Interatrial shunts having biodegradable material, and methods of making and using same
A device for regulating blood pressure between a patient's left atrium and right atrium comprises an hourglass-shaped stent comprising a neck region and first and second flared end regions, the neck region disposed between the first and second end regions and configured to engage the fossa ovalis of the patient's atrial septum, and a drug-eluting biodegradable material that biodegrades over time to release a drug that limits tissue overgrowth. The inventive device also may include a biodegradable material that biodegrades to offset flow changes caused by tissue overgrowth. The inventive device may reduce left atrial pressure and left ventricular end diastolic pressure, and may increase cardiac output, increase ejection fraction, relieve pulmonary congestion, and lower pulmonary artery pressure, among other benefits.
1. A device for regulating blood pressure between a patient's left atrium and right atrium to treat a cardiovascular condition, the device comprising:
a stent comprising a first flared end region, a second flared end region, a neck region disposed between the first and second flared end regions and configured to engage a fossa ovalis of the patient's atrial septum, and a passageway extending from an inlet of the first flared end region through the neck region and out an outlet of the second flared end region, the stent configured to shunt blood between the left atrium and the right atrium;
a biocompatible material disposed on the stent to define a continuous sheath that channels blood flow through the passageway; and
a biodegradable material disposed on the device adjacent to the inlet of the first flared end region or the outlet of the second flared end region or both, the biodegradable material configured to inhibit tissue overgrowth across the biodegradable material and into the passageway of the stent.
2. The device of claim 1 , wherein the stent comprises a plurality of rings interconnected by a plurality of longitudinally extending struts.
3. The device of claim 2 , wherein at least one of the plurality of rings of the stent comprises one or more depressions formed on a surface of the at least one of the plurality of rings, and wherein the biodegradable material is disposed within the one or more depressions.
4. The device of claim 1 , wherein the biocompatible material is disposed in the neck region, the second flared end region, and a portion of the first flared end region of the stent.
5. The device of claim 1 , wherein the biocompatible material comprises ultra-high-molecular-weight-polyethylene (UHMWPE), expanded-polytetrafluoroethylene (ePTFE), polyurethane, DACRON (polyethylene terephthalate), silicone, polycarbonate urethane, or pericardial tissue from an equine, bovine, or porcine source, or any combination thereof.
6. The device of claim 1 , wherein the biodegradable material comprises at least one of collagen-terpolymer, polylactic acid (PLA), poly L-lactic acid (PLLA), polyglycolic acid (PGA), poly(lactic-co-glycolic) acid copolymer (PLGA), poly(ε-caprolactone), methacrylated dextran-aminoethyl methacrylate copolymer (Dex-MA/AEMA), polydiaxanone, poly(glycerol sebacate) (PGS), polysialic acid (PSA), collagen type I/III chitosan, or chitin, or any combination thereof.
7. The device of claim 1 , wherein the biodegradable material comprises a drug deposited within the biodegradable material, the drug configured to inhibit tissue overgrowth, and wherein the biodegradable material is configured to biodegrade after implantation to release the drug such that tissue overgrowth is inhibited across the biodegradable material.
8. The device of claim 7 , wherein the drug comprises an “-olimus” drug such as rapamycin.
9. The device of claim 7 , wherein the biocompatible material comprises a first biocompatible material layer and a second biocompatible material layer, and wherein the biodegradable material is sandwiched between the first and second biocompatible material layers, at least one of the first or second biocompatible material layers comprising a plurality of nodal pores sized and shaped to permit the drug to be released via the plurality of nodal pores as the biodegradable material biodegrades.
10. The device of claim 7 , wherein the biodegradable material comprises a first biodegradable layer having a first concentration of the drug, and a second biodegradable layer having a second concentration of the drug, the second concentration of the drug different from the first concentration of the drug.
11. The device of claim 1 , wherein the biodegradable material comprises one or more biodegradable rings disposed on a surface of the biocompatible material adjacent to at least the inlet of the first flared end region or the outlet of the second flared end region, the one or more biodegradable rings configured to inhibit tissue overgrowth across the one or more biodegradable rings.
12. The device of claim 11 , wherein the biocompatible material comprises one or more cavities extending through a surface of the biocompatible material, and wherein the one or more biodegradable rings are disposed within the one or more cavities.
13. The device of claim 1 , wherein the biodegradable material comprises a first biodegradable layer having a first biodegradable rate, and a second biodegradable layer having a second biodegradable rate, the second biodegradable rate different from the first biodegradable rate.
14. The device of claim 1 , further comprising a biodegradable substance layer disposed on the biocompatible material at an inner surface of the neck region to define a cross-sectional area of a blood flow path, the biodegradable substance layer configured to biodegrade after implantation to increase the cross-sectional area of the blood flow path at the neck region over time.
15. The device of claim 14 , wherein the biodegradable substance layer is configured to biodegrade after implantation to increase the diameter of the blood flow path cross-sectional area at the neck region from an initial diameter of 5 mm to a diameter of 6 mm over at least a month.
16. The device of claim 14 , wherein the biodegradable substance layer is configured to biodegrade responsive to application of an external stimulus.
17. The device of claim 16 , wherein the external stimulus is heat.
18. The device of claim 16 , wherein the external stimulus is a biocompatible degradation activating material.
19. The device of claim 16 , wherein the biodegradable substance layer comprises a first biodegradable substance layer configured to biodegrade responsive to application of a first external stimulus, and a second biodegradable substance layer configured to biodegrade responsive to application of a second external stimulus different from the first external stimulus.
20. A method of treating a subject with a cardiovascular condition, the subject having a heart with an atrial septum having a fossa ovalis therein, the method comprising:
selecting a stent comprising a neck region between first and second flared end regions and a passageway extending from an inlet of the first flared end region through the neck region and out an outlet of the second flared end region, the stent further comprising a biocompatible material disposed on the stent and a biodegradable material disposed on the biocompatible material adjacent to the inlet of the first flared end region or the outlet of the second flared end region or both;
deploying the stent at a puncture through the fossa ovalis such that the neck region is positioned in the puncture, the first flared end region is disposed in the right atrium, and the second flared end region is disposed in the left atrium;
shunting blood between the left atrium and the right atrium through the passageway; and
inhibiting tissue overgrowth into the passageway of the stent using the biodegradable material.
21. The method of claim 20 , wherein the biodegradable material comprises a drug deposited within the biodegradable material, the drug configured to inhibit tissue overgrowth, and wherein the inhibiting comprises biodegrading the biodegradable material to release the drug.
22. The method of claim 21 , wherein the biocompatible material comprises a first biocompatible material layer and a second biocompatible material layer, at least one of the first or second biocompatible material layers comprising a plurality of nodal pores, wherein the biodegradable material is sandwiched between the first and second biocompatible material layers, and wherein the inhibiting comprises biodegrading the biodegradable material to release the drug through the plurality of nodal pores.
23. The method of claim 20 , wherein the biodegradable material comprises one or more biodegradable rings disposed on a surface of the biocompatible material adjacent to at least the inlet of the first flared end region or the outlet of the second flared end region, and wherein the inhibiting comprises biodegrading the one or more biodegradable rings.
24. The method of claim 20 , wherein the biodegradable material comprises a first biodegradable layer having a first biodegradable rate, and a second biodegradable layer having a second biodegradable rate, the second biodegradable rate different from the first biodegradable rate, and wherein the inhibiting comprises biodegrading the first biodegradable layer at the first biodegradable rate and biodegrading the second biodegradable layer at the second biodegradable rate.
25. The method of claim 20 , wherein the stent further comprises a biodegradable substance layer disposed on the biocompatible material at an inner surface of the neck region, the method further comprising biodegrading the biodegradable substance layer after implantation to increase a cross-sectional area at the neck region.