DE19857887A1 - Verankerungsstütze für eine Herzklappenprothese und ein Verfahren zu deren Herstellung - Google Patents
Verankerungsstütze für eine Herzklappenprothese und ein Verfahren zu deren HerstellungInfo
- Publication number
- DE19857887A1 DE19857887A1 DE1998157887 DE19857887A DE19857887A1 DE 19857887 A1 DE19857887 A1 DE 19857887A1 DE 1998157887 DE1998157887 DE 1998157887 DE 19857887 A DE19857887 A DE 19857887A DE 19857887 A1 DE19857887 A1 DE 19857887A1
- Authority
- DE
- Germany
- Prior art keywords
- anchoring
- anchoring support
- support
- heart valve
- shaped elements
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
- A61F2/2412—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body with soft flexible valve members, e.g. tissue valves shaped like natural valves
- A61F2/2418—Scaffolds therefor, e.g. support stents
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0028—Shapes in the form of latin or greek characters
- A61F2230/0054—V-shaped
Abstract
Die Erfindung betrifft eine Verankerungsstütze für eine Herzklappenprothese und ein Verfahren zu deren Herstellung. Für die Verankerungsstütze (Stent) wird ein Formgedächtnismetall verwendet, mit dem erreicht werden soll, daß die Verankerungsstütze gemeinsam mit einer Herzklappenprothese, ohne größeren operativen Eingriff, durch die Aorta bis in die unmittelbare Nähe des Herzens geführt und dort implantiert werden kann. Erfindungsgemäß ist hierfür die Verankerungsstütze als einteiliger Körper, der aus stabförmigen Elementen, die zumindest teilweise eine Gitterstruktur darstellen, gebildet.
Description
Die Erfindung betrifft eine Verankerungsstütze
(Stent) für eine Herzklappenprothese sowie ein Ver
fahren zu deren Herstellung, bei dem ein Formgedächt
nismetall, auch Memory-Metall genannt, verwendet
wird, um eine Herzklappenprothese zu implantieren,
ohne einen größeren operativen Eingriff, mit voll
ständiger Öffnung des Thorax durchführen zu müssen.
So ist es neben anderem, beispielsweise aus der DE 195 46 692 A1
bekannt, eine selbstexpandierende Herz
klappenprothese mit einer Verankerungsstütze über ein
Herzkathetersystem ohne Öffnung des Brustkorbes über
die in der Leistengegend eines Menschens geöffnete
Aorta einzuführen und bei Erreichen des gewünschten
Ortes, in der Nähe des Herzens, vorzugsweise im Be
reich der ursprünglichen Herzklappe zu positionieren
und diese dort durch eine Selbstexpansion fest zu
installieren.
Es hat sich jedoch gezeigt, daß das dort angedeutete
Lösungsprinzip bisher nicht praktikabel umgesetzt
werden konnte. Es konnte bisher kein Weg aufgezeigt
werden, mit dem eine Verankerungsstütze für eine
Herzklappenprothese einmal in einem Zustand so klein
zusammengefaltet werden konnte, daß sie gemeinsam mit
einem Katheter durch die Aorta und hier insbesondere
durch den Aortenbogen zum Herzen geführt werden konn
te. Eine solche Verankerungsstütze muß aber zusätz
lich in der Lage sein, in einem zweiten Zustand eine
Größe und Form zu erreichen, mit der gesichert ist,
daß die Herzklappenfunktion über einen ausreichend
langen Zeitraum wieder gesichert werden kann.
Als ebenfalls nicht praktikabel hat sich der DE 43 16 971 A1
entnehmbare Vorschlag erwiesen. Dort soll ein
Memory-Material verwendet werden, das am Einsatzort
aufrollbar bzw. aufweitbar sein soll. Der dort als
Herzklappen-Verankerungsring bezeichnete Träger für
eine künstliche Herzklappe soll im zusammengerollten
Zustand, wie bereits erwähnt, mittels eines Katheters
zum Herzen geführt und dort bei Erwärmung infolge der
Aufwicklung des Verankerungsringes sich an die Aorte
ninnenwandung anlegen, wobei für die Verankerung zu
sätzlich Verankerungsmittel am Verankerungsring nach
außen ragend, vorhanden sind.
Auch diese Lösung konnte bisher nicht praktikabel
umgesetzt werden, da der spiralförmig aufgewickelte
Körper in seinem Durchmesser immer noch zu groß ist,
um durch eine Aorta problemlos zum Herzen geführt
werden zu können. Außerdem muß eine entsprechende
Einrichtung, wenn Sie in der Nähe des Herzens
plaziert werden soll, äußerst exakt positioniert wer
den, da die Öffnungen der Herzkranzgefäße in keiner
Weise verschlossen werden dürfen.
Problematisch dürfte sich zusätzlich auch die dort
vorgeschlagene Lösung bezüglich der Erhöhung einer
Thrombosegefahr erweisen.
Auch die Verwendung von Ballonkathetern, für die hier
bezweckte Applikation, hat bisher keine befriedigen
den Ergebnisse gezeigt und so konnte auch das in
WO 91/17720 A1 beschriebene System in der Praxis noch
nicht eingesetzt werden. Dabei wird ein aus mehreren
Metalldrähten zusammengesetztes und gebogenes Element
verwendet, an dem eine Herzklappenprothese befestigt
werden kann und das mit dem an dem Katheter vorhanden
Ballon mechanisch aufgespannt wird. Die hierfür er
forderliche Größe genügt jedoch den tatsächlich zur
Verfügung stehenden räumlichen Verhältnissen in der
Aorta nicht, und so ist es auch bisher nicht gelun
gen, einen entsprechenden operativen Eingriff mit
Erfolg durchführen zu können.
Es ist daher Aufgabe der Erfindung, eine Veranke
rungsstütze für eine Herzklappenprothese zur Verfü
gung zu stellen, die einfach herstellbar ist und mit
der man in die Lage versetzt wird, diese gemeinsam
mit einer Herzklappenprothese durch die Aorta bis in
die unmittelbare Nähe des Herzens zu führen und dort
mit Erfolg zu implantieren.
Erfindungsgemäß wird diese Aufgabe mit den Merkmalen
des Patentanspruchs 1 für die Verankerungsstütze an
sich und in Merkmalen des Patentanspruchs 12 für ein
Verfahren zur Herstellung einer entsprechenden Ver
ankerungsstütze gelöst. Vorteilhafte Ausgestaltungs
formen und Weiterbildungen der Erfindung ergeben sich
durch die in den untergeordneten Ansprüchen genannten
Merkmale.
Dabei geht die erfindungsgemäße Lösung von dem be
kannten Gedanken, der Verwendung eines Memory-Materi-
als aus und es wird demzufolge vorgeschlagen, eine
Verankerungsstütze aus einem Formgedächtnismetall zu
verwenden, das in der Lage ist, bei Erreichen einer
bestimmten vorgebbaren Sprungtemperatur eine einge
prägte Form und Größe einzunehmen, die einen sicheren
Halt, Dichtheit der Herzklappenprothese, geringe
Thrombosegefahr und die Beachtung der Freihaltung der
Herzkranzgefäßöffnungen ermöglicht. Die erfindungs
gemäße Verankerungsstütze für eine Herzklappenprothe
se ist daher als einteiliger Körper ausgebildet, der
aus einzelnen stabförmigen Elementen gebildet ist,
die zumindest teilweise eine Gitterstruktur darstel
len.
Dabei wird die Dicke der stabförmigen Elemente so
klein, wie möglich gewählt, um einmal eine ausrei
chende Festigkeit und Stabilität zu sichern und zum
anderen jedoch die Thrombosegefahr entsprechend klein
zu halten. Demzufolge liegt die Stärke der stabförmi
gen Elemente im Bereich zwischen 0,3 bis maximal
1 mm.
Dadurch kann gesichert werden, daß der aus einem
Halbzeug, das aus einem Formgedächtnismetall besteht,
hergestellte Körper zum anderen sehr klein zusammen
gedrückt bzw. gefaltet werden kann und der bei der
Positionierung des zusammengedrückten bzw. zusammen
gefalteten Körpers durch die Aorta nicht zu über
schreitende freie Querschnitt von ca. 7 mm mit
Sicherheit eingehalten werden kann.
Erfindungsgemäß wird die Verankerungsstütze aus einem
aus einem Formgedächtnismetall bestehenden Halbzeug
hergestellt, in dem die eigentliche Struktur mit den
stabförmigen Elementen ausgeschnitten bzw. ausge
stanzt wird. Beim Ausschneiden hat sich besonders
vorteilhaft ein Laserschneidverfahren herausgestellt,
mit dem man in die Lage versetzt ist, sehr genau und
exakt die gewünschten Strukturen in den relativ klei
nen Wandstärken auszubilden.
Nachdem die gewünschte Struktur ausgebildet ist, wird
die Verankerungsstütze in die gewünschte Form und
Größe für den implantierten Zustand gebracht und
gleichzeitig bei einer Wärmebehandlung, unter Berück
sichtigung der einzustellenden Sprungtemperatur, die
vorteilhaft im Bereich von ca. 37°C liegen sollte,
eingeprägt.
Als Halbzeug kann ein entsprechend ausgebildetes
plattenförmiges Element, bevorzugt aber ein rohrför
miges Halbzeug verwendet werden. Für den Fall, daß
ein plattenförmiges Element verwendet wird, muß die
ses für das Einprägen der gewünschten Form und Größe
nicht nur aufgeweitet, sondern auch entsprechend, zu
mindest annähernd in eine kreisrunde Form gebogen
werden.
Nach dem Einprägen der Form und Größe der erfindungs
gemäßen Verankerungsstütze kann an ihr die Herzklap
penprothese befestigt werden. Die Herzklappenprothese
kann von außen von einer Seite auf die Verankerungs
stütze übergestülpt und gegebenenfalls zusätzlich
angenäht werden, wobei dieser Teil der Verankerungs
stütze so geformt und dimensioniert ist, daß die
Kommissuren einer biologischen Herzklappenprothese,
die z. B. von einem Schweineherz entnommen sein kann
und in präparierter Form zur Verfügung gestellt wird,
berücksichtigt wird. Eine solche Herzklappenprothese
kann aber auch durch die Verankerungsstütze geführt
sein und von innen an der entsprechend ausgebildeten
Gitterstruktur oder bogenförmigen Elementes befestigt
werden. In ähnlicher Weise kann aber auch eine künst
liche Herzklappenprothese aus hierfür geeigneten Ma
terialien eingesetzt werden.
Als Formgedächtnismetall kann eine Nickel-Titanlegie
rung, die z. B. unter der Bezeichnung "Nitinol" kom
merziell erhältlich ist, verwendet werden. Nach der
Ausbildung der Struktur und dem Einprägen der ge
wünschten Form und Größe im implantierten Zustand,
kann die Verankerungsstütze mittels bekannter Ober
flächenbehandlungsverfahren, wie z B. dem Elektropo
lieren an ihrer Oberfläche veredelt und geglättet
werden, so daß auch hierdurch der Thrombosegefahr
entgegengewirkt werden kann.
Bei der erfindungsgemäßen Verankerungsstütze wird
eine Gitterstruktur ausgebildet, bei der stabförmige
Elemente zum Teil mäanderförmig ausgebildet sind und
in ihrer Ausrichtung mindestens einen Stützring bil
den, der sich als solcher im implantierten Zustand an
der Aorteninnenwandung anlegen kann. An dem einen
aber auch an mehreren solcher mit den stabförmigen
Elementen gebildeten Stützringen können verankerungs
haken ausgebildet sein, die ebenfalls aus dem verwen
deten Formgedächtnismetall bestehen. Diesen Veranke
rungshaken wird beim Einprägen jedoch eine radial
nach außen aufgerichtete Stellung eingestellt, so daß
sie sich im implantierten Zustand in der Aorteninnen
wandung verhaken und die Verankerungsstütze entspre
chend sicher gehalten werden kann und die Verhakung
zusätzlich zur Spannkraft der expandierten Veranke
rungsstütze wirken kann.
Vorteilhaft ist es, wenn den verankerungshaken ver
schiedene Aufrichtrichtungen eingeprägt werden, die
jeweils in entgegengesetzten Richtungen in bezug zur
Längsachse der Verankerungsstütze in einem Winkel
ungleich 90° liegen, so daß eine sichere Verankerung
in beiden möglichen Bewegungsrichtungen einer Veran
kerungsstütze erreicht werden kann. Die verankerungs
haken sollten eine Länge von mindestens 1 und maximal
5 mm aufweisen, so daß eine vollständige Durchtren
nung der Aortenwandung vermieden werden kann.
Wird eine Verankerungsstütze mit mehr als einem
Stützring verwendet, können diese Stützringe mittels
Verbindungsstegen zwischen nebeneinander angeordneten
Mäandern, die durch die stabförmigen Elemente der
Stützringe gebildet sind, erreicht werden.
Die Herzklappenprothese kann an einem stirnseitig
angeordneten geschlossenen Kreisring oder einem aus
einem Vieleck gebildeten Ring anliegen.
Es besteht aber auch die Möglichkeit, an dieser
Stirnseite der Verankerungsstütze drei bogenförmige
Elemente für die Fixierung der Herzklappenprothese
auszubilden. Dabei liegen diese bogenförmigen Elemen
te im implantierten Zustand an der Aorteninnenwand
an. Mit den bogenförmigen Elementen kann im Gegensatz
zu einem geschlossenen Ring eine höhere Elastizität
bei der Selbstexpansion und gleichzeitig eine Anpas
sung an die Form der Kommissuren einer Herzklappen
prothese erreicht werden.
Neben einer Röhrenform kann die erfindungsgemäße Ver
ankerungsstütze auch in Form eines Vieleckes ausge
bildet sein, wobei dieses aber mindestens über acht
Ecken verfügen sollte. Die letztgenannte Form hat
einen erhöhten Selbstarretiereffekt, da die Eckkanten
und die für die Verbindung von mehreren Stützringen
verwendeten stabförmigen Elemente nicht parallel zur
Längsachse der Verankerungsstütze ausgerichtet sein
können. Daher kann ein erhöhter Formschluß für den
sicheren Halt der Verankerungsstütze in der Aorta
erreicht werden.
Nach der Befestigung der Herzklappenprothese an der
erfindungsgemäßen Verankerungsstütze kann beides ge
meinsam zusammengedrückt bzw. -gefaltet und in einer
Tasche, die an einem Katheter befestigt ist, unterge
bracht werden. Dabei ist die Tasche mit einem Kühlsy
stem verbunden, durch das entsprechend gekühlte Koch
salzlösung geführt wird, so daß die Verankerungsstüt
ze unterhalb der Sprungtemperatur gehalten wird.
Das Katheter kann dann in bekannter Form, an einem
Draht durch die Aorta bis in die unmittelbare Nähe
des Herzens geführt werden. Nach dem Erreichen der
gewünschten Position und Überprüfung der Lage bezüg
lich der Herzkranzgefäßöffnungen kann die schützende
Kappe entfernt oder zerstört werden und bei Erreichen
der Sprungtemperatur stellt sich infolge von Selbst
expansion die für die Implantation gewünschte Form
und Größe der Verankerungsstütze ein, wobei sich
gleichzeitig die Verankerungshaken aufrichten und in
der Aorteninnenwandung verklammern.
Im Anschluß hieran können Führungsdraht und Katheter
wieder entfernt werden und die Herzklappenprothese,
die Funktion der natürlichen Herzklappe übernehmen.
Nachfolgend soll die Erfindung beispielhaft, anhand
von Ausführungsbeispielen näher erläutert werden.
Dabei zeigen:
Fig. 1 ein Beispiel einer erfindungsgemäßen Ver
ankerungsstütze mit einer Herzklappenpro
these in implantierter Form und Größe und
Fig. 2 eine Gitterstruktur eines Beispiels einer
Verankerungsstütze in einer Abwicklung.
Bei dem in Fig. 1 gezeigten Beispiel verfügt die
Verankerungsstütze über zwei aus sägezahnförmig an
einandergereihten stabförmigen Elementen 4 gebildete
Stützringe 6, die mit Verbindungsstegen 3 miteinander
verbunden sind. Außerdem sind ein Dicht- und Befesti
gungsring 1 für die Herzklappenprothese 2, der hier
eine Kreisringform aufweist sowie weitere stabförmige
Elemente vorhanden sind, die die Verbindung zu den
Stützringen 6 darstellen und die Form und Größe der
Kommissuren von Herzklappenprothesen berücksichtigen.
Außerdem sind an den Stützringen 6 zusätzlich Veran
kerungshaken 5 vorhanden, die sich, wie im allgemei
nen Teil der Beschreibung bereits erwähnt, bei Über
schreiten der durch Prägung vorgegebenen Sprungtempe
ratur radial nach außen aufrichten.
Bei dem in Fig. 2 gezeigten Beispiel einer erfin
dungsgemäßen Verankerungsstütze, wurde die Darstel
lungsform einer Abwicklung gewählt, um die im Formge
dächtnismetall ausgebildete Struktur deutlicher er
kennen zu können. Bei diesem Beispiel wurden wiederum
zwei Stützringe 6, durch sägezahnförmige Ausbildung
von stabförmigen Elementen 4, an denen wiederum Ver
ankerungshaken 5 vorhanden sind, gewählt. Die beiden
Stützringe 6 sind außerdem wieder mit Verbindungsste
gen 3 verbunden, die für einen gegebenenfalls erfor
derlichen Längenausgleich teilweise schlaufenartig
abgebogen sind.
Im Bereich der Verankerungsstütze, an dem die Herz
klappenprothese positioniert und fixiert werden soll,
sind bei diesem Beispiel drei bogenförmige Elemente 7
ausgebildet, an denen die Herzklappenprothese anlie
gen kann und befestigt wird. Die Form der bogenförmi
gen Elemente 7 berücksichtigt die Form und Größe der
Kommissuren einer biologischen Herzklappenprothese.
Claims (18)
1. Verankerungsstütze für eine Herzklappenprothese,
die aus einem, bei einer vorgebbaren Temperatur
eine vorbestimmte Form einnehmenden Formgedächt
nismetall gebildet ist,
dadurch gekennzeichnet,
daß die Verankerungsstütze ein einteiliger Kör
per ist, der aus stabförmigen Elementen (1, 3,
4, 5), die zumindest teilweise eine Gitterstruk
tur darstellen, gebildet ist.
2. Verankerungsstütze nach Anspruch 1,
dadurch gekennzeichnet, daß die stabförmigen
Elemente (4) sägezahnförmig ausgebildet sind und
mindestens einen Stützring (6) bilden.
3. Verankerungsstütze nach Anspruch 1 oder 2,
dadurch gekennzeichnet, daß Verankerungshaken
(5), die sich bei Erreichen der Sprungtemperatur
des Formgedächtnismetalls radial nach außen auf
richten, am/an dem/den Stützring(en) (6) vorhan
den sind.
4. Verankerungsstütze nach einem der Ansprüche 1
bis 3,
dadurch gekennzeichnet, daß die Verankerungsha
ken (5) eine Länge von mindestens 1 mm aufwei
sen.
5. Verankerungsstütze nach einem der Ansprüche 1
bis 4, dadurch gekennzeichnet, daß Verankerungs
haken (5), die sich in Bezug zur Längsachse der
Verankerungsstütze in entgegengesetzten Richtun
gen in einem Winkel ungleich 90° radial nach
außen aufrichten, vorhanden sind.
6. Verankerungsstütze nach einem der Ansprüche 1
bis 5, dadurch gekennzeichnet, daß die Stütz
ringe (6) mittels Verbindungsstegen (3) verbun
den sind.
7. Verankerungsstütze nach einem der Ansprüche 1
bis 6, dadurch gekennzeichnet, daß an der Seite,
an der die Herzklappenprothese fixiert ist, drei
bogenförmige Elemente (7) zur Fixierung der
Herzklappenprothese (2) ausgebildet sind, die an
der Aorteninnenwand anliegen.
8. Verankerungsstütze nach einem der Ansprüche l
bis 7, dadurch gekennzeichnet, daß sämtliche
Elemente (1, 3, 4, 5) eine(n) Breite/Durchmesser
von maximal 1 mm aufweisen.
9. Verankerungsstütze nach einem der Ansprüche 1
bis 8, dadurch gekennzeichnet, daß die Gitter
struktur, die Größe und Lage der Herzkranzgefäß
öffnungen berücksichtigend, ausgebildet ist.
10. Verankerungsstütze nach einem der Ansprüche 1
bis 9, dadurch gekennzeichnet, daß die Veranke
rungsstütze innerhalb einer gekühlten Tasche, an
einem Katheter während der Positionierung durch
die Aorta angeordnet ist/sind.
11. Verankerungsstütze nach einem der Ansprüche 1
bis 10, dadurch gekennzeichnet, daß der/die
Stützring(e) (6) als Vieleck, mit mindestens
acht Ecken ausgebildet ist.
12. Verfahren zur Herstellung einer Verankerungs
stütze nach einem der Ansprüche 1 bis 11,
dadurch gekennzeichnet, daß
- - eine Gitterstruktur mit stabförmigen Ele menten (1, 3, 4, 5) in einem Halbzeug aus Formgedächtnismetall ausgebildet;
- - die Verankerungsstütze in die gewünschte Form und Größe in implantierter Stellung gebracht und diese dem Formgedächtnismetall bei einer Wärmebehandlung, unter Berück sichtigung der Sprungtemperatur eingeprägt wird.
13. Verfahren nach Anspruch 12,
dadurch gekennzeichnet, daß die Gitterstruktur
durch ein Laserschneidverfahren ausgebildet
wird.
14. Verfahren nach Anspruch 12 oder 13,
dadurch gekennzeichnet, daß ein rohrförmiges
Halbzeug aus einem Formgedächtnismetall verwen
det wird.
15. Verfahren nach einem der Ansprüche 12 bis 14,
dadurch gekennzeichnet, daß ein Halbzeug, dessen
Wandstärke die Dicke der stabförmigen Elemente
(1, 3, 4, 5) aufweist, verwendet wird.
16. Verfahren nach einem der Ansprüche 12 bis 15,
dadurch gekennzeichnet, daß das Einprägen der
Form und Größe der Verankerungsstütze für eine
Sprungtemperatur von ca. 37°C durchgeführt
wird.
17. Verfahren nach einem der Ansprüche 12 bis 16,
dadurch gekennzeichnet, daß eine Nickel-Titan-
Legierung verwendet wird.
18. Verfahren nach einem der Ansprüche 12 bis 17,
dadurch gekennzeichnet, daß die Verankerungs
stütze mittels Elektropolieren einer Ober
flächenbehandlung unterzogen wird.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
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DE1998157887 DE19857887B4 (de) | 1998-12-15 | 1998-12-15 | Verankerungsstütze für eine Herzklappenprothese |
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DE1998157887 DE19857887B4 (de) | 1998-12-15 | 1998-12-15 | Verankerungsstütze für eine Herzklappenprothese |
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Cited By (364)
Publication number | Priority date | Publication date | Assignee | Title |
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