Nitinol Release of Nickel under Physiological Conditions: Effects of Surface Oxide, pH, Hydrogen Peroxide, and Sodium Hypochlorite.

Nitinol is a nickel-titanium alloy widely used in medical devices for its unique pseudoelastic and shape-memory properties. However, nitinol can release potentially hazardous amounts of nickel, depending on surface manufacturing yielding different oxide thicknesses and compositions. Furthermore, nitinol medical devices can be implanted throughout the body and exposed to extremes in pH and reactive oxygen species (ROS), but few tools exist for evaluating nickel release under such physiological conditions. Even in cardiovascular applications, where nitinol medical devices are relatively common and the blood environment is well understood, there is a lack of information on how local inflammatory conditions after implantation might affect nickel ion release. For this study, nickel release from nitinol wires of different finishes was measured in pH conditions and at ROS concentrations selected to encompass and exceed literature reports of extracellular pH and ROS. Results showed increased nickel release at levels of pH and ROS reported to be physiological, with decreasing pH and increasing concentrations of hydrogen peroxide and NaOCl/HOCl having the greatest effects. The results support the importance of considering the implantation site when designing studies to predict nickel release from nitinol and underscore the value of understanding the chemical milieu at the device-tissue interface.

Temperature dependence of nickel ion release from nitinol medical devices.

Nitinol exhibits unique (thermo)mechanical properties that make it central to the design of many medical devices. However, nitinol nominally contains 50 atomic percent nickel, which if released in sufficient quantities, can lead to adverse health effects. While nickel release from nitinol devices is typically characterized using in vitro immersion tests, these evaluations require lengthy time periods. We have explored elevated temperature as a potential method to expedite this testing. Nickel release was characterized in nitinol materials with surface oxide thickness ranging from 12 to 1564 nm at four different temperatures from 310 to 360 K. We found that for three of the materials with relatively thin oxide layers, ≤ 87 nm nickel release exhibited Arrhenius behavior over the entire temperature range with activation energies of 80 to 85 kJ/mol. Conversely, the fourth ''black-oxide'' material, with a much thicker, complex oxide layer, was not well characterized by an Arrhenius relationship. Power law release profiles were observed in all four materials; however, the exponent from the thin oxide materials was approximately 1/4 compared with 3/4 for the black-oxide material. To illustrate the potential benefit of using elevated temperature to abbreviate nickel release testing, we demonstrated that a > 50 day 310 K release profile could be accurately recovered by testing for less than 1 week at 340 K. However, because the materials explored in this study were limited, additional testing and mechanistic insight are needed to establish a protective temperature scaling that can be applied to all nitinol medical device components.

Full-field microscale strain measurements of a nitinol medical device using digital image correlation.

Computational modeling and simulation are commonly used during the development of cardiovascular implants to predict peak strains and strain amplitudes and to estimate the associated durability and fatigue life of these devices. However, simulation validation has historically relied on comparison with surrogate quantities like force and displacement due to barriers to direct strain measurement-most notably, the small spatial scale of these devices. We demonstrate the use of microscale two-dimensional digital image correlation (2D-DIC) to directly characterize full-field surface strains on a nitinol medical device coupon under emulated physiological and hyperphysiological loading. Experiments are performed using a digital optical microscope and a custom, temperature-controlled load frame. Following applicable recommendations from the International DIC Society, hardware and environmental heating studies, noise floor analyses, and in- and out-of-plane rigid body translation studies are first performed to characterize the microscale DIC setup. Uniaxial tension experiments are also performed using a polymeric test specimen to characterize the strain accuracy of the approach up to nominal stains of 5%. Sub-millimeter fields of view and sub-micron displacement accuracies (9nm mean error) are achieved, and systematic (mean) and random (standard deviation) errors in strain are each estimated to be approximately 1,000µÏµ. The system is then demonstrated by acquiring measurements at the root of a 300µm-wide nitinol medical device strut undergoing fixed-free cantilever bending motion. Lüders-like transformation bands are observed originating from the tensile side of the strut that spread toward the neutral axis at an angle of approximately 55°. Despite the inherent limitations of optical microscopy and 2D-DIC, simple and relatively economical setups like that demonstrated herein could provide a practical and accessible solution for characterizing cardiovascular implant micromechanics, validating computational model strain predictions, and guiding the development of next-generation material models for simulating superelastic nitinol.

A Computational Study on Deformed Bioprosthetic Valve Geometries: Clinically Relevant Valve Performance Metrics.

Transcatheter aortic valves (TAV) are symmetrically designed, but they are often not deployed inside cylindrical conduits with circular cross-sectional areas. Many TAV patients have heavily calcified aortic valves, which often result in deformed prosthesis geometries after deployment. We investigated the effects of deformed valve annulus configurations on a surgical bioprosthetic valve as a model for TAV. We studied valve leaflet motions, stresses and strains, and analog hydrodynamic measures (using geometric methods), via finite element (FE) modeling. Two categories of annular deformations were created to approximate clinical observations: (1) noncircular annulus with valve area conserved, and (2) under-expansion (reduced area) compared to circular annulus. We found that under-expansion had more impact on increasing stenosis (with geometric orifice area metrics) than noncircularity, and that noncircularity had more impact on increasing regurgitation (with regurgitation orifice area metrics) than under-expansion. We found durability predictors (stress/strain) to be the highest in the commissure regions of noncircular configurations such as EllipMajor (noncircular and under-expansion areas). Other clinically relevant performance aspects such as leaflet kinematics and coaptation were also investigated with the noncircular configurations. This study provides a framework for choosing the most challenging TAV deformations for acute and long-term valve performance in the design and testing phase of device development.

Comparison of ASTM F2129 and ASTM F746 for Evaluating Crevice Corrosion.

Crevice corrosion is one of the major mechanisms that drives implant failure in orthopedic devices that have modular interfaces. Despite the prevalence of crevice corrosion in modular interfaces, very little is known with regards to the susceptibility of different material combinations to participate in crevice corrosion. In this study, we compare two electrochemical methods, ASTM F2129, Standard Test Method for Conducting Cyclic Potentiodynamic Polarization Measurements to Determine the Corrosion Susceptibility of Small Implant Devices, and a modified version of ASTM F746, Standard Test Method for Pitting or Crevice Corrosion of Metallic Surgical Implant Materials, in their ability to induce crevice corrosion. Four commonly used metals, 316 stainless steel, commercially pure titanium (Ti grade 2), Ti-6Al-4V (Ti grade 5), and cobalt-chromium-molybdenum per ASTM F1537, Standard Specification for Wrought Cobalt-28Chromium-6Molybdenum Alloys for Surgical Implants (UNSR31537, UNSR31538, and UNSR31539), were used to form crevices with a rod and washer combination. As a control, the metal rod materials were tested alone in the absence of crevices using ASTM F2129 and the modified ASTM F746 method. As another control to determine if crevices formed with polymeric materials would influence crevice corrosion susceptibility, experiments were also conducted with metal rods and polytetrafluorethylene washers. Our results revealed more visible corrosion after ASTM F2129 than ASTM F746. Additionally, ASTM F746 was found to falsely identify crevice corrosion per the critical pitting potential when visual inspection found no evidence of crevice corrosion. Hence, ASTM F2129 was found to be more effective overall at evaluating crevice corrosion compared to ASTM F746.

Impact of Clinically Relevant Elliptical Deformations on the Damage Patterns of Sagging and Stretched Leaflets in a Bioprosthetic Heart Valve.

After implantation of a transcatheter bioprosthetic heart valve its original circular circumference may become distorted, which can lead to changes in leaflet coaptation and leaflets that are stretched or sagging. This may lead to early structural deterioration of the valve as seen in some explanted transcatheter heart valves. Our in vitro study evaluates the effect of leaflet deformations seen in elliptical configurations on the damage patterns of the leaflets, with circular valve deformation as the control. Bovine pericardial tissue heart valves were subjected to accelerated wear testing under both circular (N = 2) and elliptical (N = 4) configurations. The elliptical configurations were created by placing the valve inside custom-made elliptical holders, which caused the leaflets to sag or stretch. The hydrodynamic performance of the valves was monitored and high resolution images were acquired to evaluate leaflet damage patterns over time. In the elliptically deformed valves, sagging leaflets experienced more damage from wear compared to stretched leaflets; the undistorted leaflets of the circular valves experienced the least leaflet damage. Free-edge thinning and tearing were the primary modes of damage in the sagging leaflets. Belly region thinning was seen in the undistorted and stretched leaflets. Leaflet and fabric tears at the commissures were seen in all valve configurations. Free-edge tearing and commissure tears were the leading cause of valve hydrodynamic incompetence. Our study shows that mechanical wear affects heart valve pericardial leaflets differently based on whether they are undistorted, stretched, or sagging in a valve configuration. Sagging leaflets are more likely to be subjected to free-edge tear than stretched or undistorted leaflets. Reducing leaflet stress at the free edge of non-circular valve configurations should be an important factor to consider in the design and/or deployment of transcatheter bioprosthetic heart valves to improve their long-term performance.

The effect of fatigue on the corrosion resistance of common medical alloys.

The effect of mechanical fatigue on the corrosion resistance of medical devices has been a concern for devices that experience significant fatigue during their lifespan and devices made from metallic alloys. The Food and Drug Administration had recommended in some instances for corrosion testing to be performed on post-fatigued devices [Non-clinical tests and recommended labeling for intravascular stents and associated delivery systems: guidance for industry and FDA staff. 2005: Food and Drug Administration, Center for Devices and Radiological Health], although the need for this has been debated [Nagaraja S, et al., J Biomed Mater Res Part B: Appl Biomater 2016, 8.] This study seeks to evaluate the effect of fatigue on the corrosion resistance of 5 different materials commonly used in medical devices: 316 LVM stainless steel, MP35N cobalt chromium, electropolished nitinol, mechanically polished nitinol, and black oxide nitinol. Prior to corrosion testing per ASTM F2129, wires of each alloy were split into subgroups and subjected to either nothing (that is, as received); high strain fatigue for less than 8 min; short-term phosphate buffered saline (PBS) soak for less than 8 min; low strain fatigue for 8 days; or long-term PBS soak for 8 days. Results from corrosion testing showed that the rest potential trended to an equilibrium potential with increasing time in PBS and that there was no statistical (p > 0.05) difference in breakdown potential between the fatigued and matching PBS soak groups for 9 out of 10 test conditions. Our results suggest that under these nonfretting conditions, corrosion susceptibility as measured by breakdown potential per ASTM F2129 was unaffected by the fatigue condition. 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2019-2026, 2017.

Effect of wire fretting on the corrosion resistance of common medical alloys.

Metallic medical devices such as intravascular stents can undergo fretting damage in vivo that might increase their susceptibility to pitting corrosion. As a result, the US Food and Drug Administration has recommended that such devices be evaluated for corrosion resistance after the devices have been fatigue tested in situations where significant micromotion can lead to fretting damage. Three common alloys that cardiovascular implants are made from [MP35N cobalt chromium (MP35N), electropolished nitinol (EP NiTi), and 316LVM stainless steel (316LVM)] were selected for this study. In order to evaluate the effect of wire fretting on the pitting corrosion susceptibility of these medical alloys, small and large fretting scar conditions of each alloy fretting against itself, and the other alloys in phosphate buffered saline (PBS) at 37°C were tested per ASTM F2129 and compared against as received or PBS immersed control specimens. Although the general trend observed was that fretting damage significantly lowered the rest potential (Er ) of these specimens (p < 0.01), fretting damage had no significant effect on the breakdown potential (Eb , p > 0.05) and hence did not affect the susceptibility to pitting corrosion. In summary, our results demonstrate that fretting damage in PBS alone is not sufficient to cause increased susceptibility to pitting corrosion in the three common alloys investigated. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2487-2494, 2017.

Effect of Applied Potential on Fatigue Life of Electropolished Nitinol Wires.

Nitinol is used as a metallic biomaterial in medical devices due to its shape memory and pseudoelastic properties. The clinical performance of nitinol depends on factors which include the surface finish, the local environment, and the mechanical loads to which the device is subjected. Preclinical evaluations of device durability are performed with fatigue tests while electrochemical characterization methods such as ASTM F2129 are employed to evaluate corrosion susceptibility by determining the rest potential and breakdown potential. However, it is well established that the rest potential of a metal surface can vary with the local environment. Very little is known regarding the influence of voltage on fatigue life of nitinol. In this study, we developed a fatigue testing method in which an electrochemical system was integrated with a rotary bend wire fatigue tester. Samples were fatigued at various strain levels at electropotentials anodic and cathodic to the rest potential to determine if it could influence fatigue life. Wires at potentials negative to the rest potential had a significantly higher number of cycles to fracture than wires held at potentials above the breakdown potential. For wires for which no potential was applied, they had fatigue life similar to wires at negative potentials.

A Parametric Computational Study of the Impact of Non-circular Configurations on Bioprosthetic Heart Valve Leaflet Deformations and Stresses: Possible Implications for Transcatheter Heart Valves.

Although generally manufactured as circular devices with symmetric leaflets, transcatheter heart valves can become non-circular post-implantation, the impact of which on the long-term durability of the device is unclear. We investigated the effects of five non-circular (EllipMajor, EllipMinor, D-Shape, TriVertex, TriSides) annular configurations on valve leaflet stresses and valve leaflet deformations through finite element analysis. The highest in-plane principal stresses and strains were observed under an elliptical configuration with an aspect ratio of 1.25 where one of the commissures was on the minor axis of the ellipse. In this elliptical configuration (EllipMinor), the maximum principal stress increased 218% and the maximum principal strain increased 80% as compared with those in the circular configuration, and occurred along the free edge of the leaflet whose commissures were not on the minor axis (i.e., the "stretched" leaflet). The D-Shape configuration was similar to this elliptical configuration, with the degree to which the leaflets were stretched or sagging being less than the EllipMinor configuration. The TriVertex and TriSides configurations had similar leaflet deformation patterns in all three leaflets and similar to the Circular configuration. In the D-Shape, TriVertex, and TriSides configurations, the maximum principal stress was located near the commissures similar to the Circular configuration. In the EllipMinor and EllipMajor configurations, the maximum principal stress occurred near the center of the free edge of the "stretched" leaflets. These results further affirm recommendations by the International Standards Organization (ISO) that pre-clinical testing should consider non-circular configurations for transcatheter valve durability testing.

High compressive pre-strains reduce the bending fatigue life of nitinol wire.

Prior to implantation, Nitinol-based transcatheter endovascular devices are subject to a complex thermo-mechanical pre-strain associated with constraint onto a delivery catheter, device sterilization, and final deployment. Though such large thermo-mechanical excursions are known to impact the microstructural and mechanical properties of Nitinol, their effect on fatigue properties is still not well understood. The present study investigated the effects of large thermo-mechanical pre-strains on the fatigue of pseudoelastic Nitinol wire using fully reversed rotary bend fatigue (RBF) experiments. Electropolished Nitinol wires were subjected to a 0%, 8% or 10% bending pre-strain and RBF testing at 0.3-1.5% strain amplitudes for up to 10(8) cycles. The imposition of 8% or 10% bending pre-strain resulted in residual set in the wire. Large pre-strains also significantly reduced the fatigue life of Nitinol wires below 0.8% strain amplitude. While 0% and 8% pre-strain wires exhibited distinct low-cycle and high-cycle fatigue regions, reaching run out at 10(8) cycles at 0.6% and 0.4% strain amplitude, respectively, 10% pre-strain wires continued to fracture at less than 10(5) cycles, even at 0.3% strain amplitude. Furthermore, over 70% fatigue cracks were found to initiate on the compressive pre-strain surface in pre-strained wires. In light of the texture-dependent tension-compression asymmetry in Nitinol, this reduction in fatigue life and preferential crack initiation in pre-strained wires is thought to be attributed to compressive pre-strain-induced plasticity and tensile residual stresses as well as the formation of martensite variants. Despite differences in fatigue life, SEM revealed that the size, shape and morphology of the fatigue fracture surfaces were comparable across the pre-strain levels. Further, the mechanisms underlying fatigue were found to be similar; despite large differences in cycles to failure across strain amplitudes and pre-strain levels, cracks initiated from surface inclusions in nearly all wires. Compressive pre-strain-induced damage may accelerate such crack initiation, thereby reducing fatigue life. The results of the present study indicate that large compressive pre-strains are detrimental to the fatigue properties of Nitinol, and, taken together, the findings underscore the importance of accounting for thermo-mechanical history in the design and testing of wire-based percutaneous implants.

Comparing Rotary Bend Wire Fatigue Test Methods at Different Test Speeds.

Given its relatively simple setup and ability to produce results quickly, rotary bend fatigue testing is becoming commonplace in the medical device industry and is the subject of a new standard test method ASTM E2948-14. Although some research has been conducted to determine if results differ for different rotary bend fatigue test setups or test speeds, these parameters have not been extensively studied together. In this work, we investigate the effects of these two parameters on the fatigue life of three commonly used medical device alloys (ASTM F2063 nitinol, ASTM F138 stainless steel, and ASTM F1058 cobalt chromium). Results with three different rotary bend fatigue test setups revealed no difference in fatigue life among those setups. Increasing test speed, however, between 100 and 35,000 RPM led to an increased fatigue life for all three alloys studied (average number of cycles to fracture increased between 2.0 and 5.1 times between slowest and fastest test speed). Supplemental uniaxial tension tests of stainless steel wire at varying strain rates showed a strain rate dependence in the mechanical response which could in part explain the increased fatigue life at faster test speeds. How exactly strain rate dependence might affect the fatigue properties of different alloys at different alternating strain values requires further study. Given the difference in loading rates between benchtop fatigue tests and in vivo deformations, the potential for strain rate dependence should be considered when designing durability tests for medical devices and in extrapolating results of those tests to in vivo performance.

A study on the effects of covered stents on tissue prolapse.

Polyvinyl alcohol (PVA) cryogel covered stents may reduce complications from thrombosis and restenosis by decreasing tissue prolapse. Finite element analysis was employed to evaluate the effects of PVA cryogel layers of varying thickness on tissue prolapse and artery wall stress for two common stent geometries and two vessel diameters. Additionally, several PVA cryogel covered stents were fabricated and imaged with an environmental scanning electron microscope. Finite element results showed that covered stents reduced tissue prolapse up to 13% and artery wall stress up to 29% with the size of the reduction depending on the stent geometry, vessel diameter, and PVA cryogel layer thickness. Environmental scanning electron microscope images of expanded covered stents showed the PVA cryogel to completely cover the area between struts without gaps or tears. Overall, this work provides both computational and experimental evidence for the use of PVA cryogels in covered stents.

Biomaterial testing for covered stent membranes: evaluating thrombosis and restenosis potential.

Covered stents may be able to prevent both thrombosis and restenosis, but new mechanically suitable and biocompatible materials are needed before this treatment option can become a reality. Hydrophilic polyvinyl alcohol (PVA) cryogels have desirable mechanical properties for covered stent membranes and may be able to provide a physical barrier to restenosis with low thrombogenicity. An in vitro flow loop with porcine blood was used to compare thrombus formation on different blood-contacting biomaterials. PVA cryogels were found to maintain blood flow with low thrombogenicity and were significantly less thrombogenic than polyester (p < 0.05). The ability to prevent hyperplasic in-growth was evaluated using a modified Boyden chamber cellular migration assay. PVA cryogel membranes used as a physical barrier were found to nearly eliminate cellular migration (p < 0.05) without cellular toxicity. Overall, this article demonstrates pivotal feasibility results for a covered stent membrane material that could prevent restenosis by means of a hydrogel barrier with low thrombogenicity.