Abstract:
The invention provides an implantable component which is connectable to a manipulating device in a self-retaining manner by means of a coupling device, which provides a first coupling element and a second coupling element. The implantable component can thus be really positioned by the manipulating device which can, for example, already be connected to the implantable component before a therapeutic procedure and can be separated therefrom again after the surgical procedure. This is in particular advantageous with minimally invasive procedures.

Description:
BACKGROUND OF THE INVENTION 
     The invention is in the field of medical engineering, in particular implant medicine, and in particular relates to the possibilities of implanting components with a minimal effort using minimally invasive procedures. 
     Implant medicine allows the use of the most varied units and elements in a patient&#39;s body for the replacement of specific organs and body parts in a temporary or permanent manner or the insertion of specific units to support bodily functions. 
     Such units can usually be put in place in a simple manner with a large opening of the patient&#39;s body, but with considerable surgical trauma arising. The reduction of surgical trauma requires smaller procedures, with the openings for introducing components into the body in part only being a little larger or even smaller, with an elastic widening, than the components to be introduced. Corresponding units can be introduced in parts and can also be assembled inside the body. 
     The minimal invasive introduction often does not allow the direct handling of components by hand so that additional instruments such as forceps are used. However, the use of such holding instruments is also not always simple. The components to be implanted are frequently designed as small as possible and also rounded so as to provide as little irritation as possible in the body, in particular with cardiac assist systems having a plurality of parts which conduct blood. On the other hand, it brings along a difficult management by corresponding holding instruments such as forceps. A precisely targeted positioning or the assembly of individual components in the patient&#39;s body is also difficult. This can in particular be the case with cardiac assist systems when pumps, canulae and drive components have to be assembled. 
     Various aids are known from the prior art for implanting parts of cardiac assist systems into a patient&#39;s body. 
     An apparatus is known from PCT/US2008/081082 having an anchor which can be inserted close to the heart and which is connected to a guide fiber. A tubular hollow body is displaceable toward the anchor on the guide fiber and can be held there by means of a magnetic device. 
     A handling device for a canula is known from WO 2009/029387 A1 which has a guide body extending through the interior of the canula and a holding body which can be expanded radially in the manner of a cushion to hold the canula. Said holding body can be expanded so far that it jams in the interior of the canula. 
     BRIEF SUMMARY OF THE INVENTION 
     Against the background of the prior art, it is the underlying object of the invention to provide a blood-conductive implantable component which effectively cooperates with a corresponding manipulating device to allow a reliable insertion and positioning in a patient&#39;s body with minimally invasive surgery. A further subject of the solution is a corresponding manipulating device, a coupling device for the mechanical coupling of an implantable component with a manipulating device as well as the system comprising the component and the manipulating device and a corresponding method for connecting the components to a manipulating device and for separating them. 
     The object is achieved by an implantable component in accordance with the invention, by a manipulating device for handling such a component, by a coupling device for the mechanical coupling of a component with a manipulating device, by a system comprising at least one implantable component and at least one manipulating device, by a corresponding method for connecting an implantable component to a manipulating device and by a method for separating an implantable component from a manipulating device. 
     The invention relates to an implantable component which bounds a blood-conductive passage within a human or animal body in operation, which in particular forms a part of a blood conveying device and which has a coupling element which is configured for mechanical coupling to a manipulating device, wherein the coupling between the manipulating device and the component allows a manipulation in all spatial directions. This means that the component is displaceable in freely selectable spatial directions depending on the necessities in handling. In addition, the component can also be rotatable and/or pivotable about different axes, in particular a plurality of axes. These axes can extend inside and/or outside of the implantable component and, for example, also through a coupling element. A fixed-angle connection of the coupling elements to one another in one or more planes, in particular at all sides, can in particular be provided for this purpose. 
     Such a component can generally be any component usable in a patient&#39;s body, in particular a part of a cardiac assist system, a blood pump, a blood pump for coupling to a heart, a valve, a canula, a catheter, corresponding connection systems between these components as well as a medicine dispensing pump. 
     Many of these components are equipped with particularly smooth and rounded surfaces to avoid lesions on the insertion into or dwelling in a body. This makes the handling by the hand of the surgeon or by grasping forceps difficult. For this reason, in accordance with the invention, a coupling element is provided which is configured for the mechanical coupling of a manipulating device to the component. In this connection, a surgical instrument is, for example, understood as a manipulating device which has, for example, a handle at the proximal end facing the surgeon as well as a shaft and a distal end which is connectable to the coupling element of the component. 
     For this purpose, a further coupling element which is connectable to the first coupling element fastened to the implantable component or integrated therein can be provided at the distal end of the manipulating device. 
     A mechanical coupling is thus provided which allows a reliable manipulation of the implantable component from outside the body by means of the manipulating device both on the first implantation and later. 
     More than one coupling element can also be arranged at the implantable component to be able to use a plurality of manipulating devices or a divided manipulating device which can, in simplified terms, also be used in this case for the alignment of the implantable component. The plurality of coupling elements at the implantable component are spaced apart from one another at the surface of the implantable component for this purpose and can also be used to be able to select the most suitable access path depending on the implantation site. 
     The coupling element at the component is furthermore configured for the self-retaining coupling of a manipulating device. This means that the implantable component does not have to be held tight permanently by actuation of the manipulating device as is the case, for example, with various surgical forceps. The coupling between the component and the manipulating device is advantageously designed as self-retaining so that the manipulating device can also be left out of consideration at times by the surgeon without the coupling being released. 
     The coupling devices are advantageously configured so that corresponding coupling forces are only developed between the coupling elements, for example by elastic deformation of one of the coupling elements, without forces being transmitted via the shaft of the manipulating device for this purpose. 
     The surgeon can hereby concentrate sequentially on different manipulating devices and it is ensured that the relative position of a manipulating device to the implantable component is fixed in a stable and unmovable manner. 
     The coupling element can be integrated in the component or fixedly connected thereto. In this respect, the coupling between the coupling element fastened to or integrated in the component and the manipulating device should advantageously also be releasable again in a particularly easy manner so that the manipulating device can be easily removed from the patient&#39;s body after the positioning and assembly of the implantable component. 
     The coupling element itself can in this respect, for example, be formed as an internal thread in the implantable component, preferably inside a bore and a further coupling element in the form of a threaded spigot can be screwed into it. 
     The coupling element can equally be designed as a bore or as a group of bores in the component into which bolts of a further coupling element can be introduced. Corresponding bolts can, for example, comprise metal, but also elastic materials such as rubber or also spring wire which can be introduced into the corresponding bores in a force-locking manner. A coupling element can typically also be designed as a groove, for example, having an undercut, for example, as a dovetail groove, into which a body of a further component which is designed in a correspondingly complementary manner can be inserted. 
     Bores or blind holes or other openings with or without undercuts can also form a coupling element, with the respective complementary coupling element then, for example, being able to have a deformable and/or movable body having projections and/or latching elements which effect a coupling and which can either be latched by means of an actuation device or which can be deformed on the provision of a pulling force and the exceeding of a specific trigger force to separate the coupling elements. For this purpose, for example, one of the coupling elements can at least partly comprise an elastomer or a spring. 
     For example, the manipulating device can include a corresponding coupling element and additionally a hollow shaft which is coupled to a handle. The corresponding actuation member for latching noses or for releasing a screw connection in the region of the coupling between the coupling elements can be provided within the shaft and the actuation member can be actuable in the region of the handle of the manipulating device. 
     It is also conceivable to form a coupling element as a cone which is integrated in the component, for example, a wall of the component, and into which a further cone can be pushed which forms a second coupling element which is connected to a manipulating device. The cone surfaces can, for example, be coupled to one another by a press fit, but also by means of adhesive or by a vacuum-tight closure. Skew cone clamps can also be used for such a connection. 
     It is moreover conceivable that one or more wrench flats at the implantable component serve as the coupling element and allow the shape-matched engagement of a corresponding coupling element of the manipulating device. Provision can also advantageously be made that the corresponding coupling element at the component side is fastened to the implantable component, for example bonded, welded or soldered thereto or also formed in one part therewith. This can be made, for example, in that a coupling plate having a threaded bore or an eyelet or a solid body, which can in turn have a bore, a groove, wrench flats or cone surfaces, is fastened to the implantable component. 
     The coupling element can, for example, also be formed as a smooth, surface-smoothed area onto which a suction cup serving as a second coupling element can be placed. The suction cup can, for example, be directly aerated and vented through the shaft of the manipulating device to which it is connected in order directly to establish and release the coupling between the coupling elements. 
     The connection of two smooth coupling surfaces of two coupling elements by means of an adhesive is also conceivable, with the adhesive being able to be directly dissolved or embrittled to release the connection. The adhesive can, for example, be made as a thermoplastic which can be liquefied in a short time to separate the coupling elements from one another or as a curable resin which can be embrittled by radiation cross-linking, for example by UV light, so that the adhesive bond can be easily broken. 
     It is also conceivable to connect the implantable component to a coupling element of the manipulating device in one piece in the manufacture by casting so that the implantable component, the coupling element connected thereto and at least one part of the manipulating device itself or the total manipulating device are made in one piece, for example in an injection molding process. 
     A desired break point is then provided between the coupling elements of the implantable component and of the manipulating device to be able to remove the manipulating device after the positioning of the implantable component by breaking the coupling between the coupling elements. 
     A magnet or a ferromagnetic workpiece can, for example, be provided as a coupling element at the component side which is arranged at the outer side or in the interior of the component and which cooperates with a magnet or with a ferromagnetic part of the manipulating device for the coupling. A part of a motor or of a rotor can also act as a magnet in the component, for example. A fitting surface can be provided at the outer side of the component for the coupling of the manipulating device. One of the magnets of the coupling device can be designed as a switchable electromagnet. A corresponding fitting surface can be designed, for example when it forms a part of the coupling element at the component side, as a mechanical catching device for the second coupling element associated with the manipulating device and can have a recess which has introduction chamfers or similar introduction aids for the second coupling element. An introduction chamfer can, for example, be integrated in an introduction cone, a hollow sphere or another recess tapering toward the component interior. The second coupling element can optionally have a complementary geometrical shape. 
     In particular when the first coupling element is formed as a fitting surface, particularly with an introduction chamber, and in particular when the fitting surface itself is not located in direct proximity to a ferromagnetic body of the component, but also in all other cases described here, the component can be designed such that the contour of the fitting surface can be reproduced by imaging processes, for example X-rays or ultrasound. This is e.g. possible by a metal surface cover of the component in the region of the fitting surface or by a marker body which has a higher density than the wall of the component and which is integrated in the component in direct proximity of the fitting surface or with a recognizable geometrical relation to the fitting surface. A coupling can thus be established more easily and without visual contact between a manipulating device having a ferromagnetic coupling element and the component on a further invention which may become necessary after the first implantation. 
     An eyelet can also be provided at an outer surface of the component as a coupling element through which eyelet a thread is guided which serves as a coupling element of the manipulating device. Such a design is in particular of interest when a part of a longer flexible component such as a tubular canula should be drawn from an entry site to a target site. The coupling can then be easily separated by separation of the thread. 
     The associations with the component, on the one hand, and with the manipulating device, on the other hand, can generally be swapped over in the above-described complementary coupling elements. 
     A coupling device in accordance with the invention correspondingly provides a first coupling element which is associated with the implantable component as well as a second coupling element which is associated with the manipulating device, with the coupling elements being connectable or connected to one another in a force-locking manner and/or in a shape-matching manner and/or with material continuity. 
     The coupling device is in this respect advantageously configured so that the coupling is kept stable without an external effect. 
     If the coupling comprises a connection with material continuity between the first component and the second component, said connection can be separated by breaking, cutting or changing the mechanical material properties of at least one part of the coupling device. The change in the mechanical material properties is understood, for example, as an embrittlement by radiation effect or thermal effect or a melting of a part of the coupling or a vaporizing, for example by the effect of a laser. 
     The invention also relates, in addition to an implantable component, a manipulating device and a coupling device, to a corresponding system having one or more components and one or more manipulating devices which are correspondingly configured to be couplable in a simple self-retaining manner by means of the coupling elements. The corresponding couplings must also be able to be released again in a simple and gentle manner inside the patient. 
     The invention further also relates to a method of connecting an implantable component to a manipulating device, with the component being mechanically connected to the manipulating device before the introduction into the patient&#39;s body by means of a self-retaining releasable coupling device. 
     This can, for example, already take place in the manufacture of the implantable component by integration of the coupling device, in that, for example, the component and at least one part of the manipulating device are manufactured in one piece together with the coupling device in an injection molding process or are connected to one another in a joining process. 
     The implantable component can also be releasably screwed, clamped, bonded or latched to the manipulating device, with a respective one of the coupling elements cooperating in a complementary manner with the other coupling element and with, for example, a threaded bore being arranged in the component and a corresponding threaded bolt at the manipulating device and with each of the coupling elements also each being able to be provided in swappable manner at the respective other part. If, therefore, for example, an eyelet is provided at the implantable component and a corresponding hook at the manipulating device, the hook can also be provided at the implantable component and the eyelet at the manipulating device. This also applies to all other embodiments of the coupling elements. 
     If the implantable component and the manipulating device are already connected to one another before the start of a surgical procedure, this facilitates and accelerates the surgical procedure. 
     The separation of the implantable component from the manipulating device can typically only take place after the end of the implantation, for example by mechanical breaking of the coupling device or by another separation of the coupling device. 
     The coupling device can be mechanically weakened, for example, before the separation, e.g. by cooling, heating, irradiating, bending or by kinking the coupling device. 
     If the method for separating the implantable component from the manipulating device takes place in manner which does not provide any displacement or movement of the manipulating device with respect to the component, this has the advantage that the positioning of the component does not have to be changed again after the end of the surgical procedure. A corresponding release of the coupling device can take place, for example, by cutting or chemical dissolving, degrading, liquefying or vaporizing of a part of the coupling device. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The invention will be shown and described in the following with reference to an embodiment in a drawing. There are shown 
         FIG. 1  a representation of an implantable component and of two manipulating devices in a three-dimensional view; 
         FIG. 2  schematically in section, a manipulating device, a section of an implantable component and a coupling device; 
         FIG. 3  a view of a coupling device; 
         FIG. 4  a coupling device from  FIG. 3  in a plan view; 
         FIG. 5  a further coupling device; 
         FIG. 6  a coupling device, a section of a component and a manipulating device; 
         FIG. 7  a section of a component and a coupling device; 
         FIG. 8  a section of an implantable component; 
         FIG. 9  a section of an implantable component with a coupling device; 
         FIG. 10  an alternative coupling device to that shown in  FIG. 9 ; 
         FIG. 11  a section of a component with a coupling device; 
         FIG. 12  a part of an implantable component in a section with a coupling device; 
         FIG. 13  a further alternative of a coupling device with a section of an implantable component; and 
         FIG. 14  an alternative of a coupling device with an inflatable coupling element. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       FIG. 1  shows schematically and in a stylized fashion an implantable component  1 , which, for example, represents a pump for conveying blood as a part of a cardiac assist system, having a cylindrical outer wall  2  of a pump housing and a axial rotor, which is not shown in detail, supported in the hollow cylinder. 
     A coupling element  4  of a manipulating device  5  is fastened to the end face  3  of the component  1  and is connected to a coupling element which is not shown in any more detail and which is integrated in the component  1 . 
     The coupling element  4  is connected to a shaft  6  of the manipulating device  5  which is connected at its proximal end to a handle  7 . A knob  8  is moreover provided at the handle  7  and can, for example, be connected to a core  9  which extends in a hollow space of the shaft  6  up to the coupling element  4 . 
     The knob  8  can be moved with respect to the handle  7 , for example displaced and/or rotated, to move the core  9  with respect to the shaft  6  in order thus to actuate the coupling element  4  and, for example to release the manipulating device  5  from the component  1 . 
     A further manipulating device  5 ′ is connected to the component  1  at another point via a further coupling element  4 ′. The further manipulating device  5 ′ likewise has a handle  7 ′ and a knob  8 ′. The component  1  cannot only be displaced, but also rotated by both manipulating devices  5 ,  5 ′ together which are fastened at the component  1  to points spaced apart from one another. 
     The second manipulating device  5 ′ can also have a core  9 ′, which is movable by means of the knob  8 ′, within a hollow shaft  6 ′. 
       FIG. 2  shows an exemplary implementation of a coupling device  10  at the component  1  having a blind hole which has an internal thread into which a threaded bolt  11  is screwed. The threaded bolt  11  is connected as a coupling element of the manipulating device to a core  9  which extends through a hollow shaft  6  and can be rotated therein to screw the threaded bolt  11  into or out of the threaded bore  10 . The shaft  6  can thus be fastened to the component  1 , which is only shown sectionally in  FIG. 2 , and released from it again. 
     Generally, a coupling element can be formed by a cut-pout, in particular a bore or a groove, having an undercut or without an undercut. 
     It is prevented by additional spigots at the shaft, which engage into corresponding bores of the implant, that the implant also rotates on the release of the screw connection. This moreover ensures that the implant can also be rotatingly manipulated. 
     A flange  72  can also be provided in the shaft  6  and can be screwed to the component  1  by means of the threaded bolt  11  and a head  73  of the threaded bolt by screwing into the threaded bore  10 . 
       FIG. 3  schematically shows a coupling element  12  of a manipulating device in the form of a flat, plate-shaped thermoplastic end part at which a shaft  13  is engaged which forms a part of a manipulating device. The plate-shaped part  12  is connected to, the wall piece  14 , for example made in a planar fashion and forming a coupling element at the component side, for example welded thereto, bonded thereto or manufactured in one piece therewith as an injection molded part. The component  1  can thus be manipulated by means of the shaft  13  until the coupling element  12  is broken off at the component by kinking the plate  12 . 
     For better clarity, this configuration is shown in a plan view in  FIG. 4 , with the plate  12  and the shaft  13  being recognizable. The plate  12  can be kinked and removed by pivoting in the direction of the arrows  15 ,  16 . 
     The attachment of the plate-shaped piece  12  in the wall  14  of the component  1  forms the coupling element which is integrated there and to which the kinkable part of the plate  12  is connected as a coupling element of the manipulating device. 
     In accordance with  FIG. 5 , a shaft  17  is connected to a bell-shaped coupling element  18  which is connected to the implantable component  1  by means of a short wire  19 . The wire  19  provides that the bell  18  is seated on the component  1  and the component  1  can thus be moved by means of the shaft  17 . 
     The wire  19  can be turned off or torn off by a rotation of the shaft  17  at its longitudinal axis or by a tilting of the bell part with a large expenditure of force to remove the manipulating device  17 ,  18  from the component  1 . The coupling elements  18 ,  19  provide a good handling of the component  1  via the manipulating device as long as the connection exists. 
     In  FIG. 6 , a coupling device is shown having a coupling element  20  which comprises an elastomer and which is connected to a handle  22  of a manipulating device by means of a shaft  21 . The element  20  is fixed in a force-locking manner in a bore  23  as a coupling element of an implementable component  1 . For example, the element  20  can be heated and pressed into the bore  23  to establish a connection of the coupling device  20 ,  23 . The manipulating device  20 ,  21 ,  22  can subsequently be removed from the component  1  by pulling at the shaft  21 . It is also conceivable previously to heat the coupling element  20  or to cool it considerably to allow it to shrink. 
     In  FIG. 7 , a coupling device is shown having a first component  1  onto which a coupling element in the form of a plate  24  is set, for example welded, soldered or bonded. The plate  24  can also be designed as an integrated part of the component  1 . 
     A suction cup  25  is placed on the smooth surface of the coupling element  24  and can, for example, comprise an elastomer, but also a hard highly polished plate, for example of steel. The two plates  24 ,  25  adhere as coupling elements to one another in a sucking manner with a sufficient surface quality. This is in particular the case when one of the components is formed as an elastomer suction cup. 
     A ventilating passage  26  can be provided within the second coupling element  25 ; it extends through the shaft  27  and can be aerated or evacuated from the proximal end of the manipulating device  25 ,  26 ,  27  to couple or release the coupling device  24 ,  25 . 
     In  FIG. 8 , a section of an implantable component  51  is shown schematically having a dovetail groove  28  or a bore having undercuts. 
     If it is a radially symmetrical bore having undercuts, in accordance with  FIG. 9 , a tulip-like coupling element  29  having outwardly facing latching noses can thus be inserted therein which elastically latch into the undercuts of the bore  28 . The coupling element  29  is connected to a shaft  30  of a manipulating device and can also only be pulled out of the bore  28  by sufficient pulling at this shaft  30  when a blocking element  51  in the form of a cylinder is spaced apart axially from the latching noses  29  within a cut-out  52  in the manipulation apparatus by means of movement of the core  53  and thus releases an inward movement of the latching noses. The shaft  30  is hollow to receive the core  53 . 
     Another constellation of a coupling element  31  is shown in  FIG. 10  which is equally arranged in a bore of the implantable component  1  having undercuts and which is substantially cylindrical with outwardly facing latching noses of elastically bendable end regions of end fingers of the coupling element. The coupling element  31  is also fixedly seated in the bore  28 , but can be pulled out thereof by expenditure of force or by pulling in the latching noses of the coupling element  31 . 
       FIG. 11  shows a coupling apparatus having a first coupling element  32  and a second coupling element  33  which are each formed in plate-shape. The first coupling element  32  is fastened to a section of an implantable component  1  by bonding, welding or other joining technique and has a planar, smooth surface on the side remote from the component  1 . The second coupling element  33  is laid onto the surface and is fastened there, for example, by means of an adhesive, e.g. an epoxy resin or another curable resin. 
     The coupling elements are thereby connected to one another and the shaft  34  of a manipulating device is connected in a fixed and self-retaining manner to the component  1  via this coupling apparatus. 
     The connection can be permanently established, for example, before introduction of the component  1  into a patient&#39;s body. 
     To release the coupling connection, the epoxy resin between the coupling elements  32 ,  33  can be rehardened so much, for example by means of a UV radiation source  35 , that it becomes brittle so that the coupling elements  32 ,  33  can easily be separated from one another. 
     Provision can, however, also be made that the coupling elements  32 ,  33  are connected to one another by a thermoplastic adhesive which can be liquefied by irradiation, for example by a heat source, so that the coupling can be dissolved in this manner and the manipulating device can be removed by separation of the second coupling element  33  from the first coupling element  32 . Ultrasonic pulses or laser beams can also be used to dissolve the coupling. 
     A constellation is shown in  FIG. 12  in which a hollow cylindrical component  1  as a coupling element has, for example, a spherical fitting surface  54  and two conical fitting surfaces  55 ,  56 . The complementary cone  57  can run into the fitting surface  56  parallel to the longitudinal axis of the cylindrical component  1 ; the complementary bodies  58 ,  59  can move radially into the other fitting surfaces. The bodies  57 ,  58 ,  59  each represent coupling elements of a manipulating device and can be formed as ferromagnetic bodies, optionally as magnets, and also as switchable electromagnets. 
     The fitting surfaces  54 ,  55 ,  56  can each be surrounded by ferromagnetic and/or magnetized material of the component  1 , as shown for the example of the fitting surface  56  by hatching of the magnetic region  60 . 
     Provision can also be made that the magnetic effect of magnetically effective parts  61  in the interior of the component  1 , for example of parts of a pump drive or of a magnetic valve, are used for the coupling. 
     To facilitate a coupling of the manipulating device to the component by means of imaging processes, a marker body  70  integrated in the wall of the component or a surface coat  71  of a fitting surface  54  comprising a material of high density, in particular metal, preferably a precious metal, chromium or surgical steel, can be provided. 
     To release such a magnetic coupling, either a corresponding electromagnet can be switched off or the manipulation apparatus can be moved in a jerky manner. A demagnetization of the magnets by means of an alternating field can also take place. A different alignment of the magnetic poles with respect to one another can however, also be achieved by rotating the one magnet with respect to the other so that a simplified release is made possible by the magnetic repelling forces which arise. 
     In  FIG. 13 , a coupling apparatus is shown having a plate  32 ′ which is jointed to an implantable component  1  and which has a blind bore  44  having an internal thread. The plate  32 ′ having the blind bore  44  in this respect represents a first coupling element of the component  1 . A second coupling element can be connected to this first coupling element and has a threaded bolt  45  which is connected to a core  46 . The core  46  extends in the hollow space of a shaft  47  which represents a part of a manipulating device and is proximally connected to a handle not shown in  FIG. 13 . The shaft  47  and the core  46  are connected to the coupling element  32 ′ of the implantable component  1  by means of the threaded bolt  44 . 
     If the core  46  is rotated with respect to the shaft  47  via a knob at the handle of the manipulating device, the threaded bolt  45  can hereby be screwed into the plate  32 ′ or out of it or of the threaded bore  44  in order to establish or separate the coupling depending on the situation. 
     In the state of an established coupling, the coupling apparatus is self-retaining, i.e. the first component  1  can easily be displaced and positioned or rotated as desired at the handle, not shown, of the manipulating device. 
     The threaded bolt  47  can selectively also be replaced with a nut having an internal thread connected to the core  46  and the threaded bore  44  with a corresponding threaded bolt. 
     As a further embodiment, the implantable component can also have a wrench flat, for example a hexagonal flat, as a coupling element to which a complementary wrench can engage as a second coupling element. If this combination is designed in a press fit, the connection is self-retaining. 
     Provision is advantageously made in the described coupling devices to form them at the implant at the surface not conducting blood. Any contamination or damage to the passage conducting blood can thereby be prevented. In addition, any cut-outs, bores or the like provided are not provided at the blood conducting passage so that dead flow regions are avoided. 
     As shown in  FIG. 14 , a combination of an inflatable hollow body, in particular of cushion, on the one hand, and of a gripping surface, on the other hand, can also be provided as a coupling device, for example at the component side. 
     For example, a cushion inflatable via the shaft of a manipulating device can be introduced into a hollow space of a component and inflated there. For this purpose, the corresponding hollow space can have an undercut. The inflatable hollow body can also be made as a torus  63 ,  64  and be pushed over the component  1  or a part  62  of the component and inflated there. 
     As soon as the implant has been positioned and aligned, the pressure in the hollow body can be reduced and the coupling apparatus thus separated. 
     The hollow body can be coated with an elastomer for better adhesion to the component and to save the component surfaces. 
     A fluid passage  66  is in each case provided in the shaft  65  of the manipulating device for inflating and pressure reducing of the hollow body. Beads  67 ,  68  can be provided at the component  1  for holding the hollow body which thus form corresponding fitting surfaces as a coupling element at the component side. 
     The component can be simply positioned and aligned by a surgeon by the different variants shown of a self-retaining coupling apparatus between an implantable component and a manipulating device without the hand of the surgeon having to be directly guided into the operating field. A comparatively small access to the operating field is thereby made possible. The connection between the instrument or the manipulating device, on the one hand, and the component, on the other hand, can already be established before the actual surgical procedure and can be dissolved after the implantation. 
     The manipulating device, the coupling device and the implantable component can be characterized generally by the following principles of action as special aspects of the invention:
     1st aspect: the provision of fixed wrench flats at the component which cooperate with a complementary form of a coupling element;   2nd aspect: the coupling via a force locking (clamping) by an inflatable body or by a body of a coupling element spreadable in an opening;   3rd aspect: the coupling simultaneously at two points spaced apart from one another at the component, whereby the rotatability and tiltability is improved as a consequence of the separate manipulation possibilities of the coupling points;   4th aspect: the magnetic coupling of a coupling element of the manipulating device to a magnetically active part of the implantable component, in particular a drive unit, further particularly a pump unit.