Design Optimization of Printed Multi-Layered Electroactive Actuators Used for Steerable Guidewire in Micro-Invasive Surgery.

To treat cardiovascular diseases (i.e., a major cause of mortality after cancers), endovascular-technique-based guidewire has been employed for intra-arterial navigation. To date, most commercially available guidewires (e.g., Terumo, Abbott, Cordis, etc.) are non-steerable, which is poorly suited to the human arterial system with numerous bifurcations and angulations. To reach a target artery, surgeons frequently opt for several tools (guidewires with different size integrated into angulated catheters) that might provoke arterial complications such as perforation or dissection. Steerable guidewires would, therefore, be of high interest to reduce surgical morbidity and mortality for patients as well as to simplify procedure for surgeons, thereby saving time and health costs. Regarding these reasons, our research involves the development of a smart steerable guidewire using electroactive polymer (EAP) capable of bending when subjected to an input voltage. The actuation performance of the developed device is assessed through the curvature behavior (i.e., the displacement and the angle of the bending) of a cantilever beam structure, consisting of single- or multi-stack EAP printed on a substrate. Compared to the single-stack architecture, the multi-stack gives rise to a significant increase in curvature, even when subjected to a moderate control voltage. As suggested by the design framework, the intrinsic physical properties (dielectric, electrical, and mechanical) of the EAP layer, together with the nature and thickness of all materials (EAP and substrate), do have strong effect on the bending response of the device. The analyses propose a comprehensive guideline to optimize the actuator performance based on an adequate selection of the relevant materials and geometric parameters. An analytical model together with a finite element model (FEM) are investigated to validate the experimental tests. Finally, the design guideline leads to an innovative structure (composed of a 10-stack active layer screen-printed on a thin substrate) capable of generating a large range of bending angle (up to 190°) under an acceptable input level of 550 V, which perfectly matches the standard of medical tools used for cardiovascular surgery.

Haptic Feedback Device Using 3D-Printed Flexible, Multilayered Piezoelectric Coating for In-Car Touchscreen Interface.

This study focuses on the development of a piezoelectric device capable of generating feedback vibrations to the user who manipulates it. The objective here is to explore the possibility of developing a haptic system that can replace physical buttons on the tactile screen of in-car systems. The interaction between the user and the developed device allows completing the feedback loop, where the user's action generates an input signal that is translated and outputted by the device, and then detected and interpreted by the user's haptic sensors and brain. An FEM (finite element model) via ANSYS multiphysics software was implemented to optimize the haptic performance of the wafer structure consisting of a BaTiO3 multilayered piezocomposite coated on a PET transparent flexible substrate. Several parameters relating to the geometric and mechanical properties of the wafer, together with those of the electrodes, are demonstrated to have significant impact on the actuation ability of the haptic device. To achieve the desired vibration effect on the human skin, the haptic system must be able to drive displacement beyond the detection threshold (~2 µm) at a frequency range of 100-700 Hz. The most optimized actuation ability is obtained when the ratio of the dimension (radius and thickness) between the piezoelectric coating and the substrate layer is equal to ~0.6. Regarding the simulation results, it is revealed that the presence of the conductive electrodes provokes a decrease in the displacement by approximately 25-30%, as the wafer structure becomes stiffer. To ensure the minimum displacement generated by the haptic device above 2 µm, the piezoelectric coating is screen-printed by two stacked layers, electrically connected in parallel. This architecture is expected to boost the displacement amplitude under the same electric field (denoted E) subjected to the single-layered coating. Accordingly, multilayered design seems to be a good alternative to enhance the haptic performance while keeping moderate values of E so as to prevent any undesired electrical breakdown of the coating. Practical characterizations confirmed that E=20 V/µm is sufficient to generate feedback vibrations (under a maximum input load of 5 N) perceived by the fingertip. This result confirms the reliability of the proposed haptic device, despite discrepancies between the predicted theory and the real measurements. Lastly, a demonstrator comprising piezoelectric buttons together with electronic command and conditioning circuits are successfully developed, offering an efficient way to create multiple sensations for the user. On the basis of empirical data acquired from several trials conducted on 20 subjects, statistical analyses together with relevant numerical indicators were implemented to better assess the performance of the developed haptic device.

Development and Optimization of 3D-Printed Flexible Electronic Coatings: A New Generation of Smart Heating Fabrics for Automobile Applications.

Textile-based Joule heaters in combination with multifunctional materials, fabrication tactics, and optimized designs have changed the paradigm of futuristic intelligent clothing systems, particularly in the automobile field. In the design of heating systems integrated into a car seat, conductive coatings via 3D printing are expected to have further benefits over conventional rigid electrical elements such as a tailored shape and increased comfort, feasibility, stretchability, and compactness. In this regard, we report on a novel heating technique for car seat fabrics based on the use of smart conductive coatings. For easier processes and integration, an extrusion 3D printer is employed to achieve multilayered thin films coated on the surface of the fabric substrate. The developed heater device consists of two principal copper electrodes (so-called power buses) and three identical heating resistors made of carbon composites. Connections between the copper power bus and the carbon resistors are made by means of sub-divide the electrodes, which is critical for electrical-thermal coupling. Finite element models (FEM) are developed to predict the heating behavior of the tested substrates under different designs. It is pointed out that the most optimized design solves important drawbacks of the initial design in terms of temperature regularity and overheating. Full characterizations of the electrical and thermal properties, together with morphological analyses via SEM images, are conducted on different coated samples, making it possible to identify the relevant physical parameters of the materials as well as confirm the printing quality. It is discovered through a combination of FEM and experimental evaluations that the printed coating patterns have a crucial impact on the energy conversion and heating performance. Our first prototype, thanks to many design optimizations, entirely meets the specifications required by the automobile industry. Accordingly, multifunctional materials together with printing technology could offer an efficient heating method for the smart textile industry with significantly improved comfort for both the designer and user.

Design Rules of Bidirectional Smart Sensor Coating for Condition Monitoring of Bearings.

This paper reports a novel monitoring technique of bearings' bidirectional load (axial and radial) based on a smart sensor coating, which is screen printed onto the surface of a cross-shaped steel substrate. To ensure the accuracy and stability of measurement as well as the durability of the printed coating, the developed prototype is built according to design rules commonly used in electronic circuits. The finite element model (FEM) is used to predict the mechanical property of the tested substrate under either unidirectional or bidirectional loads. Regarding the output voltage of the piezoelectric sensor, experimental results are revealed to be well-corelated to the numerical simulation. It is pointed out that the output signal generated from the sensor (electrode) could be particularly affected due to the capacitive parasite coming from the conductive tracks (CTs). Such a phenomenon might be reduced by printing them on the dielectric layer rather than on the piezocomposite layer. The study also investigates a highly anisotropic shape of electrodes (rectangular instead of circle), indicating that the orientation of such electrodes (axial or radial) does affect the output measurement. To sum up, the high performance of a sensor network coating depends not only on the ultimate characteristics of its own materials, but also on its structural design. Such an issue has been rarely reported on in the literature, but is nonetheless crucial to achieving reliable condition monitoring of bearings, especially for multidirectional loads-a key signature of early failure detection.

Molten-State Dielectrophoretic Alignment of EVA/BaTiO3 Thermoplastic Composites: Enhancement of Piezo-Smart Sensor for Medical Application.

Dielectrophoresis has recently been used for developing high performance elastomer-based structured piezoelectric composites. However, no study has yet focused on the development of aligned thermoplastic-based piezocomposites. In this work, highly anisotropic thermoplastic composites, with high piezoelectric sensitivity, are created. Molten-state dielectrophoresis is introduced as an effective manufacturing pathway for the obtaining of an aligned filler structure within a thermoplastic matrix. For this study, Poly(Ethylene-co Vinyl Acetate) (EVA), revealed as a biocompatible polymeric matrix, was combined with barium titanate (BaTiO3) filler, well-known as a lead-free piezoelectric material. The phase inversion method was used to obtain an optimal dispersion of the BaTiO3 within the EVA thermoplastic matrix. The effect of the processing parameters, such as the poling electric field and the filler content, were analyzed via dielectric spectroscopy, piezoelectric characterization, and scanning electron microscopy (SEM). The thermal behavior of the matrix was investigated by thermogravimetric analysis (TGA) and differential scanning calorimetry analysis (DSC). Thermoplastic-based structured composites have numerous appealing advantages, such as recyclability, enhanced piezoelectric activity, encapsulation properties, low manufacturing time, and being light weight, which make the developed composites of great novelty, paving the way for new applications in the medical field, such as integrated sensors adaptable to 3D printing technology.

Extrusion-Based 3D Printing of Stretchable Electronic Coating for Condition Monitoring of Suction Cups.

Suction cups (SCs) are used extensively by the industrial sector, particularly for a wide variety of automated material-handling applications. To enhance productivity and reduce maintenance costs, an online supervision system is essential to check the status of SCs. This paper thus proposes an innovative method for condition monitoring of SCs coated with printed electronics whose electrical resistance is supposed to be correlated with the mechanical strain. A simulation model is first examined to observe the deformation of SCs under vacuum compression, which is needed for the development of sensor coating thanks to the 3D printing process. The proposed design involves three circle-shaped sensors, two for the top and bottom bellows (whose mechanical strains are revealed to be the most significant), and one for the lip (small strain, but important stress that might provoke wear and tear in the long term). For the sake of simplicity, practical measurement is performed on 2D samples coated with two different conductive inks subjected to unidirectional tensile loading. Graphical representations together with analytical models of both linear and nonlinear piezoresistive responses allows for the characterization of the inks' behavior under several conditions of displacement and speed inputs. After a comparison of the two inks, the most appropriate is selected as a consequence of its excellent adhesion and stretchability, which are essential criteria to meet the target field. Room temperature extrusion-based 3D printing is then investigated using a motorized 3D Hyrel printer with a syringe-extrusion modular system. Design optimization is finally carried out to enhance the surface detection of sensitive elements while minimizing the effect of electrodes. Although several issues still need to be further considered to match specifications imposed by our industrial partner, the achievement of this work is meaningful and could pave the way for a new generation of SCs integrated with smart sensing devices. The 3D printing of conductive ink directly on the cup's curving surface is a true challenge, which has been demonstrated, for the first time, to be technically feasible throughout the additive manufacturing (AM) process.

Investigation of Blood Coagulation Using Impedance Spectroscopy: Toward Innovative Biomarkers to Assess Fibrinogenesis and Clot Retraction.

This study focused on a coagulation assessment based on the novel technique of blood-impedance-magnitude measurement. With the impedance characterization of recalcified human blood, it was possible to identify two significative biomarkers (i.e., measurable indicators) related to fibrin formation (1st marker) and clot retraction (2nd marker). The confocal microscopy of clotting blood provided a complete visual analysis of all the events occurring during coagulation, validating the significance of the impedance biomarkers. By analyzing the impedance phase angle (Φ) of blood during coagulation, as well as those of the clot and serum expelled after retraction, it was possible to further clarify the origin of the 2nd marker. Finally, an impedance-magnitude analysis and a rotational thromboelastometry test (ROTEM®) were simultaneously performed on blood sampled from the same donor; the results pointed out that the 1st marker was related to clotting time. The developed technique gives rise to a comprehensive and evolutive insight into coagulation, making it possible to progressively follow the whole process in real time. Moreover, this approach allows coagulation to be tested on any materials' surface, laying the ground for new studies related to contact coagulation, meaning, thrombosis occurring on artificial implants. In a near future, impedance spectroscopy could be employed in the material characterization of cardiovascular prostheses whose properties could be monitored in situ and/or online using effective biomarkers.

Optimization Strategies Used for Boosting Piezoelectric Response of Biosensor Based on Flexible Micro-ZnO Composites.

Piezoelectric ZnO-based composites have been explored as a flexible and compact sensor for the implantable biomedical systems used in cardio surgery. In this work, a progressive development route was investigated to enhance the performance of piezoelectric composites incorporated with different shape, concentration and connectivity of ZnO fillers. ZnO microrods (MRs) have been successfully synthesized homogeneously in aqueous solution using a novel process-based on chemical bath deposition (CBD) method. The morphological analysis along with Raman scattering and cathodoluminescence spectroscopy of ZnO MRs confirm their high crystalline quality, their orientation along the polar c-axis and the presence of hydrogen-related defects acting as shallow donors in their center. The experimental characterizations highlight that ZnO MR-based composites, with a higher aspect ratio (AR), lead to a significant improvement in the mechanical, dielectric and piezoelectric properties as opposed to the ZnO microparticles (MP) counterparts. The dielectrophoretic (DEP) process is then subjected to both ZnO MP- and MR-based composites, whose performance is expected to be improved as compared to the randomly dispersed composites, thanks to the creation of chain-like structures along the electric field direction. Furthermore, a numerical simulation using COMSOL software is developed to evaluate the influence of the material structuration as well as the filler's shape on the electric field distribution within different phases (filler, matrix and interface) of the composites. Finally, the aligned MR piezoelectric composites are revealed to be high potential in the development of innovative compact and biocompatible force-sensing devices. Such a technological breakthrough allows the achievement of a real-time precise characterization of mitral valve (MV) coaptation to assist surgeons during MV repair surgery.

Eco-audit of conventional heart surgery procedures.

OBJECTIVES: Healthcare systems have a significant environmental impact and, thus, indirectly affect public health. In order to improve current practices, a better understanding of the actual environmental impact generated by surgical procedures is necessary. METHODS: An eco-audit methodology was carried out to assess the greenhouse gas emissions arising from conventional isolated cardiac surgery procedures. This inquiry took into account 3 workstations (the surgical, the anaesthesia and the cardiopulmonary bypass workstations). All wastes were analysed including the disposable medical products, pharmaceuticals and energy consumption during such surgeries. RESULTS: Twenty-eight cardiac surgeries were analysed out of a 4-week study period. The mean emissions during a single cardiac surgery was 124.3 kg of carbon dioxide equivalent (CO2-e). Eighty-nine per cent of the total emissions was related to the use of disposable medical products. The environmental impact of pharmaceuticals used at anaesthesia workstations was 12.4 kg of CO2-e (10% of total greenhouse gas emission), with 11.1 kg of CO2-e resulting from the use of halogenated gas. Direct electrical consumption resulted in 4.0 kg of CO2-e per surgery (3% of all emission), including lighting and air conditioning. CONCLUSIONS: Conventional isolated cardiac procedures yield the global warming equivalent of a 1080 km plane ride for a single passenger. The environmental impact of such life-saving interventions, therefore, must be put in perspective alongside pollution induced by 'non-indispensable' human activities. However, numerous initiatives at the local and individual level as well as at a larger systemic and countrywide scale appear to provide accessible pathways to meaningfully reduce greenhouse gas emissions during cardiac surgery.

Dielectrophoresis Structurization of PZT/PDMS Micro-Composite for Elastronic Function: Towards Dielectric and Piezoelectric Enhancement.

Piezoelectric materials have been used for decades in the field of sensors as transducers and energy harvesters. Among these, piezoelectric composites are emerging being extremely advantageous in terms of production, costs, and versatility. However, the piezoelectric performances of a composite with randomly dispersed filler are not comparable with bulk ferroelectric ceramics and electroactive polymers. In order to achieve highly performing and low-cost materials, this work aims to develop flexible composites made of Lead zirconate titanate (PZT) filler in Polydimethylsiloxane (PDMS) matrix, with a specific internal structure called quasi-1-3 connectivity. Such a structure, comprising particles arranged in columns along a preferred direction, is performed through dielectrophoresis by applying an alternating electric field on the composite before and during the polymerization. The developed flexible material could be introduced into complex structures in various application fields, as sensors for structural monitoring.

Influence of Matrix and Surfactant on Piezoelectric and Dielectric Properties of Screen-Printed BaTiO3/PVDF Composites.

The aim of this paper was to provide insight into the impact of matrix and surfactants on the rheology, morphology, and dielectric and piezoelectric properties of screen-printed BaTiO3/PVDF composites. Two matrices were compared (PVDF-HFP and PVDF-TrFE), and lead-free BaTiO3 microparticles were added in volume fractions of 30% and 60%. Here, we demonstrated that the presence of surfactants, helping to prevent phase separation, was crucial for achieving a decent screen-printing process. Fourier-transform infrared (FTIR) spectroscopy together with scanning electron microscopy (SEM) showed that the two "fluoro-benzoic acid" surfactants established stable bonds with BaTiO3 and improved the dispersion homogeneity, while the "fluoro-silane" proved to be ineffective due to it evaporating during the functionalization process. PVDF-TrFE composites featured a more homogeneous composite layer, with fewer flaws and lower roughness, as compared with PVDF-HFP composites, and their inks were characterized by a higher viscosity. The samples were polarized in either AC or DC mode, at two different temperatures (25 °C and 80 °C). The 30% BaTiO3 PVDF-TrFE composites with two fluorinated surfactants featured a higher value of permittivity. The choice of the surfactant did not affect the permittivity of the PVDF-HFP composites. Concerning the d33 piezoelectric coefficient, experimental results pointed out that PVDF-TrFE matrices made it possible to obtain higher values, and that the best results were achieved in the absence of surfactants (or by employing the fluoro-silane). For instance, in the composites with 60% BaTiO3 and polarized at 80 °C, a d33 of 7-8 pC/N was measured, which is higher than the values reported in the literature.

Characterizing and Optimizing Piezoelectric Response of ZnO Nanowire/PMMA Composite-Based Sensor.

Due to the outstanding coupling between piezoelectric and semiconducting properties of zinc oxide nanowires, ZnO NW-based structures have been demonstrating promising potential with respect to their applicability in piezoelectric, piezotronic and piezo-phototronic devices. Particularly considering their biocompatibility and biosafety for applications regarding implantable medical detection, this paper proposed a new concept of piezoelectric composite, i.e., one consisting of vertically aligned ZnO NW arrays and an insulating polymer matrix. First, the finite element method (FEM) was employed to drive optimization strategies through adjustment of the key parameters such as Young's modules and the dielectric constant of the dielectric constituents, together with the density and dimension of nanowire (NW) itself. Second, to investigate the functionality of each individual layer of composite, different designed structures were fabricated and characterized in terms of electrical and piezoelectric properties. Next, experimental and simulation tests were performed, indicating that the decreasing thickness of the top poly(methyl methacrylate) layer (PMMA) can substantially enhance the piezoelectric sensitivity of the ZnO NW composite. Besides the further benefit of no polarization being needed, our material has a comparable charge coefficient (d33) with respect to other lead-free alternatives (e.g., BaTiO3), confirming the high sensing abilities of the developed structure based on vertically aligned ZnO NW arrays. Finally, a time-varying model combining piezoelectricity and electric circuit modules was investigated in detail, giving rise to an estimation of the d33 coefficient for ZnO NWs. Based on this study, the developed material is revealed to be highly promising in medical applications, particularly regarding the FFR technique, where coronary pressure can be measured through a piezoelectric sensor.

Accurate Electroadhesion Force Measurements of Electrostrictive Polymers: The Case of High Performance Plasticized Terpolymers.

Electroadhesion is a phenomenon ruled by many characteristic intrinsic parameters. To achieve a good adhesion, efficient and durable, a particular attention must be provided to the adhesion forces between the involved parts. In addition to the size and geometry of electrodes, parameters of materials such as dielectric constant, breakdown electric field, and Young's modulus are key factors in the evaluation of electroadhesion efficiency for electrostrictive polymers and electroactive devices. By analyzing these material parameters, a method is proposed to justify the choice of polymer matrices that are fit to specific electroadhesion applications. Another purpose of this work aims to demonstrate a possibility of accurately measuring the electroadhesion force. This physical parameter has been usually estimated through equations instead, because of the complexity in setup implementation to achieve highly precise measure. Comparisons based on the parameters criterion reveal that besides the intrinsic properties of material, some other parameters relating to its physical phenomena (e.g., saturation of dipolar orientation under high electric field leads to decrease dielectric constant), or physical behavior of the system (i.e., surface roughness reduces the active electrode area) must be thoroughly considered. Experimental results pointed out that plasticized terpolymer leads boosted electroadhesion performance compared to the other counterparts, up to 100 times higher than conventional polymers. The developed materials show high potential in applications of active displacement control for electrostrictive actuation.

Effect of beta-based sterilization on P(VDF-TrFE-CFE) terpolymer for medical applications.

Electroactive polymers (EAP) are one of the latest generations of flexible actuators, enabling new approaches to propulsion and maneuverability. Among them, poly(vinylidene fluoride-trifluoroethylene-chlorofluoroethylene/chlorotrifluoroethylene), abbreviated terpolymer, with its multifunctional sensing and actuating abilities as well as its impressive electrostrictive behavior, especially when being doped with an plasticizer, has been demonstrated to be a good candidate for the development of low-cost flexible guidewire tip for endovascular surgery. To minimize the possibility of bacterial, fungal, or viral disease transmission, all medical instruments (especially components made from polymers) must be sterilized before introduction into the patient. Gamma/beta (γ/ß) irradiation is considered to be one of the most efficient techniques for targeted reduction of microbials and viruses under low temperature, often without drastic alterations in device properties. However, radiation may cause some physical and chemical changes in polymers. A compromise is required to ensure sufficient radiation for microbial deactivation but minimal radiation to retain the material's properties. The main idea of this study aims at assessing the electromechanical performances and thermal/dielectric properties of ß-irradiated terpolymer-based sterilization treatment. Ionizing ß-rays did not cause any significant risk to the neat/plasticized terpolymers, confirming the reliability of such electrostrictive materials for medical device development.

High-Capacity, Fast-Response, and Photocapacitor-Based Terpolymer Phosphor Composite.

This paper describes a new class of light transducer-based poly (vinylidene fluoride-trifluoroethylene-chlorotrifluoroethylene) (P(VDF-TrFE-CTFE)) terpolymer doped with 50% wt. phosphor particles that enables to efficiently transform light energy into an electrical signal. Broadband dielectric characterization together with experimental results on photo-electric conversion demonstrated high capacitance variation of the proposed composite under light exposure, confirming promising potential of our sensor device for application in retinal prostheses where the converted electrical signal can affect the biological activity of the neuron system. In addition to the benefit of being light-weight, having ultra-flexibility, and used in a simple process, the proposed photodetector composite leads to fast response and high sensibility in terms of photoelectrical coupling where significant increases in capacitance change of 78% and 25% have been recorded under blue and green light sources, respectively. These results demonstrated high-performance material design where phosphor filler contributes to promote charge-discharge efficiency as well as reduced dielectric loss in P(VDF-TrFE-CTFE), which facilitate the composite for flexible light transducer applications, especially in the medical environment.

Enhancing the Low-Frequency Induction Heating Effect of Magnetic Composites for Medical Applications.

This study aims to enhance the low-frequency induction heating (LFIH) effect in a thermoplastic polymer doped with iron oxide magnetic particles, which are promising candidates for several medical applications thanks to their confirmed biocompatibility. Two main approaches were proposed to successfully boost the heating ability; i.e., improving the magnetic concentration of the composite with higher filler content of 30 wt %, and doubling the frequency excitation after optimization of the inductor design. To test the magnetic properties of the ferromagnetic composite, a measurement of permeability as a function of temperature, frequency, and particle content was carried out. Thermal transfer based COMSOL simulations together with experimental tests have been performed, demonstrating feasibility of the proposed approach to significantly enhance the target temperature in a magnetic composite. These results are encouraging and confirmed that IH can be exploited in medical applications, especially for the treatment of varicose veins where local heating remains a true challenge.

Mitral valve repair based on intraoperative objective measurement.

In this paper, we propose a very innovative designed system that enables optimal length adjustment during transapical neochordae implantation for mitral valve repair, increasing accuracy and reproducibility of neochordae length adjustment. Also, such a new device allowed real-time measurement and recording of chordae tension, producing original physiological data. To the best of our knowledge, the tension of chordae had never been measured previously as precisely, especially in in vivo human clinical trials. Preliminary experimental data have been collected on 10 selected patients, giving us the opportunity to assess for the first time the tension applied on the chordae implanted in beating human hearts. The final goal of our measuring device is to provide reliable objective intraoperative data to improve the understanding of changes occurring after mitral valve repair (MVR). This novel measuring instrument may bring change in the paradigm of MVR by allowing repair with strong objective and quantitative, instead of qualitative anatomical analysis.

Reducing leakage current and dielectric losses of electroactive polymers through electro-annealing for high-voltage actuation.

Electroactive polymers (EAPs) such as P(VDF-TrFE-CTFE) are very promising in the field of flexible sensors and actuators. Their advantages in smart electrical devices are due to their low cost, elastic properties, low density, and ability to be manufactured into various shapes and thicknesses. In earlier years, terpolymer P(VDF-TrFE-CTFE) attracted a lot of research due to its relaxor-ferroelectric property that exhibits high electrostriction phenomena. While widely used in flexible actuation, this class of material is still limited by the high electric fields required (≥30 V µm-1) to achieve sufficient strain levels (>2%). This inevitably leads to high levels of leakage current and thus a short lifetime. This paper proposes a new approach based on electro-annealing thermal treatment for a pure terpolymer P(VDF-TrFE-CTFE) matrix in order to limit the conduction mechanisms. This in turn reduces the dielectric losses at a high level of electric fields. The experimental results demonstrate that a huge decrease in leakage current of 80% is achieved for a wide range of electric fields (i.e. up to 90 V µm-1) with a 4-fold extension in time-to-breakdown at high voltage excitations of 40 V µm-1.

Measuring chordae tension during transapical neochordae implantation: Toward understanding objective consequences of mitral valve repair.

OBJECTIVES: Complex structure of mitral valve and its central position in the heart limit assessment of mitral function to standardized calculated parameters assessed using medical imaging (echocardiography). Novel techniques, which allow mitral valve repair (MVr) in a beating heart, offer the opportunity for innovative objective assessment in physiologic and pathologic conditions. We report, to our knowledge, the first data of real-time chordal tension measurement during a transapical neochordae implantation. METHODS: Seven patients with severe degenerative mitral regurgitation due to posterior prolapse underwent transapical MVr using the NeoChord DS 1000 (NeoChord Inc, Minneapolis, Minn). During prolapse correction, the tension applied on the neochordae was measured in addition to hemodynamic and echocardiographic parameters. RESULTS: The traction applied on 1 chorda sustaining the P2 segment was measured at between 0.7 and 0.9 N, and oscillated with respiration. When several neochordae were set in tension, this initial tension was spread homogeneously on each chorda (mean sum of the amplitude of tension 0.98 ± 0.08 N). To achieve an optimal echocardiographic correction, a complementary synchronous traction on all chordae was required. During this adjustment, the sum of the tension decreased (mean 12 ± 2%; P = .018), suggesting that when normal physiology was restored, the valvular apparatus was in a low-stress state. This method allowed us to apply a precise and reproducible technique, leading to a good procedural success rate with a low morbidity and mortality rate. CONCLUSIONS: The tension applied on chordae during transapical implantation of neochordae for degenerative mitral regurgitation can be measured, providing original data about the objective consequences of MVr on the mitral apparatus.