Expandable aortic or pulmonary root

Abstract

A support layer for a synthetic root comprises at least a first region and a second region. The pattern, material, density and/or tension of the support layer in the first region is different to that in the second region. The support may be formed from a knitted, woven, braided or 3D-printed material. The support layer may be comprised within a synthetic aortic or pulmonary root. In at least one region the synthetic root may have a multi-layered structure with the support layer disposed between an inner and an outer nanofiber layer.

Claims

1. A synthetic root comprising at least two regions, wherein in at least one of the at least two regions the synthetic root has a multi-layered structure comprising a support layer formed of a knitted, woven, braided or 3D-printed material, or a combination thereof; the support layer being disposed between an inner and an outer nanofiber layer; and wherein the support layer comprises at least a first support layer region and a second support layer region wherein the pattern, material, density and/or tension of the support layer in the first support layer region is different to that in the second support layer region; the support layer having a tubular shape with first and second ends, wherein a support layer region of increased diameter formed by three outwardly protruding portions arranged around the circumference of the tube is located between the first and second ends; and the support layer further comprising a crown-shaped support layer region between the support layer region of increased diameter and one of the ends, the crown-shaped support layer region comprising three triangular portions connected by a base of circular cross-section, wherein each triangular portion extends between adjacent outwardly protruding portions; the at least two regions of the synthetic root has the same multilayered structure to provide a uniform structure or alternatively has a different structure, wherein the other of the at least two regions having different structure comprises a single layer or a nanofiber layer to provide a non-uniform structure.

2. The synthetic root of claim 1, wherein the support layer is knitted.

3. The synthetic root of claim 1, wherein the stiffness of the first support layer region is different to the stiffness of the second support layer region.

4. The synthetic root of claim 1, wherein the support layer is formed from a yarn.

5. The synthetic root of claim 4, wherein the yarn is formed from a polymer selected from PCL, polyester, PLA, PLGA, silk (poly(dioxanone), poly(ortho esters), poly(amide esters), poly(anhydrides), polyvinyl esters, (poly(tetrafluoroethylene), poly(ethylene), poly(ethylene glycol), polypropylene oxide, or combinations thereof.

6. The synthetic root of claim 1, wherein the inner and/or outer nanofiber layer comprises a polymer selected from polycaprolactone (PCL), polyester, (poly(dioxanone), poly(ortho esters), poly(amide esters), poly(anhydrides), polyvinyl esters, (poly(tetrafluoroethylene), poly(ethylene), poly(ethylene glycol), polypropylene oxide, polylactic acid (PLA), poly(lactic-co-glycolic acid (PLGA), silk, or combinations thereof.

7. The synthetic root of claim 1, wherein the nanofibers of the inner and/or nanofiber layer are aligned.

8. The synthetic root of claim 1, wherein the inner and/or outer nanofiber layers are decorated with bioactive molecules.

9. The synthetic root of claim 1, wherein the triangular portions comprise a hydrogel.

Description

DETAILED DESCRIPTION

(1) Embodiments of the invention will now be described by way of example and with reference to the accompanying figures, in which:

(2) FIG. 1 is a diagram of an aortic root;

(3) FIG. 2 is a schematic cross-sectional diagram showing the layered structure of a synthetic root in accordance with an embodiment of the invention;

(4) FIG. 3A, FIG. 3B, FIG. 3C, and FIG. 3D show photographs of a knitted support layer in commissural view with 2 bulges (FIG. 3A) and in single bulge view (FIG. 3B), with their representative schematic drawings (FIG. 3C) and (FIG. 3D), respectively; and

(5) FIG. 4A and FIG. 4B are photographs of a knitted support layer, according to an embodiment of the invention.

(6) With reference to FIG. 1, an aortic root (10) comprises sinuses (12), aortic valve leaflets or cusps (14), commissures (16), interleaflet triangles (18), a sinotubular junction (20), and an annulus (ventriculo-aortic junction) (22). The cusps (14) are attached to the sinus wall along the crown-shaped annulus.

(7) The invention provides a 3D, free-standing scaffold which is capable of both reproducing the physical properties of the natural root and attracting the appropriate type of cells. The aim is to maintain the dynamism which is believed to be essential for the function of the root, and ultimately to reproduce the native living root in vivo. The 3D scaffold consists of a hybrid of nanofibers and a support layer which can reproduce the specific physical properties of the component parts of the root.

(8) FIG. 2 shows the layered structure of a synthetic root according to the invention. The synthetic root comprises inner (30) and outer (32) nanofiber layers, which may be formed from PCL by jet spraying. In these layers the fibres are circumferentially aligned. Between the nanofibers layers there is a knitted support layer (34), of varying tension. It can be seen that this multi-layered structure defines a substantially tubular shape, with a region of increased diameter (36) corresponding to the sinus regions. In the interior of the tube, leaflets (38) corresponding to cusps project inwardly into the tube. The leaflets (38) are formed from a single nanofiber layer. However, it will be appreciated that in other embodiments of the present invention the leaflets which may further comprise a support layer, such as a knitted support layer.

(9) As will be understood by the skilled person, the curvature, shape and dimensions of the cusps and sinuses can be varied, which in turn has implications for sinus vortex development as well as helical patterns and the opening and closing of the valves. For example, the curvature of the cusps modulates the surface area of the leaflet that faces the inlet flow, which in turn enables the valve to reach its maximum opening potential. A high curvature and volume of the sinus bulges, together with a high curvature of the cusps, allows the development of a large vortex between the sinus and the leaflet, which allows the leaflet to close and coapt fully. Furthermore, optimizing the bulge shape with respect to the annulus and sino-tubular junction diameters enables healthy sinus vortex development over the cardiac cycle, particularly in late systole and early diastole to ensure healthy coronary flow supply and ensure the crucial reservoir.

(10) FIGS. 3A and 3B are images of a knitted support layer (40) in accordance with an embodiment of the invention, while FIGS. 3C and 3D show their respective schematic diagrams. FIGS. 3A and 3C show the commissural view which shows two of the sinus bulges. FIGS. 3B and 3D show an alternative view wherein only a single bulge is visible. It can be seen from these figures that the support has an approximately tubular structure with first (42) and second (44) ends. The first end (42), shown as the upper end in the figures, is constituted by a top sewing ring, while the second end (44) is constituted by a bottom sewing ring.

(11) Below the top sewing ring, between the ends (42, 44), three outwardly protruding portions (46) are arranged side by side, spanning the circumference of the support. Each of these portions 46 forms a bulge which corresponds in shape to the sinus of an aortic or pulmonary root. Each of the outwardly protruding portions (46) is defined by a curved lower boundary (43), which extends in the direction of the second end (44) of the support.

(12) Beneath the outwardly protruding portions (46) which form the sinus regions, a crown-shaped region is provided, comprising three triangular portions (54) connected by a base (56) of circular cross-section. Each triangular portion (54) extends between two adjacent outwardly protruding portions (46), and corresponds to an interleaflet triangle. The bottom sewing ring (44) is located beneath the crown-shaped region.

(13) FIGS. 4A and 4B are images of a further support layer (40) according to an embodiment of the invention. It can be seen from these figures that the knitted structure is shaped to resemble the structure of the natural root. Similarly to the support shown in FIG. 3, the support layer is substantially tubular in shape, with first (42) and second (44) ends. Between the ends a region of increased diameter is formed by three outwardly protruding portions (46), which are arranged adjacent to one another around the circumference of the tube. These protruding portions (46) correspond to the sinus regions of the root.

(14) Each of the outwardly protruding portions (46) is partly defined by a curved edge (47) which extends in the direction of the second end (44) of the root and then curves back in the opposition direction where the edge (47) meets a junction (49), corresponding to the commissure, between adjacent protruding portions (46). Between the curved edges (47) of adjacent outwardly protruding portions (46), an approximately triangular area (54) is formed which corresponds to the interleaflet triangles. The upper boundary (50) of the outwardly protruding portions (46) corresponds to the sinotubular junction.

(15) Between the outwardly protruding portions (46) and the first end (42), an elongate region (48) is provided with a substantially constant diameter. This region corresponds to the ascending artery.

(16) The support layer of FIG. 4 was knitted from a PCL yarn using an industrial knitting machine, which was programmed to follow a prescribed pattern. Different tensions, knit patterns and stitches were used to confer the shape and stiffness of the different regions of the support, which include the ascending artery (48), the sinotubular junction (50), the sinus region (52), the interleaflet triangles (54), and the annulus (56). The knit pattern used is a jersey knit with tuck stitches strategically placed to follow the contours of the annulus (56). Each patterned area conveys a different region of different tension.

Example 1

(17) A synthetic aortic root is prepared using the following method:

(18) 1) Using a dissolvable polymer such as PVA, 3D printing is used to create a mould unit A that mimics one sinus, one valve leaflet (cusp) and one third of an ascending artery, as according to a scanned image from a patient;

(19) 2) A nanofiber layer is formed on mould unit A by jet spraying a polymer solution (e.g. PCL) so as to deposit nanofibers onto the first mould unit while the first mould unit rotates at speed of 10 m/s to 50 m/s. This provides different degrees of alignment of the nanofiber, thus mimicking the anisotropic property of the valve leaflet;

(20) 3) Three individual units of nanofiber-coated mould unit A are assembled onto a 3D-printed dissolvable holder together with a single mould unit B, which mimics part of the extending artery, and a single mould unit C, which mimics the extension from the sinuses, thereby forming a complete mould having three cusps, three sinuses and the ascending artery;

(21) 4) Optionally, a nanofiber layer is formed over the complete mould by jet spraying while the assembled mould units rotate at a speed of less than 10 m/s;

(22) 5) A knitted, braided, woven or 3D-printed support layer is manufactured according to the 3D outer shape of a natural root, based on the scanned images from a patient;

(23) 6) The support layer is mounted over the nanofiber-coated mould;

(24) 7) A further nanofiber layer is formed by jet spraying to sandwich the support structure between inner and outer nanofiber layers;

(25) 8) The final construct is immersed in a solvent capable of dissolving the dissolvable polymer of the mould units, so as to remove the mould from the construct.

Example 2

(26) A knitted support for a synthetic aortic or pulmonary root can be prepared using the following protocol:

(27) A commercial Stoll CMS 16gg dubied, flat double bed knitting machine is used with 220 dtex PCL yarn. The pattern is designed using software M1plus. M1Plus® pattern software from Stoll is the most effective solution for producing patterns for a highly-optimized knitting process. The programme suggests a knitting order for the knitting and transfer rows and these can be changed in the arrangement editor. A number of needles and rows are selected. The pattern is created in the design mode. Specific stitch types are chosen and allocated positions in selected areas.

(28) A jersey knit pattern chosen for optimal shaping. A 1 & 1 set-up seed—tuck-gore is used for starting and ending the knit. Different tensions assigned to specific regions corresponding to the anatomical regions of the root. In an embodiment, the sewing ring has a specified tension. The sinus regions have more allocated rows and a different tension, while above the sinotubular region, the tension is again changed. Tuck stitches are inserted in specific regions. The ply is varied for certain models. A module arrangement is generated which is saved as a pattern module and sent for knitting.