PATENT DOCUMENT

Abstract:
Sealable and repositionable implant devices are provided with features that increase the ability of implants such as endovascular grafts and valves to be precisely deployed or re-deployed, with better in situ accommodation to the local anatomy of the targeted recipient anatomic site, and/or with the ability for post-deployment adjustment to accommodate anatomic changes that might compromise the efficacy of the implant. A surgical implant includes an implant body and a selectively adjustable assembly attached to the implant body, the assembly having adjustable elements and being operable to cause a configuration change in a portion of the implant body and, thereby, permit implantation of the implant body within an anatomic orifice to effect a seal therein under normal physiological conditions.

Full Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application:
         claims the priority, under 35 U.S.C. §119, of U.S. Provisional Patent Application No. 61/550,004, filed Oct. 21, 2011; and   claims the priority, under 35 U.S.C. §119, of U.S. Provisional Patent Application No. 61/585,937, filed Jan. 12, 2012;   claims the priority, under 35 U.S.C. §119, of U.S. Provisional Patent Application No. 61/591,753, filed Jan. 27, 2012;   claims the priority, under 35 U.S.C. §119, of U.S. Provisional Patent Application No. 61/601,961, filed Feb. 22, 2012;   claims the priority, under 35 U.S.C. §119, of U.S. Provisional Patent Application No. 61/682,558, filed Aug. 13, 2012,       the prior applications are herewith incorporated by reference herein in their entireties.   

    
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
     Not Applicable 
     FIELD OF THE INVENTION 
     The present invention lies in the field of stents, stent grafts, heart valves (including aortic, pulmonary, mitral and tricuspid), and methods and systems for controlling and implanting stents, stent grafts and heart valves. 
     BACKGROUND OF THE INVENTION 
     Medical and surgical implants are placed often in anatomic spaces where it is desirable for the implant to conform to the unique anatomy of the targeted anatomic space and secure a seal therein, preferably without disturbing or distorting the unique anatomy of that targeted anatomic space. 
     While the lumens of most hollow anatomic spaces are ideally circular, in fact, the cross-sectional configurations of most anatomic spaces are, at best, ovoid, and may be highly irregular. Such lumenal irregularity may be due to anatomic variations and/or to pathologic conditions that may change the shape and topography of the lumen and its associated anatomic wall. Examples of anatomic spaces where such implants may be deployed include, but are not limited to, blood vessels, the heart, other vascular structures, vascular defects (such as thoracic and abdominal aortic aneurysms), the trachea, the oropharynx, the esophagus, the stomach, the duodenum, the ileum, the jejunum, the colon, the rectum, ureters, urethras, fallopian tubes, biliary ducts, pancreatic ducts, or other anatomic structures containing a lumen used for the transport of gases, blood, or other liquids or liquid suspensions within a mammalian body. 
     For a patient to be a candidate for existing endograft methods and technologies, to permit an adequate seal, a proximal neck of, ideally, at least 12 mm of normal aorta must exist downstream of the left subclavian artery for thoracic aortic aneurysms or between the origin of the most inferior renal artery and the origin of the aneurysm in the case of abdominal aneurysms. Similarly, ideally, at least 12 mm of normal vessel must exist distal to the distal extent of the aneurysm for an adequate seal to be achieved. The treatment of Aortic Stenosis through Transcather Aortic Valve Replacement (TAVR) is becoming more common. The limitations of current TAVR techniques do not allow for repositioning of the implant once it has been deployed in place. Further, the final expanded diameter of the current devices is fixed making presizing a critical and difficult step. 
     Migration of existing endografts has also been a significant clinical problem, potentially causing leakage and profusion of aneurysms and/or compromising necessary vascular supplies to arteries such as the coronary, carotid, subclavian, renal, or internal iliac vessels. This problem only has been addressed partially by some existing endograft designs, in which barbs or hooks have been incorporated to help retain the endograft at its intended site. However, most existing endograft designs are solely dependent on radial force applied by varying length of stent material to secure a seal against the recipient vessel walls. 
     Because of the limitations imposed by existing vascular endograft devices and endovascular techniques, a significant number of abdominal and thoracic aneurysms repaired in the U.S. are still managed though open vascular surgery, instead of the lower morbidity of the endovascular approach. 
     Pre-sizing is required currently in all prior art endografts. Such pre-sizing based on CAT-scan measurements is a significant problem. This leads, many times, to mis-sized grafts. In such situations, more graft segments are required to be placed, can require emergency open surgery, and can lead to an unstable seal and/or migration. Currently there exists no endograft that can be fully repositioned after deployment. 
     Thus, a need exists to overcome the problems with the prior art systems, designs, and processes as discussed above. 
     SUMMARY OF THE INVENTION 
     The invention provides surgical implant devices and methods for their manufacture and use that overcome the hereinafore-mentioned disadvantages of the heretofore-known devices and methods of this general type and that provide such features with improvements that increase the ability of such an implant to be precisely positioned and sealed, with better in situ accommodation to the local anatomy of the targeted anatomic site. The invention provide an adjustment tool that can remotely actuate an adjustment member(s) that causes a configuration change of a portion(s) of an implant, which configuration change includes but is not limited to diameter, perimeter, shape, and/or geometry or a combination of these, to create a seal and provide retention of an implant to a specific area of a target vessel or structure even when the cross-sectional configuration of the anatomic space is non-circular, ovoid, or irregular. 
     The invention provides an actively controllable stent, stent graft, stent graft assembly, heart valve, and heart valve assembly, and methods and systems for controlling and implanting such devices that overcome the hereinafore-mentioned disadvantages of the heretofore-known devices and methods of this general type and that provide such features with control both in opening and closing and in any combination thereof even during a surgical procedure or after completion of a surgical procedure. 
     One exemplary aspect of the present invention is directed towards novel designs for endovascular implant grafts, and methods for their use for the treatment of aneurysms (e.g., aortic) and other structural vascular defects. An endograft system for placement in an anatomic structure or blood vessel is disclosed in which an endograft implant comprises, for example, a non-elastic tubular implant body with at least an accommodating proximal end. Accommodating, as used herein, is the ability to vary a configuration in one or more ways, which can include elasticity, expansion, contraction, and changes in geometry. Both or either of the proximal and distal ends in an implant according to the present invention further comprise one or more circumferential expandable sealable collars and one or more expandable sealing devices, capable of being expanded upon deployment to achieve the desired seal between the collar and the vessel&#39;s inner wall. Exemplary embodiments of such devices can be found in co-pending U.S. patent application Ser. No. 11/888,009, filed Jul. 31, 2007, and Ser. No. 12/822,291, filed Jun. 24, 2010, which applications have been incorporated herein in their entireties. Further embodiments of endovascular implants and delivery systems and methods according to the present invention may be provided with retractable retention tines or other retention devices allowing an implant to be repositioned before final deployment. In other embodiments, the implant can be repositioned after final deployment. An endograft system according to the present invention further comprises a delivery catheter with an operable tubular sheath capable of housing a folded or compressed endograft implant prior to deployment and capable of retracting or otherwise opening in at least its proximal end to allow implant deployment. The sheath is sized and configured to allow its placement via a peripheral arteriotomy site, and is of appropriate length to allow its advancement into, for example, the aortic valve annulus, ascending aorta, aortic arch, and thoracic or abdominal aorta, as required for a specific application. Sheath movement is provided in a novel manner by manual actuation and/or automatic actuation. 
     While some post-implantation remodeling of the aortic neck proximal to an endovascular graft (endograft) has been reported, existing endograft technology does not allow for the management of this condition without placement of an additional endograft sleeve to cover the remodeled segment. Exemplary prostheses of the present invention as described herein allow for better accommodation by the implant of the local anatomy, using an actively controlled expansion device for the sealing interface between the prosthesis collar and the recipient vessel&#39;s inner wall. Furthermore, exemplary prostheses of the present invention as disclosed herein are provided with a controllably releasable disconnect mechanism that allows remote removal of an adjustment tool and locking of the retained sealable mechanism after satisfactory positioning and sealing of the endograft. In some exemplary embodiments according to the present invention, the controllably releasable disconnect mechanism may be provided in a manner that allows post-implantation re-docking of an adjustment member to permit post-implantation repositioning and/or resealing of a prostheses subsequent to its initial deployment. 
     Certain aspects of the present invention are directed towards novel designs for sealable endovascular implant grafts and endovascular implants, and methods for their use for the treatment of aortic aneurysms and other structural vascular defects and/or for heart valve replacements. Various embodiments as contemplated within the present invention may include any combination of exemplary elements as disclosed herein or in the co-pending patent applications referenced above. 
     In an exemplary embodiment according to the present invention, a sealable vascular endograft system for placement in a vascular defect is provided, comprising an elongated main implant delivery catheter with an external end and an internal end for placement in a blood vessel with internal walls. In such an exemplary embodiment, the main implant delivery catheter further comprises a main implant delivery catheter sheath that may be openable or removable at the internal end and a main implant delivery catheter lumen containing within a compressed or folded endovascular implant. Further, an endovascular implant comprises a non-elastic tubular implant body with an accommodating proximal end terminating in a proximal sealable circumferential collar that may be expanded by the operator to achieve a fluid-tight seal between the proximal sealable circumferential collar and the internal walls of the blood vessel proximal to the vascular defect. Moreover, an endovascular implant may further comprise a non-elastic tubular implant body with an accommodating distal end terminating in a distal sealable circumferential collar controlled by a distal variable sealing device, which may be expanded by the operator to achieve a fluid-tight seal between the distal sealable circumferential collar and the internal walls of the blood vessel distal to the vascular defect. 
     In a further exemplary embodiment according to the present invention, an implant interface is provided for a sealable attachment of an implant to a wall within the lumen of a blood vessel or other anatomic conduit. 
     In a yet further exemplary embodiment according to the present invention, an implant gasket interface is provided for a sealable attachment of an implant to a wall within the lumen of a blood vessel or other anatomic conduit, wherein the sealable attachment provides for auto-adjustment of the seal while maintaining wall attachment to accommodate post-implantation wall remodeling. 
     Still other exemplary embodiments of endografts and endograft delivery systems according to the present invention serve as universal endograft cuffs, being first placed to offer their advantageous anatomic accommodation capabilities, and then serving as a recipient vessel for other endografts, including conventional endografts. 
     Furthermore, exemplary embodiments of endografts and endograft delivery systems according to the present invention may be provided with a mechanism to permit transfer of torque or other energy from a remote operator to an adjustment member comprising a sealable, adjustable circumferential assembly controlled by an adjustment tool, which may be detachable therefrom and may further cause the assembly to lock upon detachment of the tool. In some exemplary embodiments of the present invention, the variable sealing device may be provided with a re-docking element that may be recaptured by subsequent operator interaction, allowing redocking and repositioning and/or resealing of the endograft at a time after its initial deployment. 
     Moreover, the various exemplary embodiments of the present invention as disclosed herein may constitute complete endograft systems, or they may be used as components of a universal endograft system as disclosed in co-pending patent applications that may allow the benefits of the present invention to be combined with the ability to receive other endografts. 
     Additionally, the present invention encompasses sealable devices that may be used in other medical devices such as adjustable vascular cannulas or other medical or surgical devices or implants, such as heart valves. 
     With the foregoing and other objects in view, there is provided, in accordance with the invention, a surgical implant including an implant body and a selectively adjustable assembly attached to the implant body, having adjustable elements, and operable to cause a configuration change in a portion of the implant body and, thereby, permit implantation of the implant body within an anatomic orifice to effect a seal therein under normal physiological conditions. 
     Although the invention is illustrated and described herein as embodied in an actively controllable stent, stent graft, stent graft assembly, heart valve, and heart valve assembly, and methods and systems for controlling and implanting such devices, it is, nevertheless, not intended to be limited to the details shown because various modifications and structural changes may be made therein without departing from the spirit of the invention and within the scope and range of equivalents of the claims. Additionally, well-known elements of exemplary embodiments of the invention will not be described in detail or will be omitted so as not to obscure the relevant details of the invention. 
     Additional advantages and other features characteristic of the present invention will be set forth in the detailed description that follows and may be apparent from the detailed description or may be learned by practice of exemplary embodiments of the invention. Still other advantages of the invention may be realized by any of the instrumentalities, methods, or combinations particularly pointed out in the claims. 
     Other features that are considered as characteristic for the invention are set forth in the appended claims. As required, detailed embodiments of the present invention are disclosed herein; however, it is to be understood that the disclosed embodiments are merely exemplary of the invention, which can be embodied in various forms. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a basis for the claims and as a representative basis for teaching one of ordinary skill in the art to variously employ the present invention in virtually any appropriately detailed structure. Further, the terms and phrases used herein are not intended to be limiting; but rather, to provide an understandable description of the invention. While the specification concludes with claims defining the features of the invention that are regarded as novel, it is believed that the invention will be better understood from a consideration of the following description in conjunction with the drawing figures, in which like reference numerals are carried forward. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying figures, where like reference numerals refer to identical or functionally similar elements throughout the separate views, which are not true to scale, and which, together with the detailed description below, are incorporated in and form part of the specification, serve to illustrate further various embodiments and to explain various principles and advantages all in accordance with the present invention. Advantages of embodiments of the present invention will be apparent from the following detailed description of the exemplary embodiments thereof, which description should be considered in conjunction with the accompanying drawings in which: 
         FIG. 1  is a fragmentary, partially longitudinally cross-sectional, side elevational view of an exemplary embodiment of an actively controllable stent/stent graft deployment system of the present invention in a non-deployed state with a front half of the outer catheter removed; 
         FIG. 2  is a fragmentary, side elevational view of an enlarged distal portion of the stent deployment system of  FIG. 1 ; 
         FIG. 3  is a fragmentary, perspective view of the stent deployment system of  FIG. 1  from above the distal end; 
         FIG. 4  is a fragmentary, perspective view of the stent deployment system of  FIG. 1  from above the distal end with the system in a partially deployed state; 
         FIG. 5  is a fragmentary, side elevational view of the stent deployment system of  FIG. 2  in a partially deployed state; 
         FIG. 6  is a is a top plan view of a drive portion of the stent deployment system of  FIG. 2 ; 
         FIG. 7  is a fragmentary, longitudinally cross-sectional view of a rear half of the stent deployment system of  FIG. 6 ; 
         FIG. 8  is a fragmentary, perspective view of the stent deployment system of  FIG. 6 ; 
         FIG. 9  is a fragmentary, perspective view of the stent deployment system of  FIG. 1  from above the distal end with the system in an expanded state and with the assembly-fixed needles in an extended state; 
         FIG. 10  is a fragmentary, longitudinal cross-sectional view of the stent deployment system of  FIG. 11  showing the rear half in a partially expanded state of the stent lattice; 
         FIG. 11  is a fragmentary, longitudinal cross-sectional view of the stent deployment system of  FIG. 10  showing the front half in a further expanded state; 
         FIG. 12  is a fragmentary, longitudinal cross-sectional view of the stent deployment system of  FIG. 11  with a deployment control assembly in a partially disengaged state; 
         FIG. 13  is a fragmentary, longitudinally cross-sectional view of the stent deployment system of  FIG. 12  with the deployment control assembly in a disengaged state; 
         FIG. 14  is a fragmentary, longitudinally cross-sectional view of an enlarged portion of the stent deployment system of  FIG. 12  in the partially disengaged state; 
         FIG. 15  is a fragmentary, longitudinally cross-sectional view of an enlarged portion of the stent deployment system of  FIG. 13  in a disengaged state; 
         FIG. 16  is a fragmentary, partially cross-sectional, side elevational view of the stent deployment system of  FIG. 9  rotated about a longitudinal axis, with the deployment control assembly in the disengaged state, and showing a cross-section of a portion of the deployment control assembly; 
         FIG. 17  is a fragmentary, longitudinally cross-sectional view of the stent deployment system of  FIG. 16  showing a cross-section of a drive portion of a stent assembly with a fixed needle; 
         FIG. 18  is a fragmentary, perspective view of the stent deployment system of  FIG. 16 ; 
         FIG. 19  is a fragmentary, perspective view of an enlarged portion of the stent deployment system of  FIG. 18 ; 
         FIG. 20  is a fragmentary, perspective view of the stent deployment system of  FIG. 18  with a diagrammatic illustration of paths of travel of strut crossing points as the stent is moved between its expanded and contracted states; 
         FIG. 21  is a fragmentary, side elevational view from an outer side of an alternative exemplary embodiment of a jack assembly according to the invention in a stent-contracted state with a drive sub-assembly in a connected state and with a needle sub-assembly in a retracted state; 
         FIG. 22  is a fragmentary, cross-sectional view of the jack assembly of  FIG. 21 ; 
         FIG. 23  is a fragmentary, cross-sectional view of the jack assembly of  FIG. 21  in a partially stent-expanded state; 
         FIG. 24  is a fragmentary, cross-sectional view of the jack assembly of  FIG. 23  with a needle pusher in a partially actuated state before extension of the needle; 
         FIG. 25  is a fragmentary, cross-sectional view of the jack assembly of  FIG. 24  with the needle pusher in another partially actuated state with the needle pusher in another partially actuated state with an extension of the needle; 
         FIG. 26  is a fragmentary, cross-sectional view of the jack assembly of  FIG. 25  with the drive sub-assembly in a partially disconnected state without retraction of the needle pusher; 
         FIG. 27  is a fragmentary, cross-sectional view of the jack assembly of  FIG. 26  with the drive sub-assembly in a further partially disconnected state with partial retraction of the needle pusher; 
         FIG. 28  is a fragmentary, cross-sectional view of the jack assembly of  FIG. 27  with the drive sub-assembly in a still a further partially disconnected state with further retraction of the needle pusher; 
         FIG. 29  is a fragmentary, cross-sectional view of the jack assembly of  FIG. 23  with the drive sub-assembly and the needle pusher in a disconnected state; 
         FIG. 30  is a fragmentary, cross-sectional view of another alternative exemplary embodiment of a jack assembly according to the invention in a stent-contracted state with a drive sub-assembly in a connected state and with a needle sub-assembly in a retracted state; 
         FIG. 31  is a fragmentary, cross-sectional view of the jack assembly of  FIG. 30  in a partially stent-expanded state; 
         FIG. 32  is a fragmentary, cross-sectional view of the jack assembly of  FIG. 31  with the needle sub-assembly in an actuated state with extension of the needle; 
         FIG. 33  is a fragmentary, cross-sectional view of the jack assembly of  FIG. 32  with the drive sub-assembly in a disconnected state and the needle sub-assembly in a disconnected state; 
         FIG. 34  is a fragmentary, perspective view of the jack assembly of  FIG. 33  with the extended needle rotated slightly to the right of the figure. 
         FIG. 35  is a fragmentary, perspective view of the jack assembly of  FIG. 34  rotated to the right by approximately 45 degrees; 
         FIG. 36  is a fragmentary, partially cross-sectional, perspective view from above the jack assembly of  FIG. 30  showing the interior of the distal drive block; 
         FIG. 37  is a fragmentary, enlarged, cross-sectional view of the jack assembly of  FIG. 33 ; 
         FIG. 38  is a photograph of a perspective view from above the upstream end of another exemplary embodiment of an actively controllable stent graft according to the invention in a substantially contracted state; 
         FIG. 39  is a photograph of a perspective view of the stent graft of  FIG. 38  in a partially expanded state; 
         FIG. 40  is a photograph of a perspective view of the stent graft of  FIG. 38  in an expanded state; 
         FIG. 41  is a photograph of a side perspective view of the stent graft of  FIG. 38  in an expanded state; 
         FIG. 42  is a photograph of a perspective view of another exemplary embodiment of an actively controllable stent for a stent graft according to the invention in a substantially expanded state with integral upstream anchors; 
         FIG. 43  is a photograph of a perspective view of the stent of  FIG. 42  in a partially expanded state; 
         FIG. 44  is a photograph of a perspective view of the stent of  FIG. 42  in another partially expanded state; 
         FIG. 45  is a photograph of a perspective view of the stent of  FIG. 42  in a substantially contracted state; 
         FIG. 46  is a photograph of a side perspective view of another exemplary embodiment of an actively controllable stent for a stent graft according to the invention in a substantially expanded state with a tapered outer exterior; 
         FIG. 47  is a photograph of a top perspective view of the stent of  FIG. 46 ; 
         FIG. 48  is a photograph of a perspective view of the stent of  FIG. 46  from above a side; 
         FIG. 49  is a photograph of a perspective view of the stent of  FIG. 46  from above a side with the stent in a partially expanded state; 
         FIG. 50  is a photograph of a perspective view of the stent of  FIG. 46  from above a side with the stent in a substantially contracted state; 
         FIG. 51  is a photograph of an exemplary embodiment of a low-profile joint assembly for actively controllable stents/stent grafts according to the invention; 
         FIG. 52  is a photograph of struts of the joint assembly of  FIG. 51  separated from one another; 
         FIG. 53  is a photograph of a rivet of the joint assembly of  FIG. 51 ; 
         FIG. 54  is a fragmentary, side perspective view of another exemplary embodiment of an actively controllable stent system for a stent graft according to the invention in a substantially expanded state with a tapered outer exterior; 
         FIG. 55  is a side perspective view of the stent system of  FIG. 54 ; 
         FIG. 56  is a side elevational view of the stent system of  FIG. 54 ; 
         FIG. 57  is a side elevational view of the stent system of  FIG. 54  in a substantially contracted state; 
         FIG. 58  is a side elevational view of another exemplary embodiment of a portion of an actively controllable stent system for a stent graft according to the invention in a substantially contracted state; 
         FIG. 59  is a perspective view of the stent system portion of  FIG. 58 ; 
         FIG. 60  is a top plan view of the stent system portion of  FIG. 58 ; 
         FIG. 61  is a side perspective view of the stent system portion of  FIG. 58  in a partially expanded state; 
         FIG. 62  is a top plan view of the stent system portion of  FIG. 61 ; 
         FIG. 63  is a side elevational view of the stent system portion of  FIG. 61 ; 
         FIG. 64  is a perspective view of a downstream side of an exemplary embodiment of a replacement valve assembly according to the invention in an expanded state; 
         FIG. 65  is a side elevational view of the valve assembly of  FIG. 64 ; 
         FIG. 66  is a fragmentary, perspective view of a delivery system according to the invention for the aortic valve assembly of  FIG. 64  with the aortic valve assembly in the process of being implanted and in the right iliac artery; 
         FIG. 67  is a fragmentary, perspective view of the delivery system and aortic valve assembly of  FIG. 66  with the aortic valve assembly in the process of being implanted and in the abdominal aorta; 
         FIG. 68  is a fragmentary, perspective view of the delivery system and aortic valve assembly of  FIG. 66  with the aortic valve assembly in the process of being implanted and being adjacent the aortic valve implantation site; 
         FIG. 69  is a fragmentary, perspective view of the delivery system and aortic valve assembly of  FIG. 66  with the aortic valve assembly implanted in the heart; 
         FIG. 70  is a fragmentary, enlarged, perspective view of the delivery system and the aortic valve assembly of  FIG. 69  implanted at an aortic valve implantation site; 
         FIG. 71  is a perspective view of a side of another exemplary embodiment of a replacement aortic valve assembly according to the invention in an expanded state with the graft material partially transparent; 
         FIG. 72  is a perspective view of the replacement aortic valve assembly of  FIG. 71  from above a downstream side thereof; 
         FIG. 73  is a perspective view of the replacement aortic valve assembly of  FIG. 71  from above a downstream end thereof; 
         FIG. 74  is a perspective view of the replacement aortic valve assembly of  FIG. 71  from below an upstream end thereof; 
         FIG. 75  is a perspective view of an enlarged portion of the replacement aortic valve assembly of  FIG. 74 ; 
         FIG. 76  is a perspective view of the replacement aortic valve assembly of  FIG. 71  from a side thereof with the graft material removed; 
         FIG. 77  is a perspective view of the replacement aortic valve assembly of  FIG. 76  from above a downstream side thereof; 
         FIG. 78  is a side elevation, vertical cross-sectional view of the replacement aortic valve assembly of  FIG. 76 ; 
         FIG. 79  is a perspective view of the replacement aortic valve assembly of  FIG. 76  from a side thereof with the valve material removed, with the stent lattice in an expanded state; 
         FIG. 80  is a perspective view of the replacement aortic valve assembly of  FIG. 79  with the stent lattice in an intermediate expanded state; 
         FIG. 81  is a perspective view of the replacement aortic valve assembly of  FIG. 79  with the stent lattice in an almost contracted state; 
         FIG. 82  is a downstream plan view of the replacement aortic valve assembly of  FIG. 79  in an intermediate expanded state; 
         FIG. 83  is an enlarged downstream plan view of a portion of the replacement aortic valve assembly of  FIG. 79  in an expanded state; 
         FIG. 84  is a side elevational view of the replacement aortic valve assembly of  FIG. 79  in an expanded state, with graft material removed, and with distal portions of an exemplary embodiment of a valve delivery system; 
         FIG. 85  is a perspective view of an exemplary embodiment of a jack assembly of the replacement aortic valve assembly of  FIG. 84  from a side thereof with the valve delivery system sectioned; 
         FIG. 86  is a perspective view of the replacement aortic valve assembly of  FIG. 79  in an expanded state, with graft material removed, and with distal portions of another exemplary embodiment of a valve delivery system; 
         FIG. 87  is a fragmentary, enlarged perspective view of the replacement aortic valve assembly of  FIG. 86  with graft material shown; 
         FIG. 88  is a fragmentary, enlarged, perspective view of the delivery system and the aortic valve assembly of  FIG. 71  implanted at an aortic valve implantation site; 
         FIG. 89  is a fragmentary, side elevational view of another exemplary embodiment of an actively controllable and tiltable stent graft system according to the invention in a partially expanded state and a non-tilted state; 
         FIG. 90  is a fragmentary, side elevational view of the system of  FIG. 89  in a partially tilted state from a front thereof; 
         FIG. 91  is a fragmentary, side elevational view of the system of  FIG. 90  in another partially tilted state; 
         FIG. 92  is a fragmentary, side elevational view of the system of  FIG. 90  in yet another partially tilted state; 
         FIG. 93  is a fragmentary, perspective view of the system of  FIG. 90  in yet another partially tilted state; 
         FIG. 94  is a fragmentary, partially cross-sectional, side elevational view of another exemplary embodiment of an actively controllable and tiltable stent graft system according to the invention in an expanded state and a partially front-side tilted state 
         FIG. 95  is a fragmentary, perspective view of the system of  FIG. 94  in a non-tilted state; 
         FIG. 96  is a fragmentary, side elevational view of the system of  FIG. 94  in a non-tilted state; 
         FIG. 97  is a fragmentary, side elevational view of the system of  FIG. 96  rotated approximately 90 degrees with respect to the view of  FIG. 96 ; 
         FIG. 98  is a fragmentary, longitudinally cross-sectional, side elevational view of the system of  FIG. 94  showing the rear half of the system and a tubular graft material in a non-tilted state and partially expanded state; 
         FIG. 99  is fragmentary, partially cross-sectional, perspective view of the system of  FIG. 94  showing the rear half of the tubular graft material and in a non-tilted state and a partially expanded state; 
         FIG. 100  is a fragmentary, partially cross-sectional, side elevational view of the system of  FIG. 94  showing the rear half of graft material for a bifurcated vessel and in a non-tilted state; 
         FIG. 101  is a fragmentary, partially cross-sectional, side elevational view of the system of  FIG. 100  in an expanded state and a partially tilted state; 
         FIG. 102  is a fragmentary, partially cross-sectional, side elevational view of the system of  FIG. 101  rotated approximately 45 degrees with respect to the view of  FIG. 101 ; 
         FIG. 103  is a fragmentary, side perspective view of another exemplary embodiment of an actively controllable stent graft system according to the invention in an expanded state; 
         FIG. 104  is a fragmentary, side elevational view of the system of  FIG. 103 ; 
         FIG. 105  is a fragmentary, front elevational and partially cross-sectional view of a self-contained, self-powered, actively controllable stent graft delivery and integral control system according to the invention with the prosthesis in an expanded state with the graft material in cross-section showing a rear half thereof; 
         FIG. 106  is a perspective view of the control portion of the system of  FIG. 105  as a wireless sub-system; 
         FIG. 107  is a fragmentary, front elevational view of another exemplary embodiment of a self-contained, self-powered, actively controllable stent graft delivery and separate tethered control system according to the invention with different controls and with the prosthesis in an expanded state; 
         FIG. 108  is a fragmentary, perspective view of a control handle of an exemplary embodiment of a self-contained, self-powered, actively controllable prosthesis delivery device according to the invention from above a left side thereof with the upper handle half and power pack removed; 
         FIG. 109  is a fragmentary, vertically cross-sectional view of the handle of  FIG. 108  with the power pack removed; 
         FIG. 110  is a fragmentary, enlarged, vertically cross-sectional and perspective view of a sheath-movement portion of the handle of  FIG. 108  from above a left side thereof; 
         FIG. 111  is a fragmentary, further enlarged, vertically cross-sectional view of the sheath-movement portion of  FIG. 110  from below a left side thereof; 
         FIG. 112  is a fragmentary, enlarged, vertically cross-sectional view of a power portion of the handle of  FIG. 108  viewed from a proximal side thereof; 
         FIG. 113  is a fragmentary, perspective view of a needle control portion of the handle of  FIG. 108  from above a distal side with the upper handle half and power pack removed and with the needle control in a lattice-contracted and needle-stowed position; 
         FIG. 114  is a fragmentary, perspective view of the needle control portion of the handle of  FIG. 113  with the needle control in a lattice-expanded and needle-stowed position; 
         FIG. 115  is a fragmentary, perspective view of the needle control portion of the handle of  FIG. 114  with the needle control in a needle-extended position; 
         FIG. 116  is a fragmentary, perspective view of an engine portion of the handle of  FIG. 108  from above a left side thereof with the upper handle half removed; 
         FIG. 117  is a fragmentary, enlarged, vertically cross-sectional view of the engine portion of  FIG. 116  viewed from a proximal side thereof; 
         FIG. 118  is a fragmentary, enlarged, vertically cross-sectional view of the engine portion of the handle portion of  FIG. 117  viewed from a distal side thereof; 
         FIG. 119  is a flow diagram of an exemplary embodiment of a procedure for implanting an abdominal aorta prosthesis according to the invention; 
         FIG. 120  is a perspective view of an exemplary embodiment of a self-expanding/forcibly-expanding lattice of an implantable stent assembly having nine lattice segments in a native, self-expanded position with jack screw assemblies disposed between adjacent pairs of repeating portions of the lattice, with jack screws through a wall of the lattice, and with each jack screw backed out in a thread-non-engaged state to allow crimp of lattice for loading into a stent delivery system; 
         FIG. 121  is a perspective view of the lattice of  FIG. 120  in a contracted/crimped state for loading into the stent delivery system with each jack screw in a thread-non-engaged state; 
         FIG. 122  is a perspective view of the lattice of  FIG. 121  after being allowed to return to the native position of the lattice in a deployment site with each jack screw in a thread-engaged state for further outward expansion or inward contraction of the lattice; 
         FIG. 123  is a perspective view of the lattice of  FIG. 122  partially expanded from the state shown in  FIG. 122  with each jack screw in a thread-engaged state for further outward expansion or inward contraction of the lattice; 
         FIG. 124  is a tilted perspective view of the lattice of  FIG. 123  partially expanded from the state shown in  FIG. 123  with each jack screw in a thread-engaged state for further outward expansion or inward contraction of the lattice; 
         FIG. 125  is a perspective view of the lattice of  FIG. 124  further expanded near a maximum expansion of the lattice with each jack screw in a thread-engaged state; 
         FIG. 126  is a fragmentary, enlarged perspective and longitudinal cross-sectional view of a portion of two adjacent halves of repeating portions of an alternative exemplary embodiment of a self-expanding/forcibly-expanding lattice of an implantable stent assembly with a separate jack screw assembly connecting the two adjacent halves and with a lattice-disconnect tube of a stent delivery system in an engaged state covering a pair of drive screw coupler parts therein and with the jack screw in a thread-engaged state for further outward expansion or inward contraction of the lattice; 
         FIG. 127  is a fragmentary, further enlarged portion of the two adjacent halves of the repeating portions and intermediate jack screw assembly of  FIG. 125  with the disconnect tube in a disengaged state with respect to the pair of drive screw coupler parts; 
         FIG. 128  is a fragmentary enlarged portion of the two adjacent halves of the repeating portions and intermediate jack screw assembly of  FIG. 125  with the disconnect tube in a disengaged state and with the pair of drive screw coupler parts disconnected from one another; 
         FIG. 129  is a perspective view of another exemplary embodiment of a self-expanding/forcibly-expanding lattice of an implantable stent assembly having nine separate lattice segments with an exemplary embodiment of a proximal disconnect block of a stent delivery system as an alternative to the disconnect tube of  FIGS. 126 to 128  with the proximal disconnect block in an engaged state covering a pair of drive screw coupler parts therein and with each jack screw in a thread-engaged state for further outward expansion or inward contraction of the lattice; 
         FIG. 130  is a perspective view of the lattice of  FIG. 129  with the proximal disconnect blocks of the delivery system disconnected from the lattice with the proximal disconnect block in a disengaged state with respect to the pair of drive screw coupler parts and illustrating how all of the pairs of drive screw coupler parts can be coupled for simultaneous release; 
         FIG. 131  is a perspective view of another exemplary embodiment of a self-expanding/forcibly-expanding lattice of an implantable stent assembly having nine separate lattice segments connected to intermediate tubes for jack screws with each jack screw in a thread-engaged state for further outward expansion or inward contraction of the lattice; 
         FIG. 132  is a top plan view of the lattice of  FIG. 131 ; 
         FIG. 133  is a perspective view of another exemplary embodiment of a self-expanding/forcibly-expanding lattice of an implantable stent assembly having nine lattice segments with locally thicker sections of lattice to accommodate and connect to non-illustrated jack screw assemblies; 
         FIG. 134  is a perspective view of another exemplary embodiment of a self-expanding/forcibly-expanding lattice of an implantable stent assembly having nine lattice segments with bent-over tabs for connecting to non-illustrated jack screw assemblies; 
         FIG. 135  is a perspective view of another exemplary embodiment of a self-expanding/forcibly-expanding lattice of an implantable valve assembly having six lattice segments in an expanded position with jack screw assemblies disposed between adjacent pairs of repeating portions of the lattice and having three valve leaflets and jack screws through a wall of the lattice in a thread-non-engaged state of the jack screw; 
         FIG. 136  is a plan view of the valve assembly of  FIG. 135 ; 
         FIG. 137  is a plan view of the valve assembly of  FIG. 135  in a partially compressed state of the lattice without the valve leaflets and with each jack screw in a thread-non-engaged state; 
         FIG. 138  is a perspective view of another exemplary embodiment of a self-expanding/forcibly-expanding lattice of an implantable valve assembly having six lattice segments in a native, self-expanded position with jack screw assemblies attached at an interior surface between adjacent pairs of segments of the lattice without the valve leaflets and with each of the jack screws in a thread-engaged state for further outward expansion or inward contraction of the lattice; 
         FIG. 139  is a perspective view of the lattice of  FIG. 138  in a contracted/crimped state for loading into the stent delivery system with each jack screw in a thread-non-engaged state; 
         FIG. 140  is a tilted perspective view of the lattice of  FIG. 138 ; 
         FIG. 141  is a perspective view of the lattice of  FIG. 138  partially expanded from the state shown in  FIG. 138  with each jack screw in an engaged state for further outward expansion or inward contraction of the lattice; and 
         FIG. 142  is a perspective view of the lattice of  FIG. 138  further expanded near a maximum expansion of the lattice with each jack screw in an engaged state for further outward expansion or inward contraction of the lattice; 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     As required, detailed embodiments of the present invention are disclosed herein; however, it is to be understood that the disclosed embodiments are merely exemplary of the invention, which can be embodied in various forms. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a basis for the claims and as a representative basis for teaching one skilled in the art to variously employ the present invention in virtually any appropriately detailed structure. Further, the terms and phrases used herein are not intended to be limiting; but rather, to provide an understandable description of the invention. While the specification concludes with claims defining the features of the invention that are regarded as novel, it is believed that the invention will be better understood from a consideration of the following description in conjunction with the drawing figures, in which like reference numerals are carried forward. 
     Alternate embodiments may be devised without departing from the spirit or the scope of the invention. Additionally, well-known elements of exemplary embodiments of the invention will not be described in detail or will be omitted so as not to obscure the relevant details of the invention. 
     Before the present invention is disclosed and described, it is to be understood that the terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting. The terms “a” or “an”, as used herein, are defined as one or more than one. The term “plurality,” as used herein, is defined as two or more than two. The term “another,” as used herein, is defined as at least a second or more. The terms “including” and/or “having,” as used herein, are defined as comprising (i.e., open language). The term “coupled,” as used herein, is defined as connected, although not necessarily directly, and not necessarily mechanically. 
     Relational terms such as first and second, top and bottom, and the like may be used solely to distinguish one entity or action from another entity or action without necessarily requiring or implying any actual such relationship or order between such entities or actions. The terms “comprises,” “comprising,” or any other variation thereof are intended to cover a non-exclusive inclusion, such that a process, method, article, or apparatus that comprises a list of elements does not include only those elements but may include other elements not expressly listed or inherent to such process, method, article, or apparatus. An element proceeded by “comprises . . . a” does not, without more constraints, preclude the existence of additional identical elements in the process, method, article, or apparatus that comprises the element. 
     As used herein, the term “about” or “approximately” applies to all numeric values, whether or not explicitly indicated. These terms generally refer to a range of numbers that one of skill in the art would consider equivalent to the recited values (i.e., having the same function or result). In many instances these terms may include numbers that are rounded to the nearest significant figure. 
     The terms “program,” “programmed”, “programming,” “software,” “software application,” and the like as used herein, are defined as a sequence of instructions designed for execution on a computer system. A “program,” “software,” “computer program,” or “software application” may include a subroutine, a function, a procedure, an object method, an object implementation, an executable application, an applet, a servlet, a source code, an object code, a shared library/dynamic load library and/or other sequence of instructions designed for execution on a computer system. 
     Herein various embodiments of the present invention are described. In many of the different embodiments, features are similar. Therefore, to avoid redundancy, repetitive description of these similar features may not be made in some circumstances. It shall be understood, however, that description of a first-appearing feature applies to the later described similar feature and each respective description, therefore, is to be incorporated therein without such repetition. 
     Described now are exemplary embodiments of the present invention. Referring now to the figures of the drawings in detail and first, particularly to  FIGS. 1 to 19 , there is shown a first exemplary embodiment of an actively controllable stent deployment system  100  according to the invention. Even though this exemplary embodiment is illustrated as a stent deployment system without the presence of a stent graft, this embodiment is not to be considered as limited thereto. Any stent graft embodiment according the invention as disclosed herein can be used in this embodiment. The stent graft is not shown in these figures for clarity. Further, as used herein, the terms “stent” and “stent graft” are used herein interchangeably. Therefore, any embodiment where a stent is described without referring to a graft should be considered as referring to a graft additionally or in the alternative, and any embodiment where both a stent and a graft are described and shown should be considered as also referring to an embodiment where the graft is not included. 
     In contrast to prior art self-expanding stents, the actively controllable stent deployment system  100  includes a stent lattice  110  formed by interconnected lattice struts  112 ,  114 . In this exemplary embodiment, pairs of inner and outer struts  114 ,  112  are respectively connected to adjacent pairs of inner and outer struts  114 ,  112 . More particularly, each pair of inner and outer struts  114 ,  112  are connected pivotally at a center point of each strut  114 ,  112 . The ends of each inner strut  114  of a pair is connected pivotally to ends of adjacent outer struts  112  and the ends of each outer strut  112  of a pair is connected pivotally to ends of adjacent inner struts  114 . In such a configuration where a number of strut pairs  114 ,  112  are connected to form a circle, as shown in each of  FIGS. 1 to 19 , a force that tends to expand the lattice  110  radially outward will pivot the struts  114 ,  112  at each pivot point and equally and smoothly expand the entire lattice  110  from a closed state (see, e.g.,  FIG. 3 ) to any number of open states (see  FIGS. 4 to 13 ). Similarly, when the stent lattice  110  is at an open state, a force that tends to contract the stent lattice  110  radially inward will pivot the struts  114 ,  112  at each pivot point and equally and smoothly contract the entire stent lattice  110  towards the closed state. This exemplary configuration, therefore, defines a repeating set of one intermediate and two outer pivot points about the circumference of the stent lattice  110 . The single intermediate pivot point  210  is, in the exemplary embodiment shown in  FIGS. 1 to 19 , located at the centerpoint of each strut  112 ,  114 . On either side of the single intermediate pivot point  210  is a vertically opposing pair of outer pivot points  220 . 
     To provide such expansion and contraction forces, the actively controllable stent deployment system  100  includes at least one jack assembly  700  that is present in each of  FIGS. 1 to 19  but is described, first, with regard to  FIG. 7 . Each jack assembly  700  has a distal drive block  710 , a proximal drive block  720 , and a disconnector drive block  730 . A drive screw  740  connects the distal drive block  710  to the proximal drive block  720 . The drive screw  740  has a distal threaded drive portion  742  having corresponding threads to a threaded drive bore  712  of the distal drive block  710 . The drive screw  740  has an intermediate unthreaded portion  744  that rotates freely within a smooth drive bore  722  of the proximal drive block  720 . In the embodiment shown, the inner diameter of the smooth drive bore  722  is slightly larger than the outer diameter of the unthreaded portion  744  so that the unthreaded portion  744  can freely rotate within the smooth drive bore  722  with substantially no friction. The drive screw  740  also has an intermediate collar  746  just proximal of the proximal drive block  720 . The outer diameter of the intermediate collar  746  is greater than the inner diameter of the smooth drive bore  722 . Lastly, the drive screw  740  has a proximal key portion  748  extending from the intermediate collar  746  in a proximal direction. The jack assembly  700  is configured to retain the drive screw  740  within the distal drive block  710  and the proximal drive block  720  in every orientation of the stent lattice  110 , from the closed state, shown in  FIG. 3 , to a fully open state, shown in  FIG. 11 , where the distal drive block  710  and the proximal drive block  720  touch one another. 
     Each jack assembly  700  is attached fixedly to the stent lattice  110  at a circumferential location thereon corresponding to the vertically opposing pair of outer pivot points  220 . In one exemplary embodiment of the jack assembly  700  shown in  FIGS. 1 to 19 , the outer surface  714  of the distal drive block  710  and the outer surface  724  of the proximal drive block  720  each have a protruding boss  716 ,  726  having an outer shape that is able to fixedly connect to a respective one of the outer pivot points  220  of the stent lattice  110  but also rotationally freely connect thereto so that each of the inner and outer struts  114 ,  112  connected to the boss  716 ,  726  pivots about the boss  716 ,  726 , respectively. In this exemplary embodiment, each boss  716 ,  726  is a smooth cylinder and each outer pivot point  220  is a cylindrical bore having a diameter corresponding to the outer smooth surface of the cylinder but large enough to pivot thereon without substantial friction. The materials of the boss  716 ,  726  and the outer pivot points  220  of the inner and outer struts  114 ,  112  can be selected to have substantially frictionless pivoting. 
     Accordingly, as the drive screw  740  rotates between the open and closed states, the unthreaded portion  744  of the drive screw  740  remains longitudinally stable within the proximal drive block  720 . In contrast, the distal threaded drive portion  742  progressively enters the threaded drive bore  712  from the proximal end to the distal end thereof as the stent lattice  110  expands outwardly. As shown in the progressions of  FIG. 2  to  FIG. 4  and  FIGS. 5 to 7 to 8 to 9 , as the drive screw  740  rotates within the proximal drive block  720 , the distal drive block  710  moves closer and closer to the proximal drive block  720 , thereby causing a radial expansion of the stent lattice  110 . 
     To implant the stent lattice  110  in a tubular anatomic structure (such as a vessel or a valve seat), the stent lattice  110  needs to be disconnected from the delivery system. Delivery of the stent lattice  110  to the anatomic structure will be described in further detail below. When the stent lattice  110  enters the implantation site, it will be most likely be in the closed state shown in  FIG. 3 , although for various reasons, the stent lattice  110  can be expanded partially, if desired, before reaching the implantation site. For purposes of explaining the disconnect, the extent of expansion is not relevant. When at the implantation site, the stent lattice  110  will be expanded by rotating the drive screw  740  in a corresponding expansion direction (the direction of threads of the drive screw  740  and the drive bore  712  will determine if the drive screw  740  needs to be rotated clockwise or counter-clockwise). The stent lattice  110  is expanded to a desired expansion diameter, for example as shown in the progression of  FIGS. 4 to 9  or  FIGS. 10 to 11 , so that it accommodates to the natural geometry of the implantation site, even if the geometry is non-circular or irregular. When the implantation diameter is reached, e.g., in  FIGS. 9 and 11 , the jack assemblies  700  need to be disconnected from the remainder of the stent deployment system  100 . 
     To accomplish disconnect of the jack assemblies  700 , the disconnector drive block  730  is provided with two lumens. A first lumen, the drive lumen  732 , accommodates a drive wire  750  that is able to rotationally engage the proximal key portion  748 . In the exemplary embodiment shown, which is most clearly illustrated in  FIG. 19 , the proximal key portion  748  has a square cross-sectional shape. A drive wire bushing  734  rotationally freely but longitudinally fixedly resides in the drive lumen  732 . The drive wire bushing  734  is connected to the drive wire  750  either as an integral part thereof or through a connection sleeve  752 . Regardless of the connection design, any rotation of the drive wire  750  in either direction will cause a corresponding rotation of the drive wire bushing  734 . A key hole  738  at the distal end of the disconnector drive block  730  and having an internal shape corresponding to a cross-section of the proximal key portion  748  allows a rotationally fixed but longitudinally free connection to occur with the proximal key portion  748 . In the exemplary embodiment shown in  FIG. 19 , the key hole  738  also has a square cross-sectional shape. 
     The disconnector drive block  730  also has a second lumen, a disconnect lumen  731 , which is best shown in  FIGS. 14 and 16 . Residing in the disconnect lumen  731  in a rotationally free but longitudinally fixed manner is a retainer screw  760 . The retainer screw  760  has a distal threaded portion  762 , an intermediate shaft  764 , and a proximal connector  766 . The distal threaded portion  762  has an exterior thread corresponding to an internal thread of a connect lumen  1631 , which is located in the proximal drive block  720  and is coaxial with the disconnect lumen  731 . The intermediate shaft  764  has a smooth exterior surface and a cross-sectional shape that is slightly smaller than the cross-sectional shape of the disconnect lumen  731  so that it can be rotated freely within the disconnect lumen  731  substantially without friction. The proximal connector  766  has a flange with an outer diameter greater than the inner diameter of the disconnect lumen  731 . The proximal connector  766  is connected at a proximal end thereof to a disconnect wire  770 , which connection can either be an integral part thereof or through a secondary connection, such as a weld or connection sleeve. 
     With such a configuration of the proximal drive block  720  and the disconnector drive block  730  of a jack assembly  700 , rotation in a securing direction will longitudinally secure the proximal drive block  720  to the disconnector drive block  730  so that the stent lattice  110  remains connected to the drive wire  750  and the disconnect wire  770 . In the connected state, the stent lattice  110  may be extended outward and retracted inward as many times until implantation alignment according to the surgeon&#39;s desire. Likewise, rotation in a disconnecting direction will longitudinally release the proximal drive block  720  from the disconnector drive block  730  so that the stent lattice  110  disconnects entirely from the drive wire  750  and the disconnect wire  770 . 
     This process is illustrated with regard to  FIGS. 10 to 19 . In the exemplary illustration of  FIG. 10 , the stent lattice  110  is not fully expanded. Because the distal threaded portion  762  of the retainer screw  760  is threaded within the connect lumen  1631  of the proximal drive block  720 , the disconnector drive block  730  remains longitudinally fixed to the proximal drive block  720 —ideally, a configuration that exists from the time that the stent deployment system  100  first enters the patient and at least up until implantation of the stent lattice  110  occurs. Expansion of the stent lattice  110  is finished in the configuration of  FIG. 11  and, for purposes of this example, it is assumed that the stent lattice  110  is correctly implanted at the implantation site. Therefore, disconnection of the delivery system can occur. It is noted that this implantation position just happens to be at a circumferential extreme of the stent lattice  110  because the distal drive block  710  and the proximal drive block  720  are touching. In actual use, however, it is envisioned that such touching does not occur when expanded for implantation and, in such a state, there is a separation distance between the distal drive block  710  and the proximal drive block  720  to give the stent lattice  110  room to expand into the implantation site if needed. Disconnection of the stent lattice  110  begins by rotating the disconnect wire  770  in a direction that unscrews the threaded portion  762  of the retainer screw  760  from the connect lumen  1631 . As the stent lattice  110  is implanted with expansive force at the implantation site, the disconnector drive block  730  moves proximally as unthreading occurs. Complete unthreading of the retainer screw  760  is shown in  FIGS. 12 and 14 . In a configuration with more than one jack assembly  700  (the configuration of  FIGS. 1 to 19  has  4 , for example), each disconnect wire  770 ,  770 ′ will rotate synchronously to have each disconnector drive block  730  disconnect from its respective proximal drive block  720  substantially simultaneously, as shown in  FIG. 12 . Such synchronous movement will be described in greater detail below. With the stent lattice  110  implanted, as shown in  FIGS. 13, 15, 18, and 19 , the delivery system for the stent lattice  110  can be withdrawn proximally away from the implantation site and be retracted out from the patient. 
     It is noted that the exemplary embodiment of  FIGS. 1 to 19  shows the actively controllable stent deployment system  100  as having four jack assemblies  700  equally spaced around the circumference of the lattice  110 . This configuration is merely exemplary and any number of jack assemblies  700  can be used to expand and contract the lattice  110 , including a minimum of one jack assembly  700  in total and a maximum of one jack assembly  700  for each intersection between each inner and outer strut pair  112 ,  114 . Herein, three and four jack assemblies  700  are depicted and used to show particularly well performing configurations. By using an even number, counter-rotating screws can be used to null the torque. 
       FIG. 20  is provided to further explain how the stent lattice  110  moves when it is expanded and contracted. As set forth above, the actively controllable stent deployment system  100  is based upon the construction of the stent lattice  110  and the attachment of the proximal and distal drive blocks  720 ,  710  of at least one jack assembly  700  to at least one set of the vertically opposing upper and lower pivot points  220  of the stent lattice  110 . With the exemplary connections  716 ,  726  and pivot points  210 ,  220  shown in  FIGS. 1 to 19 , a longitudinal vertical movement of one of the proximal or distal drive blocks  720 ,  710  with respect to the other will expand or contract the stent lattice  110  as described herein.  FIG. 20  illustrates with solid cylinders  2000  a radial path of travel that each intermediate pivot point  210  will traverse as the stent lattice  110  is moved between its expanded (e.g.,  FIG. 9 ) and contracted (e.g.,  FIG. 2 ) states. Because the travel path is linear, the stent lattice  110  expands and contracts smoothly and equally throughout its circumference. 
     It is noted that the struts  112 ,  114  shown in  FIGS. 1 to 19  appear to not be linear in certain figures. Examples of such non-linearity are the struts in  FIGS. 10 and 11 . Therein, each strut  112 ,  114  appears to be torqued about the center pivot point such that one end is rotated counter-clockwise and the other is rotated clockwise. This non-linearity can create the hourglass figure that will help fix the graft into an implantation annulus and to create a satisfactory seal at the top edge of the implant. The non-linear illustrations are merely limitations of the computer design software used to create the various figures of the drawings. Such non-linear depictions should not be construed as requiring the various exemplary embodiments to have the rotation be a part of the inventive struts or strut configuration. Whether or not the various struts  112 ,  114  will bend, and in what way they will bend, is dependent upon the characteristics of the material that is used to form the struts  112 ,  114  and upon how the pivot joints of the lattice  110  are created or formed. The exemplary materials forming the struts  112 ,  114  and the pivots and methods for creating the pivots are described in further detail below. For example, they can be stamped, machined, coined or similar from the family of stainless steels and cobalt chromes. 
     With the invention, force is applied actively for the controlled expansion of the stent lattice  110 . It may be desirable to supplement the outwardly radial implantation force imposed on the wall at which the stent lattice  110  is implanted. Prior art stent grafts have included barbs and other similar devices for supplementing the outward forces at the implantation site. Such devices provide a mechanical structure(s) that impinge(s) on and/or protrude(s) into the wall of the implantation site and, thereby, prevent migration of the implanted device. The systems and methods of the invention include novel ways for supplementing the actively applied outward expansion force. One exemplary embodiment includes actively controllable needles, which is described, first, with reference to  FIG. 17 . In this exemplary embodiment, the distal drive block  710  and the proximal drive block  720  contain a third lumen, a distal needle lumen  1711  and a proximal needle lumen  1721 . Contained within both of the distal and proximal needle lumens  1711 ,  1721  is a needle  1700 . In an exemplary embodiment, the needle  1700  is made of a shape memory material, such as Nitinol, for example. The needle  1700  is preset into a shape that is, for example, shown in the upper left of  FIG. 12 . A portion that remains in the distal and proximal needle lumens  1711 ,  1721  after implantation of the stent lattice  110  can be preset into a straight shape that is shown in  FIG. 17 . A tissue-engaging distal portion of the needle  1700 , however, is formed at least with a curve that, when extended out of the distal drive block  710 , protrudes radially outward from the center longitudinal axis of the stent lattice  110 . In such a configuration, as the needle  1700  extends outward, it drives away from the outer circumferential surface  714  (see  FIG. 5 ) of the distal drive block  710  (i.e., towards the viewer out from the plane shown in  FIG. 5 ). The needle  1700  also has a longitudinal extent that places the distal tip  1210  within the distal needle lumen  1711  when the stent lattice  110  is in the closed state, e.g., shown in  FIG. 2 . 
     Deployment of the needles  1700  in each jack assembly  700  (or the number of needles can be any number less than the number of jack assemblies  700 ) is illustrated, for example, starting with  FIG. 5 . In this example, the needles  1700  in each of the four jack assemblies  700  has a length that is shorter than the longitudinal end-to-end distance of the proximal and distal drive blocks  720 ,  710  because the needles  1700  have not yet protruded from the distal upper surface  612  of each distal drive block  710  even though the stent lattice  110  is partially expanded. When the stent lattice  110  has expanded slightly further, however, as shown in  FIG. 7 , the needles  1700  begin protruding from the distal upper surface  612 . As the needles  1700  are prebent as set forth above, the needles  1700  immediately begin bending into the natural pre-set curved shape. See also  FIGS. 7 and 8 .  FIG. 10  illustrates two needles  1700  even further extended out from the distal needle lumen  1711  (only two are shown because this is a cross-section showing only the rear half of the stent lattice  110 ).  FIG. 11  illustrates two needles  1700  in a fully extended position (as the distal and proximal drive blocks  710 ,  720  touch one another in the most-expanded state of the stent lattice  110 ).  FIGS. 9, 13, 16, 17, 18, and 21  also show the needles  1700  in an extended or fully extended state. 
     How the needles  1700  each extend from the distal drive block  710  can be explained in a first exemplary embodiment with reference to  FIG. 17 . A proximal portion of the needle  1700  is connected fixedly inside the proximal needle lumen  1721 . This can be done by any measure, for example, by laser welding. In contrast, the intermediate and distal portions of the needle  1700  is allowed to entirely freely slide within the distal needle lumen  1711 . With the length set as described above, when the distal and proximal drive blocks  710 ,  720  are separated completely, as shown in  FIG. 3 , the needle  1700  resides in both distal and proximal needle lumens  1711 ,  1721 . As one of the distal and proximal drive blocks  710 ,  720  begins to move towards the other (as set forth above, the exemplary embodiment described with regard to these figures has the distal drive block  710  move towards the proximal drive block  720 ), the proximal portion of the needle  1700  remains in the proximal needle lumen  1721  but the distal portion of the needle  1700  begins to exit the distal upper surface  612 , which occurs because the intermediate and distal portions of the needle  1700  are slidably disposed in the distal needle lumen  1711 . This embodiment where the proximal portion of the needle  1700  is fixed in the proximal needle lumen  1721  is referred to herein as dependent control of the needles  1700 . In other words, extension of the needles  1700  out from the distal needle lumen  1711  occurs dependent upon the relative motion of the distal and proximal drive blocks  710 ,  720 . 
     Alternatively, the supplemental retention of the stent lattice  110  at the implantation site can occur with independent control of the needles.  FIGS. 21 to 29  illustrate such an exemplary embodiment of a system and method according to the invention. Where similar parts exist in this embodiment to the dependently controlled needles  1700 , like reference numerals are used. The jack assembly  2100  is comprised of a distal drive block  710 , a proximal drive block  720 , a disconnector drive block  730 , a drive screw  740 , a drive wire  750  (shown diagrammatically with a dashed line), a retainer screw  760 , and a disconnect wire  770 . Different from the jack assembly  700  of  FIGS. 1 to 19 , the jack assembly  2100  also includes a needle  2200  and a needle pusher  2210  and both the proximal drive block  720  and the disconnector drive block  730  each define a co-axial third lumen therein to accommodate the needle pusher  2210 . More specifically, the distal drive block  710  includes a first pusher lumen  2211 , the proximal drive block  720  includes a second pusher lumen  2221  and the disconnector drive block  730  includes a third pusher lumen  2231 . As described above, the retainer screw  760  keeps the proximal drive block  720  and the disconnector drive block  730  longitudinally grounded to one another up until and after implantation of the stent lattice  110  and separation of the delivery system occurs. Rotation of the drive screw  740  causes the distal drive block  710  to move towards the proximal drive block  720 , thereby expanding the stent lattice  110  to the desired implantation diameter. This movement is shown in the transition between  FIG. 22  and  FIG. 23 . Now that the stent lattice  110  is determined to be properly implanted within the implantation site, it is time to deploy the needles  2200 . Deployment starts by advancing the needle pusher  2180  as shown in  FIG. 24 . The needle pusher  2810  can, itself, be the control wire for advancing and retracting the needle  2200 . Alternatively, and/or additionally, a needle control wire  2182  can be attached to or shroud the needle pusher  2180  to provide adequate support for the needle pusher  2180  to function. Continued distal movement of the needle pusher  2180  causes the needle  2200  to extend out from the distal upper surface  612  and, due to the preset curvature of the memory-shaped needle  2200 , the needle tip curves outward and into the tissue of the implantation site. This curvature is not illustrated in  FIG. 25  because the curvature projects out of the plane of  FIG. 25 . 
     Now that the stent lattice  110  is implanted and the needles  2200  are extended, disconnection of the stent lattice  110  occurs. First, as shown in  FIG. 26 , the retainer screw  760  is rotated to disconnect the proximal drive block  720  from the disconnector drive block  730  and a proximally directed force is imparted onto one or both of the drive wire  750  and the disconnect wire  770 . This force moves the disconnector drive block  730  distally to remove the proximal key portion  748  of the drive screw  740  out from the keyhole  738 , as shown in the progression from  FIGS. 26 to 27 . Simultaneously, distal movement of the disconnector drive block  730  starts the withdrawal of the needle pusher  2180  from the first pusher lumen  2211  (if not retracted earlier). Continued distal movement of the disconnector drive block  730  entirely removes the needle pusher  2180  from the first pusher lumen  2211 , as shown in  FIG. 28 . Finally, withdrawal of the stent lattice delivery system entirely from the implantation site removes the needle pusher  2180  out from the second pusher lumen  2221  leaving only the implanted stent lattice  110 , the jack assembly(ies)  2100 , and the needle(s)  2200  at the implantation site. 
       FIGS. 30 to 37  illustrate another exemplary embodiment of an independent needle deployment system and method according to the invention. Where similar parts exist in this embodiment to the embodiments described above, like reference numerals are used. The jack assembly  3000  is comprised of a distal drive block  3010 , a proximal drive block  3020 , a disconnector drive block  3030 , a drive screw  3040 , a drive wire  750 , a retainer screw  760 , and a disconnect wire  770 . The jack assembly  3000  also includes a needle  3070  and a needle movement sub-assembly  3090 . The needle movement sub-assembly  3090  is comprises of a needle support  3092 , a needle base  3094 , a needle disconnect nut  3096 , and a needle disconnect wire  3098 . 
     The distal drive block  3010  defines three longitudinal lumens. The first is a support rod lumen  3012  and is defined to slidably retain a support rod  3080  therein. As rotational torque is imparted when any screw associated with the jack assembly  3000  rotates, the support rod  3080  is employed to minimize and/or prevent such torque from rotating the distal and proximal drive blocks  3010 ,  3020  and disconnector drive block  3030  with respect to one another and, thereby, impose undesirable forces on the stent lattice  110 . The longitudinal length of the support rod  3080  is selected to not protrude out from the distal upper surface  3011  of the distal drive block  3010  in any expansion or retracted state of the stent lattice  110 . The second vertically longitudinal lumen is the drive screw lumen  3014 . As in previous embodiments, the drive screw lumen  3014  is configured with internal threads corresponding to external threads of the drive screw  740  and the longitudinal vertical length of the drive screw lumen  3014  is selected to have the drive screw  740  not protrude out from the distal upper surface  3011  of the distal drive block  3010  in any expansion or retracted state of the stent lattice  110 . Finally, the distal drive block  3010  defines a needle assembly lumen that is comprises of a relatively wider proximal needle lumen  3016  and a relatively narrower distal needle lumen  3018 , both of which will be described in greater detail below. 
     In comparison to other proximal drive blocks described above, the proximal drive block  3020  of jack assembly  3000  defines two vertically longitudinal lumens. The first lumen is a drive screw lumen  3024 . In this exemplary embodiment, the drive screw  740  is longitudinally fixedly connected to the proximal drive block  3020  but is rotationally freely connected thereto. To effect this connection, a distal drive screw coupler part  3052  is fixedly secured to the proximal end of the drive screw  740  within a central bore that is part of the drive screw lumen  3024  of the proximal drive block  3020 . The distal drive screw coupler part  3052  is shaped to be able to spin along its vertical longitudinal axis (coaxial with the vertical longitudinal axis of the drive screw  740 ) freely within the central bore of the drive screw lumen  3024 . A distal portion of the drive screw lumen  3024  is necked down to have a diameter just large enough to allow a portion of the drive screw  740  (e.g., non-threaded) to spin therewithin substantially without friction. Through a circular port  3100  in a side of the proximal drive block  3020 , the distal drive screw coupler part  3052  can be, for example, spot-welded to the proximal non-threaded end of the drive screw  740 . With such a connection, the drive screw  740  is longitudinally fixedly grounded to the proximal drive block  3020  within the central bore of the drive screw lumen  3024 . This means that rotation of the drive screw  740  causes the distal drive block  3010  to move towards the proximal drive block  3020  and, thereby, cause an expansion of the stent lattice  110  connected to the jack assembly  3000 , for example, at bosses  3600  shown in  FIG. 36 . Fasteners  3610  in the form of washers, rivet heads, or welds, for example, can hold the stent lattice  110  to the bosses  3600 . Further explanation of the drive screw coupler  3052 ,  3054  is made below with regard to the disconnector drive block  3030 . 
     The second lumen within the proximal drive block  3020  of jack assembly  3000  is a retainer screw lumen  3022 . A distal portion of the retainer screw lumen  3022  is shaped to fixedly hold a proximal end of the support rod  3080  therein; in other words, the support rod  3080  is fastened at the distal portion of the retainer screw lumen  3022  and moves only with movement of the proximal drive block  3020 . Fastening can occur by any measures, for example, by corresponding threads, welding, press fitting, or with adhesives. A proximal portion of the retainer screw lumen  3022  has interior threads corresponding to exterior threads of the retainer screw  760 . Accordingly, disconnection of the disconnector drive block  3030  from the proximal drive block  3020  is carried out by rotation of the retainer screw  760  fixedly connected to disconnector wire  770 . Connection between the retainer screw  760  and the disconnector wire  770  can be accomplished by any measures, including for example, a hollow coupler sheath fixedly connected to both the distal end of the disconnector coupler wire  770  and the proximal end of the retainer screw  760  as shown in  FIG. 30 . As described above, the retainer screw  760  keeps the proximal drive block  3020  and the disconnector drive block  3030  longitudinally grounded to one another until after implantation of the stent lattice  110  and separation of the delivery system occurs. 
     This exemplary embodiment also has an alternative to the device and method for uncoupling the drive screw  740  from the remainder of the jack assembly  3000 , in particular, the two-part drive screw coupler  3052 ,  3054 . The distal drive screw coupler part  3052  as, at its proximal end, a mechanical coupler that is, in this exemplary embodiment, a semicircular boss extending in the proximal direction away from the drive screw  740 . The proximal drive screw coupler part  3054 , has a corresponding semicircular boss extending in the distal direction towards the drive screw  740 . These can be seen, in particular, in the enlarged view of  FIG. 37 . Therefore, when the two semicircular bosses are allowed to interconnect, any rotation of the proximal drive screw coupler part  3054  will cause a corresponding rotation of the distal drive screw coupler part  3052 . The disconnector drive block  3030  has a screw coupler bore  3031  shaped to retain the distal drive screw coupler part  3052  therein. As in the proximal drive block  3020 , the screw coupler bore  3031  is shaped to surround the proximal drive screw coupler part  3054  and allow the proximal drive screw coupler part  3054  to rotate freely therewithin substantially without friction. A proximal portion of the screw coupler bore  3031  is necked down to a smaller diameter to prevent removal of the proximal drive screw coupler part  3054  after it is fixedly connected to the drive wire  750  either directly or through, for example, a hollow coupler as shown in  FIGS. 30 to 37 . 
     Implantation of the stent lattice  110  with the jack assembly  3000  is described with regard to  FIGS. 30 through 35 . First, rotation of the drive screw  740  causes the distal drive block  3010  to move towards the proximal drive block  3020 , thereby expanding the stent lattice  110  to the desired implantation diameter. This movement is shown in the transition between  FIG. 30  and  FIG. 31 . Now that the stent lattice  110  is properly within the implantation site, deployment of the needles  3070  can occur. Deployment starts by advancing the needle sub-assembly  3090  as shown in the transition between  FIGS. 31 and 32 . Continued distal movement of the needle subassembly  3090  causes the needle  3070  to extend out from the distal upper surface  3011  and, due to the preset curvature of the memory-shaped needle  3070 , the tip of the needle  3070  curves outward and into the tissue of the implantation site. This curvature is not illustrated in  FIGS. 32 and 33  because the curvature projects out of the plane of these figures. 
     In comparison to previous proximal drive blocks above, the disconnector drive block  3030  does not have a lumen associated with the needle  3070 . Only distal drive block  3010  has a lumen therein to accommodate the needle  3070 . More specifically, the distal drive block  3010  includes a distal needle lumen  3018  and a proximal needle lumen  3016 . The distal needle lumen  3018  is shaped to accommodate the needle  3070  only. In contrast to other needle lumens, however, the proximal needle lumen  3016  is non-circular in cross-section and, in the exemplary embodiment, is ovular in cross-section. This shape occurs because the memory-shaped needle  3070  is supported on its side along its proximal extent by a needle support  3092 , which is fastened side-to-side, for example, by welding. The needle support  3092  has a relatively higher columnar strength than the needle  3070  and, therefore, when fixedly connected to the side of the needle  3070 , the needle support  3092  significantly increases the connection strength to the needle  3070  at its side than if the needle  3070  was controlled only from the very proximal end thereof. A high-strength, exterior threaded needle base  3094  is fixedly attached to the proximal end of the needle support  3092 . This configuration also keeps the needle clocked properly so that its bend direction is away from the center of the lattice and most directly attaches to the vessel wall. 
     Control of the needle  3070  is, as above, carried out by a needle disconnect wire  3098  (depicted with dashed lines). Attached to the distal end of the disconnect wire  3098  is a needle disconnect nut  3096  defining a distal bore with interior threads corresponding to the exterior threads of the needle base  3094 . In this configuration, therefore, rotation of the needle disconnect wire  3098  causes the needle disconnect nut  3096  to either secure to the needle base  3094  or remove from the needle base  3094  so that disconnection of the delivery system from the stent lattice  110  can occur. The top side of the distal drive block  3010  is cross-sectioned in  FIG. 36  at the boss  3600  to show the shapes of the various lumens therein. As described above, the support rod lumen  3012  is a smooth, circular-cross-sectional bore to allow the support rod  3080  to slide longitudinally vertically therein. Similarly, the distal-portion of the drive screw lumen  3014  is also a smooth, circular-cross-sectional bore to allow the drive screw  740  to move longitudinally vertically therein as it is rotated and the threads engage the proximal threaded portion of the drive screw lumen  3014 . The proximal needle lumen  3016 , in contrast, is non circular (e.g., ovular) to accommodate the cylindrical-shaped needle  3070  and the side-by-side-connected, cylindrical-shaped, needle support  3092 . As shown in the view of  FIG. 36 , at least the contacting portion of the needle  3070  to the needle support  3092  is shrouded with a connector sleeve  3071 , which has material properties that allow it to be fixedly connected to the needle  3070  and, at the same time, to the needle support  3092 . 
     Extension of the needle  3070  out from the distal upper surface  3011  by the distal movement of the disconnect wire  3098  is illustrated by the transition from  FIG. 31  to  FIG. 32 . Only a small portion of the needle  3070  extends from the distal upper surface  3011  because the views of  FIGS. 30 to 33  are vertical cross-sections along a curved intermediate plane shown, diagrammatically, with dashed line X-X in  FIG. 36 . As the needle  3070  extends in front of this sectional plane, it is cut off in these figures.  FIGS. 34 and 35 , however clearly show the extended needle  3070  curving out and away from the outer side surface  3415 , however, merely for clarity purposes, the needle  3070  is rotated on its longitudinal axis slightly to the right so that it can be seen in  FIG. 34  and seen better in  FIG. 35 . It is note that another exemplary embodiment of the needle  3070  includes a hooked or bent needle tip  3072 . Correspondingly, the distal drive block  3010  includes a needle tip groove  3013  to catch the bent needle tip  3072  and utilize it in a way to keep tension on the needle  3070  and the needle disconnect wire  3098 . The bend in the needle tip  3072  also allows the needle  3070  to penetrate earlier and deeper than without such a bend. Another advantage for having this bend is that it requires more load to straighten out the tip bend than the overall memory shape of the needle and, thereby, it keeps the needle located distally in the jack assembly  3000 . If space allowed in the distal drive block, a plurality of needles (e.g., a forked tongue) could be used. 
     Removal of the delivery system is described with regard to  FIGS. 32, 33, and 37  after the stent lattice  110  is implanted and the needle  3070  of each jack assembly  3000  is extended. The retainer screw  760  keeps the proximal drive block  3020  and the disconnector drive block  3030  longitudinally grounded to one another up until implantation of the stent lattice  110  and extension of the needles  3070  (if needles  3070  are included). Separation of the delivery system begins by rotation of the disconnector wire  770  to unscrew the retainer screw  760  from the retainer screw lumen  3022 , which occurs as shown in the transition from  FIG. 32  to  FIG. 33 . Because the two parts of the drive screw coupler  3052 ,  3054  are not longitudinally fastened to one another, the drive screw coupler  3052 ,  3054  does not hinder disconnection of the disconnector drive block  3030  in any way. Before, at the same time, or after removal of the retainer screw  760  from the retainer screw lumen  3022 , the needle disconnect wire  3098  is rotated to, thereby, correspondingly rotate the needle disconnect nut  3096 . After a number of rotations, a needle disconnect nut  3096  is entirely unscrewed from the threads of the needle base  3094 , which is shown in  FIG. 33 , for example. The delivery system, including the disconnector drive block  3030 , its control wires (drive wire  750  and disconnect wire  770 ), and the needle disconnect wire  3098  and disconnect nut  3096 , can now be removed from the implantation site. 
     Other exemplary embodiments of the stent lattice according to the invention is shown with regard to  FIGS. 38 to 50 . In a first exemplary embodiment, the stent lattice is a proximal stent  3810  of a stent graft  3800 . The proximal stent  3810  is connected to and covered on its exterior circumferential surface with a graft  3820 . With the proximal stent  3810  in a partially expanded state in  FIG. 39  and other expanded states in  FIGS. 40 and 41 , it can be seen that the outer struts  3812  have at least one throughbore  3814 , in particular, a line of throughbores from one end to the other, extending through the outer strut  3812  in a radial direction. These throughbores allow the graft  3820  to be sewn to the outer struts  3812 . 
     As described above, it can be beneficial for stents to have barbs, hooks, or other measures that catch and do not release tissue when they contact the tissue at or near an implantation site.  FIGS. 42 to 45  illustrate one exemplary embodiment of the invention. When constructing the stent lattice  4200 , attachment of the three pivot points makes each outer strut  4230  curve about its center pivot point, as can be seen in the lower right corner of  FIG. 44 , for example. Past the outer two pivot points of each outer strut  4230 , however, there is no curve imparted. The invention takes advantage of this and provides extensions  4210  and barbs  4220  on one or more ends of the outer struts  4230  because the lack of curvature at the ends of the outer strut  4230  means that the outer portion will extend outward from the circumferential outer surface of the stent lattice  4200 . In the expanded configuration of the stent lattice  4200  shown in  FIG. 42 , it can be seen that the extensions  4210  and barbs  4220  each project radially outward from the outer circumferential surface of the stent lattice  4200  and the points of the barbs  4220  also point radially outward, even if at a shallow angle. 
     It is noted that each of the exemplary embodiments of the stent lattices illustrated above has the intermediate pivot point at the center point of each strut. Having the intermediate pivot point in the center is only exemplary and can be moved away from the center of each strut. For example, as shown in  FIGS. 46 to 50 , the stent lattice  4600  can have the intermediate center pivot  4612  of the struts  4610  be closer to one end  4614  than the other end  4616 . When the center pivot  4612  is off-center, the side closer to the one end  4614  tilts inwards so that the outer circumferential surface of the stent lattice  4600  takes the shape of a cone.  FIGS. 48, 49, and 50  illustrate the conical stent lattice  4600  expanded, partially expanded, and almost completely retracted, respectively. 
     The exemplary stent lattice embodiments in  FIGS. 38 to 50  show the pivot points connected by screws. Any number of possible pivoting connections can be used at one or more or all of the pivot points. One exemplary embodiment of a strut-connection assembly  5100  can be seen in  FIGS. 51 to 53 . Because the stent lattice of the invention is intended to be small and fit in very small anatomic sites (e.g., heart valve, aorta, and other blood vessels), it is desirable to have the lattice struts be as thin as possible (i.e., have a low profile). The profile of the screws shown in  FIGS. 38 to 50  can be reduced even further by the inventive strut-connection system  5100  as shown in  FIGS. 51 to 53 .  FIG. 51  illustrates one such low-profile connection, which is formed using a rivet  5110  and forming the rivet bores in the each of the strut ends with one of a protrusion  5120  and an opposing indention (not illustrated in  FIG. 53 ). The rivet  5110  formed with a low-profile rivet head  5112  and intermediate cylindrical boss  5114 , and a slightly outwardly expanded distal end  5116 . By placing two of the ends of the struts next to one another as shown in  FIG. 53 , with one of the protrusions  5120  placed inside the indention of the opposing strut, the two strut ends form a pivot that is able to slide about the central pivot axis. The rivet  5110  is merely used to lock to strut ends against one another by having the expanded distal end  5116  enter through one of the non-illustrated indention sides of the strut and exit through the protrusion-side of the opposing strut. It is the features on the struts that form the pivot and not the features of the rivet  5110 . 
       FIGS. 54 to 63  illustrate various alternative configurations of the struts in stent lattices according to exemplary embodiments of the invention. Each of the different lattice configurations provides different characteristics. One issue that occurs with lattices having alternating struts is that expansion and contraction of the adjacent struts can adversely rub against the graft securing measures (e.g., stitchings). With that consideration, the invention provides two separate cylindrical sub-lattices in the embodiment of  FIGS. 54 to 57 . Each of the crossing points of the interior and exterior sub-lattices is connected via fasteners (e.g., rivets, screws, and the like). The outer ends of the struts, however, are not directly connected and, instead, are connected by intermediate hinge plates having two throughbores through which a fastener connects respectively to each of the adjacent strut ends. The intermediate hinge plates translate longitudinally towards each other upon expansion of the stent lattice and never have any portion of stent lattice pass in front or behind them. These hinge plates, therefore, could serve as connection points to the graft or could connect to a band or a rod, the band serving to join the two hinge plates together and, thereby, further spread the expansion forces on the graft. In an exemplary embodiment where the graft material has a transition zone where expansible material transitions to non-expansible material (and back again if desired), such bands or rods could extend further past the longitudinal end of the lattice and provide an attachment or securing point for a non-expansible portion of the graft material. In this configuration, as shown in  FIG. 57 , for example, if graft material is attached to the outer sub-lattice, then, there is no interruption and the graft is not damaged with the struts acting as scissors.  FIGS. 58 to 63  illustrate another exemplary embodiment of the strut lattices according to the invention in which the inner sub-lattice is shorter in the longitudinally vertical direction than the outer sub-lattice. 
     The exemplary actively controllable stent lattices of the invention can be used in devices and methods in which prior art self-expanding stents have been used. In addition to the example of a proximal stent shown in the exemplary stent graft of  FIGS. 38 to 41 , the technology described herein and shown in the instant stent delivery systems and methods for delivering such devices can be use in any stent graft or implant, such as those used in abdominal or thoracic aneurysm repair. Additionally, the exemplary stent lattices of the invention can be used in replacement heart valves, for example. 
     Referring now to the figures of the drawings in detail and first, particularly to  FIGS. 64 to 70 , there is shown a first exemplary embodiment of an actively controllable aortic valve assembly and methods and systems for controlling and implanting such devices. Even though the exemplary embodiment is shown for an aortic valve, the invention is not limited thereto. The invention is equally applicable to pulmonary, mitral and tricuspid valves. 
     The inventive technology used, for example, with regard to aortic valve repair includes a replacement aortic valve assembly  6400  according to the invention. One exemplary aortic valve assembly  6400  is depicted in  FIGS. 64 and 65 .  FIG. 64  illustrates an adjustable lattice assembly  6410  similar to that shown in  FIG. 103 . In particular, the lattice assembly  6410  includes a number of struts  6412  crossing one another in pairs and pivotally connected to one another in an alternating manner at crossing points  6420  and end points  6422  of the struts  6412 . Like the embodiment in  FIG. 103 , the lattice assembly  6410  is controlled, in this exemplary embodiment, by a set of three jack assemblies  6430  each having a proximal drive block  6432 , a distal drive block  6434 , and a drive screw  740  connecting the proximal and distal drive blocks  6432 ,  6434  together. In this exemplary embodiment, the drive screw  740  performs as above, it is is longitudinally fixed but rotationally freely connected to the distal and proximal drive blocks  6432 ,  6434  such that, when rotated in one direction, the distal and proximal drive blocks  6432 ,  6434  move away from one another and, when rotated in the other direction, the distal and proximal drive blocks  6432 ,  6434  move towards one another. In such a configuration, the former movement radially contracts the lattice assembly  6410  and the latter movement expands the lattice assembly  6410 . The lattice assembly  6410  shown in  FIGS. 64 and 65  is in its expanded state, ready for implantation such that it accommodates to the natural geometry of the implantation site. Connected at least to the three jack assemblies  6430  at an interior side of one or both of the distal and proximal drive blocks  6432 ,  6434  is an exemplary embodiment of a three-leaf valve assembly  6440  (e.g., an aortic valve assembly). The valve assembly  6440  can be made of any desired material and, in an exemplary configuration, is made of bovine pericardial tissue or latex. 
     An exemplary embodiment of a delivery system and method shown in  FIGS. 66 to 70  and disclosed herein can be used to percutaneously deploy the inventive aortic valve assembly  6440  in what is currently referred to as Transcatheter Aortic-Valve Implantation, known in the art under the acronym TAVI. As set forth above, this system and method can equally be used to deploy replacement pulmonary, mitral and tricuspid valves as well. The configuration of the delivery system and the valve assembly  6440  as an aortic valve assembly provide significant advantages over the prior art. As is known, current TAVI procedures have a risk of leak between an implanted device and the aortic valve annulus, referred to as perivalvular leak. Other disadvantages of prior art TAVI procedures include both migration (partial movement) and embolism (complete release). The reason for such movement is because the prior art replacement aortic valves are required before use and entry into the patient, to be crushed manually by the surgeon onto an interior balloon that will be used to expand that valve when ready for implantation. Because the native annulus of the implantation site is not circular, and due to the fact that the balloon forces the implanted pre-crushed valve to take a final shape of the circular balloon, prior art implants do not conform to the native annulus. Not only are such prior art systems hard to use, they provide no possibility of repositioning the implanted valve once the balloon has expanded. 
     The progression of  FIGS. 66 to 70  illustrates an exemplary implantation of the inventive aortic valve assembly  6440 . Various features of the delivery system are not illustrated in these figures for reasons of clarity. Specifically, these figures show only the guidewire  6610  and the nose cone  6620  of the delivery system.  FIG. 66  shows the guidewire  6610  already positioned and the aortic valve assembly  6440  in a collapsed state resting in the delivery system just distal of the nose cone  6620 . In this illustration, the aortic valve assembly  6440  and nose cone  6620  are disposed in the right iliac artery.  FIG. 67  depicts the aortic valve assembly  6440  and nose cone  6620  in an advanced position on the guidewire  6610  within the abdominal aorta adjacent the renal arteries.  FIG. 68  shows the aortic valve assembly  6440  just adjacent the aortic valve implantation site. Finally,  FIGS. 69 and 70  show the aortic valve assembly  6440  implanted in the heart before the nose cone  6620  and/or the guidewire  6610  are retracted. 
     The inventive delivery system and aortic valve assembly  6440  eliminate each of the disadvantageous features of the prior art. First, there is no need for the surgeon to manually crush the implanted prosthesis. Before the aortic valve assembly  6440  is inserted into the patient, the delivery system simply reduces the circumference of the lattice  6410  automatically and evenly to whatever diameter desired by the surgeon. The stent and valve assemblies described herein can be reduced to a loading diameter of between 4 mm and 8 mm, and, in particular, 6 mm, to fit inside a 16-20 French sheath, in particular, an 18 French or smaller delivery sheath. When the aortic valve assembly  6440  reaches the implantation site, the surgeon causes the delivery system to evenly and automatically expand the aortic valve assembly  6440 . As this expansion is slow and even into the implant position, it is gentle on calcification at the implant site. Likewise, the even expansion allows the lattice structure to assume the native, non-circular perimeter of the implant site not only due to the way the delivery system expands the lattice assembly  6410 , but also because the hinged connections of each of the struts  6412  allows the lattice assembly  6410  to bend and flex naturally after implantation dependent upon the corresponding tissue wall adjacent to each pivoting strut  6412  (assumption of the natural shape of the implantation wall also occurs with the alternative non-hinged embodiments disclosed herein). Due to these facts, a better seating of the implant occurs, which leads axiomatically to a better perivalvular seal. The inventive delivery system sizes the prosthesis precisely, instead of the gross adjustment and installation present in the prior art. Another significant disadvantage of the prior art is that a balloon is used within the central opening of the valve to expand the valve, thus completely occluding the aorta and causing tremendous backpressure on the heart, which can be hazardous to the patient. The valves described herein, in contrast, remain open during deployment to, thereby, allow continuous blood flow during initial deployment and subsequent repositioning during the procedure and also start the process of acting as a valve even when the implant is not fully seated at the implantation site. 
     Significantly, prior art TAVI systems require a laborious sizing process that requires the replacement valve to be sized directly to the particular patient&#39;s annulus, which sizing is not absolutely correct. With the delivery system and aortic valve assemblies described herein, however, the need to size the valve assembly beforehand no longer exists. 
     The aortic valve assembly  6440  is configured to have a valve leaf overlap  6542  (see  FIG. 65 ) that is more than sufficient when the aortic valve assembly  6440  is at its greatest diameter and, when the aortic valve assembly  6440  is smaller than the greatest diameter, the valve leaf overlap  6542  merely increases accordingly. An exemplary range for this overlap can be between 1 mm and 3 mm. 
     A further significant advantage not provided by prior art TAVI systems is that the inventive delivery system and valve assembly can be expanded, contracted, and re-positioned as many times operatively as desired, but also the inventive delivery system and valve assembly can be re-docked post-operatively and re-positioned as desired. Likewise, the learning curve for using the inventive delivery system and valve assembly is drastically reduced for the surgeon because an automatic control handle (described in further detail below) performs each operation of extending, retracting, adjusting, tilting, expanding, and/or contracting at a mere touch of a button (see, e.g.,  FIGS. 105 to 107 ). 
     Another exemplary use of the inventive lattice assembly and delivery system is for a latticework-actuated basket filter, that can be either added to the disclosed devices, systems, and methods or stand-alone. Such an embolic umbrella can perform better than, for example, the EMBOL-X® Glide Protection System produced by Edward Lifesciences. Such a filter would be attached to the docking jacks so that it expands in place automatically as the device is expanded and would be removed with the delivery system without any additional efforts on the part of the surgeon. 
     Another exemplary embodiment of a replacement heart valve assembly  7100  according to the invention is shown in  FIGS. 71 to 83 . Even though the exemplary embodiment is shown for an aortic valve, the invention is not limited thereto. This embodiment is equally applicable to pulmonary, mitral and tricuspid valves with appropriate changes to the valve leaflets, for example. The replacement heart valve assembly  7100  shown in various views in  FIGS. 71 to 75  is comprised of a stent lattice  7110 , graft enclosures  7120 , jack assemblies  3000 , graft material  7130 , valve leaflets  7140 , and commisure plates  7150 . Operation and construction of the replacement heart valve assembly  7100  is explained with reference to  FIGS. 76 to 83  with various views therein having the graft material  7130  and/or the valve leaflets  7140  removed. In  FIGS. 75 and 76 , the replacement heart valve assembly  7100  is in an expanded state (when used herein, “expanded state” does not mean that the state shown is the greatest expanded state of the prosthesis; it means that the prosthesis is expanded sufficiently enough to be sized for an implantation in some anatomic site) such that it accommodates to the natural geometry of the implantation site. With the graft material removed (see, e.g.,  FIG. 76 ), the structure around the three valve leaflets  7140  is easily viewed. The proximal and distal drive blocks  3020 ,  3010  have internal configurations and the support rod  3080 , the drive screw  740 , and the distal drive screw coupler part  3052  disposed therein. 
     The stent lattice  7110  is similar to previous embodiments described herein except for the center pivot points of each strut  7112  of the stent lattice  7110  and the graft enclosures  7120 . In the exemplary embodiment shown, the center pivot points are not merely pivoting connections of two struts  7112  of the stent lattice  7110 . In addition, the outer-most circumferential surface of the pivoting connection comprises a tissue anchor  7114 , for example, in the form of a pointed cone in this exemplary embodiment. Other external tissue anchoring shapes are equally possible, including spikes, hooks, posts, and columns, to name a few. The exterior point of the tissue anchor  7114  supplements the outward external force imposed by the actively expanded stent lattice  7110  by providing structures that insert into the adjacent tissue, thereby further inhibiting migration and embolism. 
     The graft enclosures  7120  also supplement the outward external force imposed by the actively expanded stent lattice  7110  as explained below. A first characteristic of the graft enclosures  7120 , however, is to secure the graft material  7130  to the replacement heart valve assembly  7100 . The graft material  7130  needs to be very secure with respect to the stent lattice  7110 . If the graft material  7130  was attached, for example, directly to the outer struts  7112  of the stent lattice  7110 , the scissoring action that the adjacent struts  7112  perform as the stent lattice  7110  is expanded and contracted could adversely affect the security of the graft material  7130  thereto—this is especially true if the graft material  730  was sewn to the outer struts  7112  and the thread passed therethrough to the inside surface of the outer strut  7112 , against which the outer surface of the inner strut  7112  scissors in use. Accordingly, the graft enclosures  7120  are provided at a plurality of the outer struts  7112  of the stent lattice  7110  as shown in  FIGS. 71 to 87 . Each graft enclosure  7120  is fixedly attached at one end of its ends to a corresponding end of an outer strut  7112 . Then, the opposing, free end of the graft enclosure  7120  is woven through the inner side of the graft material  7130  and then back from the outer side of the graft material  7130  to the inner side thereof as shown in  FIGS. 71 to 75 , for example. The opposing, free end of the graft enclosure  7120  is fixedly attached to the other end of the outer strut  7112 . This weaving reliably secures the outer circumferential side of the graft material  7130  to the stent lattice  7110 . 
     As mentioned above, graft enclosures  7120  simultaneously supplement the outward external force imposed by the actively expanded stent lattice  7110  with edges and protrusions that secure the replacement heart valve assembly  7100  at the implantation site. More specifically, the graft enclosures  7120  are not linear as are the exemplary embodiment of the outer struts  7112  of the stent lattice  7110 . Instead, they are formed with a central offset  7622 , which can take any form and, in these exemplary embodiments, are wave-shaped. This central offset  7622  first allows the graft enclosure  7120  to not interfere with the tissue anchor  7114 . The central offset  7622  also raises the central portion of the graft enclosure  7120  away from the stent lattice  7110 , as can be seen, for example, to the right of  FIGS. 76 and 77  and, in particular, in the views of  FIGS. 82 and 83 . The radially outward protrusion of the central offset  7622  inserts and/or digs into adjacent implantation site tissue to, thereby, inhibit any migration or embolism of the replacement heart valve assembly  7100 . By shaping the central offset  7622  appropriately, a shelf  7624  is formed and provides a linear edge that traverses a line perpendicular to the flow of blood within the replacement heart valve assembly  7100 . In the exemplary embodiment of the central offset  7622  shown in  FIGS. 76, 77, and 79 to 81 , the shelf  7624  is facing downstream and, therefore, substantially inhibits migration of the replacement heart valve assembly  7100  in the downstream direction when exposed to systolic pressure. Alternatively, the central offset  7622  can be shaped with the shelf  7624  is facing upstream and, therefore, substantially inhibits migration of the replacement heart valve assembly  7100  in the upstream direction when exposed to diastolic pressure. The graft material needs to be able to say intimately attached to the lattice throughout a desired range of terminal implantable diameters. To accomplish this, the graft material is made from a structure of material that moves in a fashion like that of the lattice. That is to say, as its diameter increases, its length decreases. This kind of movement can be accomplished with a braid of yarns or through the fabrication of graft material where its smallest scale fibers are oriented similarly to a braid, allowing them to go through a scissoring action similar to the lattice. One exemplary embodiment of the material is a high end-count braid made with polyester yarns (e.g., 288 ends using 40-120 denier yarn). This braid can, then, be coated with polyurethane, silicone, or similar materials to create stability and reduce permeability by joining all the yarns together. Likewise, a spun-fiber tube can be made with similar polymers forming strands from approximately 2-10 microns in diameter. These inventive graft fabrication methods provide for a material that will be about 0.005″ to 0.0015″ (0.127 mm to 0.381 mm) thick and have all the physical properties necessary. A thin material is desirable to reduce the compacted diameter for easier introduction into the patient. This material is also important in a stent graft prosthesis where the lattice is required to seal over a large range of possible terminal diameters. The adjustable material is able to make the transition from the final terminal diameter of the upstream cuff to the main body of the graft. 
     As best shown in  FIG. 73 , the valve leaflets  7140  are connected by commisure plates  7150  to the jack assemblies  3000 . Fixed connection of the commisure plates  7150  to the jack assemblies  3000  is best shown in  FIGS. 82 and 83 . Each valve leaflet  7140  is connected between two adjacent commisure plates  7150 . Each commisure plate  7150  is comprises of two vertically disposed flat plates having rounded edges connected, for example, by pins projecting orthogonally to the flat plates. Pinching of the flat plates against the two adjacent valve leaflets  7140  securely retains the valve leaflets  7140  therein while, at the same time, does not form sharp edges that would tend to tear the captured valve leaflets  7140  therein during prolonged use. This configuration, however, is merely exemplary. This could be replaced with a simpler rod design around which the leaflets are wrapped and stitched into place. 
     Even though each valve leaflet  7140  can be a structure separate from the other valve leaflets  7140 ,  FIGS. 71 to 78  illustrate the three leaflets  7140  as one piece of leaf-forming material pinched, respectively, between each of the three sets of commisure plates  7150  (the material can, alternatively, pinch around the commisure plate or plates). The upstream end of the valve leaflets  7140  must be secured for the replacement heart valve assembly  7100  to function. Therefore, in an exemplary embodiment, the upstream end of the graft material  7130  is wrapped around and fixedly connected to the replacement heart valve assembly  7100  at the upstream side of the valve leaflets  7140 , as shown in  FIG. 78 . In such a configuration, the upstream edge of the valve leaflets  7140  is secured to the graft material  7130  entirely around the circumference of the stent lattice  7110 . Stitches can pass through the two layers of graft and the upstream edge of the leaflet material to form a hemmed edge. 
       FIGS. 79 to 81  show the stent lattice  7110  in various expanded and contracted states with both the graft material  7130  and the valve leaflets  7140  removed.  FIG. 79  illustrates the stent lattice  7110  and jack assemblies  3000  in an expanded state where the tissue anchor  7114  and the central offset  7622  protrude radially out from the outer circumferential surface of the stent lattice  7110  such that the stent lattice  7110  accommodates to the natural geometry of the implantation site.  FIG. 80  illustrates the stent lattice  7110  and the jack assemblies  3000  in an intermediate expanded state and  FIG. 81  illustrates the stent lattice  7110  and the jack assemblies  3000  in a substantially contracted state. 
       FIGS. 84 and 85  show an exemplary embodiment of a support system  8400  of the delivery system and method according to the invention for both supporting the jack assemblies  3000  and protecting the various control wires  750 ,  770 ,  2182 ,  3098  of the jack assemblies  3000 . In these figures, the support bands  8410  are shown as linear. This orientation is merely due to the limitations of the computer drafting software used to create the figures. These support bands  8410  would only be linear as shown when unconnected to the remainder of the delivery system for the replacement heart valve assembly  7100 . When connected to the distal end of the delivery system, as diagrammatically shown, for example, in  FIGS. 1, 3, 4, and 9  with a wire-guide block  116 , all control wires  750 ,  770 ,  2182 ,  3098  will be directed inwardly and held thereby. Similarly, the proximal ends  8412  of the support bands  8410  will be secured to the wire-guide block  116  and, therefore, will bend radially inward. In the exemplary embodiment of the support bands  8410  shown in  FIGS. 84 and 85 , the distal ends  8414  thereof are fixedly secured to the disconnector drive block  3030  by an exemplary hinge assembly  8416 . In this exemplary embodiment, therefore, the support bands  8410  are of a material and thickness that allows the delivery system to function. For example, while traveling towards the implantation site, the replacement heart valve assembly  7100  will traverse through a curved architecture. Accordingly, the support bands  8410  will have to bend correspondingly to the curved architecture while, at the same time, providing enough support for the control wires  750 ,  770 ,  2182 ,  3098  to function in any orientation or curvature of the delivery system. 
     An alternative exemplary connection assembly of the support bands  8610  according to the invention is shown in  FIGS. 86 and 87 . The distal end  8614  of each support band  8610  is connected to the disconnector drive block  3030  by a hinge assembly  8416 . The hinge assembly  8416 , for example, can be formed by a cylindrical fork at the distal end  8614  of the support band  8610 , an axle (not illustrated, and a radially extending boss of the disconnector drive block  3030  defining an axle bore for the axle to connect the cylindrical fork to the boss. In such a configuration, the support bands  8610  can have different material or physical properties than the support bands  8410  because bending movements are adjusted for with the hinge assembly  8416  instead of with the bending of the support bands  8410  themselves. The proximal end of the support bands  8610  are not shown in either  FIG. 86 or 87 . Nonetheless, the proximal ends can be the same as the distal end of the support bands  8610  or can be like the distal end  8614  of the support bands  8410 . By pre-biasing the support bands to the outside, they can help reduce or eliminate the force required to deflect the control wires. An embodiment of the replacement heart valve assembly  7100  as an aortic valve is shown implanted within the diseased valve leaflets of a patient&#39;s heart in  FIG. 88 . As can be seen in this figure, the natural valve takes up some room at the midline of the replacement heart valve assembly  7100 . Therefore, the stent lattice of the replacement heart valve assembly  7100  can be made to have a waistline, i.e., a narrower midline, to an hourglass shape instead of the barrel shape. In such a configuration, the replacement heart valve assembly  7100  is naturally positioned and held in place. 
     A further exemplary embodiment of the inventive actively controllable stent lattice and the delivery system and method for delivering the stent lattice are shown in  FIGS. 89 to 93 . In this embodiment, the prosthesis  8900  includes a stent lattice  110 ,  3810 ,  4200 ,  4600 ,  6410 ,  7110  and three jack assemblies  700 ,  2100 ,  3000 ,  6430 . These figures also illustrate a distal portion of an exemplary embodiment of a delivery system  8910  for the inventive prosthesis  8900 . Shown with each jack assembly  700 ,  2100 ,  3000 ,  6430  are the drive and disconnect wires  750 ,  700 , which are illustrated as extending proximally from the respective jack assembly  700 ,  2100 ,  3000 ,  6430  into a wire guide block  116 . Due to the limitations of the program generating the drawing figures, these wires  750 ,  770  have angular bends when traversing from the respective jack assembly  700 ,  2100 ,  3000 ,  6430  towards the wire guide block  116 . These wires, however, do not have such angled bends in the invention. Instead, these wires  750 ,  770  form a gradual and flattened S-shape that is illustrated diagrammatically in  FIG. 89  with a dashed line  8920 . Operation of the prosthesis  8900  is as described above in all respects except for one additional feature regarding the wires  750 ,  770 . In other words, rotation of the drive wire  750  in respective directions will contract and expand the stent lattice  110 ,  3810 ,  4200 ,  4600 ,  6410 ,  7110 . Then, when the stent lattice  110 ,  3810 ,  4200 ,  4600 ,  6410 ,  7110  is implanted correctly in the desired anatomy, the disconnect wire  770  will be rotated to uncouple the proximal disconnector drive block and, thereby, allow removal of the delivery system  8910 . This embodiment provides the delivery system  8910  with a prosthesis-tilting function. More specifically, in the non-illustrated handle portion of the delivery system  8910 , each pair of drive and disconnect wires  750 ,  770  are able to be longitudinally fixed to one another and, when all of the pairs are fixed respectively, each pair can be moved distally and/or proximally. 
     In such a configuration, therefore, if the wires  750 ,  770  labeled with the letter X are moved proximally together and the other two pairs of wires Y and Z are moved distally, then the entire prosthesis  8900  will tilt into the configuration shown in  FIG. 90 . Alternatively, if the wires X are kept in position, the wires Y are moved proximally and the wires Z are moved distally, then the entire prosthesis  8900  will tilt into the configuration shown in  FIG. 91 . Likewise, if the wires X are moved distally and the wires Y and Z are moved proximally, then the entire prosthesis  8900  will tilt into the configuration shown in  FIG. 92 . Finally, if the wires X are extended distally, the wires Y are extended further distally, and the wires Z are moved proximally, then the entire prosthesis  8900  will tilt into the configuration shown in  FIG. 93 . 
     Still a further exemplary embodiment of the inventive actively controllable stent lattice and the delivery system and method for delivering the stent lattice are shown in  FIGS. 94 to 102 . In this embodiment, the prosthesis  9400  is a stent graft having a proximal, actively controlled stent lattice  110 ,  3810 ,  4200 ,  4600 ,  6410 ,  7110  and only two opposing jack assemblies  700 ,  2100 ,  3000 ,  6430 . Instead of two additional jack assemblies  700 ,  2100 ,  3000 ,  6430 , this embodiment contains two opposing pivoting disconnector drive blocks  9430 . These disconnector drive blocks  9430 , as shown for example in the view of  FIG. 96  rotated circumferentially ninety degrees, have bosses  9432  extending radially outward and forming the central pivot joint for the two crossing struts  9410 . The two disconnector drive blocks  9430  act as pivots to allow the prosthesis  9400  to tilt in the manner of a swashplate when the two opposing sets of control wires  750 ,  770  are moved in opposing distal and proximal directions.  FIG. 94  shows the near set of control wires  750 ,  770  moved proximally and the far set moved distally. In  FIG. 95 , the swashplate of the prosthesis  9400  is untilted, as is the prosthesis  9400  in  FIGS. 96 and 97 , the latter of which is merely rotated ninety degrees as compared to the former.  FIGS. 98 and 99  depict the prosthesis  9400  as part of a stent graft having the stent lattice  9810  inside a proximal end of a tubular shaped graft  9820 . 
     The prosthesis  9400  in  FIGS. 100 to 102  is also a stent graft but, in this exemplary embodiment, the graft  10010  is bifurcated, for example, to be implanted in an abdominal aorta.  FIGS. 101 and 102  show how the proximal end of the prosthesis  9400  can be tilted with the swashplate assembly of the invention, for example, in order to traverse a tortuous vessel in which the prosthesis  9400  is to be implanted, such as a proximal neck of abdominal aortic aneurysm. 
     The exemplary embodiment of the prosthesis  10300  shown in  FIGS. 103 and 104  does not include the swashplate assembly. Instead, the delivery system includes a distal support structure  10310  that ties all of the support bands  10312  to a cylindrical support base  10314  connected at the distal end of the delivery catheter  10316 . 
     An exemplary embodiment of the entire delivery system  10500  for the prosthesis  10300  is depicted in  FIGS. 105 to 107 . In  FIG. 105 , the delivery system is entirely self-contained and self-powered and includes the actively controllable stent lattice with an integral control system  10510 . The prosthesis  10300  is in an expanded state and the graft material is in cross-section to show a rear half. An alternative to the integral control system  10510  is a wireless control device  10600  that wirelessly communicates  10610  control commands to the system. Another alternative to the integral control system  10510  shown in  FIG. 107  separates the control device  10700  with a cord  10710  for communicating control commands to the system. In this exemplary embodiment, the controls comprise four rocker switches  10712 ,  10714 ,  10716 ,  10718  arranged in a square, each of the switches having a forward position, a neutral central position, and a rearward position. 
     Yet another exemplary embodiment of a control handle  10800  for operating a prosthesis having the actively controllable stent lattice according to the invention is depicted in  FIGS. 108 to 118 . The views of  FIGS. 108 and 109  show various sub-assemblies contained within the control handle  10800 . A user-interface sub-assembly  10810  includes a circuit board  10812  having circuitry programmed to carry out operation of the systems and methods according to the invention. Electronics of the user-interface sub-assembly  10810  comprise a display  10814  and various user input devices  10816 , such as buttons, switches, levers, toggles, and the like. A sheath-movement sub-assembly  11000  includes a sheath-movement motor  11010 , a sheath movement transmission  11020 , a sheath movement driveshaft  11030 , and a translatable delivery sheath  11040 . A strain relief  11042  is provided to support the delivery sheath  11040  at the handle shell  10802 . A power sub-assembly  11200  is sized to fit within the handle  10800  in a power cell compartment  11210  containing therein power contacts  11220  that are electrically connected to at least the circuit board  10812  for supplying power to all electronics on the control handle  10800  including all of the motors. A needle-movement sub-assembly  11300  controls deployment of the needles and keeps tension on the needles continuously even when the delivery sheath  11040  is bent through tortuous anatomy and different bends are being imposed on each of the needles. The needles are three in number in this exemplary embodiment. Finally, a jack engine  11600  controls all movements with regard to the jack assemblies. 
     The user-interface sub-assembly  10810  allows the surgeon to obtain real-time data on all aspects of the delivery system  10800 . For example, the display  10814  is programmed to show the user, among other information, deployment status of the stent lattices, the current diameter of the stent lattices, any swashplate articulation angle of the stent lattice to better approximate an actual curved landing site, all data from various sensors in the system, and to give audio feedback associated with any of the information. One informational feedback to user can be an indicator on the display  10814  that the delivery sheath  11040  is retracted sufficiently far to completely unsheath the prosthesis. Other information can be a force feedback indicator showing how much force is being imparted on the lattice from the vessel wall, e.g., through a torque meter, a graphical change in resistance to the stepper motor, a mechanical slip clutch, direct load/pressure sensors on lattice. With such information, the prosthesis can have Optimal Lattice Expansion (OLE), achieve its best seal, migration and embolization is decreased, the amount of outward force can be limited (i.e., a force ceiling) to stop expansion before tissue damage occurs. A visual indicator can even show in a 1:1 ratio the actual diameter position of the stent lattice. Other possible sensors for taking measurements inside and/or outside the prosthesis (e.g., above and below touchdown points of lattice) can be added into the inventive powered handle. These devices include, for example, intravascular ultrasound, a video camera, a flow wire to detect flow showing blood passing around prosthesis/double lumen catheter and showing pressure gradients, a Doppler device, an intrinsic pressure sensor/transducer, and an impedance of touchdown zone. 
     Having all of the user interface actuators  10816  within reach of a single finger of the user provides unique and significant advantages by allowing the surgeon to have one-hand operation of the entire system throughout the entire implantation procedure. In all mechanical prior art systems when torque is applied, the second hand is needed. Pushing of single button or toggling a multi-part switch eliminates any need for the user&#39;s second hand. Using different kinds of buttons/switches allows the user to be provided with advanced controls, such as the ability to have coarse and fine adjustments for any sub-procedure. For example, expansion of the lattice can be, initially, coarse by automatically directly expanded out to a given, pre-defined diameter. Then, further expansion can be with fine control, such as a millimeter at a time. The varying of diameter can be both in the open and close directions. If the prosthesis needs to be angled, before, during, and/or after varying the expansion diameter, the user can individually manipulate each jack screw or control wires to gimbal the upstream end of implant so that it complies with vessel orientation; both during diameter/articulation changes, the physician can inject contrast to confirm leak-tightness. Even though the exemplary embodiment of the needle deployment shown is manual, this deployment can be made automatic so that, once the prosthesis is implanted, and only after the user indicates implantation is final, an automatic deployment of the engaging anchors can be made. With regard to undocking the delivery system, this release can be with a single touch, for example, of a push button. Also, with an integrated contrast injection assembly, a single touch can cause injection of contrast media at the implantation site. 
     The sheath-movement sub-assembly  11000  also can be controlled by a single button or switch on the circuit board  10812 . If the user interface is a two-position toggle, distal depression can correspond with sheath extension and proximal depression can correspond with sheath retraction. Such a switch is operable to actuate the sheath movement motor  11010  in the two rotation directions. Rotation of the motor axle  11022 , therefore, causes the transmission  11024 ,  11026  to correspondingly rotate, thereby forcing the threaded sheath movement driveshaft  11030  to either extend distally or retract proximally. The exemplary embodiment of the transmission includes a first gear  11024  directly connected to the motor axle  11022 . The first gear  11024  is meshed with the outside teeth of a larger, hollow, driveshaft gear. The interior bore of the driveshaft gear  11026  has threads corresponding to the exterior threads of the sheath movement driveshaft  11030 . As such, when the driveshaft gear  11026  rotates, the sheath movement driveshaft  11030  translates. The driveshaft gear  11026  is surrounded by a bushing  11028  to allow rotation within the housing shell  10802 . In order to prevent rotation of the sheath movement driveshaft  11030 , as shown in  FIG. 111 , the sheath movement driveshaft  11030  has a longitudinal keyway  11032  that has a cross-sectional shape corresponding to a key that is grounded to the handle shell  10802 . The sheath movement driveshaft  11030  also is hollow to accommodate a multi-lumen rod  10804  (shown best in  FIG. 112 ) housing, within each respective lumen, any of the control wires  750 ,  770 ,  2182 ,  3098  and the guidewire  6610 , these lumens corresponding to those within the wire guide block  116  at the distal end of the delivery sheath  10040 . 
     The size and shape of the power sub-assembly  11200  is limited in shape only by the power cell compartment  11210  and the various wires and rods that traverse from the needle-movement sub-assembly  11300  and the jack engine  11600  therethrough until they enter the lumens of the multi-lumen rod  10804 . Some of these wires and rods are illustrated with dashed lines in  FIG. 112 . Power distribution to the circuit board  10812  and/or the motors is carious out through power contacts  11220 . Such power distribution lines are not illustrated for reasons of clarity. This method or similar such as a rack and pinion or drag wheels can be used to drive the sheath extension and retraction. 
     The needle-movement sub-assembly  11300  is described with reference to  FIGS. 113 to 115 , and best with regard to  FIG. 113 . Each of the needle rods  11302  that connect to the needles in the prosthesis to the needle-movement sub-assembly  11300  is associated with a tension spring  11310 , an overstroke spring  11320 , and a control tube  11332 . The three control tubes  11332  are longitudinally held with respect to a control slider  11330  by the overstroke spring  11320 . As long as the force on the needles is not greater than the force of the overstroke spring  11320 , movement of the needle rod  11302  will follow the control slider  11330 . A needle deployment yoke  11340  slides with respect to the shell  10802  of the control handle  10800 . When the needle deployment yoke  11340  contacts the control slider  11330  as it moves distally, the needle deployment yoke  11340  carries the control slider  11330  and the needle rods  11302  distally to, thereby, deploy the needles. The transition from  FIGS. 113 to 114  shows how the tension spring  11310  keeps tension on the needles by biasing the control slider  11330  proximally. Deployment of the needles is shown by the transition from  FIGS. 114 to 115 . As mentioned above, the needles  3070  each a have bent needle tip  3072 . In a configuration where the needles  3070  are connected directly all the way back to the needle-movement sub-assembly  11300 , there is a high likelihood that bending of the delivery catheter  11040  will impart various different forces on the needle rods  11302 . These forces will tend to pull or push the needle rods  11302  and, thereby possibly extend the needles  3070  when not desired. Accordingly, each tension spring  11310  is longitudinally connected to the needle rod  11302  to compensate for these movements and keep the bent needle tip  3072  within the needle tip groove of the  3013  distal drive block  3010 . 
     Because deployment of the needles is intended (ideally) to be a one-time occurrence, a yoke capture  11350  is provided at the end of the yoke stroke. Capture of the yoke  11340  can be seen in  FIG. 116 . Of course, this capture can be released by the user if such release is desired. Finally, if too much force is imparted on the needles when being deployed, the force of the overstroke spring  11320  is overcome and the control tube  11332  is allowed to move with respect to the control slider  11330 . The compression of the overstroke spring  11320  cannot be shown in  FIG. 115  because of the limitation of the software that created  FIG. 115 . 
     The jack engine  11600  is configured to control all rotation of parts within the various jack assemblies  700 ,  2100 ,  3000 ,  6430 . The exemplary embodiment of the control handle  10800  shown in  FIGS. 108 to 118  utilizes three jack assemblies similar to jack assemblies  3000  and  6430 . In other words, the needles are separate from the proximal drive blocks of both assemblies and only two rotational control wires  750 ,  770  are needed. Therefore, for the three jack assemblies, six total control wires are required—three for the drive wires  750  and three for the disconnect wires  770 . These control wires  750 ,  770  are guided respectively through six throughbores  10806  (surrounding the central guidewire throughbore  10807  in  FIG. 115 ) and proximally end and are longitudinally fixed to a distal part  11512  of each of six telescoping wire control columns  11510 , shown in  FIGS. 115 and 116 . All control wires, even the needle rods  11302 , terminate at and are fixed longitudinally to a distal part  11512  of a respective telescoping wire control column  11510 . Each part of these telescoping wire control columns  11510 ,  11512  are rigid so that rotation of the proximal part thereof causes a corresponding rotation of the distal part  11512  and, thereby, rotation of the corresponding control wire  750  or  770 . The reason why all control wires, even the needle rods  11302 , terminate at and are fixed longitudinally to a distal part  11512  of a respective telescoping wire control column  11510  is because tortious curving of the wires/rods from their proximal ends to the distal ends longitudinally fixed at the stent assembly to be implanted will cause the wires to move longitudinally. If there is no play, the wires/rods will impart a longitudinal force on any parts to which they are grounded, for example, to the threaded connection at the stent assembly at the distal end. This longitudinal force is undesirable and is to be avoided to prevent, for example, the drive screws from breaking loose of their threads. To avoid this potential problem, the proximal end of each wire/rod is longitudinally fixed to the distal part  11512  of a respective telescoping wire control column  11510 . The distal part  11512  is keyed to the wire control column  11510 , for example, by having an outer square rod shape slidably movable inside a corresponding interior square rod-shaped lumen of the proximal part of the wire control column  11510 . In this configuration, therefore, any longitudinal force on any wire/rod will be taken up by the respective distal part  11512  moving longitudinally proximal or distal depending on the force being exerted on the respective wire/rod. 
     Torque limiting is required to prevent breaking the lattice or stripping the threads of the drive screw. This can be accomplished in software by current limiting or through a clutch mechanism disposed between the drive motors and the sun gears. An integral contrast injection system can be incorporated into the handle of the delivery system through another lumen. With a powered handle, therefore, a powered injection as part of handle is made possible. 
     Because all of the drive wires  750  need to rotate simultaneously, and due to the fact that all of the disconnect wires also need to rotate simultaneously, the jack engine  11600  includes a separate control motor  11650 ,  11670  (see  FIG. 115 ) and separate transmission for each set of wires  750 ,  770 . The view of  FIG. 117  illustrates the transmission for the drive-screw control motor  11650 . At the output shaft  11651  of the drive-screw control motor  11650  is a first drive gear  11652  interconnected with a larger second drive gear  11653 . The second drive gear  11653  is part of a coaxial planetary gear assembly and has a central bore therein for passing therethrough the guidewire  6610 . A hollow rod  11654  is fixedly connected in the central bore and extends through a transmission housing  11610  to a distal side thereof, at which is a third drive gear  11655 , as shown in  FIG. 118 . The third drive gear  11655  is interconnected with three final drive gears  11656 , each of the final drive gears  11656  being fixedly connected to a respective proximal part of one of the three telescoping wire control columns  11510  associated with each drive wire  750 . Accordingly, when the drive-screw control motor  11650  rotates, the three final drive gears  11656  rotate the control columns  11510  that rotate the drive screws of the jack assemblies  3000 ,  6430 . 
     The disconnect control motor  11670  operates in a similar manner. More specifically and with regard to  FIG. 116 , the output shaft  11671  of the disconnect control motor  11670  is a first disconnect gear  11672  interconnected with a larger second disconnect gear  11673 . The second disconnect gear  11673  is part of a coaxial planetary gear assembly and has a central bore therein for passing therethrough the guidewire  6610 . A hollow rod  11674  is fixedly connected in the central bore about the hollow rod  11654  and extends through the transmission housing  11610  to the distal side thereof, at which is a third disconnect gear  11675  (also disposed about the hollow rod  11654 ), as shown in  FIG. 118 . The third disconnect gear  11675  is interconnected with three final disconnect gears (not illustrated), each of the final disconnect gears being fixedly connected to a respective proximal part of one of the three telescoping wire control columns  11510  associated with each disconnect wire  770 . Accordingly, when the disconnect control motor  11670  rotates, the three final disconnect gears rotate the control columns  11710  that rotate the retainer screws of the jack assemblies  3000 ,  6430 . The activation of the disconnect drive also unscrews the needle connections when included. One exemplary embodiment for having the needles disconnect before the entire implant is set free from the docking jacks provides a lower number of threads on the needle disconnects. 
     Not illustrated herein is the presence of a manual release for all actuations of the delivery system. Such manual releases allow for either override of any or all of the electronic actuations or aborting the implantation procedure at any time during the surgery. Manual release sub-assemblies are present for retraction of the delivery sheath, expansion and contraction of all stent lattices, undocking of all disconnect drive blocks, and retraction of the distal nose cone into the delivery sheath. 
     Based upon the above, therefore, the delivery system control handle  10800  is entirely self-contained and self-powered and is able to actively control any prosthesis having the stent lattice and jack assemblies of the invention. 
     An exemplary embodiment of a process for delivering an abdominal aortic stent graft of the invention as shown in  FIG. 107  with the stent lattice as a proximal stent is described with regard to the flow chart of  FIG. 119 . The procedure is started in step  11900  where the lattice has been translated through the femoral artery to the implantation site just downstream of the renal arteries. Actuation of the upper left button rearward in Step  11902  causes the delivery sheath  10720  to unsheathe from the AAA implant  10730  sufficient to expose the actuatable end (e.g., stent lattice) of the implant  10730 . In Step  11904 , visualization, such as through fluoroscopy, provides the user with feedback to show where the distal end  10732  of the prosthesis  10730  is situated. In this position, the stent lattice is in a contracted state (the expanded state is shown in the view of  FIG. 107 ). Radiopaque markers on the prosthesis  10730  are visible to show the proximal most points of the prosthesis  10730 . In Step  11906 , another surgery staff, typically, has marked the location of the renal arteries on the screen (on which the surgeon sees the markers) with a pen or marker. In Step  11908 , the surgeon translates the lattice of the prosthesis  10730  with the radiopaque markers to a location targeted below the renal arteries. The physician begins to expand the lattice in Step  11910  by pressing the upper right button forward (i.e., forward=open and rearward=close). Depending upon the desire of the surgeon or as set in the programming of the control device  10700 , the lattice can open incrementally (which is desirable due to blood flow issues) or can be expanded fluidly outward. Implantation occurs in Step  11912  and has three phases. In the first phase of implantation, the physician performs a gross orientation of the proximal end of the prosthesis  10730  until touchdown in the abdominal aorta. In the second phase, the physician fine-tunes the implantation using intermittent expansion prior to coaptition in all three dimensions and, in the third phase, the proximal end of the implant  10730  is either satisfactorily coadapted or, if the physician is not satisfied with the coaptition, then the physician reduces the diameter of the stent lattice and starts, again, with phase two. It is noted that the control device  10700  can be programmed to, at the first touch of the upper right button, to go to a particular diameter opening. For example, if the implantation site is 20 mm, then the control device  10700  can be programmed to expand directly to 15 mm and, for each touch of the upper right button thereafter, expansion will only occur by 1 mm increments no matter how long the upper right button is pushed forward. During Step  11912 , the physician is able to view all of the various feedback devices on the control handle, such as the real time diameter of the prosthesis, the angulation thereof, a comparison to a predetermined aortic diameter of the touchdown point, an intravascular ultrasound assessing proximity to wall, and when wall touch occurs. With the digital display  10711  of the invention, the physician can even see an actual representation of the expanding lattice demonstrating all of the characteristics above. During the various implantation phases, the physician can pause at any time to change implant position. Angulation of the stent lattice can be done actively or while paused. As the outer graft material approaches the wall, adjustment of the entire delivery device continues until complete coaptation of the prosthesis  10730 , where it is insured that the location with respect to the renal arteries is good, along with proper angulation. As the stent graft touches the aortic wall, the physician can analyze all of the feedback devices to make implantation changes. At any time if the physician questions the implantation, then restart occurs to readjust the stent lattice along with a return to phase two. Further, as coaptation occurs, any other fixation devices can be utilized, for example, passive tines/barbs, a outwardly moving flex-band that presses retention device (e.g., through graft) and into aortic wall, the tissue anchor  7114 , and the graft enclosures  7120 . For such devices, there is no secondary action required to disengage/retract tines that are engaged. In Step  11914 , the physician performs an angiogram to determine positioning of the implantation (the angiogram can be either separate or integral with the delivery system  10700 ), and if the positioning is not as desired, the physician can retract the stent lattice and use the sheath  10720  to re-collapse the stent lattice using the graft material to ease delivery sheath  1020  back over the lattice. However, if the physician determines that there is good positioning, the physician retracts the delivery sheath  10720  by pressing the upper left button rearward until at least contralateral gate is exposed. It is noted that stabilization of the ipsilateral graft material with the delivery system  10700  allows for better cannulization of the contralateral gate for a secondary prosthesis. 
     In Step  11916 , the contralateral limb is deployed as is known in the art. However, if desired, the contralateral limb can also include the actively expanded stent lattice according to the invention. It is also desirable to perform a balloon expansion at the graft-to-graft junction if the contralateral limb utilizes a self-expanding distal stent. If the actively controllable stent lattice is used, then Steps  11900  to  11914  are repeated but for the contralateral limb. In Step  11918 , the delivery sheath  10720  is retracted by pressing the upper left button rearward until ipsilateral limb is deployed. The prosthesis  10730  is, now, ready to be finally deployed. 
     In Step  11920 , the physician actuates the lower left button rearward to unscrew the retainer screws and, thereby undock the disconnect drive blocks from the prosthesis  10730 . One significant advantage of the delivery system  10700  is that there is no surge either distal or proximal when undocking occurs and finally releases the prosthesis because the entire undocking movement is merely an unscrewing of a rod from a threaded hole. The upper left button is pressed forward to extend the delivery sheath  10720  so that it connects with the distal end of nose cone  10740  while making sure that the open distal end of the delivery sheath  10720  does not catch any part of the ipsilateral distal stent or the actively controlled proximal stent. It is at this point where the manual override would be employed if the surgeon wanted to feel the redocking of the delivery sheath  10720  to the nose cone  10740 . If desired, using the lower right button pressing rearward, the physician can retract the nose cone  10740  into the distal end of the delivery sheath  10720  with the lower right button. In Step  11922 , if the ipsilateral distal stent is self-expanding, the physician performs a final balloon expansion. However, if the ipsilateral distal stent utilizes the actively controllable stent lattice of the invention, Steps  11900  to  11914  are repeated but for the ipsilateral limb. A completion angiogram is performed in Step  11924  to make sure the prosthesis did not shift and that all leak possibilities have been ruled out. In an exemplary embodiment where the control system  10700  includes an integral dye system, the physician would extend the system proximal to the proximal active lattice. Finally, in Step  11926 , the lower right button is pressed rearward to retract the delivery system as much as possible into the handle and, in Step  11928 , the delivery system  10700  is removed from the patient. 
       FIG. 120  shows an exemplary embodiment of a self-expanding/forcibly-expanding lattice of an implantable stent assembly  12000  having nine lattice segments  12010  in a self-expanded native position as will be described below. In one exemplary embodiment, each of the nine lattice segments is formed with one-half of either a threaded or smooth bore  12012  for respective coordination with either a threaded or smooth portion of a jack screw  12020 . In another exemplary embodiment, the nine lattice segments are formed from one integral piece of a shape memory metal (e.g., Nitinol) and with a jack screw  12020  disposed between adjacent pairs of repeating portions of the lattice and through the wall of the stent lattice. In the views shown in  FIGS. 120 and 121 , each jack screw  12020  is placed in a non-engaged state to allow crimp of the stent lattice for loading into a stent delivery system. In this regard,  FIG. 121  illustrates the stent assembly  12000  in a contracted/crimped state for loading into the stent delivery system. In this non-engaged state, as the stent assembly  12000  is crimped for delivery, the proximal jack strut  12014  surrounding the non-threaded portion of each jack screw  12020  can slide thereabout with play between the two positions shown in  FIGS. 120 and 121  without hindrance or bottoming out the distal drive screw coupler part  12052  while the lattice expands longitudinally when contracted by the delivery sheath of the delivery system. When the stent assembly  12000  is allowed to self-expand back to the position shown in  FIG. 120 , the jack screw  12020  moves into the bore of the distal jack strut  12014  until the distal drive screw coupler part  12052  hits the proximal end of the proximal jack strut  12014 . Accordingly, with rotation of the jack screw  12020  in the stent-expansion direction, after the distal drive screw coupler part  12052  hits the proximal end of the proximal jack strut  12012 , further lattice-expanding movement of the drive screw  12020  starts moving the proximal jack strut  12014  towards the distal jack strut  12013  to expand the stent assembly  12000 . 
     Longitudinally, the stent assembly  12000  is provided with pairs of jack struts  12013 ,  12014  connected by a respective jack screw  12020  and intermediate non-moving struts  12030 . In the exemplary embodiment of the stent assembly  12000  shown, there are nine pairs of jack struts  12013 ,  12014  and nine non-moving struts  12030 . This number is merely exemplary and there can be, for example, only six of each or any other number desired. Connecting the pairs of jack struts  12013 ,  12014  and the non-moving struts  12030  are laterally extending arms  12040 . As the stent assembly  12000  is either contracted or expanded, the arms  12040  each pivot at their two endpoints, one at a respective non-moving strut  12030  and the other at a respective one of a pair of jack struts  12013 ,  12014 . As can be seen from the configuration shown in  FIG. 121 , when the stent assembly  12000  is contracted (e.g., for installation into the delivery sheath), the arms  12040  move towards a longitudinal orientation. Conversely, when the stent assembly  12000  is expanded (e.g., for implantation), the arms  12040  move towards a longitudinal orientation. 
       FIG. 122  shows the lattice after being allowed to return to its native position, for example, at a deployment site. Each jack screw  12020  is in an engaged state for controlled further outward expansion of the lattice. As the lattice is sized for implantation, the delivery system forcibly expands the lattice, as shown in the progression of  FIGS. 123, 124, and 125 . In the view of  FIG. 125 , the lattice is about to enter a maximum expansion state, which occurs when the proximal surface of the distal jack strut  12013  contacts the distal surface of the proximal jack strut  12014 . It is noted that this exemplary embodiment does not show features of a valve sub-assembly. Valve sub-assemblies, such as shown in  FIGS. 135 to 136  are envisioned to be used with this stent assembly  12000  but is not shown for reasons of clarity. 
       FIG. 126  is an alternative exemplary embodiment of a portion of a self-expanding/forcibly-expanding lattice of an implantable stent assembly  12600 . In the portion of the configuration shown, a separate jack screw assembly  12610  connects the two adjacent lattice segments (here the non-moving strut  12616  is shown in a vertical cross-section passing through the mid-line thereof). Separate jack tube halves  12612 ,  12613  are connected respectively to upper and lower jack-contact struts  12614  of the two adjacent lattice segments. In the exemplary embodiment shown, the external threads of the jack screw  12620  are engaged with the interior threads of the distal jack tube half  12612 . A lattice-disconnect tube  12630  of the stent delivery system is engaged to cover a pair of drive screw coupler parts therein.  FIG. 127  shows the lattice-disconnect tube  12630  disengaged from the pair of drive screw coupler parts  12752 ,  12754 . This connected state of the pair of drive screw coupler parts  12752 ,  12754  is idealized because, due to the natural lateral/radial forces existing in the disconnect joint, once the lattice-disconnect tube  12630  retracts proximally past the coupling of the drive screw coupler parts  12752 ,  12754 , the two drive screw coupler parts  12752 ,  12754  will naturally separate, as shown in the view of  FIG. 128 . In this disconnected view, the proximal member of the pair of drive screw coupler parts  12752 ,  12754 , which is part of the delivery system, is partially retracted into the central bore of the lattice-disconnect tube  12630 . 
       FIG. 129  illustrates another exemplary embodiment of a self-expanding/forcibly-expanding lattice of an implantable stent assembly. This assembly also has nine separate lattice segments, but more or less in number is equally possible, for example, six segments. In this embodiment, a proximal disconnect block  12930  and disconnect subassemblies  12931 ,  12932  of a stent delivery system is an alternative to the lattice-disconnect tubes  12630  of the embodiment of  FIGS. 126 to 128 . Here, a proximal disconnect block  12930  is in an engaged state covering the pair of drive screw coupler parts  13052 ,  13054  therein. After the disconnect block  12930  is retracted in a proximal direction, all of the lattice-disconnect arms  12932  are removed from covering the pair of drive screw coupler parts  13052 ,  13054 , thereby allowing disconnect of the lattice  12900  from the delivery system, as shown in  FIG. 130 . The proximal disconnect block  12930  allows all of the pairs of drive screw coupler parts  13052 ,  13054  to be coupled together for simultaneous release. 
       FIGS. 131 and 132  show an alternative to the exemplary embodiment of the self-expanding/forcibly-expanding lattice of  FIGS. 126 to 130 . Here, the intermediate jack tubes halves  13112 ,  13113  for receiving one jack screw  13120  therein are connected to the adjacent lattice segments with the adjacent lattice segments  13114  not directly on opposing sides of the jack tubes  13112 ,  13113 . The angle that the two adjacent lattice segments make is less than 180 degrees and greater than 90 degrees. In particular, the angle is between 130 degrees and 150 degrees and, more specifically, is about 140 degrees, as shown in  FIG. 132 . 
       FIG. 133  is another exemplary embodiment of a self-expanding/forcibly-expanding lattice of an implantable stent assembly  13300 . In this embodiment, there are nine lattice segments but more or less is equally possible, for example, six segments. Here, the distal and proximal jack struts  13313 ,  13314  of the lattice are locally thicker to accommodate and connect to non-illustrated jack screw assemblies. 
       FIG. 134  is another exemplary embodiment of a self-expanding/forcibly-expanding lattice of an implantable stent assembly  13400 . In this embodiment, there are nine lattice segments but more or less is equally possible, for example, six segments. Instead of having the non-illustrated jack screws pass entirely through the material of the lattice as shown in previous embodiments, here, the jack struts of the lattice are elongated and the elongated portions are bent-over to form tabs  13413 ,  13414  for connecting to non-illustrated jack screw assemblies. The tabs  13413 ,  13414  are shown here as bent inwards, but they can also be bent to face outwards. To operate the jacks, various ones of each of the set of longitudinal tabs are threaded or smooth. 
       FIGS. 135 to 137  show another exemplary embodiment of the self-expanding/forcibly-expanding lattice of an implantable valve assembly  13500 . The jack assemblies are similar to the embodiment of  FIGS. 120 to 125 . Here, however, there are six lattice segments. The intermediate non-moving struts  13530  between the jacks  13520  form commisure connections and include through-bores  13532  for connecting the valve end points of the intermediate valve  13540  to the lattice. The valve here is shown with three leaflets  13542  and therefore three commisure connections exist at three of the non-moving struts  13530 . The valve assembly is shown in  FIGS. 135 and 136  in an expanded position that can be commensurate with an implantation position of the valve assembly.  FIG. 137 , in comparison, shows the lattice of the valve assembly  13500  in a natural, non-expanded state. 
       FIGS. 138 to 142  show another exemplary embodiment of the self-expanding/forcibly-expanding lattice of an stent assembly  13800 . As in the above embodiments, this exemplary embodiment does not show features of a valve sub-assembly for reasons of clarity even though valve sub-assemblies, such as shown in  FIGS. 135 to 136 , are envisioned to be used with this stent assembly  13800 . Here, the lattice of the stent assembly  13800  has six lattice segments. Instead of having the jack screws contact longitudinal bores in the wall of the lattice, pairs of jack tubes  13812 ,  13813  are connected (e.g., laser welded) to respective longitudinal pairs of jack connection struts  13822 ,  13823 . The embodiment shows the jack tubes  13812 ,  13813  connected on the interior of the lattice but they can also be connected on the exterior, or the pairs can even be staggered on the interior and exterior in any way and in any number. The jack tubes  13812 ,  13813  are formed with interior threads or interior smooth bores. 
     After being forcibly contracted, the lattice of  FIG. 138  can be further compressed within the delivery sheath of the delivery system, an orientation that is shown in  FIG. 139 . After delivery to the implantation site, the lattice is expanded for implementation.  FIGS. 140 to 142  show various expansion stages of the lattice in various perspective views with  FIG. 142  showing the lattice expanded near a maximum expansion extent. 
     The exemplary embodiments of the valve assemblies described herein seeks to have a valve that is sized and formed for a minimum deployment diameter. This valve is secured inside the stent lattice/frame that is capable of expanding to a much larger final diameter than the internal valve. The commisures of the valve are secured to the frame with a mechanical linkage that allows the frame to expand and keep the valve at a proper size to minimize regurgitation. A lower skirt of the valve is attached to the stent through a loose connection of the variable diameter braided graft or a similar device. This configuration allows the stent frame to continue to grow and fit into a variety of native annuli that are larger than the valve carried within the device. 
     The foregoing description and accompanying drawings illustrate the principles, exemplary embodiments, and modes of operation of the invention. However, the invention should not be construed as being limited to the particular embodiments discussed above. Additional variations of the embodiments discussed above will be appreciated by those skilled in the art and the above-described embodiments should be regarded as illustrative rather than restrictive. Accordingly, it should be appreciated that variations to those embodiments can be made by those skilled in the art without departing from the scope of the invention as defined by the following claims.