Source: https://patents.google.com/patent/CN107334563B/en
Timestamp: 2019-07-22 23:15:28
Document Index: 211547471

Matched Legal Cases: ['art 20', 'art 24', 'art 20', 'art 24', 'art 24', 'art 20', 'art 60', 'art 62', 'art 14', 'art 60', 'art 174', 'art 178', 'art 138', 'art 216', 'art 216', 'art 240', 'art 240', 'art 620', 'art 610', 'art 610', 'art 632', 'art 610', 'art 610', 'art 666', 'application No.12']

CN107334563B - Heart valve prosthesis delivery apparatus - Google Patents
Heart valve prosthesis delivery apparatus Download PDF
CN107334563B
CN107334563B CN201710555247.3A CN201710555247A CN107334563B CN 107334563 B CN107334563 B CN 107334563B CN 201710555247 A CN201710555247 A CN 201710555247A CN 107334563 B CN107334563 B CN 107334563B
CN201710555247.3A
CN107334563A (en
G·巴卡斯
T·V·阮
L·T·范
A·迈琪科
2013-05-20 Priority to US61/825,476 priority
2014-05-20 Application filed by 爱德华兹生命科学公司 filed Critical 爱德华兹生命科学公司
2014-05-20 Priority to CN201480026432.8A priority patent/CN105188612B/en
2017-11-10 Publication of CN107334563A publication Critical patent/CN107334563A/en
2019-05-14 Publication of CN107334563B publication Critical patent/CN107334563B/en
The some embodiments of the disclosure provide artificial valve (such as heart valve prosthesis) and the valve delivery device for delivering artificial valve to natural valve position via mankind's vascular system.The delivery apparatus is particularly suited for promoting heart valve prosthesis into the natural aortic valve for replacing illness by aorta (that is, method to drive in the wrong direction).Delivery apparatus in a particular embodiment is configured at target position in vivo affix one's name to artificial valve from delivery sheath pipe portion in accurate and controlled mode.
Heart valve prosthesis delivery apparatus
The application is the Chinese patent Shen of entitled " the heart valve prosthesis delivery apparatus " submitted on May 20th, 2014 Please 201480026432.8 (PCT/US2014/038852) divisional application.
The present invention relates to the realities of artificial valve (for example, heart valve prosthesis) and the delivery apparatus for implantable prosthetic valve Apply example.
For many years, heart valve prosthesis has been used to treatment heart valve obstacle.Native heart valve (such as aorta Valve, pulmonary valve and bicuspid valve) provided in terms of guaranteeing abundant blood supply flow forward by cardiovascular system it is important Function.Due to inborn, inflammatory or communicable condition, these heart valves may be presented with being less effective.Valve this Kind damage can lead to serious cardiovascular risk or death.It for many years, is straight in heart to the definitive treatment of this obstacle Depending on the operation reparation or replacement of valve during operation, but easily there are many complication for this surgical operation.Recently, menses have been researched and developed Manifold technology, for using flexible conduit to introduce in a manner of infringement smaller than cardiac operation under direct vision and implanted prosthetic heart valve.
In the art, the artificial valve in rolled state is installed on the end section of flexible conduit and is pushed away Into the blood vessel by patient until artificial valve reaches implant site.Artificial valve at catheter tip is then in defective day It is expanded to its functional dimension at the position of right valve, such as by making the balloon inflation being mounted on artificial valve.Alternatively, Artificial valve can have the bracket or frame of elasticity, self expandable, when delivering sheath of the artificial valve from distal end of catheter promotes When, artificial valve is expanded to its functional dimension by the bracket or frame.
Can balloon expandable artificial valve be generally preferable for replacement calcification natural valve because catheter-balloon can be applied Add enough expansionary forces to make the frame of artificial valve be anchored to calcified tissue around.On the other hand, although the people of self expandable Work valve can be used for replacing narrow valve, but they be preferred for replacing sometimes it is defective, non-narrow (non-calcified ) natural valve.One associated with the implantation artificial valve of self expandable the disadvantage is that, when operator starts from delivering sheath Open end promote artificial valve when, artificial valve be intended to as quick as thought from the end of sheath " jumps " out；In other words, artificial valve The outwardly biased power of the frame of film is intended to that artificial valve is caused to pop up from the distal end of delivering sheath as quick as thought, to be difficult with essence True and controlled mode delivers artificial valve from sheath and increases the risk to patient trauma.
Another problem associated with artificial valve is percutaneously implantable in non-narrow natural valve is artificial valve Enough power may not be applied to surrounding tissue to resist the movement of artificial valve.In general, the bracket of artificial valve is necessary Additional anchoring or affixation devices are provided with to help artificial valve being anchored to surrounding tissue.In addition, helping to be anchored artificial valve This stent anchors equipment of film or part usually extend in the non-diseased region of vascular system and are fixed to the non-diseased area In domain, intervene if necessary to following, for example, if needing to remove artificial valve from patient, this will lead to complication.
The some embodiments of the disclosure provide artificial valve (for example, heart valve prosthesis) and for via mankind's vascular systems Valve delivery device of the system delivering artificial valve to natural valve position.The delivery apparatus is particularly suitable for promoting artificial valve The native aortic valve of illness is replaced by aorta (that is, method to drive in the wrong direction).Delivering in a particular embodiment Device is configured at target position in vivo affix one's name to artificial valve from delivery sheath pipe portion in accurate and controlled mode.
In one aspect, delivery components include artificial valve, positioned at the elongated shaft of artificial valve nearside, positioned at axis distal side Suture holding member, slidable release component and outer sheath.Artificial valve includes Self-expanded stent, has and surrounds bracket Multiple tops for being partially circumferentially spaced of first end, wherein each top has hole.Suture holding member may include nearside Part and the distal part separated with portions of proximal, the portions of proximal are coupled to axis.At least one slidable release component May extend through suture holding member portions of proximal and distal part and from the portions of proximal of suture holding member extend Multiple suture circles.Multiple suture circles may extend through the hole in the top of bracket and in the proximal portion of suture holding member Divide at the position between distal part and extend around release component, so that at least one suture circle extends through each top Hole.Outer sheath can promote on artificial valve so that artificial valve is maintained in the state of radial compression, and can be opposite The radial dilatation to allow artificial valve is retracted in artificial valve, while bracket remains connected to suture via suture circle and retains structure Part.In entire artificial valve after sheath deployment, sheath can be distally advanced and returned it on artificial valve, thus When artificial valve is recycled by sheath, artificial valve is caused radially to be collapsed.
In some embodiments, suture circle is formed by the suture material of single length.
In some embodiments, axis includes first axle, and component further comprises extending at least partially by first axle The second axis, wherein by relative to first axle rotate the second axis, outer sheath can relative to artificial valve promote or retract.
In some embodiments, at least one release component relative to suture holding member slidably, and when release structure Part to proximal retraction so that the distal end of release component close to suture holding member distal part when, suture circle can be from releasing The distal end for putting component slides, to discharge artificial valve from suture holding member.
In some embodiments, at least part of outer sheath includes the metal tube of fluting.
In some embodiments, the distal portions of outer sheath include the delivering cabin for being connected to the distal end of metal tube of fluting, The delivering cabin is configured to extend on artificial valve and is maintained at artificial valve in radial compression.
In some embodiments, delivering cabin includes polymer casing.
In some embodiments, the length of sheath is at least about 3-10cm and no more than about 40cm.
In some embodiments, the thickness of at least one of suture circle is greater than the thickness of other suture circles.
It in another aspect, include: the first elongated shaft for the delivery apparatus of implantable prosthetic valve, with proximal part And distal portions；Second elongated shaft extends through first axle and has proximal part and distal portions；And delivery sheath Pipe, with distal portions and proximal part, the distal portions are configured to receive the artificial valve in the sending state of compression Film is simultaneously maintained at artificial valve in the sending state of compression, and the proximal part is connected to the distal portion of the second elongated shaft Point.Second axis can be rotatable relative to first axle but resists axial movement fixation relative to first axle.Deliver the proximal end of sheath Part can be more flexible than the distal portions of sheath.In the case where unrestricted, deliver sheath length be at least about 3-5cm and No more than about 40cm.Second axis may be configured to rotatable relative to first axle so that the rotation of the second axis causes to deliver Sheath is moved axially relative to first axle and the second axis.
In some embodiments, delivery apparatus further comprises screw rod and nut, and the screw rod is connected to the second axis Distally, the nut is installed on screw rod and is connected to delivering sheath so that the rotation of the second axis and screw rod causes Axial movement of the nut relative to screw rod, to generate the axial movement of delivering sheath.
In some embodiments, the length of the proximal part of sheath is delivered between about 5cm to about 30cm.
In some embodiments, the distal portions of first axle extend through delivering sheath and the metal tube including fluting.
In some embodiments, delivery apparatus further comprises: suture holding member is connected to the distal portion of first axle Point；Multiple suture circles extend from suture holding member and are configured to extend through the opening in artificial valve frame；With And at least one slidable release component, it is configured to extend through suture holding member and suture circle to releasedly Artificial valve is fixed to suture holding member.
In some embodiments, suture holding member includes portions of proximal and the distal portion axially-spaced with first part Point, and release component relative to suture holding member between the first posture and the second posture slidably, wherein described first Posture extends through the portions of proximal and distal part of suture holding member, and in second posture, release component is retracted into The position of the nearside of the distal part of suture holding member.When release component is in the first posture and suture circle extends through frame When being open and extending at the position between portions of proximal and distal part around release component of frame, artificial valve is fixed To suture holding member.When release component is in the second posture, suture circle can be slid from the distal end of release component with from suture Holding member discharges artificial valve.
In some embodiments, at least one release component includes the multiple release structures for extending through suture holding member Part.
In some embodiments, the portions of proximal of outer sheath includes the metal tube of fluting.
In some embodiments, the distal part of outer sheath includes being connected to the delivering cabin of the distal end of metal tube of fluting. Delivering cabin may be configured to extend on the artificial valve in the sending state of compression and artificial valve made to be maintained at compression In sending state.In some embodiments, delivering cabin includes polymer casing.
In another aspect, the method for aortic valvular ring for delivering artificial valve to heart includes by elongated delivering Device is inserted into the femoral artery of patient, and the delivery apparatus includes delivering sheath, and it includes the artificial valves in radial compression Film.The method, which may further include, promotes delivery apparatus by aorta until artificial valve is in aortic valvular ring At implantation position, wherein delivering sheath extends through aorta ascendens and the arch of aorta when artificial valve is at implantation position, and And the proximal end of sheath is delivered in descending aorta.The method, which may further include, retracts delivering sheath relative to artificial valve To dispose artificial valve from the distal end of delivering sheath.
In some embodiments, the length for delivering sheath is at least about 3-5cm and no more than 40cm.
In some embodiments, delivering sheath includes distal portions and the proximal part more flexible than distal portions.It is inserting Enter and promote delivery apparatus movement during, the distal portions of sheath can extend on the artificial valve in radial compression And it is maintained at artificial valve in radial compression, and when artificial valve is at implantation position, proximal part can be with Extend through aorta ascendens, the arch of aorta and descending aorta.
In some embodiments, artificial valve is releasably secured to delivery apparatus via multiple suture circles.
In some embodiments, the movement for retracting delivering sheath includes affixing one's name to entire artificial valve from delivery sheath pipe portion and permitting Perhaps artificial valve radial dilatation, while delivery apparatus is remained fixed to via suture circle.
In some embodiments, the method further includes leading to after affixing one's name to entire artificial valve from delivery sheath pipe portion Cross distally advance delivering sheath return it on artificial valve, recapture/recycling artificial valve.
In another aspect, the method for natural valve ring for delivering artificial valve to heart includes by elongated delivering Device is inserted into the vascular system of patient, and the delivery apparatus includes delivering sheath, and it includes artificial in radial compression Valve, wherein artificial valve is releasably secured to delivery apparatus via multiple suture circles.The method may further include Delivering sheath is retracted relative to artificial valve, to affix one's name to entire artificial valve from delivery sheath pipe portion, allow artificial valve radial dilatation, Delivery apparatus is still fixed to via suture circle simultaneously.The method may further include, entire from delivery sheath pipe portion administration After artificial valve, is returned it on artificial valve by distally advancing delivering sheath, recycle artificial valve.
Fig. 1 is according to the perspective view of the artificial valve of one embodiment, and the artificial valve is substituted for the natural heart Dirty aorta petal.
Fig. 2 is the perspective view of a part of artificial valve of Fig. 1, shows the braced frame of two leaflets and artificial valve Connection.
Fig. 3 is the side front view of the braced frame of the artificial valve of Fig. 1.
Fig. 4 is the perspective view of the braced frame of the artificial valve of Fig. 1.
Fig. 5 A is the section view of heart, shows the artificial valve for the Fig. 1 being implanted in aortic valvular ring.
Fig. 5 B is the enlarged view of Fig. 5 A, the artificial valve being implanted in aortic valvular ring is shown, wherein in order to clear For the sake of, the leaflet structure of artificial valve is removed.
Fig. 6 is the perspective view in the leaflet structure of the artificial valve fixed to the previously shown Fig. 1 of braced frame.
Fig. 7 is the section view of the artificial valve of Fig. 1.
Fig. 8 is the section view of the embodiment of delivery apparatus, and the delivery apparatus can be used for delivering and implantable artificial valve Film, artificial valve such as shown in FIG. 1.Fig. 8 A to Fig. 8 C is the amplification section view of the section of Fig. 8.
Fig. 9 is the decomposition view of the delivery apparatus of Fig. 8.
Figure 10 is the side view of the guiding catheter of the delivery apparatus of Fig. 8.
Figure 11 is the decomposition perspective view of the proximal part of the guiding catheter of Figure 10.
Figure 12 is the decomposition perspective view of the distal portions of the guiding catheter of Figure 10.
Figure 13 is the side view of the torque shaft conduit of the delivery apparatus of Fig. 8.
Figure 14 is the enlarged side view of the rotatable screw rod of the torque shaft conduit of Figure 13.
Figure 15 is the enlarged perspective that the coupling member of torque shaft end is arranged in.
Figure 16 is the enlarged perspective of the screw nut used in the torque shaft conduit of Figure 13.
Figure 17 is the amplification of the distal portions of the front end pig tail catheter (nose cone catheter) of the delivery apparatus of Fig. 8 Side view.
Figure 17 A is the amplification section view of the front end Tapered Cup (nose cone) of conduit shown in Figure 17.
Figure 17 B is the amplification section view of the distal portions of the delivery apparatus of Fig. 8, shows and is maintained in delivering sheath The bracket of artificial valve in compressive state.
Figure 18 is the amplification profile of the distal portions of the delivery apparatus of Fig. 8, shows to be delivered in patient and locates Delivering sheath in the delivering posture of artificial valve in covering compressive state.
Figure 19 is the amplification section view of the section of the distal portions of the delivery apparatus of Fig. 8, shows fixed artificial valve Bracket to delivery apparatus valve holding mechanism.
Figure 20 is the amplification section view similar to Figure 19, is shown for releasing from delivery apparatus release artificial valve Put the interior fork of the valve holding mechanism in position.
Figure 21 and Figure 22 be Fig. 8 delivery apparatus distal portions enlarged side view, show for from delivering sheath Dispose the operation of the torque axis of artificial valve.
Figure 23 to Figure 26 is the various views of the embodiment of motor-driven delivery apparatus, and the motor-driven delivery apparatus can be used for grasping Make the torque axis of delivery apparatus shown in fig. 8.
Figure 27 is the perspective view of alternative motor, and the alternative motor can be used for operating delivering dress shown in fig. 8 The torque axis set.
Figure 28 A is the enlarged view of the distal segment of the guiding catheter axis of Figure 10.
Figure 28 B shows the cutting pattern for metal tubular to be such as cut by laser into the part of axis shown in Figure 28 A.
The enlarged view of the distal segment of the guiding catheter axis of another embodiment according to Figure 29 A.
Figure 29 B is for metal tubular to be such as cut by laser into the cutting pattern of the axis of Figure 29 A.
Figure 30 is the side front view of the supporting support used in artificial valve.
Figure 31 A is the enlarged view of exemplary delivery component, and the delivery components have for can two-way/inverse ground (reversibly) multiple suture circles of the supporting support of Figure 30 are engaged.
Figure 31 B is the side view of the exemplary suture holding member used in the delivery components of Figure 31 A.
Figure 31 C is the proximal end view of the suture holding member of Figure 31 B, is shown with distad outwardly extending suture circle First (nearside) disc element proximal end.
Figure 31 D is the distal end view of the suture holding member of Figure 31 B, is shown with distad outwardly extending suture circle The first disc element distal end view.For clarity, the second (distal side) disc element and axis structure of suture holding member Part is omitted from Figure 31 D.
Figure 32 be include Figure 31 A delivery catheter exemplary delivery component side front view, wherein suture circle, which is shown, connects Close the bracket of Figure 30.
Figure 33 is the enlarged view for engaging the delivery components of Figure 32 of bracket of Figure 30.
Figure 34 is the side front view for keeping the delivery components of Figure 32 of bracket of Figure 30, and wherein suture circle engagement bracket is every A top.
Figure 35 is the side front view of the delivery components of Figure 32, and wherein the sheath component of delivery components is advanced to the bracket of Figure 30 A part on.
Figure 36 is the side front view of the delivery components of Figure 32, and wherein the sheath component of delivery components is fully advanced into Figure 30's On bracket.
Figure 37 is the side front view of the delivery catheter of Figure 32, and wherein the bracket of suture circle and Figure 30 are detached from.
Figure 38 is the top view of another exemplary delivery component, shows delivering cylinder and screw mechanism.Delivery components It can have the single continuous outer sleeve portion (not shown) of coating member.
Figure 39 A is the top view that cylinder and screw mechanism are delivered used in the delivery components of Figure 38.The screw machine Structure can be used for promoting and retracting delivering cylinder.Delivering cylinder, screw member and nut is shown respectively.
The top view of delivering cylinder and screw mechanism that Figure 39 B is Figure 39 A, wherein nut is mounted on the screw rod being separately depicted On component and delivering cylinder.
The top view of delivering cylinder and screw mechanism that Figure 39 C is Figure 39 A, wherein the ledge portion of nut (is mounted on spiral shell In bar component) extend through the proximally-oriented window for delivering cylinder.
Figure 40 is the top view of the distal portions of the first conduit of the delivery apparatus of Figure 38.
Figure 41 is the top view of the section of the delivery apparatus of Figure 38, is shown coupled to the screw mechanism of delivering sheath.
Figure 42 is the top view of the distal portions of the delivery apparatus of Figure 38, shows the delivery sheath for being retracted into proximal position Pipe.
Figure 43 is the detailed view of the distal portions of the delivery apparatus of Figure 38, wherein the delivery sheath pipe is advanced to and is used for Its farthest position of artificial valve delivering.
Figure 44 is the front view of coil and gasket assembly, and the coil and gasket assembly can replace screw rod shown in Figure 13 It is incorporated into torque axis with screw rod shown in nut assembly or Figure 39 A and nut assembly.
Figure 45 is the side view of the coil of Figure 44 shown partially and the section of gasket assembly.
Figure 46 is the amplification section view according to the distal portions of the delivering sheath of one embodiment.
Figure 47 is can be used in the side view of the metal tube of the alternative fluting in the delivery apparatus of Figure 38.
Figure 48 be include fluting shown in Figure 47 metal tube delivery apparatus a part side view.
Figure 49 is the enlarged view of the distal portions of the metal tube of the fluting of Figure 47, shows the distal portion of the metal tube of fluting Divide and is connected to suture holding member.
With reference first to Fig. 1, the prosthetic aortic heart valve 10 according to one embodiment is shown.Artificial valve 10 includes can The framing component or bracket 12 of expansion support flexible leaflet section 14.Artificial valve 10 can radially be compressed to compressive state To be delivered to site of deployment for passing through body and be expanded to its functional dimension shown in FIG. 1 at site of deployment.In spy Determine in embodiment, artificial valve 10 is self expandable；That is, when artificial valve is promoted from the distal end of delivering sheath, people Work valve can be radially expanded into its functional dimension.Dermal delivery particularly suitable for self expandable artificial valve is described below in detail With the device of implantation.In other embodiments, artificial valve can be balloon-expandable artificial valve, may be adapted to compress State is mounted on the sacculus of delivery catheter.As known in the art, by making balloon inflation, artificial valve can be Its functional dimension is expanded at site of deployment.
Although artificial valve 10 shown in can be used for other natural valves of replacement heart, and artificial valve 10 is suitable for It is deployed in native aortic annulus.In addition, artificial valve 10 may be adapted to replace other valves, such as vein in body Valve.
For illustrative purposes, Fig. 3 and Fig. 4 is shown without the bracket 12 of leaflet section 14.As shown, bracket 12 can be with It is formed by the framing component or strut 16 of multiple substantially sinusoidals longitudinally extended.Strut 16 is formed with alternate bending, and It is welded to one another in the node 18 formed by neighbouring curved vertex or otherwise fixes to form reticular structure.Branch Bar 16 can be made of suitable shape-memory material, such as the referred to as Nitinol of Nitinol, the shape-memory material Allow artificial valve to be compressed to the diameter of diminution to be used for the delivering in delivery apparatus (such as described below), and then works as people Work valve causes artificial valve to be expanded to its functional dimension in patient's body when disposing from delivery apparatus.If artificial valve is ball The distensible artificial valve of capsule, bracket 12 can be made of suitable ductile material, such as stainless steel, wherein balloon expandable Artificial valve is suitable for being crimped on the balloon-expandable of delivery apparatus and by the expanse of sacculus to its functional dimension.
Bracket 12, which has, flows into end 26 and outflow end 27.It include general cylindrical by the reticular structure that strut 16 is formed "upper" or outflow end part 20, outside bow or the intermediate section 22 to swell, and the inwardly "lower" of bow or stream Enter end part 24.The Wa Ersaerwa sinus that intermediate section 22 is designed size and shape ideally to extend in aortic root/ In aortic sinus (Valsalva sinuses), to facilitate for artificial valve to be anchored on if artificial valve is implanted suitable When in position.As shown, reticular structure ideally has a curved shape along its entire length, diameter is from outflow end part 20 gradually increase to intermediate section 22, and then its diameter gradually subtracts from intermediate section 22 to the position flowed into end part 24 It is few, and then its diameter is gradually increased to be formed in the flared part for flowing into and terminating at end 26.
When artificial valve is in its expanded state middle, intermediate section 22 has diameter D1, flowing into end part 24 has most Minor diameter D2, flowing into end 26 has diameter D3, and end part 20 is flowed out with diameter D4, wherein D2Less than D1And D3, and D4It is small In D2.In addition, it is desirable that D1And D3Greater than the diameter of natural annulus, artificial valve will be implanted in natural annulus.By this method, The overall shape of bracket 12 helps for artificial valve to be maintained at implant site.More specifically, and referring to Fig. 5 A and Fig. 5 B, Artificial valve 10 can be implanted in natural valve (aorta petal in the example shown in the series of figures), so that lower section 24 It being placed in aortic valvular ring 28, intermediate section 24 is extended to above aortic valvular ring in Wa Ersaerwa sinus 56, and Lower part flared end 26 extends below aortic valvular ring.Artificial valve 10 resists aortic valvular ring 28 by lower section 24 The force radially of surrounding tissue and the geometry of bracket and be maintained in natural valve.Specifically, intermediate section 24 Aortic valvular ring 28 is extended radially outward beyond with flared lower section end 26 preferably to resist artificial valve in upstream and downstream Variation of axial position on direction (towards aorta and far from aorta).As described in Fig. 5 B, according to the condition of native leaflet 58, people Work valve is usually deployed in natural annulus 28, and native leaflet 58 is folded up and is compressed in the appearance of bracket 12 Between face and the wall of Wa Ersaerwa sinus.In some cases it may be desirable to cut off leaflet before implantable prosthetic valve 10 58。
Well known artificial valve with self expandable frame usually has in the non-diseased region for extend to vascular system simultaneously And it is fixed to the additional anchoring arrangement or frame part in the non-diseased region of vascular system.Because the shape of bracket 12 facilitates Artificial valve is kept, so not needing additional anchoring arrangement, and the total length L of bracket can be minimized to prevent bracket Top 20 extends in the non-diseased region of aorta, or top 20 is at least made minimally to extend to the non-diseased of aorta In region.In the case where needing following intervene, the non-diseased region for avoiding the vascular system of patient helps avoid complication. For example, artificial valve can be easier to remove from patient because bracket is mainly anchored into the diseased part of natural valve. In addition, shorter artificial valve is easier to surround arch of aorta traveling/navigation.
In a particular embodiment, for the artificial valve being intended for use in the annulus of 22mm to 24mm, diameter D1 is about 28mm to about 32mm, wherein 30cm is particular example；Diameter D2 is about 24mm to about 28mm, and wherein 26mm is particular example；Directly Diameter D3 is about 28mm to about 32mm, and wherein 30mm is particular example；And direct D4 is about 24mm to about 28mm, and wherein 26mm is Particular example.Length L in a particular embodiment is about 20mm to about 24mm, and wherein 22mm is particular example.
Referring to Fig.1, the retaining arm or protrusion that bracket 12 can have multiple angled intervals of 30 form of column are (in shown reality Applying in example has 3), retaining arm or protrusion extend from frame upper 20.Each retaining arm 30 has respective aperture 32, aperture 32 Be dimensioned so as to receive the skewer of valve holding mechanism, the skewer of shown valve holding mechanism can be used for artificial Releasable connection is formed between valve and delivery apparatus (as described below).In alternative embodiments, if not using valve Holding mechanism does not need then to provide retaining arm 30.
If Fig. 6 and Fig. 7 are best seen from, the leaflet component 14 in illustrated embodiment includes 3 be fabricated from a flexible material Leaflet 34a, 34b, 34c.Each leaflet, which has, flows into end part 60 and outflow end part 62.Leaflet may include any suitable Biomaterial (for example, pericardium of pericardial tissue, such as ox or horse), biocompatibility synthetic material or other such materials, it is all Such as United States Patent (USP) No.6, described in 730,118 those, which is incorporated by reference herein.Leaflet component 14 can wrap Include annular and reinforce sleeve (skirt) 42, be fixed at the suture 44 at the inflow end of neighbouring artificial valve leaflet 34a, The outer surface of the inflow end part of 34b, 34c.By the way that sleeve 42 to be sewn onto the strut 16 of the lower section 24 of bracket, leaflet group The inflow end part of part 14 can be fixed to bracket 12 (such as Fig. 1 best seen from).As shown in fig. 7, leaflet component 14 can be into One step includes internal reinforcing strip 46, is fixed to the inner surface of the inflow end part 60 of leaflet.
Referring to Figures 1 and 2, the outflow end part of leaflet component 14 can be between 3 of leaflet 34a, 34b, 34c be at an angle of Every the attached place of joint be fixed to the top of bracket 12.If Fig. 2 is best seen from can be by the comissure that two leaflets are formed Reinforce section 36 around the adjacent package of upper rim 38 of a pair of of leaflet and is fixed to suture 48 by section 36 is reinforced Marginal portion 38, it is attached to form each joint.Then the interlayer of reinforcement material and leaflet can use 50 near bracket of suture Outflow end is fixed to the strut 16 of bracket 12.Therefore, leaflet is ideally along the whole length of bracket or basic whole length from stream Enter end 26 and extends to outflow end 27.Reinforce section 36 and reinforces leaflet to the attached of bracket, to minimize answering at suture Power is concentrated and avoids " pin hole " on the leaflet part of warpage in use.Reinforce section 36, sleeve 42 and inside to add Strong band 46 is ideally by the biocompatibility synthetic material of such as polytetrafluoroethylene (PTFE) (PTFE) or such as Woven polyester (for example, poly- Ethylene terephthalate (PET)) textile material be made.
Fig. 7 shows the operation of artificial valve 10.During diastole, leaflet 34a, 34b, 34c collapse to effectively Close artificial valve.As shown, the curved shape of the intermediate section 22 of bracket 12 limits sky between intermediate section and leaflet Between, which imitates Wa Ersaerwa sinus.Therefore, when leaflet is closed, the reflux into " sinus " is generated along the upper surface of leaflet Turbulent blood flow, as shown in arrow 52.The turbulent flow facilitates cleaning leaflet and sleeve 42 and is formed to minimize grumeleuse.
Artificial valve 10 can be implanted into retrograde method, wherein being mounted on the far-end of delivery apparatus with rolled state Artificial valve is introduced into body via femoral artery and is advanced to heart by the arch of aorta, such as in U.S. Patent Publication It is further described in No.2008/0065011, which is incorporated by reference herein.
Fig. 8 and Fig. 9 shows the delivery apparatus 100 according to one embodiment, can be used for self expandable artificial valve is (all Such as above-mentioned artificial valve 10) deliver the vascular system for passing through patient.Delivery apparatus 100 includes having the first of elongated shaft 104 most Outer conductor or main pipe 102 (Figure 10 is separately shown), the distal end of main pipe 102 are coupled to delivering 106 (Figure 18 of sheath；? Referred to as deliver cylinder).The proximal end of main pipe 102 is connected to the handle of delivery apparatus.Figure 23 to Figure 26, which is shown, to be had for operating The embodiment of the handle mechanism of the electric motor of delivery apparatus.Handle mechanism is described below in detail.In the delivering of artificial valve Cheng Zhong, handle can be used by surgeon, to make delivery apparatus promote and retract by the vascular system of patient.Although not yet It requires, but main pipe 102 may include guiding catheter, is configured to be pushed through the vascular system of patient with axis 104 System allows the bending of the distal portions of surgeon's guidance or control shaft 104 or the amount of warpage, all as described further below. Another embodiment of guiding catheter is disclosed in U.S. Patent Publication No.2008/0065011, which is incorporated into this Text is as reference.
As Fig. 9 best seen from, delivery apparatus 100 further includes the second intermediate conductor 108 (also referred herein as torque shaft conduit), Its elongate threaded screw 112 with elongated shaft 110 (also referred herein as torque axis) and the distal end for being connected to axis 110.Intermediate conductor 108 Axis 110 extend coaxially through the axis 104 of main pipe 102.Delivery apparatus 100 can also include third front end pig tail catheter 118, the front-end element or front end Tapered Cup 122 of the distal portions with elongated shaft 120 and fixed to axis 120.Front-end element 122 can With with tapered outer surface, as shown, for carrying out hurtless measure tracking by patient's vascular system.Front end pig tail catheter Axis 120 extends through the axis 110 of artificial valve 10 (Fig. 8 is not shown into Fig. 9) and intermediate conductor 108.In the configuration shown in, Innermost layer axis 120 is configured to axially and be rotatably moved relative to axis 104 and 110, and torque axis 110 is configured At rotatable relative to axis 104 and 120, to realize that artificial valve is disposed and discharged from the valve of delivery apparatus, such as below Detailed description.In addition, innermost layer axis 120 can have chamber, chamber is for receiving guide line so that delivery apparatus can be It is advanced on guide line inside the vascular system of patient.
If Figure 10 is best seen from, outer catheter 102 may include the warpage control mechanism 168 located at its proximal end, be used for When the distal portions of outer shaft 104 are pushed through the vascular system of patient, bending or the warpage of the distal portions of outer shaft 104 are controlled Amount, it is all as described further below.Outer shaft 104 may include proximal section 166 and distal segment 126, wherein proximal section 166 from Warpage control mechanism 168 extends, and distal segment 126 includes the metal tube of fluting, and the metal tube of the fluting increases the position The flexibility of the outer shaft at place.The distal portions of distal segment 126 may include the outer fork 130 of valve holding mechanism 114,130 quilts of outer fork It is configured to so that artificial valve 10 is releasably secured to delivery apparatus 100 during valve delivery, such as retouches in detail below It states.
Figure 28 A is the enlarged view of a part of the distal segment 126 of outer shaft 104.Figure 28 B, which is shown, can be used for passing through laser Pattern is cut in metal tube to form the cutting pattern of distal segment 126.Distal segment 126 includes endless belt or the chain of multiple interconnection (link) 160 is saved, the metal tube of fluting is formed.Draught line 162 can be placed in the inside of distal segment 126 and can be from remote The position 164 (Figure 10 and Figure 12) of side section 126 extends to warpage control mechanism.The distal end of draught line 162 can such as pass through weldering Connect the inner surface for the distal segment 126 being fixed at position 164.The proximal end of draught line 162 can be operatively attached to warpage Control mechanism 168, warpage control mechanism 168 are configured to apply and discharge bending of the tension to draught line so as to control shaft, such as It is described further below.Gap between the chain link 160 and adjacent link of axis is shaped as when applying slight tug to leading The bending of axis is allowed for when on lead 162.In an illustrated embodiment, if Figure 12 is best seen from distal segment 126 is fixed to tool There is the proximal section 166 of different configuration (for example, one or more layers polymer pipe).In the illustrated embodiment, proximal section 166 is from folding Bent control mechanism 168 extends to proximal section 126, and therefore forms most of length of outer shaft 104.In alternate embodiments In, the entire length of outer shaft 104 or basic entire length can be by the slotted metals of the chain link 160 including one or more snippets interconnection Pipe is formed.In any situation, with such construct main shaft use can permit delivery apparatus height it is controllable, especially when It (is described below) when being used in conjunction with the torque axis with construction shown in Figure 40 and Figure 41.
The width of chain link 160 can be changed, to change the flexibility of distal segment along its length.For example, slotted-tube is remote Chain link in end part can be with relative narrower, to increase the flexibility of the axis at that position, and the proximal part of slotted-tube Interior chain link can be relatively wide so that axis is relatively less flexible at this location.
Figure 29 A illustrates that the alternate embodiments of the distal segment for 126 ', the distal segment can for example pass through laser Metal tube is cut to be formed.Segment 126 ' may include the distal segment (as shown in figure 12) or outer shaft of the outer shaft of delivery apparatus Basic whole length can have construction shown in Figure 29 A.Figure 29 B shows the cutting pattern for being used to form segment 126 '.? In another embodiment, delivery apparatus may include compound outer shaft, and compound outer shaft includes swashing made of being laminated with polymeric outer layer Light cuts metal tube, which merges in gap in the metal layer.In one example, composite shaft may include tool There is the laser cut metal pipe of the cutting pattern of Figure 29 A and Figure 29 B and merges in the gap between the chain link 160 of metal tube Polymeric outer layer.In another example, composite shaft may include that there is the laser of the cutting pattern of Figure 28 A and Figure 28 B to cut It cuts metal tube and merges the polymeric outer layer in the gap between the chain link 160 of metal tube.Composite shaft can also include melting Close the polymer inner layer in the gap between the chain link 160 of metal tube.
Referring to Fig. 8 A and Figure 11, warpage control mechanism 168 may include rotatable shell or handle portion 186, hold Sliding nut 188 of the Naan on guide rail 192.Sliding nut 188 is prevented to revolve inside the shell by one or more bars 192 Turn, each bar 192 is partially disposed in the slot in the respective recesses in guide rail 192 and on 188 inside of nut or recess. The proximal end of draught line 162 is fixed to nut 188.Nut 188 has the external screw thread of the internal screw thread of engagement shell.Therefore, according to The direction of rotation of shell, rotational shell 186 cause nut 188 to move axially inside the shell along nearside or distal direction.Along first Rotational shell causes nut to move in a proximal direction in direction (for example, clockwise), to apply tension to draught line 162, this causes the distal end bending of delivery apparatus or warpage.Rotational shell causes spiral shell in a second direction (for example, counterclockwise) Mother moves in a distal direction, to release the tension in draught line 162 and allow the distal end of delivery apparatus in its own elasticity Under go back to it pre- warpage configuration.
If Figure 13 includes the annular protrusion (also referred to as anchoring disk) of 128 form of ring best seen from, torque shaft conduit 108, Ring 128 is installed on the distal portions of the torque axis 110 of neighbouring screw rod 112.Ring 128 is fixed to the appearance of torque axis 110 Face, so that it cannot axial direction or moving in rotation relative to torque axis.The inner surface of outer shaft 104 is formed with such as slot or recess Feature, this feature receives ring 128 in this way, that is, the corresponding feature on the inner surface of ring and outer shaft 104 allows to turn Square axis 110 rotates relative to outer shaft 104 but torque axis is prevented to move axially relative to outer shaft.On the outer shaft 104 for receiving ring 128 Individual features can be the ledge portion to extend internally formed in distal segment 126, such as Figure 12 164 shown in.Showing In embodiment out (such as Figure 14 best seen from), ring 128 is the component part of screw rod 112 (that is, screw rod 112 and ring 128 are single The part of component).Alternatively, screw rod 112 and ring be the component being formed separately but they be all firmly fixed to torque axis 110 distal end.
Torque axis 110 be desirably configured to it is rotatable relative to delivering sheath 106, to realize artificial valve 10 from passing Send the incremental and controlled propulsion of sheath 106.In order to reach this purpose, and according to one embodiment, delivery apparatus 100 It may include the sheath retaining ring for 150 form of screw nut being mounted on the external screw thread of screw rod 112.As Figure 16 best seen from, Nut 150 includes the externally threaded internal screw thread 152 and axially extending supporting leg 154 of engagement screw rod.Each supporting leg 154 has convex The distal portions risen, raised distal portions are extended in the opening 172 in the proximal end of sheath 106 and/or are formed and sheath 106 Proximal end in the clamping engagement connection (such as Figure 18 best seen from) that connects of opening 172, so that sheath 106 is fixed to nut 150.As shown in Figure 17 B and 18, sheath 106 extends on artificial valve 10 and artificial valve is made to be maintained at radial compression In, until sheath 106 is retracted by user to dispose artificial valve.
If Figure 21 and Figure 22 is best seen from the outer fork 130 of valve holding mechanism includes multiple skewers 134, each forked Object extends through the region being limited between two neighbouring supporting legs 154 of nut, to prevent the nut phase when screw rod rotates Screw rod 112 is rotated.Therefore, the rotation of torque axis 110 (and therefore screw rod 112) causes the corresponding axial direction of nut 150 It is mobile.Connection between nut 150 and sheath 106 is configured so that nut along screw rod 112 (on distal side or proximal direction) Axial movement cause sheath 106 to move axially in the same direction relative to screw rod and valve holding mechanism.Figure 21 shows place In the nut 150 of distal position, wherein sheath 106 (being not shown in Figure 21) extends on artificial valve 10 and by artificial valve 10 are maintained in compressive state to deliver.Nut 150 causes from distal position (Figure 21) to the movement of proximal position (Figure 22) Sheath 106 moves in a proximal direction, to dispose artificial valve from sheath 106.For realizing the axial movement of sheath 106 The rotation of torque axis 110 can be used motor-driven mechanism (shown in such as Figure 23 to Figure 26 and being described below) or by manual Rotating crank or wheel are completed.
Figure 17 is shown affixed to the enlarged view of the front end Tapered Cup 122 of the distal end of innermost layer axis 120.Implement shown in Front end Tapered Cup 122 in example includes proximal part 174, is sized to fit in the distal internal of sheath 106.Front end The intermediate section 176 of Tapered Cup is disposed close to the end of sheath in use, and is formed with multiple longitudinal grooves, or recessed Part 178.Diameter of the intermediate section 176 at its proximal end at 180 is ideally slightly greater than the overall diameter of sheath 106.Proximal end 180 can be with It keeps being in close contact with the distal end of sheath 106, to prevent surrounding tissue from contacting with the metal edge of sheath.With delivery apparatus It is pushed through guide sheath, groove 178 allows intermediate section to be radially compressed.This allows front end Tapered Cup relative to guiding The interior diameter of device sheath has slightly larger size.Figure 17 B shows the cross section of the sheath 106 in front end Tapered Cup 122 and delivery location, Wherein artificial valve is maintained in sheath 106 with the sending state compressed and (for illustrative purposes, only shows the branch of artificial valve Frame 12).As shown, the proximal end 180 of intermediate section 176 can abut the distal end of sheath 106, and front end Tapered Cup is tapered close Side surface 182 can extend in the distal portions of bracket 12.
As described above, delivery apparatus 100 may include the valve guarantor for releasably holding the bracket 12 of artificial valve Hold mechanism 114 (Fig. 8 B).Valve holding mechanism 114 may include outer fork 130 (such as Figure 12 best seen from) (also referred to as " outer trident " Or " release trident ") form the first valve fixation member and interior fork 132 (such as Figure 17 best seen from) (also referred to as " interior three Fork " or " locking trident ") form the second valve fixation member.Outer fork 130 cooperates with interior fork 132 to form the guarantor with bracket 12 The releasable connection of gripping arm 30.
The proximal end of outer fork 130 is connected to the distal segment 126 of outer shaft 104, and the distal end pitched outside is releasably connected To bracket 12.In an illustrated embodiment, outer to pitch 130 Hes although these components are separately formed and are then connected to each other Distal segment 126 can also be integrally formed into single component (for example, outer fork and distal segment can be cut by laser or in addition by metal The single-piece work of pipe forms).Interior fork 132 can be installed on nose catheter axis 120 (such as Figure 17 best seen from).Interior fork 132 Connect the holder to the distal portions of nose catheter axis 120.As described further below, nose catheter axis 120 can be opposite It is moved axially in outer shaft 104, to discharge artificial valve from valve holding mechanism.
If Figure 12 is best seen from outer fork 130 includes the fork at multiple angled intervals corresponding with the retaining arm 30 of bracket 12 Shape object 134 (has 3) in the shown embodiment, and wherein skewer extends from the distal end of distal segment 126.Each skewer 134 Distal portions include respective opening 140.If Figure 17 is best seen from interior fork 132 includes corresponding with the retaining arm 30 of bracket 12 The skewer 136 at multiple angled intervals, wherein skewer extends from the base part 138 of the proximal end of interior fork.The base of interior fork Bottom point 138 is firmly fixed to nose catheter axis 120 (for example, with suitable adhesive), to prevent interior fork relative to preceding Hold the axial movement and moving in rotation of catheter shaft 120.
Each skewer of outer fork and the cooperation of the corresponding skewer of interior fork are releasable with the retaining arm 30 of bracket to be formed Connection.In an illustrated embodiment, for example, the distal portions of each skewer 134 are formed with opening 140.When artificial valve quilt When fixed to delivery apparatus (such as Figure 19 best seen from), each retaining arm 30 of bracket 12 extends inwardly through the skewer of outer fork 134 opening 140, and the skewer 136 of interior fork pass through retaining arm 30 opening 32 insertion so as to keep the retaining arm 30 with Exempt from it to return to outside opening 140.Figure 42 is also shown in front of artificial valve is loaded into sheath 106 and is fixed by interior fork and outer fork To the artificial valve 10 of delivery apparatus.Skewer 136 is so that forked in retracting to nearside (on the direction of the arrow 184 of Figure 20) Object is removed from opening 32 effectively discharges artificial valve 10 from holding mechanism.When interior fork 132 is moved to proximal position (Figure 20), The retaining arm 30 of bracket can move radially outward under the screen resilience of bracket from the opening 140 in outer fork 130.With this side Formula, valve holding mechanism 114 form the releasable connection with artificial valve, and the releasable connection is sufficiently stable relative to delivering Device keeps artificial valve, so that user be allowed to finely tune or adjust artificial valve after delivery sheath pipe portion administration in artificial valve Position.It, can be by retracting nose catheter relative to outer shaft 104 when artificial valve is placed at desired implant site Axis 120 (it retracts interior fork 132 relative to outer fork 130), discharges the connection between artificial valve and holding mechanism.
Described below for compression and artificial valve 10 is loaded to the technology in sheath 106.Once artificial valve 10 is filled It is loaded into delivering sheath 106, delivery apparatus 100 can be inserted into the delivering in patient body so as to artificial valve.One In kind method, artificial valve can be delivered with program of driving in the wrong direction, and wherein delivery apparatus is inserted into femoral artery and is pushed into logical The vascular system for crossing patient reaches heart.Before being inserted into delivery apparatus, guide sheath can be inserted into femoral artery, then It is guide line, the vascular system for being pushed through patient passes through aorta and enters in left ventricle.Delivery apparatus 100 is then Guide sheath can be inserted through and promoted on guide line, until the distal end of the delivery apparatus including artificial valve 10 Part is advanced to the position in neighbouring natural aortic valve or natural aortic valve.
Thereafter, by the way that relative to 104 rotating torques axis 110 of outer shaft, artificial valve 10 can be disposed from delivery apparatus 100. As described below, the proximal end of torque axis 110 can be operatively attached to the handle portion that can be manually rotated or motor-driven mechanism, allow Surgeon realizes rotation of the torque axis 110 relative to outer shaft 104.The rotation of torque axis 110 and screw rod 112 causes nut 150 It is mobile (Figure 22) towards outer shaft in a proximal direction with sheath 106, to dispose artificial valve from sheath.With artificial valve from The open distal end of delivering sheath promotes and starts to expand, and the rotation of torque axis 110 causes sheath with accurate and controlled mode phase It is mobile for artificial valve.Therefore, it is different from well known delivery apparatus, as artificial valve starts to promote and expand from delivering sheath , artificial valve, which is kept, resists the uncontrolled movement from sheath, and uncontrolled movement is artificial by resistance sheath distal end The expansionary force of valve causes.In addition, artificial valve 10 is by valve holding mechanism 114 relative to interior as sheath 106 is contracted The end of axis 120 and outer shaft 104 is maintained in resting position.Just because of this, as sheath is contracted, artificial valve 10 can phase Target position intracorporal for body is remain stationary.In addition, in artificial valve after the propulsion of sheath tube portion, it may be desirable to retract people Work valve is returned in sheath, for example, relocating artificial valve or recalling artificial valve completely from body.Partial deployment Artificial valve can by reversely rotate torque axis be contracted back in sheath, so as to cause sheath 106 along distal side side To being pushed back on artificial valve.
In well known delivery device, surgeon must apply push-pull force so that artificial valve goes out to axis and/or sheath Sheath.Therefore, it is difficult to transfer force to the distal end of equipment in the case where non-warping axis (for example, being compressed axially or stretch axis), turn round Crankshaft leads to the uncontrolled movement of the artificial valve during sheath process out again.In order to alleviate this as a result, axis and/or sheath can To be made more rigid, this is worthless, because equipment, which becomes difficult to be steered, passes through vascular system.In contrast, on It states artificial valve and goes out the mode of sheath and eliminate and apply push-pull force on axis as required by well-known devices, so as to relatively large and accurate Power can be applied to the distal end of axis, the flexibility without damaging equipment.In certain embodiments, up to the power of 20lbs can pass It is delivered to torque the tip of the axis, without negatively affecting out sheath process.In contrast, during sheath process out, push-pull is utilized The prior art device of structure generally can not be more than about the power of 5lbs.
It is promoted in artificial valve 10 from delivering sheath and is expanded to its functional dimension (Figure 42 description is fixed to delivery apparatus Expansion artificial valve 10) after, artificial valve still remains connected to delivery apparatus via holding mechanism 114.As a result, After delivering sheath propulsion, surgeon can relocate artificial valve relative to implantation position desired in natural valve Artificial valve such as by delivery apparatus mobile on nearside and distal direction or moves left and right delivery apparatus, or rotation delivering Device, so as to cause the corresponding movement of artificial valve.Holding mechanism 114 is desirable to provide between artificial valve and delivery apparatus Connection, as the position of artificial valve is adjusted relative to the expectation implantation position in natural valve, the holding mechanism 114 The sufficiently stable and hard mobile phase to resist blood keeps delivery apparatus the position of artificial valve.Once surgeon will Artificial valve is placed at the expectation implantation position in natural valve, can be by contracting in a proximal direction relative to outer shaft 104 Innermost layer axis 120 is returned to discharge the connection between artificial valve and delivery apparatus, so that fork 132 is so that it is pitched in effectively retracting Shape object 136 recalls (Figure 20) from the opening 32 in the retaining arm 30 of artificial valve.The slight retraction of outer shaft 104 allows outer fork 130 The retaining arm 30 of artificial valve is exited, retaining arm 30 slides outward through the opening 140 in outer fork so that artificial valve is completely de- From holding mechanism 114.Thereafter, delivery apparatus can be recalled from body, leave the aortic valve prosthesis being implanted in natural valve 10 (all shown as shown in Figure 5 A and 5B).
Delivery apparatus 100 has the semi-rigid segment being made of the component of relative stiffness in its far-end, is used to turn The axial movement for being converted to sheath of square axis.Specifically, the semi-rigid segment of this in illustrated embodiment by artificial valve and Screw rod 112 is constituted.The advantages of delivery apparatus 100, is that the total length of semi-rigid segment is minimized because using nut 150 and It is not the internal screw thread on outer shaft to realize the translation of sheath.The length of the reduction of semi-rigid segment increases along the distal end of delivery catheter Partial total flexibility.In addition, the length of semi-rigid segment and position remain unchanged, because torque axis is not axially flat relative to outer shaft It moves.Just because of this, the curved shape of delivery catheter can valve dispose during in be maintained, this improves the stabilization of deployment Property.Delivery apparatus 100 further has an advantage that ring 128 prevents axial load (compression and tension) to be transferred to torque axis 110 and exists The section in the distal side of ring.
In alternative embodiments, delivery apparatus may be adapted to deliver balloon-expandable artificial valve.As described above, valve Holding mechanism 114 can be used for for artificial valve being fixed to the end of delivery apparatus.Since the bracket of artificial valve is not to expand certainly , therefore sheath 106 is optional.Holding mechanism 114 enhances delivery apparatus and artificial valve component passes through guide sheath Motive force.
Figure 23 to Figure 26 shows the proximal part of the delivery apparatus 100 according to one embodiment.Delivery apparatus 100 can wrap Include handle 202, handle 202 be configured to be releasably connectable to include the conduit tube component 204 of conduit 102,108,118 proximal end Part.For various reasons, it is expected that handle 202 and conduit tube component 204 are detached from.For example, handle disengaging is made to can permit another Equipment slips over conduit tube component, and such as valve withdraws equipment or facilitates the equipment for manipulating conduit tube component.It should be noted that conduit Any feature of component 204 and handle 202 can be implemented in any embodiment of delivery apparatus disclosed herein.
Figure 23 and Figure 24 shows the close end for the conduit tube component 204 being partially inserted into the distal openings of handle 202 Point.The proximal part of main shaft 104 is formed with annular groove 212 (such as Figure 24 best seen from), the fixing structure with handle inner Or blocking mechanism 214 cooperates.As illustrated in figs. 25 and 26, when the proximal part of conduit tube component is fully inserted into handle, Gu The bonding part 216 for holding mechanism 214 extends at least partially into groove 212.The side of fixing structure 214 is connected to button 218, Button 218 extends through the shell of handle.The opposite side of fixing structure 214 is contacted by spring 220, and spring 220 makes fixing machine Structure 214 is biased into the position that main shaft 104 is engaged at groove 212.Engagement of the fixing structure 214 in groove 212 prevents conduit Component and handle axial separation.Conduit tube component can be discharged from handle by push button 218, to make fixing structure 214 From engaging movement with spindle lock.In addition, main shaft 104 can be formed with flat surface portion in groove 212.Flat table Face part engages against the respective flat surface part setting of part 216.As torque axis rotates during valve deployment, this is connect Conjunction remain stationary main shaft 104 relative to torque axis 110.
The proximal part of torque axis 110 can have driven nut 222 (Figure 26), and driven nut 222 is slideably connect It is received in the driving cylinder 224 (Figure 25) for being mounted on handle inner.By the way that nut 222 is fixed on coupling member 170 (Figure 15) On, nut 222 can be fixed to the proximal end of torque axis 100.Figure 26 is the perspective view of the inside of handle 202, wherein driving column Body and other components are removed to show and be placed in the driving intracorporal driven nut of column and other components.Cylinder 224, which has, to be extended The port (or chamber) of cylinder length, the shape of port are configured to correspond to the flat of nut 222 to drive the rotation of cylinder Turn effectively rotating nuts 222 and torque axis 110.Driving cylinder can have widened distal portions 236, distal portions 236 It can accommodate one or more sealing elements (for example, o-ring 246) (Figure 25), the outer surface of sealing element and main shaft 104 forms close Envelope.Handle can also accommodate accessory 238, and accessory 238 has the rinse mouth being connected to the chamber of the chamber of torque axis and/or main shaft.
Cylinder 224 is driven to be connected to electric motor 226 operably by gear 228 and 230.Handle can also accommodate electricity Pond compartment 232, cell compartments 232 include for providing the battery of power to motor 226.The rotation of motor in one direction is drawn It plays torque axis 110 to rotate, to make the artificial valve of the far-end of the retraction of sheath 106 and exposure conduit tube component again.Motor is in phase Rotation on opposite direction causes torque axis rotate in the opposite direction, so that sheath be made back to move on artificial valve.Handle On operator's button 234 allow user to activate motor, motor can rotate in either direction so that artificial valve goes out sheath Or withdraw (retrieve) expansion or part expansion artificial valve.
As described above, the distal portions of nose catheter axis 120 can be fixed to interior fork 132, it is interior to pitch 132 relative to outer fork 130 is mobile to discharge the artificial valve for being fixed to delivery apparatus end.Axis 120 is relative to main shaft 104 (it fixes outer fork 130) Movement can realize by the proximal part 240 of handle, the proximal part of the handle relative to main shell 244 slidably.End End part 240 is operably connected to axis 120, so that the movement of end section 240 effectively makes axis 120 relative to main shaft 104 axial translations (cause artificial valve from interior fork and the release of outer fork).End section 240 can have in the opposite sides of handle Flexible side plate 242, side plate 242 are usually biased outwardly to keep terminal part relative to main shell 244 in latched position Point.During the deployment of artificial valve, user can press side plate 242, and the individual features in side plate 242 and shell are detached from simultaneously And allow to pull end section 240 to nearside relative to main shell, the corresponding axial shifting so as to cause axis 120 relative to main shaft It is dynamic.Movement of the axis 120 to nearside causes the skewer 136 of interior fork 132 to be detached from the aperture 32 in bracket 12, this allows bracket again Retaining arm 30 is from the radially outward deflection of opening 140 in the skewer 134 of outer fork 130, to discharge artificial valve.
Figure 27 shows the alternate embodiments of motor (as shown in 400), motor can be used for driving torque axis (for example, Torque axis 110).In this embodiment, in the case where no transmission device, conduit tube component can be directly connected to the axis of motor 402 one end.Axis 402 includes chamber, and chamber allows the innermost layer axis (for example, axis 120) of conduit tube component, draught line and/or for rushing Wash passing through for the fluid of the chamber of conduit tube component.
Alternatively, the power source for rotating torque axis 110 is arranged to make the hydraulic of torque axis rotation Power source (for example, hydraulic pump) or pneumatic (air-operated) power source.In another embodiment, can have can hand for handle Mobile control stick or wheel are moved, can be used to rotate torque axis 110.
In another embodiment, power source (for example, electronic, hydraulic or pneumatic power source) can be operationally It is connected to axis, axis is connected to artificial valve 10.Power source be configured to make axis in a distal direction relative to valve sheath with Accurate and controlled mode longitudinally reciprocating motion is to promote artificial valve from sheath.Alternatively, power source can operate Ground is connected to sheath, to move back and forth sheath longitudinally relative to artificial valve in a proximal direction to dispose from sheath Artificial valve.
Figure 44 to Figure 45 shows screw rod 112 and nut for delivery apparatus 100 or delivery apparatus 600 (being described below) 150 alternative configuration.In this embodiment, with spiral winding 700, (it can be such as compression of metals or tension to screw rod 112 Spring) replacement, and the sheath retaining ring replacement of 702 form of washer or piece being mounted on coil 700 of nut 150.Coil Proximal end be firmly fixed to the distal end (such as by welding or suitable adhesive) of torque axis 110.Coil 700 can be by Any one of various suitable metals (for example, stainless steel, Nitinol etc.) or polymeric material are made.
Washer 702 has centre bore 704, receiving coil 700 and internal tooth 706, and internal tooth 706, which engages, is limited to the outer of coil It groove on surface and is ideally extended radially inwardly between coil neighbouring circle or circle.The neighboring of washer 702 can To be formed with multiple recess or groove 708, each recess or groove 708 are dimensioned so as to receive the skewer of outer fork 130 134, to prevent the rotation of washer when torque axis 110 rotates.Sheath 106 can be fixed to washer in any convenient manner 702 neighboring.For example, the part between recess 708 extends in the opening 172 (Figure 18) of sheath, thus relatively Sheath is axially and rotationally fixed in washer.Alternatively, washer can be soldered to sheath or be adhesively fixed to sheath.
When coil 700 and washer 702 are included in delivery apparatus 100, coil 700 and washer 702 are to be similar to spiral shell The mode of bar 112 and nut 50 operates.Therefore, when torque axis 110 rotates, move washer 702 axially along the length of coil 700 It is dynamic, to realize the corresponding axial movement of sheath, to dispose artificial valve or by artificial valve recapture/recycling (recapture) it returns in sheath.The advantages of coil and gasket arrangements, is the distal end for the delivery apparatus that its permission is occupied by coil Part bending or warpage, to be conducive to be advanced through the vascular system of patient, particularly with the relatively small arch of aorta and The vascular system of the patient of short aorta ascendens.When coil is in warpage or bending state inside the vascular system of patient When, coil also allows sheath (proximally or distally) mobile in torque axis rotation.In a particular embodiment, it is occupied by coil Delivery apparatus distal portions can be flexed into from straight configuration bending configuration, bending configuration have about 1cm radius of curvature. In addition, coil can change its screw pitch under dynamic load (compression or tension), to reduce the product along delivery apparatus length Poly- tension and the abrasion that washer is avoided when being subjected to bending force.
Coil and gasket arrangements can be implemented in other delivery apparatus, and other delivery apparatus are used for will be various other In the artificial implantation implantation body pipe of type.For example, coil and gasket arrangements can be included in coronary sinus interplantation In the delivery apparatus for entering bracket or similar implantation material.Coil and gasket arrangements can also use in various non-medical applications, with Screw rod and nut assembly are replaced, wherein screw rod is subjected to bending force.
Figure 30 shows another example bracket 300, and bracket 300 in heart valve prosthesis for using.For explanation Purpose, bare bracket 300 is only shown, and omit include leaflet and sleeve artificial valve other components.However, should manage Solution, such as about the description of the upper surface of artificial valve 10, artificial valve may include leaflet 34a, 34b, 34c and be installed to bracket 300 Sleeve 42.Other than all tops 302 at the outflow end in bracket 300 all have respective aperture 304, bracket 300 It can have global shape identical with the bracket 12 of above-mentioned artificial valve 10 and configuration.Bracket 300 can also be at outflow end It further comprise 3 joint columns 306 with perforation 308 (it is referred to herein as " top ").Delivery apparatus 500 and 600 is (such as It is lower described to be used together with bracket 300) it can be used for delivering stent 10 (or any other bracket of top not fenestrated). In this case, suture circle is wound by surrounding top at bracket one end (for example, outflow end), delivery apparatus can engage Bracket.In some embodiments, bracket can have the recess that formation or adjacent top end are formed in top, channel or other narrow Narrow portion, with the suture circle for stably keeping each top end.
Figure 31 A to Figure 37 shows the exemplary delivery device 500 for delivering stent 300.Delivery apparatus 500 is similar to and passs Device 100 is sent, in addition to delivery apparatus 500 includes the different institutions for releasedly fixing artificial valve to delivery apparatus.? Shown in delivery apparatus 500 in embodiment include main shaft 502, be installed to axis 502 distal end sheath 504, it is coaxial extend it is logical It crosses the inner shaft 506 of main shaft 502 and is installed to the front end Tapered Cup 508 of the distal end of inner shaft 506.Inner shaft 506 can have guide line Chamber is configured to receive guide line 509.If Figure 31 A is best seen from suture holding member 510 can be from the distal end of main shaft 502 It is distally extending.Inner shaft 506 can coaxially extend through suture holding member 510.
Although it is not shown, but delivery apparatus 500 can also include torque axis, and effectively make sheath 504 in nearside and remote Artificial valve in side direction relative to main shaft 502 and relative to the distal end for being fixed to delivery apparatus is mobile.The distal end of main shaft 502 Part can have configuration identical with the distal segment 126 of axis 104 of above-mentioned delivery apparatus 100.
Suture holding member 510 is including nearside disc element 512, distal side disc element 516 and in nearside disc element Extend and be separately connected the axis of nearside disc element 512 and distal side disc element 516 between 512 and distal side disc element 516 514.If Figure 33 is best seen from nearside disc element 512 can be fixed to the inside of main shaft 502.Each 512 He of disc element 516 could be formed with one or more axially extending openings 518 (Figure 31 C and Figure 31 D), and the size of each opening 518 is set Count into the distal portions (Figure 32) for receiving suture release component 520.Release component 520 can be such as hard metal wire, and because This is hereinafter referred to as cable release.In an illustrated embodiment, delivery apparatus includes single cable release 520, is extended distally through Be open 518 and the handle (not shown) along the length of delivery apparatus towards delivery apparatus accordingly in disc element 512 and 516 It extends proximally across main shaft 502.The proximal end of cable release (not shown) can be exposed to the proximal end of delivery apparatus for leading to Cross user's manipulation, or the actuator that can be coupled on the delivery apparatus handle for the axial movement that can control cable release.
Cable release 520 on nearside and distal direction relative to suture holding member 510 slidably, thus via multiple seams Bracket 300 is fixed to suture holding member 510 and discharges bracket 300 from suture holding member by coil 522, such as following into one Step description.In some embodiments, delivery apparatus may include more this cable release 520 (such as 2 or 3 cable releases 520), every cable release extends through is open 518 accordingly in disc element 512 and 516.These cable releases 520 can with One or more suture circles 522 interact and can contribute to balanced load distribution.
As described above, bracket 300 can be releasably attached to suture holding member by using multiple suture circles 522 510.For above-mentioned purpose, nearside disc element 512 may include (in addition to the opening 518 for cable release 520) multiple Opening 528 and 530 is used for suture circle across nearside disc element (Figure 31 A and Figure 31 B).As described in Figure 31 A, suture circle 522 It can be by folding repeatedly so that the single-piece suture material for forming multiple circles 522 is formed, wherein the multiple suture circle 522 is proximally Opening in disc element 512 is distally extending.In alternative embodiments, each circle 522 can be by the separation of suture material Part is formed.In some cases, each suture circle 522 is made of the circle of suture material completely, and in other cases, one or Multiple suture circles 522 may include have circle part nearside without circle part (linear segments of such as suture material).Just because such as This, even if having circle part itself not originating from given position or extending through given position, but as long as including the seam for enclosing part Condensation material extends from given position, then " suture circle " can have the characteristics that from given position " extension ".However, " suture Circle " is described as around given structure winding or extends and/or particularly relates to suture the case where residing in given position Circle has circle part.
As shown in Figure 31 A to Figure 31 D, multiple circles 522 (for example, 2 or 3 circle) can be proximally in disc element 512 Each outward opening extend, although each suture circle 522 can also be from an independent opening extension in other embodiments. As fig. 3 id, nearside disc element 512 can have 6 openings.3 suture circles 522 can proximally disc element 512 In 4 opening 528 in each opening extend, and pass through top 302 aperture 304.5th opening 530 can have from It extends to engage one or more suture circles (such as 3 suture circles) of the joint post holes eye 308 of bracket 300.Finally, release Line 520 can be outer distally extending towards the second disc element 516 from the 6th opening 518.In an illustrated embodiment, single seam Coil extends from the eyelet 308 that the 5th opening 530 passes through each joint column.In some cases, have across joint post holes eye The 308 single suture circles extended provide better tension forces, so as to cause the more controlled release and/or again of artificial valve New capture.(multiple) the suture circle extended across joint post holes eye 308 may be thicker than the seam extended across other cantilever tips 302 Coil 522.For example, in one embodiment, (multiple) the suture circle extended across joint column is 4-0 suture, and passes through top The suture circle of extension is 3-0 suture.(Figure 31 D) as shown in the figure, 6 openings can be arranged with circular pattern, and suture circle 522 It may be configured to extend outwardly thus according to their opposite engagement position cantilever tips 302 in the circular pattern, to make Suture circle 522 will not be across reaching their own cantilever tip each other.In other embodiments, suture circle can be configured At engagement cantilever tip 302, so that suture circle across reaching respective cantilever tip each other.
Referring to Figure 32 and Figure 33, when bracket 300 to be loaded on delivery apparatus, the top 302 of bracket 300 is adjacent to distal side Disc element 516 disposes, and each suture circle 522 passes through the corresponding aperture 304 in one of top 302.Due to 302 He of top 306, which can be used suture 522, radially-inwardly collapses, (including every by making respective seam coil 522 extend through each top 302 A joint column 306), artificial valve can completely recoverable (while being connected to delivery apparatus).In certain embodiments, from sheath Pipe 504 is disposed after valve and before valve recapture/recycling, can use the function of artificial valve.In various realities It applies in example, the quantity of top and corresponding suture circle can change, as long as sufficient amount of top is connected, so that when top The end of artificial valve is collapsed when end is radially collapsed.In an illustrated embodiment, 12 suture circles pass through 12 respective tops End.The end 524 of each suture circle 522 is then placed over the area between nearside disc element 512 and distal side disc element 516 In domain, and the corresponding opening 519 (Figure 31 A) that cable release 520 passes through in suture circle and distal side disc element 516 slides axially, So that the end 524 of suture circle is maintained in cable release as described in Figure 33.For illustrative purposes, Figure 32 and Figure 33 are only shown Single suture circle 522, is releasably connected to cable release 520 for one in the top 302 of bracket.It is desirable that suture circle The 522 each aperture/eyelets 304 and 308 for passing through the top 302 and 306 of bracket are inserted into and are kept by cable release 520.Figure 34 Bracket 300 of the suture circle 522 across the insertion of all tops of bracket and after being maintained in cable release 520 is shown.Institute as above It states, although only showing a cable release 520 in an illustrated embodiment, delivery apparatus can be provided with for keeping suture circle 522 multiple cable releases 520.
When making suture circle 522 pass through the opening 304 and 308 on top, suture circle 522 can pass through each opening 304 and 308, it is moved in a circumferential direction around bracket.In another embodiment, suture circle 522 can be passed through every one Or two or three openings 304 and 308 are inserted into and are placed in cable release 520, around bracket, movement is more in a circumferential direction It is secondary, until suture circle is inserted through each opening, so as to relative to 520 balance bracket attachment of cable release.
After bracket 300 is connected to suture holding member 510 (Figure 34), sheath 504 is distally advanced (for example, passing through rotation Turn the torque axis of delivery apparatus) artificial valve to be loaded into sheath.As sheath 504 promotes on suture circle 522, seam Tension in coil causes top 302 and 306 radially-inwardly to be collapsed towards main shaft 502.Sheath 504 is further promoted, thus Cause sheath 504 to extend on bracket 300 and bracket 300 is made to collapse (as shown in figure 35), until the distal end of sheath 504 is adjacent Meet front end Tapered Cup 508 (Figure 36).If Figure 33 is best seen from top 302 can lean against the distal surface of distal side disc element 516 On, to prevent artificial valve from sliding to nearside, and as sheath is contracted, keep the tension in suture circle 522.
When artificial valve is delivered to the intracorporal expectation implant site of body, sheath 504 is contracted (for example, being turned by rotation Square axis) to dispose artificial valve.As described in Figure 34, after artificial valve is disposed completely from sheath, bracket 300 is still through seam Coil 522 is connected to bracket holding member 510.Therefore, artificial valve is withdrawn if necessary, such as removing or pacifying again It sets, then distally advances sheath 504 to retract artificial valve in sheath.On the other hand, if it is determined that artificial valve is accurate It is placed at desired implant site, then can pull cable release 520 proximally to discharge the end 524 of suture circle 522.Such as Figure 37 Described, the slight of main shaft 502 retracts the opening 302 effectively pulled out suture circle in bracket 300.The proximal end of cable release 502 can To be exposed on the proximal end of delivery apparatus, so that user can pull manually cable release to discharge artificial valve.It is alternative Ground, handle can have actuator or switch, and actuator or switch are configured to realize that the nearside of cable release is mobile.
Sheath 504 can be made of polymeric material, such as PEEK or Nylon-12, and can have the distal side point of reinforcement End part, such as by the way that becket to be fixed to the distal portions of sheath, to preferably be supported as bracket is pulled in sheath The expansionary force of bracket processed.Alternatively, sheath 504 may include metal cartridge, has reflux or is molded into the distal end of cylinder The soft tip portion of partial polymerization.
Figure 38 to Figure 43 shows another delivery apparatus 600, generally comprises the first conduit 602, coaxially extends through Second conduit 604 of one conduit 602 and the delivering sheath or cylinder 612 for being coupled to the distal end of conduit 602 and 604.602 He of conduit 604 proximal end can be coupled to handle (for example, handle 202 shown in such as Figure 23).If Figure 40 is best seen from the first conduit 602 include from the distally extending elongated shaft 606 of handle, from the distally extending intermediate section 608 in the distal end of axis 606 and from The distally extending distal portions 610 of intermediate section 608.Intermediate section 608 includes the guide rail 613 at multiple angled intervals, is led Rail 613 extends lengthwise into distal portions 610 from axis 606.Guide rail 613 cooperates rotation but permission to inhibit nut with nut 640 The longitudinal movement of nut in the rotation of the second conduit 604.In this approach, guide rail 613 is used as in the rotation for preventing nut 150 Purpose identical with skewer 134.Distal portions 610 in an illustrated embodiment include the metal tube of fluting to enhance first The flexibility of the section of conduit 602.
If Figure 39 A to 39C is best seen from the second conduit 604 may include that (it can be referred to as " torque to elongated shaft 614 Axis "), the thread screw 618 that is connected to the coupling member 616 of 614 proximal end of axis and is connected to 614 distal end of axis.Coupling member 616 It is configured to connect to handle as described above (for example, handle 202).Screw rod 618 has the outer of the internal screw thread of coupling nut 640 Screw thread.If Figure 41 is best seen from when assembling the device, the elongated shaft 614 of the second conduit 604 coaxially extends through the first conduit 602 elongated shaft 606, and screw rod 618 coaxially extends through the guide rail section 608 of the first conduit 602.Nut 640 is mounted On screw rod 618 and it is connected to the proximal part for delivering cylinder 612.The distal portions 610 of first conduit 602 coaxially extend logical Cross delivering cylinder 612.
If Figure 40 to Figure 42 is best seen from suture holding member 626 may be connected to the distal end of slotted-tube 610.Suture Holding member 626 can have similar to the above-mentioned feature for suture holding member 510 comprising be connected to slotted-tube 610 Distal end nearside disc element 638, distal side disc element 636 and at least one release component or cable release 628, release component Or cable release 628 extends through nearside and distal side disc element for interacting with one or more suture circles 522.
Referring now to Figure 39 A to Figure 39 C, delivering cylinder 612 in an illustrated embodiment includes relatively more flexible close Side section 630 and relatively less flexible distal portions 632.Portions of proximal 630 may include the metal tube or cylinder of fluting, To enhance the flexibility of the section of delivering cylinder 612.Distal portions 632 include casing or sheath (also referred to as " valve holding parts Point "), it is configured in delivery process extend on artificial valve and artificial valve is maintained at radial compression In.In some embodiments, sheath 632 can extend (figure in delivery process on artificial valve and suture holding member 626 43).Alternatively, suture holding member 626 can (at least partly) be contained in portions of proximal 630 in delivery process. Sheath 632 can be made of suitable polymeric material, such as PEEK, Nylon-12 and/or PEBAX, or the gold with polymerization liner Category is made.When sheath 632 is made of polymeric material, sheath 632 can be thermally bonded to slotted-tube 630.It saves the distal end of sheath 632 Section 634 can radially outward expand, to enhance the recapture ability of artificial valve.Distal segment 634 may include polymerization And/or the material of elasticity, such as PEEK, nylon and/or PEBAX.In a particular embodiment, distal segment 634 compares distal portions Remaining section it is more flexible and/or be elastomer.In working Examples, distal segment 634 includes PEBAX and distal portion The remainder for dividing 632 includes nylon.As shown in figure 46, distal segment 634 may include radially projecting ring bump 650 In favor of the loading and recapture of artificial valve.During recapture, bulge 650 presses inward against suture 522, thus Top 302 and 306 is caused inwardly to be collapsed, to allow sheath to slip over frame.
As shown in figure 42, delivery apparatus 600 may further include the front-end-cone for being connected to the distal end of front end tapered shaft 622 Shape part 620, front end tapered shaft 620 extend through the distal shaft part 610 of the first conduit 602, suture holding member 626 and The screw rod 618 and axis 614 of two conduits 604.Front end tapered shaft 622 may include that guidewire lumen and can extending proximally into is passed Send the handle of device.
Delivering cylinder 612 is cooperated with screw rod 618 and nut 640 to allow to deliver cylinder 612 relative to distal shaft part 610 It is mobile with suture holding member 626 longitudinal (that is, nearside and/or distal side).The rotary motion of screw rod 618 (is rotated by user The torque axis 614 and be activated) can via along screw rod 618 external screw thread dispose nut 640 (Figure 39 B) be converted to delivering column The translational movement of body 612.Nut 640 can have internal screw thread, be configured to engage the outer spiral shell of screw member 618 in phase Line.Nut 640 may further include the one or more lugs 642 projected radially outwardly, and delivers cylinder 612 and can wrap The one or more receiving areas (such as one or more windows 644) for including the proximal end of neighbouring cylinder 612, are used for and these lugs 642 engagements.Specifically, the top of (multiple) lug 642 may extend through (multiple) window 644 to generate and deliver cylinder 612 secure fit (for example, clamping engagement).
As described above, the first conduit 602 includes section 608, section 608 includes the guide rail 613 at multiple angled intervals, is led Rail 613 cooperates with (multiple) lug 642 of nut.As Figure 41 best seen from, screw rod 618 coaxially extends through guide rail 613, and Nut 640 is arranged on screw rod 618, wherein each lug 642 is placed in the space between two neighbouring guide rails 613. It, can be by using torque axis 614 in order to generate the movement of delivering cylinder 612 as described in above for delivery apparatus 100 Rotary screw 618.The placement of (multiple) lug 642 between guide rail 613 prevents nut 640 from rotating together with screw rod 618.Due to The limited swivel of nut 640, the rotation of screw rod 618 generate nut 640 along the translational movement of screw rod 618.Nut 640 is along screw rod 618 (on nearside or distal direction) axial movement causes cylinder 612 also to move axially, and with nut 640 (relative to Screw rod 618) it moves on identical direction.Therefore, it is vertically moved with nut 640 along screw rod 618, drive delivering cylinder 612 ( Nut is connected at window 644) it moves together.
Outer sleeve portion 648 can be placed in the first conduit 602 and the second conduit 604 (Figure 41) and delivering cylinder 612 Above, and therefore the outermost layer of delivery apparatus 600 is formed.The sleeve portion 648 allows user effectively to be rinsed with liquid Delivery apparatus 600, for example to eliminate bubble.In some embodiments, sleeve portion 648 may include elastomeric material and/or Delivering cylinder 612 can be adhered in one or more positions.Specifically, the sleeve portion 648 with rubber elastomer characteristics can To be adhered to both elongated shafts 606 of delivering cylinder 612 and (nearside of intermediate section 608) first conduit 602.This In the case of, when nut 640 and delivering cylinder 612 are pushed into, sleeve portion 648 can be drawn between cylinder 612 and axis 606 It stretches, and when these components are contracted, sleeve portion 648 can loosen.In some embodiments, sleeve portion 648 is base This rigidity and/or be adhered only to delivering cylinder 612.In this case, entire sleeve portion 648 can be with delivering cylinder 612 distally advance together relative to the first conduit or to proximal retraction.
In the case where having screw rod 618 and nut 640 of standard-type thread, being rotated clockwise for screw rod 618 can To cause nut 640 to move along the nearside of screw rod 618.On the contrary, rotating counterclockwise for master screw 618 can lead to spiral shell The distal side of mother 640 is mobile.In this fashion, the rotation of screw rod 618 can cause the delivering cylinder 612 for being connected to nut 640 Nearside or distal side it is mobile.Alternatively, screw flight can invert, so that rotating counterclockwise for screw rod causes The nearside of nut is mobile, and being rotated clockwise for nut causes the distal side of nut mobile.
Figure 43, which shows delivering cylinder 612 and is pushed forward, enters its distal-most position for delivering.In delivering configuration, distal end Part 632 extends on artificial valve (not shown), and artificial valve is maintained in the state of radial compression and by multiple Suture 522 is releasably attached to suture holding member 626.It is delivered in configuration when delivering cylinder is in, delivering cylinder 612 Distal end can abut the shoulder (as shown in figure 43) of front end Tapered Cup 620.Figure 42 shows the delivering cylinder in deployment configuration 612, wherein delivering cylinder 612 is retracted into proximal position.In this position, distal portions 632 are retracted proximally into artificial valve After (artificial valve is allowed to expand) and the distal side disc element 636 of suture holding member 626.In order to from suture holding member 626 release artificial valves retract cable release 628 so that its distal end is in 636 nearside of the second disc element, to make suture circle 522 distal end 524 gets rid of artificial valve.
Lower deployment and recycling is allowed to turn to metal connection with the metal between suture circle replaceable holder and delivery apparatus Square.The torque of these reductions allows screw mechanism further from the repositioning of delivery apparatus distal end.Increase screw rod 618 and artificial valve The relative rigid portion for the delivery apparatus that the far-end in delivery apparatus is occupied by artificial valve is advantageously reduced in spacing between film Section.Referring to Figure 43, the part of the delivering cylinder 612 extended on artificial valve has length L3, and delivery system 600 Total section (it does not include the length of front end Tapered Cup) of relative rigid has length L4, correspond in this embodiment in people The length for the delivering cylinder 612 that work valve and suture holding member 626 extend above.For example, in some embodiments, L4About Length L31.3 times.In various other embodiments, L4With L3Ratio be about 1.6 or smaller, about 1.5 or smaller, or about 1.4 Or it is smaller.
Referring to Figure 40 to Figure 41 and Figure 43, passing for the distal end of screw rod 618 is extended to from the proximal end of suture holding member 626 Send the part (its length L2 for being equal to distal shaft part 610) of device 600 can be than hard section (its etc. of receiving artificial valve In the length L4 of delivering cylinder 612) it is more flexible.It is desirable that relatively more flexible section is sufficiently long such that when delivery system 600 It is pushed through aorta so that when implantable prosthetic valve, the section of relative rigid is placed in liter at the aorta petal of subject In aorta, screw rod 618 is placed in descending aorta, and the opposite ductile portion extended therebetween is placed in aorta In bow.This greatly facilitates manipulation delivery apparatus and is properly positioned in aortic valvular ring by the arch of aorta and by artificial valve Place.
In various embodiments, for example, the distal end of screw rod 618 can be positioned in apart from the remote of suture holding member 626 Holding at least about 5cm, at least about 10cm, at least about 15cm, at least about 20cm or at least about 30cm, (and artificial valve is releasable Ground is connected to suture holding member 626).In various embodiments, delivering cylinder 612 can have total length L1, total length L1? Between about 3cm to about 40cm, between about 5cm to about 40cm, between about 10cm to about 35cm, between about 15cm to about 30cm or about Between 18cm to about 25cm.In various embodiments, distal shaft part 610 can have total length L2, total length L2In about 0cm To between about 30cm, between about 5cm to about 25cm, between about 10cm to about 22cm or between about 15cm to about 20cm.
In alternative embodiments, the length L of cylinder 612 is delivered140cm can be longer than, and in some embodiments, It can extend proximally into the handle of delivery apparatus.
Figure 47 shows alternative slotted-tube 652, the slotted-tube 610 being substituted in delivery apparatus 600.Fluting Pipe 652 is with the multiple teeth or protrusion 654 formed in every circle or coil, in the respective recesses in coil extended adjacent to To increase torque drag.The distal end of pipe could be formed with one or more longitudinal openings 656, thus the shape between neighbouring opening At the guide rail 658 to cooperate for the protrusion 642 with nut 640.At the proximally and distally place of guide rail 658, pipe be could be formed with out Mouthfuls 660 to allow draught line 662 to extend through opening and allow screw rod 618 on 652 outside of draught line 662 and slotted-tube simultaneously Row extends.The proximal end of pipe 652 could be formed with multiple inwardly projecting lugs 664.As shown in figure 49, lug 664 can engage Annular recesses part 666 on the outer surface of the Proximal member 638 of suture holding member 626.Lug 664 may be configured to shape At the clamping engagement with Proximal member 638, which is enough suture holding member being fixed to slotted-tube.
In alternative embodiments, slotted-tube 610 and slotted-tube 630 can have other patterns or configuration, such as Figure 12, Any of those patterns shown in 28A, 28B, 29A or 29B or configuration.
For the purpose of the description, this document describes some aspects of embodiment of the disclosure, advantage and novel features.Nothing By how, the disclosed method, apparatus and system property of should not be construed as limited to.On the contrary, this disclosure relates to various disclosed All novel and non-obvious features and aspect of embodiment, either individually or various combinations with one another and subgroup It closes.Method, apparatus and system are not limited to its any specific aspect or feature or combinations thereof, and disclosed embodiment also not find out existing Any one or more specific advantages solve the problems, such as.
In conjunction with certain aspects of the present disclosure, the feature of embodiment or example description, integer, characteristic, compound, chemical component Or group is construed as being suitable for any other aspect described herein, embodiment or example, unless incompatible with it.In this theory Bright book (include any accompanying claims, abstract and drawings) disclosed in all features and/or disclosed any method or All steps of process can be with any other than wherein at least some this category features and/or the mutually exclusive situation of step Combination is combined.The present invention is not limited to the details of any previous embodiment.The present invention extend in this specification (including appoint What accompanying claims, abstract and drawings) disclosed in feature any novel feature or any novel combination, or Any novel step or any novel combination for the step of extending to disclosed any method or process.
Although describing the operation of some disclosed methods with specific, continuous sequence for the ease of expression, should managing Solution, this describing mode includes rearranging, unless concrete syntax requires specific sequence.For example, the operation continuously described can To be re-arranged or be performed simultaneously in some cases.In addition, for simplicity, disclosed method is not shown in attached drawing The various modes that can be used in combination with other methods.As used herein, term "one", "an" and "at least one" packet Include one or more specific elements.That is there may also be one in these elements if there is two element-specifics And therefore there is "one" element.Term " multiple " and " a variety of " indicate two or more specific elements.
As used herein, the term "and/or" used between most latter two element for enumerating element indicates listed member Any one or more of element.For example, phrase " A, B and/or C " expression " A ", " B ", " C ", " A and B ", " A and C ", " B and C " or " A, B and C ".
As used herein, term " coupling/connection " usually indicates physical couplings or link, and is not excluded for lacking tool The presence of the neutral element between coupling item in the case of the opposite language of body.
In view of many possible embodiments of the principle of the present invention can be applied, it should be appreciated that the embodiment of explanation is only For preferable example of the invention, and should not be considered as limiting the scope of the invention.
In view of many possible embodiments of the principle of the present invention can be applied, it should be appreciated that the embodiment of explanation is only For preferable example of the invention, and should not be considered as limiting the scope of the invention.In addition, additional embodiment is in United States Patent (USP) Apply disclosing in No.2010/0049313 (U. S. application No.12/429,040), the application is incorporated herein in way of reference. Therefore, the scope of the present invention is limited by claim.Therefore we, which are claimed, falls into these the scope of the claims and essence All inventions in mind.
1. a kind of delivery apparatus for implantable prosthetic valve, the artificial valve include bracket, the bracket, which has, surrounds institute Multiple tops that the first end of bracket is partially circumferentially spaced are stated, the delivery apparatus includes:
First axle, with proximal part and distal portions；
Second axis extends through the first axle and has proximal part and distal portions, and second axis is relative to institute It states that first axle is rotatable, but is fixed against the axial movement relative to the first axle；And
Sheath is delivered, with distal portions and proximal part, the distal portions are configured to receive the sending state of compression In artificial valve and be maintained at artificial valve in the sending state of compression, the proximal part is connected to second axis The distal portions；
Wherein second axis is configured to rotatable relative to the first axle, so that the rotation of second axis causes The delivering sheath is moved axially relative to the first axle and second axis；
Suture holding member, the suture holding member have portions of proximal, the distal part separated with the portions of proximal and Intermediate shaft portion, the intermediate shaft portion are extended between the portions of proximal and the distal part and are firmly attached either directly or indirectly To the portions of proximal and the distal part, the portions of proximal is firmly coupled to the distal portion of the first axle Point；
At least one slidable release component extends through the portions of proximal of the suture holding member and described remote Side section；With
Multiple suture circles extend from the portions of proximal of the suture holding member, and are configured to around the branch The top of frame extends or extends through the hole in the top of the bracket, and in the position along the intermediate shaft portion It sets place to extend around the release component, to keep the artificial valve relative to the suture holding member.
2. delivery apparatus according to claim 1, in conjunction with the artificial valve, wherein at least one suture circle is around every A top extends or extends through the hole on each top.
3. delivery apparatus according to claim 1, further comprises screw rod and nut, the screw rod is connected to described The distal end of two axis, the nut are installed on the screw rod and are connected to the delivering sheath so that described second The rotation of axis and the screw rod causes the nut relative to the axial movement of the screw rod, to generate the delivering sheath Axial movement.
4. delivery apparatus according to any one of claim 1-3, wherein the proximal part of the delivery sheath pipe Length is between 2cm to 35cm.
5. delivery apparatus according to any one of claim 1-3, wherein the distal portions of the first axle extend The distal portions by the delivering sheath, and the first axle include the metal tube of fluting.
6. delivery apparatus according to any one of claim 1-3, in which:
The release component relative to the suture holding member between the first posture and the second posture slidably, wherein described First posture extends through the portions of proximal and the distal part of the suture holding member, in second posture In, the release component is retracted into the position of the distal part nearside of the suture holding member；
Wherein when the release component in first posture and the suture circle extends or extends logical around the top It crosses at the hole of the bracket and the position between the portions of proximal and the distal part around the release structure When part extends, the artificial valve is fixed to the suture holding member；
Wherein when the release component is in second posture, the suture circle can be sliding from the distal end of the release component It falls, to discharge the artificial valve from the suture holding member.
7. delivery apparatus according to any one of claim 1-3, wherein at least one described release component includes extending Pass through multiple release components of the suture holding member.
8. delivery apparatus according to any one of claim 1-3, wherein the close end subpackage of the delivery sheath pipe Include the metal tube of fluting.
9. delivery apparatus according to claim 8, wherein the distal portions of the delivery sheath pipe include being connected to institute The delivering cabin of the distal end of the metal tube of fluting is stated, the delivering cabin is configured to the people in the sending state of the compression Extend on work valve and is maintained at the artificial valve in the sending state of the compression.
10. delivery apparatus according to claim 9, wherein the delivering cabin includes polymer casing.
11. a kind of artificial valve delivery components comprising:
Artificial valve including Self-expanded stent, the Self-expanded stent have around the bracket first end partially circumferentially Multiple tops at interval；
Second axis extends through the first axle and has proximal part and distal portions, and second axis is held to Resist the axial movement relative to the first axle；
It is connected to the suture holding member of the distal portions of the first axle, the suture holding member has proximal portion The distal part and intermediate shaft portion, the intermediate shaft portion divide, separated with the portions of proximal extends in the portions of proximal Between the distal part and it is firmly attached either directly or indirectly the portions of proximal and the distal part, the portions of proximal quilt Firmly it is coupled to the distal portions of the first axle；
At least one slidable release component extends through the portions of proximal of the suture holding member and described remote Side section；
Multiple suture circles extend from the portions of proximal of the suture holding member, around the top of the bracket Extend or extend through the hole in the top of the bracket, and around described at the position along the intermediate shaft portion Release component extends；And
Sheath is delivered, with distal portions and proximal part, the proximal part is connected to the distal end of second axis Part, wherein the proximal part of the delivery sheath pipe includes the metal tube of fluting, and the delivering sheath is described remote End part includes being connected to the delivering cabin of the distal end of metal tube of the fluting, and the delivering cabin is configured to the delivering in compression Extend on the artificial valve in state and is maintained at the artificial valve in the sending state of the compression；
Wherein the distal portions of the first axle extend through the delivering sheath；
Wherein the artificial valve is releasedly coupled to the distal portions of the first axle.
12. component according to claim 11, further comprising:
Third axis extends through second axis and the suture holding member；With
Front end Tapered Cup is mounted on the distal portions of the third axis in the distal side of the suture holding member.
13. component according to claim 11, wherein the length of the delivery sheath pipe is at least 5cm and is not more than 40cm。
14. component described in any one of 1-13 according to claim 1, further comprises screw rod and nut, the screw rod is connected It is connected to the distal end of second axis, the nut is installed on the screw rod and is connected to the delivering sheath to make The rotation for obtaining second axis and the screw rod causes the nut relative to the axial movement of the screw rod, thus described in generating Deliver the axial movement of sheath.
15. component according to claim 14, wherein the first axle includes the guide rail with multiple angled intervals Section, the guide rail engage the lug of the nut to prevent the rotation of the nut in screw rod rotation.
16. a kind of artificial valve delivery components comprising:
Positioned at the elongated shaft of the artificial valve nearside；
Suture holding member positioned at the distal side of the axis, the suture holding member include portions of proximal and the proximal portion The distal part and intermediate shaft portion separated, the intermediate shaft portion extends in the portions of proximal and the distal portion divides it Between and be firmly attached either directly or indirectly the portions of proximal and the distal part, the portions of proximal is firmly coupled to described Axis；
Multiple suture circles extend from the portions of proximal of the suture holding member, around the top of the bracket Extend, or extend through the hole in the top of the bracket, and in the portions of proximal of suture holding member and remote Extend at position between side section around the release component, suture circle described in wherein at least one extends around each top Or extend through the hole on each top；And
Outer sheath, the outer sheath can promote on the artificial valve so that the artificial valve is maintained at radial compression shape In state, and the outer sheath can retract the radial dilatation to allow the artificial valve relative to the artificial valve, together Shi Suoshu bracket remains connected to the suture holding member via the suture circle；
Wherein after the whole deployment from the outer sheath of the artificial valve, when the artificial valve is by the outer sheath weight When new capture, the outer sheath can be distally advanced and returned it on the artificial valve, to cause the artificial valve Radial direction is collapsed.
17. component according to claim 16, wherein distal portion of the proximal part of the outer sheath than the outer sheath Divide more flexible.
18. component according to claim 16, wherein the length of the outer sheath is at least 3cm and no more than 40cm.
19. component described in any one of 6-18 according to claim 1, further comprises screw rod and nut, the screw rod is connected It is connected to the distal end of the second axis, the nut is installed on the screw rod and is connected to the outer sheath so that described The rotation of second axis and the screw rod causes the nut relative to the axial movement of the screw rod, to generate the outer sheath Axial movement.
20. component described in any one of 6-18 according to claim 1, wherein suture of the multiple suture circle by single length Material is formed.
21. component described in any one of 6-18 according to claim 1, wherein at least one of the multiple suture circle has The thickness bigger than the thickness of other suture circles in the multiple suture circle.
22. component described in any one of 6-18 according to claim 1 further comprises handle, the handle operationally coupling It is connected to the proximal part of the elongated shaft, the handle accommodates motor, and when the motor is actuated by the user, the motor is matched It is set to and rotates the second axis relative to the elongated shaft.
CN201710555247.3A 2013-05-20 2014-05-20 Heart valve prosthesis delivery apparatus CN107334563B (en)
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CN201710555247.3A CN107334563B (en) 2013-05-20 2014-05-20 Heart valve prosthesis delivery apparatus
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