed from synthetic materials is a change in the properties, structure and/or performance of those materials after implantation. Using an expandable heart valve as an example, the free edge of one or more leaflets may retract or curl after implantation which can impact the completeness of coaptation of the leaflets and thereby result in leakage or regurgitation. Leaflet retraction has been observed before. See, Amir Basir, et al., noted above. This can cause a reduction in the rejection fraction of oxygenated blood pumped out of the heart and into the balance of the circulatory system and thus a reduction in pumping efficiency. This means that the heart must work harder to supply sufficient oxygen to the tissues and organs of the body.
The present invention is a stabilized fabric which comprises a stabilized woven fabric (a term which includes knitted fabrics) or a mesh, methods of stabilizing a woven fabric or a mesh, and stabilized medical devices made from a stabilized fabric as described herein. The present invention also comprises stabilized fabrics and stabilized medical devices comprising at least one component that is produced from a stabilized fabric that is resistant to conformation changes caused by tissue growth.
The disclosure describes stabilized polymer fabric materials (also referred to herein as “stabilized fabric(s)”). Stabilized fabrics include not only a stabilized woven fabric but also a mesh, unless the context suggests otherwise (such as when discussing a weaving technique or the relationship of warp and weft fibers). Stabilized fabric materials in accordance with the invention may be used for construction of, and as components of, stabilized medical devices including, without limitation: venous valves, occluders, prosthetic vascular conduits, grafts, and embolic protection devices, fabrics for treating hernias, skin patches, vaginal patches, cardiac patches, adhesion barriers, surgical heart valves (those requiring open chest surgery to implant) and collapsible/expandable prosthetic heart valves which can be implanted using a catheter such as trans-femorally, trans-apically, and trans-septally. These include expandible aortic valves, expandible mitral valves, expandible tricuspid valves and expandible pulmonary valves.
When the stabilized fabric used in stabilized medical device is a woven fabric, it comprises a woven polymer fabric having warp and weft fibers that meet at a plurality of intersections. In one embodiment, at least one of this plurality of intersections is stabilized by being mechanically fastened, chemically fastened or energetically fastened or is stabilized by weaving. “Fastened” and “fastening” in the context of a stabilized fabric of this invention means that one or more of the intersections is acted upon for reasons other than attaching the fabric to another piece of fabric, a stent, or some other structure of the medical device. Moreover, the intersections in question which result in a stabilized fabric are generally located in a portion of the fabric that is subject to movement in operation, and generally not located in a portion of the fabric that are attached to another structure or to itself (such as a portion of the fabric that is folded over and retained by being sutured).
Mechanically fastened means using a mechanical device such as, without limitation, a suture or a staple to bind one or more fiber intersections. Chemically fastening means something, such as, without limitation, using a glue or adhesive to bind one or more of the fiber intersections. Energetically fastening means using one or more types of energy to weld and therefore bind one or more fiber intersections. Stabilized by weaving means altering the nature of the weave and or the nature of the fibers to create additional friction and to restrict relative motion of the fibers at or adjacent one or more of the fiber intersections. This can be done by a number of techniques, such as, without limitation, by increasing the weave density of a localized area of the fabric, using fibers of variable thickness, using fibers of greater than usual thickness, using a denser weave or by controlling the weave pattern.
When the stabilized fabric used in a stabilized medical device is a mesh, it will be appreciated that a mesh is not woven and does not have intersections formed of fibers crossing one another. It is a continuous web or matrix of struts and junctions and, assuming the right materials and physical properties are employed, is intrinsically more stable than an un-stabilized fabric of similar material and physical dimensions. Thus, in the context of a stabilized fabric which is a mesh or a stabilized medical device made using a mesh, the mesh need not include further mechanical, chemical, energetic fastening or stabilizing by weaving. So long as the mesh is produced of the correct materials having the correct physical properties, it will be stabilized. That said, additional stability might be obtained by employing some of these same techniques and are therefore contemplated in addition.
In one particular embodiment, there is provided a balloon expandible or self-expandable prosthetic heart valve which can be implanted using a catheter trans-femorally, trans-apically, or trans-septally for replacement of a native aortic valve, mitral valve, tricuspid valve or pulmonary valve. The valve comprises at least one leaflet produced from a stabilized fabric (stabilized woven fabric or mesh) as just described. When the leaflet is composed of a stabilized woven fabric, the woven fabric has warp and weft fibers that meet at a plurality of intersections at least one of which is stabilized by being mechanically fastened, chemically fastened or energetically fastened or is stabilized by weaving. In some embodiments, the stabilized intersections are at least located in portions of the leaflet that are subject to movement during operation, and often not portions attached to another structure or to itself (such as a portion of the fabric that is folded over and retained by being sutured). When the leaflet is composed of a mesh, the entire leaflet may be composed of that mesh or mesh may be only disposed in that portion of the leaflet that is not attached to another structure or to itself (such as a portion of the fabric that is folded over and retained by being sutured) and thereby restricted in movement.
In another embodiment, the stabilized medical devices and/or fabrics of the invention are resistant to changes in conformation caused by tissue growth. That is to say that the stabilized fabrics or stabilized medical devices made therefrom provide a conformation that, following implantation, is closer to the original conformation of that fabric than would result from implanting an otherwise identical fabric or device that has not been stabilized as described. When the stabilized fabric or stabilized medical device resistant to changes in conformation caused by tissue growth is composed of a stabilized woven fabric, the woven fabric has warp and weft fibers that meet at a plurality of intersections, a sufficient number of relevant intersections are stabilized by being mechanically fastened, chemically fastened or energetically fastened or is stabilized by weaving so as to resist changes in conformation caused by tissue growth. Preferably, the stabilized intersections are located in a portion of the device where the fabric is subject to movement during operation and often not to portions that are not attached to another structure or to itself (such as a portion of the fabric that is folded over and retained by being sutured). When the stabilized fabric or stabilized medical device is composed of a mesh, the mesh is composed of a polymer, and has a structure, thickness, pore/dimple density, etc., that would resist changes in conformation caused by tissue growth.
In one particular embodiment, there is provided a balloon expandible or self-expandable prosthetic heart valves which can be implanted using a catheter such as trans-femorally, trans-apically, or trans-septally for replacement of a native aortic valve, mitral valve, tricuspid valve or pulmonary valve. The valve comprises at least one leaflet produced with a stabilized fabric (stabilized woven fabric or mesh) that would resist changes in conformation caused by tissue growth. When the leaflet is composed of a stabilized woven fabric, the woven fabric has warp and weft fibers that meet at a plurality of intersections. A sufficient number of these intersections have been stabilized by being mechanically fastened, chemically fastened or energetically fastened or is stabilized by weaving so as to provide a leaflet that is resistant to changes in conformation caused by tissue growth. In particular, intersections are fastened in a portion of the leaflet subject to movement in operation. In some embodiments, these stabilized intersections are not located in a portion of the leaflet that is attached to another structure or to itself (such as a portion of the fabric that is folded over and retained by being sutured). When the stabilized valve comprises, a leaflet composed of a mesh, the mesh is composed of materials and has physical properties rendering it resistant to changes in conformation caused by tissue growth. The entire leaflet may be composed of that mesh or mesh may be only disposed in that portion of the leaflet that is not attached to another structure or to itself (such as a portion of the fabric that is folded over and retained by being sutured).
The stabilized fabrics of the disclosure include uncoated woven fabrics, uncoated meshes, partially coated woven fabrics, partially coated/meshes, coated woven fabrics, and coated meshes. When the stabilized fabric is a woven fabric, it is made from interlaced fibers and includes, inter alia, woven fabrics, knitted fabrics, and the like. The woven fabric materials described herein include at least some synthetic fibers, such as, for example, fibers made from polyolefins such as polytetrafluoroethylene (PTFE) (which includes expanded and stretched PTFE and PTFE of any molecular weight) (also known as Teflon)° , polyethylenes including those of any molecular weight (e.g., ultra-high molecular weight polyethylene (UHMWPE)), and polypropylenes including those of any molecular weight (e.g., ultra-high molecular weight polypropylene (UHMWPP), as well as polyurethanes, PEEK, polyvinyl alcohols, silicones, rayons, polyesters, aramids, spandex, or combinations, blends and copolymers thereof. These same polymer materials may also be used to produce a stabilized fabric mesh of the present invention. Meshes are not constructed from interlaced fibers but instead from a continuous web of these same polymers.
The uncoated woven fabrics used to produce the stabilized fabrics of the invention may have at least one of the following properties: a thread count of at least about 150 fibers per square inch, and the thread count need not be symmetrical; a high density weave of generally at least 300 fibers or more per square inch; a tensile strength of at least 50N and in some embodiments, 100 N or more; and/or an areal density of between 0.5 and 1.3 ounces/yard2 (the areal density being the mass of the fabric per square yard). The uncoated fabric may have a thickness of between about 10 μm and about 200 μm. For these properties specifically, and physical properties of woven fabrics discussed herein in general, they refer to properties of the woven fabric before any coating or stabilization. Just as an example, mechanical fasteners could increase the thickness in a localized area. Tensile strength could increase and deflection or bending stiffness could increase. Therefore, unless the context suggests otherwise, references to the properties of a woven fabric means before stabilization.
These same thicknesses are applicable to layers made of a mesh instead of or in addition to a woven polymer fabric layer. The mesh generally contains pores and/or divots which are analogous to the gaps between fibers in a woven fabric. Pores traverse the entire thickness of the mesh having two openings, one on each major surface. Divots have only on opening. Pores and divots therefore have at least one opening and in each case, the size of the opening can vary widely from a micron2 to much larger. In general, the openings have an average area which could range from about 100 microns2 to about 5,000 microns2. That is to say that each pore or divot has at least one opening and each such opening has an area. The average area of the openings of these pores/divots in this embodiment runs from about 100 microns2 to about 5,000 microns2. In another embodiment, these openings have an average area that ranges from between about range from about 1,000 to about 3,000 microns2. In one embodiment, the mesh has a pore density (a term which is used to cover the density of pores and/or divots) of about 1 to about 25% of the total area and in still another embodiment, the pore density is about 5 to about 15%.
In some embodiments the woven polymeric fabric or polymer mesh, may be coated with at least one polymer layer to form a coated fabric. “Coated” as used herein means that the stabilized fabric has a polymer layer or coating applied to at least a portion of it after the woven fabric or mesh has otherwise been formed. And coatings, unless specified otherwise are applied to a woven fabric that has been stabilized or to a mesh. Although the order is not important. It will be appreciated that a mesh is generally stable because it is not made of fibers that can move relative to each other—it is a fixed web. Nonetheless it can be further stabilized by adding a coating. But coatings may be added for reasons other than stabilization and the use of a coated, partially coated, or uncoated mesh, coated for additional stabilization or to alter or improve its properties are both contemplated. A woven fabric on the other hand, has fibers that can move and may not be as intrinsically stable as a mesh of similar dimensions, physical properties and materials. A coating could be used to alter or improve properties of a woven fabric other than providing stability. Indeed, a coating could be applied to a fabric before or after, for example, a laser is used to “spot weld” a plurality of fiber intersections—a step which is primarily intended to enhance stability. Unless a coating is described as being used as a means to impart stabilization herein, it is contemplated that its use is to alter or improve some other property of the woven fabric. And when a coated or partially coated stabilized woven fabric is described, that will generally mean a fabric that is stabilized by a technique or device other than that coating. Also, coatings for stabilization might be applied using different materials, in a different way to a different area of the fabric. Coatings may be formed of a single polymer layer, multiple polymer layers, and/or patterns of discrete polymer layers on one or more surfaces of the stabilized fabric. Where multiple polymer coatings are used, they may be the same or different in terms of thickness, composition, number of layers and/or location. In some embodiments, the polymer coating may provide improved or altered properties to the fabric relative to the uncoated fabric. These altered properties may include, without limitation, one or more of: (1) adjusting the porosity of the fabric, (2) adjusting surface roughness, (3) altering strength, abrasion resistance, and/or flexibility, (4) altering lubricity, (5) providing weight or rigidity to portions of the fabric, (6) promoting folding in specific regions, (7) altering cell adhesion to the fabric, and (8) retention or release of a therapeutic agent.
The polymers which may be used for the coatings include all of those previously identified for use for the fabric. In addition, in some embodiments, the polymer coating can be bioabsorbable, biodegradable, and/or bio-erodible. Exemplary bioabsorbable, biodegradable, and/or bio-erodible polymers may include poly-glycolic acid, poly-L-lactic acid, copolymers of poly-glycolic acid, poly-L-lactic acid, polycaprolactone, poly-DL lactic acid, polytrimethylene carbonate, polydioxanone, poliglecaprone and polyglactin. Such bioabsorbable, biodegradable, and/or bio-erodible polymers may be provided as a coating on a surface in a thickness sufficient to delay tissue growth on the coated surface.
A single polymer coating layer may be used on one major surface of a fabric layer or multiple layers of the same or different polymer materials may be used on both major surfaces. Indeed, up to about 20 layers may be used on any surface or edge of the fabric. The total thickness of all such coatings can range from a minimum of about 0.50 μm to a maximum of about 100 μm per side of the fabric.
The coating may also be a partial coating and/or a contoured coating. Partially coated means that some portion of a major surface or edge is uncoated while other portions are coated. Contoured surfaces may be coated completely, but to different thicknesses or degrees. Either or both may be used to provide specific structural features to a side or edge of a coated fabric, to provide different patterns, and the like. Partial coatings may alter flexibility, provide extra resistance against wear from contact, can add weight, can help maintain a desired shape, can help prevent fraying or unravelling of the fabric, facilitate attachment, add strength, etc., to a localized area of the fabric and any structure made from that fabric. Coated (including partially coated) and uncoated fabrics may be provided with grommets to facilitate attachment while reducing damage that can come from the use of, for example, sutures. Coated and uncoated fabrics may also be constructed with indicia to assist in placement or confirming operability during surgery. Structures made from uncoated fabrics, coated fabrics, and partially coated fabrics include, without limitation: the elements of a valve assembly used in a collapsible/expandable heart valve such as interior cuffs, exterior cuffs, and leaflets. In some embodiments, one or more coatings or partial coatings are applied to a stabilized fabric. In other embodiments, one or more partial coatings may be applied to stabilize the woven fabric or mesh buy being placed in specific areas in need of stabilization—such as the free edge of a leaflet.
In another embodiment, leaflets, cuffs or other structures may be reinforced, weighted, or have their flexibilities altered by the addition of other features, with or without coatings. For example, a row of sutures could be added, of varying number of stiches, in a line or other desired shape, across the full length of the structure or any portion thereof. The properties can be altered based on the number and density of stiches, the number of sutures applied and the pattern in which they are applied. For example, by using one or more sutures extending from an attachment edge to a free edge of a leaflet, alternating stiffening and more flexible zones or “hinges” can be created. A suture could also be stitched to at least a portion of the attachment edge and/or the free edge of a leaflet to provide reinforcement and/or weight and/or to introduce or preserve a shape. In an alternate aspect of this embodiment, instead of or in addition to a coating and/or a suture, localized portions of denser weaves can be used for the same purposes—at the attachment edge, the free edge, and/or across at least a portion of a major surface of the leaflet. And in still another aspect of this embodiment, wires, such as a steel or nitinol wire could be used and inserted into the weave along the attachment edge, the free edge or across a major surface of a leaflet, for example. Wires or sutures or other structures could also be applied by gluing, laminating, etc. to a coated or uncoated fabric of the invention. For example, a wire could be disposed between a fabric material and a coating or layer laminated thereto at the free edge of a leaflet. The wire or other reinforcement may extend across the entire edge, just a portion of it, and may be continuous or discontinuous.
And while sutures, partial coatings and increased localized weave density can provide weight and reinforcement as just discussed, it has been found that these techniques, and other techniques discussed herein, can be useful in forming a stabilized fabric. Medical devices produced using synthetic materials could exhibit changes in shape, size, flexibility or other properties during use (collectively referred to herein as a change in “conformation.) which could interfere with important functions of the device. Changes in conformation could result from one, or a combination of factors. A woven fabric material could exhibit changes in the regularity of the woven pattern over time—fibers moving relative to each other or changing the size and shape of gaps between them or the nature and orientation of the intersections of warp and weft fibers. As discussed in more detail, it is believed that these changes in conformation can come from inter alia the growth of tissue onto and/or into the fabric (or a mesh). Moreover, woven fabrics might stretch over time. Flexibility could be altered. Or the shape/orientation of the woven fabric could change—effectively shrinking, curling, retracting and the like. This too could happen to a mesh. As will be readily appreciated, the causes of this change in conformation are complex and not completely understood. It may be rooted in the types of cells that attach to portions of the woven fabric and how they attach thereto exerting their influence to tighten or misshape localized structures. Or it could be simple mechanical stretching with repeated use, exposure to body temperatures, the friction from motion or blood moving past it, etc. Using an expandable prosthetic heart valve as an example, the free edge of one or more prosthetic leaflets may retract or curl after implantation which can impact the completeness of coaptation of the leaflets and thereby result in leakage or regurgitation. This conformation change in the leaflet material can ultimately cause a reduction in the rejection fraction of oxygenated blood pumped out of the heart and into the balance of the circulatory system and thus a reduction in pumping efficiency. This means that the heart must work harder to supply sufficient oxygen to the tissues and organs of the body.
However, it has now been discovered that controlling and retarding changing conformation and other similar phenomena can be achieved by stabilizing the weave of the fabric to maintain the relative spacing of its fibers and their geometry relative to each other. This can also be accomplished by using a mesh. Whether caused by cell attachment or some other biological or physiological cause, by movement while in use, material stretching or shrinking, exposure to body temperatures, tissues, fluids, or otherwise, the individual fibers of a weave can moved over time relative to other fibers of the weave. Just for example, instead of woven fibers being perpendicular and crossing each other to form roughly right angles, they can become moved forming more acute and obtuse angles. Instead of defining a regular pattern or roughly square openings between the fibers, the openings can become distorted into irregular polygons such as, without limitation, parallelograms, rhombus, trapezium and isosceles trapezium, kites or other irregular quadrilaterals. The size of these openings can vary along with the relative spacing of the adjacent fibers.
And the fiber contour can become more extreme as they protrude further in one or more directions. A change in conformation has been found to occur in fabrics that have been implanted into test animals once they are harvested and analyzed. Irrespective of the cause, it has now been found that controlling the structure of the fabric to prevent changes in its original structure reduce or retard changes in a woven fabric's conformation.
Any way to accomplish this stabilization and control of the original woven fabric structure and inhibit conformation changes is contemplated. As noted earlier, sutures and suture lines can serve to add weight and localized rigidity or reinforcement to a woven fabric. And, of course, sutures can be used to secure the leaflet, cuff, or other structure to a superstructure such as a stent. But sutures have not been used in the past to stabilize a woven fabric, particularly by using it in an area of the fabric which is not secured to another structure. Sutures, or other fasteners such as staples, could be used for stabilizing the structure of the weave and in particular, in the case of an expandable valve, proximate to the free end or other area of a leaflet or cuff wherein the suture does not affix the leaflet to another structure. On a micro level, individual intersections of fibers (e.g. where warp and weft fibers cross over or under each other), where they cross at, for example, right angles (90 degrees), could be sutured together, fastened, or otherwise tied off to make their relative movement more difficult. The fastener applies pressure and friction to prevent movement of the individual fibers at the intersection. Not every intersection of a fabric need be sutured or otherwise fastened in this way to form a stabilized fabric. Selected intersections in the region of interest could be fastened while others are not. It is also possible to suture or fasten a small region to form a localized “groups” or “gather” of intersections and the action of gathering them can help lock in the conformation of the remaining portion of the weave in that area. Fasteners could be staggered or placed in a specific pattern.
Instead of, and/or in addition to a mechanical fastener, a chemical fastener, such as an adhesive, could be used to help maintain the intended weave conformation. Where fibers cross, adhesive(s) could be used to lock the fibers in place. This could again be done by applying an adhesive to the fibers at individual intersections and allowing the adhesive to set or cure. Alternatively, the adhesive could be applied to groups or gathers of the fibers and fiber intersections. Adhesives could be applied at where the fibers are in intimate contact or the intersection could be coated with an adhesive. And the adhesives could be applied in staggered spots or groups or in some other pattern. The adhesive could be self-curing and or could be activated with heat, light, activators such that where fibers cross, adhesion occurs. Adhesive could be applied to individual intersections or groups of intersections in a pattern including a staggered pattern. And still another alternative is to use a partial coating, on one or both sides of the fabric to lock the fibers into their intended positions and orientations. The adhesive could be applied to the fiber before the manufacturing process (e.g. weaving) or to the bulk fabric.
Energy in the form of heat, pressure, laser, high intensity light, ultrasonics, vibration, gases, radiofrequency, friction, spin welding, electrical current and the like could be used, alone or with mechanical and/or adhesive fasteners, to melt or otherwise “weld” fibers together at their intersections to form a stabilized fabric. Again, this can be done at individual intersections. As an alternative, a larger “spot” can be treated with heat, pressure, or one of the other sources of energy mentioned so that all of the intersections in that spot are welded together while the surrounding intersections are untouched. Energy could be applied in this way to an entire area such that the weave of the fabric in that area is impacted but other portions of the fabric are not. As an example, heat could be applied along the entire free edge of a prosthetic heart valve leaflet and for a few millimeters inward from the edge. This would weld substantially all of the fiber intersections proximate that edge and immobilize the weave fibers at and near that edge. The rest of the structure of the prosthetic leaflet would be relatively unaffected—however, the fused strip at the free edge could influence the shape, flexibility, and other properties of the overall prosthetic leaflet.
In an alternative, the intersections of warp and weft fibers could remain relatively unaltered (not mechanically fastened, not glued together, not welded) when compared to the fibers of the weave extending between the intersections. These fibers could be altered to preserve the original conformation (shape, orientation and relative positions of the individual fibers) and thereby produce a fabric that is resistant to a change in conformation such as by tissue growth during operation. And in another alternative, the fabric could be woven from fibers of undulating or variable thickness. Those undulations when woven into the fabric, increase the friction between fibers and can allow them to “nest” at various intersections making their relative movement more difficult. In another possibility, the fibers could be woven from relatively thicker and or wider fibers. A mixed weave is also possible. Relatively thicker and/or wider fibers could also have an undulating or variable thickness or could be woven with same—all the warp fibers having a relatively uniform thickness and widths and every other weft fiber having an undulating surface.
Another approach which can be used, alone or in combination with any or all of those just described, is the use of a localized increase in weave density. Relative to the rest of the woven fabric, a higher weave density has more intersections and its fibers are closer together. Proximity, lack of freedom of movement, and the increased collective friction at the increased number of intersections make it relatively more difficult to distort the fibers of the fabric in this region. “Localized” in this context means that something less than about 50% of the area of a side of the woven fabric includes a higher weave density than the remainder of the fabric used in that element or medical device—prior to its use. A localized increase in weave density can be accomplished as part of the initial weaving process or additional fibers could be woven into a specific area of a pre-woven fabric. The fibers used to increase the weave density in a localized area need not be the same as those used to produce the woven fabric overall. Relative to the weave density of the remainder of the fabric, this localized weave density increase could be by as much as 50%. In some embodiments, however, the increase is between about 20% to about 40% of the weave density of the rest of the fabric.
Instead of through localized weave density changes, this resistance to a change in conformation might also be accomplished by using a fabric having an overall denser weave to create the leaflet (or other medical device) than would otherwise have been used. For example, U.S. patent application Ser. No. 16/899,205, filed Jun. 11, 2020 discloses using a fabric with an areal density of at least 0.65±0.1 ounces/yard2 and an areal density of about at most about 1.3±0.1 ounces/yard2. Using a material of even denser weave, not just in a localized, area might provide the same overall benefit in terms of preserving the original conformation of the woven fabric.
Another aspect of a weave can impact stability as well, namely the type of weave. Certain weaves may intrinsically reduce the freedom of movement of individual fibers or pack them in closer. Any such weave may be used and these can include, without limitation, a Plain weave, Rib weave, Basket weave, Twill Weave, Herringbone weave, Satin weave, Sateen weave, Leno weave, Oxford Weave, Bedford cord weave, Waffle weave, Pile weave, Jacquard weave, Dobby weave, Crepe weave, Lappet weave, Tapestry Weave, Striped weave, Checquered weave, or Double cloth weave. Weaves can include any number of warp and weft fibers such as, for twills as an example, a 2/1 twill, a 3/1 twill, a 2/1 twill, a 2/2 twill, a 3/2 twill, a 4/2 twill, a 3/3 twill, a 6/2 twill, and for satin weaves a 4 harness satin weave, 5 harness satin weave,
Finally, in place of a stabilized woven polymer fabric as described herein, a mesh can be used to provide the same or similar stability and allow a material to resist changes in conformation when implanted due to, for example, tissue growth. For example, a collapsible and/or expandable heart valve, or surgical valve could be constructed using a coated or uncoated mesh for its leaflets, its cuff, and/or its sewing ring with the resulting valve being resistant to leaflet retraction or other change in conformation. Indeed, an uncoated, partially coated, or fully coated polymer mesh can be used with, or as a substitute for any of the woven polymer fabrics described herein and used to produce any of the medical devices described herein. To produce a medical device with a stabilized mesh, and indeed one resistant to changes in conformation due to tissue growth, it is important that the polymer used, the physical dimensions of the mesh—size of the struts and their length, number and size of the junctions, size of the openings and the density of pores or divots, and the like, and the resulting physical properties, must be sufficient to reduce the impact of tissue growth on the original structure of the mesh after implantation.
In still a further embodiment, the medical device or an element thereof, such as a leaflet and/or cuff, could be constructed or attached so as to form a pleat or fold across a major surface thereof.
Another embodiment of the disclosure provides a method of manufacturing a collapsible/expandable valve prosthesis that includes providing an uncoated stabilized polymeric fabric or mesh as just discussed having a top surface and a bottom surface (first and second major surfaces); providing a polymer such as, without limitation, an ultra-high molecular weight polyolefin; and applying the polymer to the top surface and/or the bottom surface of the stabilized fabric (including a mesh) to form a coated stabilized woven fabric or coated mesh. One or more polymer films may be laminated to one or more surfaces of a woven fabric or mesh by gluing or the application of energy as noted earlier. A polymer coating layer may also be formed on the stabilized fabric by applying a liquid polymer material to a surface of the woven fabric or mesh and allowing it to solidify, cross-link, or otherwise become an adhered layer. This may be done by, for example, spray coating a polymer on one or more sides of the stabilized fabric, dip coating, and the like. Other techniques for applying the polymer coating include, for example, 3D printing. Partial coatings may be applied to a limited portion of the stabilized fabric or mesh as just discussed or may be formed by applying a complete coating to the fabric or mesh and removing portions by, for example, ablation.
The stabilized fabric or mesh, as well as any medical device made using that stabilized fabric or mesh, may undergo sterilization. This may be done with a variety of sterilization modalities, for example, with ethylene oxide, peracetic acid, nitrogen oxide, e-beam, steam, gamma radiation, carbon dioxide and chemical liquid sterilant.
Various methods of forming the components of medical devices, including valve components and valve assemblies, may be used. These include mechanical methods, for example cutting with scissors or a blade. Other techniques include, for example, cautery; stamping; chemical, laser, ultrasonic, or water jet cutting, bio-glue, folding or lamination.
One embodiment of a useful coated, partially coated or uncoated stabilized fabric is a high density woven fabric of a polyethylene, a polypropylene or a PTFE, or blends or copolymers thereof, the woven fabric having a thread count of 300-500×100-300 fibers per square inch, a tensile strength of at least 65N, an areal density of at least 0.65±0.1 ounces/yard2, and a thickness of approximately 50-100 μm or the stabilized fabric comprises a mesh of the invention made from this same material and thickness and containing pores and/or divots having at least one opening having an average area which could range from about 100 microns2 to about 5,000 microns2 and/or a pore density or divot density of about 1 to about 25 In the case of the stabilized woven fabric, stabilization is achieved by mechanically fastening individual intersections without fastening that portion of the fabric to another structure, mechanically fastening bundles of intersections without fastening that portion of the fabric to another structure, chemically adhering individual intersections, chemically adhering bundles of intersections, welding individual intersections by the application of energy, welding bundles of intersections by the application of energy, increasing the weave density of a localized area of the fabric, using fibers of variable thickness, and/or coating a localized area of the fabric.
In another embodiment, a useful coated, partially coated or uncoated stabilized fabric which is composed of a woven fabric of a polyethylene (such as UHMWPE), a polypropylene (such as UHMWPP), or a halogenated polymer (such as UHMWPTFE or expanded or e-PTFE), or blends or copolymers thereof, before being stabilized the woven fabric has a thread count of 300-500×100-300 fibers per square inch, a tensile strength of at least 65N, an areal density of at least 0.5±0.1 ounces/yard2, and a thickness of approximately 20-200 μm. Stabilization of these woven fabrics may be achieved: mechanically such as by mechanically fastening individual intersections without fastening that portion of the fabric to another structure, mechanically fastening bundles of intersections without fastening that portion of the fabric to another structure (collectively “mechanically”); chemically such as by chemically adhering individual intersections, chemically adhering bundles of intersections (collectively “chemically”); energetically such as by welding individual intersections by the application of energy, welding bundles of intersections by the application of energy (collectively “energetically”); through the weave by increasing the weave density of a localized area of the fabric, using fibers of variable thickness, using fibers of different thickness, using a denser weave or by controlling the weave pattern (collectively “weaving”) and/or using a coating such as by coating a localized area of the fabric.
In one embodiment the woven fabric is stabilized by weaving, mechanically, chemically or energetically. In another embodiment the woven fabric is stabilized by weaving, mechanically, or energetically. Alternatively, the stabilized fabric comprises a mesh of the invention made from these same materials and thickness and containing pores or divots each having openings having an average area that ranges from between about range from about 1,000 to about 3,000 microns2 and/or a pore density or divot density from about 5 to about 15%.
In another embodiment, a useful coated, partially or uncoated stabilized fabric is a woven fabric of ultra-high molecular weight polyethylene or e-PTFE having a thread count of 440×220 fibers per square inch. In a particular embodiment, the uncoated fabric has a tensile strength of at least about 75N, an areal density of at least 0.65±0.1 ounces/yard2, and a maximum thickness of approximately 50-100 μm stabilized by weaving, mechanically, chemically or energetically and in still another embodiment the woven fabric is stabilized by weaving, mechanically, or energetically. In an alternative for this embodiment, the stabilized fabric comprises a mesh of the invention made from these same materials and thickness and containing pores or divots each with at least one opening having an average area that ranges from between about range from about 1,000 to about 3,000 microns2 and/or a pore density or divot density is about 5 to about 15%.
In another embodiment, a useful coated, partially coated or uncoated stabilized fabric is a woven fabric of ultra-high molecular weight polyethylene or e-PTFE having a thread count of 440×220 fibers per square inch. In a particular embodiment, the uncoated fabric has a tensile strength of at least about 75N, an areal density of at least 0.5±0.05 ounces/yard2, and a thickness of approximately 50-100 μm stabilized by weaving, mechanically, chemically or energetically and in still another embodiment the woven fabric is stabilized by weaving, mechanically, or energetically. In an alternative for this embodiment, the stabilized fabric comprises a mesh of the invention made from this same material and the same thickness and containing pores and/or divots having at least one opening having an average area which could range from about 100 microns2 to about 5,000 microns2 and/or a pore density or divot density of about 1 to about 25%.
In another embodiment, a useful coated, partially coated or uncoated stabilized fabric is a woven fabric of ultra-high molecular weight polyethylene or e-PTFE having a thread count of 300-500×100-300 fibers per square inch. In a particular embodiment, the uncoated fabric has a tensile strength of at least 75N, an areal density of about 0.8±0.05 ounces/yard2, and a thickness of approximately 76 μm stabilized by weaving, mechanically, chemically or energetically and in still another embodiment the woven fabric is stabilized by weaving, mechanically, or energetically. In an alternative for this embodiment the stabilized fabric comprises a mesh of the invention made from these same materials and thickness and having pores or divots with openings having an average area that ranges from between about range from about 1,000 to about 3,000 microns2 and/or a pore density or divot density is about 5 to about 15%.
In another embodiment, a useful coated, partially coated or uncoated stabilized fabric is a woven fabric of ultra-high molecular weight polyethylene or e-PTFE having a thread count of 440×220 fibers per square inch. In a particular embodiment, the uncoated fabric has a tensile strength of at least about 75N, an areal density of at least 0.65±0.05 ounces/yard2, and a thickness of approximately 50 μm stabilized by weaving, mechanically, chemically or energetically and in still another embodiment the woven fabric is stabilized by weaving, mechanically, or energetically. In an alternative for this embodiment the stabilized fabric comprises a mesh of the invention made from this same material and thickness and containing pores and/or divots having at least one opening having an average area which could range from about 100 microns2 to about 5,000 microns2 and/or a pore density or divot density of about 1 to about 25%.
In another embodiment, the invention is a useful uncoated, coated or partially coated stabilized fabric that is a high-density woven fabric of PE or PTFE having a thread count of 300-500×100-300 fibers per square inch. In a particular embodiment, the uncoated fabric has a tensile strength of at least about 75N, an areal density of at least 0.65±0.05 ounces/yard2, and a thickness of approximately 250 μm or less stabilized by weaving, mechanically, chemically or energetically and in still another embodiment the woven fabric is stabilized by weaving, mechanically, or energetically. In an alternative for this embodiment the stabilized fabric comprises a mesh of the invention made from this same material and thickness containing pores and/or divots having at least one opening having an average area which could range from about 100 microns2 to about 5,000 microns2 and/or a pore density or divot density of about 1 to about 25%.
In some embodiments, the stabilized fabric material used in a medical device as described herein, is produced from a woven fabric or mesh that, before being stabilized, has a thickness of between about 1 μm and about 1,000 μm and in some embodiments, between about 1 μm and about 500 μm and in still others, between about 5 μm and about 300 μm. It also may have a tensile strength of at least about 35 N and in some embodiments at least about 50 N. In still other embodiments, the fabric material will have a tensile strength of at least about 70 N.
In particular for the valve components of expandable or surgical valves, including leaflets and cuffs, the stabilized fabric materials (woven fabric or mesh) used may exhibit one or more of the properties described in Table 1 below before being stabilized. It should be understood that, although Table 1 lists various characteristics with values grouped in a “broader range” and a “narrower range,” the fabric material may include any combination of characteristics from the “broader range” and the “narrower range,” and further, the fabric material may include in some instances characteristics that are outside the “broader range” and the “narrower range.”
In some embodiments, leaflets and/or cuffs formed of a stabilized UHMWPE fabric or mesh that, prior to stabilization and/or coating, may have one or more of: a thickness of about 250 μm or less, a tensile strength of at least about 75N and preferably at least about 90N; a stiffness/flexural rigidity of about 3.0+/−1.75 cm; a permeability of about 850-950 mL/cm2/min; a suture retention meeting ISO7198; a stretch/strain of about 20-25%; and a tear strength meeting or exceeding ASTM D2261-13. For a leaflet or cuff formed of an expanded or stretched PTFE, the overall properties can be similar. Where made of a woven fabric, the stabilized fabric is stabilized by weaving, mechanically, chemically or energetically and in still another embodiment the woven fabric is stabilized by weaving, mechanically, or energetically. In an alternative for this embodiment the stabilized fabric comprises a mesh of the invention made from this same material and thickness containing pores and/or divots having at least one opening having an average area which could range from about 100 microns2 to about 5,000 microns2 and/or a pore density or divot density of about 1 to about 25%. It should be noted that the “permeability” characteristic described above may apply particularly to fabrics/meshes that are coated with another material, or uncoated fabrics/meshes that have been exposure to blood for a time where the interaction of the blood with the fabric reduces the permeability of the uncoated fabric over time.
An embodiment of the invention is therefore a stabilized replacement heart valve comprising: a self-expandable or balloon-expandable stent; and a valve assembly sutured to the stent, the valve assembly comprising a cuff and a prosthetic leaflet at least one of which is composed of a coated or uncoated stabilized woven polymer fabric having warp and weft fibers that meet at a plurality of intersections, or a mesh, having at least one of: (i) an ultimate tensile strength between 25 MPa and 250 MPa; (ii) a tear strength of between 10 lbF and 40 lbF; (iii) a permeability of between 10 mL/cm2/min- and 1,200 mL/cm2/min; (iv) a suture retention of between 30 N and 70 N; (v) a stiffness/flexural rigidity of between 0.001 cm and 4 cm; and (vi) a stretch of between 3% and 50%; wherein the prosthetic leaflet has a thickness of between about 5 μm and about 500 μm and the cuff has a thickness of between about 1 μm and about 300 μm stabilized by weaving, mechanically, chemically or energetically and in still another embodiment the woven fabric is stabilized by weaving, mechanically, or energetically.
That stabilized replacement heart valve could also comprise: a self-expandable or balloon-expandable stent; and a valve assembly sutured to the stent, the valve assembly comprising a cuff and a prosthetic leaflet at least one of which is composed of a coated, partially coated, or uncoated polymer mesh The mesh has pores or divots each having at least one openings and wherein the average area of their which could range from about 100 microns2 to about 5,000 microns2. In another embodiment, the average area ranges from between about 1,000 to about 3,000 microns2 In one embodiment, the mesh has a pore density (and/or divot density as noted earlier) of about 1 to about 25% and in still another embodiment, the pore density is about 5 to about 15%. The materials used to produce this mesh, the number of layers used, the number and types of coating, etc., their properties, and their thickness are the same as previously described for the woven fabrics described herein. In a particular embodiment, when used in prosthetic leaflets the mesh material has a thickness of between about 5 μm and about 500 μm and when used in a cuff the mesh material has a thickness of between about 1 μm and about 300 μm.
Thus in one embodiment of the disclosure, there is provided a replacement heart valve which is specifically designed to replace or repair a native aortic, native pulmonary, native tricuspid, or native mitral valve, the replacement heart valve being made using a stabilized fabric. The stabilized fabric comprises either a mesh or a stabilized woven fabric.
If a mesh, the stabilized fabric is composed an uncoated mesh, a partially coated mesh or a coated mesh composed of one or more polymer materials which may be polyolefins such as polytetrafluoroethylene (PTFE) (including expanded (e-PTFE), stretched, low molecular weight, medium molecular weight, high molecular weight and ultra-high molecular weight (UHMW)), polyethylenes (PE) (including low, medium, high and ultra-high molecular weight polyethylene (UHMWPE —e.g., having an average molecular weight of between about 2 and about 7.5 million atomic mass units)), and polypropylene (PP) (including low, medium, high and ultra-high molecular weight polypropylene (UHMWPP)), as well as polyurethane, PEEK, polyvinyl alcohol, silicone, rayon, polyesters, aramid, and spandex. The uncoated mesh has a thickness of between about 1 μm and about 500 μm. And the mesh has pores and/or divots having at least which have openings having an average area ranging from about 100 microns2 to about 5,000 microns2, a pore density (divot density) of about 1 to about 25%, or both. In another embodiment, the mesh is composed an uncoated mesh or a partially coated mesh composed of one or more polymer materials which may be a PTFE, a PE, or a PP and either pores and/or divots having openings having an average area ranging from about 1,000 to about 3,000 microns2 or a pore density (divot density) of about 5 to about 15%, or both.
Methods of making medical devices such as heart valves as described herein include: forming one of the described stabilized fabrics into a component of a medical device, such as at least one leaflet or a cuff, and attaching it to other parts of the medical device or forming it into a medical device—such as by creating a valve assembly from the leaflet or cuff produced from the stabilized fabric and attaching it to a support or stent.
This disclosure may be best understood by reference to the following description taken in conjunction with the accompanying drawing figures in which:
“Stabilized” in the context of a stabilized medical device or stabilized fabric in accordance with the invention means a suitable mesh or a woven or knitted fabric having warp and weft fibers that meet at a plurality of intersections. At least one, and in general, a plurality of these intersections is stabilized by being mechanically fastened, chemically fastened or energetically fastened or is stabilized by weaving. “Fastened” and “fastening” in the context of a stabilized fabric of this invention means that one or more of the intersections is acted upon so as to increase the localized friction between crisscrossing fibers or locking them in place. Alternatively, stabilized in connection with weaving means altering the nature of the weave and/or the nature of the fibers to create additional friction and to restrict relative motion of the fibers at or adjacent fiber intersections. This can be done by a number of techniques, such as, without limitation, by increasing the weave density of a localized area of the fabric, using fibers of variable thickness, using fibers of greater than usual thickness, using a denser weave or by controlling the weave pattern. In one embodiment, stabilized woven fabrics include sufficient fastened intersection, located an appropriate, so as to render it resistant to changes in conformation.
“Conformation” in accordance with the present invention means the original relative position of the fibers, intersections, and gaps of a woven fabric and the original relative position of the struts, junctions and pores/divots of a mesh. Medical devices produced using synthetic materials could exhibit changes in shape, size, flexibility or other properties during use which could interfere with important functions of the device. As noted earlier, changes in conformation could result from one, or a combination of factors. A woven fabric material could exhibit changes in the regularity of the woven pattern over time—fibers moving relative to each other or changing the size and shape of gaps between them. Woven fabrics might stretch over time. Flexibility could be altered. Or it could be simple mechanical stretching with repeated use, exposure to body temperatures, the friction from motion or blood moving past it, etc. In some embodiments, stabilized medical devices made from stabilized fabrics will be resistant to changes in conformation by virtue of being stabilized.
Fabrics and medical devices made therefrom may in some other embodiments be stabilized such that they are resistant to changes in conformation caused by tissue growth. The term “tissue growth” as used herein is meant to encompass cells and tissues that may attach and/or grow onto and into the medical device and the materials it is made from. But it embraces more than that—indeed it is used herein to encompass the attachment, growth and/or accumulation of any biological or physiological materials and molecules within the body including, without limitation, cells, tissues, proteins, collagen, calcium, proteases, growth factors and the like. It has been found that these biological and physiological processes can cause a change in conformation of the fabric and any device made from it which could alter its ability to function as intended. This may be rooted in the types of cells that attach to portions of the fabric and how they attach thereto exerting their influence to tighten or misshape localized structures. But that process, and the materials that cause these issues are not completely understood. However, fabrics, meshes and medical devices made therefrom can be designed which are resistant to changes in conformation caused by these processes, again, herein, collectively referred to as “tissue growth.” When implanted into a patient, the stabilized fabrics and/or devices of the invention retain relatively more of their original conformation than would result from implanting an otherwise identical fabric or device that has not been stabilized.
When one wants to evaluate a fabric or device produced from it to determine the extent of conformation change, or resistance to conformation changes caused by tissue growth during implantation in a patient, one can perform a visual inspection and a trained observer will be able to assess the results. But other more objective measures are also available. Speaking of a woven fabric, one can compare the distance between roughly parallel warp and weft fibers or intersections before and after implantation. For example, first and second weft fibers are selected which are spaced apart from each other by an initial distance. A first weft fiber could be chosen and a second weft fiber that is ten fibers away from the first fiber can be chosen and the distance between them measured. The distance between these two first and second weft fibers can be measured again after the valve is recovered from a patient or animal model following implantation for several weeks or longer. Those distances can be compared. In the alternative, the distance between a first and a second intersection spaced apart from each other, for example 10 intersections spaced apart in the warp or weft direction can be measured before implantation and after implantation in a model. Note that when reference is made to a “model” and more specifically a “sheep model” herein, it means a sheep is preferred unless, for size or other reasons known in the art, a sheep is not an appropriate model. In that case a pig is used.
That the distance is substantially unchanged after implantation based on testing in a suitable model, such as a sheep model, or a pig model if sheep is not appropriate, for 140 days, indicates that the fabric is indeed a stabilized fabric and resistant to a change in conformation caused by tissue growth. Indeed, it has been found that using a non-stabilized woven fabric, the distance between the first and second intersections (a total of 10 intersections in the warp or weft direction—also referred to herein as the warp length or weft length respectively) could decrease by 10-30%. One way to demonstrate that a fabric or mesh is resistant to changes in conformation caused by tissue growth is to measure the degree of shortening of the distance between warp and/or weft lengths before and after implantation in a suitable model for a suitable time. In
It will be appreciated that both warp length 8635 and weft length 8625 changes can be measured and can be measured in a single location or in multiple locations of the fabric. Indeed, warp length 8635 and/or weft length 8625 can be measured at the free edge, near the attachment edge, in the intermediate or moving area or all of these. Analogous measurements can be taken of the relative distance between junctions in a mesh.
There are other techniques that can be used to measure resistance to changes in conformation following implantation as well. The fibers in a woven fabric form gaps between the fibers. As illustrated in
The number of intersections to be fastened by welding, mechanical fastening or adhesive fastening in accordance with the invention can vary with the nature of the fibers used, their thickness, the type of weave and weave density, the polymer used, and the technique used to stabilize the intersections and the type of medical device being constructed. Generally however, the intersections in question, those that will be stabilized, are disposed in a movement area and, in such a movement area, at a minimum, it is expected that a subset of at least about 25% of the intersections within the movement area will be fastened and in other embodiments, at least about 50% of those intersections will be fastened. In still another embodiment, the subset of intersections within the movement area that are fastened is at least about 75% and that number can be as high as at least about 90% or more. Indeed, in some instances, it may be desirable to fasten substantially all the intersections in the movement area.
The placement and distribution of the subset of fastened intersections can vary widely and can be random or in a pattern depending upon fabric used, the medical device in question, and the like. For the leaflets of a replacement heart valve, they are located in the movement area. However, without wishing to be bound by any particular theory of operation, tissue growth comprising cells, tissues and other biological and physiological materials will deposit, attach, grow or accumulate from the attachment edge first and then progress toward the free edge. It is believed that the degree of movement of a particular part of the leaflet impacts the timing, extent and type of tissue growth with it being easier to grow where there is no, or relatively less movement or slower movement.
It is possible that when discussing a medical device and the number of intersections fastened, reference is being made to the entirety of the fabric used. But it may also refer to only a portion of the fabric and the number of intersections fastened in that area. Using a leaflet as a non-limiting example, as shown in
There is an intermediate area 8560 between the attachment end 8530 and the free edge 8550 which, in a valve, can often have a belly taking the shape of something like a spinnaker sail or a roughly parabolic structure that approximates the anatomy of a native valve leaflet. This intermediate region 8560, along with the free edge 8550, generally moves during operation as the blood flows past the leaflets and back into the leaflets with the beating of the heart. This area which is subject to movement during operation and includes the free edge and intermediate portions of the leaflet between the free edge and the attachment end contains a subset of all of the intersections that might exist in the fabric that forms the leaflet. And in some embodiments, it is only a number of the intersections of this subset, in this movement area of the leaflet, that are stabilized by being fastened 8570. Thus a leaflet with 90% of its intersections fastened in the movement area means 90% of that subset of intersections are fastened, not that 90% of all of the intersections present in the leaflet are fastened. The attachment end may be attached to a stent, for example, but sutures, and, broadly speaking, this too could “fasten” fiber intersections. But as they are outside of the movement area, in this instance, they are not counted.
Moreover, it will be appreciated that the impact of tissue growth on the conformation of a fabric portion that is sutured to another structure is generally less a concern as it should not cause a change in conformation. Areas of the fabric that are subject to movement or are not otherwise attached to another structure is far more like to exhibit a change in performance or other impact if its conformation changes. So in general, references to stabilizing fabric, or rendering a fabric resistant to changes in conformation will involve portions of the fabric that are able to move or are not directly attached to another structure in use.
A mesh is not woven and does not have intersections formed of fibers crossing one another and to not define gaps. But its structure is very analogous. A mesh is a web or matrix of struts that meet at and define junctions and the space between these structs and junctions are pores or divots. It is therefore intrinsically more stable than an un-stabilized fiber of similar material and physical dimensions—thickness of the struts versus thickness of the fibers, number of junctions versus number of intersections, size and density of pores versus size of fabric gaps and areal density, and the like. Thus, in the context of a stabilized fabric, a mesh need not include further mechanical, chemical, energetic fastening or stabilizing by weaving to be resistant to changes in conformation. That said, additional stability might be obtained by employing some of these same techniques and are therefore contemplated in addition. In one embodiment, the mesh is resistant to changes in conformation caused by tissue growth. And one can tell if the materials selected and the construction of the mesh is sufficient to be relatively resistant to changes in conformation in general and because of tissue growth specifically, in the same way as one does so for a woven fabric. The distance between parallel spaced apart struts or junctions can be determined and the closer that distance remains before and after implantation, (the less the distance between, for example a first and a 10th junction changes) the more stable the mesh. If the distance does not change by 10% or more, and preferably, about 5% or less, it is considered sufficiently stable to be resistant to a change in conformation due to tissue growth. Similarly, the area of a pore/divot, or a group of pores/divots will decrease less than 10% and preferably about 5% or less in such a stabilized mesh.
Mechanically fastened means using a mechanical device such as, without limitation, a suture or a staple to bind one or more fiber intersections. Chemically fastening means something, such as, without limitation, using a glue or adhesive to bind one or more of the fiber intersections. Energetically fastening means using one or more types of energy to weld and therefore bind one or more fiber intersections. Stabilized by weaving means altering the nature of the weave and or the nature of the fibers to create additional friction and to restrict relative motion of the fibers at or adjacent one or more of the fiber intersections. This can be done by a number of techniques, such as, without limitation, by increasing the weave density of a localized area of the fabric, using fibers of variable thickness, using fibers of greater than usual thickness, using a denser weave or by controlling the weave pattern.
As used herein in connection with a prosthetic heart valve, the term “inflow end” refers to the end of the heart valve through which blood enters when the valve is functioning as intended, and the term “outflow end” refers to the end of the heart valve through which blood exits when the valve is functioning as intended. As used herein, the terms “proximal” and “upstream” refer to the inflow end of a prosthetic heart valve and these terms may be used interchangeably. The terms “distal” and “downstream” refer to the outflow end of a prosthetic heart valve and also may be used interchangeably. As used herein, the terms “generally,” “substantially,” and “about” are intended to mean that slight deviations from absolute are included within the scope of the term so modified. When used herein in the context of a prosthetic heart valve, or a component thereof, the lengthwise or axial direction refers to a direction parallel to a longitudinal axis passing through the center of the stent or heart valve from the inflow end to the outflow end. When used herein in the context of a prosthetic heart valve, or a component thereof, the circumferential direction refers to a direction extending along the circumference of the prosthetic heart valve.
Frame 12 may be covered by a fabric covering (not shown), particularly over each commissure post 12a-c. One example of an appropriate covering fabric is reemay fabric, which is a spun form of polyester. A ring 22 (
The collapsible/expandable prosthetic heart valves of the disclosure have an expanded condition and may also have a collapsed condition. Although aspects of the disclosure apply to a collapsible/expandable prosthetic heart valve for replacing a native aortic valve, the disclosure is not so limited, and may apply to prosthetic valves for replacing other types of cardiac valves, including, the mitral valve, the tricuspid valve and the pulmonary valve. Nor is the disclosure limited to a specific method of delivery. For example, the collapsible/expandable prosthetic heart valves described herein may be delivered via any suitable transcatheter delivery route, including a transfemoral route, a transvenous route, a transapical route, a transjugular route, a transaortic route, a transsubclavian route, etc. Further, the collapsible/expandable prosthetic heart valves described herein may be delivered via traditional surgical routes, or any suitable minimally invasive route.
Stent 102 may include one or more retaining elements 118 at outflow end 132, the retaining elements being sized and shaped to cooperate with retaining structures provided on a delivery device (not shown). The engagement of retaining elements 118 with the retaining structures on the deployment device may help maintain prosthetic heart valve 100 in assembled relationship with the deployment device, minimize longitudinal movement of the prosthetic heart valve relative to the deployment device during unsheathing or resheathing procedures, and help prevent rotation of the prosthetic heart valve relative to the deployment device as the deployment device is advanced to the target location and during deployment. One such deployment device is described in U.S. Patent Publication No. 2012/0078352, the disclosure of which is hereby incorporated by reference herein.
Stent 102 may also include a plurality of commissure attachment features 116 for mounting the leaflet commissures of the valve assembly to the stent. As can be seen in
Prosthetic heart valve 100 includes a valve assembly 104 which, in one embodiment, may be positioned entirely in the annulus section 140 of stent 102. Valve assembly 104 includes a plurality of leaflets 108 that collectively function as a one-way valve by coapting with one another, and a cuff 106 positioned on the luminal surface of stent 102 surrounding leaflets 108. Although cuff 106 is shown in
Cuff 106 may be scalloped at the inflow end 130 of stent 102, and may have a zig-zag structure at its outflow end, following certain stent struts 114 up to commissure attachment features 116 and other stent struts closer to the inflow end of the stent at circumferential positions between the commissure attachment features. When open, leaflets 108 may remain substantially completely within annulus section 140, or they may be designed to extend into transition section 141. In the embodiment shown, substantially the entirety of valve assembly 104 is positioned between the inflow end 130 of stent 102 and commissure attachment features 116, and none of the valve assembly is positioned between the commissure attachment features and the outflow end 132 of the stent.
In operation, prosthetic heart valve 100 may be used to replace a native heart valve, such as the aortic valve, a surgical heart valve, or a heart valve that has undergone a surgical procedure. Prosthetic heart valve 100 may be delivered to the desired site (e.g., near the native aortic annulus) using any suitable delivery device. During delivery, prosthetic heart valve 100 is disposed inside the delivery device in the collapsed condition. The delivery device may be introduced into the patient using any known percutaneous procedure, such as a transfemoral, transapical, transvenous, or transseptal delivery procedure. Once the delivery device has reached the target site, the user may deploy prosthetic heart valve 100. Upon deployment, prosthetic heart valve 100 expands into secure engagement within the native aortic annulus. When prosthetic heart valve 100 is properly positioned inside the heart, it works as a one-way valve, allowing blood to flow in one direction and preventing blood from flowing in the opposite direction. (See U.S. Pat. No. 7,585,321
Outer cuff 350 may also comprise multiple pieces of material that, when joined together, form a shape and provide a function that are similar to what has been described above. Also, rather than being formed of a single substantially rectangular piece of material that is wrapped around the circumference of stent 302, outer cuff 350 may be formed as a continuous annular web without side edges 354, 356. Preferably, outer cuff 350 has an axial height measured from its proximal edge 352 to its distal edge 358 that is approximately half the axial height of a cell 312 in the proximal-most row of cells in stent 302 as measured along the major axis of the cell between two of its apices when the cell is in an expanded condition. However, outer cuff 350 may have other suitable heights, such as the full axial height of a cell 312 in the proximal-most row of cells, or more or less than the full axial height of a cell 312 in the proximal-most row of cells. Still further, although inner cuff 306 and outer cuff 350 are described above as separate pieces of material joined to stent 302 and to each other, the cuffs may be formed integrally with one another from a single piece of material that is wrapped around the inflow edge of the stent, with the distal edge 358 of the outer portion of the cuff joined to the stent and/or to the inner portion of the cuff at attachment points S1 as described above. With this configuration, the proximal edge 352 of outer cuff 350 does not need to be sutured to stent 302, although it still may be preferable to provide such attachment. The various valve components including, without limitation, inner cuffs, outer cuffs and leaflets, and valve assemblies made therefrom, may be attached to each other and/or to the stent in any conventional manner, including suturing, gluing, molding, welding, heating, cross-linking, and the like. (See U.S. Pat. Nos. 6,821,297; 6,458,153; 7,585,321; 5,957,949.)
Valve assemblies, such as valve assembly 104 comprising inner cuff 106/306, leaflets 108, as well as outer cuff 350, may be formed of the same or different materials, including any suitable biological material, including “fixed” bovine or porcine tissue, or a polymer such as, for example, polyolefins such as polytetrafluoroethylene (PTFE), polyethylenes including ultra-high molecular weight polyethylene (UHMWPE), and polypropylene, as well as polyurethane, PEEK, polyvinyl alcohol, silicone, or combinations thereof (See U.S. Pub. No. 2018/0055631 A1, the disclosure of which regarding the structure, function and manufacture of a heart valve are hereby incorporated by reference herein.) In accordance with the present disclosure, at least one of the components of a valve, including, without limitation, leaflets or cuffs, valve assemblies, and the like, is produced from an uncoated or coated stabilized fabric, a term which, as noted earlier, includes both a stabilized woven fabric or a mesh as described herein.
The description of surgical heart valve 10 and collapsible/expandable prosthetic heart valve 100 are for context only. Thus, the stabilized fabric materials described herein may be used in surgical heart valves that are similar to surgical heart valve 10 or surgical heart valves that are very different therefrom. Similarly, the presently disclosed stabilized fabric materials may be used in collapsible/expandable prosthetic heart valves that are similar to prosthetic heart valve 100, or prosthetic heart valves that are very different therefrom, such as heart valves having a balloon-expandable stent; heart valves that do not have an aortic section; heart valves in which the stent has an hourglass profile, right cylindrical sections or ovoid cross-sections; heart valves intended to replace other cardiac valves, such as the mitral valve; etc. For example, the stent may be made of a single or multiple bent wires such as illustrated in U.S. Pat. Nos. 5,411,552 or 5,855,601, forming a zigzag or sinusoidal shape, or may be made from interwoven or intercrossing bars such as shown in U.S. Pat. Nos. 5,545,214 and 7,585,321. The stent may also be formed of woven materials which can be such as shown in EP 2,926,766, which is hereby incorporated by reference herein for its teaching of a woven stent and for its teachings regarding the mounting of a cuff and/or sac on the interior or exterior of a stent. Often, however, the stent is made from a laser-cut nitinol tube. A balloon-expandable stent may be composed of biocompatible metals known in the art, including but not limited to, cobalt chromium and stainless steel. The stent may be continuous or discontinuous (made in sections that are attached to one another directly or indirectly—see, for example, U.S. Pat. No. 5,957,949). Therefore, the descriptions herein of surgical heart valve 10 and collapsible/expandable prosthetic heart valve 100 should in no way be considered as limiting the features and applications of the coated and uncoated fabric materials disclosed herein.
According to the present disclosure, one or more of the valve components and, in particular, the inner and/or outer cuff(s) and/or one or more leaflets, may be made from a mesh or a woven fabric, a term which includes knitted fabric). As used herein, the term “fabric” refers to a polymer-fiber containing material having filaments, threads, yarns, or other strands (collectively, “fibers”) that are interlaced with one another. This term is used interchangeably with the term “woven fabric.” However, the term “stabilized fabric” or as the context of the use of the term “fabric” demands, includes not only a woven fabric stabilized as discussed herein but also a mesh. When discussing a woven fabric, the fibers may be formed of any one or more of a variety of materials, including natural materials, polymers, or blends of natural materials and polymers, so long as it includes a majority of polymer fibers. The natural materials may include cotton, wool, hemp, jute, silk, linen, alpaca, cashmere and the like. The polymer fibers may include, for example, polyolefins such as polytetrafluoroethylene (PTFE) (including expanded (e-PTFE), stretched, low molecular weight, medium molecular weight, high molecular weight and ultra-high molecular weight (UHMW)), polyethylenes (including low, medium, high and ultra-high molecular weight polyethylene (UHMWPE —e.g., having an average molecular weight of between about 2 and about 7.5 million atomic mass units)), and polypropylene (including low, medium, high and ultra-high molecular weight polypropylene (UHMWPP)), as well as polyurethane, PEEK, polyvinyl alcohol, silicone, rayon, polyesters, aramid, spandex, or combinations thereof. The fibers may have any cross-sectional shape, including round, rectangular, triangular, polygonal, oval, etc. Moreover, the fibers may be selected to have desired dimensions, such as diameter, width, thickness and/or length. The fibers may also have an irregular, undulating or variable diameter along its length. Fibers are often extruded, and their diameter may be varied during the extrusion process to provide this undulating profile of thicker and thinner regions. The fibers may also be porous or nonporous, and drug-eluting or non drug-eluting. In addition, the fibers may each consist of a single strand or filament, or of multiple strands or filaments. For fibers comprised of multiple strands or filaments, the strands or filaments may be braided, twisted or otherwise joined together in a bundle. (When used herein, the term “fibers” shall include both individual fibers as well as fiber bundles.) The fibers may be selected based on certain properties, such as creep, tensile strength, elastic modulus, strain/elongation, compressibility, flexural rigidity and stiffness, and twist direction and magnitude. Other properties that may influence the selection of certain fibers include melt flow viscosity, percent spin finish, linear density, tenacity, melting temperature, biocompatibility, purity, Denier, color, radiopacity, surface friction and entanglement. The polymers just mentioned herein as being useful for fibers used in the woven fabric and a stabilized woven fabric of the present invention can also be used to produce a mesh for use as a stabilized fabric.
In addition to their mechanical properties, the individual fibers may be uncoated, or they may be coated with another material. In one form of coated fiber, the fiber may be conjugated (i.e., chemically reacted) with another material, for example, a therapeutic drug or a lubricious material. In another form of coated fiber, the fiber may be coated with a polymer or other material. In still another form of coated fiber, a porous fiber may be infused with a polymer, a therapeutic drug, a lubricity-promoting agent or another material. Any known technique may be used to coat the fiber with a polymer or other material, including spray coating, dip coating and the like. Once coated, the fibers may be allowed to dry or, for polymer coatings, the polymer may be solidified by cross-linking. It will be appreciated that, for coated fibers, the coating may be applied uniformly around the surface of the fiber, or it may be applied to only portions of the fiber surface and/or along only portions of the fiber length.
The weave of the fabric may determine the extent of porosity in the fabric. The fabric's porosity corresponds to the number and size of the open areas formed between the fibers as a result of the weaving or knitting process. When used as a component of a prosthetic heart valve, the fabric, when the prosthetic heart valve has been implanted, may be in contact with tissue and may promote a healing response. The porosity of the woven or knitted fabric may allow cells to flow through the valve component, but after blood makes contact with the fabric, the fabric may become less permeable or impermeable.
Expanding on the foregoing, a stabilized fabric may promote cell adhesion, wherein cells may attach to a single fiber of the fabric or to a plurality of fibers of the fabric or to a single strand or multiple strands of a mesh. The cells may adhere or attach to the stabilized fabric without inhibiting the expected performance of the material. Cell adhesion may be aided by the deposition of blood proteins, plasma, coagulation products, fibrin or other materials. In some embodiments, cells may migrate into the prosthetic heart valve from the adjacent tissue and may attach or adhere to the stabilized fabric components. In other embodiments, cells from the blood may be entrapped in the fabric and may attach or adhere to individual fibers of the woven fabric or struts or strands of the mesh.
The adhesion of cells to the stabilized fabric may also be influenced by the composition of the fibers, the weave, or mesh and whether the fibers or mesh are coated or uncoated, and if coated, the composition of the coating. In some embodiments, porous fibers or a porous mesh may be impregnated with a drug or other material that may either promote or retard cell adhesion. In other embodiments, the individual fibers or the mesh may be either partially or fully conjugated or coated with a polymer, a therapeutic drug and/or another material.
The woven fabrics or meshes may also be engineered to have certain mechanical properties, such as a desired creep, compression, burst strength, suture retention, flexural rigidity/stiffness, tearing strength, delamination strength, and stretch/elongation. Other properties that may be sought include a specific anisotropy, color, weight, extractable content, permeability, radiation sensitivity, radiopacity, moisture sensitivity, temperature sensitivity, and/or chemical sensitivity. As noted, many of these parameters may be influenced by the particular fibers used to form the woven fabric or the polymers used to produce the mesh, while others may be more influenced by the manner in which the fabric is formed from the fibers or the mesh is produced. In addition, the fabric or mesh may include one or more radiopaque fibers or other features to assist in identifying the location and orientation of one or more features of the prosthetic heart valve or other medical device in which the fabric or mesh is incorporated.
The fabrics may be engineered to have a desired thread count, a desired tensile strength, a desired areal density, and/or a desired thickness, all measured before the medical device incorporating the fabric is implanted in a patient. When the fabric is a woven fabric, it preferably has a thread count of at least about 150, 200, 250, 300, 350, 400, 450, 500, 600, 700, 800, 900, 1000 or more total fibers per square inch per layer of fabric. The thread count need not be symmetrical. For example, one could use a fabric of about 100×50, 100×125, 220×110, 330×170, 360×180, 400×200 and 440×220 fibers in a square inch. In one embodiment, the thread count is from about 200 to about 500 by about 200 to about 500 fibers in a square inch (200-500×200-500), and in another embodiment is from about 300 to about 500 by about 100 to about 300 fibers in a square inch (300-500×100-300). In some embodiments, the fabric is a high-density weave having more than 300 fibers per square inch. Further, the thread count in one portion of the fabric may be different from the thread count in another portion of the fabric. For example, when the fabric is used to form a leaflet of a prosthetic heart valve, the thread count at the attachment edge may be greater than the thread count in the belly portion or at the free edge of the leaflet. The greater thread count at the attachment edge produces a fabric with greater strength in the region at which the leaflet is attached to the cuff and/or stent and experiences a large amount of stress in use. The density of the weave may be adjusted, and often reduced, to promote flexibility and adhesion of layers, including adhesion through the fabric of a coating on one major surface of the fabric to a coating on the other major surface of the fabric. When the fabric is a knitted fabric, it typically has a lower thread count or stitch density than a woven fabric. Knitted fabrics may have a stitch density of from about 2 to about 750 per square inch or from about 5 to about 500 per square inch.
In some embodiments, the fabric has a tensile strength of at least about 50N, and in other embodiments about 60N. In still other embodiments, the tensile strength is about 70N or more. A tensile strength of at least about 75N may be used, as may a tensile strength of at least about 85N or at least about 100N. A mesh used in producing a stabilized fabric can have these same properties.
In some embodiments, woven or knitted fabric has an areal density of at least about 0.5±0.1 ounces/yard2, in other embodiments, an areal density of at least about 0.65±0.1 ounces/yard2, and in still other embodiments, an areal density of about 0.8±0.05 ounces/yard2. It will be appreciated that weave density and thread counts balance the need for strength, flexibility and porosity. For an uncoated fabric, pore density between woven/knitted fabric fibers should not be large enough to cause appreciable leakage through the fabric. On the other hand, in general, the fewer the number of fibers and/or the larger the number of pores in the fabric, the greater will be the flexibility of the fabric and the more a synthetic fabric leaflet will resemble a healthy native leaflet. Stated another way, the woven or knitted fabric in one embodiment has an areal density of at most about 1.3±0.1 ounces/yard2, and in another embodiment, an areal density of no more than about 1.0±0.1 ounces/yard2. Of course, the weave density could increase locally as a means of stabilizing the woven fabric as described herein.
Obviously, a mesh is not a woven fabric, it is a continuous web of polymer struts that meet at a variety of common locations to form a regular pattern very analogous to a woven fabric. The junctions of the struts are analogous to the intersections of warp and weft fibers and the struts that run between and connect these junctions are analogous to the fibers. And like woven fabrics, struts and their junctions define openings or gaps, which are called divots or pores in case of a mesh. The number of struts and junctions in the web can be configured to provide a density and size of these pores/divots analogous to the gaps and intersections of woven fabrics as noted above. Alternatively, the mesh may contain pores and/or divots having at least one opening having an average area which could range from about 100 microns2 to about 5,000 microns2. In another embodiment, this opening has an average area that ranges from between about range from about 1,000 to about 3,000 microns2. In one embodiment, the mesh has a pore density (divot density) of about 1 to about 25% and in still another embodiment, the pore/divot density is about 5 to about 15%.
In some embodiments, the uncoated fabric or mesh has a thickness of about 10 μm to about 200 μm, and in other embodiments, a thickness of about 20 μm to about 100 μm. In some embodiments, the thickness of the fabric is from about 50 μm to about 100 μm. Thickness is a balance between durability, resilience, and flexibility. At a thickness of about 75 μm, the fabric leaflets of the disclosure are often only about 20% of the thickness of most tissue leaflets used in conventional collapsible heart valves, which are about 300-450 μm thick, or about 10% of the thickness of most tissue leaflets used in surgical heart valves, which are about 400-800 μm thick. In some embodiments, the thickness of the mesh could be as little as 5 μm.
Any of the properties of the stabilized fabric may be selected depending on the particular application. For example, while some parameters may be suitable for stabilized fabrics forming the cuffs and/or leaflets of a collapsible/expandable prosthetic heart valve, stabilized fabrics having other parameters may be better suited for other medical devices described below.
Additional weaving techniques can be used to form the fabric as well. One additional weaving technique is the leno weave, shown in
A variety of knitting techniques may also be used to produce the woven fabric. Knitting involves interlacing loops of at least one fiber. The main fabrics produced by knitting are weft knits, specialized weft knits and warp knits. A weft knit fabric can either be a single knit or a double knit. A single knit fabric is produced by one set of needles, while a double knit fabric is produced by two sets of needles. (Random House Kernerman Webster's College Dictionary, 2010, K Dictionaries Ltd.) The most common example of a single knit fabric is a single jersey. The most common double knit fabrics include rib knit, purl knit, interlock knit, cable fabric, bird's eye, cardigans, Milano ribs and pointelle. Examples of single knit and purl knit fabrics are shown in
No matter their form, woven polymer fabrics or meshes may be coated, either partially or completely, with one or more polymer layers, resulting in a coated fabric. “Coated fabric” in accordance with the disclosure means any of the uncoated fabrics described above, to which a polymer coating, film or layer is deposited or applied, either partially or completely covering at least a portion of one surface or edge of the fabric. The materials used for the fabric, as described previously, can be used for any coating or partial coating. Individual coatings may be the same as or different from one another and from the fabric, and include, without limitation, a PTFE, such as ultra-high molecular weight PTFE (UHMWPTFE) and expanded (e-PTFE) or stretched PTFE, a polyethylene, such as UHMWPE, and a polypropylene, such as UHMWPP, copolymers or block copolymers of polyethylenes and polypropylenes, and combinations or blends thereof. Other polymers which may be used alone or in combination with those mentioned above include, without limitation, polyurethanes, acrylics, polyesters, polyamides, polyimides, vinyl acetates, alkyds, epoxies, silanes, siloxanes, and the like. Homo- and co-polymers of these materials may also be used. A woven fabric could include fibers of one of or more of these materials or fiber bundles of one or more of these materials. Individual layers of a coating could be made of a single one of these materials or of blends/copolymers of them. When more than one coating layer is used, each of the layers may have the same or a different composition.
In some embodiments, the polymer coating may be produced using films that are directionally oriented in the same or in different directions. In one example, a polymer film may be applied to a top side of the fabric in one direction and a second polymer film may be applied to the bottom side of the fabric in a different direction. In another example, if more than one polymer film is applied to the top or bottom side of the fabric, the polymer film on each side of the fabric may be applied in the same direction or in different directions such that one polymer film is oriented differently from the polymer film that it sits on top of The fabric/coating could further include or be coated with a drug or active pharmaceutical ingredient (API) or the coating could include the API, which gradually elutes from it. API's may include, for example, Sirolimus, Paclitaxel, Everolimus, or any treatment to enhance resistance to calcification. APIs may also include growth factors, such as vascular endothelial growth factor (VEGF) and transforming growth factor (TGF-beta). It may also be coated with, or the coating may include hyaluronan, hyaluronic acid, glycosaminoglycans (GAGs), Heparin, or amino acids for cell attachment sites, and anti-oxidants such as super oxide dismutase or ascorbic acid. In another embodiment, the fabric can be coated with one or more layers (completely or partially) which are composed of one or more bio-absorbable/biodegradable polymers such as, without limitation: poly-glycolic acid; poly-L-lactic acid; copolymers of poly-glycolic acid and poly-L-lactic acid; polycaprolactone; poly-DL lactic acid; polytrimethylene carbonate; polydioxanone; poliglecaprone; and polyglactin, as well as blends, mixtures and copolymers of the foregoing. It may be important that, for example, tissue ingrowth onto a surface be delayed. Applying a coating to an otherwise porous fabric—sufficiently porous to promote cell attachment—might prevent this, depending on many factors including the type of coating. Using a bio-absorbable/biodegradable polymer for the coating could retard cell attachment until the coating erodes or is absorbed. In another embodiment, and as described elsewhere herein, the coating may include an API that is released gradually. Taxol and other drugs have been released from coated stents in a like manner for a variety of reasons, including mitigating the initial stress of placement of the stent. But it may be that an uncoated fabric in contact with the annulus of a heart valve, for example, might be otherwise desirable, such as to allow cell ingrowth to fix the valve in place. Using a thin outermost layer of a cuff material of the disclosure, for example made of one or more bio-absorbable/biodegradable polymers. could facilitate drug release, then get out of the way.
In some embodiments, up to 20 layers of polymer film may be applied to one or to each side of the fabric layer. In other embodiments, 1 to 10 layers of polymer film may be applied to one or to both sides of the fabric layer. In still other embodiments, 1 to 5 layers of polymer film may be applied to one or to both sides of the fabric layer. Thus, each side of the fabric layer can be covered, completely or partially, by 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20 polymer film layers.
When more than one coating layer is used, the various layers need not each have the same thickness or, as noted previously, the same composition or orientation. While even thicker coatings are possible, generally speaking, the thickness of the coating on each side, whether comprised of 1 layer or 20, may range from about 0.5 μm to about 100 μm, in another embodiment from about 0.5 μm to about 50 μm, and in some further embodiments from about 10 μm to about 40 μm. In one other embodiment, the thickness of the coating on each side may range from about 15 μm to about 30 μm. Very thin polymer layers, i.e., from about 0.50 μm to about 2 μm, may be applied simply to fill the open pores in the fabric or for other reasons.
A resultant coated fabric in accordance with the disclosure often will be thicker than an uncoated fabric. The overall thickness of a coated fabric could be as high as about 500 μm, or even higher (about 1,000 pm), depending on the fabric being used, the type and number of coatings, and the intended use of the fabric. If the coating is being applied just at or adjacent the attachment edge of a leaflet such that it can be sewn through when attaching the leaflet to a cuff and/or stent, it can be relatively thicker as it will not impact the flexibility of the balance of the leaflet. The thickness of the leaflet could also vary along a gradient, such as from the attachment edge to the free edge of the leaflet. In general, the coated fabric will have a maximum thickness in some embodiments of no more than about 500 μm, in other embodiments of no more than about 250 μm, and in still other embodiments of no more than about 200 μm.
It will be appreciated that the thicknesses of the polymer film layers, woven fabrics, coated woven fabric, mesh and coated mesh are dictated by a balancing of properties and functionality. The number of layers of polymer film applied to the fabric or mesh can have an impact on the size to which a collapsible medical device, such as a collapsible prosthetic heart valve, can be collapsed. For non-collapsible devices, such as prosthetic heart valves that are only expandable and surgical heart valves, collapsibility is not a factor dictating thickness. In such instances, other properties may dictate composition, number of layers and thickness, such as, without limitation, rigidity, porosity, stability and flexibility. Of course, there are many other factors involved as well including, without limitation, the size and geometry of the stent or other medical devices to which the coated fabric may be applied or attached.
Leaflets, cuffs, or other structures of medical devices may be reinforced, weighted, or have their flexibilities altered, or their three-dimensional shape established or preserved by the addition of other features, with or without coatings. That is to say that in addition to coatings or partial coatings or layers, structures such as sutures, wires, denser weaves and the like may also be used for these purposes
One such structure that could be used is a suture. A suture could be attached in any number of ways and any number of locations to a woven fabric or mesh. Using a valve leaflet for example, a single stitch could be placed in the middle of a major surface of the leaflet, or in a specific location on the free edge. A series or pattern of a plurality of individual stitches could be used as well. These could provide reinforcement, could alter the flexibility, or provide weight in order to, for example, bias the leaflet into a proper closed position. One or more sutures could be used to form a one or a plurality of suture lines across an entire major surface or a portion of the major surface of a leaflet, including for example along the attachment edge or along the free edge of the leaflet for any of the reasons just described. For example, a row of sutures could be added, of varying number of stiches, in a line or specified shape, across the full length of the leaflet in a single row from the attachment edge to the free edge of a leaflet. A suture line or suture lines could be spaced from but roughly parallel the free edge as well such as shown in
It should be understood that leaflets and cuffs are often sutured to each other and/or to a stent. Frequently, as few sutures as required are used for this attachment, and in some instances a single suture could be used to attach each of the leaflets. Using a suture in this fashion, the suture is stitched a plurality of times—sometimes 10's or even 100's of times—through the leaflet. Each of these is obviously a stitch. But, a “stitch” in the case of reinforcing, shaping and biasing purposes of a woven fabric leaflet or cuff or a mesh leaflet or cuff refers to a single stitch or knot of a suture material not used to attach, for example, a portion of the leaflet to a cuff, etc. A suture line in this instance is a suture stitched a plurality of times through a cuff or leaflet also not primarily intended to attach the cuff or leaflet to another structure. As used herein, a “continuous” suture line refers to a single suture line formed from a single continuous suture, or multiple sutures that are substantially continuous with one another (e.g. the first suture ends where the second suture beings). On the other hand, a “discontinuous” suture line refers to a suture line formed of two or more sutures, where the sutures are substantially discontinuous with one another (e.g. the second suture begins at a spaced location from where the first suture ends).
One or more sutures could also be stitched to at least a portion of the attachment edge and/or the free edge of a leaflet to provide reinforcement and/or weight and/or to introduce or preserve a shape. The use of sutures here could provide additional strength in an edge that could be sutured or otherwise attached to a cuff and/or stent and can help retard fraying or delamination at the edge. These suture lines could be formed of one or more sutures, can be continuous or discontinuous, and can either be extended in a narrow area or across the entire length of one of these edges.
Instead of or in addition to a coating and/or a suture, localized portions of denser weaves can be used for the purposes just described, using a leaflet as an example—at the attachment edge, the free edge, and/or across at least a portion of the face. As used herein, the phrase “denser weave,” “increased weave density,” or similar terms refer to a fabric having a weave with more fabric per unit area or per unit volume compared to other areas of the weave. In the example of a fabric leaflet having portions with increased weave density, those portions with the increased weave density may be formed by introducing more fabric in that area during formation of the fabric leaflet, or otherwise after the fabric leaflet is formed with a uniform weave density. For example, after forming a fabric leaflet with a substantially uniform weave density, additional fabric material or fibers may be woven into area where it is desired to increase weave density, or additional pre-woven material may be added onto the fabric leaflet, for example a swatch of fabric may be coupled to the fabric leaflet in areas where it is desired to increase weave density. Note also that an increase weave density can be provided, in a manner of speaking, to a mesh. Fibers can be woven in and out of the pores or openings of a mesh to provide reinforcement, shape or bias.
And in still another aspect of this embodiment, instead of, or in addition to coating, partial coatings, denser weaves, sutures or the like, other reinforcing structures such as wires, including without limitation, steel or nitinol wires, could be used. These structures could be inserted into the weave along the attachment edge, the free edge or across some portion of a major surface of a leaflet, again used only for an example. They could also be applied by gluing, laminating, etc. to a coated or uncoated fabric of the invention. For example, a wire could be disposed between a fabric material and a coating or layer laminated thereto at the free edge of a leaflet. The wire or other reinforcement may extend across the entire edge, just a portion of it, may be continuous or discontinuous. A “continuous” or “discontinuous” wire has a similar definition as the continuous or discontinuous suture line described above, except the reference material is a wire instead of a suture. A suture could be used instead of a wire, or other fiber which is attached by being glued or laminated between the fabric and a layer or partial layer instead of being stitched. A wire could be used as part of the mesh or woven into it.
In addition to, or instead of, reinforcing, shaping and biasing, many of these same structures, and others, can be used to produce a stabilized woven fabric. Specifically, fasteners, such as sutures, welding, adhesives and increases in weave density, as well as other innovations, can also be used to help maintain the geometry and/or relative spacing of the individual fibers in a weave thereby providing additional stability to the woven fabric and retard or control the propensity of it to change conformation after implantation which can impact the intended functions of the medical device. In the case of a collapsible and/or expandable heart valve, or a surgical valve, leaflet retraction proximate free edges of the leaflet could interfere with the completeness of coaptation. The creation and use of stabilized fabrics to reduce this possibility is one aspect of the invention. A mesh could also be used to provide a stabilized fabric where the number, shape and location of the pores/divots and interconnecting struts are resistant to a change in conformation.
The same fabric, however, may have a very different conformation after implantation as represented by the fabric shown in
As noted, one way to accomplish this fabric stabilization is by using a localized denser weave. Relative to the rest of the woven fabric, a higher weave density has more intersections and the fibers in the zone with the high weave density are closer together. Proximity, lack of freedom of movement, and the increased collective friction at the increased number of intersections makes it relatively more difficult to distort the fabric in this region.
Filaments when used to produce the stabilized woven fabrics of the invention, those that include fastened intersections, those that are altered but have unaltered intersections, and those based on weaving to provide increased stabilization, generally will have a diameter of about 0.5 to about 20 microns, and in certain embodiments, from about 5 to 15 microns. This assumes that the fibers have a generally circular cross section which may or may not be the case. If other shapes/cross sections are used, an analogous size is contemplated. Another measure that is useful in connection with filaments and fibers is dTex which is short for decitex and is a measure of the mass in grams for every 1,000 meters of fiber. This measurement is often counted in tenths. The filaments may also have a dTex of 0.1 to about 5 and often between about 0.5 to about 2 dTex. In terms of a solid single fiber or a bundle of filaments twisted or otherwise formed into a fiber the dTex could be from about 1 to about 100 dTex and often from about 5 to about 20 dTex.
Synthetic fibers used in any of the stabilized fabrics of the invention may be made from a single filament as just described, a single extruded fiber, or, more commonly, 1 to about 100 filaments and more often about 1 to about 20 filaments bundled, twisted, adhered together and the like. In another embodiment, the number of filaments in a fiber is from about 1 to about 15 filaments. When the fiber has a circular cross section or the bundle has a generally circular cross section, the diameter could range from about 10 to about 150 microns, in another embodiment, from about 10 to 100 microns and in still another embodiment, from about 10 and about 50 microns. However, fibers need not have a substantially circular cross section. It could be more oblong in shape which could be rectangular, ovoid, or more irregular with a thickness that is less than its width. In these situations, the fiber intersections generally comprise a portion of the elongated surfaces of the adjacent fibers being in intimate contact. The width is always the largest dimension and the measurement. Thus it is possible that the thickness of the fabric could be less than the width of a single fiber used to produce it. The fiber thickness can range from about 10 to about 150 microns and in another embodiment from about 25 to about 100 microns while the fiber width could range from about 50 to about 300 microns and in another embodiment, from about 100 to about 200 microns. For further clarity, a weave could be made from warp and weft fibers having a thickness of about 37 microns and a width of about 100 microns. The resulting fabric would have intersections having a thickness (and thus the thickness of the fabric) of about 75 microns. Fabric overall thickness, whether coated, partially coated or uncoated, could be as much as 500 microns and as little as about 10 microns. In another embodiment, the overall fabric thickness is from about 10 to about 150 microns and in still another embodiment of about 10 to about 100 microns.
In one noted embodiment, the fibers or filaments can be extruded or assembled such that their diameter (diameters where the fiber is made of multiple filaments) may be varied during the extrusion process to provide this undulating profile of thicker and thinner regions. Specifically, in terms of individual filaments, their relative diameter could vary along the length of each filament from about 0.5 to about 20 microns, and in certain embodiments, from about 5 to 15 microns. In terms of a solid single fiber or fiber bundle, the diameter could be up to about 150 microns and if not substantially circular in cross section, a thickness of about 10 to about 150 microns and a width of about 50 to about 200 microns.
Alternatively, and as shown in
Another way to stabilize a woven fabric is “mechanically” to use one or more fasteners such as sutures and staples. On a micro level, individual intersections of fibers, where they crisscross at, for example, right angles (90 degrees), could be sutured together, fastened, or otherwise tied off to make their relative movement more difficult. This is illustrated in
As illustrated in
Instead of an art recognized glue or adhesive, one could also use melted synthetic materials (such as UHMWPE, polyester, etc.) applied between polymers or around an intersection, or poured into a gap as noted earlier, and allowed to cool and harden. A polymer dissolved in a solvent system could also be applied in analogous fashion followed by the removal of the solvent. Polymers could also be used and allowed to, or activated to, cross-link.
As illustrated in
Fasteners and adhesives could be used to plug the holes or gaps exiting in woven fabric or by making localized bundles of fibers rather than intersections. As shown in
Finally, energy in the form of heat, pressure, laser, high intensity light, ultrasonics, vibration, gases, radiofrequency, friction, spin welding, electrical current and the like could be used to melt or “weld” fibers together at some or all of their intersections (“energetically” stabilizing). Any known way of doing this can be used. Some illustrative techniques, however, are discussed.
In an alternative, shown in
Instead of individual intersections or gathers or groups of intersections, heat, pressure, coherent light or sonic waves or other forms of energy can be applied to a localized area as well. As shown in
In another “bulk” stabilization method, the intersections in a localized area can be stabilized by the application of one or more layers or coating. This can be done at one or more places on the leaflet, but, in particular, one or more layers or coatings could applied to one or each of the major surfaces of the fabric leaflet at and/or adjacent the free edge and/or on the free edge. As shown in
It will be appreciated that the above discussions of techniques for stabilizing a woven polymer fabric to prevent changes in conformation of a heart valve leaflet. The areas of a leaflet most in need of stabilization often are those areas that are in motion when in use to an appreciable degree. For that reason, much of this discussion focused on the area of the leaflet adjacent to its free edge. However, stabilization might also be needed in other areas of the leaflet that move including the so-called belly of the leaflet—indeed everything but the commissures and the attachment edge, and perhaps the area immediately adjacent those. Regions of the leaflet that move are believed to be most impacted by changes in their properties and in particular changes in their conformation resulting from cell growth on its surfaces. Accordingly, it is preferably these regions; regions that are in motion when in use, are preferably subject to stabilization by fixation of intersections in such areas, by using other weaves in those areas, or by use of the other techniques described herein. Generally, “stabilization” will occur in moving areas of the leaflet and not in other areas. That does not mean that, for an example, a coating or line of sutures cannot be used to reinforce the attachment edge, preventing unravelling, facilitating suturing, or influencing the folding and the like. But, that is generally not considered to be stabilization as it is not an area of the leaflet that tends to be in motion. Occluders, grafts, and other medical devices may not have leaflets. However, they may have regions that are subject to movement, as the body moves, with the passage of blood or other fluids and the like, as well as regions that are relatively immobile and/or attached to another structure. Stabilization will occur in the regions of these structures and devices that are subject to motion in use and generally not in areas that are immobile and/or attached to another structure.
All of the stabilized fabric embodiments discussed to this point have involved preventing the relative movement of crisscrossing fibers of a woven fabric to maintain their positions, relative angles, contours, and relative spacing. In an alternative embodiment, stabilization can be accomplished by using a mesh instead of using a woven fabric. But stabilized fabrics can also be produced using a mesh which is not a woven fabric. As illustrated in
The pattern of pores, their size, shape, number, and proximity to each other may be uniform across the length and width of the mesh or may be highly variable, or anywhere in between uniform and highly variable. A mesh could have no pore or divots in one area and a high overall density of pores or divots in another area. As illustrated in
As noted earlier, “pores” are channels traversing the material of the mesh and having openings in both opposed major surfaces. It will be appreciated that the three-dimensional shape of the pores need not be a right cylinder having circular openings The pores could be any shape such as a triangular cylinder, a quadrilateral cylinder, a pentagonal cylinder or a hexagonal cylinder. And the pores shape could be irregular and varied from pore to pore. The openings to the pores/divots could be as small as about a 1 micron2 across. However, the average area of the openings of each pore/divot will generally range from about 100 microns2 to about 5,000 microns2. In another embodiment, the area ranges from between about range from about 1,000 to about 3,000 microns2 In one embodiment, the mesh has a pore/divot density of about 1 to about 25% and in still another embodiment, the pore/divot density is about 5 to about 15%. In one aspect, the mesh could have pores of two or more different three-dimensional shapes, could include a variety of different shapes, areas, and volumes, and a variable pore density. Moreover, the openings at one end of a pore may differ in area from the area of the openings at the other end.
In another embodiment, instead of pores, the mesh includes divots. A divot is a pore wherein its interior volume is only accessible through a single opening in a single major surface—it is not a pore which is open on both ends. Divots may alternatively be thought of as depressions in the topography of a surface, with the term “opening” referring to the depressed area relative to the adjacent non-depressed area. The divots could have all of their openings on a single side of the mesh or some openings on one side and some the other. There could be an alternating pattern where in a row every other divot faces the opposite direction. Divots could also alternate with pores. In terms of the size, shape, and density of the divots, they may be substantially the same as just noted for the pores. It will be appreciated that for pore/divot density, where pores have different opening sizes at its different ends, or where they alternate with divots, or where divots are on different sides of the mesh, calculations may need to be adjusted. Where the size of the openings are different, they can be averaged, or density can be reported for a single side—where the density is measured using the smallest area of the openings of the pores. Where pores are interspersed with divots, the side with more openings should be used. And where divots are placed on opposite major surfaces, the density is based on either one surface.
In another embodiment, a mesh could be made that looks, in most regards, like a woven fabric. A polymer sheet can be cut or ablated in a pattern so as to form a mesh that closely resembles an otherwise woven fabric. A laser, for example, could ablate not only hole, gaps, pores or divots, but it could selectively ablate a pattern into the sheet's surface resulting in a regular pattern of “hills” and “valleys” where the hills would have the increased thickness that results from fabric fiber crisscrossing and the valleys have a thickness more like that of the fibers extending between intersection. The result can look like a woven fabric. However, it is a mesh as the intersections are not composed of two independent fibers that are stabilized by heat, adhesives, fasteners and the like—they are a solid singular mass of material.
Mesh can be used alone or with other fabrics, stabilized or not. It can be used in place of any of the woven fabrics noted herein, and in any of the surgical devices described herein. In particular it can be used for leaflets or cuffs used in collapsible and/or expandable heart valves in place of other synthetic or biologic materials. It can also used in connection with nonwoven sheets. The mesh can be coated with other material or polymer, such as drug releasing polymers as noted earlier. And a mesh can be coated or laminated as previously described for woven fabrics. It can be used in the same number of layers and have the same relative thicknesses as described herein for woven polymer fabrics as well. Indeed, any laminate or multi-layered construct previously described can have one or all of its woven fabric layers replace with a mesh. And of course an uncoated mesh can be used in place of any uncoated fabric described herein.
These techniques can be combined. A mesh as just described can also include a series of fasteners to retain a group of interconnections or that group of interconnections could be glued or welded together. Similarly, fiber could be woven through the pores of a mesh effectively mimicking increasing the weave density. Or the size, number and spacing of the pores could be altered in a localized area and this also could mimic the effect of increasing or decreasing woven density in a specific area. Returning to woven fabrics, heat could be applied to weld the intersections in a particular area and fasteners could be applied additionally in that area to gather, retain and restrain a group of welded intersections. Or this sort of area welding could be applied only to an area of a leaflet with increased weave density. These are just examples, any other such combination that achieves these objectives is contemplated.
In still a further embodiment, the medical device, or an element thereof, such as a fabric leaflet, could be constructed or attached so as to form a pleat or fold across a major surface of the leaflet. In particular, this can be accomplished by suturing a gathering of the fabric at the attachment edge and optionally by including structures, cuts or ablations on a major surface of the leaflet in order to form folding zones or pleats.
Producing coated fabrics and/or coated meshes may be accomplished by any known method. U.S. Pat. No. 2,852,811, for example, describes methods for casting thin plastic films, particularly those composed of polytetrahaloethylene. U.S. Pat. No. 4,610,918 describes the production of fluoropolymer coated textiles and U.S. Pat. No. 7,109,135 relates to a woven fabric sandwiched between PTFE layers. In some embodiments, the polymer layers may be extruded via any extrusion mechanism known to those of skill in the art and applied or laminated to fabrics using heat and pressure, such as rollers. In some embodiments, polymer layers may be bonded to fabric layers using an adhesive or adhesion promoting agent. The polymer layers may also be formed in situ by spray coating or dip coating the fabric layers, or a side thereof, with a polymer that will dry, or that can be cross-linked, to form a layer or layers. The coatings and partial coatings may also be applied by 3D printing. The coated fabric may also include intermediate materials or layers intended to improve adhesion between the polymer layers and the fabric layers.
Ablation can also be used to provide a pattern in a coated surface or to impart other surface features. Ablation could be used, for example, to taper the thickness of a leaflet, just for example, from an attachment edge to the free edge. This is accomplished by progressively ablating the coating layer(s) from one edge to the other, deeper and deeper, thus removing more and more of the coating. As another example, ablation could be used to remove a portion of the coating(s) in a selected area, such as in the portion of a leaflet that will form its belly when in use in a heart valve, to provide additional flexibility to that region. Other surface patterns may also be developed. In addition, surface roughening, such as to promote cell adhesion generally or in specific areas of the surface, may be employed.
When ablation is used, it may be preferable to use a single thicker coating layer rather than multiple layers. In other circumstances, the topmost layers that will be selectively ablated could be composed of one polymer material, with one or more under layers that are not to be removed or patterned being composed of a different polymer material. Indeed, while these processes for removing portions of a full coating have just been described in connection with forming partial coatings, they may also be used to provide patterns and/or surface features in complete coatings where no portion of the major surface of the fabric is substantially uncoated. See, for example,
The polymer layer or layers may therefore form a pattern or relief on one or both sides of a fabric layer. They may vary thickness; provide rigidity or additional cohesion to specific regions; retard fraying; reinforce shape, stretch, or friction; alter porosity; provide or encourage cell attachment or prohibit it in specific areas; enhance coaptation; and the like.
Looking at
Leaflet 2808 has a free edge 2830, an attachment edge 2825, and a plurality of tabs or flaps 2835. Generally, the leaflet is attached to the cuff and/or to the stent at or adjacent the attachment edge 2825. The tabs 2835 often form commissures at which two adjacent leaflets meet. Each tab 2835 is often attached to an adjacent tab of an adjacent leaflet and/or to the stent at, for example, a commissure attachment feature such as element 116 in
As noted, the fabric leaflet 2808 in
Similarly,
The three polymer layers 3150, 3151, and 3152 illustrated in
Partial polymer layer 3450 is shown extending fully across the entirety of the free edge 3430 of leaflet 3408 between tabs 3435. This need not be the case. Partial polymer layer 3450 may be provided adjacent free edge 3430 but not overlying tabs 3435. Further, partial polymer layer 3450 may be a discontinuous layer of two, three, or more coated portions forming in essence a dashed line adjacent free edge 3430. Still further, layer 3450 may be formed of spots or dots formed intermittently adjacent free edge 3430. Each dot or each dash may have a different thickness and/or may be composed of a different composition.
As was true for the partial layer 3450 in
Partial polymer layer 3545 is illustrated as being disposed on the upstream surface 3520 of fabric layer 3540. Fabric layer 3540 may be a woven fabric, a stabilized woven fabric or a mesh. However, it may be disposed on the downstream surface or on both the upstream and downstream surfaces to provide additional reinforcement and/or other advantages. Partial layer 3545 also is illustrated as covering the entire attachment edge and tabs of leaflet 3508. That need not be the case. It need not be provided at the tabs and/or may be provided as discontinuous dashes or spots of varying compositions, number of layers and thicknesses as previously discussed in connection partial layer 3450 in
As illustrated in
While ribs 3850 are shown applied to the downstream surface 3815 of fabric layer 3840, they could be applied to the upstream surface 3820 thereof instead of, or in addition to, their application to the downstream surface. Moreover, the entire downstream surface of the leaflet in
This concept of reinforcing ribs is further illustrated in
The leaflet 4308 in
Wire 6420 may be positioned through the fabric, the coating, through both, between the fabric and the coating or on one of the major surfaces. The fabric layer may be a woven fabric, a stabilized woven fabric or a mesh. The wire could be used to conduct energy to weld intersections and stabilize the fabric.
The uses of partial coatings or patterned full coatings to provide abrasion resistance to the free edge of leaflets, to help facilitate the attachment of the leaflets to a supporting structure by reinforcing and preventing the unraveling of attachment edges, to provide reinforcing structures, folding zones, etc., and to provide indicia, have been described mainly in terms of leaflets and, to a lesser extent, cuffs designed for use in collapsible/expandable valves. However, some of the described structures, such as grommets and indicia, may be incorporated in both coated and uncoated fabrics for use in other collapsible/expandable valves. They may all be used as well in constructing leaflets and cuffs or other structures for surgical valves—those sewn in place using open heart surgery. And they may be used in other medical devices as described herein.
One coated fabric which may be useful for some applications is composed of five layers, two polymer layers (each about 20 μm thick) laminated to one side of a woven fabric and two other polymer layers (each about 20 μm thick) laminated to the other side of the same fabric. These polymer layers may be, for example, made of Dyneema Purity® membrane 55501 available from DSM Biomedical (www.dsmbiomedical.com). Dyneema Purity® membrane 55501 is composed of UHMWPE and is said to be known for uses in the medical device industry. The properties of Dyneema Purity® membrane 55501 are specified in its Product Data Sheet from DSM Biomedical dated June 2015. Other materials, a greater or lesser number of layers, layers of variable thicknesses, and different woven fabrics may be used instead. For example, Dyneema Purity® TG dtex10 TS450 may be an example of a suitable fiber for use in producing the fabrics disclosed herein, including for cuffs and/or leaflets of a prosthetic heart valve. The properties of Dyneema Purity® TG dtex10 TS450 are specified in its Product Data Sheet from DSM Biomedical dated September 2013. That fabric may be used in uncoated form, or may include Dyneema Purity® membrane 55501 as one or more polymer coating layers.
After the desired fabric material has been created and shaped or cut, it will typically need to be connected to a supporting structure (such as a stent if the material is intended for use as a cuff and/or prosthetic leaflets). The attachment may be accomplished through any one of a number of suitable methods, including suturing, heat bonding, weaving or knitting directly to the supporting structure, gluing, wrapping, electrospinning, laminating, mechanical attachment such as hooks, hook-and-loop fasteners, being sandwiched between two supporting structures, or being bonded directly to the supporting structure, such as integrating the fabric to the supporting structure while the supporting structure is in a non-set state (e.g., a liquid) in which curing the supporting structure results in the fabric being integrated into the supporting structure.
In attaching fabric-based components to a stent and/or to another support structure of a medical device, the fabric may be attached such that the fibers are oriented in a particular direction. This consideration applies both to uncoated fabrics, as well as coated fabrics described below. Most woven fabrics are produced using fibers that are woven at right angles to each other. These fabrics may be cut and attached to the support structure such that the direction of at least one of the fibers in the weave is substantially parallel to the longitudinal axis of the support structure, and another fiber is oriented generally perpendicular to the longitudinal axis of the support structure. Alternatively, these fabrics may be mounted to the support structure such that the fibers are generally oriented on a bias, i.e., at an oblique angle, relative to the longitudinal axis of the support structure. The fabrics may, for example, be used to form an inner cuff and/or an outer cuff of a collapsible/expandable heart valve or the skirt or other fabric covering of a surgical heart valve. When used for an inner cuff or an outer cuff of a collapsible/expandable heart valve, the oblique angle may be between about 30 degrees and about 60 degrees relative to the longitudinal axis of the support structure when the heart valve is in an expanded use condition. In some embodiments, the fabric may be oriented such that the fibers are oriented at about 45 degrees relative to the longitudinal axis of the support structure when the heart valve is in an expanded use condition. (See EP 2,949,292, the disclosure of which is hereby incorporated by reference herein for its teaching of the manufacture and attachment of a woven fabric at an oblique angle relative to the longitudinal axis of a stent.)
One aspect of the disclosure is a collapsible/expandable heart valve which may be implanted through a catheter or trocar, the heart valve including a valve assembly comprising a coated or uncoated fabric as described herein, and in particular, a heart valve in which the coated or uncoated fabric is used to form the leaflets and/or cuffs shown in
In another embodiment, at least one leaflet may be made from a coated or uncoated fabric material in accordance with the disclosure. In another embodiment, some, but not all of the leaflets may be made from a coated or uncoated fabric material in accordance with the disclosure. It is also contemplated that all leaflets may be produced from a coated or uncoated fabric material in accordance with the disclosure. In one desirable embodiment, all of the leaflets may be made of the same uncoated fabric of the disclosure. In another embodiment, all of the leaflets may be made of the same coated fabric of the disclosure. The fabric used may be a non-stabilized fabric, a stabilized woven fabric or a mesh.
It is also an embodiment of this aspect of the disclosure that at least one cuff and at least one leaflet of the valve assembly may be composed of a coated or uncoated fabric of the disclosure. In one further embodiment, both the at least one cuff and the at least one leaflet of the valve assembly may be made of a coated fabric in accordance with the disclosure. In another embodiment, both the cuff and the leaflet may be made from an uncoated fabric in accordance with the present disclosure. The fabric used may be a non-stabilized fabric, a stabilized woven fabric or a mesh.
While the disclosure above provides for the use of uncoated and/or coated fabrics for prosthetic leaflets, inner cuffs, and/or outer cuffs of collapsible/expandable and surgical prosthetic cardiac valves, the concepts may be similarly or identically applied to other prosthetic valves, such as prosthetic venous valves. Prosthetic venous valves may have generally similar structures and components as those described for the prosthetic heart valves, including a stent, one or more prosthetic leaflets, and optionally inner and/or outer cuffs. If the stent is self-expandable or balloon expandable, the stent may maintain a desired position within the vasculature via a friction fit. If the stent is non-collapsible, it may be sutured or otherwise fixed at the desired position within the vasculature. The one or more prosthetic leaflets may be coupled to the stent and/or to an inner and/or outer cuff attached to the stent, for example via sutures. The prosthetic leaflets may allow blood to flow in substantially only one direction within the vasculature. The inner and/or outer cuffs may assist in enhancing sealing to help prevent blood from flowing in the retrograde direction past the prosthesis and may also aid in coupling the one or more prosthetic leaflets to the stent. The prosthetic leaflets, inner cuffs, and outer cuffs of the prosthetic venous valves may be formed of any of the materials described above for similar components of the prosthetic cardiac valves, for example including the uncoated and/or coated fabrics described herein. The fabric used may be a non-stabilized fabric, a stabilized woven fabric or a mesh.
The uncoated and/or coated fabrics described herein may have still further applications, for example with occluders, which may also be referred to as closure devices. Such occluders may be used to treat any suitable abnormality or condition, including patent foramen ovale (“PFO”), atrial septal defect (“ASD”), ventricular septal defect (“VSD”), patent ductus arteriosus (“PDA”), and left atrial appendage (“LAA”) closure. Occluders may have various different configurations depending on factors such as the type of abnormality to be occluded, the location of the target site, the condition of the patient's vasculature or cardiac anatomy, and the practitioner's preferences. The occluders described herein have a collapsed condition and an expanded condition. For example, in the embodiment shown in
As depicted in
At the same time, in the expanded condition, the first expanded volume portion 2010 of the closure device 2000 may have a diameter that is larger than the diameter of the second expanded volume portion 2020. This larger diameter is intended to abut the wall surrounding the abnormal aperture to prevent device movement further into the aperture and to assist in sealing the aperture. For example, the first expanded volume portion 2010 may be oversized so as to overlie the ostium or opening of the LAA in a position adjacent to, and in flush contact with, the wall of the atrium. The first expanded volume portion 2010 may also be flexible so as to be capable of conforming to the curvature of the wall of the atrium in LAA applications or other cardiac or vascular structures in other applications. Although one configuration of the first and second expanded volume portions 2010, 2020 is described above and shown in the figures, various other configurations and sizes may be used depending on the particular application or condition to be treated. For example, one or both expanded volume portions 2010, 2020 may be thin disks or disks having a convex distal end, or the device may include a smaller diameter cylindrical portion between two larger diameter disks. Moreover, the depth or thickness of the first and/or second expanded volume portions may depend on the thickness and number of layers used to make the closure device 2000.
The first expanded volume portion 2010, the second expanded volume portion 2020, and the axial portion 2030 may each be formed of a shape-memory alloy, such as braided nitinol, to facilitate collapsing the closure device 2000 for minimally invasive delivery, and to facilitate expansion to a pre-set shape upon delivery of the closure device 2000 to the intended location. A first coupling 2015 may be disposed adjacent the first expanded volume portion 2010 and may enable connection of a delivery device or other device to closure device 2000. For example, first coupling 2015 may include internal or external threads that mate with corresponding threads of another device. A second coupling 2025, similar to the first coupling 2015, may be disposed adjacent to or within the second expanded volume portion 2020. Second coupling 2025 may also include internal or external threads for connection to corresponding threads of another device. It should be understood that other coupling mechanisms, such as press-fit or snap-fit arrangements, may be utilized in first and second couplings 2015, 2025. Additional details of closure device 2000 and similar devices are described in U.S. Pat. No. 8,758,389, the disclosure of which is hereby incorporated by reference herein.
The uncoated and/or coated fabrics described herein may also be used to form the entirety, or portions, of various types of prosthetic vascular conduits. The fabric used may be a non-stabilized fabric, a stabilized woven fabric or a mesh. For example, a prosthetic aortic graft may be implanted into the aorta to treat a weakened portion of the aorta resulting from a thoracic aneurysm. Prosthetic vascular conduits may be used to perform a bypass to reroute the path of blood flow, for example as a lower extremity bypass, a cardiac bypass in conjunction with open heart surgery, or to serve as an access point to the circulatory system, such as for hemodialysis. Prosthetic vascular conduits may also be used as arteriovenous (“AV”) shunts. AV fistulas are abnormal connections between an artery and vein, although they may be surgically created in order to assist with hemodialysis treatment. When an AV fistula is surgically created, an AV shunt formed from the uncoated and/or coated fabrics described herein may be implanted to provide the desired connection between the artery and vein. Prosthetic vascular conduits are typically cylindrical in shape and have been formed of PTFE or Dacron. However, prosthetic vascular grafts may instead be formed of the uncoated and/or coated fabrics described herein.
In addition to the above uses, the fabrics described herein may have additional uses. For example, hernias occur when there is an opening or a weakness in the muscle and/or connective tissue through which organs begin to push. Hernias are frequently treated with a fabric mesh that provides closure and support of the weakness and/or opening that forms the hernia. The mesh acts to patch the hernia, and is frequently formed of a plastic material. Such patches may instead be formed of the uncoated or coated fabrics disclosed herein, whether the patches are continuous or formed as a mesh. And while hernia repair is one exemplary use of patches formed of the uncoated or coated fabrics disclosed herein, such patches may be used in any other suitable procedure, including skin patches, vaginal patches, and/or cardiac patches to provide the desired support to the underlying anatomy. The fabric used may be a non-stabilized fabric, a stabilized woven fabric or a mesh.
In some embodiments, the fabrics described herein may be used to form adhesion barriers. Adhesion barriers are medical implants that may be used to reduce abnormal internal scarring following surgery. The uncoated or coated fabrics of the adhesion barriers may act to separate internal tissues and/or organs while they heal post-surgery. The fabric used may be a nonstabilized fabric, a stabilized woven fabric or a mesh.
While the above-described embodiments of devices that incorporate the uncoated or coated fabrics described herein are generally directed to devices intended to be permanently implanted into the body, the fabrics may be used for various types of medical devices that are used in medical procedures, but not intended to be implanted at all, or not intended to be implanted for longer than the surgical procedure. One such example is an embolic protection device. Generally, an embolic protection device may be used to prevent emboli that are dislodged during a medical procedure from entering the vasculature. Typically, embolic protection devices either capture dislodged emboli so that the emboli can be removed from the body, or otherwise deflect emboli from entering high-risk vasculature (such as the carotid arteries) so that the emboli are able to pass through the vasculature where there may be a lower risk of complications from the emboli. Embolic protection devices may include various types of filters that allow blood to pass through the filter, but are formed as meshes or with pore sizes small enough to trap emboli therein, or otherwise to deflect emboli. Such embolic protection devices may be formed of the fabrics described herein. Examples of embolic protection devices are disclosed in greater detail in U.S. Patent Pub. Nos. 2014/0249567 and 2018/0116780, the disclosures of which are hereby incorporated by reference herein. While the fabrics described herein may be used with short-term filters such as those described immediately above, they may also be used in permanently implanted filters, such as inferior vena cava (“IVC”) filters, whether or not the IVC filter is intended to be retrievable. IVC filters typically have a central base and a plurality of legs that extend outwardly from the base to form an overall conical shape, with the legs intended to make contact with the interior surface of the lumen of the IVC to help support the IVC filter in place. The IVC filter functions by allowing blood to flow around the filter, while trapping emboli that pass into the filter, preventing the emboli from causing blockages in the vasculature downstream of the IVC filter. The IVC filters may be formed of a metal or other biocompatible material and the uncoated and coated fabrics described herein may encapsulate portions or all of the IVC filter, or in other embodiments the IVC filter may be formed entirely of the coated fabrics described herein. It should be understood that for IVC filters, or any other application disclosed herein, specific parameters of the disclosed fabrics, such as dimensions, as well as fabrication methods, may be altered to suit the particular application. The fabric used may be a non-stabilized fabric, a stabilized woven fabric or a mesh.
Various medical devices, including collapsible and expandable prosthetic heart valves, have been described above which may incorporate the fabrics described herein. The fabric used may be a non-stabilized fabric, a stabilized woven fabric or a mesh. Although the prosthetic collapsible and expandable heart valves have generally been described in connection with a prosthetic aortic valve, those heart valves may be designed for replacing any heart valve. For example, collapsible and expandable prosthetic mitral valves may include an outer stent portion to anchor into the mitral valve annulus, and an inner stent portion to house the prosthetic leaflets, with the inner stent connected to the outer stent, for example so that the inner stent is substantially mechanically isolated from the outer stent. In such embodiments, the outer stent portion may include features to help secure the prosthetic mitral valve within the mitral valve annulus, and the inner stent portion may be substantially cylindrical (e.g. a right cylinder) so that the valve assembly may have a generally circular profile in cross section. The fabrics described herein may be used for prosthetic leaflets of the prosthetic mitral valve and/or for any cuffs or skirts on the prosthetic mitral valve, which may include inner cuffs and/or outer cuffs of the inner stent portion and the outer stent portion, as well as any other cuff or skirt portions, such as cuff portions that connect the inner stent portion to the outer stent portion. Prosthetic mitral valves having inner and outer stent portions are described in greater detail, for example, in U.S. Patent Publication Nos. 2017/0196688 and 2019/0328525, and U.S. Pat. No. 10,052,204, the disclosures of which are hereby incorporated by reference herein.
According to an aspect of the disclosure, a prosthetic heart valve comprises:
an expandable stent extending in a longitudinal direction between an inflow end and an outflow end;
a cuff coupled to a luminal surface of the stent; and
a plurality of prosthetic leaflets coupled to at least one of the cuff and the stent and having an open condition and a closed condition, the plurality of prosthetic leaflets adapted to allow blood to flow from the inflow end toward the outflow end when in the open condition and to retard blood from flowing from the outflow end toward the inflow end when in the closed condition, each of the plurality of leaflets being formed of a stabilized fabric;
wherein the stabilized fabric is a mesh of ultra-high molecular weight polyethylene (UHMWPE) , PTFE or PP with pores or divots with openings with an area of from about 100 microns2 to about 5,000 microns2 and in a further embodiment, from about 1,000 to about 3,000 microns2 and a pore density/divot density of about 1 to about 25% and in still another embodiment, about 5 to about 15%. It the stabilized fabric is a woven fabric, it has a first group of fibers extending in a first direction of the fabric and a second group of fibers extending in a second direction of the fabric different than the first direction, the first group of fibers and the second group of fibers being interlaced in an ordered arrangement and defining intersections and gaps, the first group of fibers and the second group of fibers both being composed of UHMWPE , PTFE or PP, at least one layer of the fabric having a thread count of between about 300 and about 500 fibers by between about 100 and about 300 fibers per square inch, the fabric having a thickness of between about 50 μm and about 100 μm; and/or
each of the plurality of prosthetic leaflets includes a free edge adapted to move as the plurality of prosthetic leaflets transitions between the open condition and the closed condition, and an attachment edge directly attached to at least one of the cuff and the stent; and/or
when each of the plurality of leaflets is in a flattened condition, the first group of fibers extend in the first direction at an angle of between about 30 degrees and about 60 degrees relative to a line that extends perpendicular to the free edge; and/or
the stabilized fabric is not coated by a polymer coating; and/or
the stabilized fabric is at least partially coated with a first polymer coating; and/or
the stabilized fabric has a tensile strength of between about 50 N and about 100 N before coating; and/or
the stabilized fabric having an areal density of between about 0.5 ounces/yard2 and about 1.0 ounces/yard2; and/or
the stabilized fabric having an areal density of greater than about 1.3 ounces/yard2; and/or
each of the plurality of prosthetic leaflets includes a free edge adapted to move as the plurality of prosthetic leaflets transitions between the open condition and the closed condition, and an attachment edge directly attached to at least one of the cuff and the stent; and/or
a polymer coating wherein the polymer coating is disposed on the first major surface adjacent the attachment edge or on the second major surface adjacent the attachment edge; and/or
the attachment edge is directly attached to the at least one of the cuff and the stent via one or more sutures extending through a polymer coating; and/or
at least some portions of the first major surface are not coated by the polymer coating, and at least some portions of the second major surface are not coated by the polymer coating; and/or
the polymer coating is disposed adjacent the attachment edge on the second major surface, at least some other portions of the second major surface remaining uncoated by the polymer coating, and the polymer coating is disposed adjacent the free edge on the first major surface, at least some other portions of the first major surface remaining uncoated by the polymer coating; and/or
portions of the first major surface adjacent the free edge are coated by the polymer coating, at least some other portions of the first major surface remaining uncoated by the polymer coating, and portions of the second major surface adjacent the free edge are not coated by the polymer coating; and/or
the second major surface is entirely uncoated by the polymer coating; and/or
portions of the second major surface adjacent the free edge are coated by the polymer coating, at least some other portions of the second major surface remaining uncoated by the polymer coating, and portions of the first major surface adjacent the free edge are not coated by the polymer coating; and/or
the polymer coating is disposed adjacent the free edge on the second major surface, at least some other portions of the second major surface remaining uncoated by the polymer coating, and the polymer coating is disposed adjacent the free edge on the first major surface, at least some other portions of the first major surface remaining uncoated by the polymer coating; and/or
the polymer coating is disposed in a plurality of strips on the second major surface so that portions of the second major surface between adjacent ones of the plurality of strips are uncoated by the polymer coating, each of the plurality of strips extending in a direction from the attachment edge toward the free edge.
According to another aspect of the disclosure, a prosthetic heart valve comprises:
an expandable stent having a luminal surface; and
a valve assembly attached to the luminal surface of the stent, the valve assembly including a cuff and a leaflet, the leaflet having a first major surface, an opposed second major surface, an attachment edge, a free edge, and a plurality of tabs, the leaflet composed of an uncoated stabilized woven fabric composed of a polymer, the woven fabric having a thread count of 300-500×100-300 fibers per square inch, an areal density of between 0.5 and 1.0 ounces/yd2, a thickness of between about 20 and about 250 μm, and a tensile strength of between about 50 N and about 100 N; and/or
a valve assembly attached to the luminal surface of the stent, the valve assembly including a cuff and a leaflet, the leaflet having a first major surface, an opposed second major surface, an attachment edge, a free edge, and a plurality of tabs, the leaflet composed of an uncoated polymer mesh with pores or divots with openings with an area of from about 100 microns2 to about 5,000 microns2 and in a further embodiment, from about 1,000 to about 3,000 microns2 and a pore density/divot density of about 1 to about 25% and in still another embodiment, a pore density/divot density of about 5 to about 15%; and/or
the polymer is polytetrafluoroethylene (“PTFE”); and/or
the polymer is low density PTFE, high density PTFE, or ultra-high molecular weight PTFE (“UHMWPTFE”); and/or
the polymer is stretched PTFE or expanded PTFE; and/or
the polymer is polyethylene (“PE”); and/or
the polymer is low density PE, high density PE, or ultra-high molecular weight PE (“UHMWPE”); and/or
the polymer is polypropylene (“PP”); and/or
the polymer is low density PP, high density PP, or ultra-high molecular weight PP (“UHMWPP”); and/or
the polymer is a copolymer or block polymer of PE and PP; and/or
the polymer is a polyurethane, an acrylic, a polyester, a polyamide, a polyimide, a vinyl acetate, an alkyd, an epoxy, a silane, or a siloxane; and/or
the stabilized woven fabric has an areal density of about 0.5 ounces/yd2; and/or
the stabilized woven fabric has an areal density of about 0.8 ounces/yd2; and/or
the stabilized woven fabric has an areal density of about 1.0 ounces/yd2; and/or
the stabilized woven fabric has an areal density of greater than about 1.0 ounces/yd2; and/or
the stabilized woven fabric has an areal density of greater than about 1.3 ounces/yd2; and/orthe woven fabric has a thickness of between about 50 and about 100 μm; and/or
the woven fabric has a thickness of between about 75 μm; and/orthe woven fabric has a tensile strength of about 75N; and/or
the woven fabric has a thread count of 440×220 fibers per square inch; and/or
at least one grommet is disposed in the attachment edge or in one of the plurality of tabs.
According to a further aspect of the disclosure; a prosthetic heart valve comprises:
an expandable stent having a luminal surface; and
a valve assembly attached to the luminal surface of the stent, the valve assembly including a cuff and a leaflet, the leaflet having a first major surface, an opposed second major surface, an attachment edge, a free edge, and a plurality of tabs, both the cuff and the leaflet composed of a woven fabric composed of a first polymer, the leaflet further comprising a coating composed of a second polymer disposed on at least one of the first major surface and the second major surface; and/or
the woven fabric has an areal density of between 0.5 and 1.0 ounces/yd2; and/or
the woven fabric has an areal density of about 0.5 ounces/yd2; and/or
the woven fabric has an areal density of about 0.8 ounces/yd2; and/or
the woven fabric has an areal density of about 1.0 ounces/yd2; and/or
the woven fabric, including the coating, has a thickness of between about 20 and about 250 μm; and/or
the woven fabric, including the coating, has a thickness of between about 50 and about 100 μm; and/or
the woven fabric, including the coating, has a thickness of between about 75 μm; and/or
the woven fabric has a tensile strength of between about 50 N and about 100 N; and/or
the woven fabric has a tensile strength of about 75 N; and/or
the woven fabric has a thread count of 300-500×100-300 fibers per square inch; and/or
the woven fabric has a thread count of 440×220 fibers per square inch; and/or
the first polymer is polytetrafluoroethylene (“PTFE”); and/or
the first polymer is low density PTFE, high density PTFE, or ultra-high molecular weight PTFE (“UHMWPTFE”); and/or
the first polymer is stretched PTFE or expanded PTFE; and/or
the first polymer is polyethylene (“PE”); and/or
the first polymer is low density PE, high density PE, or ultra-high molecular weight PE (“UHMWPE”); and/or
the first polymer is polypropylene (“PP”); and/or
the first polymer is low density PP, high density PP, or ultra-high molecular weight PP (“UHMWPP”); and/or
the first polymer is a copolymer or block polymer of PE and PP; and/or
the first polymer is a polyurethane, an acrylic, a polyester, a polyamide, a polyimide, a vinyl acetate, an alkyd, an epoxy, a silane, or a siloxane; and/or
the second polymer is polytetrafluoroethylene (“PTFE”); and/or
the second polymer is low density PTFE, high density PTFE, or ultra-high molecular weight PTFE (“UHMWPTFE”); and/or
the second polymer is stretched PTFE or expanded PTFE; and/or
the second polymer is polyethylene (“PE”); and/or
the second polymer is low density PE, high density PE, or ultra-high molecular weight PE (“UHMWPE”); and/or
the second polymer is polypropylene (“PP”); and/or
the second polymer is low density PP, high density PP, or ultra-high molecular weight PP (“UHMWPP”); and/or
the second polymer is a copolymer or block polymer of PE and PP; and/or
the second polymer is a polyurethane, an acrylic, a polyester, a polyamide, a polyimide, a vinyl acetate, an alkyd, an epoxy, a silane, or a siloxane; and/or the coating is composed of between 1 and 20 coating layers having a total coating thickness of between about 5 μm and about 50 μm; and/or
at least one grommet is disposed in the attachment edge or in one of the plurality of tabs; and/or the stabilized fabric further comprises at least one partial coating adjacent the free edge of each leaflet and/or the if the fabric is a woven fabric it is stabilized by a fastener, an adhesive or a weld applied to at least one intersection of a warp and weft fiber
And in yet another embodiment of the disclosure, there is provided a replacement heart valve as described above in the foregoing paragraphs which is specifically designed to replace or repair a native aortic, native pulmonary, native tricuspid, or native mitral valve, the replacement heart valve being made using a stabilized fabric which is either a mesh or a stabilized woven fabric stabilized by: a fastener to fasten at least one fiber intersection; an adhesive to glue at least one fiber intersection; weld created by the application of energy to at least one intersection; an increased localized weave density; having an areal density of greater than about 1.0 ounces/yard2 and in another embodiment, more than 1.3 ounces/yard2; fibers with a non-uniform cross-section along their length; at least one partial coating; a fastener to fasten adjacent or parallel fibers other than at an intersection; and/or an adhesive gluing adjacent or parallel fibers other than at an intersection.
Methods of making these heart valves include forming a mesh into at least one leaflet or a cuff and creating a valve assembly from the leaflet or cuff produced from that mesh. These methods could also include producing a at least one leaflet or cuff from a stabilized woven fabric stabilized by: a fastener to fasten at least one fiber intersection; an adhesive to glue at least one fiber intersection; weld created by the application of energy to at least one intersection; an increased localized weave density; having an areal density of greater than about 1.0 ounces/yard2 and in another embodiment, more than 1.3 ounces/yard2; fibers with a non-uniform cross-section along their length; at least one partial coating; a fastener to fasten adjacent or parallel fibers other than at an intersection; and/or an adhesive gluing adjacent or parallel fibers other than at an intersection, and creating a valve assembly from the leaflet or cuff produced from that stabilized fabric. In one embodiment of such a prosthetic mitral valve, the prosthetic mitral valve comprises a self-expandable or balloon-expandable stent that includes a first inner stent portion having a generally cylindrical shape and a second outer stent portion attached to the first inner stent portion. The second outer stent portion is disposed generally surrounding the first inner stent portion. When implanted into a native mitral valve annulus, the second outer stent portion engages the native valve annulus and at least partially mechanically isolates the first inner stent portion from being deformed by the anatomy of the native valve annulus or calcification of the native valve. Thus, the first inner stent portion retains its generally cylindrical shape. Moreover, the prosthetic mitral valve includes a valve assembly that is substantially only attached to the first inner stent portion. The valve assembly comprises at least one cuff attached to a surface of the stent and two or three prosthetic leaflets attached to the cuff and/or the luminal surface of the first inner stent portion. The cuff(s) and/or prosthetic leaflets are composed of a coated or uncoated woven polymer fabric itself composed of one or more layers of ultra-high molecular weight polyethylene or polytetrafluoroethylene. At least one layer of the woven polymer fabric exhibits one of the following properties: an ultimate tensile strength of from about 25 to about 250 MPa; a tear strength of from about 10 to about 40 lbF; a permeability of from about 10 to about 1,200 mL/cm2/min; a suture retention of from about 30 to about 70 N; a stiffness/flexural rigidity of from about 0.001 to about 4 cm; or a stretch of from about 3 to about 50%. The prosthetic leaflets have a thickness of from about 50 μm to about 350 μm and the cuff has a thickness of from about 5 μm to about 200 μm. And in some additional aspects of this embodiment, the at least one of the prosthetic leaflets or the cuff further comprises a wire, stitch, a suture line or grommet. In the case of a stitch or a suture line, they are not provided to substantially attach the cuff or prosthetic leaflet to another structure of the replacement heart valve.
In yet another set of embodiments, the disclosure encompasses a stabilized replacement heart valve comprising: a transapical or trans-catheter valve which includes a self-expandable, balloon-expandable stent, or a surgical valve that includes a frame. A valve assembly is attached to the stent or frame. The valve assembly includes a cuff and 2 to 4 leaflets. The leaflets are made of a stabilized fabric as recited herein. In some aspects of this set of embodiments, the leaflets are composed of a woven polymer fabric having a thickness of between about 5 μm and about 500 μm and having a plurality of warp and weft fibers that meet at and define intersections. As shown in
In some instances the leaflets of the stabilized replacement heart valve include within their movement areas a sufficient number of intersections in movement area that are mechanically fastened, chemically fastened or energetically fastened so as to render the movement area of the leaflets resistant to changes in conformation caused by tissue growth onto or into the leaflets. Often, this can be established by measuring the distance between a first fastened intersection within the subset and a second parallel intersection fastened intersection within the subset spaced apart from the first fastened intersection (a total of 10 intersections including the first and second intersections) in either the warp or weft direction (See 8635 and 8625 respectively in
In some of the embodiments of this set of embodiments, the stabilized intersections are created by a plurality of welds which are produced by the application of heat, pressure, a laser, high intensity light, ultrasonics, vibration, a gas, a plasma, radiofrequency, friction, spin welding or electrical current. The woven fabric used for these leaflets can have any of the following properties before stabilization: (i) an ultimate tensile strength between 25 MPa and 250 MPa; (ii) a tear strength of between 10 lbF and 40 lbF; (iii) a permeability of between 10 mL/cm2/min- and 1,200 mL/cm2/min; (iv) a suture retention of between 30 N and 70 N; (v) a stiffness/flexural rigidity of between 0.001 cm and 4 cm; and (vi) a stretch of between 3% and 50%. The woven fabric may have at least one of: an areal density of between 0.5 and 1.3 ounces/yard2 or a thread count of about 300-500×100-300 fibers per square inch before and after stabilization, and in some of this set of embodiments, an areal density of at least 0.65±0.1 ounces/yard2 and at most about 1.0±0.1 ounces/yard2 and a thread count of about 400-500×200-300 fibers per square inch. In still further aspects of these embodiments, the woven fabric leaflets have an areal density of at least 0.65±0.1 ounces/yard2 and at most about 1.0±0.1 ounces/yard2 and a thread count of about 400-500×200-300 fibers per square inch. In some additional embodiments of this set of embodiments, the woven fabric leaflets have a maximum thickness of approximately 100 μm.
The cuff and leaflets of the stabilized replacement heart valves discussed herein and specifically the warp and weft fibers can be made from, inter alia, polyolefins, halogenated polyolefins, polyurethanes, PEEK, polyvinyl alcohols, silicones, rayons, polyesters, aramids, spandex, or combinations, blends and copolymers thereof. In particular, the warp and weft fibers are composed of polyolefins or halogenated polyolefins selected from the group consisting of a polyethylene, a polypropylene and a polytetrafluoroethylene as well as combinations, blends and copolymers thereof and in particular can be selected from the group consisting of ultra-high molecular weight polyethylene, ultra-high molecular weight polypropylene or expanded polytetrafluoroethylene as well as combinations, blends and copolymers thereof.
In another of this set of embodiments, the disclosure relates to a method of stabilizing a replacement heart valve comprising the steps of: (a) providing leaflets composed of a woven polymer fabric having a thickness of between about 5 μm and about 500 μm, having at least one of an areal density of between 0.5 and 1.3 ounces/yard2 or a thread count of about 300-500×100-300 fibers per square inch, and having a plurality of warp and weft fibers that meet at and define intersections, the leaflets having a free edge, an attachment end and a movement area subject to movement during operation, the movement area including the free edge and intermediate portions of the leaflet between the free edge and the attachment end; (b) energetically welding a subset of at least about 50% of the intersections within the movement area by applying heat, pressure, laser light, high intensity light, ultrasonics, vibration, a gas, a plasma, radiofrequency, friction, spin welding or electrical current thereto to form a plurality of welded intersections; and (c) attaching the leaflets to a support so as to form a replacement heart valve. In some cases, the stabilized replacement heart valve will include leaflets wherein the subset comprises at least about 75% of the intersections in the movement area and in other instances, at least about 90% of the intersections in the movement area.
Similar methods are contemplated for making a stabilizing a replacement heart valve using a mesh as discussed below comprising the steps of: (a) providing leaflets composed of a polymer mesh having a thickness of between about 1 μm and about 500 μm, containing a plurality of pores or divots having openings with an average area ranging from about 100 microns2 to about 5,000 microns2 and having a pore density or divot density of about 1 to about 25%, the mesh comprising a matrix of struts that meet at and define junctions, the leaflets having a free edge, an attachment end and a movement area subject to movement during operation, the movement area including the free edge and intermediate portions of the leaflet between the free edge and the attachment end and (b) attaching the leaflets to a self-expandable or balloon-expandable stents or a frame so as to form a replacement heart valve.
In still others of this set of embodiments, the stabilized replacement heart valve has leaflets composed of a woven polymer fabric having a thickness of between about 5 μm and about 500 μm and having a plurality of warp and weft fibers that meet at and define intersections. The leaflets also has a free edge, an attachment end and a movement area subject to movement during operation with the movement area including the free edge and intermediate portions of the leaflet between the free edge and the attachment end. These leaflets are stabilized by using fibers of: a undulating or variable diameter or thickness/width; a uniform diameter or width/thickness; an increased localized weave density which is up to about 50% greater than that of other portions of the leaflet and in some further embodiments, between about 20-40% greater than that of other portions of the leaflet.; an areal density of greater than 1.3 ounces/yard2; or a weave selected from Plain weave, Rib weave, Basket weave, Twill Weave, Herringbone weave, Satin weave, Sateen weave, Leno weave, Oxford Weave, Bedford cord weave, Waffle weave, Pile weave, Jacquard weave, Dobby weave, Crepe weave, Lappet weave, Tapestry Weave, Striped weaves, Checquered weaves, or Double cloth weave.
In some further embodiments of this set of embodiments, the stabilized replacement heart valves described herein contemplate a self-expandable, balloon-expandable stent or frame; and a valve assembly attached to the stent or frame. The valve assembly comprising a cuff and 2 to 4 leaflets and the leaflets are composed of a polymer mesh having a thickness of between about 1 μm and about 500 μm. The mesh is made from a matrix of struts that meet at and define junctions and the struts and junctions together define a plurality of pores or divots. The pores or divots each have at least one opening and the openings have an average area ranging from about 100 microns2 to about 5,000 microns2 and have a pore density or divot density of about 1 to about 25%. The leaflets have a free edge, an attachment end and a movement area subject to movement during operation, the movement area including the free edge and intermediate portions of the leaflet between the free edge and the attachment end. The stabilized replacement heart valve produced using a mesh can be resistant to a change in conformation caused by tissue growth on and into the mesh which can be determined by a change in the distance between a first strut or junction and a second strut or junction spaced apart from and parallel to the first strut before and after implantation using the same model, timing and procedure described previously for fastened woven fabrics. If the decrease is less than 10% and more preferably about 5% or less, than the mesh can be considered resistant to a change in conformation caused by tissue growth on and into the mesh. In some other instances, the mesh has a maximum thickness of approximately 150 μm and in other instances from about 5 to about 100 microns. The polymers that can be used are the same as previously described in the context of a stabilized woven fabric noted above. In particular, the mesh can be composed of a polyolefin selected from the group consisting of ultra-high molecular weight polyethylene, ultra-high molecular weight polypropylene or expanded polytetrafluoroethylene as well as combinations, blends and copolymers thereof, and the mesh contains a plurality of pores or divots having openings with an average area ranging from about 1,000 microns2 to about 3,000 microns2 and having a pore density or divot density of about 1 to about 15%.
The stabilized replacement heart valve described above can be designed for replacing and repairing a native aortic valve, a native mitral valve, a native pulmonary valve, or a native tricuspid valve. In one particular embodiment of this set of embodiments, the stabilized replacement heart valve is a mitral valve and is constructed from a self-expandable or balloon-expandable stents including a first inner stent portion having a generally cylindrical shape and a second outer stent portion generally surrounding the first inner stent portion, the second outer stent portion attached to the first inner stent portion so that when the stabilized replacement heart valve is implanted into a native mitral valve annulus, the second outer stent portion engages the native mitral valve annulus and at least partially mechanically isolates the first inner stent portion from being deformed by the anatomy of the native mitral valve annulus or calcification of the native mitral valve such that the first inner stent portion retains its generally cylindrical shape, the valve assembly being substantially only attached to the first inner stent portion. The leaflets are composed of the stabilized fabrics, either the stabilized woven fabric or the mesh, described above.
To this point, leaflets have been described. But all of the materials described in the preceding paragraphs can instead, or in addition, be used to produce a cuff disposed on a luminal surface of the stent, an abluminal surface of the stent, or both. In particular, the cuff can be composed of a woven polymer fabric having a thickness of between about 5 μm and about 500 μm and having a plurality of warp and weft fibers that meet at and define intersections a subset of which may be mechanically fastened, chemically fastened or energetically fastened and thereby stabilized. In certain of this set of embodiments, the cuff's subsets of intersections are energetically fastened by a plurality of welds. And in some other embodiments of this set, the cuff is on the abluminal surface and it includes one or more structures to reduce paravalvular leaks around the abluminal surface of the stent.
Although the present disclosure has been made with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the principles and applications of the present disclosure. It is therefore to be understood that numerous modifications may be made to the illustrative embodiments and that other arrangements may be devised without departing from the spirit and scope of the present disclosure as defined by the appended claims. For example, features of one embodiment described above may be combined with features of other embodiments described above.
The present application is a divisional application of U.S. application Ser. No. 17/038,832, filed Sep. 30, 2020, which is a continuation-in-part of U.S. patent application Ser. No. 16/899,205, filed Jun. 11, 2020, which is continuation-in-part of U.S. patent application Ser. No. 16/713,356, filed Dec. 13, 2019, which claims the benefit of the filing dates of U.S. Provisional Patent Application Nos. 62/779,176, filed Dec. 13, 2018; 62/925,379, filed Oct. 24, 2019; 62/925,391, filed Oct. 24, 2019; 62/925,402, filed Oct. 24, 2019; and 62/925,412, filed Oct. 24, 2019, the disclosures of all of which are hereby incorporated by reference herein. U.S. application Ser. No. 17/038,832 is also a continuation-in-part of U.S. patent application Ser. No. 16/899,084, filed Jun. 11, 2020, which claims the benefit of the filing dates of U.S. Provisional Patent Application Nos. 62/925,410, filed Oct. 24, 2019; and 62/925,418, filed Oct. 24, 2019, the disclosures of all of which are hereby incorporated by reference herein.
| Number | Date | Country | |
|---|---|---|---|
| 62925402 | Oct 2019 | US | |
| 62925379 | Oct 2019 | US | |
| 62925391 | Oct 2019 | US | |
| 62925412 | Oct 2019 | US | |
| 62779176 | Dec 2018 | US | |
| 62925418 | Oct 2019 | US | |
| 62925410 | Oct 2019 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 17038832 | Sep 2020 | US |
| Child | 17937723 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 16899205 | Jun 2020 | US |
| Child | 17038832 | US | |
| Parent | 16713356 | Dec 2019 | US |
| Child | 16899205 | US | |
| Parent | 16899084 | Jun 2020 | US |
| Child | 17038832 | US |
