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Transcatheter aortic valve replacement has become today a largely considered alternative technique to surgical valve replacement in patients with high risk for open chest surgery. Biological valve tissue used in the transcatheter devices has shown success over 5 years now, but the procedure remains expensive. Moreover, different studies point out potential degradations that the tissue can undergo when folded to lower diameter and released in calcified environment with irregular geometry, which may jeopardize the durability of the device. The use of synthetic materials, like textile in particular, to replace biological valve leaflets would help reducing the procedure costs, and limit the degradations when the valve is crimped. Textile polyester material has been extensively used in the vascular surgery and is characterized by outstanding folding and strength properties combined with proven biocompatibility. However, the friction effects that occur between filaments and between yarns within a fabric under flexure loading could be critical for the resistance of the material on the long term. The purpose of this study was to assess the early fatigue performances of textile valve prototypes under accelerated cyclic loading up to 200 Mio cycles. Durability tests show that the fibrous material undergoes rearrangements between fibrous elements within the textile construction and the mechanical properties are modified on the long term. But testing is not complete with 200 Mio cycles. The material should be tested up to a higher number of cycles in future work to test the effective long-term durability. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 986-992, 2016.

Transcatheter aortic valve implantation (TAVI) has become a popular alternative technique to surgical valve replacement. However, the biological valve tissue used in these devices appears to be fragile material in the long term particularly due being folded for low diameter catheter insertion purposes and when released in a calcified environment with irregular geometry. Textile polyester material is characterized by outstanding folding and strength properties combined with proven biocompatibility. It could therefore be considered as a replacement for biological valve leaflets in the TAVI procedure. The folding process associated with crimping, however, may degrade the filaments involved in the fibrous assembly and limit the durability of the device. The purpose of the present work is to study the effect of different crimping conditions on the mechanical performances of textile valve prototypes made from various fabric constructions. Results show that crimping generates some creases in the fabrics, which surface topography varies with fabric construction and crimping configuration. The mechanical properties of the crimped materials are globally slightly reduced. To determine how critical the modifications due to crimping are for prosthesis durability, more detailed long term in vitro and in vivo trials with crimped textile prototypes are needed in addition to this preliminary work.

It was previously showed that PLLA nanofiber mesh promoted good endothelial cell proliferation. A new technique was developed to produce nanofibers by air jet spinning inside the tubular shape of vascular prostheses and to characterize this nanofiber mesh. Polymer macromolecule stability was assessed by gel permeation chromatography. Thermal analyses were conducted with differential scanning calorimetry and dynamic mechanical analysis on PLLA nanofibers obtained with 4% and 7% solutions (w/v) in chloroform. Polyethylene terephthalate (PET) was also treated with atmospheric pressure dielectric barrier discharge under air or nitrogen atmosphere to optimize PLLA nanofiber adherence, assessed by peel tests. Air spinning induced a reduction of number-average molecular weight (Mn) for the 7% PLLA solution but not for the 4% solution. The nanofibers were more crystalline and less sensible to viscoelastic relaxation as a function of aging in the 4% solution than in the 7% solution. Discharge treatment of the PET promoted identical surface modification on PET film and PET textile surfaces. Moreover, the best PLLA nanofibers adhesion results were obtained under nitrogen atmosphere. This study demonstrates that it is possible to coat the internal side of tubular vascular prostheses with PLLA nanofibers, and provides a better understanding of the air spinning process as well as optimizing nanofibers adhesion. © 2010 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2010

The rapid developments and success in percutaneous vascular surgery over the last two decades with the now common stent grafts implantation, make the noninvasive surgery technique today attractive even for heart valve replacement. Less traumatic for the patient and also less time consuming, percutaneous heart valve replacement is however at its beginning and restricted to end of life patients. The noninvasive procedure expects from the heart valve prosthesis material to be resistant and adapted to folding requirements of the implantation process (catheter). Polyester fabric could be a suited material for heart valve implanted percutaneously. Highly flexible and resistant, polyester fabric proved to be well adapted to the dynamic behavior of a valve and polyester (Dacron) is also widely used for vascular grafts implantation and shows good biocompatibility and durability. However, today there's no data available on long-term durability of fabric used as heart valve material. The purpose of this work is to study the long term behavior of a microdenier polyester fabric construction under combined in vitro flexure and tension fatigue stress. In the novel in vitro testing technique presented, a fabric specimen was subjected to combined flexural and tensile fatigue generated by fluid flow under physiological pressure conditions. The results obtained show how flexural properties change with fatigue time, which reflects directly on the suitability of a fabric in such devices. It was also observed that these fabric structural changes directly influence the in vitro behavior of the textile heart valve prosthesis.

This article attempts to develop and prove a technique to determine the degradation of polyethylene terephthalate (PET) for vascular prostheses. The implicit goal is to be able to quantify the amount of degradation to study the effect of in vivo aging. Nuclear magnetic resonance spectroscopy (1H-NMR) provides a comprehensive view of chemical macromolecular structures. Examination of a series of PET vascular prostheses showed significant chemical differences between the virgin prostheses and the explants collected after aging, especially for diethylene glycol and cyclic oligomers groups. Aging was investigated in terms of chemical scission of ester and ether linkages caused by hydrolytic reaction during the in vivo stay. Besides, we extended this 1H-NMR technique to determine hydroxyl end-group concentrations and therefore the average number of macromolecular weight. To validate 1H-NMR results, complementary techniques, the chemical titration method and the classical viscosimetric method, were used. The results showed an increase of hydroxyl end-group concentration and a decrease in the macromolecular weight for the explants. © 2009 Wiley Periodicals, Inc. J Appl Polym Sci, 2009

Impaired skeletal muscle energetic participates in peripheral arterial disease (PAD) patient's morbidity and mortality. Angiotensin converting enzyme inhibition (ACEi), cornerstone for pharmacologic risk factor management in PAD patients, might also be interesting by protecting skeletal muscle energetic. We therefore determined whether chronic ACEi might reduce ischemia-induced mitochondrial respiratory chain dysfunction in the frequent setting of hindlimb ischemia-reperfusion. Ischemic legs of rats submitted to 5 h ischemia induced by a rubber band tourniquet applied on the root of the hindlimb followed by reperfusion without (IR, n = 11) or after ACEi (n = 14; captopril 40 mg/kg per day during 28 days before surgery) were studied and compared to that of sham-operated animals (n = 11). The effect of ACEi on the non-ischemic contralateral leg was also determined in the ACEi group. Maximal oxidative capacities (V(max)) and complexes I, II and IV activities of the mitochondrial respiratory chain of the gastrocnemius muscle were determined using glutamate-malate, succinate and TMPD-ascorbate substrates. Arterial blood pressure was significantly decreased after ACEi (124 +/- 2.8 vs. 108 +/- 4.19 mmHg; P = 0.01). Ischemia-reperfusion reduced V(max) (4.4 +/- 0.4 vs. 8.7 +/- 0.5 micromol O2/min/g dry weight, -49%, P < 0.001), affecting mitochondrial complexes I, II and IV activities. ACEi failed to modulate ischemia-induced dysfunction (V(max) 5.1 +/- 0.7 micromol O2/min/g dry weight) or the non-ischemic contralateral muscle respiratory rate. Ischemia-reperfusion significantly impaired the mitochondrial respiratory chain I, II and IV complexes of skeletal muscle. Pharmacologic pre-treatment with ACEi did not prevent or increase such alterations. Further studies might be useful to improve the pharmacologic conditioning of PAD patients needing arterial revascularization.

Aging mechanisms have been investigated on polyethylene terephthalate (PET) fibres extracted from various vascular prostheses in order to identify the different modifications of the material's degradation. NMR spectroscopy provides a comprehensive view of chemical structures of macromolecules. Examination of a series of PET fibres showed significant chemical differences between the virgin prostheses and the explants, especially for diethylene glycol (DEG) and cyclic oligomeric groups. These analyses revealed that PET failures in vascular prostheses are susceptible to hydrolysis during in vivo stay. We also extended this 1H NMR technique to determine the hydroxyl and carboxyl end-group concentrations. In order to validate the 1H NMR results, complementary techniques — chemical titration and classical viscosimetry — were used. The obtained results showed an increase in end-group concentrations and a decrease of the viscosity averaged macromolecular weight (Mν) for the explants. Copyright © 2009 John Wiley & Sons, Ltd.

Layer-by-layer (LBL) polyelectrolyte films offer extensive potentials to enhance surface properties of vascular biomaterials. From the time of implantation, PET prostheses are continuously subjected to multiple mechanical stresses such as important distorsions and blood pressure. In this study, three LBL films, namely (1) poly(sodium 4-styrenesulfonate)/poly(allylamine hydrochloride), (2) poly(L-lysine)/hyaluronan, and (3) poly(L-lysine)/poly(L-glutamic acid) were built on to isolated PET filaments, thread, and vascular prostheses. The three LBL films uniformly covered the surface of the PET samples with rough, totally smooth, and "wrinkled" appearances respectively for (PAH/PSS)(24), (PLL/HA)(24), and (PLL/PGA)(24) systems. We then assessed the behavior of these LBL films, in an aqueous environment [by environmental scanning electronic microscopy (ESEM)], when subjected to unidirectional longitudinal stretches. We found that stretching induces ruptures in the multilayer films on isolated filaments for longitudinal stretches of 14% for (PSS/PAH)(24), 13% for (PLL/PGA)(24), and 30% for (PLL/HA)(24) films. On threads, the rupture limit is enhanced to be respectively 26, 20, and 28%. Most interestingly, we found that on vascular prosthesis no rupture is visible in any of the three multilayers types, even for elongations of 200% (200% undergone by the PET prostheses is representative of those encountered during graft deployment) which by far exceeds elongations observed under physiological conditions (10-20%, blood pressure). In term of mechanical behaviors, these preliminary data constitute a first step toward the possible use of LBL film to coat and functionalize vascular prosthesis.

Background: Renal transplantation is an excellent therapeutic alternative for end-stage renal diseases. Nevertheless, the cardiac function is often impaired in renal-transplant patients (RTR) and importantly determines their prognosis. Adrenomedullin (ADM), a peptide involved in cardiovascular homeostasis, is believed to protect both cardiac and renal functions – by increasing local blood flows, attenuating the progression of vascular damage and remodelling and by reducing glomerular injury – and might be involved in renal-transplantation physiopathology. This work was performed to investigate whether an increase in circulating ADM might be related to RTR cardiac function. Methods: Twenty-nine subjects, 19 RTR and 10 healthy subjects, participated in the study. After 15 min rest in supine position, heart rate and systemic blood pressure were measured together with cyclosporine through levels, creatinine and ADM. Systolic and diastolic cardiac functions were assessed, using Doppler echocardiography. Results: Subjects were similar concerning age, weight, heart rate and blood pressure. Creatinine and ADM (53.8±6.9 vs. 27.2±4.1 pmol/L, p = 0.02) were significantly increased in RTR (73±10 months after transplantation). Cardiac systolic function was normal, but a reduced mitral E:A ratio was observed in RTR (0.90±0.06 vs. 1.38±0.10, p