US 9,149,358 B2Grant
Delivery systems for prosthetic heart valves
Issue Date:2015-10-06
•13 Claims
•8 Drawing Sheets
Abstract
A delivery system for delivery of an implantable stented device to a body lumen, the device having a plurality of structures at its proximal end, wherein the delivery system comprises a first body portion removably attached to a second body portion and wherein the second body portion includes a plurality of attachment components at its distal end for attachment to the plurality of structures at the proximal end of the device.
Metadata
Assignee
- Medtronic, Inc.
Inventors
- Charles Tabor
- Paul Rothstein
- Eliot Bloom
Application Information
Application Number:US 12/358,489
Filing Date:2009-01-23
Priority Date:2008-01-24
Art Unit:3734
Classifications
IPC:
A61F2/06A61F2/24A61F2/95
Field of Search:
A61F 2/95A61F 2002/9505A61F 2002/9511A61F 2002/9665A61F 2220/0025A61F 2220/0091A61F 2250/0062A61F 2/2427A61F 2/2439A61F 2002/9517A61F 2002/9534A61F 2/962A61F 2/966A61F 2002/011A61F 2/2466
Patent Drawings (8 sheets)
Description
Cross-Reference to Related Application
[0001] The present application claims priority to U.S. Provisional Application No. 61/062,207, filed Jan. 24, 2008, and titled “Delivery Systems and Methods of Implantation for Prosthetic Heart Valves”, the entire contents of which is incorporated herein by reference in its entirety.
Technical Field
[0002] The present invention relates to prosthetic heart valves. More particularly, it relates to devices, methods, and delivery systems for percutaneously implanting prosthetic heart valves.
Background
[0003] Diseased or otherwise deficient heart valves can be repaired or replaced using a variety of different types of heart valve surgeries. Typical heart valve surgeries involve an open-heart surgical procedure that is conducted under general anesthesia, during which the heart is stopped while blood flow is controlled by a heart-lung bypass machine. This type of valve surgery is highly invasive and exposes the patient to a number of potentially serious risks, such as infection, stroke, renal failure, and adverse effects associated with use of the heart-lung machine, for example.
[0004] Recently, there has been increasing interest in minimally invasive and percutaneous replacement of cardiac valves. Such surgical techniques involve making a very small opening in the skin of the patient into which a valve assembly is inserted in the body and delivered to the heart via a delivery device similar to a catheter. This technique is often preferable to more invasive forms of surgery, such as the open-heart surgical procedure described above. In the context of pulmonary valve replacement, U.S. Patent Application Publication Nos. 2003/0199971 A1 and 2003/0199963 A1, both filed by Tower, et al., describe a valved segment of bovine jugular vein, mounted within an expandable stent, for use as a replacement pulmonary valve. The replacement valve is mounted on a balloon catheter and delivered percutaneously via the vascular system to the location of the failed pulmonary valve and expanded by the balloon to compress the valve leaflets against the right ventricular outflow tract, anchoring and sealing the replacement valve. As described in the articles: “Percutaneous Insertion of the Pulmonary Valve”, Bonhoeffer, et al., Journal of the American College of Cardiology 2002; 39: 1664-1669 and “Transcatheter Replacement of a Bovine Valve in Pulmonary Position”, Bonhoeffer, et al., Circulation 2000; 102: 813-816, the replacement pulmonary valve may be implanted to replace native pulmonary valves or prosthetic pulmonary valves located in valved conduits.
[0005] Various types and configurations of prosthetic heart valves are used in percutaneous valve procedures to replace diseased natural human heart valves. The actual shape and configuration of any particular prosthetic heart valve is dependent to some extent upon the valve being replaced (i.e., mitral valve, tricuspid valve, aortic valve, or pulmonary valve). In general, the prosthetic heart valve designs attempt to replicate the function of the valve being replaced and thus will include valve leaflet-like structures used with either bioprostheses or mechanical heart valve prostheses. In other words, the replacement valves may include a valved vein segment that is mounted in some manner within an expandable stent to make a stented valve. In order to prepare such a valve for percutaneous implantation, the stented valve can be initially provided in an expanded or uncrimped condition, then crimped or compressed around the balloon portion of a catheter until it is as close to the diameter of the catheter as possible.
[0006] Other percutaneously-delivered prosthetic heart valves and systems for delivering them have been suggested, such as by Bonhoeffer, P. et al., “Transcatheter Implantation of a Bovine Valve in Pulmonary Position.” Circulation, 2002; 102:813-816, and by Cribier, A. et al. “Percutaneous Transcatheter Implantation of an Aortic Valve Prosthesis for Calcific Aortic Stenosis.” Circulation, 2002; 106:3006-3008, the disclosures of which are incorporated herein by reference. These heart valves and delivery techniques rely at least partially upon a frictional type of engagement between the expanded support structure and the native tissue to maintain a position of the delivered prosthesis, although the stents can also become at least partially embedded in the surrounding tissue in response to the radial force provided by the stent and balloons that are sometimes used to expand the stent. Thus, with these transcatheter techniques, conventional sewing of the prosthetic heart valve to the patient's native tissue is not necessary. Similarly, in an article by Bonhoeffer, P. et al. titled “Percutaneous Insertion of the Pulmonary Valve.” J Am Coll Cardiol, 2002; 39:1664-1669, the disclosure of which is incorporated herein by reference, percutaneous delivery of a biological valve is described. The valve is sutured to an expandable stent within a previously implanted valved or non-valved conduit, or a previously implanted valve. Again, radial expansion of the secondary valve stent is used for placing and maintaining the replacement valve.
[0007] Implantable, catheter-based devices, such as heart valves, are often pre-attached to a delivery system in order to simplify the procedure and minimize the degree and amount of clinician handling and associated risks. On the other hand, typical transcatheter valve systems include a valve that is not attached to the delivery system because it is not desirable for the tissue to be compressed in a delivery catheter for long periods of time. Thus, these systems require the clinician to directly handle the implantable valve in order to rinse the bioprosthetic valve and also significantly manipulate both the valve and stent and delivery system in order to attach the valve to the delivery system. This handling and manipulation increases the potential for damage to and/or misassembly of the stent/valve/delivery system, potentially leading to short or long-term consequences that can affect device placement or performance. In addition, direct handling of the valve/stent device by a clinician can increase the potential for contamination, which in turn can lead to patient infection or other serious patient consequences.
[0008] Although there have been advances in percutaneous valve replacement techniques and devices, there is a continued desire to provide different designs of cardiac valves that can be implanted in a minimally invasive and percutaneous manner. There is also a continued desire to provide a simplified manner of attaching a stented valve to a delivery system that requires less direct handling by a clinician immediately prior to implantation.
Summary
[0009] Replacement heart valves that can be used with delivery systems of the invention each include a stent within which a valve structure can be attached, although it is possible that the delivery systems instead be used for delivery of valveless stents. The stents used with delivery systems and methods of the invention include a wide variety of structures and features that can be used alone or in combination with other stent features. In particular, these stents provide a number of different docking and/or anchoring structures that are conducive to percutaneous delivery thereof. Many of the structures are thus compressible to a relatively small diameter for percutaneous delivery to the heart of the patient, and then are expandable either via removal of external compressive forces (e.g., self-expanding stents), or through application of an outward radial force (e.g., balloon expandable stents). The devices delivered by the delivery systems described herein include stents, valved stents, or other interventional devices such as atrial septal defect closure devices, ventricular septal defect closure devices, or patent foramen ovale occluders.
[0010] Methods for insertion of the replacement heart valves of the invention include delivery systems that can maintain the stent structures in their compressed state during their insertion and allow or cause the stent structures to expand once they are in their desired location. In particular, the methods of the invention for implanting a stent can include the use of delivery systems having a cartridge that can be pre-attached to a stent. The cartridge and stent can be provided to the operator in such a way that when the operator attaches the cartridge to the remainder of the delivery system, the delivery system will be ready for the surgical valve implantation procedure. Because the stent is preloaded on the cartridge, this approach can thereby eliminate or greatly reduce the time that is otherwise normally spent in the surgical area attaching a stent to a delivery system. The cartridge concept simplifies the attachment of the valve to the delivery system, improves the reliability and consistency of the attachment and prevents the undesirable consequences that can occur if the valve is attached backwards onto the delivery system. In addition the cartridge approach provides a surface for the clinician to grasp the implant during the valve rinsing process, thereby alleviating the need for direct contact with the implantable valve/stent during the valve rinsing process.
[0011] In one embodiment, the cartridge has a first or distal end to which the stent is attached and a second or proximal end that is attachable to the delivery system using one of a number of different connection configurations. The cartridge of the invention can also include sleeves or other devices for securing the stent to the cartridge after the initial attachment of these components. In addition, delivery methods of the invention can include features that allow the stents to be retrieved for removal or relocation thereof after they have been deployed or partially deployed from the stent delivery systems. The methods may include implantation of the stent structures using either an antegrade or retrograde approach. Further, in many of the delivery approaches of the invention, the stent structure is rotatable in vivo to allow the stent structure to be positioned in a desired orientation.
Brief Description of the Drawings
[0012] The present invention will be further explained with reference to the appended Figures, wherein like structure is referred to by like numerals throughout the several views, and wherein:
[0013] FIG. 1 is a perspective view of one embodiment of a delivery system of the invention;
[0014] FIG. 2 is a perspective view of a proximal end of the delivery system illustrated in FIG. 1 ;
[0015] FIG. 3 is a perspective view of a cartridge having plural wires with coiled ends as the wires are being attached to a stent frame;
[0016] FIG. 4 is an enlarged side view of the cartridge of FIG. 3 attached to the crowns at one end of a stent;
[0017] FIG. 5 is a side view of the cartridge and attached stent of FIG. 4 in proximity to a portion of a delivery system to which they will be attached;
[0018] FIG. 6 is a side view of a delivery system of the invention with an attached stent;
[0019] FIG. 7 is a perspective view of one configuration of another cartridge of the invention in proximity to a portion of a delivery system to which it will be attached;
[0020] FIG. 8 is a side view of a cartridge of the invention with a stent attached to its distal end;
[0021] FIG. 9 is a perspective view of the cartridge of FIG. 7 , with the components in another configuration relative to each other;
[0022] FIG. 10 is another perspective view of the cartridge of FIG. 7 , with the components in yet another configuration relative to each other;
[0023] FIG. 11 is an enlarged perspective view of a portion of the cartridge of FIG. 10 ;
[0024] FIG. 12 is another view of the cartridge of FIG. 11 ;
[0025] FIG. 13 is yet another view of the cartridge of FIG. 11 , but with the sleeve lock removed; and
[0026] FIGS. 14-16 are enlarged perspective views of a configuration for attaching a stent to a wire having a hook at its distal end.
Detailed Description
[0027] The embodiments of the present invention described below are not intended to be exhaustive or to limit the invention to the precise forms disclosed in the following detailed description. Rather, the embodiments are chosen and described so that others skilled in the art may appreciate and understand the principles and practices of the present invention.
[0028] As referred to herein, the prosthetic heart valves used in accordance with the various devices and methods of heart valve delivery may include a wide variety of different configurations, such as a prosthetic heart valve having tissue leaflets or a synthetic heart valve having polymeric, metallic, or tissue-engineered leaflets, and can be specifically configured for replacing any heart valve. That is, while much of the description herein refers to replacement of aortic valves, the prosthetic heart valves of the invention can also generally be used for replacement of native mitral, pulmonic, or tricuspid valves, for use as a venous valve, or to replace a failed bioprosthesis, such as in the area of an aortic valve or mitral valve, for example.
[0029] Although each of the prosthetic valves used with the delivery devices and methods described herein would typically include leaflets attached within an interior area of a stent, for clarity purposes, such leaflets are not shown in the illustrated embodiments. In general, the stents used with the delivery systems and methods described herein include a support structure comprising a number of strut or wire portions arranged relative to each other to provide a desired compressibility and strength to the heart valve. Although a number of different configurations of stents can be used, in general terms, the stents described herein are generally tubular support structures within which leaflets can be secured to provide a valved stent. The leaflets can be formed from a variety of materials, such as autologous tissue, xenograph material, or synthetics, as are known in the art. The leaflets may be provided as a homogenous, biological valve structure, such as a porcine, bovine, or equine valve. Alternatively, the leaflets can be provided as independent structures (e.g., bovine or equine pericardial leaflets) that are subsequently assembled to the support structure of the stent. In another alternative, the stent and leaflets can be fabricated at the same time, such as may be accomplished using high strength nano-manufactured NiTi films of the type produced by Advanced Bio Prosthetic Surfaces Ltd. (ABPS) of San Antonio, Tex., for example. The support structures are generally configured to accommodate three leaflets; however, the replacement prosthetic heart valves described herein can incorporate more or less than three leaflets.
[0030] In more general terms, the combination of a support structure with one or more leaflets can assume a variety of other configurations that differ from those shown and described, including any known prosthetic heart valve design. In certain embodiments of the invention, the support structure with leaflets can be any known expandable prosthetic heart valve configuration, whether balloon expandable, self-expanding, or unfurling (as described, for example, in U.S. Pat. Nos. 3,671,979; 4,056,854; 4,994,077; 5,332,402; 5,370,685; 5,397,351; 5,554,185; 5,855,601; and 6,168,614; U.S. Patent Application Publication No. 2004/0034411; Bonhoeffer P., et al., “Percutaneous Insertion of the Pulmonary Valve”, Pediatric Cardiology, 2002; 39:1664-1669; Anderson H R, et al., “Transluminal Implantation of Artificial Heart Valves”, EUR Heart J., 1992; 13:704-708; Anderson, J. R., et al., “Transluminal Catheter Implantation of New Expandable Artificial Cardiac Valve”, EUR Heart J., 1990, 11: (Suppl) 224a; Hilbert S. L., “Evaluation of Explanted Polyurethane Trileaflet Cardiac Valve Prosthesis”, J Thorac Cardiovascular Surgery, 1989; 94:419-29; Block P C, “Clinical and Hemodyamic Follow-Up After Percutaneous Aortic Valvuloplasty in the Elderly”, The American Journal of Cardiology, Vol. 62, Oct. 1, 1998; Boudjemline, Y., “Steps Toward Percutaneous Aortic Valve Replacement”, Circulation, 2002; 105:775-558; Bonhoeffer, P., “Transcatheter Implantation of a Bovine Valve in Pulmonary Position, a Lamb Study”, Circulation, 2000:102:813-816; Boudjemline, Y., “Percutaneous Implantation of a Valve in the Descending Aorta In Lambs”, EUR Heart J, 2002; 23:1045-1049; Kulkinski, D., “Future Horizons in Surgical Aortic Valve Replacement: Lessons Learned During the Early Stages of Developing a Transluminal Implantation Technique”, ASAIO J, 2004; 50:364-68; the teachings of which are all incorporated herein by reference).
[0031] Optional orientation and positioning of the stents of the invention may be accomplished either by self-orientation of the stents (such as by interference between features of the stent and a previously implanted stent or valve structure) or by manual orientation of the stent to align its features with anatomical or previous bioprosthetic features, such as can be accomplished using fluoroscopic visualization techniques, for example. For example, when aligning the stents of the invention with native anatomical structures, they should be aligned so as to not block the coronary arteries, and native mitral or tricuspid valves should be aligned relative to the anterior leaflet and/or the trigones/commissures.
[0032] The wires of the support structures of stents can be formed from a shape memory material such as a nickel titanium alloy (e.g., Nitinol). With this material, the support structure is self-expandable from a contracted state to an expanded state, such as by the application of heat, energy, and the like, or by the removal of external forces (e.g., compressive forces provided by a sheath). This support structure can be compressed and re-expanded without damaging the structure of the stent. In addition, the support structure of such an embodiment may be laser cut from a single piece of material or may be assembled from a number of different components. For these types of stent structures, one example of a delivery system that can be used includes a catheter with a retractable sheath that covers the stent until it is to be deployed, at which point the sheath can be retracted to allow the stent to expand.
[0033] The stents can alternatively be a series of wires or wire segments arranged so that they are capable of transitioning from a collapsed state to an expanded state only with the application of some type of force (e.g., an internal radial force pressing the stent outwardly). The wires comprising the support structure can be formed of a metal or other material. Further, these wires are arranged in such a way that allows for folding or compressing the stent to a contracted state in which its internal diameter is greatly reduced from when the structure is in an expanded state. When such a support structure (which preferably has an attached valve) is in its collapsed state, it can be mounted over a delivery device, such as a balloon catheter, for example. The support structure is configured so that it can be converted to its expanded state when desired, such as by the expansion of a balloon catheter. The delivery systems used for such a stent can be provided with degrees of rotational and axial orientation capabilities in order to properly position the new stent at its desired location.
[0034] Referring now to the Figures, wherein the components are labeled with like numerals throughout the several Figures, and initially to FIGS. 1-6 , one embodiment of a stent delivery system is illustrated. This system includes a cartridge for initial attachment of a stent and/or stent device to a stent base device and subsequent attachment of the cartridge and attached stent to the delivery system, thereby providing quick and simple attachment of a stent to a delivery system by an operator. In this embodiment of the invention, the attachment mechanism is a dovetail type of arrangement, which includes a mating feature on both a cartridge and a delivery system that allows the stent and cartridge to be preloaded and easily attached to the delivery system. Other mechanical attachment mechanisms can instead be used in place of the dovetail connection, such as threaded members, snap-fit connections, frictional connections, pins, and magnetic connections, for example.
[0035] In particular, FIG. 1 illustrates one exemplary delivery system 10 that generally includes a proximal end 12 and a distal end 14. FIG. 2 shows an enlarged view of the proximal end 12 of the delivery system 10 of FIG. 1 . Proximal end 12 includes a first knob 30 and a second knob 32 for use in controlling the delivery and deployment of a stent at the generally distal end 14, as will be described in further detail below. A delivery system for percutaneous stent and valve delivery can comprise a significantly longer delivery system that can be maneuvered through a patient's vasculature until a desired anatomical location is reached. In any case, the delivery system can include features that allow it to deliver a stent to a desired location in a patient's body.
[0036] A cartridge 16 is illustrated in FIG. 3 adjacent to an exemplary wire stent 18 to which it will be attached, is shown in FIG. 4 . The cartridge 16 includes a post 19 having a series of wires 20 extending from one end and a dovetail attachment portion 22 at the opposite end. Each of the wires 20 can be a spring wire that is formed at its distal end into a coiled or “pigtail” configuration and includes a generally straight portion that is connected to the post 19 at its proximal end. Each wire 20 is made of a shape-memory type of material (e.g., Nitinol) that can be straightened by applying an external force when in the proximity of a stent to which it will be attached and that will return generally to its coiled configuration when the straightening force is removed. Alternatively, the wires can be somewhat malleable so that they do not necessarily return to their original coil shape once stented valve features have been released from the wire. The size and exact configuration of the pigtail end portion of each wire can be chosen or designed so that the forces required to retract and deploy the stent are within a desirable range.
[0037] In order to load a stent onto the wires 20 of cartridge 16, the coiled or pigtail portions of each wire 20 can be straightened or partially straightened and placed adjacent to one of the crowns or “V” ends of the stent. The force on each wire 20 can then be removed or reduced so that the distal end of the wire coils back toward its pigtail configuration, thereby wrapping around and capturing one crown of the stent 18, as shown in FIG. 4 . The wire can be made of spring materials or shape memory materials that may be cured or “set” via a heat treating process so that the coiled wire end can be retracted, clocked, redeployed, disengaged, or the like, without the use of additional tools or the management of removed parts. If a different stent construction is used, the coiled wires can instead engage with some other feature of that type of stent. One wire having a pigtail or coiled wire end is preferably provided for each of the crowns of the stent, although the cartridge can be provided with more or less wires having coiled ends. It is also contemplated that a single crown of a stent may have more than one pigtail wire attached to it. After the wires 20 of the cartridge 16 are attached to the stent 18, the cartridge and stent combination can be considered to be “loaded” and is then ready for attachment to the delivery system 10.
[0038] In one method of the present invention, the process of attaching a stent to the cartridge can be performed immediately prior to the surgery during which the sent will be implanted in the patient. In this case, the valved stent can be attached in the operating room or its general proximity at approximately the same time that the clinician is preparing to implant the valved stent. Alternatively, the attachment of a valved stent to the cartridge can occur at a remote time and/or place relative to the time and location of the implantation. For example, the valved stent can be pre-attached to a cartridge, and then the valved stent and cartridge can be packaged together within a gluteraldehyde solution and provided in a pre-assembled manner to a clinician. In this way, the clinician can simply remove the assembly at the time of the implantation procedure and attach it to the delivery system, which can reduce the amount of time the valved stent needs to be manipulated immediately prior to the time of implantation. This attachment of a stent to the cartridge can be performed at any appropriate period of time prior to the implantation procedure, as long as the quality of the valve material remains acceptable
[0039] The exemplary stent 18, one end of which is shown in the Figures, is made of a series of wires that are compressible and expandable through the application and removal of external forces, and may include a series of Nitinol wires that are approximately 0.011-0.015 inches in diameter, for example. That is, the stent 18 may be considered to be a self-expanding stent. However, the stent to which the coiled wire portions of the cartridge are attached can have a number of different configurations and can be made of a wide variety of different materials.
[0040] FIG. 5 illustrates one end of the delivery system 10 as having a dovetail notch portion 24 that can mate or attach to a corresponding dovetail tab portion 22 of the cartridge 16. To attach the components to each other, the tab portion 22 is slid into the notch portion 24 until these two components are sufficiently engaged with each other so that manipulation of the delivery system will not cause them to become disengaged from each other. A dovetail configuration is one exemplary engagement mechanism of the cartridges of the invention. Other mechanical arrangements of cooperating elements on two portions of a delivery system can instead be used, some of which are described below. In general terms, however, the stent structure is attached to a cartridge, which in turn is mechanically attachable to another piece of the delivery system.
[0041] As shown in FIG. 6 , after the cartridge is attached to the delivery system, the cartridge and its attached stent can then be retracted into a hollow tube or lumen 26 of the delivery system by moving or pulling the cartridge toward the proximal end of the delivery device. This movement is continued until the crowns of the stent 18 are adjacent to the end of the lumen 26. Due to the compressible nature of the stent 18, continued movement of the cartridge 16 toward the proximal end of the delivery device will pull the wires 20 toward a central lumen 28 of the delivery system, thereby also moving the wires of the stent 18 toward the central lumen 28 (i.e., compressing the stent). The lumen 26 can then continue to be moved toward the proximal end of the device until the stent 18 is completely enclosed within the lumen 26, as illustrated in FIG. 1 .
[0042] The delivery system can then be used to deliver the stent 18 to its desired location in a lumen (e.g., a heart valve area) of a patient and deploy the valved stent. In one deployment method, the lumen 26 can be moved away from a distal tip of the delivery system to expose the free end of the stent 18. As the lumen is moved in this way, the compressive forces that were provided by the lumen are removed so that the stent 18 is allowed to expand outwardly. The wires 20 are then manipulated via an actuating mechanism of the delivery system until they are sufficiently uncoiled or straightened so that they become disengaged from the stent 18, thereby deploying the stent. The delivery system can then be removed from the patient and the cartridge 16 can be disconnected from the remainder of the delivery system, if desired, by disconnecting the tab attachment portion 22 and the notch portion 24.
[0043] With this system described above, full or partial blood flow through the valve can advantageously be maintained during the period when the stented valve is being deployed into the patient but is not yet released from its delivery system. This feature can help to prevent complications that may occur when blood flow is stopped or blocked during valve implantation with some other known delivery systems. In addition, it is possible for the clinician to thereby evaluate the opening and closing of leaflets, examine for any paravalvular leakage and evaluate coronary flow and proper positioning of the valve within the target anatomy before final release of the stented valve.
[0044] The process of pulling the wires toward the lumen in many of the described embodiments of the invention can be accomplished in a number of ways, such as by rotating the device over coarse threads or pushing a button to slide it to pull the wires toward the lumen. That is, a number of different mechanisms can be used to accomplish this movement of the wires relative to the delivery system. Further, it is noted that while the coiled wire ends described herein are generally shown to be engaging with the end crowns of a stent, the coiled wire ends can instead engage with intermediate stent crowns or other stent features.
[0045] Another exemplary embodiment of a delivery system of the invention, which includes a cartridge 50, is illustrated in FIGS. 7 through 13 . With particular reference to FIGS. 7 and 8 , cartridge 50 generally includes a distal or dilator tip 52, a proximal end 72, a hook assembly 54 adjacent to the proximal end 72, and a sleeve assembly 56 generally adjacent to the hook assembly 54. Sleeve assembly 56 includes a base portion 70 and multiple sleeves 58 that extend from the base portion 70 toward the distal tip 52. The sleeves 58 are shown in a compressed configuration in FIG. 7 , which is the general position the sleeves 58 will be in when they are being held within a sleeve during the process of being delivered into a body lumen, for example. FIG. 8 shows the sleeves 58 in a splayed or expanded configuration, such as would be the case when a sleeve or similar mechanism is not compressing the sleeves 58 toward a central axis of the delivery system. In this configuration, a proximal end of each of the sleeves 58 is attached to the base portion 70, while a distal end of each sleeve 58 is free to move away from the central axis of the delivery system. The proximal end of the sleeves 58 may be surrounded or partially surrounded by a collar or cover to secure the sleeves 58 to the base portion 70. Each of the sleeves 58 has an elongated tubular construction and is designed to surround the outer diameter of a straight portion of a wire of the hook assembly 54, which is described in further detail below.
[0046] Hook assembly 54 includes a base portion 76 from which multiple wires 74 extend. Each of the wires 74 are attached at a proximal end to the base portion 76 and terminate at a hook 60 at a distal end. As shown, each hook 60 extends from the distal end of a corresponding sleeve 58. The hooks 60 are designed for engagement with wires or another structure of a stent, where an exemplary stent 80 is shown in FIG. 8 as being attached to such hooks 60. The hooks 60 can have a wide variety of configurations, such as angled, curved, and the like, and should be positioned for engagement with some structure feature or features of the stent 80. In one embodiment of the invention, the number of hooks 60 that are provided is the same as the number of crowns on a corresponding stent so that each hook can be engaged with one stent crown; however, the number of hooks and stent crowns can be different and/or the hooks can be configured for engagement with a different structure of the stent than its crowns.
[0047] The delivery system further includes a hook holding tube 62 from which an inner actuation tube 64 extends. The inner actuation tube 64 includes an external threaded portion on its distal end. In order to engage with the hook holding tube 62, the cartridge 50 further includes an internal threaded portion within the sleeve assembly 56 and an external thread on the outside of the hook assembly 54. In this way, the external threaded portion of the inner actuation tube 64 can engage with the internal threaded portion of the sleeve assembly 56. Further, the hook holding tube 62 includes an internal threaded portion at its distal end that can engage with the external thread of the hook assembly 54.
[0048] In order to attach a stent to the cartridge 50, the hooks 60 are positioned for engagement with a structure of the stent, such as the crowns of a stent, as is described above. In order to further secure the hooks 60 to these stent structures, the sleeve assembly 56 can be slid in a direction 82 toward the distal end of the cartridge 50, as illustrated in FIG. 9 . The sleeves 58 are preferably made of a relatively expandable material so that each sleeve can deform at least slightly as it slides over a corresponding hook 60, thereby capturing or enclosing the stent and the hook within the sleeve 58. As illustrated in FIG. 10 , a sleeve lock 66 can then be slid into the space between the base 70 of sleeve assembly 56 and the base 76 of hook assembly 54, and locked or snapped into place around the cartridge. The sleeve lock 66 is designed to prevent the sleeve assembly 56 from sliding back toward the proximal end of the cartridge 50, thereby keeping the hooks 60 captured within the sleeves 58. Alternatively, another mechanism can be used to keep the sleeves 58 from becoming disengaged from the hooks 60, such as a spring that is positioned on the cartridge in such a way that the sleeve assembly 56 cannot move relative to the hook assembly 54.
[0049] After the stent 80 is attached to the cartridge 50 as described above, the cartridge 50 can be attached to the distal end of a delivery system. Referring in particular to FIGS. 11 and 12 , the cartridge 50 is attachable to the hook holding tube 62 and inner actuation tube 64 of a delivery system by guiding the distal end of the inner actuation tube 64 through the center hole of the hook assembly 54. This movement of the inner actuation tube 64 is shown as being in a direction generally indicated by arrow 86. The inner actuation tube 64 can be moved in this direction 86 until it contacts the internal threads of the sleeve assembly 56. The inner actuation tube 64 is then held stationary while the sleeve assembly 56 is rotated in a direction indicated by arrow 88 until the components are securely engaged with each other. It is possible, however, that the inner actuation tube is instead rotated relative to a stationary sleeve assembly 56 or that both the sleeve assembly 56 and the inner actuation tube 64 are rotated in opposite directions relative to each other. Any guidewire lumens provided on the dilator tip 52 and the inner actuation tube 64 should be aligned and in contact when fully engaged.
[0050] Next, the hook holding tube 62 is pulled distally until it contacts the base 76 of the hook assembly 54, as shown in FIG. 12 . The hook assembly 54 can then be held in place while the hook holding tube 62 is rotated, such as in a direction indicated by the arrow 90. Again, it is possible that the hook holding tube 62 is instead rotated relative to the hook assembly 54 that is being held stationary, or that both the hook holding tube 62 and the hook assembly 54 are rotated in opposite directions from each other. The rotation of the hook holding tube 62 and hook assembly 54 relative to each other can continue until the threads are fully engaged and so that the hook assembly 54 is being held by the hook holding tube 62.
[0051] Referring now to FIG. 13 , the sleeve lock 66 can then be removed from the assembly. At this point, sliding the inner actuation tube 64 will cause the sleeve assembly 56 to also slide. The proximal end of the inner actuation tube 64 can then be attached to any number of actuation devices, such as a thumb slide, screw drive, or the like. The actuation device or devices that are chosen can be located within a handle, for example.
[0052] Although the description above primarily discusses threaded engagement of the various components to each other, other types of engagement methods and configurations can be used. For example, the components can be connected to each other using snap-fit connections, frictional fittings, other quick-connect methods, and/or other methods or combinations of methods can be used.
[0053] The delivery systems of the invention, which include a stent attached to a cartridge, can be delivered through a percutaneous opening (not shown) in a patient. The implantation location can be located by inserting a guide wire into the patient, which guide wire extends from a distal end of the delivery system. The delivery system is then advanced distally along the guide wire until the stent is positioned relative to the implantation location. In an alternative embodiment, the stent is delivered to an implantation location via a minimally invasive surgical incision (i.e., non-percutaneously). In another alternative embodiment, the stent is delivered via open heart/chest surgery. In one embodiment of the invention, the stent can include a radiopaque, echogenic, or MRI visible material to facilitate visual confirmation of proper placement of the stent. Alternatively, other known surgical visual aids can be incorporated into the stent. The techniques described relative to placement of the stent within the heart can be used both to monitor and correct the placement of the stent in a longitudinal direction relative to the length of the anatomical structure in which it is positioned.
[0054] FIGS. 14-16 illustrate another exemplary configuration for attaching a stent to the distal hooks of a cartridge. In particular, one wire or element 150 with an angled wire tip or protrusion 152 is shown, although it is understood that the same principles described relative to this element can be equally applied to all of the elements within a single delivery system. In this configuration, a sleeve 170 is positioned over the relatively straight portion of wire or element 150, but retracted relative to its angled wire tip 152 when the element 150 is not engaged with the stent crown 154, as shown in FIG. 14 . Once the element 150 is engaged with the stent crown 154, as illustrated in FIG. 15 , the sleeve 170 can be slid toward the stent crown 154 until it encases both the end of the stent crown 154 and the angled wire tip or protrusion 152, thereby providing a more secure positioning of the components relative to each other. The sleeve 170 is preferably made of a relatively flexible material that can deform and expand as it slides over the stent crown and angled wire tip 152. This sleeve 170 prevents disengagement of the angled wire tip 152 from its respective stent crown 154, as described above relative to FIGS. 7-13 . Other alternative retaining arrangements for connection of a stent to a cartridge may also be used in accordance with the invention, such as sutures that each attach to one or more wires of a stent and/or other hook end configurations, for example.
[0055] Once the stent is loaded onto a delivery system, a driver mechanism of the delivery system can be activated to compress the stent and pull it into an outer lumen or tube. This may be accomplished in one exemplary embodiment by rotating a screw mechanism or by sliding the outer lumen over the stent. Once the stent is enclosed within the outer lumen, the loading fixture can be removed by sliding it over the distal end of the delivery device. The delivery device would now be ready for implantation of the valve within a patient.
[0056] It is noted that the aspect ratio of certain portions of the stent can be somewhat different from that shown relative to the stent embodiments of the invention. For one particular example, the overall stent length can be shorter so that when the stent is positioned within a patient, the outflow end will be below the sinotubular junction. It is further noted that if the stent of any of the embodiments is to be positioned to replace the aortic valve, the stent can be provided with a lower density wire portion in the area where the coronaries are located. To eliminate the need to clock the device, reduced wire density around the entire perimeter of the stent can be provided. Further, stent embodiments described herein may be modified to include additional structure for attachment of tissue for the valve, such as the vertical stent posts described in many of the embodiments.
[0057] A stent attached to a delivery system via a cartridge of the invention can be delivered percutaneously to an implantation location. The cartridge may be designed for use with a stent that is self-expanding, as is shown in FIGS. 7-13 . Alternatively, the cartridge shown in the Figures can be modified to include a balloon and appropriate fittings for the balloon so that a balloon-expandable stent can also be used with the cartridge systems of the invention. A delivery system for a balloon-expandable stent generally can include a transcatheter assembly, including a delivery catheter, a balloon catheter, and a guide wire. Some delivery catheters of this type are known in the art, and define a lumen within which the balloon catheter is received. The balloon catheter, in turn, defines a lumen within which the guide wire is slideably disposed. Further, the balloon catheter includes a balloon that is fluidly connected to an inflation source. It is noted that if the stent being implanted is the self-expanding type of stent, the balloon would not be needed and a sheath or other restraining means would be used for maintaining the stent in its compressed state until deployment of the stent, as described herein. In any case, for a balloon-expandable stent, the transcatheter assembly is appropriately sized for a desired percutaneous approach to the implantation location. For example, the transcatheter assembly can be sized for delivery to the heart valve via an opening at a carotid artery, a jugular vein, a sub-clavian vein, femoral artery or vein, or the like. Essentially, any percutaneous intercostals penetration can be made to facilitate use of the transcatheter assembly.
[0058] Prior to delivery, the stent is mounted over the balloon in a contracted state to be as small as possible without causing permanent deformation of the stent structure. As compared to the expanded state, the support structure is compressed onto itself and the balloon, thus defining a decreased inner diameter as compared to an inner diameter in the expanded state. While this description is related to the delivery of a balloon-expandable stent, the same basic procedures can also be applicable to a self-expanding stent, where the delivery system would not include a balloon, but would preferably include a sheath or some other type of configuration for maintaining the stent in a compressed condition until its deployment.
[0059] With the stent mounted to the balloon, the transcatheter assembly is delivered through a percutaneous opening (not shown) in the patient via the delivery catheter. The implantation location is located by inserting the guide wire into the patient, which guide wire extends from a distal end of the delivery catheter, with the balloon catheter otherwise retracted within the delivery catheter. The balloon catheter is then advanced distally from the delivery catheter along the guide wire, with the balloon and stent positioned relative to the implantation location. In an alternative embodiment, the stent is delivered to an implantation location via a minimally invasive surgical incision (i.e., non-percutaneously). In another alternative embodiment, the stent is delivered via open heart/chest surgery. In one embodiment of the stents of the invention, the stent includes a radiopaque, echogenic, or MRI visible material to facilitate visual confirmation of proper placement of the stent. Alternatively, other known surgical visual aids can be incorporated into the stent. The techniques described relative to placement of the stent within the heart can be used both to monitor and correct the placement of the stent in a longitudinal direction relative to the length of the anatomical structure in which it is positioned.
[0060] Once the stent is properly positioned, the balloon catheter is operated to inflate the balloon, thus transitioning the stent to an expanded state. Alternatively, where the support structure is formed of a shape memory material, the stent can self-expand to its expanded state.
[0061] The present invention has now been described with reference to several embodiments thereof. The entire disclosure of any patents, patent applications, publications and journal articles identified herein is hereby incorporated by reference. The foregoing detailed description and examples have been given for clarity of understanding only. No unnecessary limitations are to be understood therefrom. It will be apparent to those skilled in the art that many changes can be made in the embodiments described without departing from the scope of the invention. Thus, the scope of the present invention should not be limited to the structures described herein, but only by the structures described by the language of the claims and the equivalents of those structures.
Claims
What is claimed is:
1. A delivery system for delivery of an implantable stented device to a body lumen, the device comprising a plurality of structures at a proximal end of the device, wherein the delivery system comprises:
a first body portion comprising an outer tube from which an inner actuation member extends, the inner actuation member being slidable relative to the outer tube and comprising a distal end; and
a second body portion removably attached to the first body portion, wherein the second body portion comprises;
a wire assembly including a wire base portion and a plurality of wires extending distally from the base portion, wherein each wire comprises a distal end for attachment to the plurality of structures at the proximal end of the stented device, the outer tube of the first body portion being configured to removably engage the wire assembly, and
a sleeve assembly including a sleeve base portion and a plurality of sleeves, each of the plurality of sleeves at least partially surrounding one of the wires and being axially slideable relative to the distal end of the wire that it surrounds, the inner actuation member of the first body portion being configured to removably engage the sleeve assembly,
wherein with the outer tube engaged with the wire assembly and the inner actuation member engaged with the sleeve assembly, movement of the inner actuation member relative to the outer tube causes each of the plurality of sleeves to axially slide relative to the distal end of the wire it surrounds.
2. The delivery system of claim 1, wherein the device comprises a stented valve.
3. The delivery system of claim 2, wherein the plurality of structures at the proximal end of the stented valve comprises a plurality of stent crowns.
4. The delivery system of claim 1, wherein the removable attachment between the first and second body portions comprises a threaded connection.
5. The delivery system of claim 4, wherein the distal end of the inner actuation member comprises an external threaded portion and is configured to removably engage with an internal threaded portion of the sleeve assembly.
6. The delivery system of claim 5, wherein the outer tube includes an internal engagement surface for engagement with an external engagement surface of the wire assembly.
7. The delivery system of claim 6, wherein the internal engagement surface of the outer tube is a threaded engagement surface and the external engagement surface of the wire assembly is a threaded engagement surface.
8. The delivery system of claim 1, wherein the removable connection between the first and second body portions comprises a frictional connection.
9. The delivery system of claim 1, wherein the second body portion comprises a cartridge.
10. The delivery system of claim 1, wherein at least one of the plurality of wires comprises a coiled distal end that is removeably attachable to one of the structures of the stented device.
11. The delivery system of claim 1, wherein the outer tube includes an internal engagement surface for engagement with an external engagement surface of the wire assembly.
12. The delivery system of claim 11, wherein the internal engagement surface of the outer tube is a threaded engagement surface and the external engagement surface of the wire assembly is a threaded engagement surface.
13. The delivery system of claim 1, further comprising a sheath surrounding the outer tube and the stented device for maintaining the stented device in a radially compressed configuration.
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| US2004/0186563(A1) | 2004-09-01 | Lobbi | Examiner |
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| US2004/0210304(A1) | 2004-10-01 | Seguin et al. | Examiner |
| US2004/0210307(A1) | 2004-10-01 | Khairkhahan | Applicant |
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| US2005/0222674(A1) | 2005-10-01 | Paine | Examiner |
| US2005/0228495(A1) | 2005-10-01 | Macoviak | Applicant |
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