Aortic pressure loss reduction apparatus and methods
Apparatus and methods are described including implanting an aortic pressure-loss-reduction device in a subject's ascending aorta. While the device is inside a catheter, a distal end of the catheter is placed within the ascending aorta. A proximal covering sheath of the catheter is retracted such as to uncover at least a portion of a downstream anchor, such that the uncovered portion of the downstream anchor includes a portion of the frame that does not have material coupled thereto. Subsequently, a distal covering sheath of the catheter is advanced, such as to cause an upstream anchor to anchor an upstream end device to the subject's ascending aorta, by the upstream anchor radially expanding against an inner wall of the ascending aorta. Other applications are also described.
1. A method comprising:
implanting an aortic pressure-loss-reduction device in an ascending aorta of a subject, the aortic pressure-loss-reduction device including a frame and a material that is configured to impede blood flow therethrough coupled to at least a portion of the frame, by, sequentially:
while the aortic pressure-loss-reduction device is inside a catheter, placing a distal end of the catheter within the subject's ascending aorta, the aortic pressure-loss-reduction device being disposed within the catheter such the device is maintained in a radially-constrained configuration and such that an upstream anchor of the device is disposed distally within the catheter with respect to a downstream anchor of the device;
retracting a proximal covering sheath of the catheter, such as to:
uncover an intermediate portion of the aortic pressure-loss-reduction device to allow the intermediate portion to at least partially assume its non-constrained configuration, the intermediate portion of the device being configured to define a conduit through the device; and
uncover a portion of the downstream anchor, such that the uncovered portion of the downstream anchor includes a portion of the frame that does not have the material coupled thereto, while maintaining the downstream anchor in an at least partially-radially-constrained state;
advancing a distal covering sheath of the catheter, such as to cause the upstream anchor to anchor an upstream end of the aortic pressure-loss-reduction device to the subject's ascending aorta, by the upstream anchor radially expanding against an inner wall of the ascending aorta, the upstream anchor being having material coupled thereto, such that blood flows from the aortic valve into an upstream end of the device and out of the uncovered portion of the downstream anchor; and
further retracting the proximal covering sheath of the catheter, such as to cause the downstream anchor to anchor a downstream end of the aortic pressure-loss-reduction device to the subject's ascending aorta, by the downstream anchor radially expanding against an inner wall of the ascending aorta.
2. The method according to claim 1 , further comprising, while retracting the proximal covering sheath of the catheter, preventing the upstream anchor from radially expanding by holding projections that protrude from an upstream end of the upstream anchor within the distal covering sheath of the catheter.
3. The method according to claim 1 , wherein retracting the proximal covering sheath of the catheter such as to uncover the portion of the downstream anchor that does not have the material coupled to it comprises facilitating blood flow through the device by allowing blood to flow through the portion of the downstream anchor that does not have the material coupled thereto.
4. The method according to claim 1 , wherein causing the downstream anchor to anchor a downstream end of the device to the subject's ascending aorta, by the downstream anchor radially expanding against an inner wall of the ascending aorta comprises preventing blood flow to a brachiocephalic artery of the subject from being occluded by deploying the downstream anchor such that the portion of the frame that does not have the material coupled to it is deployed closest to the brachiocephalic artery.
5. The method according to claim 1 ,
wherein while the device is inside the catheter at least a portion of the device is disposed around a conically-shaped mount portion that converges toward a proximal end of the catheter,
the method further comprising, subsequent to further retracting the proximal covering sheath of the catheter such as to cause the downstream anchor to anchor a downstream end of the device to the subject's ascending aorta, retracting the mount portion through the conduit,
the conical shape of the mount portion being configured to facilitate retraction of the mount through the conduit.
6. The method according to claim 1 , wherein implanting the aortic pressure-loss-reduction device in the subject's ascending aorta comprises implanting the aortic pressure-loss-reduction device in the subject's ascending aorta such that an upstream end of the conduit is disposed within 25 mm of an aortic valve orifice of the subject.
7. The method according to claim 1 , wherein advancing the distal covering sheath of the catheter, such as to cause the upstream anchor to anchor the upstream end of the device to the subject's ascending aorta, by the upstream anchor radially expanding against an inner wall of the ascending aorta comprises causing the upstream end of the upstream anchor to become deployed within 5 mm of a sinotubular junction of the subject.
8. The method according to claim 7 , wherein causing the upstream end of the upstream anchor to become deployed within 5 mm of the subject's sinotubular junction comprises causing the upstream end of the upstream anchor to become deployed within 5 mm of the subject's sinotubular junction, upstream of the subject's sinotubular junction.
9. The method according to claim 7 , wherein causing the upstream end of the upstream anchor to become deployed within 5 mm of the subject's sinotubular junction comprises causing the upstream end of the upstream anchor to become deployed within 5 mm of the subject's sinotubular junction, downstream of the subject's sinotubular junction.
10. An apparatus comprising:
an aortic pressure-loss-reduction device configured to be implanted in an ascending aorta of a subject, the aortic pressure-loss-reduction device comprising a frame, and a material that is configured to impede blood flow therethrough coupled to at least a portion of the frame, the aortic pressure-loss-reduction device being configured such that in a non-radially-constrained configuration of the device, the device defines:
an upstream anchor,
a downstream anchor, at least a portion of the downstream anchor being defined by the frame and not including any material coupled to the frame, and
an intermediate portion of the device that defines a conduit through the aortic pressure-loss-reduction device; and
a catheter configured to be inserted into the subject's ascending aorta, while housing the aortic pressure-loss-reduction device inside the catheter in a radially constrained configuration, with the upstream anchor disposed within the catheter distally with respect to the downstream anchor, the catheter comprising:
a proximal covering sheath configured to be retracted such as to sequentially:
uncover the intermediate portion of the aortic pressure-loss-reduction device to allow the intermediate portion to at least partially assume its non-constrained configuration, and
uncover a portion of the downstream anchor, such that the uncovered portion of the downstream anchor includes the portion of the frame that does not have the material coupled thereto, while maintaining the downstream anchor in an at least partially-radially-constrained state;
a distal covering sheath of the catheter configured, subsequent to the proximal covering sheath being retracted such as to uncover at least the portion of the downstream anchor, to be advanced distally as to cause the upstream anchor to anchor an upstream end of the aortic pressure-loss-reduction device to the subject's ascending aorta, by the upstream anchor radially expanding against an inner wall of the ascending aorta, the upstream anchor having material covered thereto, such that blood flows from the aortic valve into an upstream end of the device and out of the uncovered portion of the downstream anchor;
the proximal covering sheath being further configured, subsequent to the distal covering sheath being advanced distally, to be further retracted, such as to cause the downstream anchor to anchor a downstream end of the aortic pressure-loss-reduction device to the subject's ascending aorta, by the downstream anchor radially expanding against the inner wall of the ascending aorta.
11. The apparatus according to claim 10 , wherein the catheter further comprises a mount, at least a distal portion of which defines a conical shape that converges toward a proximal end of the catheter, the distal portion of the mount being configured such that:
while the device is inside the catheter at least a portion of the device is disposed around the distal portion of the mount, and
the conical shape of the distal portion of the mount is configured to facilitate retraction of the distal portion of the mount through the conduit.
12. The apparatus according to claim 10 , wherein the aortic pressure-loss-reduction device is configured to be implanted in the subject's ascending aorta such that an upstream end of the conduit is disposed within 25 mm of an aortic valve orifice of the subject.
13. The apparatus according to claim 10 , wherein the aortic pressure-loss-reduction device is configured to be implanted in the subject's ascending aorta such that an upstream end of the upstream anchor is deployed within 5 mm of a sinotubular junction of the subject.
14. The apparatus according to claim 13 , wherein the aortic pressure-loss-reduction device is configured to be implanted in the subject's ascending aorta such that the upstream end of the upstream anchor is deployed within 5 mm of the subject's sinotubular junction, upstream of the subject's sinotubular junction.
15. The apparatus according to claim 13 , wherein the aortic pressure-loss-reduction device is configured to be implanted in the subject's ascending aorta such that the upstream end of the upstream anchor is deployed within 5 mm of the subject's sinotubular junction, downstream of the subject's sinotubular junction.
16. The apparatus according to claim 10 , wherein the aortic pressure-loss-reduction device further comprises a plurality of projections that protrude from an upstream end of the upstream anchor, and wherein the distal covering sheath of the catheter is configured to prevent the upstream anchor from radially expanding by holding the projections.
17. The apparatus according to claim 16 , wherein the projections comprises T-shaped projections.
18. The apparatus according to claim 16 , wherein the projections each have lengths of less than 8 mm.
19. The apparatus according to claim 16 , wherein upstream ends of the projections are curved such as to be atraumatic.
20. A method comprising:
placing an aortic pressure-loss-reduction device inside an ascending aorta of a subject, the aortic pressure-loss-reduction device including a frame and a material layer coupled to an inside of at least a portion of the frame, the material being configured to impede blood flow therethrough; and
deploying the aortic pressure-loss-reduction device inside the ascending aorta, such that the frame of the aortic pressure-loss-reduction device defines:
an upstream anchor portion that radially expands against an inner wall of a subject's ascending aorta, such as to anchor an upstream end of the aortic pressure-loss-reduction device to the subject's ascending aorta,
an intermediate portion that defines a conduit therethrough, such that blood flows through the device via the conduit, at least a portion of the conduit diverging, such that a downstream end of the diverging portion has a greater cross-sectional area than an upstream end of the diverging portion,
a downstream anchor portion that radially expands against an inner wall of a subject's ascending aorta, such as to anchor a downstream end of the aortic pressure-loss-reduction device to the subject's ascending aorta,
a first set of sinusoidal struts disposed between a downstream end of the upstream anchor and an upstream end of the intermediate portion, the sinusoidal struts forming a folded portion between the downstream end of the upstream anchor and the upstream end of the intermediate portion, and
an upstream end of the intermediate portion being reinforced with respect to at least a central portion of the intermediate portion, such that in response to a diameter of the upstream anchor changing by an absolute amount, an absolute change in a diameter of the upstream end of the intermediate portion is less than the absolute amount by which the diameter of the upstream anchor changes.