Medical implants, delivery devices, methods of making medical implants, and methods of delivering medical implants

Abstract

The present invention relates to a medical implant (1) adapted to repair or close a defect (D), particularly an opening in the ventricular wall, atrial wall, or septum (W). The medical implant (1) may, in particular, be a patch. It comprises an adhesive composition (6). It further comprises two states: in a first state, the medical implant (1) can be deployed at the implantation site while the adhesive composition (6) is inactive; it can be brought to a second state by an activation mechanism; and in the second state, the adhesive composition (6) is hardenable by a hardening mechanism.

Description

[Technical Field]

[0001] The present invention relates to a medical implant, in particular a patch, a delivery device for a medical implant and a method for delivering a medical implant according to the preambles of the independent claims. [Background technology]

[0002] Tissue defects, such as atrial septal defects (ASDs) or ventricular septal defects (VSDs), are fairly common conditions in humans that are typically treated minimally invasively or surgically. Such defects can cause a variety of symptoms, including shortness of breath and increased strain on the heart and lungs.

[0003] As a result, the prior art has proposed a myriad of implantable devices, many of which can be deployed in a minimally invasive manner.

[0004] For example, closure of an atrial septal defect (ASD) by deploying an umbrella implant through a catheter has been disclosed by Lock et al. (DOI: 10.1161 / 01.CIR.79.5.1091).

[0005] However, known implants exhibit several drawbacks. Typically, they are attached to the tissue wall or mechanically held in place. On the one hand, this can lead to slight damage to the treated tissue. On the other hand, mechanical attachment imposes constraints on the material selection and mechanical strength of the components used. Finally, mechanical fixation can also be difficult to achieve in minimally invasive procedures. Summary of the Invention [Problem to be solved by the invention]

[0006] It is therefore an object of the present invention to overcome the drawbacks of the prior art, and in particular to provide a medical implant, a device for delivering the implant, and a method for delivering the implant that are easy and safe to use. [Means for solving the problem]

[0007] This and other objects are achieved by the medical implant, delivery device and method according to the characterizing portions of the independent claims of the present invention.

[0008] The medical implant according to the present invention is adapted to repair or close defects, particularly openings in the ventricular wall, atrial wall, or septum. In particular, the medical implant may be a patch, such as a polymer or pericardial patch. It comprises an adhesive composition. It further comprises two states: in a first state, the medical implant can be deployed at the implantation site while the adhesive composition is inactive. It can be activated to a second state, preferably at the implantation site, by an activation mechanism. In the second state, the adhesive composition can be cured by a curing mechanism. In particular, it is envisioned that the activation mechanism is the same as the curing mechanism. Alternatively, two different mechanisms may be used for activation and curing.

[0009] The medical implant may also be suitable for closing a cavity, such as the left atrial appendage. In particular, the implant may be sized and shaped to allow the implant to be attached to the mouth of the cavity.

[0010] The curing mechanism may be, inter alia, exposure to electromagnetic radiation, such as exposure to visible light, UV light, IR light, and / or X-rays. Curing may, inter alia, include cross-linking of the adhesive.

[0011] A patch is to be understood as a substantially flat structure, which is preferably mechanically flexible so that it can conform to the underlying surface shape or structure.

[0012] The implant is preferably sized and shaped to close openings in the ventricular and atrial septa, such as patent foramen ovale (PFO). Typically, medical implants for such applications have a substantially round, preferably circular, shape, although any shape is possible, such as triangular, square, or more complex shapes. They are substantially flat and have a typical diameter of 20-30 mm, preferably 20-25 mm. Naturally, this may be larger or smaller depending on the patient or opening being treated. For example, openings in children's hearts may be smaller, requiring a patch diameter as small as 10 mm. This may also be as large as 30 mm, for example, if the patient is very tall. Typically, medical implants have a thickness of 100-200 μm. Naturally, the thickness can also be tailored, being as thin as 50 μm or as thick as 1.5 mm, preferably as thick as 1 mm, and particularly preferably as thick as 500 μm.

[0013] Preferably, the medical implant comprises a material with self-healing and / or self-closing properties, which allows for easier implantation, as the implant can be temporarily held in place with an instrument, for example with a needle and / or suture, through a hole that automatically closes after implantation.

[0014] Additionally or alternatively, the implant may include a hole in the central region that allows or assists in retention by a delivery device.

[0015] Generally, highly flexible materials are preferred materials for the implants according to the present invention. High flexibility reduces the risk of tearing, breaking, and / or dislodging during and after implantation. However, it will be understood that rigid materials are also suitable in principle for the implants disclosed herein.

[0016] Preferably, in the first state, the medical implant comprises at least one cavity that accommodates the adhesive composition. Preferably, the medical implant comprises a plurality of cavities that are adapted to release the adhesive composition in the second state.

[0017] A cavity is understood to be a closed structure within a medical implant that can hold another substance, such as a liquid, a viscous liquid, or even a solid. For example, the cavity may be a large hollow structure or a small pore. Cavities are particularly advantageous for storing adhesive compositions in the first state because the adhesive is protected from the surrounding medium, particularly humidity / moisture from the body, such as bodily fluids. Therefore, it will not accidentally engage tissue before activation, preventing problems during deployment of the medical implant, such as catheter clogging due to adhesive leakage.

[0018] Generally, the adhesive may be electrically activatable. An example of an electrically activatable adhesive is, for example, the voltage glue disclosed in ACS Appl. Bio Mater. 2019, 2, 6, 2633-2642, which is incorporated herein by reference. However, any other electrically activatable adhesive is suitable. Generally, such adhesives may contain elements or molecules capable of forming radicals when exposed to voltage. The formed radicals may cause crosslinking.

[0019] Preferably, the implant is manufactured by additive manufacturing / 3D printing methods. Preferably, the implant comprises an optical fiber for distributing light within the implant, for example the optical fiber may comprise or consist of glass, polymer or, particularly preferably, biodegradable polymer.

[0020] The cavity can have at least two interfaces, and at least one property of the interfaces differs between one interface and the other. Preferably, the property includes at least one of permeability and solubility.

[0021] For example, the interfaces may be differentially permeable to adhesive to preferentially release adhesive at particular locations or sides of the cavity. Additionally or alternatively, they may be differentially permeable to blood or other bodily fluids.

[0022] Additionally or alternatively, the interfaces may differ in their solubility in blood or another bodily fluid, which may result in preferential release of adhesive at a particular location or side of the cavity.

[0023] In particular, at least one of the interfaces may comprise, and preferably consist of, at least one of PEG, PLA, PET, PU.

[0024] The two different surfaces may also be configured such that one surface is adapted to provide adhesion to tissue, while the other surface is adapted to enhance tissue and / or cell growth.

[0025] The medical implant can include a radiopaque element. The radiopaque element can be any element that provides contrast in radiographic imaging. Preferably, the radiopaque element comprises, and in particular consists of, barium sulfate, platinum, iridium, and / or tungsten. The radiopaque element can also be, in particular, a wire, a particle, or another marker.

[0026] Preferably, the medical implant comprises a support structure, and the radiopaque element is disposed within or formed by the support structure. For example, the medical implant can comprise a scaffold made from a polymer containing at least one, and preferably a plurality of, barium sulfate particles. Alternatively, a similar scaffold can be made from a radiopaque metal.

[0027] Particularly preferably, multiple radiopaque elements may be arranged in a particular pattern, spacing, geometry, or alignment such that data regarding the relative positions of the radiopaque elements, e.g., their spacing and / or alignment determined from imaging data, can provide information regarding proper attachment and / or positioning of the medical implant. For example, three markers can be evenly spaced around the implant. Additionally or alternatively, the radiopaque elements may have a particular shape that provides information regarding the attachment and / or positioning of the implant. For example, the radiopaque elements may have a curved shape that is kept straight by adhesive forces when the implant is attached to a straight surface. Thus, if the curved shape is determined via radiography, it indicates that the medical device has detached from the tissue. In particular, the radiopaque elements may be adapted to not exert a force sufficient to dislodge the implant.

[0028] Preferably, the radiopaque element is disposed within or formed by the adhesive composition. For example, barium sulfate particles can be dispersed in the adhesive composition. Additionally or alternatively, the adhesive can include a coordination polymer containing barium ions. Additionally or alternatively, the radiopaque element can include or consist of barium sulfate, iodine, tantalum, iridium, and / or iohexol, which can also be dispersed in the adhesive.

[0029] Preferably, the radiopaque element comprises at least one of barium sulfate and iodine. Iodine is particularly advantageous when the radiopaque element is used to track the degradation of an adhesive, patch material, or other portion of an implant. For example, if a medical implant is designed to degrade within the human body while allowing cellular overgrowth, iodine can be incorporated into the biodegradable material. The degradation of the biodegradable material can be tracked by radioimaging. For example, if anticoagulant therapy is required during degradation, but only during degradation, the imaging data can indicate whether the anticoagulant is still needed.

[0030] Preferably, the implant comprises at least one discrete marker. Discrete is understood to mean contained in a specific region or location. For example, the discrete marker can be used to distinguish one side of the implant from the other, or to distinguish between the upper and lower portions. Additionally or alternatively, the discrete marker can be deformable by pressure and indicate pressure at a specific location of the implant, for example, pressure caused by adhesive forces between the tissue wall and the implant. Particularly preferably, the discrete marker can be a spring that can trigger detachment when the adhesive forces between the implant and the tissue fall below a certain threshold, thus facilitating detection of dislodgement (similar to a predetermined break point).

[0031] The marker can be used, in particular, to guide a robot, preferably a microrobot, to the implantation site after the implant is implanted. The marker can define a position within the body and can particularly maintain its function for a certain period of time, for example, one year. Thus, robotic guidance can also be performed a certain amount of time after implantation. The marker can be detectable by the robot, thus enabling passive guidance. Alternatively, the marker can emit a signal that can be detected by the robot, thus enabling active guidance.

[0032] Preferably, the discrete markers are at least one of radiopaque and echopaque / echogenic. Particularly preferably, the discrete markers are configured as radiopaque elements.

[0033] The implant may include at least two discrete markers arranged at a predetermined distance and / or orientation from each other.

[0034] Preferably, the medical implant has a generally planar shape with a first surface and a second surface, the first surface and the second surface facing in substantially opposite directions, and at least one characteristic of the first surface differs from a corresponding characteristic of the second surface.

[0035] Those skilled in the art will appreciate that "generally flat" can encompass slightly curved, flat surfaces and shapes, particularly disk- or chip-like shapes.

[0036] The difference between the first and second surfaces may be with respect to any measurable quantity, the measurement of which results in significantly different values. Particularly preferably, the first and second surfaces differ in polarity, charge, functionalization, surface structure, surface pattern, material, coating, and / or porosity.

[0037] The first surface may be adapted to enhance cell ingrowth. In particular, the porosity of the surface may be adapted to allow cell ingrowth, for example, by having a pore size adapted to allow cell ingrowth. The pore size may be in the range of several micrometers to several hundred micrometers. Preferably, the pores have a diameter of 50 μm to 500 μm. Additionally or alternatively, the first surface may be biocompatible, particularly functionalized with growth factors or cell adhesion motifs. The first surface may include surface charges that activate and / or attract cells. The first surface may also have a surface roughness adapted to enhance cell ingrowth and / or include a velour-like surface.

[0038] In particular, at least one of the length, size, and 3D configuration of the pores and holes may be adapted to enhance cell ingrowth. Length may refer to the longest extension along the axis of the pore or hole, particularly in the case of non-spherical pores / holes.

[0039] Preferably, the first surface and / or the second surface may comprise or consist of a derivative of a polymer peptide.

[0040] Preferably, the second surface can be adapted to provide adhesion to biological tissue. In particular, the biological tissue can be one of human or animal tissue, such as endocardial tissue, pericardial tissue, and septal tissue. For example, the second surface can include an adhesive layer.

[0041] Preferably, at least one surface of the implant, in particular at least one of the first and second surfaces of the implant, comprises a velour-like surface. Particularly preferably, all surfaces of the implant comprise a velour-like surface.

[0042] Preferably, the adhesive composition is arranged on the medical implant in a pattern. The pattern may be non-uniform. In particular, the pattern may be printed on the implant by inkjet printing or extrusion printing. The pattern may also be regular, but may include a 3D structure and / or a non-uniform topography.

[0043] Preferably, the adhesive composition comprises gelatin methacryloyl (GelMA), especially GelMA of animal origin. Particularly suitable GelMA are fish GelMA, porcine GelMA, and bovine GelMA, i.e., GelMA derived from processed fish and / or pigs and / or cows. GelMA derived from cold-water fish is particularly suitable due to its mechanical flexibility at low temperatures (especially room temperatures). However, any type of commercially available GelMA is suitable for the present invention.

[0044] In particular, GelMA, especially when derived from pigs, can have a bloom value of 250 to 325. GelMA derived from fish may not have the bloom strength.

[0045] Preferably, GelMA has a molecular weight of 50 to 170 kDa. Preferably, the GelMA may be formed by a mixture of at least two GelMAs of animal origin, particularly preferably by a mixture of fish GelMA and porcine GelMA.

[0046] Mixing two GelMAs allows the properties of different GelMAs to be combined. For example, mixing (cold water) fish GelMA with porcine GelMA can produce a GelMA with the solubility of porcine GelMA and the mechanical flexibility of fish GelMA. By selecting different GelMAs, e.g., the ratio of porcine and fish GelMA, it is also possible to gradually adjust the properties, e.g., solubility and mechanical flexibility. Such GelMAs are known to those skilled in the art and are commercially available.

[0047] Additionally or alternatively, it is possible to tailor the properties of GelMA by varying and / or blending different molecular weights.

[0048] Preferably, the adhesive composition further comprises at least one photoinitiator. The adhesive composition may comprise several different photoinitiators, a single photoinitiator, or a mixture of different photoinitiators.

[0049] The photoinitiator may be one of the so-called Type I photoinitiators, preferably lithium phenyl-2,4,6 trimethylbenzoylphosphinate, LAP, Irgacure, and camphorquinone.

[0050] Additionally or alternatively, the photoinitiator may be one of the so-called Type II photoinitiators, preferably Eosin Y and mono / di / triethanolamine, Rose Bengal and mono / di / triethanolamine, and Riboflavin and mono / di / triethanolamine.

[0051] GelMA may also be crosslinkable by X-ray radiation. Particularly preferably, GelMA is crosslinkable via a photoinitiator that can be activated by X-rays. Alternatively, GelMA may be crosslinkable without a photoinitiator.

[0052] The medical implant may also include a rivet, particularly a blind rivet, which can be used to attach the implant to tissue.

[0053] Rivets are particularly advantageous because they are insensitive to, and therefore adhere reliably in, the presence of different temperatures, chemical environments, and humidity levels. Thus, rivets can preferably be used to at least temporarily attach a medical implant to tissue, for example, while the adhesive composition cures, the implant is placed, and / or other manipulations are performed on the implant by a medical professional.

[0054] The medical implant may include at least one retaining element for retaining at least one suture around the circumference of the implant, and further, the suture may be disposed within said loop.

[0055] Such a retention element provides a particularly easy way to temporarily attach a medical implant to a delivery device. In particular, suture(s) can provide the connection to the delivery device. The implant can be released by tearing the suture(s) and / or the retention element.

[0056] Preferably, the retention element comprises or consists of a loop of fabric. Alternatively, the retention element may also be formed by a scaffold folded to form a loop in the circumferential region of the implant.

[0057] The retaining element may also include a predetermined break point. Preferably, the at least one retaining element is formed from the same material as the medical implant.

[0058] Additionally or alternatively, at least one retaining element is formed from polyurethane having a thickness of 35 to 65 μm, preferably 45 to 55 μm.

[0059] Alternatively, the at least one retention element may be configured as a separate element disposed on the medical implant. For example, the retention element may be configured as a separate fabric strip attached to a peripheral region of the implant and folded to form a loop. Alternatively, the retention element may include a loop formed by a suture.

[0060] Preferably, at least one retaining element comprises a predetermined breaking point, particularly preferably a notch, which allows for control of where the retaining element breaks when releasing the implant and therefore allows for better control of the implant procedure.

[0061] The adhesive composition may also comprise, and in particular consist of, a dry adhesive composition. The dry adhesive composition may swell and / or become at least partially liquid upon exposure to a liquid. The dry adhesive composition may also be crosslinkable upon exposure to a liquid, such as a cyanoacrylate. For example, the GelMA described herein may be dried and used in this manner. Alternatively, any film-forming polymer, particularly a biopolymer such as hyaluronic acid, collagen, heparin, and their photopolymerizable counterparts (e.g., collagen methacrylate), is also suitable.

[0062] The dry adhesive composition is preferably activatable by exposure to a liquid, such as saline, blood, and / or water, upon rehydration. Additionally or alternatively, the dry adhesive may also be activatable by exposure to a cyanoacrylate. After rehydration, the previously dry adhesive may be curable by exposure to electromagnetic radiation, such as visible and / or UV light, in the presence of a photoinitiator.

[0063] Preferably, in the first state, the medical implant comprises a plurality of cavities, in particular micro-sized cavities.

[0064] Micro-sized cavities are understood to mean cavities of any shape with a characteristic size in the micrometer range, i.e., between 1 μm and 1000 μm. For example, a medical implant may contain multiple spherical cavities with a diameter of between 10 μm and 100 μm. This is particularly advantageous, as it ensures homogeneous distribution and, if necessary, mixing of the adhesive composition as it is released.

[0065] Preferably, at least one cavity contains an additive that swells when exposed to humidity. The at least one cavity can be adapted to undergo swelling to release the adhesive composition.

[0066] This allows for a particularly easy way of releasing the adhesive, as exposure to blood automatically causes the cavities to swell and thus release the adhesive.

[0067] Preferably, the medical implant comprises at least two different types of cavities. The two types of cavities may differ in size, composition, shape, or any other characteristic. For example, the two different types of cavities may contain different additives that cause them to swell at different rates. They may also have different wall thicknesses, different radii, or be made from different materials. They may also be adapted so that one type of cavity swells and the other type of cavity does not. This allows for better control of the release of the adhesive. For example, one component can be selectively released first, or one component can be released at a different rate than the other. If the adhesive contains only one component, this may also allow for better control of the release rate. For example, it may be advantageous to release a first fraction of the adhesive and then a second fraction at a later time. It is also possible to adapt the cavities to release the adhesive composition or its components at different pressures or temperatures.

[0068] Preferably, at least two different types of cavities are adapted to contain different components of the adhesive composition, particularly in liquid, gel, dry, or gaseous form. This can include, in particular, any of the features of the two different types of cavities described above. However, it can also include specific properties that allow the storage of specific components of the adhesive. For example, a specific wall material may be particularly advantageous for one component of the adhesive composition, but incompatible with another component. Therefore, it may be advantageous to adapt the cavities to specific components of the adhesive composition. Of course, this can also include cavities of different sizes or decomposition rates to account for the desired ratio of the two components in the final (mixed) adhesive composition.

[0069] Preferably, the adhesive composition comprises two components that are separately arranged within the cavity so that they are separated in the first state. This allows for controlled mixing in the second state, for example, at the implantation site. This is, of course, particularly advantageous for two-component adhesives that are not curable prior to mixing. In this case, unintended curing prior to adhesive release, for example due to accidental exposure to humidity or elevated temperatures, can be prevented. However, it is also conceivable to have an adhesive that only contains one component that further rigidifies the adhesive composition, for example, by crosslinking. Separate arrangement of such components may also be advantageous.

[0070] Preferably, the adhesive composition is adapted to be curable upon mixing of at least two components. This prevents accidental curing before the adhesive is released. Any curing mechanism that cures the curable adhesive composition after mixing is contemplated. This may be increased temperature, exposure to humidity, exposure to electromagnetic radiation such as visible light, infrared light, or ultraviolet light, or a combination thereof.

[0071] Preferably, the adhesive composition is adapted to be spontaneously curable upon mixing of at least two components. This provides a particularly advantageous method of developing the adhesive composition, as it does not require additional processing steps beyond the release and spontaneous mixing of the two components. For example, the first component may include a primary amine, and the second component may include an NHS ester. In the presence of functional groups in the first and second components, the adhesive can be cured upon mixing. However, it is of course possible to combine such adhesive compositions with additional curing mechanisms. For example, a two-component adhesive composition can be spontaneously cured upon mixing, but exposure to additional curing mechanisms, such as electromagnetic radiation, humidity, or increased temperature, can accelerate curing if necessary. The use of a third component as an additional curing agent is also contemplated.

[0072] Preferably, the cavity is adapted to release the adhesive composition upon increasing temperature, particularly in accordance with the temperature of the human body, thereby allowing automatic release of the adhesive composition after implantation as the implant is heated up to 37°C.

[0073] Preferably, the cavities are adapted to release the adhesive composition upon exposure to electromagnetic radiation. For example, the cavities can be decomposed or ruptured upon irradiation with visible light, infrared light, ultraviolet light, or the like. They may also be adapted to release the adhesive composition upon irradiation with a specific wavelength or wavelength range. When multiple types of cavities are present, they may also be adapted to release the adhesive upon irradiation with different wavelength ranges, allowing for selective release of one component at a time. In general, cavities adapted to release the adhesive composition upon exposure to electromagnetic radiation are particularly advantageous because they allow for combination with a delivery device capable of transmitting light for release, such as the delivery device disclosed in WO 15 / 1756632. This is also a particularly safe method of releasing the adhesive composition, as light is typically not widely present in the human body, thus preventing accidental release.

[0074] Preferably, the cavity is adapted to release the adhesive composition upon an increase in pressure. In particular, this allows the adhesive composition to be released upon inflation of the balloon. However, any other mechanism for generating a pressure increase is also contemplated. For example, the cavity may be adapted so that exposure to a liquid causes osmotic swelling, which results in a pressure difference. It may also include a separate inflation reservoir for applying pressure to the cavity, the implant, or another portion thereof.

[0075] Preferably, the cavity is adapted to release the adhesive composition upon mechanical compression, for example, compression by a balloon of a delivery device can be used, which is particularly advantageous since delivery devices with balloons are known and therefore easy to implement.

[0076] Preferably, the adhesive composition is adapted to be curable by exposure to electromagnetic radiation. This provides the same advantages as those already described in the context of the cavity adapted to be released upon exposure to electromagnetic radiation. For example, the adhesive composition may be curable upon irradiation with visible light, infrared light, ultraviolet light, etc. It may also be adapted to be curable upon irradiation with a specific wavelength or range of wavelengths. In general, adhesive compositions adapted to release the adhesive composition upon exposure to electromagnetic radiation are particularly advantageous because they can be combined with a delivery device capable of transmitting light for release, such as the delivery device disclosed in WO 15 / 1756632. This is also a particularly safe method of curing the adhesive composition because light is typically not widely present in the human body, thus preventing accidental curing.

[0077] Preferably, the medical implant includes a self-expanding support structure. The support structure may be any structure having greater mechanical stiffness and / or strength than the rest of the implant. For example, it may include at least one strut of polymeric material that provides mechanical stiffness to the implant. Additionally or alternatively, it may also include a structure that holds the medical implant in place at a desired implantation location, such as a PFO. For example, it may include a structure adapted to be placed within the defect and hold two patches, one on each side of the defect. Alternatively, it may hold only one patch. The self-expanding nature of the support structure allows for particularly easy deployment through a catheter. For example, it may be composed of a shape-memory material, such as a shape-memory polymer, or a shape-memory metal, such as nitinol. However, it is also contemplated to use an elastic material that is compressed within a delivery device and expands to its original shape at the implantation site.

[0078] Preferably, the cavity is formed by a closed capsule, in particular the cavity may be formed by a spherical capsule, which can be adapted to be opened by an activation mechanism.

[0079] Preferably, the capsules are adapted to rupture by an activation mechanism. They can be adapted to rupture by any of the activations described herein, such as exposure to electromagnetic radiation, an increase in pressure, an increase in temperature, or a combination thereof.

[0080] Preferably, the capsule walls are adapted to dissolve by an activation mechanism. This is particularly advantageous if they are adapted to dissolve upon exposure to water, blood, or another bodily fluid, because such an activation mechanism does not require additional handling or processing due to the natural presence of these fluids at the implantation site. This therefore provides a particularly easy and safe way to release the adhesive composition from the capsule.

[0081] Preferably, the capsules, and in particular the capsule walls, contain a fill material that can increase the mechanical strength of the cured adhesive. Thus, such capsules can serve a dual purpose by holding the adhesive composition and providing the fill material upon release.

[0082] Preferably, the medical implant comprises a porous foam, and in the first state, the adhesive composition is disposed within the porous foam. Of course, the foam can be combined with other cavities as described herein. For example, the medical implant may comprise cavities larger than the pores of the foam and containing a second component of the adhesive, a curing agent, or another substance. Foam should be understood as a material that is essentially composed of pores separated by pore walls, particularly those made of solid or liquid components. The pores of the foam typically exhibit statistically varying sizes and shapes. Typically, they are also permeable.

[0083] In a particularly preferred embodiment, the medical implant includes a braided structure supporting a porous foam.

[0084] Preferably, the porous foam comprises a solid wall. Preferably, the porous foam comprises a wall formed from a hydrogel. Hydrogels are particularly advantageous because they are typically biocompatible. Furthermore, they can be manufactured from a wide variety of different materials, and thus can be adapted to the application or even the patient being treated. Furthermore, the hydrogel can be functionalized and contain an active ingredient. The hydrogel can also be adapted to be biodegradable.

[0085] Preferably, the pore size of the foam is adapted to allow cell ingrowth, which facilitates the formation of tissue within or around the foam. This is particularly advantageous in combination with a biodegradable material such as a hydrogel adapted in this way. Thus, the medical implant can be adapted to degrade at a slower rate than cell ingrowth. Thus, the medical implant can function as a template or scaffold, and can be degraded in the body when the implant is replaced with body tissue.

[0086] Preferably, the medical implant comprises at least one reservoir, and at least a portion of the adhesive composition is disposed in the reservoir. A reservoir is to be understood as a compartment within the medical implant having a characteristic size approximately equal to the size of the implant itself. It may be disposed as a cavity within the medical implant. However, it may also be disposed as a separate reservoir attached to the implant. For example, it may be a blister on the surface of the medical implant. A reservoir may be advantageous when a relatively large amount of adhesive needs to be released quickly and / or when it is only needed at a specific location.

[0087] Preferably, the medical implant includes at least one separate expansion reservoir, which allows for localized expansion and therefore release of adhesive disposed within the cavity or reservoir. For example, a reservoir at a particular location on the medical implant can be first expanded to release a first portion of the adhesive. The remainder of the adhesive can then be released at a second time. Similarly, it is envisioned that two expansion reservoirs could be disposed to selectively release two portions separately, for example, at two different locations.

[0088] In a particularly preferred embodiment, at least one adhesive-filled reservoir is adapted to release said adhesive upon inflation of at least one expansion reservoir. Thus, the medical implant comprises at least one reservoir at least partially filled with adhesive and at least one expansion reservoir. However, it is of course also possible for the medical implant to comprise several expansion reservoirs and / or several adhesive-filled reservoirs. In particular, one expansion reservoir can be used to release adhesive from two or more adhesive-filled reservoirs. Similarly, two or more expansion reservoirs can be adapted to release adhesive from one adhesive-filled reservoir. This can provide additional safety through redundancy or can be used to provide an easy way to release defined first and second portions of adhesive from one reservoir.

[0089] Preferably, the reservoir is adapted so that adhesive is released only on one side of the medical implant. In particular, it may be released only on the distal side of the patch or on the proximal side of the patch. However, it is also envisaged that adhesive is released only on the sidewall side of the medical implant. This ensures proper placement of the adhesive facing the tissue and improves the medical implant. ImplantsWhen the adhesive composition is not in operable contact with tissue and is not designed to do so, adhesive release is prevented. As a result, the amount of adhesive composition required is also reduced, which is more economical and safer for the patient. Medical implants can be adapted to release adhesive only on one side by selecting different materials on each side, by varying the thickness and / or density of the material on each side, by changing the pore size and / or structure of the foam, or by changing any other property that can change the permeability of the implant material to the adhesive composition.

[0090] Preferably, the medical implant comprises at least one microchannel fluidly connected to a reservoir for releasing the adhesive. A microchannel is understood to be a channel fluidly connected to the surface of the medical implant and having a longitudinal shape with a small diameter compared to the size of the medical implant and the reservoir. In particular, it may have a channel diameter in the range of 1 to 1000 μm, preferably 25 to 750 μm, and even more preferably 50 to 300 μm. Such a microchannel allows for easy release of the adhesive composition from the reservoir.

[0091] In a particularly preferred embodiment, the medical implant is adapted to release the adhesive composition only on one side of the implant and comprises at least one microchannel. In particular, the implant may be adapted so that the adhesive is released only through said microchannel. Thus, the arrangement of the microchannel provides an easy way to adapt the medical implant to release the adhesive at a specific location, for example, only on one side of the implant.

[0092] Preferably, the adhesive composition is disposed as a fiber, particularly a solid fiber. Even more preferably, the adhesive composition comprises at least two components, at least one of which is disposed as a solid fiber. The solid fiber may comprise a dry adhesive, or an adhesive that can be melted (such as a hot melt), or an adhesive that swells when exposed to humidity or water. In particular, the adhesive composition may also be disposed as a coating on the fiber.

[0093] In particular, at least one of the fibers may include an aldehyde adapted to adhere to tissue.

[0094] good Preferably, the adhesive composition is adapted to at least partially dissolve and form a gel, particularly a hydrogel, upon exposure to a liquid, particularly one of an organic solvent, saline, and blood.

[0095] Preferably, the adhesive composition comprises at least one component from the group consisting of methacrylated gelatin, methacryloyl-substituted tropoelastin, poly(acrylic) acid, and methacrylated collagen. Poly(acrylic) acid can be used with a diacrylate / dimethacrylate / amide crosslinker.

[0096] Preferably, the adhesive composition comprises dry components adapted to be curable by a curing mechanism upon exposure to a liquid, particularly an organic solvent or blood. This is particularly advantageous because it allows for automatic activation of the adhesive upon implantation due to the presence of blood. Of course, the adhesive composition can also be adapted to only allow selective activation by an organic solvent. It can also be adapted so that exposure to blood activates the adhesive, but further exposure to an organic solvent accelerates the activation process. In particular, the adhesive can be adapted to be activated by internal or external fluids prior to implantation.

[0097] In particular, the adhesive composition may be activatable by rinsing with a solution containing a photoinitiator. Alternatively, the photoinitiator may be included in the dry adhesive and activated by exposure to a liquid. For example, it may be reactive only in an at least partially swollen adhesive and kinetically inhibited in a dry, solid adhesive.

[0098] Preferably, the medical implant comprises a scaffold made from a bioabsorbable or biodegradable material (hereinafter, reference to a "biodegradable" material shall be understood to encompass both bioabsorbable and biodegradable materials), particularly a woven, knitted, electrospun, melt-spun, and / or nonwoven bioabsorbable material, and / or a biological implant made by 3D printing. The scaffold can be used, inter alia, to promote cell ingrowth and tissue formation.

[0099] The present invention also relates to a method for deploying a medical implant comprising an adhesive. The method is particularly advantageous in combination with the medical implants described herein, although it should be understood that the method can be practiced with any other medical implant comprising an adhesive. The method includes deploying the medical implant in a first state at a first site, placing the medical implant in a second state via an activation mechanism, and curing the adhesive via a curing mechanism. The first site is preferably an implantation site. However, it is also possible to place the implant in the second state either outside or inside the body rather than at the implantation site.

[0100] Preferably, the method includes increasing the temperature of the medical implant to bring it to a second state. In particular, the increased temperature can be used to release the adhesive described herein, for example, by rupturing capsules and / or dissolving cavities.

[0101] Preferably, the temperature increase is at least partially provided by an external heat source, although it may also be provided solely by an external heat source.

[0102] Alternatively or additionally, the temperature increase is provided at least in part by the patient's body heat. It may also be provided solely by the patient's body heat.

[0103] Alternatively or additionally, the temperature increase is at least partly provided by electromagnetic radiation, in particular infrared light, although it may also be provided exclusively by electromagnetic radiation.

[0104] Preferably, the method includes applying pressure to bring the implant into the second state. For example, the applied pressure can squeeze the adhesive composition out of the capsules or cavities. It can also expel the adhesive composition from the pores of the foam.

[0105] Preferably, the pressure increase is at least partially caused by osmotic pressure. Alternatively, it may be caused solely by osmotic pressure. For example, the adhesive composition may contain an ion concentration higher than that of blood and may be contained in multiple cavities having walls through which water can diffuse. Osmotic pressure causes water to diffuse into the cavities. The cavities may be adapted to burst at a pressure lower than the osmotic pressure. Of course, this can be achieved by using only one or any other number of cavities.

[0106] Preferably, the pressure increase is at least partly caused by applying a mechanical deformation, in particular a mechanical pressure, to the implant. The skilled person will of course understand that all the possibilities for increasing pressure described herein can be combined.

[0107] Preferably, the method includes exposing the implant to humidity to bring it to the second state. Humidity can, for example, cause dissolution or rupture of cavities or capsules. It can also cause the adhesive composition to swell to a hardenable or hardened state. Any other mechanism for releasing the adhesive and / or bringing it to a hardenable state as described herein is contemplated.

[0108] Preferably, the method includes exposing the medical implant to electromagnetic radiation to a second state, which may be infrared, ultraviolet, or visible light, which may cause decomposition of the cavity or any other feature described herein to release the adhesive from the cavity and / or place it in a curable state.

[0109] Preferably, the method includes spontaneously mixing the two components in a second state, which causes the adhesive to harden. For example, the adhesive composition can include two components released from separate capsules by any of the mechanisms described herein. Upon release, the mixture spontaneously mixes due to loss of separation within the cavity. Thus, the adhesive composition can be adapted so that the two components react with each other without any other external trigger. This provides a particularly easy way to harden the adhesive composition. However, it is of course possible to combine such an adhesive composition with additional hardening mechanisms to further harden or rigidify it.

[0110] Preferably, the method includes exposing the medical implant to electromagnetic radiation to a second state, which cures the adhesive.

[0111] Preferably, the method includes expanding a separate expansion reservoir to place the implant in the second state. In particular, expansion of the separate expansion reservoir can squeeze adhesive out of the adhesive-containing reservoir.

[0112] Preferably, the method includes a step of placing a liquid in the implant to bring it to the second state. The liquid may be an organic solvent, in particular an organic solvent miscible with human blood. However, the liquid may also comprise or even consist of water, in particular saline.

[0113] The present invention further relates to a medical implant. The medical implant comprises at least one tear line disposed adjacent to the periphery of the medical implant. The medical implant is adapted to repair or close a defect, preferably an opening in the ventricular wall, the atrial wall, or the vascular wall. In particular, the medical implant may be a patch or any other implant disclosed herein. The medical implant is further adapted to attach to the tissue wall and tear along the tear line when deployed at the implantation site, particularly at the site of a septal defect.

[0114] A tear line is to be understood as any type of weakening of a material that creates a predetermined break site. Thus, when mechanical stress is applied to the material, the material will first break along the tear line. This allows a medical implant to be attached to a delivery device and easily released from the delivery device by breaking or tearing along the tear line. The tear line may be, for example, a weakening of the material due to aligned holes or perforations in the material, or it may be a region of reduced thickness or different material along a specific line.

[0115] The tear line may be located around the entire circumference of the medical implant or only in selected areas where the implant is attached to the delivery device. In particular, the medical implant may also include an elongate element separable from the medical implant by the tear line for attachment to the delivery device. For example, such an elongate element may be a flap or arm of the same material as the implant, or a strut of another material, such as a polymer or metal.

[0116] A preferred method of tearing the tear line is by inflation of a balloon on the delivery device. Therefore, the tear line is preferably positioned so that mechanical stress can be applied to it by the balloon. For example, a medical implant may include a tearable flap that is too short to reach the periphery of the balloon. Therefore, the tear line is positioned perpendicular to the longitudinal axis of the flap. Inflation of the balloon induces mechanical stress along the longitudinal axis of the flap, thus causing it to rupture along the tear line.

[0117] Preferably, the medical implant comprises a biodegradable material adapted to lose its mechanical strength in the human body within 3 years, preferably within 12 months, and even more preferably within 6 months, Loss of mechanical strength is intended to include in particular loss of molecular weight of the polymeric material, which reduces mechanical stiffness.

[0118] Preferably, the medical implant is coated between the outer edge and the tear line with a non-adhesive coating, particularly silicone and / or poly(tetrafluoroethylene), which prevents adhesion of the medical implant to tissue in the area designed to be retracted by the delivery device.

[0119] Preferably, the medical implant includes a slit, particularly a cross-shaped slit, adapted to allow the delivery device to extend partially through the slit. The slit can have any shape that provides an opening in the medical implant that can be closed. For example, it can also be a semicircular slit that forms a similarly shaped flap, or it can be a square slit. Straight slits are also contemplated, but must be long enough for the delivery device to extend through them. Furthermore, the slit is adapted so that the opening formed thereby has at least a tendency to close itself. This allows the delivery device to at least partially extend to both sides of the implant during delivery, but to be retracted through the medical implant after delivery. After retraction, the flap closes the opening.

[0120] Preferably, the medical implant comprises fibers, particularly woven fibers, spun fibers, or knitted fibers. This is particularly advantageous when the medical implant comprises or consists of a fabric patch. The fibers can be adapted to specific functions, such as being coated with adhesives or drugs, and / or being biodegradable. Of course, it is possible to combine different types of fibers in one medical implant, for example, fibers coated with different adhesives, adapted to biodegrade at different rates, or fibers adapted to elute different drugs, or any combination thereof.

[0121] Preferably, the fibers are made from biodegradable materials. Preferably, the biodegradable material is poly(lactic acid-co-glycolic acid), poly(L-lactic acid ) , poly(D-lactic acid), poly(glycolic acid), poly(caprolactone), copolymers and / or blends of any of these materials. These materials are particularly advantageous in that they are non-toxic, well known, approved for medical use, and readily available on the market.

[0122] Preferably, the medical implant includes a spine structure. In particular, the spine structure can have different mechanical properties than the rest of the medical implant. For example, it may be made of a different material or have different dimensions, such as a greater thickness. The spine structure allows for greater flexibility in adjusting the implant properties, since the mechanical properties can be adjusted without necessarily changing the implant material, which may have been selected for other properties.

[0123] Preferably, the spine structure comprises polyurethane, and particularly preferably consists of polyurethane.

[0124] Preferably, the spine structure extends beyond the medical implant to provide inelastic tear arms that can be used to connect the implant to a delivery device, particularly a central lumen, allowing for more reliable implant, particularly patch, release without limiting material selection.

[0125] Particularly preferably, a holding element for holding at least one suture is formed by or on the inelastic tear arm.

[0126] For example, the inelastic tear arms can be configured as extensions of the implant by cutting an implant including extension flaps from a sheet of implant material.

[0127] Preferably, the medical implant comprises an adhesive composition, particularly an adhesive composition adapted for attaching the medical implant to human tissue. In particular, any of the adhesive compositions described herein can be used. This preferably includes glutaraldehyde for pre-treatment of the tissue to which the medical implant will be attached. In particular, the adhesive composition may include a derivative of a polymer having a linker that covalently binds to cell surface molecules. Additionally or alternatively, the adhesive composition incorporated therein may include growth factors, chemotactic factors, coagulation or anticoagulation factors, and / or anti-inflammatory compounds.

[0128] Preferably, the tear line comprises a laser cut tear line, which provides a particularly easy and precise method of manufacturing medical implants having tear lines.

[0129] Preferably, the medical implant includes at least one extension that extends radially beyond the periphery of the medical implant, which allows for attachment to a delivery device.

[0130] In particularly preferred embodiments, the medical implant includes at least one extension extending radially beyond the periphery of the medical implant and a spine structure. In particular, the spine structure may also include a non-elastic tear arm as described herein, the non-elastic tear arm being configured to be included in the extension.

[0131] Preferably, at least one extension comprises a string and / or suture. In particular, the extension may consist of a string and / or suture. This is particularly advantageous as it provides a simple way of attaching the medical implant to the delivery device, for example by knotting or suture.

[0132] Additionally or alternatively, at least one extension comprises a strip of the same material as the medical implant, which can be particularly easy to manufacture, since the medical implant can be cut directly from the substrate, for example, along with the extension.

[0133] The retaining element for retaining the at least one suture may be formed by at least one extension.

[0134] Preferably, the at least one tear line is adapted, particularly positioned and dimensioned to undergo tearing to separate the at least one extension portion from the medical implant. If the medical implant includes a spine structure having inelastic and / or inextensible tear arms, the tear line can also be positioned to weaken the inelastic tear arms at the same or a different location as the at least one extension portion.

[0135] Preferably, the extension is adapted to retain the medical implant, preferably a patch, within the delivery device, in particular a balloon included in the delivery device.

[0136] Preferably, the implant is formed by a portion of the surface of an inflatable balloon of the delivery device. The balloon can be made of an implant-grade material, such as polyurethane. It can also include a tear line adapted to rupture at a predetermined pressure or tensile force. In particular, the tear line can be formed by weakening the material other than a hole or cut to allow efficient inflation. For example, the periphery of the balloon can have a thinner wall so that the balloon ruptures along the tear line. The balloon, or the area inside the tear line, can also be coated with an adhesive.

[0137] The present invention further relates to a delivery device for delivering a medical implant, particularly an adhesive-containing medical implant, comprising a tear line as described herein. The delivery device comprises a shaft having an implant holder for holding the implant. The implant holder is adapted to hold the implant, preferably at least partially along its periphery. In particular, it can hold the implant by an adhesive ring on the periphery of the medical implant. The delivery device further comprises an actuation mechanism for increasing the distance between at least two predetermined points on the implant such that the tear line is at least partially ruptured upon actuation of the actuation mechanism.

[0138] Preferably, the actuation mechanism includes an inflatable balloon. The delivery device, in particular the implant holder, can have a suture retaining element, which is adapted to hold at least one suture connected or connectable to the medical implant.

[0139] The retention element is particularly adapted to operatively connect, i.e., retain, an implant comprising the retention element with a suture.

[0140] Preferably, the delivery device includes a gauge, particularly preferably located on the handle, for indicating the adhesion force between the medical implant and the tissue.

[0141] The indicated adhesive force can be measured directly by the delivery device, for example by pulling on a portion of the implant and measuring the force. The force can be determined in the event of implant separation, which can be detected by sudden dislodgement. Alternatively, the applied force can be measured without separation, which provides a minimum value for adhesive force.

[0142] Alternatively, the gauge may indicate a value determined by a marker on the implant, for example a marker that is deformable under pressure.

[0143] The present invention further relates to a medical implant, preferably a patch, preferably a medical implant as described herein, in particular a medical implant adapted to close a defect, preferably an opening in a heart wall, in particular an atrial wall, a ventricular wall and / or a septum, or a vascular wall, or any other defect as described herein. The medical implant comprises at least one connecting element, in particular a bead, located on the outer edge of the medical implant. The connecting element has a size, in particular a thickness, that is larger than the size of the implant, such that the connecting element is adapted to engage with a delivery device having a suitable counterpart element for connection with said connecting element.

[0144] Preferably, the beads comprise a polymeric or metallic material. In particular, they may consist entirely of a polymeric or metallic material. They may be attached to a wire or suture.

[0145] The present invention further relates to a delivery device for a medical implant, particularly a medical implant comprising a connecting element as described herein. The delivery device comprises at least one tube comprising an actuating element. The actuating element may in particular be a wire disposed within the tube. The delivery device further comprises at least one holder, preferably at least two holders, operably connected to the actuating element and in particular attached to the wire. The tube and the at least one holder, preferably at least two holders, are adapted so that the medical implant is held by the at least one holder in a first state. The medical implant can be released by actuation of the actuating element.

[0146] The present invention further relates to a method of manufacturing a medical implant, preferably a medical implant as described herein, wherein the adhesive composition is at least partially liquid and is disposed on at least one surface of the medical implant. The adhesive composition is allowed to dry.

[0147] The adhesive composition may be dried after being placed on the implant, or may be dried first and then placed on the implant.

[0148] In particular, the adhesive composition can be dried under vacuum, or at least under subatmospheric pressure. Additionally or alternatively, elevated temperatures can also be used to dry the adhesive composition.

[0149] The present invention further relates to a method for manufacturing a medical implant, preferably the method described above. The method is preferably used to manufacture the medical implants described herein. At least one extension element is arranged on the outer periphery of the medical implant. The extension element preferably includes a predetermined breaking point. The at least one extension element is configured to form a retention element. For this purpose, the ends of the extension element may be arranged on the surface of the medical implant, in particular so that the extension element forms a substantially closed loop. The ends of the extension element are joined to fix the extension element in a configuration that includes the retention element. Preferably, the method further comprises the step of arranging a suture in the retention element, in particular in the substantially closed loop.

[0150] A substantially closed loop may be formed, inter alia, by, for example, placing two ends of an extension adjacent to one another and folding the extension so as to join the two ends together.

[0151] Adhesion is preferably achieved by application of an adhesive / adhesive composition. Additionally or alternatively, joining may also be achieved by welding, soldering, molding, and / or mechanical attachment (rivets, hooks, Velcro, stitching).

[0152] Preferably, the adhesive composition is disposed on the medical implant via inkjet or extrusion printing.

[0153] In particular, inkjet or extrusion printing allows for the placement of complex structures and patterns of adhesive on medical implants that may otherwise be difficult to achieve due to the brittleness of the adhesive composition when dried.

[0154] Alternatively, a continuous film of adhesive can be deposited and the pattern created by the stamp while the adhesive is in a liquid state.

[0155] Particularly preferably, the adhesive composition is configured in a predefined pattern to allow flexibility of the implant in a particular direction. For example, the adhesive composition may be configured as slices of a round disk, with the implant then being flexible along the axis separating the individual slices. Additionally or alternatively, the predefined pattern may include spikes, cones, triangles, cubes, barbs, wings, or other shapes.

[0156] The predefined pattern may be a two-dimensional pattern, i.e., a substantially flat adhesive film having a patterned structure. Alternatively, the pattern may also be three-dimensional, i.e., may also include a pattern along an axis perpendicular to the implant surface on which the adhesive composition is placed.

[0157] Three-dimensional patterns are particularly advantageous because they allow for localized adjustment of pressure. For example, cones extending from the surface may press against tissue with higher localized pressure than a flat film. Therefore, such structures may also promote tissue accumulation by diffusion into the tissue.

[0158] The present invention further relates to a method for treating defects, particularly openings in the ventricular or atrial wall or vascular wall, comprising the step of implanting a medical device, preferably a medical device as described herein. The implant comprises an adhesive composition. The adhesive composition may be hydrated in situ. Alternatively, the adhesive composition may be hydrated prior to delivery by flushing.

[0159] Hydration may be passive, i.e., via liquid water and / or vapor naturally present in blood or other bodily fluids, or active, i.e., via delivery of liquid, for example, through fluid conduits in a delivery device.

[0160] The present invention further relates to a method for treating defects, particularly openings in the ventricular wall, atrial wall, septum, or vascular wall. The implant is preferably an implant as disclosed herein, particularly an implant including a retention element. Preferably, a delivery device as described herein, preferably including a retention element, is used to perform the method. The method includes the steps of implanting the implant and pulling at least one suture. The medical implant is released by pulling the suture.

[0161] The present invention will now be described in detail with reference to the accompanying drawings. [Brief explanation of the drawings]

[0162] [Figure 1a] 1 is an illustration of an embodiment of a medical implant. [Figure 1b] 1 is an illustration of an embodiment of a medical implant. [Figure 2] 1 is a diagram of an embodiment of a medical implant implanted in a patient. [Figure 3] 1A-1C are diagrams of an embodiment of a delivery device having a medical implant. [Figure 4] 1A-1C illustrate an embodiment of a delivery device after release of a medical implant. [Figure 5a] 1 is a diagram of one embodiment of a medical implant and a schematic release mechanism. [Figure 5b] 1 is a diagram of one embodiment of a medical implant and a schematic release mechanism. [Figure 5c] 1 is a diagram of one embodiment of a medical implant and a schematic release mechanism. [Figure 6] 1 is an illustration of an embodiment of a medical implant. [Figure 7] 1A-1C illustrate an embodiment of a medical implant having a delivery device. [Figure 8] FIG. 1 illustrates one embodiment of a delivery device. [Figure 9a] 1A-1D are diagrams of different embodiments of medical implants. [Figure 9b] 1A-1C are diagrams of different embodiments of medical implants. [Figure 9c] 1A-1C are diagrams of different embodiments of medical implants. [Figure 9d] 1A-1C are diagrams of different embodiments of medical implants. [Figure 10a] 1 is an illustration of an embodiment of a medical implant. [Figure 10b] 1 is an illustration of an embodiment of a medical implant. [Figure 11a] 1 is an illustration of an embodiment of a medical implant. [Figure 11b] 1 is an illustration of an embodiment of a medical implant. [Figure 12] 1 is a diagram of one embodiment of a medical implant and a schematic release mechanism. [Figure 13] 1 is a diagram of one embodiment of a medical implant and a schematic release mechanism. [Figure 14] 1 is a diagram of one embodiment of a medical implant and a schematic release mechanism. [Figure 15a] 1A-1C are schematic diagrams of different embodiments of adhesive delivery. [Figure 15b] 1A-1C are schematic diagrams of different embodiments of adhesive delivery. [Figure 15c] 1A-1C are schematic diagrams of different embodiments of adhesive delivery. [Figure 16a] 1 is an illustration of an embodiment of a medical implant. [Figure 16b] 1 is an illustration of an embodiment of a medical implant. [Figure 17] 1 is a diagram of an embodiment of a medical implant implanted in a patient. [Figure 18a] FIG. 1 is a diagram of a patch having capsules containing a fill material. [Figure 18b] FIG. 1 is a diagram of a patch having capsules containing a fill material. [Figure 19a] FIG. 1 is a side view of a patch having different first and second surfaces. [Figure 19b] FIG. 1 is a side view of a patch having different first and second surfaces. [Figure 20a] FIG. 1 is a top view of a patch having a patterned adhesive layer. [Figure 20b] FIG. 1 is a top view of a patch having a patterned adhesive layer. [Figure 21a] 1A-1C are diagrams of patches having different embodiments of radiopaque markers. [Figure 21b] 1A-1C are diagrams of patches having different embodiments of radiopaque markers. [Figure 21c] 1A-1C are diagrams of patches having different embodiments of radiopaque markers. [Figure 22] FIG. 1 is a diagram of a patch with discrete markers. [Figure 23a] FIG. 1 is a diagram of a patch with dry adhesive prior to activation. [Figure 23b] FIG. 10 is a diagram of a patch with dry adhesive after activation. [Figure 24a] FIG. 12 illustrates one of two embodiments of a handle for a delivery device having a gauge. [Figure 24b] FIG. 12 illustrates one of two embodiments of a handle for a delivery device having a gauge. [Figure 25] FIG. 1 is a diagram of a patch having an adhesive with a three-dimensional pattern. [Figure 26a] FIG. 1 is a schematic diagram of a method for patterning an adhesive layer on a patch. [Figure 26b] FIG. 1 is a schematic diagram of a method for patterning an adhesive layer on a patch. [Figure 26c] FIG. 1 is a schematic diagram of a method for patterning an adhesive layer on a patch. [Figure 26d] FIG. 1 is a schematic diagram of a method for patterning an adhesive layer on a patch. [Figure 27a]1 is a schematic diagram of a method for manufacturing a patch having a retention element. [Figure 27b] 1 is a schematic diagram of a method for manufacturing a patch having a retention element. [Figure 27c] 1 is a schematic diagram of a method for manufacturing a patch having a retention element. [Figure 27d] 1 is a schematic diagram of a method for manufacturing a patch having a retention element. [Figure 28a] 1 is a schematic diagram of one embodiment of a scaffold of a medical implant. [Figure 28b] 1 is a schematic diagram of one embodiment of a scaffold of a medical implant. [Figure 29] 1 is a diagram of a medical implant with a retention element attached to the retention element. [Figure 30] FIG. 1 is a schematic diagram of an implant attached to a tissue wall. DETAILED DESCRIPTION OF THE INVENTION

[0163] 1a and 1b show one embodiment of a medical implant 1 according to the present invention. The implant comprises a fabric patch 5 having a tear line 3. The fabric is a woven fabric of biocompatible fibers made of polyglycolic acid and coated with a bioadhesive. Additionally or alternatively, the fibers may be made from another polymer, such as PET.

[0164] Figure 1a shows a side view of a medical implant 1. The silicone layer 2, which is located on only one side of the implant 1, is very visible in this view. This prevents adhesion between the medical implant and the patient's tissue in areas that will not remain in the patient. The thickness T of the implant can also be seen in this view, which is 150 μm.

[0165] FIG. 1b shows a front view of the medical implant 1. The fabric is mechanically flexible and can conform to the patient's anatomy and the surface structure of the tissue at the implantation site. The tear line 3 includes multiple laser-cut portions along the periphery of the patch 5 that together form a circular, predetermined tear line. The tear line is adapted to break under radial stretching of the patch 5 and does not have any free fibers after tearing. Between the outer edge OC of the medical implant 1 and the tear line 3, there is a layered silicone 2 as a non-adhesive material. The patch 5 further includes a cross-shaped slit 4 in its center adapted to allow a delivery device (not shown) to be partially extended therethrough. The patch is adapted to degrade within the human body within six months. The woven structure promotes tissue growth to replace the tissue before the implant is degraded. The implant is 25 mm in diameter, including a rim on the outer edge OC, and the patch is 20 mm in diameter after tearing along the tear line 3.

[0166] FIG. 2 shows a medical implant 1 in the form of a patch 5 at an implantation site. The implantation site is a defect D in the atrial wall W of a patient's heart. Here, the medical implant 1 is shown during the implantation process. A delivery device C with a positioning device P extends partially through the patch 5 and its central notch (not visible). The patch is coated with an adhesive composition 6, in this case GelMA. Alternatively, glutaraldehyde may be utilized, which effectively attaches the patch 5 to the atrial wall W.

[0167] FIG. 3 shows a medical implant 1 similar to that shown in FIG. 2. Here, the implant is shown during the implantation process but before removal from a delivery device (not shown) including balloon B. The medical implant comprises a patch 5 made of knitted fabric attached to balloon B by an adhesive rim 7 on the balloon side of medical implant 1, and between the outer edge OC of medical implant 1 and its tear line. On the other side, implant 1 is coated with adhesive composition 6 in the area surrounded by tear line 3. Between tear line 3 and outer edge OC, at the site opposite adhesive rim 7, there is a PTFE coating that prevents adhesive wetting and therefore adhesion. In the illustrated illustration, balloon B is partially inflated.

[0168] 4, further expansion applies force F to the patch (not shown for clarity) and tear line 3 due to stretching of the outer rim 8 of the medical implant, which is attached to the balloon B via adhesive rim 7, in a direction perpendicular to the longitudinal axis L of the delivery device. Further expansion therefore ruptures tear line 3 and releases patch 5. Here, a delivery device C is shown, adapted to expose the patch to electromagnetic radiation E.

[0169] 5a-5c show a schematic representation of a medical implant 1 and a release mechanism for the medical implant 1. Here, the medical implant comprises a patch of spun fibers of polylactic acid. However, it will be understood by those skilled in the art that the release mechanism can be combined with any patch material or even any type of medical implant. The implant 1 comprises beads 9 made from a polymeric material. Here, the beads are made from a biodegradable polymeric material adapted to degrade in the human body, typically within two weeks. Of course, they can also be adapted to degrade faster or slower. These are attached to the edge OC of the medical implant 1.

[0170] Figure 5a shows the medical implant 1 from the side. In this view, it is particularly clear that the beads 9 have a diameter greater than the thickness of the medical implant. Here, the beads 9 have a slightly elongated shape, although it is also possible to arrange spherical beads.

[0171] In Figure 5b, the medical implant 1 is shown from above. It is clearly visible that the beads are considerably smaller than the medical implant. Typically, they have a diameter of 300 μm, but may be up to 1 mm in diameter. Here, the implant 1 includes four beads evenly spaced around the circumference of the medical implant 1. Of course, it is envisioned to have a greater or lesser number of beads on the medical implant and / or to space them unevenly.

[0172] FIG. 5c illustrates a schematic diagram of how the implant 1 shown in FIGS. 5a and 5b can be released. The delivery device includes at least one tube 10, typically one tube 10 for each bead 9 attached to the medical implant 1. The tube 10 is provided with a wire 11 having a lower holder 12a and an upper holder 12b. The holders 12a and 12b are adapted so that the bead 9 located between them within the tube 10 cannot pass through the holders along the length of the tube. Thus, for implantation, the bead 9 is positioned within the tube 10 between the upper and lower holders 12b and 12a. This enables the illustrated release mechanism, in which the wire 11 is actuated to release the upper holder 12b from the tube 10. This allows the bead 9 to also exit the tube 10, thus releasing the implant 1.

[0173] 6 shows another embodiment of a medical implant 1 and a schematic release mechanism. Here, the medical implant 1 comprises a patch 5 made from a biodegradable fabric. The fabric comprises fibers coated with an adhesive composition (not shown). The implant 1 comprises four extensions 13 extending outward from the implant 1. Each extension 13 is separated from the implant 1 by a tear line. Here, the extensions are made of the same material as the patch 5. This is particularly simple, but it is of course possible to include other materials. The tear lines are configured so that when the tear line is torn, the patch 5 becomes substantially spherical and has a diameter of 20 mm.

[0174] FIG. 7 shows another embodiment of a medical implant 1. Here, a balloon B is attached to a delivery device (C). The balloon is made of an implant-grade material, here polyurethane. The balloon is coated on its distal side with an adhesive composition 6. It is substantially circular and further includes a tear line 3 disposed in a plane substantially perpendicular to the longitudinal axis L of the delivery device C. Here, the tear line is formed as a thinner wall portion of the balloon B that creates a predetermined break point. However, it still remains sealed to allow expansion of the balloon B. The expansion of the balloon B generates tangential mechanical stress in the balloon wall. Due to the predetermined break point, the balloon breaks along the tear line 3. The patch formed by the break is adhered to the tissue by the adhesive composition 6. Thus, the medical implant was part of the balloon B during delivery.

[0175] FIG. 8 shows another embodiment of a delivery device C. Here, the delivery device C includes a balloon B described in other embodiments, which can be used to deliver a medical implant 1. Naturally, any medical implant 1 described herein can be combined with a delivery device such as the one shown herein. Here, the medical implant consists of a fabric patch having adhesive fibers. The delivery device includes a second balloon 14 that forms an outer layer around the balloon B and the medical implant 1, thus protecting the patch and adhesive from contact with tissue. Here, the outer balloon 14 includes an opening 30 located approximately in the center of the medical implant 1. This provides an advantageous method for implanting the medical implant 1, but is optional. This allows for preliminary attachment to tissue. For deployment, the outer balloon is retracted away from the implant 1 along the longitudinal axis L of the delivery device. This exposes the implant 1 to the tissue, allowing the adhesive composition to adhere to the tissue.

[0176] 9a-9d show different embodiments of fabric patches cut from the fabric scaffold. Accordingly, the extensions 13 shown here are made of the same material as the patch 5. For clarity, only one reference number is shown for certain identical features throughout FIGS. 9a-9d. The extensions 13 shown in these embodiments have a typical length of 15 mm and a width of 3.5 mm. Naturally, these values can be adapted to achieve a particular mechanical strength or to adapt the patch to a particular delivery device.

[0177] 9a shows a patch having eight extensions 13 made from PET fabric 15. The extensions 13 are each separated from the patch 5 by a tear line 3. PET is a non-absorbable material. Therefore, the illustrated embodiment is particularly advantageous when it is not possible or desirable to replace the implant with tissue, for example, because the newly formed tissue is not stable enough.

[0178] FIG. 9b shows an embodiment of patch 5 having only two extensions 13. Fabric 15 is made of knitted poly(L-lactic acid) (PLLA). PLLA is absorbed by the body within two years. Therefore, the embodiment shown is particularly advantageous when cell ingrowth is slow or when support from patch 5 is desired for one to two years.

[0179] 9c shows an embodiment of a patch 5 cut from a fabric 15 made from electrospun polycaprolactone (PCL). It includes six extensions 13, each separated from the patch 5 by a tear line 3. PCL is particularly advantageous for electrospinning, and therefore provides an easy method of manufacturing the fabric 15. It degrades in the human body within about six months, and is therefore the material of choice when relatively fast degradation is necessary or desired.

[0180] Figure 9d shows another embodiment of a patch made from the same electrospun PCL fabric 15 as shown in Figure 9c. The patch 5 has a circular shape and a continuous circular-shaped tear line 3 around its periphery that forms an outer rim 8.

[0181] 10a and 10b show another embodiment of a medical implant 1 in a cross-sectional view (FIG. 10a) and a top view (FIG. 10b). For clarity, only one reference number is shown for identical features. The medical implant 1 comprises a fiber-functionalized, directional electrospun patch. The implant 1 comprises reservoirs 16 that can be filled with an adhesive composition. Regions 18 of the patch 5 can be functionalized to have lower permeability, thereby preventing adhesive disposed in the reservoirs 16 from penetrating the patch and being released onto this side of the medical implant. Instead, the illustrated embodiment comprises microchannels 17 integrated by selective laser welding. These microchannels 17 are fluidly connected to the outer surface of the medical implant 1 and the reservoirs 17. Thus, adhesive can be released in a directional manner by the microchannels.

[0182] 11a and 11b show one embodiment of a spine structure 31. FIG. 11a shows a single spine structure 31. The illustrated spine structure is made of the same or a different polymer as the patch. It includes three elongated structures 19, 20. This is typically the most advantageous configuration in terms of providing sufficient mechanical stability to the implant. However, if necessary, the spine structure can be configured with several additional elongated structures, or only one or two of them. The elongated structures include an inner portion 20 and tear arms 19 separated by a predetermined breaking point 33. The tear arms generally have a lower elasticity than the inner portion. The inner portion 20 is positioned in an area close to the medical implant 1 and is designed to remain in the patient after implantation. Therefore, the length of one arm of the inner portion 20 is approximately half the diameter of the implant, typically about 10 mm. Naturally, the size of the entire spine structure 31 and the inner portion 20 can be adapted to the specific implant and therefore can be larger or smaller. The inner portion provides mechanical stability to the implant during delivery and implantation, and also provides additional support after implantation. The spine structure 31 further comprises a round hole 32 in the center of the structure 31. This allows a delivery device and / or a positioning device (neither shown) to be extended through the spine structure 31 and retracted again through it. Additionally, less elastic tear arms 19 can be attached to the delivery device. Fracture at a predetermined break point allows release of the implant 1. The spine structure 31 shown here provides a particularly advantageous way of decoupling the force required to release the patch from the mechanical properties of the medical implant 1.

[0183] FIG. 11b shows a spine structure with the same features as shown in FIG. 11a but in combination with a medical implant 1.

[0184] FIG. 12 shows a delivery device C and a schematic release mechanism for a medical implant 1. The delivery device C comprises an inflatable or expandable structure, such as a balloon B, and an outer strut 21 for retaining and releasing the medical implant 1. Here, the medical implant includes a suture having a notch 22 that is retained by the outer strut 21. The notch retention and release mechanism substantially corresponds to the ball release shown schematically in FIG. 5c, and the notch 22 has the technical effect of a ball shown in FIG. 5c. Thus, the balloon B can be used to apply pressure to the medical implant, but is not necessary to release the implant 1 from the delivery device C.

[0185] Figure 13 shows a delivery device C similar to that shown in Figure 12. However, here the outer struts 21 are connected to the medical implant 1 through sutures 23. The sutures are fixedly connected to the outer struts 21 which do not include a mechanism to release the sutures 23. Instead, the balloon B, when inflated, pushes the outer struts 21 away from the medical implant, thus breaking the connection and releasing the implant 1.

[0186] FIG. 14 schematically illustrates a delivery device C having a medical implant 1 similar to that shown in FIG. 6. The implant 1 includes elongated flaps 13 connected to the implant 1 through tear lines 3. The illustrated embodiment of the implant 1 has four such flaps 13, but can be adapted to have fewer or more flaps. The delivery device includes a balloon B. Upon inflation, the balloon exerts a force on the tear lines 3, causing them to rupture and release the implant. The flaps 13 can then be retracted along with the delivery device C, leaving the medical implant 1 in place within the patient. Although not shown here, the illustrated embodiment is well suited to being combined with a spine structure such as that shown in FIGS. 11a and 11b.

[0187] 15a to 15c show schematically different embodiments of a patch 5 comprising an adhesive composition.

[0188] FIG. 15a shows a patch 5 containing two different types of cavities 24a, 24b. The cavities 24a, 24b are spherical and have a diameter of approximately 1 mm. The patch has a diameter of 20 mm and is made of poly(lactic-co-glycolic acid). Other absorbable materials, such as PLA-GA, PLGA, PCL, and PU, can also be used. Alternatively, non-absorbable materials, such as PET, PE, and / or PP, can be used. The cavities 24a, 24b contain two different components of the adhesive composition: a resin and a curing agent. The resin and curing agent are physically separated from each other and become hardenable when mixed. Therefore, the adhesive composition is not hardenable in the illustrated state with the two components separated. However, the cavities 24a, 24b in the illustrated embodiment are adapted to rupture upon application of mechanical pressure, such as that exerted by an inflatable balloon. Rupture of the cavities causes the release of both components of the adhesive composition, allowing it to harden. Typical adhesives may be GelMA (methacrylated gelatin), CollMA (methacrylated collagen) or MeTro (methacrylated tropoelastin).

[0189] FIG. 15b shows a patch comprising a foam 25. The pores 35 of the foam are surrounded by walls 34 made of a hydrogel. The hydrogel is adapted to degrade within the human body within 24 months. The pores 35 are filled with an adhesive composition. The patch is adapted to release the adhesive composition from the pores 35 upon mechanical deformation. Here, the adhesive composition is curable by exposure to electromagnetic radiation. Those skilled in the art will understand that any adhesive composition can be combined with the illustrated patch, particularly with any curing mechanism. The pores 35 are sized to promote cell ingrowth, so that after release of the adhesive composition, the empty pores can function as scaffolds for tissue growth. The biodegradation of the patch 5 is adapted so that the patch degrades after new tissue formation.

[0190] FIG. 15c shows yet another embodiment of patch 5. The patch shown is made from electrospun fibers 26 of polycaprolactone. The fibers have a diameter of approximately 3 μm and a length of several hundred μm. The fibers are coated with methacrylated gelatin as an adhesive composition. This patch can therefore be easily attached to tissue and is particularly easy to manufacture by electrospinning. Of course, those skilled in the art will understand that the fibers can also be made of an adhesive composition instead of being coated therewith. Similarly, while polycaprolactone is particularly advantageous for electrospinning, the fibers may be made from other materials.

[0191] Figures 16a-b show an embodiment of a medical implant 1 in side cross section. The implant 1 comprises an expansion reservoir 27, a patch 5 and a separate layer 28 containing a reservoir 16 for containing adhesive. The illustrated embodiment is similar to the medical implant shown in Figures 10a and 10b.

[0192] Figure 16a shows the medical implant 1 in a first state. The expansion reservoir is empty. The reservoir 16 for containing the adhesive is filled with the adhesive. Typically, the adhesive may be a poly(acrylic) acid using an acrylate / methacrylate / amuse crosslinker.

[0193] The patch 5 is made of electrospun Dacron fibers and is not biodegradable, although it would of course be possible to adapt the patch 5 to be biodegradable. The layer 28 containing the adhesive reservoir 16 is made of solid Dacron.

[0194] FIG. 16b shows the medical implant 1 in a second state in which the expansion reservoir 27 is expanded. The expansion of the expansion reservoir 27 applies mechanical pressure to the adhesive-containing reservoir 16, which is subsequently squeezed out, forming a layer of adhesive 6 on one side of the implant 1. Here, the patch 5 is adapted to be impenetrable by the adhesive composition, thus selectively releasing the adhesive composition on the other side of the implant. The expansion reservoir is adapted to be removed after expansion; however, it is also envisioned that it may be formed from an implant-grade material that remains in the patient.

[0195] 17 shows another embodiment of a medical implant according to the present invention in an implanted state for closing a defect D in a heart wall W. The implant 1 comprises a support structure 29 that extends around the defect D. The support structure is made of a shape-memory polymer that provides self-expansion at the implantation site. Upon expansion, it engages the defect D. Attached to the support structure 29 are two patches 5. The patches in the illustrated embodiment comprise electrospun Dacron fibers coated with methacrylated collagen that swells when exposed to body humidity. However, it will be appreciated that any of the patches described herein may be used.

[0196] Of course, those skilled in the art will understand that the embodiments described herein are examples and do not limit the scope of the invention. In particular, different features described herein can be freely combined with other features and / or used without particular features.

[0197] 18a and 18b show an embodiment of a patch 5 that includes a capsule 36 having a fill material 37 within the capsule wall 38. FIG.

[0198] Figure 18a shows the patch in a first state. The capsules 36 are spherical, have a diameter of approximately 0.5 to 2 mm, and are uniformly distributed within the patch 5. The capsules 36 contain an adhesive composition 6 containing methacryloyl-substituted tropoelastin. Here, the capsules 36 are adapted to rupture due to osmotic pressure. For example, exposure to blood or another liquid causes the capsules 36 to swell. The resulting pressure increase then causes the capsules 36 to rupture.

[0199] Figure 18b shows the patch 5 in a second state after rupture of the capsule 36. The adhesive composition 6 is evenly distributed over the surface of the patch 5. The filler material 37 remains in the adhesive composition 6 and provides additional mechanical strength to the adhesive layer.

[0200] 19a is a side view of patch 1. Patch 1 has a first surface 101' and a second surface 102. First surface 101' is configured as a velour-like surface with short strands of fabric 101'' extending outward from first surface 101'. Second surface 102 includes an adhesive layer. Medical implant 1 is made of polyurethane, and velour-like surface 101' includes polyurethane fibers. In the configuration shown, velour-like surface 101' promotes cell ingrowth and thus tissue overgrowth, while second surface 102 provides adhesion to tissue.

[0201] FIG. 19b shows an embodiment similar to that shown in FIG. 19a. The medical implant 1 comprises a first surface 103′ and a second surface 103″. The first surface 103′ has a lower permeability to the adhesive composition (not shown) than the first surface 103′. In this case, this is achieved by a thicker layer of porous material. The implant contains the adhesive composition and is able to release it by a sponge-like mechanism when mechanical pressure is applied. The adhesive composition preferentially penetrates the second surface 103″, and therefore the second surface 103″ provides higher adhesion when activated compared to the first surface 103′.

[0202] FIG. 20a shows a patch 1 with an adhesive layer 104 having a patterned structure. The pattern is configured as five circular sectors that form the patch 1. As a result, there are four intermediate sectors 105 that do not contain an adhesive layer. The adhesive layer 104 is printed by inkjet printing and is based on a mixture of porcine and fish GelMA. Alternatively, extrusion printing may also be used. In this example, the pattern is two-dimensional. Therefore, the adhesive layer is substantially flat, and the sectors 104, 105 of the patch 1 differ in whether they have an adhesive layer or not, but the thickness of the adhesive layer does not differ.

[0203] Figure 20b shows a medical implant similar to that shown in Figure 20a. Patch 1 includes an inkjet printed pattern of adhesive 104. The adhesive pattern is two-dimensional and is located approximately around the periphery of patch 1. The adhesive pattern includes several curved lines.

[0204] It will be appreciated that any particular adhesive pattern can be placed on the patch, particularly if the adhesive is inkjet printed. Alternatively, extrusion printing may also be utilized.

[0205] 21a shows an embodiment of a patch 1 having a radiopaque element 106. The radiopaque element 106 consists of four beads comprising barium sulfate disposed in a circumferential region of the patch 1 and spread substantially evenly around the periphery of the patch 1.

[0206] Figure 21b shows an alternative embodiment of the patch 1 having a radiopaque element 107. The radiopaque element 107 consists of a cross-shaped metallic spine structure.

[0207] Figure 21c shows an alternative embodiment of the radiopaque elements 108, 109 on the patch 1. The polyurethane spine structure 108 contains iodine-filled minicapsules 109. The iodine provides radiopacity.

[0208] FIG. 22 shows a patch 1 having discrete markers 110. The discrete markers 110 are configured as spring-like elements. The discrete elements 110 are made of titanium and are therefore both radiopaque and echopaque. However, the discrete markers 110 could alternatively be configured to be non-radiopaque and / or non-echopaque. The discrete markers are deformable by pressure and thus provide information about the pressure acting on the patch 1 at that location. In this example, the pressure can be read by measuring the extension of the markers 110 along their longitudinal axis (perpendicular to the surface of the patch 1), for example by radiography.

[0209] Figure 23a shows a medical implant 1 having a dry adhesive 111'. The dry adhesive comprises fibers 112 of porcine GelMA that have been spun from an aqueous solution and then dried. Any gelatin may be utilized in addition to or as a substitute for porcine GelMA.

[0210] Figure 23b shows the medical implant 1 of Figure 23a after exposure to an aqueous liquid. The adhesive composition 111" swells from the uptake of water, and therefore the fibers 112" have a larger diameter compared to the dry fibers 111', 112'. In the swollen state, the fibers 112" exhibit adhesive strength to human tissue.

[0211] 24a shows the handle 113 of the delivery device. The handle 113 is equipped with a digital gauge 114' adapted to display a numerical value representing the adhesive strength between an implant as described herein and human tissue (not shown) to which it is attached. The gauge 114' is attached to the implant at its distal end and measures the adhesive strength.

[0212] 24b shows an alternative embodiment of the handle 113. The analog gauge 114'' provides a qualitative measure (e.g., high, medium, low) of the adhesive force between the implants described herein and the human tissue (not shown) to which it is attached.

[0213] It will be appreciated that digital gauges can also be used to indicate qualitative measurements and / or analog gauges can be used to indicate numerical values.

[0214] Figure 25 shows an embodiment of a medical implant 1 having a three-dimensionally patterned adhesive 115. The adhesive is formed as evenly spaced cones 116 on one surface of the implant. The medical implant is configured as a patch made of pericardium. The adhesive 115 consists of cones 116 of fish GelMA.

[0215] 26a-26d show a schematic representation of a method for patterning an adhesive composition onto a medical implant 1. FIG.

[0216] Figure 26a shows a medical implant 1 made of polyurethane with a smooth and homogeneous adhesive layer 117'. The adhesive is based on bovine GelMA.

[0217] 26b shows a stamp-like element 118. The stamp-like element has a shape that represents a negative of the desired adhesive pattern on the medical implant 1. The stamp-like element 118 is made of a metallic material with a PTFE coating. Therefore, the stamp-like element 118 does not adhere to the adhesive layer 117' and can be easily removed from the adhesive-bearing surface.

[0218] Figure 26c shows a stamp-like element 118 being pressed onto the adhesive layer 117' of the medical implant 1. The stamp-like element 118 displaces the adhesive laterally.

[0219] Figure 26d shows the medical implant 1 after the stamp-like element has been removed. The adhesive layer 117'' has a pattern that substantially corresponds to the negative shape of the stamp-like element. Thus, the medical implant 1 comprises areas 119 that are not covered by the adhesive layer. The collection of areas 119 substantially corresponds to the shape of the stamp-like element.

[0220] Any of the implants and adhesives disclosed herein are suitable for patterning using the method shown in Figures 26a-26d. It is also possible to pattern three-dimensional patterns using the method of Figures 26a-26b.

[0221] Figures 27a to 27d show schematically a method of manufacturing a medical implant 1 comprising a retaining element for retaining suture(s).

[0222] 27a shows the first step of the method. The medical implant 1 is positioned with three radially extending flaps 120. In this case, the extension flaps 120 are made from polyurethane and are separately attached to a patch 121 made from pericardium. One of the three extension flaps 120 includes a notch 122 that serves as a predetermined breaking point to reduce the force required to break the extension flap and / or to control where the break occurs. Alternatively, it would be possible to have any number of extension flaps 120, with or without notches.

[0223] Figure 27b shows the medical implant 1 of Figure 27a with the extension flaps folded towards the center of the medical implant 1. After folding, the medical implant 1 has a substantially round shape. A passageway is formed around the area of the fold 123 (not visible, see Figure 27c).

[0224] Figure 27c shows a cross section of the medical implant 1 of Figure 27b along the plane M. In the area of the fold 123, a channel 124 is formed which can be used to hold, for example, a suture (not shown).

[0225] Figure 27d shows a schematic representation of one embodiment of the medical implant 1 shown in Figures 27a-27c. The implant 1 is held in the fold 123 of the passage 124 by a suture 125. Pulling the suture 125 releases the implant 1 by tearing the extension flap 120 in the area of the fold 123.

[0226] FIG. 28a shows an embodiment of a spine structure 31 made of polyurethane. The spine structure 31 is generally suitable for combination with any of the disclosed medical implants. The spine structure 31 comprises three arms 126. Each arm has a thickness of 2 mm and further comprises an indentation 127, with the arms 126 having a reduced thickness of 1 mm. The indentation 127 is positioned 10 mm from the center 128 of the spine structure 31. Thus, when placed on a medical implant, the indentation is typically located at the periphery of the implant. The spine structure is also configured, in this case, to extend beyond the periphery of the implant and is therefore particularly suitable for manufacturing implants as shown in FIGS. 27a-27c.

[0227] FIG. 28b shows a cross section of a spine structure similar to that shown in FIG. 28a. The arms 126 are folded around the notches 127. In the illustrated embodiment, the spine structure 31 is attached to the medical implant 1 configured as a fabric patch. The arms 126 are bonded to the fabric of the implant 1 by thermal bonding, in which polyurethane is partially melted and diffused into the fabric, thus providing adhesion. The folded arms 126 form a passage 124 through which a suture is threaded. The folded arms 126 thus form a retention element and are held by a suture 125. The suture's mechanical strength (i.e., thickness and material selection) is adapted so that pulling the suture can tear the arms 126 of the spine structure 31 at the notches 127. The implant further includes a radiopaque element 106 configured as a platinum particle held on the implant 1 by the folded arms 126. As an alternative to platinum, iridium is also a suitable material for the radiopaque marker. Additionally or alternatively, the spine structure 31 can be made from a polymer filled with a radiopaque agent such as BaSO4.

[0228] FIG. 29 shows an implant 1 according to the present invention. The implant 1 is similar to that shown in FIG. 27d. The implant comprises elongated arms 120 cut from the same base sheet material as the main body of the implant 1. The arms 120 are folded over the patch 1, thus leaving small passages 124 in the peripheral regions of the patch 1 to allow the passage of sutures 125. The sutures 125 can be attached to a delivery system via retention elements 129. Any delivery system, such as those shown in FIGS. 12-14, is suitable for combination with the retention elements 129. When the sutures are pulled back, the sutures 129 cut through the polymer sheet, thus releasing the implant 1. The force required for cutting can be controlled / adjusted by making small notches in the arms 120, as shown in FIG. 27a. The implant further comprises a hole in the central region 128 that allows for additional retention by a delivery instrument, for example, to easily center the implant 1 at the implantation site.

[0229] 30 shows a schematic representation of an implant 1 attached to a tissue wall W to close a defect D. The implant 1 is attached to the tissue wall W by two rivets 130. The rivets are made of a biodegradable material and degrade within the human body within one year. Thus, the rivets 130 provide a temporary attachment, for example, until sufficient adhesion is formed on the implant 1 and / or until tissue has formed on the implant 1.

Claims

1. A medical implant (1) adapted to repair or close a defect (D), comprising: The medical implant (1) comprises an adhesive composition (6), The medical implant (1) has two states, in which the medical implant (1) can be deployed at an implantation site while the adhesive composition (6) is inactive in a first state, and is brought to a second state by an activation mechanism; The adhesive composition (6) is curable by a curing mechanism in the second state, A medical implant (1) further comprising at least one retaining element (123, 124) for retaining a suture (125) around the circumference of said medical implant (1), said suture providing a connection to a delivery device.

2. 2. The medical implant (1) according to claim 1, wherein in the first state, the medical implant (1) comprises at least one cavity (24) adapted to accommodate the adhesive composition (6) and to release the adhesive composition (6) in the second state.

3. 3. The medical implant (1) according to claim 2, wherein the cavity has at least two boundary surfaces, and at least one property differs between the two boundary surfaces.

4. 3. The medical implant (1) according to claim 1 or 2, comprising a radiopaque element (106, 107, 108, 109).

5. 5. The medical implant (1) according to claim 4, comprising a support structure (31, 107, 109), wherein the radiopaque element (106, 107, 108, 109) is arranged within or formed by the support structure (31, 107, 109).

6. 6. The medical implant (1) according to claim 4 or 5, wherein said radiopaque element (106, 107, 108, 109) is disposed within or formed by said adhesive composition (6, 104, 117', 117'').

7. The medical implant (1) according to any one of claims 4 to 6, wherein said radiopaque element (106, 107, 108, 109) comprises at least one of barium sulfate and iodine.

8. The medical implant (1) according to any one of the preceding claims, wherein said implant (1) comprises at least one discrete marker (110).

9. The medical implant (1) according to claim 8, wherein the marker (110) is at least one of radiopaque and echogenic.

10. 10. Medical implant (1) according to claim 8 or 9, wherein said implant comprises at least two discrete markers (110) arranged at a predetermined distance and / or orientation from each other.

11. 11. The medical implant (1) according to any one of claims 1 to 10, wherein the medical implant (1) has a generally planar shape with a first surface (101', 103') and a second surface (101', 103''), the first surface (101', 103') and the second surface (102, 103'') having substantially opposite orientations, and wherein at least one characteristic of the first surface (101', 103') differs from a corresponding characteristic of the second surface (102, 103'').

12. The medical implant (1) according to claim 11, wherein said first surface (101', 103') is adapted to enhance cell ingrowth.

13. The medical implant (1) according to claim 11 or 12, wherein said second surface (102, 103'') is adapted to provide adhesion to living tissue.

14. The medical implant (1) according to any one of the preceding claims, wherein at least one surface of the implant comprises a velour-like surface (101'').

15. The medical implant (1) according to any one of the preceding claims, wherein said adhesive composition is arranged in a pattern on said medical implant (1).

16. The medical implant (1) according to any one of the preceding claims, wherein said adhesive composition comprises GelMA.

17. 17. Medical implant (1) according to claim 16, wherein said GelMA is formed by a mixture of at least two GelMAs of animal origin.

18. 18. The medical implant (1) according to claim 16 or 17, wherein the adhesive composition further comprises a photoinitiator.

19. The medical implant (1) according to any one of the preceding claims, comprising at least one rivet (130) for attaching said implant to tissue.

20. The medical implant (1) according to any one of the preceding claims, further comprising a suture (123, 124) arranged in a loop (124) of said at least one retaining element.

21. The at least one holding element (123, 124) is adapted to hold the medical implant (1) A medical implant (1) according to any one of claims 1 to 20, made from the same material as

22. The medical implant (1) according to claim 20 or 21, wherein said at least one retaining element (123, 124) is made from polyurethane having a thickness of 35 to 65 μm.

23. The medical implant (1) according to any one of claims 20 to 22, wherein said at least one retaining element (123, 124) is configured as a separate element arranged on said medical implant (1).

24. 24. The medical implant (1) according to any one of claims 20 to 23, wherein the at least one retaining element (123, 124) comprises a predetermined breaking point configured to be able to control where the at least one retaining element (123, 124) breaks when releasing the medical implant (1).

25. The medical implant (1) according to any one of the preceding claims, wherein said adhesive composition comprises a dry adhesive composition (111', 112').

26. 26. The medical implant (1) according to claim 25, wherein the dry adhesive composition is activatable by exposure to a liquid.

27. A medical implant (1) according to any one of claims 1 to 24, adapted to close a defect (D), comprising: at least one connecting element (9, 22) arranged on the outer edge (OC) of the implant, A medical implant (1), wherein the connecting elements (9, 22) have a size greater than the size, in particular the thickness (T), of the implant (1) so that the connecting elements (9, 22) are adapted to engage with a delivery device (C) having a suitable counterpart element (10, 11, 12, 21) for connection with the connecting elements.

28. 28. The medical implant (1) according to claim 27, wherein the connecting element (9, 22) comprises a polymeric or metallic material.

29. A delivery device for delivering a medical implant (1) according to claim 27, comprising: At least one tube (10) comprising an actuation element (11); At least one holder (12a, 12b) operatively connected to said actuation element (11); wherein the tube (10) and the at least one holder (12a, 12b) are adapted such that a medical implant (1) is held by the at least one holder (12a, 12b) in a first state; A delivery device, wherein said medical implant (1) can be released by actuation of said actuation element (11).

30. 28. A method for manufacturing a medical implant (1) according to any one of claims 1 to 27, comprising the steps of: disposing an adhesive composition on at least one surface of the implant; and drying the adhesive composition, wherein the adhesive composition is at least partially liquid and is dried after being disposed on the implant, or wherein the at least partially liquid adhesive composition is first dried and then disposed on at least one surface of the implant.

31. 31. A method for manufacturing a medical implant (1) according to claim 30, comprising the steps of: arranging at least one extension element (120, 126) around the outer periphery of the medical implant (1); configuring the at least one extension element (120, 126) to form a retaining element (123, 124); and joining ends of the extension elements (120, 126) to fix the extension elements (120, 126) so that the extension elements (120, 126) comprise the retaining element (123, 124).

32. 32. The method of claim 30 or 31, wherein the adhesive composition is disposed on the medical implant (1) via inkjet printing.

33. 33. The method of claim 30 or 32, wherein the adhesive composition is disposed in a predetermined pattern on the medical implant (1).

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