JP2016531610A - 特に小児科の患者のための生物学的心臓弁置換物および製造方法 - Google Patents
特に小児科の患者のための生物学的心臓弁置換物および製造方法 Download PDFInfo
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Abstract
Description
本発明の効果的な実施形態は、従属項で定義され、かつ/または後述される。
用語「生物学的心臓弁置換物」は、ここで生体適合材料から実質的に形成される心臓弁置換物として理解される。
用語「成長適応性を備える生体適合材料」は、ここで被移植体を包囲する器官構造体に対してその寸法を付随的に増加させることができる生体適合材料として理解される。これとは対照的に、「非成長適応性を備える生体適合材料」は、ここで例えばグルタルアルデヒド固定の異種の個体の、または同型遺伝子性の組織などの実質的な成長能力のない生体適合材料として理解される。
生物学的心臓弁置換物の一実施形態(請求項8)では、非成長適応性を備える生体適合材料は固定の異種の個体の組織あるいは同型遺伝子性の生来の組織である。当業者に周知のように、移植可能な組織に関して使用される用語「固定の」は、意図した使用を考慮してその機械的性質を保存するようにグルタルアルデヒドのような固化剤で処理される生物学的組織を指す。一般に、そのような固定組織は本質的な成長適応性を有さないであろうが、構造の安定性および磨耗抵抗に関して優れた性質を有する。
これらの「成長領域」の材料は、i)迅速な(生体)分解性を備える高分子、ii)拡張性能を備える動物由来の(固定または脱細胞化された(decellularized))組織、あるいはiii)(生存可能または脱細胞化された)組織を処理した材料のうちのいずれかから構成される。
効果的な実施形態(請求項10)では、生体分解性高分子は、ポリ−4−ハイドロキシブチレート(P4HB)により浸漬コーティングされたポリグリコール酸(PGA)マトリックスから形成される。
更なる別例(請求項11)によれば、成長適応性を備える生体適合材料は組織を処理した材料である。そのような材料の例は、生体外で処理されるヒトの細胞に由来する細胞化または脱細胞化されるマトリックスである。
弁尖成長領域を更に含む生物学的心臓弁置換物を製造するために、対応するストリップ状の管状成長領域に弁尖成長領域を直接取り付けることが効果的であるものといえるであろう。管状セグメントが長手方向に切断される際に、隣接する弁尖様弁膜も適切に切開されるであろう。そのような切開は挿入される弁尖成長領域に対応する弁尖様弁膜部分を自由な状態に保持するように構成されるであろう。
大動脈弁の治療(例えば先天的な大動脈弁狭窄による)を要する小児科の患者では、繰り返される再手術の必要性により、病的状態および死の可能性が高められた。そのような患者がここに説明されるような心臓弁置換物から効果を得ると予期される。
(参考文献)
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Claims (15)
- 特に小児科の患者のための生物学的心臓弁置換物であって、近位端(Ep)、遠位端(Ed)、および前記近位端と前記遠位端との間に設けられるとともに前記弁の長手方向を規定する中央部(Pc)を含む管状セグメント(A)を備え、前記弁は、前記中央部の内側壁部(W)領域において接続領域(F)にヒンジ状に取り付けられる少なくとも1つの内側弁尖(C)を更に含み、前記内側弁尖の各々は前記弁の閉鎖位置と開放位置との間を移動可能であり、
前記管状セグメントが、成長適応性を備える生体適合材料から形成される長手方向のストリップとして構成される少なくとも1つの管状成長領域(B;B1、B2)を含み、前記管状セグメントの残部が非成長適応性を備える生体適合材料から形成されることを特徴とする生物学的心臓弁置換物。 - 前記内側弁尖(C)の各々につき1つの管状成長領域(B)を有し、同管状成長領域の各々は対応する前記内側弁尖の前記接続領域(F)を横断することを特徴とする請求項1に記載の生物学的心臓弁置換物。
- 前記内側弁尖(C)の各々につき2つの管状成長領域(B1、B2)を有し、同2つの管状成長領域は、互いに周方向に間隔をおいて設けられ、両成長領域が対応する前記内側弁尖の前記接続領域(F)を横断することを特徴とする請求項1に記載の生物学的心臓弁置換物。
- 前記管状成長領域(B)の全体によって形成される領域は、前記管状セグメントの5乃至50面積%、好ましくは10乃至30面積%に相当することを特徴とする請求項1乃至3のうちのいずれか一項に記載の生物学的心臓弁置換物。
- 前記内側弁尖(C)は各々成長適応性を備える生体適合材料から形成されるとともに前記接続領域(F)に隣接する弁尖領域に設けられるパッチとして構成される弁尖成長領域(D)を更に含むことを特徴とする請求項1乃至4のうちのいずれか一項に記載の生物学的心臓弁置換物。
- 前記弁尖成長領域(D)は略三角形であり、前記内側壁部領域(W)に隣接する三角形ベースを備えることを特徴とする請求項5に記載の生物学的心臓弁置換物。
- 前記弁尖成長領域(D)は対応する前記内側弁尖(C)の5乃至50面積%、好ましくは10乃至30面積%に相当することを特徴とする請求項5または6に記載の生物学的心臓弁置換物。
- 前記非成長適応性を備える生体適合材料は固定の異種の個体の組織あるいは同型遺伝子性の生来の組織であることを特徴とする請求項1乃至7のうちのいずれか一項に記載の生物学的心臓弁置換物。
- 前記成長適応性を備える生体適合材料は生体分解性高分子であることを特徴とする請求項1乃至8のうちのいずれか一項に記載の生物学的心臓弁置換物。
- 前記生体分解性高分子は、ポリ−4−ハイドロキシブチレートで浸漬コーティングされたポリグリコール酸マトリックスから形成されることを特徴とする請求項9に記載の生物学的心臓弁置換物。
- 前記成長適応性を備える生体適合材料は組織を処理した材料であることを特徴とする請求項1乃至8のうちのいずれか一項に記載の生物学的心臓弁置換物。
- 前記管状セグメントの径は5乃至20mmであることを特徴とする請求項1乃至11のうちのいずれか一項に記載の生物学的心臓弁置換物。
- 前記管状セグメントの長さは10乃至20mmであることを特徴とする請求項1乃至12のうちのいずれか一項に記載の生物学的心臓弁置換物。
- 請求項1乃至13のうちのいずれか一項に記載の生物学的心臓弁置換物を製造する方法であって、
a)非成長適応性を備える生体適合材料から形成される管状セグメントを備える生物学的心臓弁置換物を準備する工程であって、前記管状セグメントは、セグメント長さを有し、近位端、遠位端、および前記近位端と前記遠位端との間に設けられるとともに前記弁の長手方向を規定する中央部を含み、前記弁は、前記中央部の内側壁部領域に取り付けられる少なくとも1つの内側弁尖を更に含み、前記内側弁尖の各々は、前記弁の閉鎖位置と開放位置との間を移動可能に構成される、生物学的心臓弁置換物を準備する工程と、
b)前記管状セグメントに沿って少なくとも1つの長手方向の切断部を形成し、これにより一対の長手方向に並べられる管壁縁を形成する工程と、
c)前記セグメント長さに相当する長さを有するとともに前記対の管壁縁間に配置されるように長手方向のストリップの両縁を有する成長適応性を備える生体適合材料のストリップの形状に形成される片を設ける工程と、
d)隣接する管壁縁に各長手方向のストリップ縁を固定する工程とを含むことを特徴とする生物学的心臓弁置換物の製造方法。 - 前記固定する工程d)は、縫合により、あるいは接着により行われることを特徴とする請求項14に記載の方法。
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