Patent Publication Number: US-2021186692-A1

Title: Hydraulic crimping device

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     The present application claims the benefit of prior U.S. Appl. No. 62/951,918, filed Dec. 20, 2019, which is incorporated by reference herein in its entirety. 
    
    
     TECHNICAL FIELD 
     The disclosure relates to systems and techniques for crimping medical devices, such as prosthetic heart valves. 
     BACKGROUND 
     Medical devices such as prosthetic heart valves may be delivered to a target site in a patient using percutaneous catheterization techniques. This may require the prosthetic heart valve device to assume a configuration featuring a relatively small cross-sectional dimension to allow for the percutaneous delivery via a catheter. Once delivered and placed in the target site, the prosthetic heart valve device may expand to assume a larger cross-sectional dimension. Accordingly, these prosthetic heart valve devices may be compacted or compressed before implantation in a patient, so that the prosthetic heart valve device may be loaded into the catheter and advanced to a treatment location in the body via a percutaneous catheterization technique. 
     SUMMARY 
     In some examples, this disclosure describes a crimping device for reducing the size of prosthetic heart valve devices and other medical devices. The crimping device is configured to reduce a dimension of a prosthetic heart valve device to allow for containment of the prosthetic heart valve device within a catheter or capsule. The crimping device utilizes a funnel to provide substantially uniform compression forces to the prosthetic heart valve device as a pusher translates the prosthetic heart valve device into the funnel. A central axis of the crimping device intersects a distal opening and a proximal opening of the funnel, and the piston is configured to translate toward the funnel in a direction substantially parallel to the central axis. The piston is configured to slidably translate within a piston cylinder. A system may comprise the crimping device and a prosthetic heart valve device positioned between the pusher and the funnel. 
     In some examples, the crimping device includes a funnel attached to a housing. The funnel includes a distal opening and a proximal opening and defines a central axis, with the central axis intersecting the distal opening and the proximal opening. The distal opening defines a distal opening dimension and the proximal opening defines a proximal opening dimension, with the distal opening dimension greater than the proximal opening dimension. A piston cylinder comprising a fluid port is attached to the housing, with the distal opening between the piston cylinder and the proximal opening. A piston is configured to slidably translate in the piston cylinder over a stroke length. A pusher is between the piston and the distal opening, and some portion of the is between the distal opening and the proximal opening when the piston slidably translates toward the funnel over the stroke length. 
     A technique includes placing a prosthetic heart valve device between a pusher comprising a crimping device and a distal opening of a funnel comprising the crimping device. The technique includes delivering a pressurized fluid to a piston cylinder of the medical crimping device, translating a piston within the piston cylinder in a direction toward a distal opening of the funnel and substantially parallel to a central axis, where the central axis intersects the distal opening of the funnel and a proximal opening of the funnel. The technique includes displacing the pusher in the direction substantially parallel to the central axis using the translation of the piston, and advancing the prosthetic heart valve device toward the distal opening of a funnel using the displacement of the pusher. 
     Clause 1: In some examples, a medical crimping device comprises: a housing; a funnel attached to the housing, wherein the funnel comprises a distal opening and a proximal opening, and wherein a central axis intersects the distal opening and the proximal opening, and wherein the funnel tapers down from the distal opening to the proximal opening; a piston cylinder attached to the housing; a piston within the piston cylinder, wherein the piston is configured to slidably translate in the piston cylinder in a direction substantially parallel to the central axis; and a pusher between the piston and the funnel, wherein the piston is configured to displace the pusher in the direction substantially parallel to the central axis when the piston slidably translates in the piston cylinder. 
     Clause 2: In some examples of the medical crimping device of clause 1, the piston has a stroke length and at least a portion of the pusher is between the distal opening and the proximal opening when the piston slidably translates toward the funnel over the stroke length. 
     Clause 3: In some examples of the medical crimping device of clause 1 or 2, the pusher comprises a pusher base and a plurality of fingers extending from the pusher base. 
     Clause 4: In some examples of the medical crimping device of clause 3, the plurality of fingers is configured to insert into the funnel through the distal opening when the piston displaces the pusher in the direction substantially parallel to the central axis. 
     Clause 5: In some examples of the medical crimping device of clause 3 or 4, each finger in the plurality of fingers extends from a pivoting end to a free end, wherein the pivoting end is attached to the pusher base and the pivoting end is configured to pivot when the central axis intersects the pusher base and a force toward the central axis is applied to the free end. 
     Clause 6: In some examples of the medical crimping device of any of clauses 3-5, the pusher defines a maximum dimension substantially perpendicular to the central axis when the central axis intersects the base, and wherein the distal opening of the funnel defines a distal opening dimension substantially perpendicular to the central axis, wherein the maximum dimension is less than the distal opening dimension. 
     Clause 7: In some examples of the medical crimping device of any of clauses 1-6, the piston cylinder comprises a fluid port, wherein the fluid port is fluid communication with the piston. 
     Clause 8: In some examples of the medical crimping device of any of clauses 1-7, the piston cylinder is an annular cylinder defining a central lumen, wherein the central lumen surrounds the central axis, and wherein the pusher comprises a pusher opening surrounding the central axis. 
     Clause 9: In some examples of the medical crimping device of any of clauses 1-8, either the pusher or the piston defines a protrusion, and the other of the pusher or the piston defines a recess configured to receive the protrusion. 
     Clause 10: In some examples of the medical crimping device of any of clauses 1-9, the distal opening of the funnel defines a distal opening dimension substantially perpendicular to the central axis and the proximal opening of the funnel defines a proximal opening dimension substantially perpendicular to the central axis, wherein the distal opening dimension is greater than the proximal opening dimension, and wherein the distal opening is between the proximal opening and the piston cylinder. 
     Clause 11: In some examples of the medical crimping device of clause 10, the funnel defines a first taper and a second taper between the distal opening and the proximal opening, wherein an angle of the first taper relative to the central axis is greater than an angle of the second taper relative to the central axis. 
     Clause 12: In some examples of the medical crimping device of clause 10 or 11, the funnel comprises a distal funnel section comprising the distal opening and a proximal funnel section comprising the proximal opening, wherein the proximal funnel section is mechanically attached to the distal funnel section. 
     Clause 13: In some examples of the medical crimping device of any of clauses 10-12, the funnel comprises a surface of revolution around central axis and facing the central axis, wherein a generatrix of the surface of revolution is concave down relative to the central axis. 
     Clause 14: In some examples, a system comprises the medical crimping device of any of clauses 1-13 and a prosthetic heart valve in mechanical communication with the pusher, wherein the pusher is configured to displace the prosthetic heart valve toward the funnel when the piston displaces the pusher in the direction along the central axis. 
     Clause 15: In some examples, a medical crimping device comprises a housing; a funnel attached to the housing, wherein the funnel defines a central axis, wherein the funnel comprises a distal opening and a proximal opening and the central axis intersects the distal opening and the proximal opening, and wherein the distal opening of the funnel defines a distal opening dimension substantially perpendicular to the central axis and the proximal opening of the funnel defines a proximal opening dimension substantially perpendicular to the central axis, wherein the distal opening dimension is greater than the proximal opening dimension; a pusher; a piston cylinder attached to the housing, the piston cylinder comprising a fluid port, wherein the distal opening is between the piston cylinder and the proximal opening; and a piston within the piston cylinder, wherein the pusher is between the piston and the funnel; wherein the piston is configured to slidably translate over a stroke length in the piston cylinder in a direction substantially parallel to the central axis, wherein the piston is configured to displace the pusher in the direction substantially parallel to the central axis when the piston slidably translates in the piston cylinder and some portion of the pusher is between the distal opening and the proximal opening when the piston slidably translates toward the funnel over the stroke length, and wherein the fluid port in fluid communication with the piston. 
     Clause 16: In some examples of the medical crimping device of clause 15, the pusher comprises a pusher base and a plurality of fingers extending from the pusher base, and wherein the plurality of fingers is configured to insert into the funnel through the distal opening when the piston displaces the pusher in the direction substantially parallel to the central axis. 
     Clause 17: In some examples of the medical crimping device of clause 16, each finger in the plurality of fingers extends from a pivoting end to a free end, wherein the pivoting end is attached to the pusher base and the pivoting end is configured to pivot when the central axis intersects the pusher base and a force toward the central axis is applied to the free end. 
     Clause 18: In some examples of the medical crimping device of clause 15, the piston cylinder is an annular cylinder surrounding a central lumen, wherein the central lumen surrounds the central axis, and wherein the pusher comprises a pusher opening surrounding the central axis. 
     Clause 19: In some examples, a method comprises: placing a prosthetic heart valve device between a pusher comprising a crimping device and a distal opening of a funnel comprising the crimping device; delivering a pressurized fluid to a piston cylinder of the medical crimping device; translating a piston within the piston cylinder in a direction substantially parallel to a central axis using the supplied pressurized fluid, wherein the central axis intersects the distal opening of the funnel and a proximal opening of the funnel, and wherein the distal opening is between the proximal opening and the piston cylinder; displacing the pusher in the direction substantially parallel to the central axis using the translation of the piston; and advancing the prosthetic heart valve device in the direction along the central axis and toward the distal opening of a funnel using the displacement of the pusher. 
     Clause 20: In some examples of the method of clause 19, the method comprises advancing the prosthetic heart valve device into the funnel; contacting the prosthetic heart valve device and an interior surface of the funnel; and compressing the prosthetic heart valve device using the contact between the prosthetic heart valve device and the interior surface of the funnel. 
     The details of one or more examples are set forth in the accompanying drawings and the description below. Other features, objects, and advantages will be apparent from the description and drawings, and from the claims. 
    
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
         FIG. 1  is an isometric view of an example system for delivering an example prosthetic heart valve device. 
         FIG. 2A  is a schematic illustration of a distal portion of a delivery system positioned in a native mitral valve of a heart using a trans-apical delivery approach. 
         FIG. 2B  is a schematic illustration of the distal portion of the system of  FIG. 2A  in a deployment configuration and a deployed example prosthetic heart valve device. 
         FIG. 3  is a schematic illustration of a crimping device. 
         FIG. 4  is a cross-sectional illustration of the crimping device of  FIG. 3 . 
         FIG. 5  is a cross-sectional illustration of the crimping device of  FIG. 3  in an example configuration. 
         FIG. 6  is a cross-sectional illustration of the crimping device of  FIG. 3  in another configuration. 
         FIG. 7  is a cross-sectional illustration of a portion of an example crimping device. 
         FIG. 8  is a schematic illustration of another example crimping device. 
         FIG. 9  is a cross-sectional illustration of the crimping device of  FIG. 8 . 
         FIG. 10  is another cross-sectional illustration of the crimping device of  FIG. 8 . 
         FIG. 11  is a cross-sectional illustration of an additional crimping device. 
         FIG. 12  is a cross-section illustration a further crimping device. 
         FIG. 13  is schematic flow chart for example technique for using a crimping device. 
         FIG. 14  is a schematic illustration of a crimping device in accordance with another embodiment hereof. 
         FIG. 15  is a cross-sectional illustration of the crimping device of  FIG. 14  with a housing detached from a piston cylinder thereof. 
         FIG. 16  is a cross-sectional illustration of the crimping device of  FIG. 14  with a housing attached to a piston cylinder thereof. 
         FIG. 17  is a schematic illustration of a funnel and a housing of the crimping device of  FIG. 14  removed from a remainder thereof. 
         FIG. 18  is a schematic illustration of a piston-cylinder group of the crimping device of  FIG. 14  removed from a remainder thereof. 
     
    
    
     DETAILED DESCRIPTION 
     Prosthetic heart valve devices may be introduced into a lumen of a body vessel via percutaneous catheterization techniques. These prosthetic heart valve devices may be configured with a delivery configuration featuring a relatively small cross-sectional dimension to allow for percutaneous delivery to a treatment site via a catheter. In some prosthetic heart valve devices, the relatively small cross-sectional dimension allows for containment within a delivery capsule. Once delivered to the target site and deployed by a clinician, the prosthetic heart valve device may be configured to expand from the delivery configuration and assume a larger cross-sectional dimension. In the expanded state, the prosthetic heart valve device may have a larger cross-sectional dimension than the catheter and/or the capsule used for delivery. Accordingly, a crimping device may be used to crimp (e.g., reduce) a cross-sectional dimension of the prosthetic heart valve device to allow loading into the catheter and advancement to a treatment location in the body via a percutaneous catheterization technique. 
     Prosthetic heart valve devices may have a relatively large expanded cross-sectional dimension (e.g., about 1.97 inches or more). In some cases, prosthetic heart valve devices may be packaged and stored in an expanded state until just before implantation into a patient. Consequently, during an implantation procedure, prosthetic heart valve devices are often crimped in the operating room from an expanded cross-sectional dimension to a delivery configuration suitable for delivery via a delivery capsule. Further, the prosthetic heart valve device may be stored in a sterile solution (e.g., a saline solution) until the prosthetic heart is loaded into the delivery capsule of a delivery system. This may necessitate the crimping process occur while the prosthetic heart valve device remains submerged in the sterile solution. Such procedures benefit from crimping devices that are highly portable and readily available to perform crimping with the prosthetic heart valve device in the submerged state. Further, such procedures may benefit from systems which minimize the use of direct hand strength to provide the crimping force. A required use of direct hand strength (e.g., twisting or pushing forces directly applied by hand) in order to generate crimping forces on a prosthetic heart valve device may result in varying levels of discomfort due to variations in strength among individual clinicians. The required use of direct hand strength for crimping may also require a clinician&#39;s hands to be submerged for some extended period of time, when the prosthetic heart valve device remains submerged in sterile solution during the crimping. 
     In some examples, the disclosure relates to a hydraulically driven crimping device. The crimping device disclosed is configured to utilize a pusher and a funnel to crimp a prosthetic heart valve device. The crimping device is configured to precipitate contact between the prosthetic heart valve device and an internal surface of the funnel by positioning the prosthetic heart valve device on the pusher and translating the pusher into the large opening of the funnel. The internal surface of the funnel exerts substantially uniform inward radial forces on the prosthetic heart valve device as the pusher drives the prosthetic heart valve device into the funnel. The pusher may be configured to flex or pivot toward a center axis defined by the funnel as the tapering internal surface of the funnel exerts inward radial forces on the prosthetic heart valve device. 
     The crimping device displaces the pusher in a direction substantially parallel to the central axis of the funnel using a hydraulic piston. A pressurized fluid delivered to the hydraulic piston causes the hydraulic piston to slidably translate in a piston cylinder, and causes the pusher to displace toward the funnel. In this manner, the pressurized fluid causes the translation of the pusher to precipitate contact between the prosthetic heart valve device and the internal surface of the funnel, in order to crimp the prosthetic heart valve device in preparation for loading into a delivery system. 
     The crimping device allows the crimping of prosthetic heart valve devices into a relatively smaller cross-sectional dimension in the operating room during an implantation procedure. The hydraulically actuated device and the tapering internal surface of the funnel allows the crimping to occur in a relatively controlled manner without the necessity for extensive manual manipulation of the device. Additionally, the hydraulic operation allows the crimping device to be actuated from a position external to a required environment surrounding the prosthetic heart valve device, such as a chilled saline solution. 
     In some examples, the present disclosure is directed to systems including crimping devices for reducing the size of prosthetic heart valve devices and other prosthetic heart valve devices. The term “crimp” (e.g., used in relation to a crimping device or a crimping method) may refer to devices and methods that compact or compress a prosthetic heart valve device to a smaller size. For example, the term “crimp” may refer to devices and methods that compact or compress a prosthetic heart valve device such as a prosthetic mitral valve device from an expanded cross-sectional dimension to a smaller cross-sectional dimension that allows for percutaneous delivery to a treatment site such as a mitral valve via a catheter and/or capsule. In examples, the term “crimp” may refer to the application of inward radial compression forces on a prosthetic heart valve device. The inward radial compression forces may reduce a cross-sectional dimension of the prosthetic heart valve device. 
     Generally, the mitral valve or other type of atrioventricular valve can be accessed through a patient&#39;s vasculature in a percutaneous manner for delivery of valve replacement devices. By percutaneous it is meant that a location of the vasculature remote from the heart is accessed through the skin, typically using a surgical cut down procedure or a minimally invasive procedure. Depending on the point of vascular access, access to the mitral valve may be antegrade and may rely on entry into the left atrium by crossing the inter-atrial septum (e.g., a trans-septal approach). Alternatively, access to the mitral valve can be retrograde where the left ventricle is entered through the aortic valve. Access to the mitral valve may also be achieved using a cannula via a trans-apical approach. Depending on the approach, the interventional tools and supporting catheter(s) may be advanced to the heart intravascularly and positioned adjacent the target cardiac valve in a variety of manners, as described herein. 
     Expanding valve replacement devices may be delivered through a patient&#39;s vasculature in a percutaneous manner utilizing appropriately configured delivery systems.  FIG. 1  is an isometric view of one such example system  100  for delivering a crimped device such as a prosthetic heart valve device. The system  100  may include a catheter  102  having an elongated catheter body  108 , and may include a delivery capsule  106 . The catheter body  108  may include a proximal portion  108   a  and a distal portion  108   b  carrying the delivery capsule  106 . The delivery capsule  106  may contain a crimped medical device such as prosthetic heart valve device  110  (shown schematically in broken lines). 
     A control unit  104  coupled to the proximal portion  108   a  of catheter body  108  may provide steering capability (e.g., 360 degree rotation of the delivery capsule  106 , 180 degree rotation of the delivery capsule  106 , 3-axis steering, 2-axis steering, etc.) used to deliver the delivery capsule  106  to a target site (e.g., to a native mitral valve) and deploy the crimped prosthetic heart valve device at the target site. The catheter  102  can be configured to travel over a guidewire  120 , which can be used to guide the delivery capsule  106  into, for example, a native heart valve. The system  100  may also include a fluid assembly  112  configured to supply fluid to and receive fluid from the catheter  102  to, for example, cause the delivery capsule  106  to deploy the prosthetic heart valve device  110 . The fluid assembly  112  may include a fluid source  114  and a fluid line  116  fluidically coupling the fluid source  114  to the catheter  102 . The fluid source  114  may contain a flowable substance (e.g., water, saline, etc.) in one or more reservoirs. 
     The control unit  104  can include a control assembly  122  and a steering mechanism  124 . For example, the control assembly  122  can include rotational elements, such as a knob, that can be rotated to rotate the delivery capsule  106  about its longitudinal axis  107 . The control assembly  122  can also include features that allow a clinician to control deployment mechanisms of the delivery capsule  106  and/or the fluid assembly  112 . For example, the control assembly  122  can include buttons, levers, and/or other actuators that initiate unsheathing and/or resheathing the prosthetic heart valve device  110 . The steering mechanism  124  can be used to steer the catheter  102  through the anatomy by bending the distal portion  108   b  of the catheter body  108  about a transverse axis. In other embodiments, the control unit  104  may include additional and/or different features that facilitate delivering the prosthetic heart valve device  110  to the target site. 
     The delivery capsule  106  may include a capsule housing  126  configured to carry the prosthetic heart valve device  110  in a containment configuration and, optionally, an end cap  128  that extends distally from the capsule housing  126  and encloses the prosthetic heart valve device  110  in the capsule housing  126 . The end cap  128  may have an opening  130  at its distal end through which the guidewire  120  can be threaded to allow for guidewire delivery to the target site. As shown in  FIG. 1 , the end cap  128  can also have an atraumatic shape (e.g., a partially spherical shape, a frusto-conical shape, blunt configuration, rounded configuration, etc.) to facilitate atraumatic delivery of the delivery capsule  106  to the target site. In certain embodiments, the end cap  128  can also house a portion of the prosthetic heart valve device  110 . 
       FIGS. 2A and 2B  illustrate the prosthetic heart valve device  110  in the containment configuration ( FIG. 2A ) and in the deployment configuration ( FIG. 2B ). For the purpose of illustration,  FIG. 2A  and  FIG. 2B  illustrate a portion of the system  100  positioning the prosthetic heart valve device  110  in a native mitral valve of a heart using a trans-apical delivery approach. Other approaches may be utilized, such as a trans-septal delivery approach. Referring to  FIG. 2A , the guide catheter  140  is positioned in a trans-apical opening  141  to provide access to the left ventricle LV, with the catheter  102  extending through the guide catheter  140  such that the distal portion  108   b  of the catheter body  108  projects beyond the distal end of the guide catheter  140 . The delivery capsule  106  may then be positioned between a posterior leaflet PL and an anterior leaflet AL of a mitral valve MV. Using the control unit  104  ( FIG. 1 ), the catheter body  108  can be moved in the superior direction (as indicated by arrow  149 ), the inferior direction (as indicated by arrow  151 ), and/or rotated along the longitudinal axis of the catheter body  108  to position the delivery capsule  106  at a desired location and orientation within the opening of the mitral valve MV. 
     At the target location, the delivery capsule  106  can be driven from the containment configuration ( FIG. 2A ) towards the deployment configuration ( FIG. 2B ) to partially or fully deploy the prosthetic heart valve device  110  from the delivery capsule  106 . Referring to  FIG. 2B , in trans-apical delivery approaches, an example device such as prosthetic heart valve device  110  may be deployed from the delivery capsule  106  by drawing the capsule housing  126  proximally (i.e., further into the left ventricle LV) and, optionally, moving the end cap  128  distally (i.e., further into the left atrium LA). As the prosthetic heart valve device  110  exits the capsule housing  126 , the prosthetic heart valve device  110  may expand to secure the prosthetic heart valve device  110  in the mitral valve MV. 
     The examples provided are described herein with reference to devices, systems, and methods for crimping, loading, and delivering prosthetic heart valve devices to a native mitral valve. However, other applications and other embodiments in addition to those described herein are within the scope of the present technology. For example, at least some embodiments of the present technology may be useful for delivering prosthetics to other native valves, such as the tricuspid valve or the aortic valve. 
     As discussed, prosthetic heart valve devices may be packaged and stored in their expanded state until just before implantation into a patient. For example, a prosthetic heart valve device such as prosthetic heart valve device  110  may be stored in a sterile solution up until the time the prosthetic heart valve device is ready to be loaded into a delivery system such as system  100  ( FIG. 1 ) for implantation. As a result, during an implantation procedure, prosthetic heart devices are often crimped in the operating room from an expanded cross-sectional dimension to a configuration suitable to fit into a delivery capsule such as a delivery capsule  106 . Such procedures benefit from crimping devices that are highly portable and readily available as a sterile system. 
       FIG. 3  shows a schematic illustration of a crimping device  300  for reducing the size of a prosthetic heart valve device in accordance with the present technology. In particular, the crimping device  300  can be used to crimp or compact the prosthetic heart valve device to enable the prosthetic heart valve device to be loaded into a delivery system for percutaneously delivering the prosthetic heart valve device to a patient. In some embodiments, the prosthetic heart valve device can be a prosthetic heart valve device. For example, the prosthetic heart valve device may be a mitral valve device for implantation into a native mitral valve and the delivery system can be a delivery system for delivering the mitral valve device to the native mitral valve, such as one or more of the mitral valve devices and/or delivery systems disclosed in (1) International Patent Application NO. PCT/US2014/029549, filed Mar. 14, 2014, (2) International Patent Application NO. PCT/US2012/061219, filed Oct. 19, 2012, (3) International Patent Application NO. PCT/US2012/061215, filed Oct. 19, 2012, (4) International Patent Application NO. PCT/US2012/043636, filed Jun. 21, 2012, (5) U.S. patent application Ser. No. 15/490,047, filed Apr. 18, 2017, and (6) U.S. patent application Ser. No. 15/490,008, filed Apr. 18, 2017, each of which is incorporated herein by reference in its entirety. 
     As illustrated at  FIG. 3 , the crimping device  300  is configured to utilize a pusher  362  and a funnel  354  to crimp a prosthetic heart valve device placed between the pusher  362  and the funnel  354 . With the prosthetic heart valve device appropriately positioned between the pusher  362  and the funnel  354 , the crimping device  300  is configured to crimp the prosthetic heart valve device by translating the pusher  362  into the funnel  354  and precipitating contact between the prosthetic heart valve device and an internal surface of the funnel  354 . The internal surface of the funnel  354  exerts substantially uniform inward radial forces on the prosthetic heart valve device as the pusher  362  drives the prosthetic heart valve device into the funnel  354 . The internal surface of the funnel  354  tapers down from a larger distal opening  358  to a smaller proximal opening  356  in order to substantially maintain the inward radial forces around the prosthetic heart valve device as the prosthetic heart valve device decreases in size, and as the pusher  362  continues to translate the prosthetic heart valve device into the funnel  354 . A portion of the pusher  362  may be configured to flex or pivot toward the center axis C as the internal surface of the funnel  354  exerts inward radial forces on the prosthetic heart valve device. For example, pusher  362  may include a base section  364  and a plurality of fingers  366 , with one or more of the plurality of fingers  366  configured to pivot at base section  364  such that the one or more of the plurality of fingers  366  deflects inward toward central axis C in response to the inward radial forces exerted by funnel  354 . 
     The crimping device  300  is configured to displace the pusher  362  in a direction substantially parallel to the central axis C using a piston-cylinder group  360  generally positioned at a distal end  374  of crimping device  300  (“crimping device distal end  374 ”). As will be discussed, a pressurized fluid delivered to the piston-cylinder group  360  via a fluid port  376  may cause a piston (not shown) within piston-cylinder group  360  to translate in a direction from the crimping device distal end  374  to a proximal end  372  of the crimping device  300  (“crimping device proximal end  372 ”). The piston may be mechanically coupled to the pusher  362 , such that a hydraulically-driven displacement of the piston causes pusher  362  to translate in the direction substantially parallel to the central axis C. As discussed, translation of the pusher  362  in this manner may precipitate contact between a prosthetic heart valve device and the internal surface of the funnel  354 , when the prosthetic heart valve device is positioned between the pusher  362  and the funnel  354 . Funnel  354  and piston-cylinder group  360  are attached to a housing  352 . 
     Regarding the terms “distal” and “proximal” within this description, unless otherwise specified, the terms may reference relative positions of a portion of a crimping device. In some examples, the terms may reference an operator of a crimping device and/or a location in the vasculature or heart. For example, “proximal” may refer to a position closer to the operator of a crimping device or an incision into the vasculature, and “distal” may refer to a position that is more distant from the operator of the crimping device or further from the incision along the vasculature; However, the terms “distal” and “proximal” are not limited to these descriptions. In some cases, an operator of a crimping device may be closer to a portion of the crimping device described as distal, may be more distant to a portion of the crimping device described as proximal. 
     A schematic illustration of a crimping device  400  is further illustrated at  FIG. 4 .  FIG. 4  provides a schematic cross-section taken over a cutting plane perpendicular to a central axis C 4 . As illustrated, the central axis C 4  intersects a distal opening  458  and a proximal opening  456  of funnel  454 . Crimping device  400  includes a housing  452 , a funnel  354 , a proximal opening  356 , a distal opening  358 , a piston-cylinder group  360 , a pusher  362 , a crimping device proximal end  372 , and a crimping device distal end  374 , which may be configured similarly to and operate relative to other crimping device components in the same manner as the like-named components of the crimping device  300 . Likewise, the components of the crimping device  400  discussed below may be present in the crimping device  300 , and may be configured similarly to and operate relative to other crimping device components in the same manner as discussed for the crimping device  400 . 
     An internal surface  470  of a funnel  454  at least partially surrounds the central axis C 4  and extends between a distal opening  458  and a proximal opening  456  of the funnel  454 . The internal surface  470  tapers down from the distal opening  458  to the proximal opening  456 . A piston-cylinder group  460  comprises a piston cylinder  489  and a piston  468 , with the piston  468  configured to slidably translate in the piston cylinder  489 . A piston chamber  478  is bounded at least in part by the piston cylinder  489  and a portion of the piston  468 . A pusher  462  is mechanically coupled with the piston  468 , such that the piston  468  displaces the pusher  462  in a direction substantially parallel to the central axis C 4  when the piston  468  slidably translates in the piston cylinder  489 . 
     Here and elsewhere, when a displacement and/or length is substantially parallel to a central axis, this may mean a line parallel to the displacement and/or length is either parallel to the central axis or has an angle of intersection with the central axis of less than 30 degrees. In some examples, the angle of intersection may be less than 10 degrees, In some examples, the angle of intersection may be less than 5 degrees, and in other examples, less than 1 degree. 
     The pusher  462  may be configured to flex or pivot in order to accommodate the decreasing cross-sectional area of the internal surface  470  as the pusher  462  translates into the funnel  454  during a crimping operation. For example, the pusher  462  may comprise a base section  464  and a plurality of fingers  466  extending from the base section  464  toward the distal opening  458 . Fingers such as a finger  465  and a finger  467  in the plurality of fingers  466  may be configured to pivot inward at the base section  464  in response to a force toward the central axis C 4 . The pivoting action may allow the pusher  462  to drive a prosthetic heart valve device positioned between the pusher  462  and the proximal opening  456  of the funnel  454  into contact with internal surface  470 , so that the internal surface  470  may exert substantially uniform inward radial forces on the prosthetic heart valve device during a crimping operation. 
     For example,  FIG. 5  illustrates the crimping device  400  with a prosthetic heart valve device  482  positioned between the pusher  462  and the funnel  454 . Prosthetic heart valve device  482  may be an example of prosthetic heart valve device  110  ( FIGS. 1, 2A, 2B ). The piston  468  is configured to displace the pusher  462  in a direction substantially parallel to the central axis C 4  when the piston  468  slidably translates in the piston cylinder  489 . For example, a pressurized fluid may be delivered to piston chamber  478  via a fluid port  476 , and the pressurized fluid may act on a piston head  490  to cause the piston  468  to slidably translate in the piston cylinder  489  in a direction from the crimping device distal end  474  to the crimping device proximal end  472 . The sliding translation of the piston  468  may drive the pusher  462  and the prosthetic heart valve device  482  in a direction substantially parallel to the central axis C 4  and toward the distal opening  458  of the funnel  454 . An O-ring  497  may extend around the piston  468  to provide a fluid barrier between the piston chamber  478  and any clearances between the piston  468  and the piston cylinder  489 . 
       FIG. 6  illustrates the crimping device  400  with the piston  468  having slidably translated over a stroke length D within the piston cylinder  489  as a result of, for example, a pressurized fluid supplied to the piston chamber  478  via the fluid port  476 . The pusher  462 , and the prosthetic heart valve device  482 , have been displaced by the sliding translation of the piston  468  such that some portion of the pusher  462  is between the distal opening  458  and the proximal opening  456 , and the prosthetic heart valve device  482  is in contact with the tapering internal surface  470  of funnel  454 . The tapering internal surface  470  exerts substantially uniform inward radial forces (e.g., toward central axis C 4 ) on the prosthetic heart valve device  482  as the pusher  462  drives the prosthetic heart valve device  482  from the distal opening  458  toward the proximal opening  456 . Further, as the plurality of fingers  466  experience an inward radial force toward central axis C 4  as prosthetic heart valve device  482  contacts internal surface  470 , the plurality of fingers  466  pivot inward from base section  464  toward the central axis C, in order to accommodate the decreasing cross-sectional area of internal surface  470  as pusher  462  translates into funnel  454  during the crimping operation. 
     In this manner, the crimping device  400  is configured to utilize the pusher  462  and the funnel  454  to crimp the prosthetic heart valve device  482  when the prosthetic heart valve device  482  is appropriately positioned between the pusher  462  and the proximal opening  456  of the funnel  454 . The crimping device  400  is configured to translate the pusher  462  into the funnel  454  and precipitate contact between prosthetic heart valve device  482  and the internal surface  470  of the funnel  454 . The internal surface  470  exerts substantially uniform inward radial forces on prosthetic heart valve device  482  as the pusher  462  drives the prosthetic heart valve device  482  toward proximal opening  456 . The internal surface  470  tapers down from the larger distal opening  458  to the smaller proximal opening  456  in order to substantially maintain the inward radial forces around the prosthetic heart valve device  482  as the prosthetic heart valve device  482  decreases in size and the pusher  462  continues to translate the prosthetic heart valve device  482  into funnel  454 . Crimping device  400  may thus be utilized to crimp a prosthetic heart valve device such as prosthetic heart valve device  110  ( FIGS. 1, 2A, 2B ) from an expanded cross-sectional dimension to a configuration suitable to fit into a delivery capsule such as a delivery capsule  106  ( FIGS. 1, 2A, 2B ). 
     Returning to  FIG. 4 , the distal opening  458  and/or the proximal opening  456  of funnel  454  may be a rounded opening, such as a substantially circular opening, an elliptical opening, an oval shaped opening, and the like. The shape of distal opening  458  and/or proximal opening  456  may correspond to or otherwise be based on a shape of the prosthetic heart valve device to be compressed. As discussed, the distal opening  458  is generally a larger opening than the proximal opening  456 . In examples, the distal opening  458  defines a distal opening dimension (e.g., a first diameter) substantially perpendicular to the central axis C, and the proximal opening  456  defines a proximal opening dimension (e.g., a second diameter) substantially perpendicular to the central axis C 4 , and the distal opening dimension is greater than the proximal opening dimension. In some examples, the pusher  462  defines a pusher dimension (e.g., a maximum diameter) substantially perpendicular to the central axis C 4 , and the distal opening dimension is greater than the pusher dimension. The distal opening  458  and/or the proximal opening  456  may be co-planer with a plane having any orientation relative to the central axis C 4 . The distal opening  458  and/or the proximal opening  456  may be co-planer with a plane intersected by the central axis C. In some examples, the distal opening  458  and/or the proximal opening  456  are co-planer with a plane substantially perpendicular to the central axis C 4 . 
     The internal surface  470  at least partially surrounds the central axis C 4  and extends between the distal opening  458  and the proximal opening  456 . The internal surface  470  may be configured to exert substantially uniform inward radial forces (e.g., toward the central axis C 4 ) on a prosthetic heart valve device positioned between the pusher  462  and the funnel  454  as the pusher  462  drives the prosthetic heart valve device into the funnel  454 . The internal surface  470  tapers down from the distal opening  458  to the proximal opening  456 , and the taper may alter between the distal opening  458  and the proximal opening  456 . The altering taper may be configured to accommodate a decreasing dimension (e.g., diameter) of the prosthetic heart valve device  482  as the prosthetic heart valve device is displaced toward proximal opening  456 . The altering taper may be configured to substantially maintain a certain amount of inward radial force for a given prosthetic heart valve device  482  dimension (e.g., diameter) based on, for example, the expected size of a section of the prosthetic heart valve device  482  at a certain displacement between distal opening  458  and proximal opening  456 . 
     In some examples, the internal surface  470  defines a first taper T 1  and a second taper T 2  between the distal opening  458  and the proximal opening  456 , with the first taper T 1  defining a first angle θ 1  relative to the central axis C 4  and the second taper T 2  defining a second angle θ 2  relative to the central axis C 4 . In examples, the first angle θ 1  is greater than the second angle θ 2 . Here, an angle of a specific taper relative to the central axis C 4  means the angle between a vector co-planer with the central axis C 4  and parallel to a surface having the specific taper. 
     In some examples, some portion of the internal surface  470  may comprise a generatrix G, and the portion of the internal surface  470  may be a surface of revolution defined by a complete or partial revolution of the generatrix G around the central axis C 4 . The generatrix G may have an increasing or decreasing concavity in a direction from the crimping device distal end  474  toward the crimping device proximal end  472 . In some examples, the first taper T 1  is at least partially defined by a complete or partial revolution of a first generatrix around the central axis C 4 , and /or the second taper T 2  is at least partially defined by a complete or partial revolution of a second generatrix around the central axis C 4 , where the first generatrix and/or the second generatrix may be a straight or curvilinear line segment. 
     The funnel  454  may comprise a distal funnel section  453  and a proximal funnel section  455 . The internal surface  470  may comprise some portion of distal funnel section  453  and come portion of proximal funnel section  455 . The distal funnel section  453  may comprise the distal opening  458 , and the proximal funnel section  455  may comprise the proximal opening  456 . The distal funnel section  453  and the proximal funnel section  455  may comprise discrete parts which meet at a section border  480  using a suitable connection mechanism. For example, the distal funnel section  453  and the proximal funnel section  455  may be configured to join and meet at the section border  480  with a threaded connection, an interference fit connection, a snap-fit connection, a spring-loaded connection, or any other type of connection suitable for joining the distal funnel section  453  and the proximal funnel section  455 . 
     The plurality of fingers  466  may be configured to accommodate the taper of internal surface  470  as the plurality of fingers displace from the distal opening  458  toward the proximal opening  456 . For example, one of more fingers of the plurality of fingers  466  such as the finger  465  may comprise a free end  484  and a pivoting end  486 , with the pivoting end  486  attached to the base section  464  of pusher  462 . The finger  465  may be configured to pivot toward the central axis C 4  when the central axis C 4  intersects the base section  464  and a force toward the central axis C 4  such as F is applied to the free end  484 . The finger  465  may be resiliently biased to return to a relaxed, substantially stress-free position when the force F is removed. Thus, the plurality of fingers  466  may be configured such that one or more fingers pivot inward as the plurality of fingers  466  displaces from the distal opening  458  toward the proximal opening  456 , and internal surface  470  exerts forces toward central axis C 4  on the one or more fingers. The one or more fingers such as finger  465  may return to a relaxed, substantially zero-stress position (such as illustrated at  FIG. 3 ) when the plurality of fingers  466  is positioned between the distal opening  458  and the piston  468 . 
     The pivoting end  486  may have any configuration suitable for finger  465  to pivot inward toward central axis C 4 . The pivoting end  486  allow be integrally formed with base section  464  and comprise a flexible material, with the flexible material having material properties that allow for elastic bending of the pivoting end  486  as internal surface  470  applies a force on finger  465  toward central axis C 4 . The pivoting end  486  may be a mechanical joint (e.g., a rotary joint) configured to pivot toward central axis C 4  when internal surface  470  applies a force on finger  465  toward central axis C 4 . 
     The piston  468  may displace over a stroke length D ( FIG. 6 ). The stroke length D may be substantially parallel to central axis C 4 . In examples, crimping device  400  is configured such that, when piston  468  displaces over a stroke length D in a direction d 1  from the crimping device distal end  474  toward the crimping device proximal end  472 , at least some portion of pusher  462  is proximal to distal opening  458 . In some examples, when piston  468  displaces over a stroke length D in the direction d 1 , the distal opening  458  is between at least some portion of pusher  462  and the piston  468 . In some examples, when piston  468  displaces over a stroke length D in the direction d 1 , at least some portion of pusher  462  is between the distal opening  458  and the proximal opening  456 . Piston  468  may displace over a stroke length D in the direction d 1  sufficient to position some portion of pusher  462  proximally beyond proximal opening  456 , such that proximal opening  456  is between the portion of pusher  462  and piston  468 . 
     In some examples, crimping device  400  is configured to establish a maximum stroke length of the piston  468 , in order to reduce a risk of over-crimping, reduce burden on a clinician responsible for the delivery of pressurized fluid through fluid port  476 , or for some other reason. For example, a cylinder vent  488  may be configured to establish fluid communication through piston cylinder  489 . The cylinder vent  488  may be configured to extend through piston cylinder  489  such that, at the maximum stroke length of piston  468 , piston head  490  has traveled proximally beyond cylinder vent  488  sufficiently to allow cylinder vent  488  to establish fluid communication between piston chamber  478  and an atmosphere and/or volume outside of piston chamber  478 . The fluid communication via cylinder vent  488  may allow a pressurized fluid within piston chamber  478  to vent through cylinder vent  488  rather than fully acting on piston head  490 , ceasing or reducing the displacement of piston  468  in the direction d 1 . In some examples, crimping device  400  may include a mechanical stop (not shown) which resists further displacement of piston  468  within piston cylinder  489  in the direction d 1 . The mechanical stop may be configured to contact or abut the piston  468  and prevent further travel in the direction d 1  when the maximum stroke length is achieved. The mechanical stop may be affixed to piston cylinder  489 , or affixed to some other portion of crimping device  400  such as housing  452 , funnel  454 , or some other section configured to remain stationary relative to the displacement of piston  468 . 
     The piston  468  may mechanically engage the pusher  462  in any manner sufficient to cause displacement of the pusher  462  in a distal and/or proximal direction when the piston  468  translates within the piston cylinder  489 . The pusher  462  may be attached to piston  468  using any suitable technique, such as, but not limited to, adhesives, engineering fits, fusion, friction, or welding or soldering. The connection between the pusher  462  and the piston  468  may be substantially permanent, or, alternatively, may be configured to enable separation of the pusher  462  and the piston  468 , such that the pusher  462  and the piston  468  remain substantially usable upon separation. In some examples, pusher  462  and piston  468  mechanically communicate via a removable attachment which may be initiated and terminated manually by hand and without the use of additional tools. This may enable a clinician to relatively easily attach and detach pusher  462  from piston  468 . This may be advantageous, for example, when a prosthetic heart valve device  110 ,  482  ( FIGS. 1, 2A, 2B, 5, 6 ) is configured to be loaded into a crimping device  400  with pusher  462  already in mechanical communication with prosthetic heart valve device  110 ,  482 . For example, when prosthetic heart valve device  110 ,  482  is supplied attached to a pusher such as pusher  462 . 
     In some examples, either the pusher  462  or the piston  468  may define a protrusion, and the other of the pusher  462  or the piston  468  may define a recess configured to receive the protrusion.  FIG. 7  illustrates a portion of a crimping device  700  including a piston  768  configured to translate with a piston cylinder  789 , and a pusher  762  including a base section  764  and plurality of fingers  766 .  FIG. 7  is a cross-section view taken over a cutting plane perpendicular to a central axis C 7  extending through the portion of crimping device  700 . Piston  768 , piston cylinder  789 , pusher  762 , base section  764 , and plurality of fingers  766  may be configured similarly to and operate relative to other crimping device components in the same manner as the like-named components of crimping device  300  and crimping device  400 . As illustrated by  FIG. 7 , pusher  762  includes a protrusion  791  and piston  768  includes a recess  792 . Recess  792  is configured to receive protrusion  791  to allow for mechanical engagement of pusher  762  with piston  768 . This arrangement may enable relatively easily attachment and/or detachment of pusher  762  from piston  768  by a clinician during an implantation procedure or otherwise. 
     In some examples, the plurality of fingers may be configured to substantially maintain a prosthetic heart valve device between some portion of a first finger and some portion of a second finger comprising the plurality of fingers. The first finger and the second finger may be configured to have opposing bearing surfaces, where the bearing surfaces may be configured to engage opposite sides of a portion of a prosthetic heart valve device when the prosthetic heart valve device is positioned on the plurality of fingers. For example,  FIG. 7  illustrates a first finger  761  having a bearing surface  703  (“first finger bearing surface  703 ”) and a second finger  763  having a bearing surface  705  (“second finger bearing surface  705 ”). First finger bearing surface  703  may substantially face toward longitudinal axis C 7  while second finger bearing surface  705  may substantially face away from longitudinal axis C 7 . In examples, when first finger  761  and second finger  763  are in a relaxed, substantially zero-stress position, first finger bearing surface  703  is displaced farther from central axis C 7  than second finger bearing surface  705 . In some examples, when a funnel such as funnel  354 ,  454  exerts a force on the plurality of fingers  766  in a direction toward central axis C 7 , first finger bearing surface  703  is displaced farther from central axis C 7  than second finger bearing surface  705 . First finger bearing surface  703  may be adjacent to a free end of first finger  761 , and second finger bearing surface  705  may be adjacent to a free end of second finger  763 . 
     The crimping device may include a central lumen extending centrally through the piston and the pusher. The central lumen may provide access by a delivery system such as delivery system  100  either distally or proximally. For example,  FIG. 8  schematically illustrate a crimping device  800  including a central lumen  894 .  FIG. 9  provides a schematic cross-section of the crimping device  800  taken over a cutting plane perpendicular to a central axis C 8 , and illustrates the central lumen  894  extending into crimping device  800 . Crimping device  800  includes a housing  852 , a funnel  854 , a distal funnel section  853 , a proximal funnel section  855 , a proximal opening  856 , a distal opening  858 , a piston-cylinder group  860  including a piston  868  (and piston head  890 ) and piston cylinder  889 , a pusher  862 , a crimping device proximal end  872 , a crimping device distal end  874 , a fluid port  876 , and an O-ring  897 , which may be configured similarly to and operate relative to other crimping device components in the same manner as the like-named components of the crimping device  300  and/or crimping device  400 . Likewise, the components of the crimping device  800  discussed below may be present in the crimping device  300  and/or crimping device  400 , and may be configured similarly to and operate relative to other crimping device components in the same manner as discussed for the crimping device  800 . 
     As illustrated by  FIG. 9 , the central lumen  894  may extend through piston-cylinder group  860  and at least partially surround the central axis C 8 . The central axis C 8  intersects the distal opening  858  and the proximal opening  856  of funnel  854 . The central lumen  894  may be in fluid communication with a piston opening  895  and a pusher opening  896 , such that the central lumen  894 , the piston opening  895 , and the pusher opening  896  substantially form a single passage accessible from both the crimping device proximal end  872  and the crimping device distal end  874 . In some configurations, such as the transfemoral delivery system, it may be advantageous to pass the delivery system through the central lumen in order to attach a prosthetic heart valve device to a delivery system in an opposite orientation to other configurations, such as the transapical delivery system. This may allow for different directions of approach to the native anatomy and different deployment orientations for the clinician during use. 
     The central lumen  894  surrounds longitudinal axis C 8  and extends through the piston cylinder  889 . The piston cylinder  889  is configured to substantially surround some portion of the central lumen  894 . The piston cylinder  889  may comprise an exterior wall  892  and an interior wall  891 , where the interior wall  891  is between the exterior wall  892  and the central axis C 8 . The interior wall  891  may define an inner wall of the central lumen  894 . The interior wall  891  and/or the exterior wall  892  may define any cross-section perpendicular to the central axis C 8 . For example, the interior wall  891  and/or the exterior wall  892  may define an elliptical (including circular) cross-section, an oval-shaped cross-section, a regular or irregular polygonal cross-section, or some other cross-sectional shape which surrounds at least some portion of the central axis C 8 . 
     The piston  868  is configured to translate within piston cylinder  889  and form a piston chamber bounded at least in part by piston cylinder  889  and a piston head  890  of piston  868 . The O-ring  897  extends around an exterior-facing perimeter of piston  868  to provide a fluid barrier between the piston chamber formed and any clearances between piston  868  and exterior wall  892 . A second O-ring  898  extends around an interior-facing perimeter of piston  868  to provide a fluid barrier between the piston chamber formed and any clearances between piston  868  and interior wall  891 . A pressurized fluid delivered via a fluid port  876  may act on the piston head  890  and cause the piston  868  to translate in a direction from the crimping device distal end  874  to the crimping device proximal end  872 . Fluid port  876  may comprise a Luer fitting or other type of suitable fitting for the delivery of a pressurized fluid. 
     The piston  868  is mechanically coupled to the pusher  862 , such that a hydraulically-driven displacement of the piston  868  causes pusher  862  to translate in the direction substantially parallel to the central axis C 8 . In order to allow access throughout crimping device  800  (either proximally or distally), the pusher  862  may include pusher opening  896 . Pusher opening  896  extends through pusher  862  and at least partially surrounds central axis C 8 . Pusher opening  896  is in fluid communication with central lumen  894 . 
     As before, translation of the pusher  862  may precipitate contact between a prosthetic heart valve device and the internal surface  870  of the funnel  854 , when the prosthetic heart valve device is positioned between the pusher  862  and the funnel  854 . Funnel  854  and piston cylinder  889  are attached to housing  852 . For example,  FIG. 10  illustrates the crimping device  800  with the piston  868  having slidably translated over a stroke length D 8  within the piston cylinder  889  as a result of, for example, a pressurized fluid supplied to the piston chamber  878  via the fluid port  876 . The pusher  862  has been displaced by the sliding translation of the piston  868  such that some portion of the pusher  862  is between the distal opening  858  and the proximal opening  856  of funnel  854 . In this manner, the crimping device  800  is configured to utilize the pusher  862  and the funnel  854  to crimp a prosthetic heart valve device when the prosthetic heart valve device is appropriately positioned between the pusher  862  and the proximal opening  856  of the funnel  854 . 
     The piston of the crimping device may be a base piston connected to the pusher. The base piston and the pusher may be connected via an extending member. For example,  FIG. 11  illustrates a crimping device  1100  which includes a housing  1152 , a funnel  1154 , a distal funnel section  1153 , a proximal funnel section  1155 , a proximal opening  1156 , a distal opening  1158 , a piston-cylinder group  1160  including a piston  1168  (configured as a base piston), piston head  1190 , and piston cylinder  1189 , a pusher  1162 , a crimping device proximal end  1172 , a crimping device distal end  1174 , a fluid port  1176 , piston chamber  1178 , and an O-ring  1197 , which may be configured similarly to and operate relative to other crimping device components in the same manner as the like-named components of the crimping device  300 , crimping device  400 , and/or crimping device  800 . An extending member  1193  connects base piston  1168  and pusher  1162 , with extending member configured such that displacement of base piston  1168  is a direction substantially parallel to longitudinal axis C 11  causes extending member  1193  to displace pusher  1162  in the direction substantially parallel to longitudinal axis C 11 . The use of a relatively large base piston and an extender as illustrated at  FIG. 11  may allow a reduction in the physical footprint of crimping device  1100 , and/or may allow an increase in the force delivered to pusher  1162  for a given pressure of fluid through fluid port  1176 , as compared to smaller pistons. In examples, piston  1168  has a maximum piston dimension perpendicular to longitudinal axis C 11  (such as a diameter) and extending member  1193  has a maximum extending dimension perpendicular to C 11  (such as another diameter), and the maximum piston diameter is greater than or equal to the maximum extending dimension. 
     The pusher of the crimping device may be configured such that the piston inserts into the base section in order to displace the pusher toward the distal opening of the funnel. For example,  FIG. 12  illustrates crimping device  1200  which includes a housing  1252 , a funnel  1254 , a distal funnel section  1253 , a proximal funnel section  1255 , a proximal opening  1256 , a distal opening  1258 , a piston-cylinder group  1260  including a piston  1268 , piston head  1290 , and piston cylinder  1289 , a pusher  1262 , a crimping device proximal end  1272 , a crimping device distal end  1274 , a fluid port  1276 , piston chamber  1278 , and an O-ring  1297 , which may be configured similarly to and operate relative to other crimping device components in the same manner as the like-named components of the crimping device  300 , crimping device  400 , crimping device  800 , and/or crimping device  1100 . Pusher  1262  includes a base section  1264  configured to receive some portion of piston  1268 . An arrangement whereby piston  1268  inserts into pusher  1262  as piston  1268  displaces pusher  1262  toward distal opening  1258  may allow a reduction in the physical footprint of crimping device  1200 . Piston  1268  may be configured to engage pusher  1262  in any manner whereby piston  1268  translates pusher  1262  toward distal opening  1258  when piston  1268  translates toward distal opening  1258 . For example, piston  1268  may be attached to pusher  1262  with a mechanical or other attachment means such that piston  1268  is substantially fixably attached to pusher  1262 , or piston  1268  and/or pusher  1262  may be configured such that pusher  1262  may slidably translate over piston  1268 . 
       FIG. 13  illustrates a flow diagram of an example technique  1300  for crimping a prosthetic heart valve device. Although the technique is described with various reference to crimping device  300  ( FIG. 3 ), crimping device  400  ( FIGS. 4, 5, 6 ) crimping device  800  ( FIGS. 8, 9, 10 ), crimping device  1100  ( FIG. 11 ), and/or crimping device  1200  ( FIG. 12 ) in other examples, the technique may be used with another crimping device. One or more steps, or all steps, may be conducted with the crimping device and the prosthetic heart valve device submerged in a solution, such as a saline solution. The crimping device and the prosthetic heart valve device may remain submerged at least until the prosthetic heart is loaded into the delivery capsule of a delivery system, such as delivery capsule  106  of delivery system  100 . 
     The technique includes placing a prosthetic heart valve device  110 ,  482  between a pusher  362 ,  462 ,  862 ,  1162 ,  1262  and a distal opening  358 ,  458 ,  858   1158 ,  1258  of a funnel  354 ,  454 ,  854 ,  1154 ,  1254  wherein the funnel  354 ,  454 ,  854 ,  1154 ,  1254  comprises the crimping device  300 ,  400 ,  800 ,  1100 ,  1200  ( 1302 ). The pusher  362 ,  462 ,  862 ,  1162 ,  1262  may be mechanically coupled to a piston  468 ,  868 ,  1168 ,  1268  of a piston-cylinder group  360 ,  460 ,  860 ,  1160 ,  1260  comprising the crimping device  300 ,  400 ,  800 ,  1100 ,  1200 . The pusher  362 ,  462 ,  862 ,  1162 ,  1262  may include a plurality of fingers  366 ,  466 ,  866  with one or more fingers configured to pivot toward a central axis C, C 4 , C 8 , C 11 , C 12  of the crimping device  300 ,  400 ,  800 ,  1100 ,  1200  when a force in a direction toward central axis C, C 4 , C 8 , C 11 , C 12  is applied to a free end of the one or more fingers. The prosthetic heart valve device  110 ,  482  may be positioned to at least partially cover and/or surround the free end of the one or more fingers. 
     The technique includes delivering a pressurized fluid to a piston cylinder  489 ,  889 ,  1189 ,  1289  of the crimping device  300 ,  400 ,  800 ,  1100 ,  1200  ( 1304 ). The pressurized fluid may be delivered to the piston cylinder  489 ,  889 ,  1189 ,  1289  via a fluid port  376 ,  476 ,  876 ,  1176 ,  1276  in fluid communication with the piston cylinder  489 ,  889 ,  1189 ,  1289 . The pressurized fluid may exert a pressure on a piston head  490 ,  890 ,  1190 ,  1290  causing the piston  468 ,  868 ,  1168 ,  1268  to translate within piston cylinder  489 ,  889 ,  1189 ,  1289  in a direction from a crimping device distal end  374 ,  474 ,  874 ,  1174 ,  1274  to a crimping device proximal end  372 ,  472 ,  872 ,  1172 ,  1272 . Fluid port  376 ,  476 ,  876 ,  1176 ,  1276  may include a Luer fitting. The pressurized fluid may be delivered to fluid port  376 ,  476 ,  876 ,  1176 ,  1276  from any source suitable for delivery of a pressurized fluid, such as a syringe, an inflation device, a pump, or some other device configured to contain the fluid and exert a pressure on the contained fluid. 
     The technique includes translating piston  468 ,  868 ,  1168 ,  1268  within piston cylinder  489 ,  889 ,  1189 ,  1289  in a direction substantially parallel to the central axis C, C 4 , C 8 , C 11 , C 12  and from the crimping device distal end  374 ,  474 ,  874 ,  1174 ,  1274  to the crimping device proximal end  372 ,  472 ,  872 ,  1172 ,  1272  ( 1306 ). The technique includes displacing the pusher  362 ,  462 ,  862 ,  1162 ,  1262  in the direction substantially parallel to the central axis C, C 4 , C 8 , C 11 , C 12  using the translation of piston  468 ,  868 ,  1168 ,  1268  within piston cylinder  489 ,  889 ,  1189 ,  1289 . 
     The technique includes advancing the prosthetic heart valve device  110 ,  482  in the direction substantially parallel to the central axis C, C 4 , C 8 , C 11 , C 12  and toward the distal opening  358 ,  458 ,  858 ,  1158 ,  1258  of the funnel  354 ,  454 ,  854 ,  1154 ,  1254  using the translation of the pusher  362 ,  462 ,  862 ,  1162 ,  1262  ( 1308 ). The technique may include advancing the prosthetic heart valve device  110 ,  482  into the funnel  354 ,  454 ,  854 ,  1154 ,  1254  (e.g., between the distal opening  358 ,  458 ,  858 ,  1158 ,  1258  and a proximal opening  356 ,  456 ,  856 ,  1156 ,  1256  of funnel  354 ,  454 ,  854 ,  1154 ,  1254 ). The technique may include contacting the prosthetic heart valve device  110 ,  482  and an internal surface  470 ,  870  of the funnel  354 ,  454 ,  854 ,  1154 ,  1254 . The internal surface  470 ,  870  of the funnel  354 ,  454 ,  854 ,  1154 ,  1254  may exerts substantially uniform inward radial forces on the prosthetic heart valve device  110 ,  482  as the pusher  362 ,  462 ,  862 ,  1162 ,  1262  advanced the prosthetic heart valve device  110 ,  482  into the funnel  354 ,  454 ,  854 ,  1154 ,  1254 . The technique may include compressing the prosthetic heart valve device  110 ,  482  using the contact between the prosthetic heart valve device  110 ,  482  and the internal surface  470 ,  870  as the pusher  362 ,  462 ,  862 ,  1162 ,  1262  advances the prosthetic heart valve device  110 ,  482  in the funnel  354 ,  454 ,  854 ,  1154 ,  1254 . 
       FIG. 14  schematically illustrate a crimping device  1400  including a central lumen  1494  in accordance with another embodiment hereof.  FIGS. 15 and 16  provide schematic cross-sections of the crimping device  1400  taken over a cutting plane perpendicular to a central axis C 14 , and illustrate, inter alia, the central lumen  1494  extending within the crimping device  1400 . With reference to  FIGS. 14-18 , the crimping device  1400  includes a housing  1452 , a funnel  1454 , a distal funnel section  1453 , a proximal funnel section  1455 , a proximal opening  1456 , a distal opening  1458 , a piston-cylinder group  1460  including a piston  1468  (and piston head  1490 ) and a piston cylinder  1489 , a pusher  1462 , a crimping device proximal end  1472 , a crimping device distal end  1474 , a fluid port  1476 , and O-rings  1497 ,  1498 , which may be configured similarly to and operate relative to other crimping device components in the same manner as the like-named components of the crimping devices  300 ,  400 ,  800 . Likewise, the components of the crimping device  1400  discussed below may be present in the crimping devices  300 ,  400 ,  800  and may be configured similarly to and operate relative to other crimping device components in the same manner as discussed for the crimping device  1400 . 
     As illustrated by  FIGS. 15 and 16 , the central lumen  1494  may extend through the piston-cylinder group  1460  and at least partially surround the central axis C 14 . The central axis C 14  intersects the distal opening  1458  and the proximal opening  1456  of the funnel  1454 . In an embodiment that is similar to that shown in  FIGS. 8-10 , the central lumen  1494  may be in fluid communication with a piston opening and a pusher opening, such that the central lumen  1494 , the piston opening, and the pusher opening substantially form a single passage accessible from both the crimping device proximal end  1472  and the crimping device distal end  1474 . In some configurations, such as the transfemoral delivery system, it may be advantageous to pass the delivery system through the central lumen in order to attach a prosthetic heart valve device to a delivery system in an opposite orientation to other configurations, such as the transapical deliver system. This may allow for different directions of approach to the native anatomy and different deployment orientations for the clinician during use. 
     The central lumen  1494  surrounds longitudinal axis C 14  and extends through the piston cylinder  1489 , such that the piston cylinder  1489  is configured to substantially surround some portion of the central lumen  1494 . The piston cylinder  1489  may include an interior wall  1491  and an exterior wall  1492  in which the interior wall  1491  is disposed between the exterior wall  1492  and the central axis C 14 . The interior wall  1491  may define an inner wall of the central lumen  1494 . The interior wall  1491  and/or the exterior wall  1492  may define any cross-section perpendicular to the central axis C 14 . For example, the interior wall  1491  and/or the exterior wall  1492  may define an elliptical (including circular) cross-section, an oval-shaped cross-section, a regular or irregular polygonal cross-section, or some other cross-sectional shape which surrounds at least some portion of the central axis C 14 . 
     The piston  1468  is configured to translate within the piston cylinder  1489  and form a piston chamber bounded at least in part by the piston cylinder  1489  and a piston head  1490  of the piston  1468 . The O-ring  1497  extends around an exterior-facing perimeter of the piston  1468  to provide a fluid barrier between the piston chamber formed and any clearances between the piston  1468  and the exterior wall  1492 . The O-ring  1498  extends around an interior-facing perimeter of the piston  1468  to provide a fluid barrier between the piston chamber formed and any clearances between the piston  1468  and the interior wall  1491 . A pressurized fluid delivered via a fluid port  1476  may act on the piston head  1490  and cause the piston  1468  to translate in a direction from the crimping device distal end  1474  to the crimping device proximal end  1472 . In the embodiment of  FIGS. 14-16 and 18 , the fluid port  1476  laterally extends through the exterior wall  1492  of the piston cylinder  1489 , or in other words from a side of the crimping device  1400 , and may comprise a Luer fitting or other type of suitable fitting for the delivery of a pressurized fluid. 
     The piston  1468  is mechanically coupled to the pusher  1462 , such that a hydraulically-driven displacement of the piston  1468  causes pusher  1462  to translate in a direction that is substantially parallel to the central axis C 14 . In order to allow access throughout the crimping device  1400  (either proximally or distally), the pusher  1462  may include a pusher opening that extends through the pusher  1462  and at least partially surrounds central axis C 14 . As previously noted, any such pusher opening would be in fluid communication with the central lumen  1494  of the piston cylinder  1489 . 
     As described in detail above with respect to prior embodiments, translation of the pusher  1462  may precipitate contact between a prosthetic heart valve device and an internal surface of the funnel  1454 , when the prosthetic heart valve device is positioned between the pusher  1462  and the funnel  1454 . In the embodiment depicted in  FIGS. 14-18 , a proximal end  1452   a  of the housing  1452  is attached to the funnel  1454  via a threadable connection  1452   c , and a distal end  1452   b  of the housing  1452  is attached to the piston cylinder  1489 . More particularly, the distal end  1452   b  of the housing  1452  includes a plurality of retention clips  1452   d  that are configured to provide a snap-fit engagement with a circumferential ledge  1489   a  of the piston cylinder  1489 . In an embodiment, and as shown in  FIGS. 14-16 and 18 , a circumferential ledge  1489   a  may extend about a perimeter of a proximal end of the piston cylinder  1489  to provide ease and ready attachment thereto by the plurality of retention clips  1452   d  no matter the orientation of the housing  1452  relative to the piston cylinder  1489 . In the embodiment of  FIGS. 14-18 , each of the retention clips  1452   d  forms a distal end of a respective arm  1452   e  of the housing  1452 . In the embodiment of  FIGS. 14-18 , the housing  1452  is shown with three arms  1452   e  distally extending from a proximal segment  1452   f  of the housing  1452 , and each of the arms  1452   e  includes a respective retention clip  1452   d . The exact number of arms and retention clips may vary without departing from the scope hereof. 
     In an embodiment, a housing  1452  with a funnel  1454  attached thereto are detached from a piston-cylinder group  1460  to permit a prosthetic heart valve device to be positioned between the pusher  1462  and the funnel  1454  as described above. The housing  1452  and the funnel  1454  are then snapped to the piston cylinder  1489  through engagement between the retention clips  1452   d  of the housing  1452  and the ledge  1489   a  of the piston cylinder  1489 . The piston  1468  of the crimping device  1400  is then slidably translated over a stroke length within the piston cylinder  1489  as a result of, for example, a pressurized fluid being supplied to the piston chamber via the fluid port  1476 . The pusher  1462  having been displaced by the sliding translation of the piston  1468  such that some portion of the pusher  1462  is between the distal opening  1458  and the proximal opening  1456  of funnel  1454 . In this manner, the crimping device  1400  is configured to utilize the pusher  1462  and the funnel  1454  to crimp a prosthetic heart valve device when the prosthetic heart valve device is appropriately positioned between the pusher  1462  and the funnel  1454 . 
     Various examples have been described. These and other examples are within the scope of the following claims.