Cardiovascular, polymeric biomaterials

Blood responses. Blood is the fluid which transports body nutrients and waste products to and from the extravscular tissue and organs, and as such is a vital and special body tissue. The major response of blood to any foreign surface (which includes most extravascular surfaces of the body s own tissues) is first to deposit a layer of proteins and then, within seconds to minutes, a thrombus composed of blood cells and fibrin (a fibrous protein). The character of the thrombus will depend on the rate and pattern of blood flow in the vicinity. Thus, the design of the biomaterial system is particularly important for cardiovascular implants and devices. The thrombus may break off and flow downstream as an embolus and this can be a very dangerous event. In some cases the biomaterial interface may eventually "heal" and become covered with a "passive" layer of protein and/or cells. Growth of a continuous monolayer of endothelial cells onto this interface is the one most desirable end-point for a biomaterial in contact with blood. Figure 10 summarizes possible blood responses to polymeric biomaterials. 

This chapter addresses the application of polymeric biomaterials in the context of implantable devices intended for long-term functionality and permanent existence in the recipients. Basic concepts of biocompatibility as well as mechanical and structural compatibility are discussed to provide appropriate background for the understanding of polymer usage in cardiovascular, orthopedic, ophthalmologic, and dental prostheses. Furthermore, emerging classes... 

Table 19.1 summarizes some of the existing usage of polymeric biomaterials in a variety of implantable prostheses for cardiovascular, orthopedic, ophthalmologic, and dental applications. 

Polymeric materials that have been used in the cardiovascular system include polytetrafluorethy-lene, polyethylene terephthalate, polyurethane, polyvinyl chloride, etc. Textiles bas on polytetra-fluorethylene and polyethylene terephthalate are us extensively as fabrics for repair of vasculature and larger-vessel replacement (greater than 6 mm in diameter). Stent-grafts are hybrid stent grafts placed by catheter to treat aortic aneurysms nonsurgically and are fabricated of the same metallic alloys used in stents and textiles similar to those used in vascular grafts. Table 14.1 lists many of the biomaterials currently used in the cardiovascular system. 

---