Biomedical Engineering Reference
In-Depth Information
3
Biocompatibility of cardiovascular devices
A. A. UCUZIAN and H. P. GREISLER,
Loyola University Medical Center, USA
Abstract : In addition to ubiquitous immunologic and infl ammatory
responses to foreign objects, unique blood-biomaterial interfacial
processes and vascular injury responses have a profound impact on the
biocompatibility of cardiovascular devices. This chapter will discuss these
host-device interactions, focusing on protein adsorption, infl ammatory
and immunologic responses, mesenchymal cell injury responses, toxicity,
and vascular healing and endothelialization. We also include a discussion
on bioresorbable materials, pharmacologic and genetic therapeutics, and
various tissue engineering strategies that attempt to improve device
biocompatibility by optimizing or minimizing host biologic responses.
Key words : cardiovascular tissue engineering, biocompatibility,
bioresorbable materials, intimal hyperplasia, endothelialization.
3.1
Introduction
Cardiovascular devices such as coronary stents, bypass conduits, heart
valves, ventricular assist devices, tissue engineered constructs, and others
are constructed from biomaterials ranging from metallic alloys to synthetic
polymers to biologic tissues. In addition to ubiquitous immunologic
responses to foreign objects, unique blood-biomaterial interfacial processes
and vascular injury responses profoundly impact the biocompatibility of
these devices. These host responses can have signifi cant clinical conse-
quences by limiting the durability and long-term functionality of implant-
able devices, and can narrow the spectrum of biomaterials available for such
applications. This chapter will focus on the host-device interactions which
impact the biocompatibility of the foreign device, focusing on protein
adsorption, infl ammatory and immunologic responses, mesenchymal cell
injury responses, toxicity, and vascular healing. Novel strategies which
attempt to improve device biocompatibility by modifying the biomaterial
itself or by optimizing or inhibiting host biologic responses will be discussed
in terms of in vitro , in vivo , and, when applicable, clinical literature.
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3.2
Blood-biomaterial interfacial events
After implantation into the host, cardiovascular devices initiate blood-
material interfacial processes including protein adsorption, platelet and
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