The present disclosure relates to implantable, expandable prosthetic devices, and in particular, prosthetic heart valves.
The human heart can suffer from various valvular diseases. These valvular diseases can result in significant malfunctioning of the heart and ultimately require replacement of the native valve with an artificial valve. There are a number of known artificial valves and a number of known methods of implanting these artificial valves in humans. Because of the drawbacks associated with conventional open-heart surgery, percutaneous and minimally-invasive surgical approaches are garnering intense attention. In one technique, a prosthetic valve is configured to be implanted in a much less invasive procedure by way of catheterization. For example, collapsible transcatheter prosthetic heart valves can be crimped to a compressed state and percutaneously introduced in the compressed state on a catheter and expanded to a functional size at the desired position by balloon inflation or by utilization of a self-expanding frame or stent. Examples of transcatheter prosthetic heart valves are disclosed in U.S. Pat. Nos. 6,730,118, 7,393,360, 7,510,575, and 7,993,394, which are incorporated herein by reference.
A prosthetic valve for use in such a procedure typically includes a radially collapsible and expandable frame, multiple leaflets supported by the frame, and one or more fabric skirts or cuffs that are used for paravalvular sealing and/or reinforcing the connection between the leaflets and the frame. During the operating cycle of the prosthetic valve, the leaflets open and close under the flow of blood through the valve and may contact the frame and/or a skirt, which may cause abrasion of the leaflets. Thus, it is desirable to prevent or mitigate such abrasion of the leaflets, which can improve long term durability of the prosthetic valve.
In one representative embodiment, an implantable prosthetic valve comprises an annular frame comprising an inflow end and an outflow end and being radially collapsible and expandable between a radially collapsed configuration and a radially expanded configuration; a leaflet structure positioned within the frame, the valvular structure being configured to permit the flow of blood from an inflow end to an outflow end of the prosthetic valve and block the flow of blood from the outflow end to the inflow end of the prosthetic valve; and a fabric inner skirt positioned along an inner surface of the frame. The inner skirt comprises a first set of yarns extending in a first direction and a second set of yarns extending in a second direction and woven with the first set of yarns, wherein the yarns of the first set are thinner than the yarns of the second set. The first set of yarns are woven with the second set of yarns such that an inner surface of the skirt is formed from more of the yarns of the first set than the yarns of the second set and an outer surface of the skirt is formed from more of the yarns of the second set than the yarns of the first set.
In some embodiments, the inner surface of the skirt has a coefficient of friction that is less than a coefficient of friction of than the outer surface.
In some embodiments, the inner surface of the skirt is smoother than the outer surface of the skirt.
In some embodiments, the first direction of the first set of yarns extends circumferentially with respect to the frame and the second direction of the second set of yarns extends axially with respect to the frame.
In some embodiments, the yarns of the first and second sets of yarns comprise multi-filament yarns.
In some embodiments, the yarns of the first set have a greater number of filaments than the yarns of the second set.
In some embodiments, the skirt comprises a weave characterized by at least two or more adjacent yarns of the first set floating over a single yarn of the second set and at least two or more yarns of the second set floating over a single yarn of the first set.
In some embodiments, the skirt comprises a weave characterized by at least four or more adjacent yarns of the first set floating over a single yarn of the second set and at least four or more yarns of the second set floating over a single yarn of the first set.
In some embodiments, the yarns of the first set have about 30 to 40 filaments per yarn and the yarns of the second set have about 10 to 20 filaments per yarn.
In some embodiments, the filaments of the first set of yarns have a thickness in a range of about 4 microns to about 6 microns.
In some embodiments, the filaments of the second set of yarns have a thickness in a range of about 10 microns to about 12 microns.
In some embodiments, the skirt comprises a satin weave.
In some embodiments, the leaflet structure comprises a plurality of leaflets having respective inflow edge portions that are sutured to the skirt.
In some embodiments, the skirt is sutured to struts of the frame.
In another representative embodiment, an implantable prosthetic valve comprises an annular frame comprising an inflow end and an outflow end and being radially collapsible and expandable between a radially collapsed configuration and a radially expanded configuration; a leaflet structure positioned within the frame, the valvular structure being configured to permit the flow of blood from an inflow end to an outflow end of the prosthetic valve and block the flow of blood from the outflow end to the inflow end of the prosthetic valve; and a fabric skirt coupled to the frame, wherein the skirt comprises a first set of yarns extending in a first direction and a second set of yarns extending in a second direction and woven with the first set of yarns in a satin weave.
In some embodiments, the skirt has an inner surface and an outer surface, wherein the inner surface is smoother than the outer surface.
In some embodiments, the first set of yarns are warp yarns and the second set of yarns are weft yarns.
In some embodiments, an inner surface of the skirt is formed from more of the yarns of the first set than the yarns of the second set and an outer surface of the skirt is formed from more of the yarns of the second set than the yarns of the first set.
In some embodiments, the first direction of the first set of yarns extends in a circumferential direction with respect to the frame and the second direction of the second set of yarns extends in an axial direction with respect to the frame.
In some embodiments, the yarns of the first set comprise a plurality of first filaments and the yarns of the second set comprise a plurality of second filaments, wherein the first filaments are thinner than the second filaments.
In some embodiments, the filaments of the first set of yarns have a thickness in a range of about 4 microns to about 6 microns.
In some embodiments, the filaments of the second set of yarns have a thickness in a range of about 10 microns to about 12 microns.
In some embodiments, the yarns of the first set comprise a greater number of filaments per yarn than the yarns of the second set.
In some embodiments, the yarns of the first set have about 30 to 40 filaments per yarn and the yarns of the second set have about 10 to 20 filaments per yarn.
In some embodiments, the skirt is an inner skirt positioned along an inner surface of the frame.
In some embodiments, the skirt is an outer skirt positioned along an outer surface of the frame.
In some embodiments, an inner surface of the skirt has a coefficient of friction that is less than a coefficient of friction of than an outer surface of the skirt.
In some embodiments, the skirt comprises a weave characterized by at least two or more floats between interlacings of the first and second yarns.
In some embodiments, the skirt comprises a weave characterized by at least four or more floats between interlacings of the first and second yarns.
In another representative embodiment, an implantable prosthetic valve comprises an annular frame comprising an inflow end and an outflow end and being radially collapsible and expandable between a radially collapsed configuration and a radially expanded configuration; a leaflet structure positioned within the frame, the valvular structure being configured to permit the flow of blood from an inflow end to an outflow end of the prosthetic valve and block the flow of blood from the outflow end to the inflow end of the prosthetic valve; and a fabric skirt coupled to the frame, wherein the skirt is constructed of a weave such that an inner surface of the skirt is smoother than an outer surface of the skirt.
In some embodiments, the weave comprises a satin weave.
In some embodiments, the weave comprises a first set of yarns extending in a first direction and a second set of yarns extending in a second direction and woven with the first set of yarns, wherein the yarns of the first set are thinner than the yarns of the second set. The first set of yarns are woven with the second set of yarns such that the inner surface of the skirt is formed from more of the yarns of the first set than the yarns of the second set and the outer surface of the skirt is formed from more of the yarns of the second set than the yarns of the first set.
In some embodiments, the yarns of the first set have about 30 to 40 filaments per yarn and the yarns of the second set have about 10 to 20 filaments per yarn.
In some embodiments, the filaments of the first set of yarns have a thickness in a range of about 4 microns to about 6 microns.
In some embodiments, the filaments of the second set of yarns have a thickness in a range of about 10 microns to about 12 microns.
In some embodiments, the skirt is sutured to struts of the frame.
In some embodiments, the skirt comprises a weave characterized by at least two or more floats between interlacings of the first and second yarns.
In some embodiments, the skirt comprises a weave characterized by at least four or more floats between interlacings of the first and second yarns.
In some embodiments, the skirt is an inner skirt positioned along an inner surface of the frame.
In some embodiments, the skirt is an outer skirt positioned along an outer surface of the frame.
In another representative embodiment, an implantable prosthetic valve comprises an annular frame comprising an inflow end and an outflow end and being radially collapsible and expandable between a radially collapsed configuration and a radially expanded configuration; a leaflet structure positioned within the frame, the valvular structure being configured to permit the flow of blood from an inflow end to an outflow end of the prosthetic valve and block the flow of blood from the outflow end to the inflow end of the prosthetic valve; and a fabric skirt coupled to the frame, wherein the skirt comprises a weave constructed from a first set of yarns extending in a first direction woven together with a second set of yarns extending in a second direction to form a plurality of interlacings, wherein the weave is characterized by at least two floats between the interlacings of the first and second yarns.
In some embodiments, the weave is characterized by at least four floats between the interlacings of the first and second yarns.
In some embodiments, an inner surface of the skirt has a coefficient of friction that is less than a coefficient of friction of than an outer surface.
In some embodiments, an inner surface of the skirt is smoother than an outer surface of the skirt.
In some embodiments, the first direction of the first set of yarns extends circumferentially with respect to the frame and the second direction of the second set of yarns extends axially with respect to the frame.
In some embodiments, the yarns of the first and second sets of yarns comprise multi-filament yarns.
In some embodiments, the yarns of the first set have a greater number of filaments than the yarns of the second set.
In some embodiments, the filaments of the first set of yarns are thinner than the filaments of the second set of yarns.
In some embodiments, an inner surface of the skirt is formed from more of the yarns of the first set than the yarns of the second set and an outer surface of the skirt is formed from more of the yarns of the second set than the yarns of the first set.
In some embodiments, the skirt is an inner skirt positioned along an inner surface of the frame.
In some embodiments, the skirt is an outer skirt positioned along an outer surface of the frame.
The foregoing and other objects, features, and advantages of the invention will become more apparent from the following detailed description, which proceeds with reference to the accompanying figures.
The valvular structure 14 can comprise three leaflets 41, collectively forming a leaflet structure, which can be arranged to collapse in a tricuspid arrangement, as best shown in
The bare frame 12 is shown in
Suitable plastically-expandable materials that can be used to form the frame 12 include, without limitation, stainless steel, a biocompatible, high-strength alloys (e.g., a cobalt-chromium or a nickel-cobalt-chromium alloys), polymers, or combinations thereof. In particular embodiments, frame 12 is made of a nickel-cobalt-chromium-molybdenum alloy, such as MP35N® alloy (SPS Technologies, Jenkintown, Pa.), which is equivalent to UNS R30035 alloy (covered by ASTM F562-02). MP35N® alloy/UNS R30035 alloy comprises 35% nickel, 35% cobalt, 20% chromium, and 10% molybdenum, by weight. It has been found that the use of MP35N® alloy to form frame 12 provides superior structural results over stainless steel. In particular, when MP35N® alloy is used as the frame material, less material is needed to achieve the same or better performance in radial and crush force resistance, fatigue resistances, and corrosion resistance. Moreover, since less material is required, the crimped profile of the frame can be reduced, thereby providing a lower profile prosthetic valve assembly for percutaneous delivery to the treatment location in the body.
Referring to
Each commissure window frame portion 30 mounts a respective commissure of the leaflet structure 14. As can be seen each frame portion 30 is secured at its upper and lower ends to the adjacent rows of struts to provide a robust configuration that enhances fatigue resistance under cyclic loading of the prosthetic valve compared to known, cantilevered struts for supporting the commissures of the leaflet structure. This configuration enables a reduction in the frame wall thickness to achieve a smaller crimped diameter of the prosthetic valve. In particular embodiments, the thickness T of the frame 12 (
The struts and frame portions of the frame collectively define a plurality of open cells of the frame. At the inflow end of the frame 12, struts 22, struts 24, and struts 34 define a lower row of cells defining openings 36. The second, third, and fourth rows of struts 24, 26, and 28 define two intermediate rows of cells defining openings 38. The fourth and fifth rows of struts 28 and 32, along with frame portions 30 and struts 31, define an upper row of cells defining openings 40. The openings 40 are relatively large and are sized to allow portions of the leaflet structure 14 to protrude, or bulge, into and/or through the openings 40 when the frame 12 is crimped in order to minimize the crimping profile.
As best shown in
The frame 12 is configured to reduce, to prevent, or to minimize possible over-expansion of the prosthetic valve at a predetermined balloon pressure, especially at the outflow end portion of the frame, which supports the leaflet structure 14. In one aspect, the frame is configured to have relatively larger angles 42a, 42b, 42c, 42d, 42e between struts, as shown in
The main functions of the inner skirt 16 are to assist in securing the valvular structure 14 to the frame 12 and to assist in forming a good seal between the prosthetic valve and the native annulus by blocking the flow of blood through the open cells of the frame 12 below the lower edge of the leaflets. The inner skirt 16 desirably comprises a tough, tear resistant material such as polyethylene terephthalate (PET), although various other synthetic materials or natural materials (e.g., pericardial tissue) can be used. The thickness of the skirt desirably is less than about 0.15 mm (about 6 mil), and desirably less than about 0.1 mm (about 4 mil), and even more desirably about 0.05 mm (about 2 mil). In particular embodiments, the skirt 16 can have a variable thickness, for example, the skirt can be thicker at least one of its edges than at its center. In one implementation, the skirt 16 can comprise a PET skirt having a thickness of about 0.07 mm at its edges and about 0.06 mm at its center. The thinner skirt can provide for better crimping performances while still providing good perivalvular sealing.
The skirt 16 can be secured to the inside of frame 12 via sutures 70, which can extend through the skirt and around struts of the frame, as shown in
Known fabric skirts may comprise a weave of warp and weft fibers that extend perpendicularly to each other and with one set of the fibers extending longitudinally between the upper and lower edges of the skirt. When the metal frame to which the fabric skirt is secured is radially compressed, the overall axial length of the frame increases. Unfortunately, a fabric skirt with limited elasticity cannot stretch as the frame elongates and therefore can deform the struts of the frame and prevent uniform crimping unless the skirt includes excess material or slack along its length when in its radially expanded state.
Referring to
Referring again to
In addition, the spacing between the woven yarns can be increased to facilitate elongation of the skirt in the axial direction. For example, for a PET inner skirt 16 formed from 20-denier yarn, the yarn density can be about 15% to about 30% lower than in a typical PET skirt. In some examples, the yarn spacing of the inner skirt 16 can be from about 60 yarns per cm (about 155 yarns per inch) to about 70 yarns per cm (about 180 yarns per inch), such as about 63 yarns per cm (about 160 yarns per inch), whereas in a typical PET skirt the yarn spacing can be from about 85 yarns per cm (about 217 yarns per inch) to about 97 yarns per cm (about 247 yarns per inch). The oblique edges 86, 88 promote a uniform and even distribution of the fabric material along inner circumference of the frame during crimping so as to reduce or minimize bunching of the fabric to facilitate uniform crimping to the smallest possible diameter. Additionally, cutting diagonal sutures in a vertical manner may leave loose fringes along the cut edges. The oblique edges 86, 88 help minimize this from occurring. Compared to the construction of a conventional skirt, the construction of the inner skirt 16 avoids undesirable deformation of the frame struts and provides more uniform crimping of the frame.
In alternative embodiments, the skirt can be formed from woven elastic yarns that can stretch in the axial direction during crimping of the prosthetic valve. The warp and weft yarns can run perpendicularly and parallel to the upper and lower edges of the skirt, or alternatively, they can extend at angles between 0 and 90 degrees relative to the upper and lower edges of the skirt, as described above.
The inner skirt 16 can be sutured to the frame 12 at locations away from the suture line 154 so that the skirt can be more pliable in that area. This configuration can avoid stress concentrations at the suture line 154, which attaches the lower edges of the leaflets to the inner skirt 16.
As noted above, the leaflet structure 14 in the illustrated embodiment includes three flexible leaflets 41 (although a greater or a smaller number of leaflets can be used). Additional information regarding the leaflets, as well as additional information regarding skirt material, can be found, for example, in U.S. Pat. No. 10,195,025, which is incorporated by reference in its entirety.
The leaflets 41 can be secured to one another at their adjacent sides to form commissures 122 of the leaflet structure. A plurality of flexible connectors 124 (one of which is shown in
As noted above, the inner skirt 16 can be used to assist in suturing the leaflet structure 14 to the frame. The inner skirt 16 can have an undulating temporary marking suture to guide the attachment of the lower edges of each leaflet 41. The inner skirt 16 itself can be sutured to the struts of the frame 12 using sutures 70, as noted above, before securing the leaflet structure 14 to the skirt 16. The struts that intersect the marking suture desirably are not attached to the inner skirt 16. This allows the inner skirt 16 to be more pliable in the areas not secured to the frame and minimizes stress concentrations along the suture line that secures the lower edges of the leaflets to the skirt. As noted above, when the skirt is secured to the frame, the yarns 78, 80 of the skirt (see
After all three commissure tab assemblies are secured to respective window frame portions 30, the inflow or cusp edges of the leaflets 41 (the lower edges in the illustrated embodiment) between the commissure tab assemblies can be sutured to the inner skirt 16. For example, as shown in
As best shown in
In lieu of or in addition to sutures, the outer skirt 18 can be attached to the inner skirt 16, for example, by ultrasonic welding. Ultrasonic welding can provide several significant advantages. For example, ultrasonic welding can be relatively less time consuming and less expensive compared to suturing, while also providing improved strength.
As shown in
As can be seen in
The outer skirt 18 can comprise an axial length or height Hs, where Hs is the height of the outer skirt 18, less the lower edge portion 174 that is wrapped around the inflow end 15 of the frame 12, as best shown in
As best shown in
As best shown in
The openings 167 can also advantageously allow back-flowing blood (e.g., retrograde blood) to enter the outer skirt 18 from a different angle or direction than the notches 166, thus improving how quickly the outer skirt 18 initially expands and improving perivalvular sealing. The openings 167 can be provided in lieu of or in addition to the notches 166.
The openings 167 can comprise various shapes. For example, the openings 167 can comprise a tear-drop shape, as shown in the illustrated embodiment. In other embodiments, the openings can be circular, elliptical, rectangular, etc.
The prosthetic valve 10 can be configured for and mounted on a suitable delivery apparatus for implantation in a subject. Several catheter-based delivery apparatuses are known; a non-limiting example of a suitable catheter-based delivery apparatus includes those disclosed in U.S. Patent Application Publication Nos. 2013/0030519 and 2017/0065415, which are incorporated by reference herein in their entirety, and U.S. Patent Application Publication No. 2012/0123529.
To implant a plastically-expandable prosthetic valve 10 within a patient, the prosthetic valve 10 can be crimped on an elongated shaft 180 of a delivery apparatus, as best shown in
When the prosthetic valve 10 expands, the notches 166 and the openings 167 allow blood to flow between the outer skirt 18 and the inner skirt 16. This blood-flow causes the excess fabric of the outer skirt 18 to further radially expand and separate from the inner skirt 16.
The expanded outer skirt 18 can fill-in gaps between the frame 12 and the surrounding native annulus to assist in forming a good, fluid-tight seal between the prosthetic valve 10 and the native annulus. The outer skirt 18 therefore cooperates with the inner skirt 16 to avoid perivalvular leakage after implantation of the prosthetic valve 10. In several embodiments, the prosthetic valve 10 comprising the outer skirt 18 that expands radially outwardly can have reduced perivalvular leakage when implanted in a subject compared to a similar prosthetic valve that has a relatively smaller outer skirt or lacks the outer skirt 18.
Alternatively, a self-expanding prosthetic valve 10 can be crimped to a radially collapsed configuration and restrained in the collapsed configuration by inserting the prosthetic valve 10 into a sheath or equivalent mechanism of a delivery catheter. The prosthetic valve 10 can then be percutaneously delivered to a desired implantation location. Once inside the body, the prosthetic valve 10 can be advanced from the delivery sheath, which allows the prosthetic valve to expand to its functional state.
When the outer skirt 18 is exposed from the delivery sheath, the notches 166 and the openings 167 allow blood to flow between the outer skirt 18 and the inner skirt 16. This blood-flow causes the excess fabric of the outer skirt 18 to further radially expand and separate from the inner skirt 16.
The skirt 200 comprises a first set of yarns 206 woven together with a second set of yarns 208. The yarns 206, 208 can comprise multi-filament yarns (yarns comprising plural fibers or filaments) or mono-filament yarns (yarns comprising single fibers or filaments). In the illustrated embodiment, the yarns 206 are oriented in the circumferential direction of the prosthetic valve 10 and the yarns 208 are oriented in the axial direction of the prosthetic valve. During manufacture of the skirt 200, the yarns 206 can be the weft yarns of the fabric and the yarns 208 can be the warp yarns of the fabric. However, in alternative embodiments, the yarns 206 can be the warp yarns of the fabric and the yarns 208 can be the weft yarns of the fabric.
Due to the weave of the fabric, the inner surface 202 of the skirt is formed from more of yarns 206 than the yarns 208, while the outer surface 204 of the skirt is formed from more of the yarns 208 than the yarns 206. Stated differently, more of the yarns 206 are exposed on the inner surface 202 than the yarns 208, while more of the yarns 208 are exposed on the outer surface 204 than the yarns 206. Specifically, as best shown in
Although the illustrated embodiment is characterized by four floats between interlacings (where a yarn extends from one surface of the fabric to the opposite surface of the fabric), the number of floats for the yarns 206, 208 can vary. In particular embodiments, each yarn 206, 208 has at least two floats between interlacings, at least three floats between interlacings, at least four floats between interlacings, at least five floats between interlacings, at least six floats between interlacings, at least seven floats between interlacings, at least eight floats between interlacings, etc. In certain embodiments, the number of floats between interlacings can vary along the length of a yarn and/or among the yarns.
In particular embodiments, the yarns 206, 208 comprises PET, although other biocompatible synthetic or natural fibers may be used.
The fabric shown in
In particular embodiments, the number of yarns 206 are greater than the number of yarns 208. Also, in particular embodiments, the yarns 206 have a diameter or thickness that is smaller than the diameter or thickness of the yarns 208. Due to the dominance of the relatively thinner yarns 206 on the inner surface 202, the inner surface 202 is relatively smoother and less rough than the outer surface 204. Moreover, the inner surface 202 has a lower coefficient of friction than the outer surface 204. Advantageously, the inner surface 204 can reduce abrasion of the leaflets 41 if they contact the inner skirt as the leaflets 41 open during working cycles of the prosthetic valve. In addition, the relatively thinner yarns 206 can reduce creasing and fold lines in the skirt after the prosthetic valve is radially expanded to its functional size.
As noted above, components 206, 208 can represent interwoven first and second yarns 206, 208, each formed from multiple filaments or fibers. In particular embodiments, the yarns 206 each comprise multiple filaments that have a diameter or thickness that is smaller than the diameter or thickness of the filaments of the yarns 208. Also, in the particular embodiments, the yarns 206 have a greater number of filaments per yarn than the yarns 208. Due to the dominance of the yarns 206 of relatively thinner filaments on the inner surface 202, the inner surface 202 is relatively smoother and less rough and has a lower coefficient of friction than the outer surface 204.
In certain embodiments, the yarns 206 have about 20 to 50 filaments per yarn, more desirably about 25 to 45 filaments per yarn, even more desirably about 30 to 40 filaments per yarn, and even more desirably about 30 to 35 filaments per yarn, with 32 filaments per yarn being a specific example. The filaments of the yarns 206 can have a thickness in the range of about 2 microns to about 10 microns, more desirably about 4 microns to about 6 microns, with 5 microns being a specific example. The yarns 208 can have about 15 to 25 filaments per yarn, more desirably 10 to 20 filaments per yarn, even more desirably about 15 to 20 filaments per yarn, with 18 filaments per yarn being a specific example. The filaments of the yarns 208 can have a thickness in the range of about 8 microns to about 16 microns, more desirably about 10 microns to about 12 microns, with 11 microns being a specific example.
As noted above, the relatively thicker yarns 208 dominate the outer surface 204 of the skirt 200 can be oriented to extend axially along the frame 12 of the prosthetic valve. In some embodiments, the outer surface 204 of the skirt can come into contact with an inner surface of an introducer sheath through the openings in the frame 12. The axially oriented yarns 208 can reduce sliding friction with the introducer sheath and can reduce the pushing force required to advance the prosthetic valve through the introducer sheath. Similarly, in some embodiments the outer surface 204 of the skirt can come into contact with a delivery capsule or sheath (such as in the case of a self-expandable prosthetic valve). The axially oriented yarns 208 can reduce sliding friction with the delivery capsule and can reduce the pushing or pulling force required to deploy the prosthetic valve from the delivery capsule.
In alternative embodiments, the yarns 206 can be oriented axially and the yarns 208 can be oriented circumferentially. In still alternative embodiments, the yarns 206, 208 can be non-perpendicular to the inflow and outflow edges of the skirt, such as described above with respect to the skirt 16 shown in
In alternative embodiments, it may be desirable to reverse the orientation of the inner skirt 200 such that the surface 202 is an outer surface facing the frame 12 and the surface 204 is an inner surface facing inwardly toward the leaflets 41, for example, if the leaflets 41 do not come into contact with the skirt during working cycles of the prosthetic valve.
In alternative embodiments, the yarns 208 can have the same number of filaments and/or filaments of the same thickness as the filaments of the yarns 206, providing a fabric wherein both surfaces 202, 204 are relatively smooth. For example, in certain implementations, the yarns 206, 208 have about 20 to 50 filaments per yarn, more desirably about 25 to 45 filaments per yarn, even more desirably about 30 to 40 filaments per yarn, and even more desirably about 30 to 35 filaments per yarn, with 32 filaments per yarn being a specific example. The filaments of the yarns 206, 208 can have a thickness in the range of about 2 microns to about 10 microns, more desirably about 4 microns to about 6 microns, with 5 microns being a specific example.
In another embodiment, the skirt 200 can be an outer skirt of a prosthetic valve. The outer skirt 200 can have an inner surface 202 facing the frame 12 and an outer surface 204 facing away from the frame 12. This may be desirable in embodiments of the prosthetic valve where an inner skirt is not provided, and the outer skirt can come into contact with the leaflets through the cells of the frame. In other implementations, the orientation of the outer skirt 200 can be reversed such that the surface 202 is the outer surface of the outer skirt and the surface 204 is the inner surface of the outer skirt outer skirt. In one specific example, the prosthetic valve 10 can have an outer skirt 200 that can have the same overall shape and configuration as the outer skirt 18 and can be assembled in the same manner as the outer skirt 18.
It should be understood that the disclosed embodiments can be adapted to deliver and implant prosthetic devices in any of the native annuluses of the heart (e.g., the aortic, pulmonary, mitral, and tricuspid annuluses), and can be used with any of various approaches (e.g., retrograde, antegrade, trans septal, transventricular, transatrial, etc.).
For purposes of this description, certain aspects, advantages, and novel features of the embodiments of this disclosure are described herein. The disclosed methods, apparatus, and systems should not be construed as being limiting in any way. Instead, the present disclosure is directed toward all novel and nonobvious features and aspects of the various disclosed embodiments, alone and in various combinations and sub-combinations with one another. The methods, apparatus, and systems are not limited to any specific aspect or feature or combination thereof, nor do the disclosed embodiments require that any one or more specific advantages be present or problems be solved.
Although the operations of some of the disclosed embodiments are described in a particular, sequential order for convenient presentation, it should be understood that this manner of description encompasses rearrangement, unless a particular ordering is required by specific language set forth below. For example, operations described sequentially may in some cases be rearranged or performed concurrently. Moreover, for the sake of simplicity, the attached figures may not show the various ways in which the disclosed methods can be used in conjunction with other methods. Additionally, the description sometimes uses terms like “provide” or “achieve” to describe the disclosed methods. These terms are high-level abstractions of the actual operations that are performed. The actual operations that correspond to these terms may vary depending on the particular implementation and are readily discernible by one of ordinary skill in the art.
As used in this application and in the claims, the singular forms “a,” “an,” and “the” include the plural forms unless the context clearly dictates otherwise. Additionally, the term “includes” means “comprises.” Further, the terms “coupled” and “associated” generally mean electrically, electromagnetically, and/or physically (e.g., mechanically or chemically) coupled or linked and does not exclude the presence of intermediate elements between the coupled or associated items absent specific contrary language.
As used herein, the term “proximal” refers to a position, direction, or portion of a device that is closer to the user and further away from the implantation site. As used herein, the term “distal” refers to a position, direction, or portion of a device that is further away from the user and closer to the implantation site. Thus, for example, proximal motion of a device is motion of the device toward the user, while distal motion of the device is motion of the device away from the user. The terms “longitudinal” and “axial” refer to an axis extending in the proximal and distal directions, unless otherwise expressly defined.
As used herein, the terms “integrally formed” and “unitary construction” refer to a construction that does not include any welds, fasteners, or other means for securing separately formed pieces of material to each other.
As used herein, the term “coupled” generally means physically coupled or linked and does not exclude the presence of intermediate elements between the coupled items absent specific contrary language.
As used herein, operations that occur “simultaneously” or “concurrently” occur generally at the same time as one another, although delays in the occurrence of one operation relative to the other due to, for example, spacing, play or backlash between components in a mechanical linkage such as threads, gears, etc., are expressly within the scope of the above terms, absent specific contrary language.
In view of the many possible embodiments to which the principles of the disclosed invention may be applied, it should be recognized that the illustrated embodiments are only preferred examples of the invention and should not be taken as limiting the scope of the invention. Rather, the scope of the invention is defined by the following claims. I therefore claim as my invention all that comes within the scope and spirit of these claims.
The present application is a continuation of International Application No. PCT/US2020/034314, filed May 22, 2020, which claims the benefit of U.S. Provisional Application No. 62/854,244, filed May 29, 2019, which is incorporated herein by reference.
Number | Date | Country | |
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62854244 | May 2019 | US |
Number | Date | Country | |
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Parent | PCT/US2020/034314 | May 2020 | US |
Child | 17530385 | US |