Intravascular blood pumps, and methods of use and manufacture

Abstract

To provide devices for moving blood within a patient, and methods of doing so.SOLUTION: The devices can include: a pump portion 2 that includes an impeller 6, 8 and a housing 4 around the impeller 6, 8; and a fluid lumen. The impeller 6, 8 can be activated to cause rotation of the impeller 6, 8 and thereby move fluid within the fluid lumen.SELECTED DRAWING: Figure 10

Description

[Technical field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims priority to the following U.S. provisional patent application: Application No. 62 / 625,312, filed February 1, 2018, the disclosure of which is incorporated herein by reference in its entirety for all purposes. Incorporation by Reference

[0002] All publications and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication or patent application was specifically and individually indicated to be incorporated by reference. [Background technology]

[0002]

[0003] Patients with cardiac disease may have a significantly reduced ability to carry blood flow through the heart and vasculature, which may pose significant risks during corrective procedures such as, for example, balloon angioplasty and stent delivery. A need exists for techniques to improve the volume or stability of the cardiac outflow tract in these patients, particularly during corrective procedures.

[0003]

[0004] Intra-aortic balloon pumps (IABPs) are commonly used to support circulatory function, such as to treat patients with heart failure. The use of IABPs is common in treating patients with heart failure, such as to support patients during high-risk percutaneous coronary intervention (HRPCI), to stabilize a patient's blood flow after cardiogenic shock, to treat patients suffering from acute myocardial infarction (AMI), or to treat decompensated heart failure. Such circulatory support may be utilized alone or in conjunction with pharmacological therapy.

[0004]

[0005] An IABP is typically placed within the aorta and functions by expanding and contracting in a counterpulsatile manner relative to cardiac contraction, one of its functions being to provide additional support to the circulatory system.

[0005]

[0006] More recently, minimally invasive rotary blood pumps have been developed that can be inserted into the body in connection with the cardiac system, such as to pump arterial blood from the left ventricle into the aorta to improve the natural pumping ability of the left side of the patient's heart. Another known method is to pump venous blood from the right ventricle to the pulmonary artery to improve the natural pumping ability of the right side of the patient's heart. The overall goal is to reduce the workload of the patient's cardiac muscle and stabilize the patient, such as during medical procedures that may place additional stress on the heart, to stabilize the patient prior to a heart transplant, or to provide continuous support to the patient.

[0006]

[0007] The smallest rotary blood pumps currently available can be inserted percutaneously into the patient's vasculature through an access sheath or through a vascular access graft to avoid the need for surgical intervention. The designation for this type of device is a percutaneously inserted ventricular assist device.

[0007]

[0008] There is a need to achieve additional improvements in the field of ventricular assist devices and similar blood pumps for treating reduced cardiac blood flow. Summary of the Invention [Means for solving the problem]

[0008]

[0009] FIELD OF THE DISCLOSURE The present disclosure relates generally to intravascular fluid transfer devices, such as blood pumps, and their methods of use and manufacture.

[0010] One aspect of the disclosure is an intravascular blood pump comprising: a foldable housing with a fluid lumen, the fluid lumen having a distal end, a proximal end, and a generally constant diameter portion having a proximal end, the fluid lumen proximal end being proximal to the proximal end of the generally constant diameter portion; and a foldable distal impeller axially spaced from the foldable proximal impeller, the distal impeller having an enlarged configuration, the proximal impeller having an enlarged configuration, the proximal impeller having an axial length in the enlarged configuration, at least a portion of the proximal impeller measured along the axial length is disposed proximal to the proximal end of the generally constant diameter portion.

[0009]

[0011] In some embodiments, at least 20% and up to 90% of the proximal impeller (axial length) is disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impeller, optionally up to 80% of the impeller, optionally up to 75% of the impeller, optionally up to 70% of the impeller, optionally up to 65% of the impeller, optionally up to 60% of the impeller, optionally up to 55% of the impeller, optionally up to 50% of the impeller, optionally up to 45% of the impeller, optionally up to 40% of the impeller, optionally up to 35% of the impeller, optionally up to 30% of the impeller, optionally up to 25% of the impeller is disposed proximal to the proximal end of the constant diameter portion.

[0010]

[0012] In some embodiments, at least 25% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers, optionally up to 65% of the impellers, optionally up to 60% of the impellers, optionally up to 55% of the impellers, optionally up to 50% of the impellers, optionally up to 45% of the impellers, optionally up to 40% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0011]

[0013] In some embodiments, at least 30% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers, optionally up to 65% of the impellers, optionally up to 60% of the impellers, optionally up to 55% of the impellers, optionally up to 50% of the impellers, optionally up to 45% of the impellers, optionally up to 40% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0012]

[0014] In some embodiments, at least 35% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers, optionally up to 65% of the impellers, optionally up to 60% of the impellers, optionally up to 55% of the impellers, optionally up to 50% of the impellers, optionally up to 45% of the impellers, optionally up to 40% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0013]

[0015] In some embodiments, at least 40% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to the most At most 75% of the impellers, optionally up to 70% of the impellers, optionally up to 65% of the impellers, optionally up to 60% of the impellers, optionally up to 55% of the impellers, optionally up to 50% of the impellers, optionally up to 45% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0014]

[0016] In some embodiments, at least 45% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers, optionally up to 65% of the impellers, optionally up to 60% of the impellers, optionally up to 55% of the impellers, optionally up to 50% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0015]

[0017] In some embodiments, at least 50% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers, optionally up to 65% of the impellers, optionally up to 60% of the impellers, optionally up to 55% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0016]

[0018] In some embodiments, at least 55% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers, optionally up to 65% of the impellers, optionally up to 60% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0017]

[0019] In some embodiments, at least 60% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers, optionally up to 65% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0018]

[0020] In some embodiments, at least 65% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0019]

[0021] In some embodiments, at least 70% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0020]

[0022] In some embodiments, at least 75% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers, optionally up to 80% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0021]

[0023] In some embodiments, at least 80% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0022]

[0024] When the proximal impeller is in the expanded configuration, a portion of the proximal impeller may extend further proximally than the proximal end of the fluid lumen.

[0025] The fluid lumen may further comprise a proximal portion disposed proximal to the generally constant diameter portion, the proximal portion including at least one surface adapted and configured to act as a fluid diffuser. The proximal portion may comprise a flared configuration. The proximal portion may have a continuous and gradual flare from the proximal end of the generally constant diameter portion to the fluid lumen proximal end. The proximal portion may have any other proximal portion configuration disclosed herein.

[0023]

[0026] The collapsible housing may include a collapsible support structure coupled to the collapsible membrane.

[0027] One aspect of the disclosure is an intravascular blood pump comprising: a foldable housing with a fluid lumen, the fluid lumen having a distal end and a flared proximal region having a distal end proximal to the fluid lumen distal end, the flared proximal region having at least one surface adapted and configured to act as a fluid diffuser; and a foldable distal impeller axially spaced from the foldable proximal impeller, the distal impeller having an enlarged configuration, the proximal impeller having an enlarged configuration, at least a portion of the proximal impeller disposed distal to the distal end of the flared proximal region, the proximal impeller having an axial length in the enlarged configuration, at least a portion of the proximal impeller measured along the axial length disposed proximal to the distal end of the flared proximal region.

[0024]

[0028] In some embodiments, at least 20% and up to 90% of the proximal impeller (axial length) is disposed proximal to the distal end of the flared proximal region, optionally up to 85% of the impeller, optionally up to 80% of the impeller, optionally up to 75% of the impeller, optionally up to 70% of the impeller, optionally up to 65% of the impeller, optionally up to 60% of the impeller, optionally up to 55% of the impeller, optionally up to 50% of the impeller, optionally up to 45% of the impeller, optionally up to 40% of the impeller, optionally up to 35% of the impeller, optionally up to 30% of the impeller, optionally up to 25% of the impeller is disposed proximal to the distal end of the flared proximal region.

[0025]

[0029] In some embodiments, at least 25% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the distal end of the flared proximal region, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers, optionally up to 65% of the impellers, optionally up to 60% of the impellers, optionally up to 55% of the impellers, optionally up to 50% of the impellers, optionally up to 45% of the impellers, optionally up to 40% of the impellers are disposed proximal to the distal end of the flared proximal region.

[0026]

[0030] In some embodiments, at least 30% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the distal end of the flared proximal region, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers, optionally up to 65% of the impellers, optionally up to 60% of the impellers, optionally up to 55% of the impellers, optionally up to 50% of the impellers, optionally up to 45% of the impellers, optionally up to 40% of the impellers are disposed proximal to the distal end of the flared proximal region.

[0027]

[0031] In some embodiments, at least 35% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the distal end of the flared proximal region, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 100% of the impellers. Up to 75% of the wheels, optionally up to 70% of the impellers, optionally up to 65% of the impellers, optionally up to 60% of the impellers, optionally up to 55% of the impellers, optionally up to 50% of the impellers, optionally up to 45% of the impellers, optionally up to 40% of the impellers are disposed proximal to the distal end of the flared proximal region.

[0028]

[0032] In some embodiments, at least 40% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the distal end of the flared proximal region, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers, optionally up to 65% of the impellers, optionally up to 60% of the impellers, optionally up to 55% of the impellers, optionally up to 50% of the impellers, optionally up to 45% of the impellers are disposed proximal to the distal end of the flared proximal region.

[0029]

[0033] In some embodiments, at least 45% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the distal end of the flared proximal region, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers, optionally up to 65% of the impellers, optionally up to 60% of the impellers, optionally up to 55% of the impellers, optionally up to 50% of the impellers are disposed proximal to the distal end of the flared proximal region.

[0030]

[0034] In some embodiments, at least 50% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the distal end of the flared proximal region, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers, optionally up to 65% of the impellers, optionally up to 60% of the impellers, optionally up to 55% of the impellers are disposed proximal to the distal end of the flared proximal region.

[0031]

[0035] In some embodiments, at least 55% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the distal end of the flared proximal region, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers, optionally up to 65% of the impellers, optionally up to 60% of the impellers are disposed proximal to the distal end of the flared proximal region.

[0032]

[0036] In some embodiments, at least 60% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the distal end of the flared proximal region, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers, optionally up to 65% of the impellers are disposed proximal to the distal end of the flared proximal region.

[0033]

[0037] In some embodiments, at least 65% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the distal end of the flared proximal region, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers are disposed proximal to the distal end of the flared proximal region.

[0034]

[0038] In some embodiments, at least 70% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the distal end of the flared proximal region, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers are disposed proximal to the distal end of the flared proximal region.

[0035]

[0039] In some embodiments, at least 75% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the distal end of the flared proximal region, optionally up to 85% of the impellers, optionally up to 80% of the impellers are disposed proximal to the distal end of the flared proximal region.

[0036]

[0040] In some embodiments, at least 80% and up to 90% of the proximal impellers (measured axially) are disposed proximal to the distal end of the flared proximal region, optionally up to 85% of the impellers are disposed proximal to the distal end of the flared proximal region.

[0037]

[0041] When the proximal impeller is in the expanded configuration, a portion of the proximal impeller may extend further proximally than the proximal end of the fluid lumen.

[0042] The fluid lumen may further include a generally constant diameter portion distal to the flared proximal region.

[0038]

[0043] The flared proximal region may have a continuous and gradual flare from the distal end of the flared region to the proximal end of the fluid lumen.

[0044] One aspect of the disclosure is an intravascular blood pump comprising: a foldable housing with a fluid lumen, the fluid lumen having a distal end, a proximal end, and a generally constant diameter portion having a proximal end; and a foldable distal impeller axially spaced from a foldable proximal impeller, the distal impeller having an enlarged configuration, the proximal impeller having an enlarged configuration, at least a portion of the proximal impeller disposed within the generally constant diameter portion, the proximal impeller having an axial length in the enlarged configuration and a midpoint midway along the axial length, the midpoint proximal to a proximal end of the generally constant diameter portion.

[0039]

[0045] One aspect of the disclosure is an intravascular blood pump comprising: a foldable housing with a fluid lumen, the fluid lumen having a distal end and a proximal end; and a foldable distal impeller axially spaced from the foldable proximal impeller, the distal impeller having an enlarged configuration and the proximal impeller having an enlarged configuration, at least a portion of each of the distal and proximal impellers disposed between the distal and proximal ends of the fluid lumen, the proximal and distal impellers each being positioned relative to the fluid lumen such that when in their enlarged configurations and when rotating, the proximal impeller is performing more than 50% of the work of the blood pump and the distal impeller is performing less than 50% of the work of the blood pump.

[0040]

[0046] The blood pump may include any other blood pump features included herein, such as the relative axial position of the proximal impeller with respect to the fluid lumen.

[0047] The blood pump may not include a vane axially disposed between the proximal and distal impellers.

[0041]

[0048] The blood pump may not include a stator vane disposed axially between the proximal and distal impellers.

[0049] At least half of the proximal impeller, measured along its axial length, can be disposed proximal to the proximal end of the substantially constant diameter portion of the fluid lumen.

[0042]

[0050] At least half of the proximal impeller, measured along its axial length, may be disposed within the flared proximal region of the fluid lumen.

[0051] The proximal impeller and the distal impeller, when in their expanded configurations, each have the proximal impeller performing 55% or more of the work of the blood pump and the distal impeller performing 55% or more of the work of the blood pump. The fluid lumen may be positioned such that less than 45% of the fluid is utilized.

[0043]

[0052] The proximal and distal impellers may each be positioned relative to the fluid lumen such that, when in their expanded configurations, the proximal impeller performs 60% or more of the blood pumping function and the distal impeller performs less than 40% of the blood pumping function.

[0044]

[0053] The proximal and distal impellers may each be positioned relative to the fluid lumen such that, when in their expanded configurations, the proximal impeller performs 70% or more of the blood pumping function and the distal impeller performs less than 30% of the blood pumping function.

[0045]

[0054] The proximal and distal impellers may each be positioned relative to the fluid lumen such that, when in their expanded configurations, the proximal impeller performs 80% or more of the blood pumping function and the distal impeller performs less than 20% of the blood pumping function.

[0046]

[0055] One aspect of the disclosure is a method of intravascularly pumping blood in a subject, the method including the steps of: positioning a first end of a fluid lumen housing a pump in a first anatomical location (e.g., the left ventricle); positioning a distal impeller of the blood pump in the first anatomical location; positioning a proximal impeller of the blood pump in a second anatomical location (e.g., the ascending aorta); positioning a second end of the fluid lumen housing the pump in the second anatomical location; positioning at least a portion of a central region of the fluid lumen to span tissue (e.g., the aortic valve); and creating a flow path between the first end of the fluid lumen disposed in the first anatomical location and the second end of the fluid lumen disposed in the second anatomical location such that the distal impeller and the proximal impeller are able to pump blood through the fluid lumen.

[0047]

[0056] The method may include rotating a distal impeller and a proximal impeller, such that the proximal impeller performs more than 50% of the blood pump's function and the distal impeller performs less than 50% of the blood pump's function.

[0048]

[0057] The rotating step may include rotating the distal impeller and the lateral impeller such that the proximal impeller performs 60% or more of the blood pump's function and the distal impeller performs less than 40% of the blood pump's function.

[0049]

[0058] The rotating step may include rotating the distal impeller and the lateral impeller such that the proximal impeller performs 70% or more of the blood pump's function and the distal impeller performs less than 30% of the blood pump's function.

[0050]

[0059] The rotating step may include rotating the distal impeller and the lateral impeller such that the proximal impeller performs 75% or more of the blood pump's function and the distal impeller performs less than 25% of the blood pump's function.

[0051]

[0060] The rotating step may include rotating the distal impeller and the lateral impeller such that the proximal impeller performs approximately 80% of the blood pumping action and the distal impeller performs approximately 20% of the blood pumping action.

[0052]

[0061] One aspect of the disclosure is an intravascular blood pump comprising: a foldable housing with a fluid lumen, the fluid lumen having a distal end and a proximal end; and a foldable distal impeller axially spaced from a foldable proximal impeller, the distal impeller having an enlarged configuration and the proximal impeller having an enlarged configuration, at least a portion of each of the distal and proximal impellers extending beyond the fluid lumen. and a foldable distal impeller disposed between the distal and proximal ends of the blood pump, the proximal and distal impellers each being positioned relative to the fluid lumen such that when the proximal and distal impellers are in their expanded configurations and when rotating, the proximal impeller generates more than 50% of the pressure generated by the blood pump and the distal impeller generates less than 50% of the pressure generated by the blood pump of the blood pump.

[0053]

[0062] The blood pump may not include a vane axially disposed between the proximal and distal impellers.

[0063] The blood pump may not include a stator vane disposed axially between the proximal and distal impellers.

[0054]

[0064] The proximal and distal impellers may each be positioned relative to the fluid lumen such that, when in their expanded configurations, the proximal impeller generates 55% or more of the pressure generated by the blood pump and the distal impeller generates less than 45% of the pressure generated by the blood pump.

[0055]

[0065] The proximal and distal impellers may each be positioned relative to the fluid lumen such that, when in their expanded configurations, the proximal impeller generates 60% or more of the pressure generated by the blood pump and the distal impeller generates less than 40% of the pressure generated by the blood pump.

[0056]

[0066] The proximal and distal impellers may each be positioned relative to the fluid lumen such that, when in their expanded configurations, the proximal impeller generates 70% or more of the pressure generated by the blood pump and the distal impeller generates less than 30% of the pressure generated by the blood pump.

[0057]

[0067] The proximal and distal impellers may each be positioned relative to the fluid lumen such that, when in their expanded configurations, the proximal impeller generates approximately 80% of the pressure generated by the blood pump and the distal impeller generates approximately 20% of the pressure generated by the blood pump.

[0058]

[0068] One aspect of the disclosure is an intravascular blood pump comprising: a foldable housing with a fluid lumen, the fluid lumen having a distal end, a proximal end, and a generally constant diameter portion having a proximal end, the fluid lumen proximal end being proximal to the proximal end of the generally constant diameter portion; and a foldable distal impeller axially spaced from a foldable proximal impeller, the distal impeller having an enlarged configuration, the proximal impeller having an enlarged configuration, at least a portion of the proximal impeller disposed within the generally constant diameter portion, the proximal impeller having an axial length in the enlarged configuration.

[0059]

[0069] Any other feature of the blood pump herein may be incorporated into this embodiment.

[0070] One aspect of the disclosure is an intravascular blood pump comprising: a foldable housing with a fluid lumen, the fluid lumen having a distal end, a proximal end, and a proximal region having a lumen wall configuration, the proximal region including a proximal end; and a foldable distal impeller axially spaced from the foldable proximal impeller, the distal impeller having an enlarged configuration, the proximal impeller having an enlargement, and at least a portion of the proximal impeller disposed distal to the proximal region of the fluid lumen, the proximal impeller having at least one blade having a surface, the at least one blade surface and the lumen wall being displaced at least 2 mm proximally relative to an initial position, such that the proximal impeller displaces less of the fluid lumen. configured such that when disposed distal to the proximal region of the proximal impeller, a change in axial position of the proximal impeller results in at least 10% in flow.

[0060]

[0071] The present disclosure includes methods of manufacturing any and all blood pumps herein.

[0072] The present disclosure includes methods of using any and all blood pumps herein, examples of which are provided herein in several exemplary anatomical locations.

[0061]

[0073] Any of the axial spacings between the proximal and distal impellers described herein may be applied to any of the embodiments within this specification, including any of the embodiments in the claims, detailed description, or Summary section. [Brief description of the drawings]

[0062] [Figure 1]

[0074] FIG. 2 is a side view of an example working portion having a conduit, multiple impellers, and an expandable member. [Diagram 2]

[0075] FIG. 2 is a side view of an example working portion having a conduit, multiple impellers, and multiple expandable members. [Figure 3A]

[0076] 1 illustrates an example working portion having a conduit, multiple impellers, and multiple expandable members. [Figure 3B] 1 illustrates an example working portion having a conduit, multiple impellers, and multiple expandable members. [Figure 3C] 1 illustrates an example working portion having a conduit, multiple impellers, and multiple expandable members. [Figure 3D] 1 illustrates an example working portion having a conduit, multiple impellers, and multiple expandable members. [Figure 4]

[0077] 1A-1C show an example arrangement of a working portion having a conduit, multiple expandable members, and multiple impellers. [Diagram 5]

[0078] FIG. 1 illustrates an example working part. [Figure 6]

[0079] FIG. 6A illustrates at least a portion of an example medical device having a pump portion in which at least two different impellers can rotate at different speeds.

[0080] FIG. 6B illustrates at least a portion of an example medical device having a pump portion in which at least two different impellers can rotate at different speeds.

[0081] FIG. 6C illustrates at least a portion of an example medical device having a pump portion with at least two impellers having different pitches. [Figure 7]

[0082] 1A-1C illustrate at least a portion of an exemplary medical device having a pump portion. [Figure 8]

[0083] FIG. 1 illustrates a pump portion with multiple impellers with curvatures formed therein between adjacent impellers. [Figure 9]

[0084] FIG. 2 shows a pump section with multiple impellers. [Figure 10]

[0085] FIG. 2 is a side view of a portion of an exemplary pump portion. [Figure 11A]

[0086] FIG. 2 shows an exemplary test, as described in more detail herein. [Figure 11B] FIG. 2 shows an exemplary test, as described in more detail herein. [Figure 11C] FIG. 2 shows an exemplary test, as described in more detail herein. [Figure 11D] FIG. 2 shows an exemplary test, as described in more detail herein. [Figure 11E] FIG. 2 shows an exemplary test, as described in more detail herein. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0063]

[0087] The present disclosure relates to medical devices, systems, and methods of use and manufacture. The medical devices herein can have a distal working portion adapted for placement within a physiological vessel, the distal working portion having one or more components that act on a fluid. For example, the distal working portion herein can have one or more rotating members that can promote the movement of fluids, such as blood, upon rotation.

[0064]

[0088] Any disclosure of the disclosures in this specification related to the aspects of system, device or method of use can be incorporated into any other suitable disclosures in this specification.For example, a figure that describes only one aspect of a device or method can be included in other embodiments even if it is not specifically described in the description of one or any part of this disclosure.Therefore, it should be understood that the combination of different parts of this disclosure is included in this specification unless otherwise specified.

[0065]

[0089] FIG. 1 is a side view of a distal portion of an exemplary intravascular fluid pump having a pump portion 1600 having a proximal impeller 1606 and a distal impeller 1616, both of which are operably connected to a drive cable 1612. In FIG. 1, the pump portion 1600 is in an expanded configuration, but is adapted to be folded into a delivery configuration so that it can be delivered in a low profile. The impellers may be attached to the drive cable 1612. The drive cable 1612 is operably connected to an external motor, not shown, and extends through an elongated shaft 1610. The phrases "pump portion" and "working portion" (or derivatives thereof) may be used interchangeably herein unless otherwise indicated. For example, but not limited to, the "pump portion" 1600 may be referred to herein as the "working portion."

[0066]

[0090] The pump portion 1600 further includes an expandable member 1602, which in this embodiment has a proximal end 1620 extending proximally beyond the proximal end of the proximal impeller 1606 and a distal end 1608 extending distally beyond the distal end of the distal impeller 1616. The expandable member 1602 is disposed radially outward of the impeller along the axial length of the impeller. The expandable member 1602 may be constructed in a manner similar to, and made from materials similar to, many types of expandable structures known in the medical arts to be collapsible and expandable. Examples of these approaches or methods are provided herein. Examples of suitable materials include, but are not limited to, polyurethane and polyurethane elastomers.

[0067]

[0091] The pump portion 1600 further comprises a conduit 1604 coupled to the expandable member 1602, the expandable member 1602 having a length L and extending axially between the impellers. The conduit 1604 forms and provides a fluid lumen between the two impellers. In use, fluid travels through the lumen provided by the conduit 1604. The conduits herein may be impermeable, or may be semi-permeable or even porous, so long as they are capable of defining a lumen. Also, unless otherwise stated, the conduits herein are flexible. The conduits herein extend completely (i.e., 360 degrees) around at least a portion of the pump portion. Within the pump portion 1600, the conduit extends completely around the expandable member 1602, but does not extend to the proximal end 1602 or the distal end 1608 of the expandable member 1602. The structure of the expandable member creates at least one inlet aperture to allow inflow "I" and at least one outlet aperture to allow outflow "O." The conduit 1604 improves the dynamics of the pumping of the impeller compared to the dynamics that the working portion 1600 would have without the conduit.

[0068]

[0092] The expandable member 1602 can have a variety of configurations and can be made from a variety of materials. For example, the expandable member 1602 can be formed like an expandable stent or stent-like device, or like any other example provided herein. For example and without limitation, the expandable member 1602 can have an open braided configuration, such as a 24-end braid. However, more or less braided wires can be used. Exemplary materials for the expandable member include Nitinol, Examples of materials that may be used include cobalt alloys, and polymers. However, other materials may be used. The expandable member 1602 has an expansion configuration as shown, where the outermost dimension of the expandable member (measured perpendicular to the longitudinal axis of the working portion) is greater at least in the region where the expandable member is disposed radially outward of the impellers, as compared to the outermost dimension of a central region 1622 of the expandable member that extends axially between the impellers. The drive cable 1612 is coaxial with the longitudinal axis in this embodiment. In use, the central region may be positioned to span a valve, such as the aortic valve. In some embodiments, the expandable member 1602 is adapted and constructed to expand to an outermost dimension of 12-24F (4.0-8.0 mm) where the impellers are axially present within the expandable member, and to an outermost dimension of 10-20F (3.3-6.7 mm) in the central region 1622 between the impellers. The smaller outer dimensions of the central region can reduce the forces acting on the valve, thereby reducing or minimizing damage to the valve. The larger dimensions of the expandable member in the region of the impeller can help axially stabilize the working portion during use. The expandable member 1602 has a general dumbbell configuration. The expandable member 1602 has an outer configuration that tapers at the transition from the impeller region to the central region 1622 and also tapers at the distal and proximal ends of the expandable member 1602.

[0069]

[0093] The expandable member 1602 has a proximal end 1620 coupled to a shaft 1610 and a distal end 1608 coupled to a distal tip 1624. An impeller and drive cable 1612 rotates within the expandable member and conduit assembly. The drive cable 1612 is axially stabilized relative to the distal tip 1624 but is free to rotate relative to the distal tip 1624.

[0070]

[0094] In some embodiments, the expandable member 1602 can be collapsed by pulling tension across the expandable member. This can include a linear movement that stretches the expandable member 1602 axially (e.g., but not limited to, moving 5-20 mm) to a collapsed configuration having an outer dimension in the collapsed state. The expandable member 1602 can also be collapsed by pushing an outer shaft, such as a sheath, over the expandable member / conduit assembly, thereby collapsing the expandable member and conduit into the collapsed delivery configuration.

[0071]

[0095] The impellers 1606 and 1616 are also adapted and constructed to stretch or radially compress one or more blades to a reduced outermost dimension (measured perpendicular to the longitudinal axis of the working portion). For example, but not limited to, any of the impellers herein may have one or more blades made from a plastic compound having spring properties, such as any of the impellers described in U.S. Pat. No. 7,393,181. The disclosure of U.S. Pat. No. 7,393,181 is incorporated herein by reference for all purposes and may be incorporated into embodiments herein unless otherwise indicated by this disclosure. Alternatively, for example, one or more foldable impellers may comprise a superelastic wire frame with a polymer or other material acting as a webbing that crosses the wire frame, such as a wire frame as described in U.S. Pat. No. 6,533,716, the disclosure of which is incorporated herein by reference for all purposes.

[0072]

[0096] The inflow and / or outflow configuration of the working portion 1600 may be predominantly axial in nature.

[0097] Exemplary sheathing and unsheathing techniques and concepts for folding and expanding a medical device are described and illustrated, for example, in U.S. Pat. No. 7,841,976 or U.S. Pat. No. 8,052,749, the disclosures of which are incorporated herein by reference. It is known from the following reasons.

[0073]

[0098] 2 is a side view of a deployed configuration (shown outside the body) of a distal portion of an exemplary embodiment of a fluid transfer system. The exemplary system 1100 has a working portion 1104 (which may also be referred to herein as a pump portion as described herein) and an elongated portion 1106 extending from the working portion 1104. The elongated portion 1106 may extend to a more proximal region of the system, not shown for simplicity, which may include, for example, a motor. The working portion 1104 has a first expandable member 1108 and a second expandable member 1110 that are axially spaced apart along a longitudinal axis LA of the working portion 1104. Axially spaced apart in this context means that the entirety of the first expandable member is axially spaced apart from the entirety of the second expandable member along the longitudinal axis LA of the working portion 1104. A first end 1122 of the first expandable member 1108 is axially spaced from a first end 1124 of the second expandable member 1110 .

[0074]

[0099] Each of the first and second expandable members 1108, 1110 generally has a plurality of elongated segments arranged relative to one another to define a plurality of apertures 1130. Only one aperture of the plurality of apertures 1130 in the second expandable member 1110 is labeled with a reference number. The expandable members can have a wide variety of configurations and can be constructed in a wide variety of ways, such as, but not limited to, any of the configurations or constructions of U.S. Pat. No. 7,841,976 or the tubes of U.S. Pat. No. 6,533,716, which are described as self-expanding metallic endoprosthesis materials. For example, but not limited to, one or both of the expandable members can have a mesh configuration or can be at least partially formed by laser cutting a tubular element.

[0075]

[0100] The working portion 1104 further includes a conduit 1112 coupled to the first and second expandable members 1108 and 1110 and extending axially between the first and second expandable members in the deployed configuration. A central region 1113 of the conduit 1112 extends across an axial distance 1132 where the working portion does not include the first and second expandable members 1108 and 1110. The central region 1113 may be considered to be axially between the expandable members. The distal end 1126 of the conduit 1112 does not extend distally as far as the distal end 1125 of the second expandable member 1110, and the proximal end 1128 of the conduit does not extend proximally as far as the proximal end 1121 of the first expandable member 1108.

[0076]

[0101] When the disclosure herein refers to a conduit coupled to an expandable member, the term coupled in this context does not require that the conduit be directly attached to the expandable member such that the conduit is in physical contact with the expandable member. However, even if not directly attached, the term coupled in this context means that the conduit and the expandable member are joined together such that as the expandable member expands or collapses, the conduit will also begin to transition to a different configuration and / or size. Thus, coupled in this context means that the conduit will move when the expandable member coupling the conduit transitions between the expanded and collapsed configurations.

[0077]

[0102] Any of the conduits herein may be deformable to some extent. For example, the conduit 1112 has an elongate member 1120 that may be made of one or more materials that allow a central region 1113 of the conduit to deform radially inward (toward the LA) to some extent, for example in response to forces from the valve tissue (e.g., leaflets) or alternative valve in use when the working portion 1104 is deployed toward the configuration shown in FIG. 2. In some implementations, In some embodiments, the conduit may be stretched tightly between the expandable members. Alternatively, the conduit may be designed to have slack to improve conformance. This may be desirable when the working portion is disposed across a fragile structure such as the aortic valve, allowing the valve to compress the conduit in a manner that minimizes point stresses in the valve. In some embodiments, the conduit may have a membrane attached to the proximal and distal expandable members. Exemplary materials that may be used for any of the conduits herein include, but are not limited to, polyurethane rubber, silicone rubber, acrylic rubber, expanded polytetrafluoroethylene, polyethylene, polyethylene terephthalate, including any combination thereof.

[0078]

[0103] Any of the conduits herein may have a thickness of 127 to 508 μm (5 to 20 thousandths of an inch (thou)), such as, for example, from 25.4 μm (1 thou) to 381 μm (15 thou), from 38.1 μm (1.5 thou) to 381 μm (15 thou), from 38.1 μm (1.5 thou) to 254 μm (10 thou), or from 50.8 μm (2 thou) to 254 μm (10 thou).

[0079]

[0104] Any of the conduits herein, or at least a portion of the conduit, may be impermeable to blood. In FIG. 2, the working portion 1104 has a lumen that extends from the distal end 1126 of the conduit 1112 to the proximal end 1128 of the conduit 1112. The lumen is defined by the conduit 1112 in the central region 1113, but may be considered to be defined by both the conduit and a portion of the expandable member in a region axially adjacent to the central region 1113. However, in this embodiment, it is the material of the conduit that causes the lumen to exist, which also prevents blood from passing through the conduit.

[0080]

[0105] Any of the conduits herein secured to one or more expandable members, unless otherwise indicated, may be secured such that the conduit is disposed radially outward of the one or more expandable members, or radially inward of the one or more expandable members, or both, and the expandable members may be filled with the conduit material.

[0081]

[0106] The proximal and distal expandable members help maintain the conduit in an open configuration to create a lumen, while each also creates an operating environment for the impeller, as described below. In the deployed configuration, each of the expandable members is maintained in a spaced apart relationship relative to the respective impeller, thereby allowing the impeller to rotate within the expandable member without contacting the expandable member. The working portion 1104 has a first impeller 1116 and a second impeller 1118, with the first impeller 1116 disposed radially within the first expandable member 1108 and the second impeller 1118 disposed radially within the second expandable member 1110. In this embodiment, the two impellers, although separate and separated, are operably connected to a common drive feature (e.g., drive cable 1117) such that the two impellers rotate together when the drive feature is activated. In this deployed configuration, the impellers 1116 and 1118 are axially spaced apart along the longitudinal axis LA just as the expansible members 1108 and 1110 are axially spaced apart.

[0082]

[0107] Impellers 1116 and 1118 also reside axially within the ends of expandable members 1108 and 1110, respectively (in addition to being radially within expandable members 1108 and 1110). Impellers herein may be considered to reside axially within the expandable members even if the expandable members have struts (e.g., struts that are tapered in side view) that extend from a central region of the expandable member toward the longitudinal axis of the working portion. In FIG. 2, the second expandable member 1110 extends from a first end 1124 (proximal end) to a second end 1125 (distal end).

[0083]

[0108] 2, a distal portion of the impeller 1118 extends distally beyond a distal end 1126 of the conduit 1112, and a proximal portion of the impeller 1116 extends proximally beyond a proximal portion 1128 of the conduit 1112. In this illustration, a portion of each impeller resides axially within the conduit in this deployment configuration.

[0084]

[0109] In the exemplary embodiment shown in FIG. 2, the impellers 1116 and 1118 are operably connected to a common drive feature 1117, in this embodiment, each of the impellers is coupled to a drive mechanism 1117 that extends through the shaft 1119 and the working portion 1104. The drive feature 1117 may be, for example, an elongated drive cable that, when rotated, also rotates the impellers. In this example, as shown, the drive mechanism 1117 extends to the distal tip 1114 and is axially fixed relative to the distal tip 1114, but the drive mechanism 1117 is also adapted to rotate relative to the distal tip 1114 upon actuation. Thus, in this embodiment, when the drive mechanism 1117 rotates, the impellers and the drive mechanism 1117 rotate together. Any number of known mechanisms may be used to rotate the drive features, such as a mechanism using a motor (external motor).

[0085]

[0110] The expandable member and the conduit are not connected to the impeller and the drive mechanism to allow rotational movement. In this embodiment, the proximal end 1121 of the proximal expandable member 1108 is coupled to the shaft 1119, which may be the shaft of the elongated portion 1106 (e.g., the outer catheter shaft). The distal end 1122 of the proximal expandable member 1108 is coupled to the central tubular member 1133, through which the drive mechanism 1117 extends. The central tubular member 1133 extends distally from the proximal expandable member 1108 in the conduit 1112 and is further coupled to the proximal end 1124 of the distal expandable member 1110. Thus, the drive mechanism 1117 rotates within the central tubular member 1133 relative to the central tubular member 1133. A central tubular member 1133 extends axially from the proximal expandable member 1108 to the distal expandable member 1110. A distal end 1125 of the distal expandable member 1110 is coupled to the distal end 1114 as shown. A drive mechanism 1117 is adapted to rotate relative to the tip 1114 but is fixed axially relative to the tip 1114.

[0086]

[0111] The working portion 1104 is adapted and configured to fold into a smaller profile than its deployed configuration (shown in FIG. 2). This allows the working portion 1104 to be delivered using a lower profile delivery device (smaller French size) than would be necessary if the working portion 1104 were not foldable. Even if not specifically described herein, any expandable members and impellers may be adapted and configured to be foldable to some degree into a smaller delivery configuration.

[0087]

[0112] The working portion of the present disclosure may be folded into a folded delivery configuration using conventional techniques, such as those using an outer sheath that is movable relative to the working portion (e.g., by axially moving one or both of the sheath and the working portion). Any of the systems, devices, or methods shown in the following references, for example and without limitation, may be used to facilitate folding the working portion of the present disclosure: U.S. Patent No. 7841,976 or U.S. Patent No. 8,052,749, the disclosures of which are incorporated herein by reference for all purposes.

[0088]

[0113] 3A-3E show an example working portion similar in some respects to the working portion shown in FIG. 2. Working portion 340 has two expandable members that are axially spaced apart from one another when the working portion is expanded, and a conduit extending between the two expandable members. 3A is a perspective view, FIG. 3B is a side cross-sectional view, and FIG. 3C and 3D are enlarged side cross-sectional views of the cross-section of the view in FIG.

[0089]

[0114] The working portion 340 has a proximal impeller 341 and a distal impeller 342, which are coupled and operably connected to a drive cable, which defines a lumen therein. The lumen may be sized to accommodate a guidewire that may be used to deliver the working portion to a desired location. The drive cable, in this embodiment, has a first section 362 (e.g., a rolled material), a second section 348 (e.g., a tubular member) that couples the proximal impeller 341, a third section 360 (e.g., a rolled material), and a fourth section 365 (e.g., a tubular material) that couples the distal impeller 342. All of these drive cable sections have equal inner diameters, resulting in a constant lumen. These drive cable sections may be secured to one another using known attachment techniques. The distal end of the fourth section 365 extends to a distal region of the working portion, thereby allowing the working portion to be advanced, for example over a guidewire, to position the working portion. In this embodiment, the second and fourth sections may have a higher stiffness than the first and third sections. For example, the second and fourth sections may be tubular and the first and third sections may be of material that is rolled to reduce stiffness.

[0090]

[0115] The working portion 340 has a proximal expandable member 343 and a distal expandable member 344, each of which extends radially outward of one of the impellers. The expandable members have distal and proximal ends that may extend axially beyond the distal and proximal ends of the impellers, as can be seen in FIGS. 3B-3D. A conduit 356 is coupled to the two expandable members, the conduit 356 having a proximal end 353 and a distal end 352. Each of the two expandable members has a plurality of proximal struts and a plurality of distal struts. The proximal struts in the proximal expandable member 343 extend to and are secured to a shaft section 345, the shaft section 345 being coupled to a bearing 361, the drive cable extending through the bearing 361 and configured and sized to rotate. The distal struts of the proximal expandable member 343 extend to and are secured to a proximal region (in this case, the proximal end) of the central tubular member 346, which is disposed axially between the expandable members. The proximal end of the central tubular member 346 is coupled to a bearing 349, as shown in FIG. 3C, through which the drive cable extends and rotates. The proximal struts of the distal expandable member 344 extend to and are secured to a distal region (in this case, the distal end) of the central tubular member 346. Furthermore, a bearing 350 is coupled to the distal region of the central tubular member 346, as shown in FIG. 3D. The drive cable extends through and rotates relative to the bearing 350. The distal struts of the distal expandable member extend to and are secured to shaft section 347 (see FIG. 3A), which may be considered a portion of the distal end. Shaft section 347 is coupled to bearing 351 (see FIG. 3D), through which the drive cable extends and about which it rotates. The distal tip further includes bearing 366 (see FIG. 3D), which may be a thrust bearing. Even if not expressly included in this description, working portion 340 may be similar or equal to working portion 1104 in some respects.In this embodiment, the conduit 356 extends at least as far as the end of the impeller as opposed to the working portion 1104. Either embodiment can be modified to extend the conduit to the positions described in other embodiments. In some embodiments, section 360 can be a tubular section instead of rolled.

[0091]

[0116] In alternative embodiments, at least a portion of any of the impellers herein extends outside the fluid lumen. For example, only a portion of the impeller may extend beyond the end of the fluid lumen in a proximal or distal direction. In some embodiments, the portion of the impeller that extends outside the fluid lumen is the proximal portion of the impeller and has a proximal end (see, e.g., the proximal impeller in FIG. 2). In some embodiments, the portion of the impeller that extends outside the fluid lumen is the distal portion of the impeller and has a distal end (see, e.g., the distal impeller in FIG. 2). When the disclosure herein refers to an impeller that extends outside (i.e., beyond) the fluid lumen, this is intended to refer to the relative axial positions of the components as most easily seen in a side or top view, such as in FIG. 2.

[0092]

[0117] However, a second impeller at another end of the fluid lumen may not extend beyond the fluid lumen. For example, an exemplary alternative design may have a proximal impeller (similar to the proximal impeller of FIG. 2) that extends proximally beyond the proximal end of the fluid lumen, and the fluid lumen does not extend distally beyond the distal end of the distal impeller (as in FIG. 3). Alternatively, the distal end of the distal impeller may extend distally beyond the distal end of the fluid lumen, but the proximal end of the proximal impeller does not extend proximally beyond the proximal end of the fluid lumen. In any of the pump portions herein, none of the impellers may extend beyond the end of the fluid lumen.

[0093]

[0118] Although certain example locations may be shown herein, the fluid pump may be usable in a wide variety of locations within the body. Some example locations for placement include near the aortic or pulmonary valve, such as extending across the valve and being located on one or both sides of the valve, and in the case of the aortic valve, optionally a portion located within the ascending aorta. In some other embodiments, for example, the pump may be located further downstream in use, disposed within the descending aorta, etc.

[0094]

[0119] FIG. 4 shows an example arrangement of the working portion 1104 from the system 1000 of FIG. 2. One difference shown in FIG. 4 is that the conduit extends at least as far as the end of the impeller as in FIGS. 3A-3D. FIG. 4 shows the working portion 1104 in a deployed configuration positioned in place to span the aortic valve. The working portion 1104 may be delivered, as shown, for example, but not limited to, via femoral artery access (a known access procedure). Although not shown for simplicity, the system 1000 may further include an outer sheath or shaft in which the working portion 1104 is disposed during delivery to a location near the aortic valve. The sheath or shaft may be moved proximally (towards the ascending aorta "AA" and away from the left ventricle "LV"), thereby allowing the working portion 1104 to deploy and expand. For example, the sheath can be retracted to allow the second expandable member 1110 to expand, and continued proximally to allow the first expandable member 1108 to expand.

[0095]

[0120] In this embodiment, the second expandable member 1110 is expanded and positioned in a deployed configuration such that the distal end 1125 is within the left ventricle "LV", distal to the aortic valve leaflet "VL", and distal to the annulus. Additionally, the proximal end 1124 is positioned distal to the leaflet "VL". However, in some embodiments, the proximal end 1124 may extend axially slightly within the leaflet VL. This embodiment is an example of a method where at least half of the second expandable member 1110 is within the left ventricle when measured along its length (measured along the longitudinal axis). Additionally, as shown, this is an example of a method where the entirety of the second expandable member 1110 is within the left ventricle. This is also an example of a method in which at least half of the second impeller 1118 is disposed within the left ventricle, and even an embodiment in which the entire second impeller 1118 is disposed within the left ventricle.

[0096]

[0121] Continued retraction of the outer shaft or sheath (and / or distal movement of the working end 1104 relative to the outer sheath or shaft) continues to release the conduit 1112 until the central region 113 is released and deployed. The expandable members 1108 and 1110 expand the conduit 1112 to a more open configuration as shown in FIG. 4. Thus, in this embodiment, the conduit 1112 does not have the same self-expanding properties as the expandable members, but upon deployment of the working end, the conduit assumes a more open deployed configuration. At least a portion of the central region 1113 of the conduit 1112 is located at the coaptation region with the aortic valve. In FIG. 3, there is a short length of the central region 1113 that extends distally beyond the leaflets VL, but at least a portion of the central region 1113 resides axially within the leaflets.

[0097]

[0122] Continued retraction of the outer shaft or sheath (and / or moving the working end 1104 distally relative to the outer sheath or shaft) deploys the first expandable member 1108. In this embodiment, the first expandable member 1108 is expanded and placed in a deployed configuration (as shown) such that the proximal end 1121 resides within the ascending aorta AA and is proximal to the leaflet "VL". Additionally, although the distal end 1122 is positioned proximal to the leaflet VL, in some methods the distal end 1122 may extend axially slightly within the leaflet VL. This embodiment is an example of a method in which at least half of the first expandable member 1110 resides within the ascending aorta when measured along its length (measured along the longitudinal axis). Additionally, as shown, this is also an example of a method in which the entirety of the first expandable member 1110 resides within the AA. This is also an example of a method in which at least half of the first impeller 1116 is disposed within the AA, and even an embodiment in which the entire first impeller 1116 is disposed within the AA.

[0098]

[0123] At any time during or after the deployment of the working portion 1104, the position of the working portion can be accessed in any manner, such as under fluoroscopy. The position of the working portion can be adjusted at any time during or after the deployment. For example, the working portion 1104 can be moved axially (distally or proximally) after the second expandable member 1110 is released but before the first expandable member 1108 is released, thereby repositioning the working portion. In addition, the working portion can be repositioned, for example, after the entire working portion is released from the sheath and reaches a desired final position.

[0099]

[0124] It should be understood that the positions of the components shown in FIG. 4 (with reference to the anatomical structures) are to be considered as exemplary final positions for the various components of the working portion 1104, even if repositioning occurs after initial deployment.

[0100]

[0125] One or more of the expandable members herein may be configured to be and may be expanded in a variety of ways, such as by self-expanding, via mechanical actuation (e.g., via one or more axial forces exerted on the expandable member, by using a separate balloon disposed radially within the expandable member that expands to push the expandable member radially outward, etc.), or a combination thereof.

[0101]

[0126] As used herein, expansion generally refers to reconfiguration to a larger profile having a larger radial outermost dimension (relative to the longitudinal axis), regardless of the specific manner in which one or more components are expanded. For example, self-expanding A stent that is subjected to a larger and / or outward radial force may "expand," as that term is used herein. A device that unfolds or unfolds may assume a larger profile and may be considered to expand, as that term is used herein.

[0102]

[0127] The impellers may likewise be adapted and configured to expand in a variety of ways depending on their configuration. For example, when one or more impellers are released from the sheath, they may automatically return to or toward another larger profile configuration due to the materials and / or configuration of the impeller design (see, e.g., U.S. Pat. No. 6,533,716 or U.S. Pat. No. 7,393,181, both of which are incorporated by reference herein for all purposes). Thus, in some embodiments, retraction of the outer restraint allows both the expandable member and the impellers to naturally return to the larger profile deployed configuration without any other actuation.

[0103]

[0128] As shown in the embodiment of FIG. 4, the working portion has first and second impellers spaced apart on either side of the aortic valve, each of the first and second impellers being disposed within a separate expandable member. This is in contrast to some designs in which the working portion has a single elongated expandable member. Unlike a single generally tubular expandable member that spans the entire valve, the working portion 1104 has a conduit 1112 that extends between the expandable members 1108 and 1110. The conduit has greater flexibility and deformability than the expandable basket, thereby allowing for greater deformation of the working portion at the location of the leaflets, as would occur if the expandable member were to extend across the aortic valve leaflets. This can reduce damage to the leaflets after the working portion is deployed in the subject.

[0104]

[0129] In addition, forces exerted on the central region of the single expandable member from the leaflets can translate axially to other regions of the expandable member, potentially causing undesired deformation of the expandable member at the location of one or more impellers. This can cause the outer expandable member to contact the impeller, thereby undesirably interfering with the rotation of the impeller. A design with separate expandable members around each impeller, and particularly one in which each expandable member and each impeller is supported at both ends (i.e., distal and proximal), allows the impellers to be positioned relative to the expandable member with a high level of precision. Two separate expandable members may be able to maintain their deployed configuration more reliably compared to a single expandable member.

[0105]

[0130] As described herein above, it may be desirable to be able to reconfigure the working portion to be able to be delivered into a 9F sheath and achieve sufficient flow rates in use that may not be possible with some current products during deployment and / or testing. For example, some products may be too large to be reconfigured to a sufficiently small delivery profile, while some compact designs may not be able to achieve the desired high flow rates. An illustrative advantage of the embodiments of Figures 1, 2, 3A-3D, and 4 is that, for example, the first and second impellers can work together to achieve the desired flow rate, and by having two axially spaced impellers, the entire working portion can be reconfigured to a smaller delivery profile than a design that uses a single impeller to achieve the desired flow rate. Thus, these embodiments use multiple smaller axially spaced reconfigurable impellers to achieve both the desired small delivery profile as well as the desired high flow rate.

[0106]

[0131] Thus, the embodiments herein are capable of achieving a small delivery profile while maintaining a sufficiently high flow rate, while creating a more deformable and flexible central region of the working portion, exemplary benefits of which are described above (e.g., cooperative contact with vulnerable valve leaflets).

[0107]

[0132] 5 shows a working portion similar to that shown in FIG. Working portion 265 has a proximal impeller 266 and a distal impeller 267, both coupled to a drive shaft 278 that extends into a distal bearing housing 272. There is a similar proximal bearing housing at the proximal end of the working portion. The working portion further has an expandable member generally indicated as 270 and a conduit 268 secured to the expandable member and extending along substantially the entire length of the expandable member. The expandable member 270 has distal struts 271 secured to strut supports 273 that extend to and are secured to the strut supports 273 that are secured to the distal tips 273. The expandable member 270 further includes a proximal strut secured to the proximal strut support. All structures similar to those of FIG. 1 are incorporated by reference in this embodiment for all purposes, even if not explicitly described. The expandable member 265 further includes a helical tension member 269 disposed along the periphery of the expandable member, the helical tension member 269 having a helical configuration when the expandable member is in the expanded configuration as shown. The helical tension member 269 is disposed and adapted to induce a rotation wrap when folded. The working portion 265 may be folded from the expanded configuration shown by simultaneously rotating one or both impellers at a relatively low speed to promote a spiral fold of the impellers due to interaction with the expandable member. The helical tension member 269 (or the helical configuration of the expandable member cells) serves as the tension member of the assembly.The helical tension member 269 is also configured so that when the expandable basket is pulled under tension along its length to collapse it (e.g., by stretching it over a long distance, such as approximately twice its length), the tension member 269 is pulled into linear alignment, which rotates / twists the desired segment of the expandable member during collapse, which causes the impeller blades to wrap radially inward as the expandable member and blades collapse. An exemplary configuration of such a tension member, when in a helical configuration, has a curved configuration that is approximately equal to the maximum length of the expandable member when collapsed. In an alternative embodiment, only a portion of the expandable member that surrounds the collapsible impeller is rotated when collapsed.

[0108]

[0133] There are alternative ways to construct the working portion such that the expandable member rotates when folded by stretching (and thus by rolling and folding the impeller blades). Any expandable member, even a dual impeller design, can be constructed with such features. For example, when using an expandable member with a number of "cells" (e.g., a laser cut elongated member) as the term is commonly understood, the expandable member can have a number of specific cells that together define a specific configuration, such as a helical configuration, where the cells that define the configuration have different physical properties than other cells in the expandable member. In some embodiments, the expandable member can have a braided configuration, where the twisted region can constitute the entire group of wires or a significant portion (e.g., half or more) of the braided wires. Such a twisted braided configuration can be accomplished during the braiding process, for example, by twisting the mandrel on which the wires are braided as it is pulled, particularly over the length of the largest diameter portion of the braided configuration. This configuration may be completed during a second operation in the construction process, such as mechanically twisting the braided configuration prior to heat setting the wrapped profile on the shaped mandrel.

[0109]

[0134] Any of the conduits herein may function, be configured, and be made of materials that create a fluid lumen therein between a first end (e.g., distal end) and a second end (e.g., proximal end). Fluid flows into the inflow region through the fluid lumen and out of the outflow region. Flow into the inflow region may be labeled with an "I" herein, and flow out at the outflow region may be labeled with an "O". Any of the conduits herein may be impermeable. Any of the conduits herein may alternatively be semi-permeable. Any of the conduits herein may be porous, but still define a fluid lumen therethrough. In some embodiments, the conduit is a membrane or other layered member that is relatively thin. Unless otherwise indicated, any of the conduits herein may be secured to an expandable member such that the conduit may be radially inside and / or outside the expandable member when secured. For example, the conduit may extend radially within the expandable member such that an inner surface of the conduit resides radially within the expandable member when secured to the expandable member.

[0110]

[0135] Any of the expandable members herein may be constructed of a variety of materials and in a variety of ways. For example, the expandable member may have a mesh-like configuration or may be formed by laser machining. The material may be deformable, such as Nitinol. The material may be deformable, such as Nitinol. The expandable member may be self-expanding or may be adapted to actively expand at least in part.

[0111]

[0136] In some embodiments, the expandable member is adapted to self-expand when released from within a containing tubular member, such as a delivery catheter, guide catheter, or access sheath. In some alternative embodiments, the expandable member is adapted to expand by active expansion, such as actuation of a pull rod to move at least one of the distal and proximal ends of the expandable member toward one another. In alternative embodiments, the deployed configuration may be influenced by the configuration of one or more expandable structures. In some embodiments, one or more expandable members may be deployed, at least in part, by the influence of blood flowing through the conduit. Any combination of the above expansion mechanisms may be used.

[0112]

[0137] The blood pump and fluid moving devices, systems, and methods herein may be used in and positioned at a variety of locations within the body, and although specific examples may be presented herein, it should be understood that the working portions may be positioned in areas within the body different than those specifically described herein.

[0113]

[0138] In any of the embodiments herein in which the medical device has multiple impellers, the device may be adapted to rotate the impellers at various speeds. FIG. 6A shows a medical device having a gear set 1340 coupled to both the inner drive member 1338 and the outer drive member 1336, which are operatively connected to the distal impeller 1334 and the proximal impeller 1332, respectively. The drive further includes a motor 1342 that initiates the rotation of the inner drive member 1338. The inner drive member 1338 extends through the outer drive member 1336. The motor 1332 is actuated to cause the two impellers to rotate at various speeds due to the underdrive and overdrive ratios. The gear set 1340 may be adapted to drive either the proximal or distal impeller faster than the other. Any of the devices herein can have any of the gear sets herein for driving the impeller at various speeds.

[0114]

[0139] Figure 6B shows a portion of an alternative embodiment of a dual impeller device (1350) that is also adapted to rotate different impellers at different speeds. A gear set 1356 is coupled to both the inner drive member 1351 and the outer drive member 1353, which are coupled to the distal impeller 1352 and the proximal impeller 1354, respectively. The device further has a motor as in Figure 6A. Figures 6A and 6B show how the gear sets can be adapted to drive the proximal impeller at a slower or faster speed than the distal impeller.

[0115]

[0140] 7 shows an example alternative embodiment of a fluid pump 1370 that can rotate the first and second impellers at various speeds. A first motor 1382 drives a cable 1376 that is coupled to the distal impeller 1372, while a second motor 1384 drives an outer drive member 1378 that is coupled to the proximal impeller 1374 (via a gear set 1380). The drive cable 1376 extends through the outer drive member 1378. The motors can be controlled and operated independently, and thus the speeds of the two impellers can be controlled separately. This system setup can be used with any of the systems herein having multiple impellers.

[0116]

[0141] In some embodiments, a common drive cable or drive shaft can initiate the rotation of two (or more) impellers, but the blade pitch (angle of rotational curvature) of the two impellers can be different, with the distal or proximal impeller having a steeper or less steeper angle than the other impeller. This can create a similar effect to having a gear set. FIG. 6C shows a portion of a medical device (1360) with a common drive cable 1366 coupled to a proximal impeller 1364 and a distal impeller 1362, which is further coupled to a motor (not shown). The proximal impeller herein can have a higher or lower pitch than the distal impeller herein. Any of the working parts (or distal parts) herein that include multiple impellers can be modified to have first and second impellers with different pitches.

[0117]

[0142] In any of the embodiments herein, the pump portion can have a compliant or semi-compliant (collectively referred to as compliant) exterior structure. In various embodiments, the compliant portion is flexible. In various embodiments, the compliant portion only partially deforms under pressure. For example, the central portion of the pump can be formed with a compliant exterior structure, such that it deforms in response to valve forces. In this way, the external force of the pump against the valve leaflets is reduced. This can help prevent damage to the valve at the location where the working portion crosses the valve.

[0118]

[0143] FIG. 8 illustrates an exemplary embodiment of a pump section having first, second, and third axially spaced apart impellers 152, each disposed within an expandable member 154. A conduit 155 may extend across the length of the pump section as described in various embodiments herein to help create and define a fluid lumen. However, in alternative embodiments, the first, second, and third impellers may be disposed within a single expandable member, as shown in FIG. 1. In FIG. 8, the fluid lumen extends from the distal end to the proximal end. Features of the distal and proximal ends are described elsewhere herein. The embodiment of FIG. 8 may have any other suitable features described herein, including methods of use.

[0119]

[0144] The embodiment of FIG. 8 is an example of an outer housing having at least one curve formed in the outer housing between the distal end of the proximal impeller and the proximal end of the distal impeller. , where a distal region of the housing distal to the bend is not axially aligned with a proximal region of the housing proximal to the bend along the axis. In this embodiment, there are two bends 150 and 151 formed in the housing, each of which is between two adjacent impellers.

[0120]

[0145] In a method of use, the curve formed in the housing can be positioned to span a valve, such as the aortic valve shown in Figure 8. In this positioning method, the middle and distal most impellers are positioned in the left ventricle and the proximal most impeller is positioned in the ascending aorta. Curve 151 is positioned just downstream of the aortic valve.

[0121]

[0146] A curve, such as curve 151 or 152, may be incorporated into any of the embodiments or designs herein. The curve may be at a preformed angle or may be adjustable in situ.

[0122]

[0147] In any of the embodiments herein, unless otherwise indicated, the outer housing can have a substantially uniform diameter throughout its length.

[0123]

[0148] In Figure 8, the pump is placed through the axillary artery, which is an exemplary method of accessing the aortic valve, allowing the patient to walk and become active without too much intrusion. Any of the devices herein may be placed through the axillary artery. However, it will be appreciated from the description herein that the pump may be introduced into position above and across the aortic arch in a variety of ways, including a femoral approach.

[0124]

[0149] One aspect of the present disclosure is an intravascular blood pump having a distal impeller axially spaced from a proximal impeller. In one embodiment, the distal impeller and the proximal impeller are separate from each other. For example, the distal impeller and the proximal impeller may be connected only by being separately attached to a common drive shaft. This is different from impellers having multiple blade rows. The distal impeller as used herein does not necessarily mean the most distal impeller of the pump, but may generally mean the impeller located distal to the proximal impeller, even if there are additional impellers located distal to the distal impeller. Similarly, the phrase proximal impeller as used herein does not necessarily mean the most proximal impeller of the pump, but may generally mean the impeller disposed proximally of the proximal impeller, even if there are additional impellers disposed proximally of the proximal impeller. Axial spacing (or any form of derivative thereof) refers to spacing over the length of the pump section, such as along the longitudinal axis of the pump section, even if there are curvatures in the pump section. In various embodiments, each of the proximal and distal impellers is disposed within a respective housing and configured to maintain a precise and constant tip clearance, with a fluid lumen having a relatively flexible (or fully flexible) span between the impellers. For example, each of the impellers may be disposed within a respective housing having an outer wall having a relatively high stiffness to resist radial folding. The section between the impellers may have a relatively high stiffness, and in some embodiments, this section is held open primarily by the fluid pressure therein.

[0125]

[0150] Although not required by the embodiments herein, there may be advantages to minimizing the axial spacing between the proximal and distal impellers. For example, the pump portion may be delivered to a target location through a portion of the anatomy having a relatively sharp curvature, such as the aorta, and even into the aortic valve. For example, the pump portion may be can be delivered to the aortic valve via femoral artery access. It can be advantageous to have a system that can be relatively easily curved to facilitate delivery of the system through curves in the anatomy. Some designs, where the impellers are very close to each other, allow the system to have a relatively high stiffness throughout the span of the length of the impellers. By spacing the impellers axially apart, and optionally providing areas of relatively high flexibility between the impellers, portions of the system can be made more flexible and easier to bend, and thus more easily and safely advanced through curves. An additional example advantage is that this axial spacing allows for areas of relatively high compliance between the impellers, which can be located, for example, at the location of the valve (e.g., the aortic valve). Additionally, there are other potential advantages and functional differences between the various embodiments of the present specification and typical multi-stage pumps. A typical multi-stage pump has functional closely spaced blade rows (sometimes referred to as impellers) such that the blade rows act together as synchronized stages. It will be recognized that flow may separate as it passes through the distal impeller. In various embodiments described herein, the distal and proximal impellers may be sufficiently separated such that flow separation from the distal impeller is significantly reduced (i.e., increased recombination of flows) and localized turbulence dissipates before the flow enters the proximal impeller.

[0126]

[0151] In any of the embodiments including a distal impeller and a proximal impeller or in any portion of the description herein, the axial spacing between the distal end of the proximal impeller and the proximal end of the distal impeller may be 1.5 cm to 25 cmm, inclusive, along the longitudinal axis of the pump portion or along the longitudinal axis of the housing portion having the fluid lumen. This distance may be measured when the pump portion having any impeller is in an expanded configuration. This exemplary range may provide flexibility benefits as described herein when the pump portion is delivered through the aorta, for example through curved portions of the anatomy such as the aortic valve. FIG. 9 (shown in an expanded configuration outside of the patient) illustrates the axial spacing between the impellers, which in some embodiments may be 1.5 cm to 25 cm, as described herein. In embodiments where there may be more than one impeller, any two adjacent impellers (i.e., impellers that do not have any other rotating impellers between them) may be axially separated by any of the axial spacing distances described herein.

[0127]

[0152] Although some embodiments have the distal end of the proximal impeller spaced axially from the proximal end of the distal impeller along the axis by 1.5 cm to 25 cm, the disclosure herein includes any subrange of axial spacing within this general range of 1.5 cm to 25 cm. That is, the disclosure includes all ranges within that range, including any lower limit equal to or greater than 1.5 cm, and all subranges, including any upper limit equal to or less than 25 cm. Exemplary subranges are shown in the following examples. In some embodiments, the distal end of the proximal impeller is spaced axially from the proximal end of the distal impeller along the axis by 1.5 cm to 20 cm, 1.5 cm to 15 cm, 1.5 cm to 10 cm, 1.5 cm to 7.5 cm, 1.5 cm to 6 cm, 1.5 cm to 4.5 cm, 1.5 cm to 3 cm. In some embodiments, the axial spacing is 2 cm to 20 cm, 2 cm to 15 cm, 2 cm to 12 cm, 2 cm to 10 cm, 2 cm to 7.5 cm, 2 cm to 6 cm, 2 cm to 4.5 cm, 2 cm to 3 cm. In some embodiments, the axial spacing is 2.5 cm to 15 cm, 2.5 cm to 12.5 cm, 2.5 cm to 10 cm, 2.5 cm to 7.5 cm, or 2.5 cm to 5 cm (e.g., 3 cm). In some embodiments, the axial spacing is 3 cm to 20 cm, 3 cm to 15 cm, 3 cm to 10 cm, 3 cm to 7.5 cm, 3 cm to 6 cm, or 3 cm to 5 cm. m to 4.5 cm. In some embodiments, the axial spacing is 4 cm to 20 cm, 4 cm to 15 cm, 4 cm to 10 cm, 4 cm to 7.5 cm, 4 cm to 6 cm, or 4 cm to 4.5 cm. In some embodiments, the axial spacing is 5 cm to 20 cm, 5 cm to 15 cm, 5 cm to 10 cm, 5 cm to 7.5 cm, or 5 cm to 6 cm. In some embodiments, the axial spacing is 6 cm to 20 cm, 6 cm to 15 cm, 6 cm to 10 cm, or 6 cm to 7.5 cm. In some embodiments, the axial spacing is 7 cm to 20 cm, 7 cm to 15 cm, or 7 cm to 10 cm. In some embodiments, the axial spacing is 8 cm to 20 cm, 8 cm to 15 cm, or 8 cm to 10 cm. In some embodiments, the axial spacing is 9 cm to 20 cm, 9 cm to 15 cm, or 9 cm to 10 cm. In various embodiments, the fluid lumens between the impellers are relatively unsupported.

[0128]

[0153] In any of the embodiments herein, one or more impellers may have a length measured in the axial direction between the distal end of the impeller and the proximal end of the impeller (referred to as "L" in FIG. 9, respectively). SD " and "L SP"), which is 0.5 cm to 10 cm, or any subrange thereof. The following examples provide exemplary subranges. In some embodiments, the impeller axial length is 0.5 cm to 7.5 cm, 0.5 cm to 5 cm, 0.5 cm to 4 cm, 0.5 cm to 3 cm, 0.5 cm to 2 cm, or 0.5 cm to 1.5 cm. In some embodiments, the impeller axial length is 0.8 cm to 7.5 cm, 0.8 cm to 5 cm, 0.8 cm to 4 cm, 0.8 cm to 3 cm, 0.8 cm to 2 cm, or 0.8 cm to 1.5 cm. In some embodiments, the impeller axial length is 1 cm to 7.5 cm, 1 cm to 5 cm, 1 cm to 4 cm, 1 cm to 3 cm, 1 cm to 2 cm, or 1 cm to 1.5 cm. In some embodiments, the axial length of the impeller is 1.2 cm to 7.5 cm, 1.2 cm to 5 cm, 1.2 cm to 4 cm, 1.2 cm to 3 cm, 1.2 cm to 2 cm, or 1.2 cm to 1.5 cm. In some embodiments, the axial length of the impeller is 1.5 cm to 7.5 cm, 1.5 cm to 5 cm, 1.5 cm to 4 cm, 1.5 cm to 3 cm, or 1.5 cm to 2 cm. In some embodiments, the axial length of the impeller is 2 cm to 7.5 cm, 2 cm to 5 cm, 2 cm to 4 cm, or 2 cm to 3 cm. In some embodiments, the axial length of the impeller is 3 cm to 7.5 cm, 3 cm to 5 cm, or 3 cm to 4 cm. In some embodiments, the axial length of the impeller is 4 cm to 7.5 cm, or 4 cm to 5 cm.

[0129]

[0154] In any of the embodiments herein, the fluid lumen has a length L P In some embodiments, the length of the fluid lumen can be from the distal end to the proximal end, denoted as L P For example, in some embodiments, the length L Pbut may be 4cm to 30cm, 4cm to 20cm, 4cm to 18cm, 4cm to 16cm, 4cm to 14cm, 4cm to 12cm, 4cm to 10cm, 4cm to 8cm, or 4cm to 6cm.

[0130]

[0155] In any of the embodiments herein, the housing is at least the location of the impellers (and, optionally, the location between the impellers), dimension D in FIG. P In some embodiments, the diameter of the deployed state may be denoted as D P may be from 0.3 cm to 1.5 cm, or any subrange therein. For example, D P may be 0.4 cm to 1.4 cm, 0.4 cm to 1.2 cm, 0.4 cm to 1.0 cm, 0.4 cm to 0.8 cm, or 0.4 cm to 0.6 cm. P But, 0.5cm to 1.4cm, 0.5cm to In some embodiments, D may be 1.2 cm, 0.5 cm to 1.0 cm, 0.5 cm to 0.8 cm, or 0.5 cm to 0.6 cm. P may be 0.6 cm to 1.4 cm, 0.6 cm to 1.2 cm, 0.6 cm to 1.0 cm, or 0.6 cm to 0.8 cm. P may be 0.7 cm to 1.4 cm, 0.7 cm to 1.2 cm, 0.7 cm to 1.0 cm, or 0.7 cm to 0.8 cm.

[0131]

[0156] In any of the embodiments herein, the impeller can have a deployed diameter, shown as dimension Di in Figure 9. In some embodiments, Di can be between 1 mm and 30 mm, or any subrange therein. For example, in some embodiments, Di can be between 1 mm and 15 mm, between 2 mm and 12 mm, between 2.5 mm and 10 mm, or between 3 mm and 8 mm.

[0132]

[0157] In any of the embodiments herein, a tip clearance exists between the outer diameter of the impeller and the inner diameter of the fluid lumen. In some embodiments, the tip clearance may be between 0.01 mm and 1 mm, such as between 0.05 mm and 0.8 mm, or such as between 0.1 mm and 0.5 mm.

[0133]

[0158] In any of the embodiments herein, at least one of a flow diffuser or stator is located along the catheter shaft between two or more impellers, which can help reduce vortexes in the fluid and improve the overall efficiency of the impellers as a group.

[0134]

[0159] In any of the embodiments herein, the structure at the fluid outlet of the expandable shroud basket or expandable member may be shaped to act as a flow diffuser, such as a stent-like strut at the attachment between the outer dimension of the catheter shaft and the outer dimension of the expandable member, and may be a blade shape with a twist oriented to change the direction of blood flow. In any of the embodiments herein, one or more portions of the catheter shaft downstream of the impeller may be flared to a larger diameter to change the angle of blood flow and slow the blood flow to a velocity closer to that of the natural aorta. Exemplary locations for the larger diameter downstream of the impeller are at or near the area where the expandable shroud basket is attached to the catheter shaft, and / or at the bearing housing adjacent to the impeller or on or adjacent to the internal motor.

[0135]

[0160] FIG. 10 is a side view of an exemplary embodiment and is used as an exemplary embodiment based on experimental findings made by the applicant. FIG. 10 illustrates an exemplary configuration of the fluid lumen in an expanded configuration, and exemplary proximal and distal impellers in an expanded configuration. Other aspects of the pump portion are not shown for clarity, but it is understood that other aspects and features may be included in the pump portion and the overall system generally (such as other features described herein). FIG. 10 shows a portion of the pump portion 2 including an expandable housing 4, a proximal impeller 6, and a distal impeller 8. The expandable housing 4 defines a fluid lumen (aspects of which are described in more detail herein) including a distal end 12 and a proximal end 10 in FIG. 10. Inflow I and outflow O are illustrated at the distal and proximal ends, respectively, which are described in more detail herein. Although a general profile of a fluid lumen is shown in FIG. 10, the expandable housing 4 may comprise one or more components, such as one or more expandable members (such as those described herein) and / or one or more conduits (such as those described herein). In some embodiments, the expandable housing 4 comprises an expandable scaffold and a deformable material (e.g., The expandable housing includes an expandable structure such as a membrane (e.g., see FIG. 5). In some embodiments, the expandable housing is formed from an expandable structure that is coated with an elastic polymer (e.g., polycarbonate urethane or polyurethane). The expandable structure may be scaffolded from NiTi, mesh, and others. The expandable housing defines a fluid lumen therethrough when in the expanded configuration.

[0136]

[0161] The configuration shown in FIG. 10 illustrates the fluid lumen configuration of the expandable housing when it is in the expanded configuration. In this example, the fluid lumen includes a generally constant diameter portion 14, a proximal region 16 having a flared configuration, and a distal region 18 having a flared configuration. In this context, the generally constant diameter portion may be referred to simply as a constant diameter portion herein, and unless indicated to the contrary, this is intended to imply the generally constant diameter portion described in more detail herein. The constant diameter portion 14 has a proximal end 19 and a distal end 17. The distal end 17 of the constant diameter region is also the proximal end of the distal flared region 18 in this example. The proximal end 19 of the constant diameter region is also the distal end of the proximal flared region 16.

[0137]

[0162] Portions of this disclosure describe unexpected experimental results related to the performance of portions of a pump when the position of the proximal impeller is varied relative to another aspect of the fluid lumen, which may be described, for example, as the position of a feature of the proximal impeller (e.g., proximal end, distal end, midpoint, length ratio, etc.) relative to the position of another feature of the fluid lumen (e.g., proximal end of a constant diameter portion, distal end of a flared region, proximal end of the fluid lumen, etc.).

[0138]

[0163] The results included in this disclosure are based on experiments in which the axial position of the impeller relative to the fluid lumen of a test apparatus was changed while maintaining the configuration of the fluid lumen and the position of the distal impeller. The configuration of the test apparatus can be used as a basis for the configuration of a portion of a pump portion, an example of which is shown in FIG. 10. FIGS. 11A-11E illustrate exemplary different positions of the proximal impeller 6 relative to the fluid lumen of an experimental apparatus, a portion of which can be used to mimic an expandable housing that includes a fluid lumen. The central region of the apparatus in FIGS. 11A-11E includes the embodiment of FIG. 10, and all aspects of and descriptions of FIG. 10 apply to FIGS. 11A-11E. For example, experiments were performed to characterize and understand how changes in the axial position of the impeller alter flow and pressure. Hemolysis was also monitored as the axial position was changed.

[0139]

[0164] Figure 11C illustrates what was taken as the nominal axial position of the proximal impeller. Figures 11B and 11A illustrate the incremental distal movement of the impeller relative to the fluid lumen and relative to the nominal impeller position shown in Figure 11C. Figures 11D and 11E illustrate the incremental proximal movement of the impeller relative to the fluid lumen and relative to the nominal impeller position shown in Figure 11C. The impeller is positioned most distally in Figure 11A and most proximally in Figure 11E.

[0140]

[0165] In this exemplary embodiment and exemplary experiment, the impeller was moved axially in 1 mm increments. For example, the impeller is 1 mm further proximally in FIG. 11D relative to FIG. 11C. In the nominal position shown in FIG. 1C, the midpoint 3 of the proximal impeller is axially aligned with the proximal end 19 of the generally constant diameter portion 14 of the fluid lumen. In this position, the distal half of the impeller is thus disposed within the constant diameter portion 14, and the proximal half of the impeller is disposed within the flared region 16.

[0141]

[0166] In some embodiments, the proximal impeller may have an axial length "AL" (measured in a proximal-distal direction, see FIG. 10) of 9 mm, with 4.5 mm of the impeller disposed within constant diameter portion 14 in the nominal position of FIG. 11C, and 4.5 mm of the impeller disposed within constant diameter portion 14 in the proximal position. In FIG. 11A, 6.5 mm of the impeller is disposed in the constant diameter portion 14 and 2.5 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11B, 5.5 mm of the impeller is disposed in the constant diameter portion 14 and 3.5 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11D, 5.5 mm of the impeller is disposed in the constant diameter portion 14 and 3.5 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11E, 2.5 mm of the impeller is disposed in the constant diameter portion 14 and 6.5 mm of the impeller is disposed in the flared proximal region 16.

[0142]

[0167] In some embodiments, the proximal impeller may have an axial length "AL" (measured in a proximal-distal direction, see FIG. 10) of 10 mm, with 5 mm of the impeller disposed in the constant diameter portion 14 and 5 mm of the impeller disposed in the proximal flared region 16 in the reference position of FIG. 11C. In FIG. 11A, 7 mm of the impeller is disposed in the constant diameter portion 14 and 3 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11B, 6 mm of the impeller is disposed in the constant diameter portion 14 and 4 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11D, 4 mm of the impeller is disposed in the constant diameter portion 14 and 6 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11E, 3 mm of the impeller is disposed within constant diameter portion 14 and 7 mm of the impeller is disposed within flared proximal region 16. In FIG.

[0143]

[0168] In some embodiments, the proximal impeller may have an axial length "AL" (measured in a proximal-distal direction, see FIG. 10) of 11 mm, with 5.5 mm of the impeller disposed in the constant diameter portion 14 and 5.5 mm of the impeller disposed in the proximal flared region 16 in the reference position of FIG. 11C. In FIG. 11A, 7.5 mm of the impeller is disposed in the constant diameter portion 14 and 3.5 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11B, 6.5 mm of the impeller is disposed in the constant diameter portion 14 and 4.5 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11D, 4.5 mm of the impeller is disposed in the constant diameter portion 14 and 6.5 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11E, 3.5 mm of the impeller is disposed within constant diameter portion 14 and 7.5 mm of the impeller is disposed within flared proximal region 16. In FIG.

[0144]

[0169] In some embodiments, the proximal impeller may have an axial length "AL" (measured in a proximal-distal direction, see FIG. 10) of 12 mm, with 6 mm of the impeller disposed in the constant diameter portion 14 and 6 mm of the impeller disposed in the proximal flared region 16 in the reference position of FIG. 11C. In FIG. 11A, 8 mm of the impeller is disposed in the constant diameter portion 14 and 4 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11B, 7 mm of the impeller is disposed in the constant diameter portion 14 and 5 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11D, 5 mm of the impeller is disposed in the constant diameter portion 14 and 7 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11E, 4 mm of the impeller is disposed within constant diameter portion 14 and 8 mm of the impeller is disposed within flared proximal region 16. In FIG.

[0145]

[0170] In some embodiments, the proximal impeller may have an axial length "AL" (measured in a proximal-distal direction, see FIG. 10) of 13 mm, with 6.5 mm of the impeller disposed in the constant diameter portion 14 and 6.5 mm of the impeller disposed in the proximal flared region 16 in the reference position of FIG. 11C. In FIG. 11A, 8.5 mm of the impeller is disposed in the constant diameter portion 14 and 4.5 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11B, 7.5 mm of the impeller is disposed in the constant diameter portion 14 and 5.5 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11D, 8.5 mm of the impeller is disposed in the constant diameter portion 14 and 4.5 mm of the impeller is disposed in the flared proximal region 16. 5.5 mm of the impeller is disposed in constant diameter portion 14 and 7.5 mm of the impeller is disposed in flared proximal region 16. In FIG. 11E , 4.5 mm of the impeller is disposed in constant diameter portion 14 and 8.5 mm of the impeller is disposed in flared proximal region 16.

[0146]

[0171] In some embodiments, the proximal impeller may have an axial length "AL" (measured in a proximal-distal direction, see FIG. 10) of 14 mm, with 7 mm of the impeller disposed in the constant diameter portion 14 and 7 mm of the impeller disposed in the proximal flared region 16 in the reference position of FIG. 11C. In FIG. 11A, 9 mm of the impeller is disposed in the constant diameter portion 14 and 5 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11B, 8 mm of the impeller is disposed in the constant diameter portion 14 and 6 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11D, 6 mm of the impeller is disposed in the constant diameter portion 14 and 8 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11E, 5 mm of the impeller is disposed within constant diameter portion 14 and 9 mm of the impeller is disposed within flared proximal region 16. In FIG.

[0147]

[0172] In some embodiments, the proximal impeller may have an axial length "AL" (measured in a proximal-distal direction, see FIG. 10) of 15 mm, with 7.5 mm of the impeller disposed in the constant diameter portion 14 and 7.5 mm of the impeller disposed in the proximal flared region 16 in the reference position of FIG. 11C. In FIG. 11A, 9.5 mm of the impeller is disposed in the constant diameter portion 14 and 5.5 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11B, 8.5 mm of the impeller is disposed in the constant diameter portion 14 and 6.5 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11D, 6.5 mm of the impeller is disposed in the constant diameter portion 14 and 8.5 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11E, 5.5 mm of the impeller is disposed within constant diameter portion 14 and 9.5 mm of the impeller is disposed within flared proximal region 16. In FIG.

[0148]

[0173] In some embodiments, the proximal impeller may have an axial length "AL" (measured in a proximal-distal direction, see FIG. 10) of 16 mm, with 8 mm of the impeller disposed in the constant diameter portion 14 and 8 mm of the impeller disposed in the proximal flared region 16 in the reference position of FIG. 11C. In FIG. 11A, 10 mm of the impeller is disposed in the constant diameter portion 14 and 6 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11B, 9 mm of the impeller is disposed in the constant diameter portion 14 and 7 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11D, 7 mm of the impeller is disposed in the constant diameter portion 14 and 9 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11E, 6 mm of the impeller is disposed within constant diameter portion 14 and 10 mm of the impeller is disposed within flared proximal region 16. In FIG.

[0149]

[0174] In some embodiments, the proximal impeller may have an axial length "AL" (measured in a proximal-distal direction, see FIG. 10) of 17 mm, with 8.5 mm of the impeller disposed in the constant diameter portion 14 and 8.5 mm of the impeller disposed in the proximal flared region 16 in the reference position of FIG. 11C. In FIG. 11A, 10.5 mm of the impeller is disposed in the constant diameter portion 14 and 6.5 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11B, 9.5 mm of the impeller is disposed in the constant diameter portion 14 and 7.5 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11D, 7.5 mm of the impeller is disposed in the constant diameter portion 14 and 9.5 mm of the impeller is disposed in the flared proximal region 16. In FIG. 11E, 6.5 mm of the impeller is disposed within constant diameter portion 14 and 10.5 mm of the impeller is disposed within flared proximal region 16. In FIG.

[0150]

[0175] The relative location of the proximal impeller position may also be described as a percentage of the impeller length rather than a length dimension. In FIG. 11A, 35% of the proximal impeller length is disposed proximal to the constant diameter portion 14 and 65% of the impeller length is disposed within the constant diameter portion 14. In FIG. 11B, 42% of the proximal impeller length is disposed proximal to the constant diameter portion 14 and 58% of the impeller length is disposed within the constant diameter portion 14. In FIG. 11C, 50% of the proximal impeller length is disposed proximal to the constant diameter portion 14 and 50% of the impeller length is disposed within the constant diameter portion 14. In FIG. 11D, 58% of the proximal impeller length is disposed proximal to the constant diameter portion 14 and 42% of the impeller length is disposed within the constant diameter portion 14. In FIG. 11E, 65% of the proximal impeller length is disposed proximal to constant diameter portion 14 and 35% of the impeller length is disposed within constant diameter portion 14. In FIG.

[0151]

[0176] In the experiment, the pump portion of the test apparatus was operated at a constant rotational speed of 30,500 RPM, and the flow rate was measured for different axial positions of the proximal impeller based on the constant rotational speed. A predicted flow rate is provided herein, which was extrapolated to 60 mm Hg for the reference position shown in FIG. 11C. The flow rate of the pump portion when the impeller was in the position of FIG. 11D was about 5% higher (e.g., 4.9% higher) than the flow rate of the reference position of FIG. 11C. The flow rate of the pump portion when the impeller was in the position of FIG. 11E was about 11% higher (e.g., 10.7% higher) than the flow rate of the reference position of FIG. 11C. The flow rate of the pump portion when the impeller was in the position of FIG. 11B was about 18% lower (e.g., 18.2% lower) than the flow rate of the reference position of FIG. 11C. The flow rate of the pump portion when the impeller was in the position of Figure 11A was about 41% less (eg, 41.2% less) than the flow rate in the reference position of Figure 11C. This information is also presented in the table below.

[0152]

[0177]

[0153] [Table 1]

[0154]

[0178] The magnitude of the difference in measured flow rate resulting from relatively small changes in axial positioning was unexpected and surprising. These unexpected results demonstrated that relatively small changes in axial position can dramatically change flow rate. Experimental results also demonstrated that for pump section designs in which the distal region of the proximal impeller is located within the generally constant diameter region of the fluid lumen and the proximal region is disposed proximal to the generally constant diameter region, there are positions or locations where the impeller may be placed that will result in a more favorable flow rate relative to other positions. Stated differently, there may be impellers that result in suboptimal flow rates and even flow rates that may prevent the pump section from achieving the desired operating parameters. However, there is a position or location where it can be located relative to a constant diameter portion.

[0155]

[0179] One aspect of the present disclosure is an intravascular blood pump including an impeller, optionally a proximal impeller, with a portion of the proximal impeller disposed within and a portion disposed outside the substantially constant diameter portion of the fluid lumen. The embodiment of FIG. 10 is an example of this aspect. As shown by the experimental results herein, there can be significant changes in flow by moving the proximal impeller relative to the fluid lumen, such as by changing the length of the impeller that extends proximally beyond the proximal end of the substantially constant diameter region of the fluid lumen. The data presented herein illustrates observed changes in pump portion performance based on exemplary testing and modeling. Although some exemplary relative positions herein illustrate some observed improvements in pump performance, it is contemplated that additional relative positions not specifically tested herein may provide benefits to pump performance, even if not specifically tested herein, and even if the improvements are not as dramatic as some other improvements herein. The following disclosure and ranges may therefore provide improved pump section performance relative to other impeller positions and are considered part of the disclosure herein. Although the claims presented herein include one or more aspects of the disclosure that are more closely related to experimental results, the disclosure is intended to include other quantitative or qualitative aspects that may not be specifically described in experimental results. For example, in some impeller designs, flow may be optimized or desirable when 20%-40% of the proximal impeller extends proximally beyond the proximal end of the constant diameter section.

[0156]

[0180] In some embodiments, at least 20% and up to 90% of the impeller (axial length) is disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impeller, optionally up to 80% of the impeller, optionally up to 75% of the impeller, optionally up to 70% of the impeller, optionally up to 65% of the impeller, optionally up to 60% of the impeller, optionally up to 55% of the impeller, optionally up to 50% of the impeller, optionally up to 45% of the impeller, optionally up to 40% of the impeller, optionally up to 35% of the impeller, optionally up to 30% of the impeller, optionally up to 25% of the impeller is disposed proximal to the proximal end of the constant diameter portion.

[0157]

[0181] In some embodiments, at least 25% and up to 90% of the impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers, optionally up to 65% of the impellers, optionally up to 60% of the impellers, optionally up to 55% of the impellers, optionally up to 50% of the impellers, optionally up to 45% of the impellers, optionally up to 40% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0158]

[0182] In some embodiments, at least 30% and up to 90% of the impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers, optionally up to 65% of the impellers, optionally up to 60% of the impellers, optionally up to 55% of the impellers, optionally up to 50% of the impellers, optionally up to 45% of the impellers, optionally up to 40% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0159]

[0183] In some embodiments, at least 35% and up to 90% of the impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers, optionally up to 6 ... Alternatively, up to 60% of the impellers, optionally up to 55% of the impellers, optionally up to 50% of the impellers, optionally up to 45% of the impellers, optionally up to 40% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0160]

[0184] In some embodiments, at least 40% and up to 90% of the impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers, optionally up to 65% of the impellers, optionally up to 60% of the impellers, optionally up to 55% of the impellers, optionally up to 50% of the impellers, optionally up to 45% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0161]

[0185] In some embodiments, at least 45% and up to 90% of the impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers, optionally up to 65% of the impellers, optionally up to 60% of the impellers, optionally up to 55% of the impellers, optionally up to 50% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0162]

[0186] In some embodiments, at least 50% and up to 90% of the impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers, optionally up to 65% of the impellers, optionally up to 60% of the impellers, optionally up to 55% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0163]

[0187] In some embodiments, at least 55% and up to 90% of the impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers, optionally up to 65% of the impellers, optionally up to 60% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0164]

[0188] In some embodiments, at least 60% and up to 90% of the impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers, optionally up to 65% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0165]

[0189] In some embodiments, at least 65% and up to 90% of the impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers, optionally up to 70% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0166]

[0190] In some embodiments, at least 70% and up to 90% of the impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers, optionally up to 80% of the impellers, optionally up to 75% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0167]

[0191] In some embodiments, at least 75% of the impeller (measured axially) % and up to 90% of the impellers are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers, optionally up to 80% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0168]

[0192] In some embodiments, at least 80% and up to 90% of the impellers (measured axially) are disposed proximal to the proximal end of the constant diameter portion, optionally up to 85% of the impellers are disposed proximal to the proximal end of the constant diameter portion.

[0169]

[0193] While Figure 10 illustrates a portion of an exemplary portion taken from the test fixture of Figure 11C, it is understood that the present disclosure also includes a pump portion generally shown in Figure 10 but including a proximal impeller having the relative position shown in Figures 11D and 11E. The present disclosure thus implicitly and essentially includes a pump portion including all of the features of Figure 10 but modified as shown in Figures 11A, 11B, 11D, and 11E, even if these figures are not explicitly provided herein.

[0170]

[0194] Some pump sections herein may have a proximal impeller that extends proximally beyond the proximal end of the fluid lumen. For example, the proximal impeller shown in Figures 11D and 11E extends proximally beyond the proximal end of the fluid lumen when incorporated into a pump section such as that shown in Figure 10.

[0171]

[0195] Some of the fluid lumens herein have one or more end regions with one or more surfaces that act as a fluid diffuser. For example, the flared proximal region 16 of FIG. 10 is an example of a proximal end region with one or more surfaces that act as a fluid diffuser due to turbulent flow. Any of the disclosures herein related to axial impeller position relative to the fluid lumen may apply to fluid lumens herein having one or more end regions with one or more surfaces that act as a fluid diffuser.

[0172]

[0196] Some of the fluid lumens herein have one or more end regions with a flared configuration. For example, proximal region 16 of FIG. 10 is an example of a proximal fluid lumen region with a flared configuration. Any of the disclosures herein related to axial impeller position relative to the fluid lumen may apply to fluid lumens herein having a proximal region with a flared configuration. As used herein, a flared configuration generally refers to a configuration that extends progressively further radially outward. A flared configuration may, but does not necessarily, require a configuration that extends continuously further radially outward along the entire axial length of the flared region. FIG. 10 is an example of a continuous flared configuration. Other configurations are possible where only a portion of the proximal region has a continuous flare and other portions of the proximal region do not include a continuous flare. For example, the proximal region may include a stepped configuration with one or more continuous flared regions.

[0173]

[0197] In some embodiments, the flared configuration may be described in terms of the radial dimension per change in axial length (as compared to the radial dimension of a region of approximately constant diameter). In any of the embodiments herein, the flared configuration may have a mean or average change in radius per change in axial length that is 5-100%, such as 10-75%, such as 15-50%, or such as 20-30%.

[0174]

[0198] In any of the embodiments herein, the outlet may have an asymmetric shape, e.g., a donut shape, to promote centrifugal flow. The flared outlet need not have a smooth surface. For example, the outlet wall may have an edge or a sharp curve. The outlet wall may be non-planar (e.g., a dimpled surface).

[0175]

[0199] One aspect of the exemplary embodiment shown in FIG. 10 (which is a modification of FIG. 10 and includes any pump portion including the relative impeller positions shown in FIGS. 11A, 11B, 11D, and 11E) is that the illustrated impeller and fluid lumen configurations described (including the proximal end configuration of the fluid lumen) provide a change in flow rate when the position of the impeller is changed. One exemplary aspect of incorporating the impeller and fluid lumen configurations shown in FIG. 10 and FIGS. 11A-11E is that when the proximal impeller is moved at least 2 mm proximally relative to an initial position and the proximal impeller is moved such that less (but not all) of the proximal impeller is disposed within the substantially constant diameter portion of the fluid lumen, the flow rate of the pump portion increases by at least 10% at 60 mm Hg. The initial position may be a position where the midpoint of the impeller is axially aligned with the proximal end of the substantially constant diameter portion. Another exemplary aspect of incorporating the impeller and fluid lumen configurations shown in Figures 10 and 11A-11E is that when the proximal impeller is moved at least 2 mm distally relative to an initial position and the proximal impeller is moved such that it is disposed more (but not all) of the substantially constant diameter portion of the fluid lumen, the flow rate of the pump portion is reduced by at least 40% at 60 mm Hg. Again, the initial position may be where the midpoint of the impeller is axially aligned with the proximal end of the substantially constant diameter portion.

[0176]

[0200] One aspect of the disclosure is an intravascular blood pump having a foldable housing with a fluid lumen, the fluid lumen having a distal end and a proximal end. The blood pump also includes a foldable distal impeller axially spaced from the foldable proximal impeller, the distal impeller having an enlarged configuration, and the proximal impeller having an enlarged configuration. At least a portion of the proximal and proximal impellers are disposed between the distal and proximal ends of the fluid lumen. The embodiments of Figures 10 and 11A-11E are examples of this aspect. In the exemplary embodiment of Figures 11D and 11E, the proximal impeller is configured to generate 50% or more of the pressure generated by the blood pump, and the distal impeller is configured to generate less than 50% of the pressure generated by the blood pump. This may alternatively be stated as the proximal impeller being configured to perform 50% or more of the work of the blood pump, and the distal impeller being configured to perform less than 50% of the work of the blood pump. In this context, work is a function of pressure and volume. Since the flow rate (volume of fluid per unit time) through the pump is generally the same for both impellers, each impeller may be configured to have a different contribution to the pressure generated by the pump, which may vary by design.

[0177]

[0201] In the embodiment of FIG. 10, the blood pump does not include a vane assembly, stator vanes, or any other flow-modifying structure axially between the proximal and distal impellers.

[0202] In some embodiments, the proximal impeller generates 55% or more of the pressure generated by the blood pump and the distal impeller generates less than 45% of the pressure generated by the blood pump. In some embodiments, the proximal impeller generates 60% or more of the blood pump pressure and the distal impeller generates less than 40% of the blood pump pressure. In some embodiments, the proximal impeller generates 70% or more of the blood pump pressure and the distal impeller generates less than 30% of the blood pump pressure. In some embodiments, the proximal impeller generates about 80% of the blood pump pressure and the distal impeller generates about 20% of the blood pump pressure.

[0178]

[0203] For any of the disclosures herein that refer to distal and proximal impellers generating a particular percentage of the pressure generated by the pump, pressure measurements can be taken at a location distal to the distal impeller, at a location axially between the impellers, and at a location proximal to the proximal impeller such that the pressure differential for each impeller can be calculated.

[0179]

[0204] One aspect of the present disclosure is a method for intravascularly pumping blood within a subject, the method including inserting a first end of a fluid lumen housing a pump into a first anatomical region, such as the left ventricle. positioning a distal impeller of the blood pump in a first anatomical region (such as the left ventricle), positioning a proximal impeller of the blood pump in a second anatomical location (such as the ascending aorta), positioning a second end of a fluid lumen housing the pump in the second anatomical location (such as the ascending aorta), positioning at least a portion of a central region of the fluid lumen to span an anatomical location (such as the aortic valve), and creating a flow path between the first end of the fluid lumen disposed in the first anatomical location (e.g., the left ventricle) and the second end of the fluid lumen disposed in the second anatomical location (e.g., the ascending aorta) such that the distal impeller and the proximal impeller can pump blood through the fluid lumens. The method may include rotating the distal and proximal impellers, thereby pumping blood, resulting in the proximal impeller generating 50% or more of the pressure generated by the blood pump, and the distal impeller generating less than 50% of the pressure generated by the blood pump. The method may include that the distal and proximal impellers generate any amount of pressure as described herein. Any other suitable method steps may be included in the method aspects, unless specifically indicated to the contrary. The method may alternatively be stated as each impeller performing more or less than a certain percentage of the action of the blood pump, rather than each impeller generating more or less than a certain percentage of the pressure generated by the pump.

[0180]

[0205] It has been found that distributing the load across two impellers (as described herein) can result in higher pump efficiency, lower pump speeds, and therefore reduced hemolysis, compared to single impeller designs.

[0181]

[0206] In Figures 10A and 11A-E, the proximal region of the impeller disposed outside the generally constant diameter region of the fluid lumen may be referred to as the proximal impeller region disposed proximal to the proximal end of the generally constant diameter region, regardless of the particular configuration of the fluid lumen proximal to the constant diameter region. In Figures 10 and 11A-E, a portion of the proximal impeller is disposed within the generally constant diameter portion.

[0182]

[0207] The test device shown in Figures 11A-11E includes proximal and distal regions that are not included in the exemplary fluid lumen in the embodiment of Figure 10. Although those expanded portions are not included in the exemplary fluid lumen in Figure 10, those regions approximate one or more anatomical regions in which the pump portions are located, in some circumstances. The term approximate, in this context, refers to having some characteristics of an anatomical location, even though the actual anatomical features differ in one or more, and possibly many, respects. For example, the expanded proximal regions in Figures 11A-E may resemble in some sense one or more aspects of the ascending aorta, even though the ascending aorta differs in some respects.

[0183]

[0208] The disclosure herein includes some embodiments of pump portions that are described as having fluid lumens with substantially constant diameter portions. For example, the embodiment of FIG. 10 has a substantially constant diameter portion 14. The term substantially constant may include some variation in diameter. For example, some expandable housings herein include a reinforcing structure (which may be referred to as an expandable member) and a conduit, such as a membrane material, secured to the reinforcing structure. The manner in which these two components may be secured together or assembled may cause some small variations in diameter. For example, if a membrane material is applied to the inner and / or outer surface of a reinforcing member (e.g., one or more stent-like devices), there may be slight variations in diameter between where the membrane material is disposed on the outer or inner surface of the reinforcing member and where immediately adjacent to those secured locations where no reinforcing member is present. Those differences may be of small orders of magnitude (e.g., millimeters or microns), but even if they are larger, those types of variations are intended to fall within the generic term substantially constant. An alternative way of interpreting the term "constant" is that the design of the fluid lumen in that region is intended to have as close to a constant diameter as possible, even if certain design or manufacturing constraints cause it to have some variation. Yet another alternative way of interpreting "approximately constant" is to ask whether the region of the fluid lumen is intended to have a variable diameter in that region, from a design and functional standpoint. If it is intended to have a variable diameter and the variable diameter provides a specific function, it may be outside the scope of the approximately constant diameter portion. Those skilled in the art will understand from the description herein that the approximately constant diameter portion does not have to be formed as a tube, but may take a variety of forms and shapes. As used herein, the approximately constant diameter portion may refer to a main section of the fluid lumen. In certain embodiments, this section has an approximately constant diameter to reduce flow turbulence along the inner wall of the lumen and / or to reduce the risk of trauma to external anatomical structures (e.g., aortic valve leaflets). However, this section may take other forms depending on the application. For example, the portion may have dimples, curved surfaces, and the like to modify the flow therethrough as desired. In certain embodiments, the substantially constant diameter portion may simply refer to the main portion of the fluid lumen as distinguished from the inlet and outlet portions.

[0184]

[0209] Any of the other disclosures herein may be incorporated into the embodiment of Figure 10 unless specifically indicated to the contrary. For example, any of the suitable expandable structures may be incorporated into the embodiment of Figure 10.

Claims

1. 1. An intravascular blood pump comprising: an expandable housing (4) defining a fluid lumen, the fluid lumen having a generally constant diameter portion (14), a proximal region (16) having a flared configuration, and a distal region (18) having a flared configuration; a proximal impeller (6) disposed in a proximal portion of the fluid lumen, a portion of the proximal impeller being disposed in the substantially constant diameter portion (14) and a portion of the proximal impeller being disposed in the proximal region (16) proximal of the substantially constant diameter portion (14); The portion of the proximal impeller (6) disposed in the proximal region (16) is between 20% and 40% of the proximal impeller measured along an axial length (AL) of the proximal impeller.

2. 2. The blood pump of claim 1, wherein the expandable housing (4) comprises an expandable scaffold and a membrane fixed to the scaffold.

3. 3. The blood pump of claim 1 or 2, further comprising an inflow (I) at a distal end (12) of the fluid lumen.

4. The blood pump according to any one of claims 1 to 3, further comprising an outflow (O) portion at a proximal end of the fluid lumen.

5. The blood pump of any one of claims 1 to 4, further comprising an expandable distal impeller (8) disposed in the fluid lumen distal to the proximal impeller (6).

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