Rajesh Kumar Madhavan, Ahmad Faryami, Nathan Tappen, Pranav Gopalakrishnan, Shaheer H Ajaz, Carolyn A Harris
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引用次数: 0
Abstract
Introduction: Although many ventricular catheter designs exist for hydrocephalus treatment, few standardized studies assess outflow resistance and the impact of design modifications on shunt drainage. This study represents the in-vitro assessment of various architectural modifications on catheter flow rate and pressure, focusing on bulk outflow dynamics and occlusion with whole blood-inoculated cerebrospinal fluid.
Methods: Catheters were manufactured utilizing a novel catheter production setup with 16 variations from standard catheters, including but not limited to changes in: hole number, hole dimensions, catheter lumen dimension, and catheter lumen impingement. These catheters were tested in a portable custom-made ventricular catheter testing device to analyze relative resistance to flow between catheter designs. A subset of catheters with varying lumen diameters was tested in 0.30 mL/min saline flow with 2.5% blood to simulate early blood exposure.
Results: With increasing hole and lumen diameter, we found a significant decrease in overall catheter relative resistance using DIH20 (P < 0.001 and P < 0.002 respectively, n = 5). With increasing lumen diameters, blood assays showed a significant increase in the time to complete obstruction (P = 0.027, n = 5). Lumen impingement, representing one obstruction-based pinch point in the lumen, showed a considerable increase in relative resistance as obstruction diameter increased and lumen diameter at the pinch point decreased (P = 0.001, n = 5). Removal of specific catheter hole rows trended toward an increase relative resistance after 75% of catheter holes were blocked, but the effect in relative outflow resistance is otherwise minimal (P > 0.05, n = 5) and no effect was observed with blocking segments.
Conclusion: This study implemented a novel method of rapid catheter manufacturing to systematically produce ventricular catheters with specific catheter architecture. By testing variables independently, we found that catheters with changes to the lumen diameter had the most dramatic shifts in overall relative resistance between catheter designs. Similarly, testing in the acute in-vitro blood assay demonstrated that smaller diameter catheters have a higher propensity to obstruct with blood compared to catheters with larger diameter. Relative resistance impacts fluid outflow efficiency, which may translate to clinical outcomes for hydrocephalus patients. These findings help us understand catheter architectural effects on resistance and inform future designs for specific ventricle morphologies.
期刊介绍：
The translation of new discoveries in medicine to clinical routine has never been easy. During the second half of the last century, thanks to the progress in chemistry, biochemistry and pharmacology, we have seen the development and the application of a large number of drugs and devices aimed at the treatment of symptoms, blocking unwanted pathways and, in the case of infectious diseases, fighting the micro-organisms responsible. However, we are facing, today, a dramatic change in the therapeutic approach to pathologies and diseases. Indeed, the challenge of the present and the next decade is to fully restore the physiological status of the diseased organism and to completely regenerate tissue and organs when they are so seriously affected that treatments cannot be limited to the repression of symptoms or to the repair of damage. This is being made possible thanks to the major developments made in basic cell and molecular biology, including stem cell science, growth factor delivery, gene isolation and transfection, the advances in bioengineering and nanotechnology, including development of new biomaterials, biofabrication technologies and use of bioreactors, and the big improvements in diagnostic tools and imaging of cells, tissues and organs.
In today`s world, an enhancement of communication between multidisciplinary experts, together with the promotion of joint projects and close collaborations among scientists, engineers, industry people, regulatory agencies and physicians are absolute requirements for the success of any attempt to develop and clinically apply a new biological therapy or an innovative device involving the collective use of biomaterials, cells and/or bioactive molecules. “Frontiers in Bioengineering and Biotechnology” aspires to be a forum for all people involved in the process by bridging the gap too often existing between a discovery in the basic sciences and its clinical application.
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