Patent Publication Number: US-2022211996-A1

Title: Flexible catheter with a drive shaft

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 16/600,807, filed Oct. 14, 2019, which is a continuation of U.S. patent application Ser. No. 15/033,443, filed Apr. 29, 2016, now U.S. Pat. No. 10,478,538, which is a U.S. National Stage filing under 35 U.S.C. § 371 of International Application No. PCT/EP2014/073504, filed Oct. 31, 2014, which claims priority to European Patent Application No. 13191307.1, filed Nov. 1, 2013, the entire contents of which are each hereby incorporated by reference herein. International Application No. PCT/EP2014/073504 was published under PCT Article 21(2) in German. 
    
    
     BACKGROUND 
     The invention relates to a flexible catheter with a pliable drive shaft, according to the preamble of the main claim, as well as to a blood pump arrangement with such a catheter. 
     Such catheters are typically used, within a body of a human or animal, to produce or transmit a torque or rotation movement. The drive shaft runs axially along the longitudinal extension of the catheter between a proximal end of the catheter and a distance end of the catheter. Typically, a proximal end of the drive shaft is connected outside the body to a drive motor, in order to produce the torque or the rotation movement and to transmit it onto the drive shaft. A rotation element or functional element which is designed according to the respective application is connected to the drive shaft in a rotational fixed manner, at the distal end of the drive shaft. With regard to the functional element, it can be the case for example of a milling cutter, a rotor ablator or a pump rotor for delivering blood. 
     For many applications, it is necessary to lead the catheter along a desired path through the body, for example along or within blood vessels, in order to position the distal end of the catheter at a desired location within the body, for example within a heart ventricle, for the duration of the respective application. Apart from the pliability and flexibility which is necessary for this, as a rule yet further criteria must be fulfilled. For example, in some applications, it is necessary for rotation movements to be produced or transmitted by the drive shaft at a very high rotation speed, for example the necessary rotation speed can be more than 10,000, more that 20,000 or even more than 30,000 revolutions per minute, such as in the already mentioned case of delivering blood for example. Moreover, particularly high demands are placed on the mechanical and the chemical loadability of the catheter, particularly at the drive shaft, in cases, in which the rotation movement must be produced over a longer period of time, thus for several hours, days or even weeks, as is can likewise when delivering (pumping) blood. Material fatigue and damaging processes on the drive shaft and on other components of the catheter should only progress as slowly as possible, and moreover as predictably and as controllably as possible. Tearing and breakage of the drive shaft on operation should be able to be ruled out with an as large as possible certainty in critical applications, such as when delivering blood. Hereby, it is not favorable if the flexible drive shaft is operated in a sheath which is too hard and which wears the shaft. 
     On the other hand, should a failure of the shaft occur despite this, then it must be ensured with the greatest possible certainly that the ends of the shaft which are thereby typically splayed open, do not work through the sheath of the catheter usually consisting of plastics, at high speed. The ends of the shaft would freely rotate in the blood vessel in such a case. 
     It is thus the object of the present invention, to suggest a flexible catheter with a pliable drive shaft and which is as reliable is possible and is also suited as much as possible for a permanent operation at high speeds. A blood pump arrangement is moreover suggested, which is likewise as reliable as possible and is as suited as much as possible also for the permanent operation at high speeds. 
     This object is achieved by a catheter according to the main claim, as well as by a catheter and a blood pump arrangement according to the auxiliary claims. Preferred embodiments and further developments are to be deduced from the dependent claims. 
     BRIEF SUMMARY 
     As is described hereinafter in a detailed manner, this patent application discloses several aspects, wherein each of these aspects is a part of a coherent invention. On the other hand, each of the aspects also per se already represents an autonomous invention. The aspects can therefore be realized independently of one another (and in each case taken by themselves represent special further developments of a generic catheter according to the preamble of the main claim) and can moreover be infinitely combined with one another, in order to synergistically improve a generic catheter or a blood pump arrangement with a generic catheter. Thus, for example a generic catheter can be designed according to one of these aspects and can simultaneously also be designed according to one (or more) further aspect(s). This catheter is then a particularly advantageous embodiment of a catheter according to the first mentioned aspect. Each of the aspects thus also permits a further development of each other aspect. 
     The first of these aspects relates to the material or the material characteristics of the drive shaft, the second aspect to the geometric design of the drive shaft, the third aspect to the design of the sleeve, the fourth aspect to the connection between the drive shaft and the drive motor, the fifth aspect to the mounting of the drive shaft and the sixth aspect to a lubricant for the drive shaft. Each of these aspects contributes to the improvement of the loadability and the reliability of the catheter or of the blood pump arrangement. 
     A generic flexible catheter accordingly comprises a drive shaft, a sleeve surrounding the drive shaft and a sheath surrounding the drive shaft and the sleeve, wherein the drive shaft, the sleeve and the sheath are pliable. The drive shaft at a proximal end of the drive shaft comprises a coupling element or a coupling head, for the connection of the drive shaft to the drive motor. 
     Typically, the (axial) total length of the catheter is between 50 cm and 200 cm, and as a rule the total length lies in a region between 80 cm and 150 cm. Typically, the (axial) total lengths of the drive shaft, the sleeve and the sheath likewise lie within of one these regions in each case. The flexibility or the pliability of the catheter, thus in particular of the drive shaft, the sleeve and the sheath, should be sufficient, in order to be able to elastically bend the catheter with a radius of curvature in a region between 20 mm and 40 mm, preferably in a region between 25 mm and 35 mm, in particular of about 30 mm. With such a curvature, in particular the drive shaft rotating at an operational speed and the sleeve, where possible, should deform only elastically, thus, if possible, no permanent (plastic) deformations or changes of the drive shaft or the sleeve should occur. In particular such an elastic curvature with the mentioned radius of curvature should also be possible with a roughly U-shaped curvature of the catheter of about 180°, with which the catheter therefore is continuously curved, for example along an axial section of the catheter with a length of about 80 mm to 150 mm, typically 100 mm to 120 mm (depending on the radius of curvature). Such curvatures of the catheter occur for example if the catheter runs through the aortic arch into the left ventricle. Moreover, a rhythmic change of the described radius of curvature typically occurs due to the rhythmic heart action, wherein the position of the curvature with respect to the catheter can also rhythmically change. 
     In many cases, it is not necessary for the catheter to have such a flexibility along its entire axial longitudinal extension. It can already be sufficient for this to be given in a certain axial section (or several axial sections). Often, at least a distal end-piece or a distal part-piece of the catheter has such a flexibility, as in the case of delivering blood, for example if a distal end of the catheter has to be placed in a ventricle. This distal end-piece or part-piece for example can have an axial length in one of the length regions mentioned above. 
     As is described in more detail further below, the pliability and flexibility of the catheter or the drive shaft also cannot be too large in some cases, in particular in those axial sections of the drive shaft, which run distally or proximally outside the sleeve or exit out of the sleeve, so that a regional stiffening of the drive shaft to a certain extent is advantageous in at least one of these sections, or, depending on the demands of the respective application, can even be necessary. A minimization of the vibration can advantageously be achieved by such stiffening, by which means the risk of a hemolysis can also be reduced. 
     According to the first aspect of the invention, the drive shaft of the catheter can consist completely or at least regionally of an alloy which in each case contains at least 10% by weight of chromium, nickel and cobalt. The alloy preferably contains at least 30% by weight of nickel, preferably however not more than 40% by weight of nickel. The alloy preferably contains at least 30% by weight of cobalt, preferably however not more than 40% by weight of cobalt. The alloy preferably contains at least 15% by weight of chromium, preferably however not more than 25% by weight of chromium. The alloy preferably also contains molybdenum, preferably at least 5% by weight, preferably however not more than 15% by weight of molybdenum. 
     The alloy for example as alloy components can comprise about 35% by weight of nickel, about 35% by weight of cobalt, about 20% by weight of chromium and about 10% by weight of molybdenum. These alloy components of the alloy in each case can be larger or smaller by up to 3% by weight, or larger or smaller by in each case up to 2% by weight. The alloy components of these elements can correspond to the alloy components of these elements in the alloy MP35N® or the alloy components of these elements in the alloy 35NLT® or differ from this in each case by up to 2% by weight higher or lower, or from this in each case by up to 1% higher or lower. The alloy can moreover contain further alloy elements. These can be selected and weighted according to those of the alloy MP35N® or those of the alloy 35NLT®. 
     Preferably, with regard to the alloy it is the case of MP35N® or 35NLT®, or is manufactured in a corresponding (or the same) manner, i.e., with corresponding (or the same) method steps and with corresponding (or the same) method parameters as MP35N® or as 35NLT®. For example, one can envisage the alloy of the drive shaft or the drive shaft as a whole being work-hardened or being manufactured or formed by way of applying (high) cold-forming or work-hardening. A work-hardening degree of the material of the drive shaft and/or of the sleeve for example is between 35% and 70% and/or between 40% and 60%. A tensile strength of the material in a region between 1900 MPa and 2200 MPa can result from this. 
     The relations between the yield point, tensile strength, elongation at break and work-hardening degree with the example of the material 35NLT® is represented by way of example in  FIGS. 16 and 17  (based on the details of the manufacturer Fort Wayne Metals). With this example, it is shown that different heat-treatment conditions and work-hardening degrees of a material can generally lead to very different material characteristics. Often, these are only found to be unsuitable for a flexible drive shaft with the benefit of hindsight. 
     A high work-hardening for example is not uncritical, since this can lead to a reduction of the maximal elongation at break as well as the toughness of the material. The reverse bending strength of the drive shaft as well as the achievable bending radius of the shaft can be negatively influenced by way of this. On the other hand, a low work-hardening entails a relatively low hardness and tensile strength of the material. A hardness which is to low has a direct influence on the wearing behavior of the shaft and thus on its endurance strength, and for example can result in an increased wear and abrasion on operation. This is particularly critical in the case of a sliding/friction pairing, as is typical for flexible shafts. A reduced tensile strength results in a low reverse bending strength. 
     The optimization of a stable and durable flexible drive shaft is highly complex since different optimization targets of the drive shaft entail diverging material characteristics, so that no standardized and meaningfully applicable optimization method or evident parameter window result for this. 
     However, it has been surprisingly found that drive shafts which consist completely or at least regionally of a material which has a tensile strength in a region between 1800 N/mm 2  and 2400 N/mm 2 , preferably from 2034 to 2241 N/mm 2  (thus from 295 KSI to 325 KSI), lead to good results. In particular, with regard to the material, it can be the case of one of the alloys described here, thus one which comprises at least 10% by weight of chromium, nickel and cobalt in each case. However, other materials are also considered for the drive shaft, apart from these alloys, such as for example metallic and non-metallic materials, in particular also plastics and composite materials. 
     A drive shaft which consists completely or at least regionally of such an alloy or such a material is also suitable for applications at a very high speeds and a long permanent operation, so that it is also possible to maintain the initially mentioned speed regions for a longer time duration with such a drive shaft. The torques, which transmit such high rotation speed by way of the drive shaft however are typically relatively low, in particular when delivering blood, wherein the torque for the drive of an expanded pump rotor is typically larger due to the larger diameter. Even if the application of the alloys MP35N® or 35NLT® may be known for different medical instruments such a stylet for example, due to their loadability and their corrosion resistance, their suitability for pliable drive shafts however is surprising due to the described special demands, in particularly at a high speed, long operational duration and large curvature, in particular in light of the fact that indeed more than 500,000,000 complete load reversals and in extreme cases more than 1,000,000,000 load reversals can occur with the application as a blood pump. 
     Alloys with a relatively high iron content or titanium content have been applied until now for the drive shaft, in particular for blood pumps, in order to achieve a high loadability. However, as has been found within the framework of the present invention, one can or indeed one should make do without a high content of iron and titanium as much as possible, in order to permit permanent operation as high rotation speeds. The weight component of iron and titanium is even preferably selected relatively low, for example in each case less than 2% by weight or even less than 1% by weight. Basically, one can completely make do without iron and titanium as alloy components, corresponding to weight component of less than 0.1% in each case. 
     According to a first aspect, the drive shaft can consist completely or at least regionally of an alloy which has a weight component of iron which is less than 2% or preferably less than 1% or particularly preferably less than 0.1%. According to the first aspect, the drive shaft can consist completely or at least regionally of an alloy which has a weight component of titanium which is less than 2% or preferably less than 1% or particularly preferably less than 0.1%. 
     The drive shaft, the sleeve, the sheath and/or bearing elements which are present as the case may be, consist as much as possible of biocompatible materials, or at least outer surfaces of the respective components consist of a biocompatible material. 
     According to the second aspect of the invention, the drive shaft can comprise a cavity extending axially within the drive shaft. With regard to the drive shaft, it can therefore be the case of a hollow shaft. The cavity can extend within the drive shaft along a complete longitudinal extension of the drive shaft. A high pliability of the drive shaft with a simultaneously relatively large torsional stiffness can be achieved by such a cavity. The pliability can be increased further if the drive shaft comprises a plurality or a multitude of coaxial windings which run spirally around the cavity of the drive shaft. Torsion and bending. stresses can moreover be converted into axial tensile or compressive stresses by way of the windings, by which means the loading of the drive shaft can be reduced. Moreover, it is also possible for the windings of the drive shaft to be arranged in two or more coaxial layers of the drive shaft. The windings within different coaxial layers then preferably have opposite winding directions. Tensile and compressive stresses between the layers and which are caused by torsion stresses can then be completely or partly mutually compensated in this manner. As a whole, bending stresses in the drive shaft can therefore also be reduced. 
     With regard to the windings of the drive shaft, it is typically the case of windings of a wound wire or several corresponding wound wires. The drive shaft can comprise exactly one or several such wires within each layer, for example 1 to 8 wires, preferably 4 to 6 wires, particularly preferably 5 wires. The wire or the wires preferably consist of the alloy which is described above. The wire or the wires typically in each case have a diameter in a range of about 0.09 mm to about 0.21 mm, preferably of about 0.135 mm to about 0.165 mm. An outer diameter of the drive shaft typically lies in a range of about 0.53 mm to about 1.32 mm, preferably in a range of about 0.79 mm to about 0.97 mm. Outer diameters of the drive shaft below 1 mm are particularly preferred. An inner diameter of the drive shaft typically lies in a range of about 0.17 mm to about 0.39 mm, preferably in a range of 0.25 mm to about 0.31 mm. Axially adjacent windings of the inner layer mutually contact in the case of two concentric layers, whereas axially adjacent windings of the outer layer preferably do not mutually contact (in each case given an alignment of the drive shaft free of curvature), but have an axial distance in a range of about 0.018 mm to about 0.042 mm, preferably of about 0.027 mm to about 0.033 mm. 
     A small outer diameter of the catheter can also be realized by a small outer diameter of the drive shaft, by which means a reduced traumatization of the tissue at the location of puncture can be achieved. Further advantages which can be achieved by a low outer diameter of the drive shaft are lower friction and wear problems due to a reduced peripheral speed of the drive shaft, lower vibration problems due to a reduced mass of the drive shaft, as well as reduced disturbance/interference of motor current signals due to vibrations which result from this, and for example a reduced danger of possibly present calcifications within the blood vessel detaching from the vessel wall and possibly getting into the circulation with possibly life-threatening consequences for the patient. 
     Surprising, it has thus been found that the transmission of adequately high torques, for example for driving an expandable pump rotor in the expanded condition, are also possible with the low outer diameters of the drive shaft of less than 1 mm which are mentioned here, over a longer period. Hereby, in particular the special ranges of the diameter of the wires and which are specified above have been found to be particularly advantageous in the case of a shaft constructed of such wires, wherein it has moreover been found that the optimal region for the diameter of the individual wires is related to the outer diameter of the drive shaft in a non-trivial manner. 
     Moreover, one can envisage the windings of the drive shaft being manufactured or formed by way of a (high) cold-forming or work-hardening, in order to improve the elasticity and endurance of the drive shaft. 
     It is possible for the cavity to be filled out with a reinforcement material, completely or within axial sections of the drive shaft, in order to set the stiffness and stability of the drive shaft in the respective axial section and increase it (regionally as the case may be). As already explained in the context of the first aspect of the invention, apart from a sufficient pliability of the drive shaft, an adequate stiffness of the drive shaft is also necessary for a reliable operation of the catheter, in particular at high speeds and longer operational duration, for example in order to permit a stable rotation of the drive shaft, in particular in axial sections of the drive shaft which run distally or proximally outside the sleeve (distal and proximal end-piece of the drive shaft restively). The first and the second aspect of the invention synergistically complement one another in this manner. In a preferred embodiment, one accordingly envisages a distal end-piece of the drive shaft and/or a proximal end or end-piece of the drive shaft being stiffened. The stiffened distal or proximal end or the end-piece preferably has a length between 10 mm to 60 mm, particularly preferably a length between 20 mm and 50 mm The drive shaft is preferably stiffened in those regions, in which (additionally to the sleeve or instead of it, which is to say in place of the sleeve) bearing elements are arranged for the axial and/or radial mounting of the drive shaft. Moreover, it can also be advantageous to stiffen the drive shaft in the region, in which the drive shaft proximally enters or exits the sleeve and as a result is not guided in the sleeve. Moreover, it can also be advantageous to stiffen the drive shaft in the region, in which the drive shaft enters or exits the sleeve distally. It is indeed in these transition regions that bending loads or other loads, such as oscillation load for example, of the drive shaft, can be reduced by way of a stiffening of the drive shaft. 
     Materials which are characterized on the one hand by a high stiffness and simultaneously by a relatively high elastic deformability on the other hand are suitable as reinforcement materials for stiffening the drive shaft. In particular, the reinforcement material or the stiffening material should tolerate all bending, to which the catheter or the pump head of the catheter is subjected during the implantation and during operation. A non-rusting, austenitic steel for example is considered as a reinforcement material, for example a steel according to the material number DIN 1.4310. 
     Alternatively, or additionally to the described reinforcement material, a suitable stiffening can also be achieved by way of (axial and/or radial) welding or soldering of (axially or radially) adjacent ones of the windings of the (spiral) drive shaft. Moreover, it is also possible for a certain (and under certain circumstances sufficient) stiffening of the drive shaft to be able to be achieved by way of the distal functional module which is typically fastened on an outer periphery of the drive shaft in a rotationally fixed manner, such as a pump rotor. 
     According to a third aspect of the invention, the sleeve can be designed as a bearing coil with a plurality of windings. The windings of the bearing coil run around the drive shaft in the axial direction in the manner of a spiral. The bearing coil for example can be a wound flat tape. The flat tape preferably has a width (measured axially) which is larger than the thickness (measured radially) by a factor of at least 3, preferably by factor of 6. Typically, the width of the windings lies in a range of about 0.36 mm to about 0.84 mm, preferably in a range of about 0.54 mm to about 0.66 mm. The thickness of the windings typically lies in a range of about 0.06 to about 0.14 mm, preferably in a range of about 0.09 mm to about 0.11 mm. An inner diameter of the sleeve typically lies in a region between about 0.6 mm and about 1.4 mm, preferably in a range of about 0.9 mm to about 1.1 mm. An outer diameter of the sleeve typically lies in a range of about 0.72 mm to about 1.68 mm, preferably in a range of about 1.08 mm to about 1.32 mm. A pitch of the bearing coil preferably lies in a range of about 0.43 to about 0.98, preferably in a range of about 0.63 to 0.77. wherein the inner diameter of the sleeve corresponds to the outer diameter of the flexible drive shaft, in particular is larger than the outer diameter of the drive shaft. 
     The bearing coil, in the case that it is designed as a wound flat tape, has low as possible manufacturing tolerances with respect to an (axial) tilting of the windings relative to the longitudinal axis of the bearing coil (in the straight condition without curvature of the bearing coil). The tilting is preferably less than 10°, in particular preferably less than 5°. The inner surface of the sleeve or of the windings of the bearing coils therefore preferably forms cylinder-shaped part-surfaces instead of conical part-surfaces (tilting). A tilting of the windings to the longitudinal axis leads to a reduction of the available bearing surface and to a greater pressure loading of the drive shaft. The lateral edges of the flat tape are preferably rounded as much as possible, in order to avoid pressure peaks upon the drive shaft as much as possible. The radius of curvature of the edges is preferably 0.04 mm or more. 
     The sleeve can consist completely or at least regionally of an alloy. The description of the alloy of the drive shaft can accordingly also be conferred upon the alloy of the sleeve. In particular, the sleeve can completely or at least regionally consist of the same material, for example of the same alloy as the drive shaft. 
     In a laboratory test, very good results could be achieved in the fatigue test with the use of the same material for the drive shaft and the sleeve, under a different pulsatile load and with bending radii significantly below 50 mm. This is surprising in many aspects. For example, specifically for reason of patient safety, it is recommended to design the flexible shaft of a wear-resistant material which is relatively hard in comparison to the drive shaft, in order, for example in the case of a shaft breakage which usually leads to a splicing of the shaft in the breakage region, to prevent the drive shaft from rubbing through the sleeve and the even softer sheath of the catheter in subsequent operation, and the rotating openly in the blood vessel. Moreover, in classical engineering, the use of equal materials as sliding partners or friction partners is usually discouraged, since in this case a so-called “eating” or corroding of the work-pieces can occur, which originates from the fact that individual molecules of the two sliding/friction partners connect to one another and can then be torn out of the molecular interconnection of the other part. The fact that it is very difficult or impossible to predict which of the two parts wears is thereby seen as being particularly critical. The use of the same materials for a rapidly rotating flexible shaft and a bearing coil located around this, which is suggested here, is therefore surprising to the man skilled in the art. 
     The fourth aspect of the invention relates to the design of the proximal coupling element or coupling head of the drive shaft which surprisingly can likewise significantly improve the reliability of the catheter and its suitability for permanent application, in particular if this aspect is combined with one of the other aspects. The basic idea of the fourth aspect lies in being able to often significantly reduce the axial compressive and tensile stresses in the drive shaft if the connection between the coupling element of the drive shaft which itself is as rigid as possible and which is connected to the drive shaft in a rotationally, tractionally and compressively fixed manner, and a coupling element of the drive motor which corresponds to this, although being rotationally fixed, however compensation movements between the coupling element of the drive shaft and the coupling element of the drive motor are possible in the axial direction. For this, the coupling elements of the drive shaft and the drive motor can comprise axial sliding surfaces which correspond to one another and which typically run parallel to the (local) rotation axis or the longitudinal axis of the respective coupling element. The shape of these axial sliding surfaces or their outer or inner contour therefore does not change in the axial direction (thus along the rotation axis or longitudinal axis). The coupling element of the drive shaft for example can have the shape of a square [end] or of another profile piece, which has a cross-sectional area (defined perpendicularly to the rotation axis or longitudinal axis) or outer contour, which is constant in the axial direction, thus along its longitudinal extension or rotation axis. The coupling element of the drive motor can accordingly be designed as a correspondingly designed receiver for the square end or the profile piece. 
     As already mentioned, the catheter at a distal end of the drive shaft can comprise a pump rotor, for example for delivering blood, which is fixedly connected to the drive shaft. The pump rotor, depending on the configuration, design and the pitch angle of the blading of the pump rotor, can be configured for example for the proximal delivery in the blood (proximal delivery direction, i.e., in the direction of the proximal end of the catheter) or for the distal delivery (distal delivery direction, i.e., in the direction of the distal end of the catheter). The fifth aspect of the invention relates to an axial mounting of the pump rotor, with which a thrust bearing of the catheter is matched to the delivery direction of the pump rotor such that axial bearing forces primarily or exclusively act upon the drive shaft as axial tension (pull) forces (and to a lesser extent or not at all as axial compressive forces). The loading of the drive shaft, particularly at high speeds can be surprisingly significantly reduced by way of this. Moreover, astonishingly, it has been found that the damage to the blood due to the pump operation is lower with such a design of the blood pump. Hereby, in the case of a proximal delivery direction, one envisages arranging the thrust bearing proximally to the pump rotor and being designed to counteract a distally directed axial displacement of the drive shaft (caused by the proximal delivery effect of the pump rotor). The thrust bearing is arranged distally to the pump rotor and is designed to counteract a proximally directed axial displacement of the drive shaft, in the case of a distal delivery direction. 
     The thrust bearing for example can comprise a first thrust bearing element and a second thrust bearing element, wherein the first thrust bearing element is connected to the drive shaft in a rotationally fixed manner, and the second thrust bearing element is fixedly connected to the sleeve or to the sheath. The first thrust bearing element and the second thrust bearing element comprise sliding surfaces (which can also be indicated as abutment surfaces or end-faces) which face one another, are preferably annular and which block an axial displacement of the drive shaft in at least one direction in the case of a mutual contact. The mentioned sliding surfaces thus overlap one another in the radial direction. The first thrust bearing element can be designed as a radial widening of the drive shaft, but also as a ring which is fastened on the drive shaft, by way of crimping for example. With regard to the second thrust bearing element, it can simultaneously be the case of a radial bearing element, for example with a sliding surface which faces the drive shaft, is preferably designed in a cylindrical manner and is arranged coaxially to the rotation axis of the drive shaft. 
     Preferably, at least one of the mentioned sliding or abutment surfaces, preferably at least the sliding surface of the first bearing element of the thrust bearing has a profiling such that the two sliding surfaces with an interaction with a (fluid) lubricant form a hydrodynamic plain bearing. The lubricant which is described further below is preferably applied as a lubricant. The profiling has the function of producing bow waves or pressure waves of the lubricant between the two sliding surfaces, wherein these waves run around the drive shaft on rotational operation. This design of the sliding surfaces could surprisingly reduce the arising wear in this region by more than 50%. 
     The profiling of the respective sliding surface for example can preferably comprise 6 to 24 prominences and/or recesses, which preferably in each case can have a height or depth of about 0.03 mm to about 0.1 mm. Typically, the prominences and/or recesses can be arranged over this sliding surface in a manner distributed uniformly along a peripheral direction or the circumferential direction of the respective sliding surface. The prominences can be the same, just as the recesses can be the same. The prominences can be laterally adjacent the recesses and vice versa. In particular, the profiling can be designed as a sequence of prominences and/or recesses which alternates (along a peripheral direction). The prominences and/or recesses for example can be designed as ribs and grooves respectively, which typically, departing from an inner edge of the sliding surface which faces the drive shaft, extend in the direction of an outer edge of the sliding surface which is away from the drive shaft. Typically, the grooves or ribs run precisely from the inner edge to exactly the outer edge and thus therefore have a length which corresponds to the radially measured width of the respective sliding surface. 
     The ribs or the grooves typically have a width (measured in the peripheral direction) in a range of about 0.08 mm to about 0.5 mm. The width of the ribs or grooves can be constant, or can change in the radial direction. Typically, the profiling along the peripheral direction of the sliding surface comprises alternating recesses or grooves and prominences or ribs. If the grooves then have a constant width, the ribs then typically widen radially outwards. Such embodiments can often be particularly simply manufactured by way of milling. On the other hand, if the ribs have a constant with, then the grooves typically widen radial outwards. However, it is also possible for the ribs as well as the grooves to widen radially outwards. The last embodiment can be manufactured particularly simply by way of laser cutting. The grooves or ribs can also be designed spirally in regions, thus extend from the inner edge to the outer edge of the sliding surface, on an arcuate path (for example a circular path). 
     The catheter can comprise the bearing elements mentioned above, as well as further bearing elements for the radial and/or axial mounting of the drive shaft. Zirconium oxide (ZrO 2 , also called zirconium dioxide, zirconia), in particular zirconium oxide stabilized with yttrium, aluminium oxide (AlO x , typically Al 2 O 3 ), ceramics as well as alloys described in the context of the first aspect are considered in each case as materials for the bearing elements for example. 
     According to a sixth aspect of the invention, a cavity or intermediate gap between the drive shaft and the sleeve is filled out with a lubricant which is biocompatible and preferably also physiological. With regard to this lubricant, it can be the case for example of distilled water or an aqueous solution, for example a saline solution and/or a glucose solution. The solution can have a concentration of common salt which is physiological, which is to say is 0.9%. However, an isotonic saline solution or so-called Ringer&#39;s solution can also be envisaged. On the one hand, the construction of the catheter can be simplified due to the fact that the lubricant is biocompatible, since an exit of the lubricant into the body does not have to be avoided at all costs. Inasmuch as the materials suggested here are used for the drive shaft, the sleeve and the bearing elements, these components are chemically relatively stable with regard to corrosion by way of these (relatively corrosive) lubricants, so that the application of these lubricants practically does not compromise the reliability and suitability of the catheter for permanent operation. The use of saline solution is particularly advantageous inasmuch as such a solution as a rule is well tolerated by the patient and has no side-effects, in particular even with the presence of a diabetic disease of the patient. 
     The blood pump arrangement which is suggested here comprises a catheter of the type suggested here, as well as a drive motor for producing a rotational movement or torque. A rotationally fixed and preferably axially displaceable connection exists between the drive motor or the already described coupling element of the drive motor, and the coupling element or coupling head of the drive shaft. With regard to the latter, the description concerning this and in the context of the fourth aspect is referred to. The drive motor can be designed to produce high rotation speeds, for example rotation speeds in a region between 10,000 and 40,000 revolutions per minute. The functional element which is connected to the distal end-piece of the drive shaft in a rotationally fixed manner is designed as a pump rotor. The catheter at its distal end comprises a pump casing, in which the pump rotor is arranged. The pump casing for example can be designed in a manner such that the pump casing (for example whilst being subjected to a (tensile) force acting towards the proximal (or distal) end of the catheter), can be brought from an expanded (or compressed) condition into a compressed (or expanded) condition. The document EP2399639 A1 is referred to concerning the details. With a use of a pump arrangement, one can for example envisage the catheter with its distal end in front being pushed through the femoral artery via the aortic arch into the left ventricle of the heart, and the pump casing remaining in the left ventricle. A downstream tubing which is proximally connected to the pump casing and which then typically runs through the aortic valves, can for example lead the blood which is driven by the pump rotor and which flows out of the pump casing, into the aorta. The proximal end of the catheter and in particular of the drive shaft, as well as the drive motor is arranged outside the body. 
     With these and similar applications, various external force effects and reverse bending loads act upon the drive shaft and, as the case may be, upon bearing elements of the catheter or of the blood pump arrangement. External force effects and reverse bending loads can be transmitted onto the catheter, for example by an inner wall of the heart, on which the catheter bears or is supported as the case may be (for example via a so-called pigtail tip), by way of pulsatile pressure changes or flow changes of the blood with a ventricle or a blood vessel, for example the left or right ventricle or the aorta, by way of a positional or attitude change of the body, in particular by an abdominal movement or a (leg) movement in the proximity of the puncture location. Despite this loading, blood can be delivered over longer time periods, for example over hours, days or even weeks at high rotation speeds of the pump rotor, for example in the mentioned speed range, such as in the application in of the blood pump arrangement which is described above, with the suggested catheter and the suggested blood pump arrangement. 
     As is to be deduced for example from “The Sternotomy Hemopump. A second generation intraarterial ventricular assist device” Wampler R K et al., ASAIO J. 1993 July-September; 39(3):M218-23, shaft breakages in the laboratory as a rule can only be realistically simulated under pulsatile compressive loads and bending radii under 2 inches (less than 50.8 mm). The significance of a multiple loading of the shaft is manifested by way of this. Apart from the pump arrangement suggested here, no pumps with a flexible shaft and which have been successfully applied under pulsatile load in the aortic arch over a longer time are known to the applicant. This is due to the processing of the problem of the flexible shaft, which to this date has not been successful. Moreover, until now, in particular in the above-mentioned publication of Wampler the al., the use of a 3-layered shaft instead of a 2-layered shaft was seen as being essential for improving the service life of the flexible shaft. The drive shafts which are suggested here, in contrast have a comparably long or even yet considerably longer durability and loadability at small bending radii (smaller than 50 mm) and a pulsatile loading, than conventional drive shafts, even with a 2-layered design, and thus in embodiments with a significantly smaller diameter than conventional drive shafts. 
     An outer surface of the drive shaft can surprisingly have a relatively high roughness RZ. The roughness RZ for example can lie in a range of 0.01 μm to 1 μm, preferably in a range of 0.1 μm to 0.8 μm. The roughness RZ for example can be about 0.6 μm. The fact that very good results could be achieved in the endurance test with a relatively high roughness of the surface of the drive shaft is quiet surprising, since due to theoretic considerations, normally an as smooth as possible surface would be preferred, in order to minimize wear due to friction, in particular if a relatively corrosive substance, such as physiological saline solution or glucose solution is used as a lubricant as is suggested here, which with regard to its lubricative effect does not even come close to lubricants common in industry, so that the design principles which are usually applicable to classic engineering evidently cannot be directly conferred even with respect to this. 
     As already described, a flexible catheter of the type suggested here comprises a drive shaft, a sleeve surrounding the drive shaft and a sheath which surroundings the drive shaft and the sleeve, wherein the drive shaft, the sleeve and the sheath are pliable, wherein the drive shaft at a proximal end of the drive shaft comprises a coupling element for connecting the drive shaft to a drive motor. 
     The drive shaft moreover can comprise an outer diameter of less than 1 mm. The drive shaft and/or the sleeve, at least regionally preferably consists of a material which has a tensile strength between 1800 N/mm 2  and 2400 N/mm 2 , preferably between 2034 N/mm 2  and 2241 N/mm 2 . The drive shaft and/or the sleeve at least regionally can consist of a non-metallic or a metallic material. In the case of a metallic material, it is hereby preferably the case of an alloy as already described further above, which thus contains in each case at least 10% by weight of chromium, nickel and cobalt. This alloy can have the features already described above. The drive shaft and the sleeve can completely or at least regionally consist of the same material. Moreover, as has already been described further above, a surface of the drive shaft can have a roughness of between 0.01 μm and 1 μm, preferably between 0.1 μm and 0.8 μm, Of course, the catheter can have all of the features and feature combinations, which have been described beforehand and are described hereinafter. 
    
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
       The mentioned aspects of the present invention are hereinafter explained in more detail by way of a special embodiment example of a catheter of the type suggested here and of a blood pump arrangement of the type suggested here, which are represented schematically in  FIGS. 1 to 16 . There are shown in: 
         FIG. 1  a catheter of the type suggested here, in a lateral view, 
         FIG. 2  a blood pump arrangement with the catheter shown in  FIG. 1 , in an implanted condition, 
         FIG. 3  axial sections of parts of the drive shaft of the catheter of  FIG. 1 , in a lateral view, 
         FIG. 4  a cross section through the drive shaft which is represented in  FIG. 3 , at the location which is characterized there at AA, 
         FIG. 5  a distal end-piece of the drive shaft which is stiffened with a reinforcement material, in a lateral view, 
         FIG. 6  a longitudinal section through the end-piece which is shown in  FIG. 5 , at the location which is characterized there at AA, 
         FIG. 7  a sleeve of the catheter which is shown in  FIG. 1 , in a lateral view, 
         FIG. 8  a cross section through a part-region of the sleeve shown in  FIG. 7  said part region being characterized there at A, 
         FIG. 9  a longitudinal section through the catheter which is shown in  FIG. 1 , in the axial part-section which is characterized there at Y, 
         FIG. 10  the distal end-piece which is represented in  FIGS. 5 and 6 , with a pump rotor which is fastened on this in a rotationally fixed manner, 
         FIG. 11  a longitudinal section through the catheter which is show in  FIG. 1 , in the axial part-section which is characterized there at Z, 
         FIG. 12  a longitudinal section through a coupling module of the catheter which is shown in  FIG. 1 , and 
         FIG. 13  an embodiment example of a bearing element of a thrust bearing shown in  FIG. 9 , in a perspective representation, 
         FIG. 14  a further embodiment example of the bearing element which is shown in  FIG. 13 , likewise in a perspective representation, 
         FIG. 15  readings of yield point, tensile strength and elongation at break, for different values of the work-hardening degree for the material 35NLT®, and 
         FIG. 16  diagrammatic representation of the readings of tensile strength and elongation at break, which are specified in  FIG. 15 , as functions of the work-hardening degree for the material 35NLT®. 
     
    
    
     Recurring features or features which correspond to one another are characterized by the same reference numerals in the figures. 
     DETAILED DESCRIPTION 
     A special embodiment of a flexible catheter  1  of the type suggested here is represented schematically in  FIG. 1 . The catheter  1  comprises a pliable drive shaft  2 , of which in this figure a proximal end-piece  3  is to be seen, said end-piece projecting out of a proximal coupling module  4  (cantilever), and at its proximal end the drive shaft  2  comprises a coupling element  5  for the connection of the drive shaft  2  to a drive motor, cf.  FIG. 2 . The catheter  1  moreover comprises a pliable sleeve  6  (not shown here, but see  FIGS. 7 to 9 ) which surrounds the drive shaft  2  and radially mounts it, and a pliable sheath  7  surrounding the drive shaft  1  and the sleeve  6 . Thus whereas the coupling module  4  and the proximal end-piece  3  of the drive shaft  2  are arranged at a proximal end  8  of the catheter  1 , the catheter  1  at a distal end  9  of the catheter  1  comprises a pump head  10  with a pump casing  11 , with a terminating housing  13  which is arranged distally to the pump casing  11  and is for drive shaft  2 , and a downstream tubing  12  which is proximally adjacent the pump casing  11  (elements running within the downstream tubing  12  are represented dashed in  FIG. 1 ). A support element  14  in the form of a so-called pigtail tip is arranged distally on the terminating housing  13 . The catheter  1  moreover comprises a lock  15 . The function of the lock is to radially compress the pump head  10  when this is pulled into the lock  15 . The pump head  10  in this compressed condition for example can be subsequently led through an introduction lock (not represented in the figures) and be implanted through this. The introduction lock for example can be fixed at a puncture location on or in the body of a patient, in order in this manner to likewise support the catheter  1  at this location. The document EP2399639 A1 is referred to in this context. 
     This catheter as part of a blood pump arrangement  16  is represented in an implanted condition in a greatly schematic manner in  FIG. 2 . What is shown is the use or application of the catheter  1  and the blood pump arrangement  16 , with which the drive shaft  2  of the catheter  1  is connected via the coupling element  5  to a corresponding coupling element  17  of a drive motor  18  of the blood pump arrangement  1 , in a rotationally fixed manner (but axially displaceable manner, see description concerning  FIG. 12 ). The drive motor  18  is designed to produce high rotation speeds in a region between 10,000 and 40,000 revolutions per minute. 
     As is shown in  FIG. 10 , a functional element which is designed as a pump rotor  20  is connected in a rotationally fixed manner to a distal end-piece  19  of the drive shaft  2 . The pump rotor  20  is arranged within the pump casing  11  which in this embodiment example is designed such that it can be brought from a radially expanded condition into a radially compressed condition. This for example can be effected with the help of a lock  15  or the introduction lock mentioned above, preferably by way of the pump casing  11 , whilst being subjected to a (tensile) force acting towards the proximal end  8  of the catheter, being at least partly pulled into the respective lock and thereby being compressed along a radial direction running transversely to the longitudinal direction. The pump casing  11  can accordingly be brought from the compressed into the expanded condition by way of a reverse force. The document EP2399639 A1 is also referred to here. 
     With the application of the pump arrangement  2  which is represented in  FIG. 2 , the catheter  1  with its distal end  9  in front, is inserted through a puncture location  21  into the body of a patient in its femoral artery  22  and is pushed along this via the aortic arch  23  into the left ventricle  24  of the heart  25 . The pump casing  11  is thus positioned in the left ventricle  24  such that it is supported by the support element  14  on an inner wall  26  of the left ventricle  24 , and the downstream tubing  12  runs through the aortic valves  27  into the aorta  28 . The blood which is driven by the pump rotor  20  and which flows out of the pump casing is thus led through the downstream tubing  12  into the aorta  28 . The proximal end  8  of the catheter  1 , the proximal end-piece  3  of the drive shaft  2  as well as the drive motor  18  are arranged outside the body. 
     In this embodiment example, an (axial) total length of the catheter and an (axial) total length of the drive shaft  2  are in each case about 150 cm (corresponding to an implantable length of about 140 cm), an (axial) total length of the distal end  9  of the catheter (including pump head  12  and support element  14 ) is about 13.5 cm, in order to permit this application. The flexibility or the pliability of the catheter  1 , thus in particular of the drive shaft  6 , the sleeve  6  and the sheath  7  are so large that the catheter  1  can be implanted and operated, as has been described above. For this, these components must be able to be elastically curved by 180° at least within the distal end  9  of the catheter, with the typically radius of curvature R of the aortic arch  23  of about 30 mm, as is shown in  FIG. 2 , without plastic deformation, in particular of the drive shaft  2  thereby occurring. 
     As is shown in  FIGS. 4 and 6 , the drive shaft  2  is designed as a hollow shaft and comprises a cavity  29  extending axially within the drive shaft  2 , in order to achieve a high pliability of this drive shaft  2 . The cavity  29  extends along the total length of the drive shaft  2 . This cavity  29  however is completely filled out with a reinforcement material  30 , a co-called core, at least within the roughly 4.5 cm long distal end-piece  19  of the drive shaft, see  FIGS. 6, 9 and 10  and the associated description further below, in order here to achieve an adequate stiffness and oscillation stability of the drive shaft  2  or of the distal end-piece  19  of the drive shaft. 
     The drive shaft  2  comprises a multitude of coaxial windings  31 ,  32  which run spirally around the cavity  29  of the drive shaft  2 , in order to convert torsion and bending stresses into axial tensile and compressive stresses. The windings  31 ,  32  are arranged in two coaxial layers  33 ,  34  which is to say plies, of the drive shaft  2 , wherein the windings  31  are arranged co-radially (with the same winding radius) within the inner layer  33 , and the windings  32  are arranged co-radially within the outer layer. The windings  31  of the inner layer  33  have an opposite winding direction compared to the windings of the outer layer  34 , so that tensile and compressive stresses can be compensated between the layers, In the shown example, the drive shaft in the inner layer  33  comprises four wires  35  which are wound coaxially and co-radially around the cavity  29 , and in the outer layer  34  five wires which are wound coaxially and co-radially around the cavity, wherein axially adjacent windings  31  of the inner layer mutually contact, but axially adjacent windings (winding packet of five wires in each case)  32  of the outer layer however do not mutually contact (in each case given an alignment of the drive shaft which is free of curvature), but have an axial distance of about 0.03 mm. An outer diameter d a  of the drive shaft in the present example is about 0.88 mm and an inner diameter di about 0.28 mm. The wires have a circularly round cross section with a diameter of about 0.15 mm. In the present example, the peripheral direction of the windings  36  of the outer layer  34  is counter to the designated rotation direction of the drive shaft  2  for the (proximal) delivery of blood. 
     Here, this rotation direction corresponds to the clockwise direction (defined for a viewing direction from the proximal to the distal end of the drive shaft). The torque to be transmitted in this case leads to the outer layer tending to contract and shorten. Since the inner layer  33  has an opposite tendency due to its opposite winding direction, these tendencies advantageous largely cancel each out. Basically, this mutual compensation can also be achieved in the reverse case, when specifically, the winding direction of the outer layer corresponds to the rotation direction and the winding direction of the inner layer is opposite to the rotation direction of the drive shaft. 
     The wires  35 ,  36  of the drive shaft  2  consist completely of an alloy, which as alloy components contain about 35% by weight of nickel, about 35% by weight of cobalt, about 20% by weight of chromium and about 10% by weight of molybdenum. These alloy components of the alloy can in each case also be greater or smaller by up to 3% by weight, or greater or smaller in each case by up to 2% by weight. With regard to the alloy, in this example it is particularly the case of 35NLT®, but it could just as easily be the case of MP35N®. The weight component of iron in the wires is thus less than 1% by weight and the weight component of titanium is less than 0.1% by weight. The alloy and the windings  31 ,  32  of the drive shaft are manufactured or formed amid the application of high cold-forming and work-hardening. In this example, a non-rusting, austenitic steel according to the material number DIN 1.4310 (X10CrNi18-8) is selected as a reinforcement material  30  for stiffening the drive shaft  2 . Alternatively, any other material which fulfils the demands specified further above in this context could also be selected as a reinforcing material. 
     The sleeve  6  is represented in  FIGS. 7 and 8 . which in the shown example is designed as a bearing coil with a multitude of windings  37 , wherein the windings  37  of the bearing coil run around the drive shaft  2  in the axial direction in the manner of a spiral. In the present example, the bearing coil is given by a wound-on flat tape  38 . The flat tape  38  has a width B (measured axially) which is larger than the thickness D (measured radially) by a factor of about 6. In the present example, the width B of the windings  37  is 0.6 mm and the thickness D of the windings  37  is 0.1 mm. The windings  37  are moreover angled which is to say tilted as little as possible relative to the longitudinal axis L of the bearing coil (in the straight condition without a curvature of the bearing coil), where possible by less than 5°, so that an inner surface  39  of the sleeve  6  which is formed by the windings  37  is as cylindrical as possible or forms as cylindrical as possible part-surfaces. Moreover, the lateral edges  54  of the flat tape are preferably as rounded as possible, with a radius of curvature r k  of about 0.04 mm. The radius of curvature r k  of the edges  54  is preferably more than 0.04 mm. Moreover, an inner diameter D 1  of the sleeve  6  is about 1 mm and an outer diameter D A  of the sleeve about 1.2 mm and has a gradient/pitch of about 0.7. The sleeve  6  or the flat tape  38  in this example consists of the same alloy as the wires  35 ,  36  of the drive shaft  2 , thus here of 35NLT®, but could however also be manufactured of another one of the materials which are mentioned for this. 
     The drive shaft  2  and the sleeve  6  could also consist of materials other than the alloys mentioned here. The drive shaft  2  is preferably manufactured from the same material as the sleeve  6 . Moreover, a surface of the drive shaft  2  can have a roughness RZ of about 0.6, by which means surprisingly a particularly good wear resistance is achieved. Surprisingly good wear characteristics and thus a high operational reliability can be achieved by way of these measures which are quite simple to implement. 
     A longitudinal section through the axial section of the catheter  1  which is indicated at Y in  FIG. 1  is represented schematically in  FIG. 9 . In this section, the catheter  1  comprises bearing elements  40 ,  41 ,  42  which are arranged proximally to the pump rotor  20 , for the radial and axial mounting of the drive shaft  2 . 
     The arrangement and design of these bearing elements  40 ,  41 ,  42  is matched to the pump rotor  20  of the catheter  1  which is shown in  FIG. 10 . This pump rotor  20  has a blading  43 , whose configuration, design and pitch angle are configured for delivering the blood proximally (proximal delivery direction, i.e., in the direction of the proximal end of the catheter). The bearing elements  40  and  41  form a thrust bearing  44  which is arranged proximally to the pump rotor  20  (The bearing element  41  is a first thrust bearing element of the thrust bearing  44 , and the bearing element  40  is a second thrust bearing element of the thrust bearing  44 ). The thrust bearing  44  on account of the design and arrangement of these (thrust) bearing elements  40 ,  41 , is designed to counteract a distally directed axial displacement of the drive shaft  2  (caused by the proximal delivering effect of the pump rotor  20 ). Axial bearing forces acting mainly act upon the drive shaft  2  as tension forces on operation of the blood pump arrangement in this manner. 
     The (first) bearing element  41  is preferably designed in an annular manner and is connected to the drive shaft  2  in a rotationally fixed manner, for example by way of crimping. The (second) bearing element  40 , just as the bearing element  42 , in contrast is fixedly connected to the sleeve  6  and to the sheath  7 . The bearing elements  40 ,  41  have annular sliding surfaces  45  and  46  respectively which face one another and which block an axial displacement of the drive shaft  2  in the distal direction in the case of a mutual contacting, The sliding surface  46  of the (first) bearing element  41  has a profiling, see  FIGS. 13 and 14  and the associated description below, by which means the formation of a stable lubricant film between the two sliding surfaces  45 ,  46  is encouraged, and basically a design of the thrust bearing  44  as a hydrodynamic sliding bearing is rendered possible. The lubricant film which is to say the hydrodynamic bearing in this example is formed with the lubricant which is described further below. The bearing element  40 , as also the bearing element  42 , is moreover designed as a radial bearing element in each case with a sliding surface which faces the drive shaft  2 , is designed in a cylindrical manner and is arranged coaxially to the rotation axis of the drive shaft  2 . 
     Moreover, as is to be recognized in  FIG. 9 , the drive shaft  2  is reinforced by the reinforcement material  30 , in the axial sections, in which it distally exits from the sleeve  6  which is to say is mounted by the bearing elements  40 ,  41 ,  42 . 
     A longitudinal section through the axial section of the catheter  1  which is characterized by the reference numeral Z in  FIG. 1  is schematically represented in  FIG. 11 , and this in particular includes the terminating housing  13  which is adjacent the pump casing  11 . The terminating housing  13  is designed in a tubular manner and comprises a distal bearing channel  47  and a bearing element  47  which is arranged therein, for the radial mounting of the distal end-piece  19  of the drive shaft  2 . The cavity  47  in particular is dimensioned sufficiently large, in order to permit axial compensation movements of the drive shaft  2 . 
     A longitudinal section through the proximal coupling module  4  shown in  FIG. 1  is represented schematically in  FIG. 12 , said coupling module comprising a proximal bearing channel  49  for the proximal end-piece  3  of the drive shaft  2 , wherein the proximal end-piece  3  of the drive shaft  2  runs axially through the bearing channel  49  and projects axially out of the proximal coupling module  4 . A bearing element  50  for the radial stabilization or mounting of the proximal end-piece  3  of the drive shaft  2  is arranged in the bearing channel  49 . The sleeve  6  extends axially through this bearing element  50  up to its proximal end. The bearing element  50  in this embodiment has the function of radially stabilizing and supporting the sleeve  6  from the outside. In an alternative embodiment, the sleeve  60  does not run through the bearing element  50 , but ends (coming from the distal side) at the distal end of the bearing element  50 . In this case, the bearing element  50  for example is designed as a sliding bearing or as a roller bearing. The proximal end-piece  3  can be stiffened by the reinforcement material  30 , just as the distal end-piece  19 , in particular in the axial sections, in which the drive shaft exits out of the bearing channel  49  or is mounted by the bearing element  50 . The bearing elements  40 ,  41 ,  42 ,  48  and  50  preferably consist of zirconium oxide, preferably in the form stabilized with yttrium, of aluminium oxide, of a ceramic or of the same materials as the wires  35 ,  36  of the drive shaft  2 . 
     The coupling housing  4  moreover comprises channels  51  for the feed and discharge of the lubricant, wherein the channels are connected in a fluid-leading manner to the bearing channel  49  as well as to an intermediate space between the sleeve  6  and the drive shaft  2 . According to the sixth aspect of the invention, an intermediate space or intermediate gap between the drive shaft and the sleeve is filled with a lubricant which is biocompatible and preferably also physiological. The lubricant is biocompatible and in this example is the case of distilled water, but it could also be a physiological saline solution or glucose solution. 
     The coupling element  5  of the drive shaft  2  is designed as rigidly as possible and is connected to the proximal end-piece  3  of the drive shaft  2  in a manner fixed with regard to rotation, traction and compression. The coupling element  5  of the drive shaft as well as the coupling element  17  of the drive motor  18 , which in this example is designed as a receiver for the coupling element  5 , comprises axial sliding surfaces  52  and  53  respectively, which correspond to one another, for forming a rotationally fixed, but axially displaceable connection. These sliding surfaces run parallel to the longitudinal axis of the respective coupling element  5  and  17  respectively and do not change their shape along the longitudinal axis of the respective coupling element  5  and  17  respectively. With this example, with regard to the coupling element  5  of the drive shaft  2  it is the case of a square end. 
     The sheath  7  can consist completely or at least regionally of a plastic, for example of polyurethane, in particular of a carbothane or a urethane. The sheath preferably has a metal reinforcement, which for example can consist of the alloy which is suggested for the drive shaft, thus for example of MP35N®. 
       FIGS. 13 and 14  in each case show a schematic perspective representation of an embodiment example of the first bearing element  41  of the thrust bearing  44  which is shown in  FIG. 9 . The sliding surface  46  of the respective bearing element  41  comprises a profiling  55 , so that the two sliding surfaces  45 ,  46  with an interaction with the lubricant form a hydrodynamic sliding bearing, by which means a wear volume of the sliding surfaces  45 ,  46  or of the two bearing elements  40 ,  41  can be significantly reduced. In the embodiments represented here, the profiling  55  of the respective sliding surface  46  comprises several prominences  56  and recesses  57 . In the example represented in  FIG. 13 , there are exactly 12 prominences and 12 recesses, in the example shown in  FIG. 14  there are precisely 8 prominences and 8 recesses, wherein the prominences  56  and recesses  57  in each case are arranged uniformly distributed over the sliding surface  46  along a peripheral direction or circumferential direction (indicated in each case by an arrow characterized by U in the figures) of the respective sliding surface  46  and are designed as an alternating sequence of ribs and grooves. 
     These ribs and grooves extend in each case from an inner edge  58  of the respective sliding surface  46  which faces the drive shaft  2 , up to an outer edge  59  of the respective sliding surface  46  which is away from the drive shaft  2 . In the example represented in  FIG. 13 , the ribs in each case have a height (this corresponds to the depth of the respective laterally adjacent groove) of about 0.06 mm and an average width (measured in the peripheral direction U) of about 0.2 mm. In the example represented  FIG. 13 , the prominences  55  which are designed as ribs in each case have a maximal height of about 0.1 mm, wherein each prominence has a leading surface  60  and a trailing surface  61 , wherein the leading surface  60  advances with respect to the trailing surface  61  given a rotation of the bearing element  41  in the designated rotation direction along the peripheral direction U (in the clockwise direction given a viewing direction to the distal end  9  of the catheter  1 ). 
     This leading surface  60  is inclined or beveled with respect to the longitudinal axis of the bearing element  41 , in a manner such that the prominence  56  reduces or tapers upwards (i.e., in the direction of the opposite sliding surface  45  of the second bearing element  40 , thus in the distal direction in the present example). Basically, thus in any other embodiment examples of profilings of the bearing element  41 , a more uniform bow wave formation of the lubricant can be achieved, and by way of this a more stable lubricant film can be formed, with such inclined which is to say beveled leading surfaces  60 . On its respective upper side  62 , each of the prominences  56  has an average width (measured in the peripheral direction U) of about 0.3 mm, wherein the width of the prominence  56  increases in the radial direction. An average width (measured in the peripheral direction U) of the grooves  57  in this example is about 0.1 mm, wherein the width of the grooves also increases radially outwards. The embodiments which are shown in  FIGS. 13 and 14  can be manufactured for example by way of a (cutting) laser. 
     “The dependency between the material characteristics yield point, tensile strength, elongation at break and cold work-hardening degree, based on the details of the manufacturer Fort Wayne Metals, is represented with the example of the material 35NLT® in  FIGS. 15 and 16 . By way of this example, it is shown that different heat-treatment conditions and work-hardening degrees of a material can generally lead to very different material characteristics. 
     For example, if the drive shaft  2  and/or the sleeve  6  of the embodiment example shown in  FIGS. 1 to 15  consist of 35NLT®, then the work-hardening degree of this material is preferably at about 35 to 70%, particularly preferably at 50% to 60%, so that here a tensile strength of about 2000 to 2200 MPa, for example 2068 MPa is achieved, and an elongation at break of 3.5% is not fallen short of. In the foregoing disclosure, it will be understood that the term “about” should be taken to mean±20% of the stated value, as is known in the art.” 
     LIST OF REFERENCE NUMERALS 
     
         
           1  catheter 
           2  drive shaft 
           3  proximal end-piece of the drive shaft 
           4  coupling module 
           5  coupling element of the drive shaft 
           6  sleeve 
           7  sheath 
           8  proximal end of the catheter 
           9  distal end of the catheter 
           10  pump head 
           11  pump casing 
           12  downstream tubing 
           13  terminating housing 
           14  support element 
           15  lock 
           16  blood pump arrangement 
           17  coupling element of the drive motor 
           18  drive motor 
           19  distal end-piece of the drive shaft 
           20  pump rotor 
           21  puncture location 
           22  femoral artery 
           23  aortic arch 
           24  left ventricle 
           25  heart 
           26  inner wall 
           27  aortic valve 
           28  aorta 
           29  cavity 
           30  reinforcement material 
           31  winding of the drive shaft 
           32  winding of the drive shaft 
           33  coaxial layer of the drive shaft 
           34  coaxial layer of the drive shaft 
           35  wire of the drive shaft 
           36  wire of the drive shaft 
           37  winding of the sleeve 
           38  flat tape 
           39  inner surface of the sleeve 
           40  bearing element 
           41  bearing element 
           42  bearing element 
           43  blading 
           44  thrust bearing 
           45  sliding surface 
           46  sliding surface 
           47  bearing channel of the terminating housing 
           48  bearing element 
           49  bearing channel of the coupling module 
           50  bearing element 
           51  channel for the lubricant 
           52  sliding surface 
           53  sliding surface 
           54  edge 
           55  profiling 
           56  prominence 
           57  recess 
           58  inner edge 
           59  outer edge 
           60  leading surface 
           61  trailing surface