Catheter system for implantation of prosthetic heart valves
A catheter is described for the transvascular implantation of prosthetic heart valves, e.g., including self-expanding anchorage supports, to reduce the risk to the patient during the implantation. Accordingly, a prosthetic heart valve with anchorage supports is temporarily housed in a folded form in a cartridge-type unit during the implantation. The cartridge-type unit can be fixed on the proximal end of a guide system, which includes a flexible region that can be guided through the aorta. Actuating elements run through the interior of the hollow guide system, permitting sections of the cartridge-type unit to be displaced radially about their longitudinal axis and/or laterally in a proximal direction, thus allowing individual sections of the anchorage support and the associated prosthetic heart valve to be sequentially released.
1. A catheter system comprising:
a prosthetic heart valve comprising a heart valve prosthesis attached to a support, wherein the support extends from a first end to a second end, and the second end of the support comprises retaining elements; and
a catheter for transvascular delivery of the prosthetic heart valve, the catheter comprising:
a guide system comprising a cartridge that includes a tip, an outer sleeve, and an inner sleeve, wherein the outer sleeve and the inner sleeve are configured to retain the prosthetic heart valve in a collapsed state radially therebetween, the inner sleeve including anchoring elements for engaging the retaining elements of the prosthetic heart valve, and wherein the outer sleeve and the inner sleeve are movable relative to each other along a longitudinal axis of the guide system for uncovering the prosthetic heart valve; and
a manipulating part coupled to the guide system for controlling movement of the guide system, the manipulating part comprising:
a handle;
a tube comprising outer threads;
a first actuator coupled to the handle, wherein a first movement of the manipulating part, including rotation of the first actuator relative to the handle, causes relative axial movement between the outer sleeve and the inner sleeve to uncover the prosthetic heart valve; and
a second actuator coupled to the handle, wherein a second movement of the manipulating part, including movement of the second actuator in a proximal-distal direction of the catheter, causes relative movement between the tip and the outer sleeve.
2. The system of claim 1 , wherein rotation of the first actuator relative to the handle engages the threads of the tube to cause movement of the tube along a longitudinal axis of the tube.
3. The system of claim 1 , wherein movement of the second actuator in the proximal-distal direction is independent of rotation of the first actuator.
4. The system of claim 1 , wherein the manipulating part includes a stop to limit movement of the tube relative to the handle.
5. The system of claim 1 , wherein the retaining elements of the support define holes for receiving the anchoring elements of the inner sleeve.
6. The system of claim 1 , wherein the outer sleeve is configured to completely cover the inner sleeve and the prosthetic heart valve to retain the prosthetic heart valve in the collapsed state.
7. The system of claim 1 , wherein the manipulating part is configured to retract the prosthetic heart valve within the outer sleeve when the first end of the support is uncovered and the second end is covered by the outer sleeve.
8. The system of claim 1 , wherein the support is self-expanding.
9. The system of claim 1 , wherein the heart valve prosthesis is attached to the support by stitching.
10. A catheter system comprising:
a prosthetic heart valve comprising a heart valve prosthesis attached to a self-expanding support, wherein the support extends from a first end to a second end, and the second end of the support comprises two retaining elements; and
a catheter for transvascular delivery of the prosthetic heart valve, the catheter comprising:
a guide system comprising a cartridge that includes a tip, an outer sleeve, and an inner sleeve, wherein the outer sleeve and the inner sleeve are configured to retain the prosthetic heart valve in a collapsed state radially therebetween, the inner sleeve including anchoring elements for engaging the retaining elements of the prosthetic heart valve, and wherein the outer sleeve and the inner sleeve are movable relative to each other along a longitudinal axis of the guide system for uncovering the prosthetic heart valve; and
a manipulating part coupled to the guide system for controlling movement of the guide system, the manipulating part comprising:
a handle;
a tube comprising outer threads;
a first actuator coupled to the handle, wherein a first movement of the manipulating part, including rotation of the first actuator relative to the handle to engage the threads of the tube, causes relative axial movement between the outer sleeve and the inner sleeve to uncover the prosthetic heart valve in a direction from the first end of the support to the second end of the support; and
a second actuator coupled to the handle, wherein a second movement of the manipulating part, including movement of the second actuator in a proximal-distal direction of the catheter, causes relative movement between the tip and the outer sleeve, independent of rotation of the first actuator.
11. The system of claim 10 , wherein the first actuator controls movement of the tube along a longitudinal axis of the tube.
12. The system of claim 10 , wherein when the prosthetic heart valve is retained radially between the inner sleeve and the outer sleeve in the collapsed state, the first end of the support is adjacent to the tip.
13. The system of claim 10 , wherein each retaining element of the support defines a hole for receiving a corresponding anchoring element of the inner sleeve in order to anchor the prosthetic heart valve to the catheter.
14. The system of claim 10 , wherein the guide system comprises a bendable region configured to navigate a bend in an aorta during transvascular delivery of the prosthetic heart valve.
15. The system of claim 10 , wherein the manipulating part comprises a fluid port in communication with the cartridge.
16. A catheter system comprising:
a prosthetic heart valve comprising a heart valve prosthesis stitched to a support, wherein the support extends from a first end to a second end, and the second end of the support comprises retaining elements; and
a catheter for transvascular delivery of the prosthetic heart valve, the catheter comprising:
a guide system comprising a cartridge that includes a tip, an outer sleeve, and an inner sleeve, wherein the outer sleeve and the inner sleeve are configured to retain the prosthetic heart valve in a collapsed state radially therebetween, the inner sleeve including anchoring elements for engaging the retaining elements of the prosthetic heart valve, and wherein the outer sleeve and the inner sleeve are movable relative to each other along a longitudinal axis of the guide system for uncovering the prosthetic heart valve; and
a manipulating part coupled to the guide system by a bendable region configured to navigate a bend in an aorta during delivery of the prosthetic heart valve, the manipulating part comprising:
a handle;
a tube comprising outer threads;
a first actuator coupled to the handle, wherein a first movement of the manipulating part, including rotation of the first actuator relative to the handle to engage the threads of the tube, causes relative axial movement between the outer sleeve and the inner sleeve to uncover the prosthetic heart valve in a direction from the first end of the support to the second end of the support; and
a second actuator coupled to the handle, wherein a second movement of the manipulating part, including movement of the second actuator in a proximal-distal direction of the catheter, causes relative movement between the tip and the outer sleeve;
wherein the manipulating part is configured to retract the prosthetic heart valve within the outer sleeve when the first end of the support is uncovered and the second end is covered by the outer sleeve.
17. The system of claim 16 , wherein the manipulating part further comprises:
a stop to limit movement of the tube relative to the handle; and
a fluid port in communication with the cartridge.
18. The system of claim 16 , wherein the support includes exactly two retaining elements, each retaining element defining a hole.
19. The system of claim 16 , wherein the first actuator engages the threads by rotating about a longitudinal axis of the tube.
20. The system of claim 19 , wherein rotation of the first actuator is independent of movement of the second actuator in the proximal-distal direction.