Patent Grant
11191642
The present invention relates generally to the treatment of cardiac valve disorders, such as mitral valve replacement, using minimally invasive techniques. In particular, this application is directed towards devices for delivering and placing replacement mitral valves.
The mitral valve lies between the left atrium and the left ventricle of the heart. Various diseases can affect the function of the mitral valve, including degenerative mitral valve disease and mitral valve prolapse. These diseases can cause mitral stenosis, in which the valve fails to open fully and thereby obstructs blood flow, and/or mitral insufficiency, in which the mitral valve is incompetent and blood flows passively in the wrong direction.
Many patients with heart disease, such as problems with the mitral valve, are intolerant of the trauma associated with open-heart surgery. Age or advanced illness may have impaired the patient's ability to recover from the injury of an open-heart procedure. Additionally, the high costs associated with open-heart surgery and extra-corporeal perfusion can make such procedures prohibitive.
Patients in need of cardiac valve repair or cardiac valve replacement can be served by minimally invasive surgical techniques. In many minimally invasive procedures, small devices are manipulated within the patient's body under visualization from a live imaging source like ultrasound, fluoroscopy, or endoscopy. Minimally invasive cardiac procedures are inherently less traumatic than open procedures and may be performed without extra-corporeal perfusion, which carries a significant risk of procedural complications.
During minimally invasive procedures for mitral valve replacement, the mitral valve prosthesis generally must be collapsed into a small delivery device for placement within the native mitral valve orifice. Such collapsing can be difficult and time-consuming. Safe and efficient delivery systems, loading devices, and methods for replacement of a cardiac valve that address some or all of these concerns are described herein.
A loading device configured to radially collapse an expandable medical implant may include an operating handle having an opening therein extending along a longitudinal axis thereof, a native sheath having a proximal end coupled to a distal end of the operating handle and partially extending into the opening of the operating handle, such that the native sheath is configured to translate relative to the operating handle parallel to the longitudinal axis, a removable sheath having a proximal end removably coupled to a distal end of the native sheath, an actuation rod extending parallel to the longitudinal axis at least partially through the opening of the operating handle, a lumen of the native sheath, and a lumen of the removable sheath, a distal end of the actuation rod being configured to be removably coupled to the expandable medical implant, and a first control element movable relative to the operating handle and coupled to the native sheath, the first control element being configured to translate the native sheath and the removable sheath relative to the operating handle in first and second longitudinal directions parallel to the longitudinal axis.
The loading device may also include a threaded rod extending within the opening parallel to the longitudinal axis and affixed to the native sheath. The first control element may be a sheathing knob threadedly engaged with the threaded rod, such that rotational motion of the sheathing knob causes the threaded rod, the native sheath, and the removable sheath to translate in one of the first or second longitudinal directions. The loading device may also include a second control element movable relative to the operating handle and coupled to the actuation rod. The second control element may be configured to translate the actuation rod relative to the operating handle in the first and second longitudinal directions. The loading device may also include a threaded rod extending within the opening parallel to the longitudinal axis and affixed to the actuation rod. The second control element may be a retention mechanism knob threadedly engaged with the threaded rod, such that rotational motion of the retention mechanism knob causes the actuation rod to translate in one of the first or second longitudinal directions.
The loading device may also include a ratchet and pawl mechanism that is coupled to the retention mechanism knob. The ratchet and pawl mechanism may be configured to permit rotation of the retention mechanism knob only in a single rotational direction. The loading device may also include a coupling element extending around the proximal end of the removable sheath and the distal end of the native sheath. The coupling element may removably couple the removable sheath to the native sheath. The lumen of the removable sheath may define a funnel having a first diameter at a distal end of the removable sheath and a second diameter at the proximal end of the removable sheath, the first diameter being greater than the second diameter.
The removable sheath may have a flange at the distal end of the removable sheath, the flange having a distal-facing surface extending in a plane oriented substantially perpendicular to the longitudinal axis, the flange having a through-opening that defines the first diameter at the distal end of the removable sheath. The actuation rod may have a threaded feature at the distal end thereof that is configured to be mated with a corresponding threaded feature of a retention mechanism that is coupled to the expandable medical implant. A medical combination may include the loading device described above, the expandable medical implant, and a retention mechanism removably coupling the expandable medical implant to the actuation rod of the loading device. The expandable medial implant may be radially collapsed within the lumen of the removable sheath.
Another loading device configured to radially collapse an expandable medical implant may include an operating handle having an opening therein extending along a longitudinal axis thereof, a brace coupled to the operating handle and configured to interface with a distal end of a delivery system configured to deploy the expandable medical implant, the brace having a lumen extending therethrough in a direction parallel to the longitudinal axis, a plurality of brace arms that extend between the brace and the operating handle, the brace arms configured to transfer a force acting on the brace along the longitudinal axis to the operating handle, a packing rod extending between the operating handle and the brace in first and second longitudinal directions parallel to the longitudinal axis, and a control element movable relative to the operating handle and coupled to the packing rod, the control element being configured to translate the packing rod relative to the operating handle and the brace in the first and second longitudinal directions.
The loading device may also include a threaded rod extending within the opening parallel to the longitudinal axis and affixed to the packing rod. The control element may be an actuation knob threadedly engaged with the threaded rod, such that rotational motion of the actuation knob causes the threaded rod and the packing rod to translate in one of the first or second longitudinal directions. The plurality of brace arms may include three brace arms that are circumferentially spaced apart from one another about the longitudinal axis, and one of the three brace arms may be configured to be selectively uncoupled from the operating handle and the brace.
The lumen of the brace may define a funnel having a first diameter at a proximal end of the brace and a second diameter at a distal end of the brace, the first diameter being greater than the second diameter. The brace may have a flange at the proximal end of the brace. The flange may have a proximal-facing surface extending in a plane oriented substantially perpendicular to the longitudinal axis. The flange may have a through-opening that defines the first diameter at the proximal end of the brace. The packing rod may have a first outer diameter at a proximal end of the packing rod within the opening of the operating handle and a second outer diameter at a distal end of the packing rod within the lumen of the brace, the first diameter being greater than the second diameter.
A method of loading an expandable medical implant into a distal end of a delivery device may include inserting an outer sheath at the distal end of the delivery device into a lumen of a brace of a loading device, removably coupling a retention mechanism to an inner shaft extending along a longitudinal axis within the outer sheath of the delivery device, the retention mechanism coupling the expandable medical implant to the inner shaft, applying a force onto the retention mechanism, the applying including pressing a distal end of a packing rod of the loading device onto a distal end of the retention mechanism, the pressing including actuating a control element of the loading device to translate the packing rod relative to the loading device in a longitudinal direction parallel to the longitudinal axis, and inserting the expandable medical implant into the outer sheath of the delivery device while the distal end of the packing rod and the outer sheath of the delivery device are positioned within the lumen of the brace of the loading device, the inserting of the expandable medical implant including further translating the packing rod relative to the loading device and the outer sheath of the delivery device in the longitudinal direction.
The control element may be an actuation knob threadedly engaged with a threaded rod that is affixed to the packing rod, and the applying of the force onto the retention mechanism may include rotating the actuation knob. The lumen of the brace may define a funnel having a first diameter at a proximal end of the brace and a second diameter at a distal end of the brace, the first diameter being greater than the second diameter. The inserting of the expandable medical implant into the outer sheath may include collapsing the expandable medical implant in a plurality of radial directions perpendicular to the longitudinal axis while at least a portion of the expandable medical implant is positioned within the lumen of the brace. The method may also include removing the outer sheath of the delivery device from the lumen of the brace of the loading device, the expandable medical implant being disposed within the outer sheath in a collapsed state after the removing is completed.
The novel features of the invention are set forth with particularity in the claims that follow. A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the invention are utilized, and the accompanying drawings of which:
The loading devices described herein can be used to load a wide variety of replacement heart valves (also referred to herein as “replacement valves” or “valve”), such as prosthetic valves, into one or more delivery systems. Exemplary prosthetic valves that can be delivered and deployed with the delivery devices described herein include the expandable prosthetic valves described in application Ser. No. 14/677,320, filed Apr. 2, 2015, in U.S. Pat. No. 8,870,948, and in International Patent Application filed May 13, 2016, titled “REPLACEMENT MITRAL VALVES,” and in U.S. patent application Ser. No. 14/677,320, filed Apr. 2, 2015, titled “REPLACEMENT CARDIAC VALVES AND METHODS OF USE AND MANUFACTURE,” all of which are incorporated by reference herein. For example, the loading devices herein are configured to deliver and deploy a replacement heart valve, such as a mitral valve, that includes distal and proximal anchors.
The loading devices and methods described herein can be used to load replacement valves into a delivery system, which can then be used to deliver the replacement valves into patients. In some embodiments, the loading devices can be used to load replacement valves into a trans-septal delivery system, which may be used to compensate for a force required to load a long, flexible catheter such as that used for a trans-septal delivery system. In some cases, the loading devices can be used to compensate for the force required to load a replacement valve, which may be difficult to achieve with a long, flexible catheter such as that used for a trans-septal delivery system. For example, it may be difficult for a long flexible device to apply the necessary forces since flexibility of a device may compromise other characteristics, like tensile strength. The loading devices may be suitable for use with any type of replacement heart valve, including replacement mitral valves.
According to some embodiments, the loading device as described herein is configured to load a valve (e.g., valve 100) into an intermediate device that maintains the valve in a collapsed state prior to being transferred into the delivery system. These embodiments are described herein with reference to
Referring to
The distal end of the removable sheath 213 can have a flange 211 that can be configured to provide smooth entry of the valve with minimal valve contact. The central channel of the elongate body 227 can include an actuation tube 217 (or rod) that engages with a retention mechanism that is coupled to the valve. In some embodiments, the actuation tube 217 includes a threaded inner or outer surface to provide secure engagement with the retention mechanism.
The tip 216 of the elongate body 227 can have features therein (e.g., on the inner diameter thereof) to guide the valve retention mechanism. For example, the tip 216 may have a funnel shape for guiding the valve retention mechanism and/or align the actuation tube 217 therein. The handle 228 can include a sheathing knob 214 (or first control element) to control actuation of the removable sheath 213. In some embodiments, rotation of the sheathing knob 214 can cause a translation motion of a sheath adaptor 219 and the actuation tube 217 in a longitudinal direction. In some embodiments, a torque bar 218 can be used for added mechanical advantage when turning the sheathing knob 214. In some embodiments, the torque bar 218 is removable. The handle 228 can include a retention mechanism knob 215 (or second control element) for controlling the retention mechanism. For example, the retention mechanism knob 215 may allow a user to switch between a first mode where the retention mechanism extended, and a second mode wherein the retention mechanism is retracted. In some cases, this may provide finer control of the retention mechanism. For example, this may allow for partial unsheathing of a valve if, for instance, it is determined that the valve is not collapsing correctly (e.g., unsymmetrically). The handle 228 may include proximal and distal race plates 224 and 222, which may be configured to ensure unidirectional travel (e.g., via a ratchet mechanism) and/or be configured to provide audible feedback to a user (e.g., via a pawl mechanism). A proximal terminator 223 and a proximal stop 221 may be configured to control limits of translation of the actuation tube 217.
The close up view of
The loading device 300 may be configured to perform the entire collapse and covering of the valve. According to some embodiments, the loading device 300 does not include a separate retention mechanism knob (e.g., retention mechanism knob 215 of
The removable sheaths (also referred to as funnels) described herein can be adapted to cooperate with delivery systems having elongated bodies (e.g., outer sheaths) of different diameters. The removable sheaths may be adjustable to match different catheter sizes without changing the loading tool (e.g., versus emphasis on matching various loading tools). This way, the removable sheath can be modified to fit any of a number of different delivery systems while maintaining compatibility with a single loading tool configuration.
A valve can be loaded onto a loading device (e.g., loading devices 200 or 300) in a number of stages.
Referring to
One or more retainers 410 (e.g., 2, 3, 4 or more retainers), which can correspond to wires, can be used to couple the petals of the ventricular side of the valve 400 to the valve holder 402. In some embodiments, the retainers 410 are have hooks that attach to the petals of the ventricular side. In some cases, hooks of the retainers 410 poke through the skirt of the valve. The retainers 410 (and in some cases other metal portions of the valve holder assembly) are made of a corrosion resistant material (e.g., nickel titanium). In some cases, the retainers 410 are made of material that is non-reactive with the inner strut frame of the valve 400, since retainers 410 may directly contact the inner strut frame of the valve 400 during the valve collapsing process. On the atrial side, the retention mechanism 412 may be part of or be coupled to the hypotube 401. In some embodiments, the retention mechanism 412 corresponds to or includes a ring having a central opening that communicates with a central opening of the hypotube 401. The retention mechanism 412 can include one or more sutures 405 (also referred to as threads) that is/are threaded therethrough. The sutures 405 can be tethered to (e.g., looped through) a corresponding petal of the atrial side and interact with features therein. For example, the sutures 405 may loop around pins on the petals. In some embodiments, the sutures 405 are threaded through the skirt of the valve. In some embodiments, the sutures 405 are one continuous thread. Tension may be placed on the sutures 405 to provide control during the loading process. In some cases, the ends of the sutures 405 are pinched (e.g., crimped) to prevent possible hooking onto other features of the valve holder assembly. In some cases, the crimps or coils on sutures 405 are secured in place by an adhesive, which can help maintain tension and avoid inadvertent separation of the sutures 405.
Once the valve 400 is attached to the valve holder, this assembly can be coupled to the loading device.
As shown in
In some embodiments, the valve can be loaded into the delivery system from an elongated tube, referred to as a chaser tube. An exemplary loading device in the form of a chaser tube 752 is shown in
An exemplary use of a chaser tube 852 with a split sheath delivery system 801 is shown in
Another embodiment of a chaser tube 952 is shown in
In some embodiments, fasteners 1018a and 1018b (e.g., screws) can be used to secure and/or remove one of the bracing arms 1006 (e.g., arm 1019 that is about 150 degrees away from the other two arms). The one or more bracing arm 1006 may be removed in order to provide space for catheter insertion into the brace 1004 and can then be replaced by attachment with the fasteners 1018a and 1018b. The handle 1002 can include a knob 1008, and optionally a torque bar 1010, for controlling the loading process. The knob 1008 can be configured to turn a threaded rod 1011, which advances the packing rod 1012 to pack the valve into the delivery catheter 1016. Reversing the direction of the knob 1008 can retract the packing rod 1012 from the delivery catheter 1016.
In some embodiments, the delivery device 1000 can include a through-lumen extending through the handle 1002 and packing rod 1012. The through-lumen can be used, for example: (1) as a port to input saline for an internal support balloon (if replacing the packing rod 1012); (2) to allow a guidewire, mandrel, or other lumen to remain through the device 1000 prior to, during, or after loading of the valve without interrupting; and/or (3) to be used with a stabilizer or stand that would allow the valve to be attached to the loading device 1000 directly.
When the knob 1008 of the loading tool 1000 is turned, the packing rod 1012 can place a pushing force upon the inner catheter 1050 at a load transfer area 1055, thereby causing the valve 1040 to be pulled into and collapse within the delivery catheter 1016. The inner catheter 1050 can facilitate guiding of the valve 1040 such that the valve is centered within the delivery catheter 1016. The inner catheter 1050 may prevent (or reduce the occurrence of) the valve 1040 from twisting during the loading. The packing rod 1012 can be tapered such that the distal portion 1022 applies a concentrated pushing force in a central region of the load transfer area 1055 to facilitate symmetric collapse of the valve 1040. The larger diameter proximal portion 1020 can maintain a central position of the valve 1040 as the proximal portion 1020 enters the delivery catheter 1016, thereby facilitating symmetric collapse of the valve 1040.
In some embodiments, a balloon can be situated in a region 1064 internal to the bracing arms 1006 to provide further support for the packing rod 1012 during forward and/or reverse movement of the packing rod 1012. For example, the balloon can be inflated during forward movement 1060 (
According to some embodiments, the direct loading device has two bracing arms.
The sizes and shapes of various components of the loading devices described herein can be configured to accommodate requirements of particular applications. For example, in some applications it may be beneficial to have a shorter or longer loading device.
Any of the loading devices described herein can be configured to be exposed to an autoclaving process. For example, the material (e.g., polymer, silicone, metal and/or ceramic) of various parts of the loading device may be durable enough to withstand the high temperature and conditions of autoclaving. If polymer materials are used, the polymer components can be configured to withstand repeated heat cycling during autoclaving. In some embodiments, the polymer components are replaced with non-polymer components (e.g., metal and/or ceramic). In some cases, portions of the loading device may be configured to shrink to minimize possible corrosion of the valve enclosed therein (e.g., when exposed to a solution).
Any of the loading device described can be implemented with a leave-in mandrel. A leave-in mandrel refers to a mandrel that remains within the delivery system with the collapsed valve. Once the delivery system delivers the valve (without the leave-in mandrel) into the patient, the leave-in mandrel can remain within the delivery device.
In some embodiments, a chaser tube can be used to directly load a valve into a split sheath delivery system.
Although described as being used for the trans-septal delivery method, the delivery devices described herein can also be used for a trans-atrial or surgical delivery methods.
Aspects of the delivery devices and methods may be combined with aspects of the delivery devices and methods described in U.S. patent application Ser. No. 14/677,320, U.S. Pat. No. 8,870,948, or International Patent Application filed May 13, 2016 and titled “REPLACEMENT MITRAL VALVES,” the entirety of which is incorporated by reference herein.
Although described herein for use with a mitral valve prosthetic, the delivery systems described herein can be used with a variety of different implantable devices, including stents or other valve prosthetics.
When a feature or element is herein referred to as being “on” another feature or element, it can be directly on the other feature or element or intervening features and/or elements may also be present. In contrast, when a feature or element is referred to as being “directly on” another feature or element, there are no intervening features or elements present. It will also be understood that, when a feature or element is referred to as being “connected”, “attached” or “coupled” to another feature or element, it can be directly connected, attached or coupled to the other feature or element or intervening features or elements may be present. In contrast, when a feature or element is referred to as being “directly connected”, “directly attached” or “directly coupled” to another feature or element, there are no intervening features or elements present. Although described or shown with respect to one embodiment, the features and elements so described or shown can apply to other embodiments. It will also be appreciated by those of skill in the art that references to a structure or feature that is disposed “adjacent” another feature may have portions that overlap or underlie the adjacent feature.
Terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. For example, as used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprises” and/or “comprising,” when used in this specification, specify the presence of stated features, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, and/or groups thereof. As used herein, the term “and/or” includes any and all combinations of one or more of the associated listed items and may be abbreviated as “/”.
Spatially relative terms, such as “under”, “below”, “lower”, “over”, “upper” and the like, may be used herein for ease of description to describe one element or feature's relationship to another element(s) or feature(s) as illustrated in the figures. It will be understood that the spatially relative terms are intended to encompass different orientations of the device in use or operation in addition to the orientation depicted in the figures. For example, if a device in the figures is inverted, elements described as “under” or “beneath” other elements or features would then be oriented “over” the other elements or features. Thus, the exemplary term “under” can encompass both an orientation of over and under. The device may be otherwise oriented (rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein interpreted accordingly. Similarly, the terms “upwardly”, “downwardly”, “vertical”, “horizontal” and the like are used herein for the purpose of explanation only unless specifically indicated otherwise.
Although the terms “first” and “second” may be used herein to describe various features/elements (including steps), these features/elements should not be limited by these terms, unless the context indicates otherwise. These terms may be used to distinguish one feature/element from another feature/element. Thus, a first feature/element discussed below could be termed a second feature/element, and similarly, a second feature/element discussed below could be termed a first feature/element without departing from the teachings of the present invention.
Throughout this specification and the claims which follow, unless the context requires otherwise, the word “comprise”, and variations such as “comprises” and “comprising” means various components can be co-jointly employed in the methods and articles (e.g., compositions and apparatuses including device and methods). For example, the term “comprising” will be understood to imply the inclusion of any stated elements or steps but not the exclusion of any other elements or steps.
As used herein in the specification and claims, including as used in the examples and unless otherwise expressly specified, all numbers may be read as if prefaced by the word “about” or “approximately,” even if the term does not expressly appear. The phrase “about” or “approximately” may be used when describing magnitude and/or position to indicate that the value and/or position described is within a reasonable expected range of values and/or positions. For example, a numeric value may have a value that is +/−0.1% of the stated value (or range of values), +/−1% of the stated value (or range of values), +/−2% of the stated value (or range of values), +/−5% of the stated value (or range of values), +/−10% of the stated value (or range of values), etc. Any numerical range recited herein is intended to include all sub-ranges subsumed therein.
Although various illustrative embodiments are described above, any of a number of changes may be made to various embodiments without departing from the scope of the invention as described by the claims. For example, the order in which various described method steps are performed may often be changed in alternative embodiments, and in other alternative embodiments one or more method steps may be skipped altogether. Optional features of various device and system embodiments may be included in some embodiments and not in others. Therefore, the foregoing description is provided primarily for exemplary purposes and should not be interpreted to limit the scope of the invention as it is set forth in the claims.
The examples and illustrations included herein show, by way of illustration and not of limitation, specific embodiments in which the subject matter may be practiced. As mentioned, other embodiments may be utilized and derived there from, such that structural and logical substitutions and changes may be made without departing from the scope of this disclosure. Such embodiments of the inventive subject matter may be referred to herein individually or collectively by the term “invention” merely for convenience and without intending to voluntarily limit the scope of this application to any single invention or inventive concept, if more than one is, in fact, disclosed. Thus, although specific embodiments have been illustrated and described herein, any arrangement calculated to achieve the same purpose may be substituted for the specific embodiments shown. This disclosure is intended to cover any and all adaptations or variations of various embodiments. Combinations of the above embodiments, and other embodiments not specifically described herein, will be apparent to those of skill in the art upon reviewing the above description.
This application claims the benefit of the filing date of U.S. Provisional Patent Application No. 62/750,731, filed on Oct. 25, 2018, the disclosure of which is hereby incorporated herein by reference.
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