Certain embodiments of the present invention are related to medical device delivery systems and methods of delivering a medical device.
Existing medical device delivery systems, such as those for use in percutaneous medical procedures, can allow a medical device to be delivered through a patient's vascular to a delivery site where it can be implanted within a patient. In some procedures a medical device in the form of a valve prosthesis can be compacted and loaded onto a delivery device for advancement through a patient's vasculature in a transfemoral, transapical, and/or transatrial procedure. There is a continuous need for improved delivery systems for use in percutaneous and other delivery techniques.
In some embodiments, a medical device delivery system can include a dilator including a tip having a taper in a distal direction, a coupler, and a flap that radially protrudes from the tip. The flap can be configured to bend against a body lumen to cover at least a portion of the delivery system when the dilator is tracked through the body lumen.
In some embodiments, a medical device delivery system can include a dilator including a tip having a lumen and a coupler having a lumen. The coupler can be configured to securely connect to the tip such that the lumen of the tip is aligned with the lumen of the coupler to allow a guide wire to pass therethrough. Methods for loading a medical device into a delivery catheter are also disclosed.
In some embodiments, a method of loading a medical device into a delivery catheter can include securing a coupler to a delivery catheter shaft, the shaft having a lumen for receiving the medical device, crimping the medical device to a diameter permitting the medical device to be loaded into the shaft lumen, loading the medical device into the shaft lumen, and securing a dilator tip to the coupler after the medical device is loaded into the shaft lumen.
The accompanying figures, which are incorporated herein, form part of the specification and illustrate embodiments of percutaneous medical procedure systems and related methods. Together with the description, the figures further serve to explain the principles of and to enable a person skilled in the relevant art(s) to make, use, and implant the valve prosthesis described herein.
The following detailed description refers to the accompanying figures which illustrate several embodiments. Other embodiments are possible. Modifications can be made to the embodiments described herein without departing from the spirit and scope of the present invention. Therefore, the following detailed description is not meant to be limiting.
A suitable medical device 10 is not limited to prosthetic heart valves. In some embodiments, medical device 10 can be a device configured to be transported via a delivery catheter. In some embodiments, medical device 10 can be an expandable device, such as, for example, a percutaneously delivered device configured to be compacted and loaded onto a delivery catheter for advancement through a natural or artificial body lumen, such as for example through a patient's vasculature. In some embodiments, medical device 10 is not expandable. In some embodiments, medical device 10 is not designed to be implanted within the patient's body. In some embodiments, medical device 10 can be an embolic filter. In some embodiments, medical device 10 can be a tool that can be used, for example, to retrieve an item from inside a patient.
As described above, in some embodiments, system 16 can be configured for use in a transfemoral delivery procedure. In one example of such a procedure, a delivery device including a prosthetic heart valve can be advanced in a retrograde manner through a patient's femoral artery and into the patient's descending aorta. A catheter can then be advanced under fluoroscopic guidance over the simulated aortic arch, through the ascending aorta, into the left ventricle, and mid-way across the defective aortic valve. Once positioning of the catheter is confirmed, the valve prosthesis can be deployed within the valve annulus. The valve prosthesis can then expand against the simulated annulus. In some embodiments, as the valve prosthesis is expanded, it can trap leaflets against the annulus, which can retain the native valve in a permanently open state.
As described above, in some embodiments, system 16 can be configured for use in a transapical delivery procedure. In one example of such a procedure, a trocar or overtube can be inserted into a patient's left ventricle through an incision created in the apex of the patient's heart. A dilator can be used to aid in the insertion of the trocar. In this approach, the native valve (for example, the mitral valve) can be approached downstream relative to blood flow. The trocar can be retracted sufficiently to release the self-expanding valve prosthesis. The dilator can be presented between the leaflets. The trocar can be rotated and adjusted to align the valve prosthesis in a desired alignment. The dilator can be advanced into the left atrium to begin disengaging the proximal section of the valve prosthesis from the dilator.
In some embodiments, system 16 can be configured for use in a transatrial delivery procedure. In one example of such a procedure, a dilator and trocar can be inserted through an incision made in the wall of the left atrium of the heart. The dilator and trocar can then be advanced through the native valve and into the left ventricle of the heart. The dilator can then be withdrawn from the trocar. A guide wire can be advanced through the trocar to the point where the valve prosthesis comes to the end of the trocar. The valve prosthesis can be advanced sufficiently to release a self-expanding valve prosthesis from the trocar. The trocar can be rotated and adjusted to align the valve prosthesis in a desired alignment. The trocar can be withdrawn completely from the heart such that the valve prosthesis self-expands into position and can assume the function of the native valve.
The few example procedures described above are not intended to be exhaustive. It is understood that not every act need be performed and additional acts can be included as would be apparent to one of ordinary skill in the art. In addition, the acts can be reordered as desired. Other medical devices and delivery techniques can be used with any of the parts described herein. It is further understood that the above delivery routes are merely exemplary and that other suitable delivery routes can be employed. The terms “delivery” and “delivery system” as used herein is intended to refer broadly to positioning a medical device at a desired location and related systems. Such terms do not necessitate a system that actually deposits a medical device at a site, such as for example a device that can be used to implant a prosthetic heart valve. The term “delivery system” can cover, for example, a system that temporarily positions a medical device at a desired location. For example, the delivery system can be used to position an embolic filter at a desired location within a patient's vascular for a period of time before removing the embolic filter.
The delivery system 16 of
In some embodiments, dilator 18 can be connected to handle 17 via one or more inner shafts (see, for example, shaft 29 described below with respect to
In some embodiments, capsule 27 can be configured to house medical device 10 for delivery via system 16. Capsule 27 can include a lumen (shown for example in
In some embodiments, capsule 27 can be configured to move relative to medical device 10 to partially or fully release medical device 10 for delivery by system 16. In some embodiments, system 16 is configured to move capsule 27 relative to medical device 10 by moving capsule 27 from a first position to a second position while medical device 10 is relatively stationary. For example, in some embodiments, capsule 27 can be configured to move in a proximal direction relative to medical device 10 (towards handle 17) to partially or fully expose medical device 10 to allow for delivery medical device 10. In some embodiments, system 16 is configured to move capsule 27 relative to medical device 10 by moving medical device 10 from a first position to a second position while capsule 27 is relatively stationary. For example. In some embodiments, medical device 10 can be pushed relative to capsule 27 in a distal direction to partially or fully expose medical device 10 for delivery in system 16.
In some embodiments, movement of capsule 27 can be automatically or manually actuated. In some embodiments, handle 17 can include a control knob 37 configured to retract capsule 27. In some embodiments, movement of capsule 27 can be controlled by a user, such as by rotating control knob 37 on handle 17 or via another suitable actuator. In some embodiments, one or more portions of system 16 can include a flushing port 39, which in some embodiments can be configured to maintain hemostasis during a medical procedure. Flushing port 39 can be connected to handle 17, or another suitable portion of system 16. In some embodiments, one or more portions of system 16, such as for example an exterior of capsule 27 can be coated with a biocompatible lubricant.
In some embodiments, hub 23 can include an integrated hemostasis control feature. Hub 23 can be connected to introducer 25 and can be configured to move introducer 25 by sliding hub 23 distally towards dilator 18. In some embodiments, hub 23 can include a feature, such as for example a spring-loaded button, that can be configured to avoid accidental movement of hub 23 during a procedure.
In some embodiments, introducer 25 can be in the form of a flexible sheath. In some embodiments, introducer 25 can be used to push capsule 27 against dilator 18 after medical device 10 has been delivered. In some embodiments, introducer 25 can be configured to cover the exposed edges of capsule 27, which in some embodiments can facilitate retraction through the deployed prosthesis. In some embodiments, once medical device 10 is released and expands against a body lumen, a user can slide hub 23 in a distal direction. System 16 can be configured such that distal movement of hub 23 will move introducer 25 in a distal direction. In some embodiments, system 16 is configured such that distal movement of introducer 25 will thereby slide capsule 27 to engage a proximal end of dilator 18.
As described above, in some embodiments, system 16 can be configured for use in a percutaneous delivery procedure including a medical device that is compacted and loaded into system 16 for advancement through a patient's vasculature.
In some conditions, an edge 33 of capsule 27 can align with dilator 18 such that it allows for a substantially continuous surface with dilator 18. However, in other conditions, such as while traversing a body lumen, a gap can be created between dilator 18 and edge 33 of capsule 27. In some embodiments, such a gap can be formed as a result of capsule 27 “fish mouthing”, which can occur when a portion of edge 33 is bent in a shape resembling an open fish mouth. In some cases, a gap between dilator 18 and capsule 27 can undesirably scrape an inside of a body lumen. In some cases, a gap between dilator 18 and capsule 27 can cause damage to one or more of capsule 27, dilator 18, medical device 10, or another component of system 16.
In order to avoid complications relating to fish mouthing, or for other advantages, delivery system 16 can be configured to cover a gap formed between capsule 27 and dilator 18 or between other components of system 16. For example, in some embodiments, dilator 18 can include flaps 32 that are configured to cover edge 33 of capsule 27 as system 16 traverses through a body lumen. In some embodiments, flaps 32 can be configured to prevent catching or snagging of the system during implantation or removal of the medical device. For example, in some embodiments, a proximal end of dilator 18 can cover an opening formed by a lumen of capsule 27. In some embodiments, flaps 32 can flex down over a portion of dilator 18 to keep a smooth transition between dilator 18 and capsule 27. In some embodiments, flaps 32 can be configured so that when medical device 10 traverses through a body lumen, one of flaps 32 can be on the outside curvature of medical device 10.
In some embodiments, flaps 32 can reduce or eliminate certain effects when recrossing a native valve, such as a native aortic valve, after resheathing. For example, when some dilators recross a native valve, a distal edge of the dilator or another component can flare out. In some cases, the flared dilator can make it difficult for a physician to cross through a native valve. In some embodiments, flaps 32 can flex down over a portion of dilator 18. In some embodiments, this can provide a smooth transition between dilator 18 and capsule 27, which in some cases can facilitate tracking through a native valve.
In some embodiments, dilator 18 can be assembled such that flaps 32 protrude from dilator 18 at an angle of approximately 90 degrees from axial direction 64. In some embodiments, flaps 32 protrude from dilator 18 at an angle greater than or less than 90 degrees, such as for example approximately 30 degrees, approximately 45 degrees, approximately 120 degrees, or approximately 150 degrees. In some embodiments, one of flaps 32 can protrude at a first angle, such as for example, approximately 90 degrees, and another of flaps 32 can protrude at a second and different angle, such as for example, approximately 30 degrees. In some embodiments, flaps 32 can be made of a thin film of polymer. In some embodiments, flaps 32 can be configured so that they are flexible enough to bend towards first portion 28 and/or second portion 30 of dilator 18 when system 16 is tracked through a body lumen. In some embodiments, flaps 32 can be stiff enough so that flaps 32 straighten back out to be perpendicular to axial direction 64 when flaps 32 are no longer pressed towards first portion 28 or second portion 30.
In some embodiments, flaps 32 are configured to bend so that flaps 32 are substantially parallel to capsule 27. As shown for example in
In some embodiments, flaps 32 can additionally be configured to bend towards first portion 28 when delivery system 16 is moved in a direction opposite to the first direction. In some embodiments, the direction opposite to the first direction can correspond to a direction in which dilator 18 moves when delivery system 16 is being retracted from a patient. In some embodiments, an ability of flaps 32 to bend towards first portion 28 can facilitate removing dilator 18 from a body lumen. In some embodiments, flaps 32 can bend towards second portion 30 when dilator 18 is moved towards a delivery site and then be inverted to bend towards first portion 28 when dilator 18 is being retracted. In some embodiments, flaps 32 are configured to only bend in one direction.
In some embodiments, first portion 28 can include a lumen configured to allow guide wire 22 to pass therethrough. In some embodiments, second portion 30 can include a lumen configured to allow guide wire 22 to pass therethrough. In some embodiments, the lumen of first portion 28 and the lumen of second portion 30 can be configured to align to form a single lumen 24 that can allow guide wire 22 to pass through both first portion 28 and second portion 30. In some embodiments, only one of first portion 28 and second portion 30 includes a lumen.
In some embodiments, such as for example the embodiment shown in
In embodiments including multiple flaps 32, flaps 32 can be formed from separate pieces of flap material. For example, in some embodiments, a left flap can be attached to a left side of dilator 18 and a right flap can be attached to a right side of dilator 18.
In some embodiments, dilator 18 includes only a single flap 32. In some embodiments, dilator 18 includes more than two flaps. For example, in some embodiments, piece 46 can be X-shaped, with four flaps protruding from an outer surface of dilator 18. In some embodiments, flaps 32 can include an end 54 that can be substantially flat, shown for example in
As further shown in
In
In some embodiments, a method of loading a medical device, such as medical device 10 into a delivery catheter can include securing coupler 70 to a delivery catheter shaft, the shaft having a lumen for receiving medical device 10. The method can further include crimping medical device 10 to a diameter that permits medical device 10 to be loaded into the shaft lumen. The method can further include loading medical device 10 into the shaft lumen. The method can further include securing dilator tip 68 to coupler 70 after medical device 10 is loaded into the shaft lumen. In some embodiments, tip 68 is secured to coupler 70 by threading dilator tip 68 onto coupler 70, such as via threads 76 and 78. In some embodiments, tip 68 is secured to coupler 70 via a snap fit between the tip 68 and the coupler 70, such as via arm 86 and collet 80. In some embodiments, coupler 70 is secured to the delivery catheter shaft via a press fit. In some embodiments, coupler 70 is secured to the delivery catheter shaft via adhesive or another suitable fastening means.
As described above, in some embodiments, tip 68 can be configured to attach to coupler 70 after a medical device, such as a valve prosthesis has been inserted into a system. In some embodiments, allowing tip 68 to attach to coupler 70 after a medical device has been loaded can increase the options for insertion of the device into the system. In some embodiments, such a configuration can allow tip 68 to be easily and securely attached to the system after loading of the device. In some embodiments, such a configuration can allow for variation in tip design for varying anatomy.
The choice of materials for the various valve prostheses described herein can be informed by the requirements of mechanical properties, temperature sensitivity, biocompatibility, moldability properties, or other factors apparent to a person having ordinary skill in the art. For example, one more of the parts (or a portion of one of the parts) can be made from suitable plastics, such as a suitable thermoplastic, suitable metals, and/or other suitable materials. One or more components or portions of components can be made of the same or similar material as any other component. One or more components or portions of components can be configured such that they are more flexible than another component or portion of component. In some embodiments, one or more components can include radiopaque materials.
In some embodiments, one or more components can include additional and/or embedded structure configured to provide increased mechanical strength while allowing for increased flexibility. In some embodiments, one or more components, such as for example capsule 27 or introducer 25, can include a metal laser cut tube, a wound coil, braid, or other suitable structure for increasing mechanical strength.
In some embodiments, one or more components can be entirely or partially constructed using a single material or a composite material and/or a multi-layer material. In some embodiments, one or more of the components can include a material with a low coefficient of friction. In some embodiments, such a material can, for example, assist in loading system 16, delivering medical device 10 and/or withdrawing system 16 from a body lumen. In some embodiments, one or more components can include a multi-layer design, including for example one or more layers can be made entirely or partially of polymer. In some embodiments, one or more layers can be made entirely or partially of high-density polyethylene (HDPE). In some embodiments, one or more layers can be made entirely or partially of polytetrafluoroethylene (PTFE).
The foregoing description of the invention has been presented for purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise form disclosed. Other modifications and variations can be possible in light of the above teachings. The embodiments and examples were chosen and described in order to best explain the principles of the invention and its practical application and to thereby enable others skilled in the art to best utilize the invention in various embodiments with modifications as are suited to the particular use contemplated. It is intended that the appended claims be construed to include other alternative embodiments of the invention.
Number | Date | Country | |
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Parent | 13681529 | Nov 2012 | US |
Child | 15863944 | US |
Number | Date | Country | |
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Parent | 15863944 | Jan 2018 | US |
Child | 17177984 | US |