Systems and methods for force reduction in delivery systems - Patents.com

Abstract

Examples of the present disclosure may be directed to reducing tensile or compressive forces within one or more shafts of a delivery system. A long catheter may include one or more shafts. The tensile or compressive forces may result from residual tension or compression within the shaft due to movement of the shaft. Alternatively or in combination, the tensile or compressive forces may result from interaction forces across multiple shafts. The tensile or compressive forces may impede operation of the delivery system and, in instances, may damage the delivery system. Systems, devices, and methods for reducing tensile or compressive forces are disclosed herein.

Description

[Technical field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims priority to U.S. Provisional Application No. 63 / 308,137, filed February 9, 2022, the entire contents of which are incorporated herein by reference.

[0002] background Certain examples disclosed herein relate generally to prostheses for implantation inside a lumen or body cavity, and to delivery systems for the prostheses. In particular, the prostheses and delivery systems relate in some examples to replacement heart valves, such as replacement mitral valves or replacement tricuspid valves. [Background technology]

[0003] Human heart valves, including the aortic, pulmonary, mitral, and tricuspid valves, essentially function as one-way valves that operate in sync with the heart's beat. The valves allow blood to flow downstream but prevent blood from flowing upstream. Diseased heart valves exhibit disorders such as valve stenosis or regurgitation, impeding the valve's ability to control blood flow. Such disorders reduce the heart's blood-pumping efficiency and can lead to debilitating and life-threatening conditions. For example, valve malfunction can result in symptoms such as cardiac hypertrophy and ventricular dilation. Thus, there have been considerable efforts to develop methods and devices for repairing or replacing malfunctioning heart valves.

[0004] Prosthetic valves exist to correct problems associated with dysfunctional heart valves. For example, mechanical tissue-based prosthetic heart valves can be used to replace dysfunctional native heart valves. Recently, there has been a great deal of effort in developing replacement heart valves, particularly tissue-based replacement heart valves that can be delivered less traumatically to the patient compared to open-heart surgery. Replacement valves are designed to be delivered by minimally invasive procedures, and even percutaneous procedures. Such replacement valves often include a tissue-based valve body that is connected to an expandable frame and then delivered to the native valve annulus.

[0005] The development of prosthetic valves, including but not limited to replacement heart valves that can be miniaturized for delivery and then controllably expanded for controlled deployment, has proven particularly challenging. An additional challenge relates to the ability to secure such prosthetic valves to endoluminal tissue, such as tissue within any lumen or cavity of the body, in an atraumatous manner.

[0006] Delivering a prosthetic valve to a desired location within the human body can also be difficult, such as delivering a replacement heart valve to the mitral valve. To achieve access to perform procedures within the heart or other anatomical locations, it may be necessary to deliver the device percutaneously through a tortuous vascular system or by open or semi-open surgical procedures. The ability to control the deployment of the prosthetic valve to the desired location can also be difficult. [Prior art documents] [Patent documents]

[0007] [Patent Document 1] US Patent Application Publication No. 2015 / 0238315 [Patent Document 2] U.S. Pat. No. 8,403,983 [Patent Document 3] U.S. Pat. No. 8,414,644 [Patent Document 4] U.S. Pat. No. 8,652,203 [Patent Document 5] US Patent Application Publication No. 2011 / 0313515 [Patent Document 6] US Patent Application Publication No. 2012 / 0215303 [Patent Document 7] US Patent Application Publication No. 2014 / 0277390 [Patent Document 8] US Patent Application Publication No. 2014 / 0277422 [Patent Document 9] US Patent Application Publication No. 2014 / 0277427 [Patent Document 10] US Patent Application Publication No. 2018 / 0021129 [Patent Document 11] US Patent Application Publication No. 2018 / 0055629 [Patent Document 12] US Patent Application Publication No. 2019 / 0262129 [Patent Document 13] US Patent Application Publication No. 2015 / 0328000 [Patent Document 14] US Patent Application Publication No. 2016 / 0317301 [Patent Document 15] US Patent Application Publication No. 2019 / 0008640 [Patent Document 16] US Patent Application Publication No. 2019 / 0008639 [Patent Document 17] US Patent Application Publication No. 2020 / 0108225 Summary of the Invention

[0008] Examples of the present disclosure are directed to delivery systems, such as, but not limited to, delivery systems for implants. Implants may include prosthetic valves, such as, but not limited to, replacement heart valves. Further examples are directed to methods of use for delivering and / or controllably deploying implants, such as, but not limited to, replacement heart valves, to desired locations within the body. In some examples, replacement heart valves are provided, as well as methods of delivering replacement heart valves to native heart valves, such as mitral or aortic or tricuspid valves.

[0009] Embodiments of the present disclosure may be directed to reducing tensile or compressive forces within one or more shafts of a delivery system. The elongate catheter may include one or more shafts. The tensile or compressive forces may be due to residual tension or compression within the shaft due to movement of the shaft. Alternatively or in combination, the tensile or compressive forces may be due to interaction forces across multiple shafts. The tensile or compressive forces may impede operation of the delivery system and, in instances, may damage the delivery system. In some cases, reducing the tensile or compressive forces may be desired.

[0010] The reduction in tension or compression may be automatic. A force reduction mechanism may be utilized to automatically reduce tension or compression forces in at least one of the one or more shafts. A force reduction mechanism may be utilized to reduce tension or compression forces in the shafts by allowing the shafts to be slidably driven proximally or distally.

[0011] In examples, the force reduction mechanism may automatically create a "backdrive" or "backoff" of the shaft. For example, a shaft may be driven proximally to create a tensile force in the shaft. The force reduction mechanism may allow the shaft to be automatically driven distally to reduce the tensile force present in the shaft due to the proximal drive. Similarly, a shaft may be driven distally to create a compressive force in the shaft. The force reduction mechanism may allow the shaft to be automatically driven proximally to reduce the compressive force present in the shaft. Various examples of force reduction and force reduction mechanisms are disclosed herein.

[0012] In examples, a dynamic adapter assembly may be provided that may be configured to reduce the force in the shaft. An indicator may be provided that may be configured to indicate that too much force is being applied on the shaft, or that the adapter is overloaded. The force reduction mechanism may be disclosed as being a mechanical device. The mechanical device may be non-powered. The force reduction mechanism may be electrical in examples and may include an electric driver.

[0013] The force reduction mechanism may include a fail-safe mechanism that may reduce the possibility of damage or failure to the shaft of the delivery system.

[0014] In an example, a delivery system for an implant is provided. The delivery system may include an elongate catheter including an implant holding region for holding the implant, the elongate catheter including one or more shafts. The delivery system may include a control mechanism for driving the one or more shafts. The delivery system may include a force reduction mechanism for automatically reducing a tensile or compressive force in at least one of the one or more shafts upon receiving a corresponding threshold tensile or compressive force, respectively, in at least one of the one or more shafts.

[0015] In an example, a delivery system for an implant is provided. The delivery system may include an elongate catheter including an implant holding region for holding the implant, the elongate catheter including one or more shafts. The delivery system may include a control mechanism for driving the one or more shafts. The delivery system may include an indicator for indicating a tensile or compressive force within at least one of the one or more shafts.

[0016] In an example, a method is provided that may include deploying an implant into a patient's body by utilizing a delivery system that may include an elongate catheter including an implant retaining region that retains the implant, the elongate catheter including one or more shafts, a control mechanism for driving the one or more shafts, and a force reduction mechanism configured to automatically reduce tensile or compressive forces within at least one of the one or more shafts.

[0017] In an example, a method is provided that may include deploying an implant into a patient's body by utilizing a delivery system that may include an elongate catheter including one or more shafts, the elongate catheter including an implant holding region for holding the implant, a control mechanism for actuating the one or more shafts, and an indicator that indicates a tensile or compressive force within at least one of the one or more shafts.

[0018] In an example, a delivery system for an implant is provided. The delivery system may include an elongate catheter including an implant holding region for holding the implant, the elongate catheter including one or more shafts. The delivery system may include a control mechanism for actuating the one or more shafts, the actuator knob having a first portion and a second portion configured to be rotationally actuated relative to the first portion to automatically limit a tensile or compressive force transmitted by the actuator knob to at least one of the one or more shafts within at least one of the one or more shafts.

[0019] In an example, a method is provided. The method may include deploying an implant into a patient's body by utilizing a delivery system. The delivery system may include an elongate catheter including an implant holding region for holding the implant, the elongate catheter including one or more shafts, and a control mechanism for actuating the one or more shafts, the actuator knob having a first portion and a second portion configured to be rotationally actuated relative to the first portion to automatically limit a tensile or compressive force transmitted by the actuator knob to at least one of the one or more shafts within at least one of the one or more shafts.

[0020] In an example, a delivery system for an implant is provided. The delivery system may include an elongate catheter including an implant holding region for holding the implant, the elongate catheter including at least one shaft. The delivery system may include an actuator knob located on the handle, the actuator knob engaged with the at least one shaft, for driving the at least one shaft forward or backward. The delivery system may include a force reduction mechanism for reducing a pulling force in the at least one shaft by allowing the at least one shaft to disengage from the actuator knob. The force reduction mechanism may disengage the at least one shaft from the actuator knob when a threshold pulling force is reached, allowing the at least one shaft to be driven to slide longitudinally relative to the actuator knob. The force reduction mechanism may reduce damage to the at least one shaft. [Brief description of the drawings]

[0021] [Figure 1] FIG. 1 shows an example of a delivery system for an implant (such as a dual-frame prosthetic heart valve). [Figure 2A] FIG. 2A shows a perspective view of the frames in a dual-frame prosthetic valve that may be delivered using the delivery system described herein. [Figure 2B] FIG. 2B shows a perspective view of the inner frame of the dual-frame prosthetic valve of FIG. 2A. [Figure 2C] FIG. 2C shows a perspective view of the outer frame of the dual-frame prosthetic valve of FIG. 2A. [Figure 2D] FIG. 2D shows a perspective view of the dual-frame prosthetic valve in a fully assembled state, including the skirt assembly and pads. [Figure 3A] FIG. 3A shows a perspective view of an example outer sheath subassembly of the delivery device of the delivery system of FIG. [Figure 3B]FIG. 3B illustrates a cross-sectional side view of the capsule sub-assembly of the outer sheath sub-assembly of FIG. 3A. [Figure 3C] FIG. 3C shows a perspective view of the capsule stent or distal hypotube of the outer sheath subassembly of FIG. 3A. [Figure 3D] FIG. 3D illustrates generally an embodiment in which a portion of the liner extending along the length of the outer sheath subassembly may have built-in slack to facilitate flex bending of the outer sheath subassembly. [Figure 4A] 4A shows a perspective view of a rail subassembly in the delivery device of the delivery system of FIG. 1. FIG. [Figure 4B] FIG. 4B shows a cross-sectional side view of the rail subassembly of FIG. 4A. [Figure 4C] FIG. 4C illustrates generally an embodiment in which the outer compression coils and tension wires may have a longer length as compared to the inner compression coils and tension wires of the rail subassembly. [Figure 5A] 5A shows a perspective view of a midshaft subassembly of the delivery device of the delivery system of FIG. 1. FIG. [Figure 5B] FIG. 5B illustrates a side cross-sectional view of the midshaft subassembly of FIG. 5A. [Figure 6A] 6A shows a perspective view of a release subassembly of the delivery device of the delivery system of FIG. [Figure 6B] FIG. 6B shows a cross-sectional side view of the release subassembly of FIG. 6A. [Figure 6C] FIG. 6C shows an enlarged side view of the distal end portion of the release subassembly. [Figure 6D] FIG. 6D shows a cross-sectional side view of the distal end portion of the release subassembly. [Figure 6E] FIG. 6E shows a bottom view of the distal end of the release subassembly. [Figure 7A]7A shows a perspective view of a manifold subassembly in a delivery device of the delivery system of FIG. 1. FIG. [Figure 7B] FIG. 7B illustrates a cross-sectional side view of the manifold subassembly of FIG. 7A. [Figure 7C] FIG. 7C shows an enlarged view of the distal end portion of the manifold subassembly. [Figure 7D] FIG. 7D shows a bottom view of the distal end portion of the manifold subassembly. [Figure 7E] FIG. 7E shows the flat cut pattern on the distal end portion of the manifold subassembly. [Figure 8A] FIG. 8A shows the distal end portions of the release subassembly and the manifold subassembly in locked and unlocked configurations, respectively. [Figure 8B] FIG. 8B shows the distal end portions of the release subassembly and the manifold subassembly in locked and unlocked configurations, respectively. [Figure 8C] FIG. 8C illustrates an embodiment in which the release subassembly and the manifold subassembly are used to lock and unlock the suture. [Figure 8D] FIG. 8D shows the suture loops locked to the eyelets of the prosthetic valve, while also being locked to the manifold subassembly of the delivery device. [Figure 9A] 9A shows a perspective view of the handle of the delivery device of FIG. [Figure 9B] FIG. 9B shows a side cross-sectional view of the handle of the delivery device. [Figure 10A] FIG. 10A illustrates how a handle of a delivery device cooperates with an example stabilization assembly in the delivery system of FIG. [Figure 10B] FIG. 10B shows a perspective view of the stabilization assembly without a delivery device attached. [Figure 10C]FIG. 10C shows a top view of the stabilization assembly of FIG. 10A. [Figure 11] FIG. 11 shows a schematic diagram of the transfemoral and transseptal delivery approaches. [Figure 12] FIG. 12 shows a schematic diagram of a prosthetic valve placed inside a native mitral valve (with the skirt assembly omitted for ease of visualization of its interaction with the native heart valve structure). [Figure 13A] FIG. 13A illustrates the various steps of deploying and recapturing a prosthetic valve using a delivery device described herein. [Figure 13B] FIG. 13B illustrates the various steps of deploying and recapturing a prosthetic valve using a delivery device described herein. [Figure 13C] FIG. 13C illustrates the various steps of deploying and recapturing a prosthetic valve using a delivery device described herein. [Figure 13D] FIG. 13D illustrates the various steps of deploying and recapturing a prosthetic valve using a delivery device described herein. [Figure 13E] FIG. 13E illustrates the various steps of deploying and recapturing a prosthetic valve using a delivery device described herein. [Figure 13F] FIG. 13F illustrates the various steps of deploying and recapturing a prosthetic valve using a delivery device described herein. [Figure 14] FIG. 14 shows a perspective view of the handle of the delivery device. [Figure 15] FIG. 15 shows a cross-sectional view of the handle of the delivery device shown in FIG. 14 along line AA. [Figure 16] FIG. 16 shows a top view of the handle of the delivery device shown in FIG. [Figure 17] FIG. 17 shows a perspective view of a distal portion of the handle of the delivery device. [Figure 18]FIG. 18 shows a perspective cross-sectional view of the distal portion of the handle of the delivery device shown in FIG. 17 along line BB. [Figure 19] FIG. 19 shows a side cross-sectional view of the distal portion of the handle of the delivery device shown in FIG. 17 along line BB. [Figure 20] FIG. 20 shows a perspective view of the handle of the delivery device. [Figure 21] FIG. 21 shows a cross-sectional view of the handle of the delivery device shown in FIG. 20 along line CC. [Figure 22] FIG. 22 shows a cross-sectional view of the handle of the delivery device. [Diagram 23] FIG. 23 shows a cross-sectional view of the handle of the delivery device shown in FIG. [Figure 24] FIG. 24 shows a perspective view of the handle of the delivery device. [Diagram 25] FIG. 25 shows a cross-sectional view of the handle of the delivery device. [Figure 26] FIG. 26 shows a cross-sectional view of the handle of the delivery device shown in FIG. [Figure 27] FIG. 27 shows a cross-sectional view of the handle of the delivery device. [Figure 28] FIG. 28 shows a cross-sectional view of the handle of the delivery device shown in FIG. [Figure 29] FIG. 29 shows a cross-sectional view of the handle of the delivery device. [Diagram 30] FIG. 30 shows a cross-sectional view of the handle of the delivery device shown in FIG. [Diagram 31] FIG. 31 shows a cross-sectional view of the handle of the delivery device. [Diagram 32] FIG. 32 shows a cross-sectional view of the handle of the delivery device shown in FIG. [Diagram 33] FIG. 33 shows a cross-sectional view of the handle of the delivery device. [Diagram 34]FIG. 34 shows a cross-sectional view of the handle of the delivery device. [Diagram 35] FIG. 35 shows a side view of the handle of the delivery device. [Diagram 36] FIG. 36 shows a perspective view of the adapter. [Figure 37] FIG. 37 shows a cross-sectional view of the handle of the delivery device. [Figure 38] FIG. 38 shows a perspective cross-sectional view of the handle of the delivery device. [Figure 39] FIG. 39 shows a perspective cross-sectional view of a portion of the handle of the delivery device. [Diagram 40] 40 shows a cross-sectional end view of a portion of the handle of the delivery device shown in FIG. [Diagram 41] FIG. 41 shows a perspective cross-sectional view of a portion of the handle of a delivery device. [Diagram 42] 42 shows a cross-sectional end view of a portion of the handle of the delivery device shown in FIG. [Diagram 43] FIG. 43 illustrates a perspective view of the actuator knob. [Diagram 44] FIG. 44 illustrates a side view of the inner portion of the actuator knob shown in FIG. [Diagram 45] FIG. 45 illustrates a side cross-sectional view of the outer portion of the actuator knob shown in FIG. [Figure 46] FIG. 46 illustrates a side cross-sectional view of the actuator knob shown in FIG. [Figure 47] FIG. 47 illustrates a side cross-sectional view of the actuator knob shown in FIG. 43 when placed on a handle. [Figure 48] FIG. 48 illustrates a perspective view of the actuator knob. [Figure 49] FIG. 49 illustrates a perspective view of the inner portion of the actuator knob shown in FIG. [Figure 50]FIG. 50 illustrates a perspective view of the outer portion of the actuator knob shown in FIG. [Figure 51] FIG. 51 illustrates a side cross-sectional view of the actuator knob shown in FIG. [Figure 52] 52 illustrates a cross-sectional view of the actuator knob shown in FIG. 48, taken perpendicular to the view shown in FIG. [Figure 53] FIG. 53 illustrates a perspective view of the actuator knob. [Figure 54] FIG. 54 illustrates a side cross-sectional view of the actuator knob shown in FIG. [Figure 55] FIG. 55 is a perspective view of the actuator knob shown in FIG. 53, showing the outer portion as transparent. [Figure 56] FIG. 56 illustrates a cross-sectional view of the actuator knob shown in FIG. [Figure 57] FIG. 57 illustrates a perspective view of the actuator knob. [Figure 58] FIG. 58 illustrates a side cross-sectional view of the actuator knob shown in FIG. [Figure 59] FIG. 59 is a perspective view of the actuator knob shown in FIG. 57, with a portion shown as transparent. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0022] The present specification and drawings provide aspects and features of the present disclosure in the context of several examples of implants, such as replacement heart valves, delivery systems, and methods configured for use in a patient's vasculature, such as for replacement of a patient's native heart valve. These examples may be described in the context of replacing a particular valve, such as aortic, tricuspid, or mitral valves, of a patient. However, it will be understood that the features and concepts described herein may be applied to products other than implants for heart valves. For example, the controlled positioning, deployment, and fixation features described herein may be applied to other medical implants, such as other types of expandable prosthetic valves, for use in other locations in the body, such as in arteries, veins, or other body cavities or locations. In addition, the specific features of valves, delivery systems, and the like should not be taken as limiting, and features in any example described herein may be combined with features in other examples as desired and appropriate. Although certain examples described herein are described in connection with a transfemoral delivery approach, it will be understood that these examples may be used in connection with other delivery approaches, such as, for example, a transapical approach or a transjugular approach. Moreover, it will be understood that certain features described in connection with some examples may be incorporated with other examples, including features described in connection with different delivery approaches.

[0023] FIG. 1 illustrates an example of a delivery system 10. The delivery system 10 can be used to deploy an implant, such as a prosthetic valve. The prosthetic valve may include, for example, a replacement heart valve to be deployed to a location within the body of a subject (e.g., a human or veterinary subject). The replacement heart valve can be delivered to the mitral or tricuspid annulus of the subject's heart, or to other heart valve locations, in a variety of manners, such as open surgery, minimally invasive surgery, and percutaneous or transcatheter delivery through the subject's vasculature. An exemplary transfemoral approach is further described in U.S. Patent Application Publication No. 2015 / 0238315, published August 27, 2015, the entirety of which is incorporated herein by reference in its entirety. Although the delivery system 10 is described in conjunction with a percutaneous delivery approach, and more specifically with a transfemoral delivery approach, it will be understood that the features in the delivery system 10 may be applied to other delivery approaches, including delivery systems for transapical delivery approaches.

[0024] The delivery system 10 can be used to deploy a prosthetic valve, such as a replacement heart valve as described elsewhere herein, to a location within a patient's body. The delivery system 10 can include multiple components, devices, or subassemblies. As shown in FIG. 1, the delivery system 10 can include an elongate catheter or delivery device 15, a stabilization assembly 1100, and other components as desired. The delivery device 15 can include an elongate shaft or shaft assembly 12 and a housing in the form of a handle 14. The shaft assembly 12 can include one or more shafts. According to examples herein, multiple shafts can be provided, although in examples, a single shaft can be utilized.

[0025] An implant (e.g., a prosthetic or replacement heart valve) 30 can be pre-loaded onto the elongated catheter or delivery device 15, which may be configured to facilitate delivery and implantation of the implant 30 into a desired target location (e.g., the annulus of the mitral or tricuspid valve of the heart, among others). The implant 30 can be pre-loaded into a distal end portion of the shaft assembly 12 and releasably locked to one or more retaining members of the shaft assembly 12 during manufacture or assembly. The pre-loaded delivery device 15 can then be packaged, sterilized, and shipped for use by one or more clinicians. According to some examples, the delivery device 15 may be ready for use upon removal from the package, without the need for a clinician to load an implant. In examples, the delivery device 15 may be cleaned and loaded prior to use.

[0026] 2A-2D show an example implant (e.g., a prosthetic or replacement heart valve) 30 that may be preloaded into and delivered by delivery device 15. Implant 30 may include a dual-frame assembly including inner and outer frames 32 and 34 that are aligned and coupled together during manufacture.

[0027] 2B illustrates an example inner frame 32. The inner frame 32 can include a proximal or inflow portion 32A, a central or middle portion 32B, and a distal or outflow portion 32C. The inner frame 32 can be shaped to assume a generally hourglass shape in the expanded configuration, i.e., the middle portion 32B has a smaller cross-sectional width compared to the cross-sectional widths of the proximal and distal portions 32A, 32C. The proximal portion 32A can include tabs 33 and / or eyelets 35 to facilitate engagement with other structures or materials (e.g., the outer frame 34, a skirt or fabric assembly, a prosthetic valve assembly, and / or a tether or retention suture in an elongated catheter or delivery device 15). The distal portion 32C can include an anchor 37 extending outwardly and upwardly to facilitate anchoring at a desired target location (e.g., a native heart valve annulus). The inner frame 32 may have a chevron cell configuration, as shown in FIG. 2B, although other cell configurations may be used. A prosthetic valve assembly including multiple prosthetic leaflets (not shown) may be coupled to the inner frame 32.

[0028] FIG. 2C illustrates an example outer frame 34. The outer frame 34 may also include a proximal or inflow portion 34A, a central or intermediate portion 34B, and a distal or outflow portion 34C. Similar to the proximal portion 32A of the inner frame 32, the proximal portion 34A of the outer frame 34 may also include one or more eyelets 35 to facilitate engagement with one or more structures or materials (e.g., the inner frame 32, a skirt or fabric assembly, and / or a tether or retention suture in the elongate catheter or delivery device 15). For ease of understanding, in FIGS. 2A-2C, the implant 30 is illustrated with only a bare metal frame structure.

[0029] 2D illustrates an example fully assembled implant (e.g., a prosthetic or replacement heart valve) 30 that includes a skirt assembly 38 that is coupled to frames 32, 34 and includes pads 39 that surround anchors 37. Implant 30 can take any of a number of forms or designs.

[0030] Additional details regarding implants (e.g., prosthetic or replacement heart valves) as well as exemplary designs are described in U.S. Pat. Nos. 8,403,983, 8,414,644, 8,652,203, U.S. Patent Application Publication No. 2011 / 0313515, 2012 / 0215303, 2014 / 0277390, 2014 / 0277422, 2014 / 0277427, 2018 / 0021129, 2018 / 0055629, and 2019 / 0262129 (e.g., the hourglass shape of the inner frame). Further details and examples regarding replacement heart valves or prosthetic valves, and methods of implanting them, are described in U.S. Patent Application Publication Nos. 2015 / 0328000, 2016 / 0317301, 2019 / 0008640, and 2019 / 0262129, each of which is incorporated by reference in its entirety.

[0031] Referring briefly back to FIG. 1 , the elongated catheter or delivery device 15 can include an elongated shaft or shaft assembly 12 including a proximal end and a distal end, with a handle 14 coupled to the proximal end of the shaft assembly 12. The elongated catheter or delivery device 15 can be used to hold an implant (e.g., a prosthetic valve, a replacement heart valve) for driving such an implant forward through the vascular system to a treatment location. In some examples, the elongated shaft or shaft assembly 12 can hold at least a portion of an expandable implant (e.g., a prosthetic valve, a replacement heart valve) in a compressed state for driving such an implant forward within the body. The elongated shaft or shaft assembly 12 can then be used to control the expansion of the implant at the desired implantation location (e.g., a treatment location). In some examples, the shaft assembly 12 can be used to enable sequential controlled expansion of the implant, as described in more detail below.

[0032] The elongate shaft or shaft assembly 12 of the delivery device 15 can include one or more shafts. In some examples, multiple shafts may be provided. The multiple shafts may include one or more subassemblies or shafts, such as, for example, an outer sheath shaft or subassembly 20, a rail shaft or subassembly 21, a midshaft or subassembly 22, a release shaft or subassembly 23, a manifold shaft or subassembly 24, and / or a nosecone shaft or subassembly, as described in detail below. In some examples, the shaft assembly 12 of the elongate catheter or delivery device 15 need not include all of the subassemblies or shafts disclosed herein. The delivery device 15 may include multiple layers of concentric shafts or subassemblies or lumens. The various lumens or shaft subassemblies will be described starting with the outermost layer. In some examples, the shafts or subassemblies disclosed below may be in a different radial order than those described.

[0033] 3A shows a perspective view of an example outer sheath shaft or subassembly 20 of the elongate catheter or delivery device 15 of the delivery system 10. The outer sheath shaft or subassembly 20 forms a radially outer covering or sheath that surrounds an implant holding area for holding an implant and prevents at least a portion of the implant (e.g., a replacement heart valve or prosthetic valve) 30 from radially expanding until it is ready for implantation. Specifically, the outer sheath subassembly 20 can prevent a distal end portion of the implant 30 from radially expanding.

[0034] The outer sheath shaft or subassembly 20 may include an outer proximal shaft 302 having a proximal end portion operably coupled (e.g., via a threaded outer sheath adapter 303 at a proximal portion of the outer sheath shaft or subassembly 20) to a capsule actuator or knob 905 of the handle 14 (which may be the most distal actuator or knob, as shown in FIGS. 9A and 9B ) such that driving the capsule knob 905 in a rotational manner (e.g., clockwise or counterclockwise rotational driving) drives the outer sheath subassembly 20 in a proximal-distal direction in a translational fashion. A capsule subassembly 306 may be attached to the distal end of the outer proximal shaft 302. The components of the outer sheath shaft or subassembly 20 may form an outermost lumen for passing other shafts or subassemblies therethrough.

[0035] The outer proximal shaft 302 may be a tube formed from plastic, but may also be formed from a metal hypotube or other material. The outer proximal shaft 302 may include an outer jacket or liner formed from a fluorinated ethylene propylene (FEP) material, a polytetrafluoroethylene (PTFE) material, an ePTFE material, or other polymeric material to provide a smooth and hemostatic outer surface of the outer proximal shaft 302. The outer proximal shaft 302 may include a connector (e.g., a flexible reflow member) at its distal end to facilitate connection or coupling to the capsule subassembly 306. At least a portion of the outer proximal shaft 302 may include a laser cut hypotube having a bend pattern, such as a universal bend pattern. An interrupted spiral pattern or an interrupted coil may be utilized.

[0036] 3B illustrates a side cross-sectional view of the capsule subassembly 306. The capsule subassembly 306 may include a distal hypotube or capsule stent 308, an inner liner positioned inside the hypotube 308, a distal capsule tip 309, and one or more outer liners or jackets 311 surrounding the hypotube 308. The outer liner or jackets 311 may include PEBAX or other suitable polymers or other suitable thermoplastic elastomer materials, such as polytetrafluoroethylene (PTFE) or expanded polytetrafluoroethylene (ePTFE). The inner liner may include PTFE, which may be pre-compressed prior to application against the inside of the hypotube 308. The distal capsule tip 309 may include an atraumatic tip configured to function as a funnel to facilitate recapture (e.g., compression) of the prosthetic valve or other implant. The distal capsule tip 309 may be constructed from polyetheretherketone (PEEK) or other thermoplastic material, from a polymeric material, or from a metallic material. The distal capsule tip 309 may be loaded with a radiopaque material (e.g., loaded with barium sulfate at 5%-40%) to facilitate detection (e.g., fluorescent) under radiographic imaging (e.g., fluoroscopy). The distal capsule tip 309 may be housed within the open distal end of the hypotube 308.

[0037] FIG. 3C shows a perspective view of the distal hypotube or encapsulated stent 308. The encapsulated stent 308 may be formed from one or more materials, such as PTFE, ePTFE, polyether block amide (Pebax®), polyetherimide (Ultem®), PEEK, urethane, nitinol, stainless steel, and / or any other biocompatible material. The encapsulated stent 308 is preferably flexible while maintaining a sufficient degree of radial strength to maintain an implant (e.g., a replacement valve) 30 within the encapsulated stent 308 without substantial radial deformation that could increase friction between the encapsulated stent 308 and the implant contained therein. The encapsulated stent 308 also preferably has sufficient column strength to resist buckling and sufficient tear resistance to reduce or eliminate the possibility of an implant tearing or damaging the encapsulated stent 308. The proximal and / or distal ends of the distal hypotube or capsule stent 308 may include a number of laser cut windows 313 configured to render the proximal and / or distal ends fluorescent or echogenic to facilitate visualization under certain imaging modalities (e.g., non-invasive ultrasound imaging or invasive fluoroscopy). In some implementations, due to the presence of the laser cut windows 313, no separate radiopaque members or elements are added to the hypotube 308 to facilitate imaging. The laser cut windows 313 may also facilitate bonding of the outer jacket 311 to the capsule stent 308 and to the inner liner by allowing an adhesive or other adhesive to flow through the laser cut windows 313. One or more layers of a connecting member formed from PEBAX or other suitable material may surround the laser cut windows 313 to facilitate coupling of the hypotube or capsule stent 308 to the distal capsule tip 309.

[0038] The hypotube 308 may be made of a plastic or metal material. In some implementations, the hypotube 308 may be a metal hypotube. If made of metal, the metal material of the hypotube 308 may include a metal alloy, such as cobalt chrome, stainless steel, titanium, or nickel-titanium alloy material. The coil configuration or cut pattern in the proximal outer shaft 302 and / or hypotube 308 allows the proximal shaft 302 to follow the rail shaft or rail subassembly 21 in any desired orientation. The cut pattern in the proximal outer shaft 302 and / or hypotube 308 may be modified (e.g., cuts per revolution, pitch, spine distance) to control tension resistance, compression resistance, flexibility, and torque resistance. For example, the number of cuts per revolution may range from 1.5 to 5.5, the pitch may range from 0.005 inches to 0.15 inches (0.127 mm to 3.81 mm), and the spine distance may range from 0.015 inches to 0.125 inches (0.381 mm to 3.175 mm). The hypotube 308 may advantageously provide both tension and compression. The outer liner or jacket 311 may allow the capsule subassembly 306 to be more flexible. The capsule hypotube 308 may bend in multiple directions. In some implementations, the distal end of the outer liner or jacket 311 may be located proximal to the distal end of the hypotube 308.

[0039] The capsule subassembly 306 may have a similar diameter as the outer proximal shaft 302, or may have a different diameter. In some examples, the capsule subassembly 306 has a uniform or substantially uniform diameter along its length. In some examples, the size of the capsule subassembly 306 may be 28 French or less (e.g., 27 French). In some examples, the capsule subassembly 306 may include a larger diameter distal portion and a smaller diameter proximal portion. The capsule subassembly 306 may be configured to hold a compressed implant (e.g., prosthetic valve) 30 within the capsule subassembly 306 (e.g., within an implant holding area 316 shown in FIG. 3D , which occupies the most distal 5 cm or 5 inches (127 mm) of the capsule subassembly 306). Additional structure and additional operational details for the capsule subassembly may be incorporated into the capsule subassembly 306, such as those described for the capsule in U.S. Patent Application Publication Nos. 2019 / 0008640 and 2019 / 0008639, which are incorporated by reference herein.

[0040] The outer sheath shaft or outer sheath subassembly 20 is configured to be independently movable or slidable relative to the other shafts or assemblies by operation of a control mechanism. The control mechanism may include an actuator in the form of one or more control knobs. The actuator may include an actuator knob or capsule knob 905 (shown in FIG. 9A). By rotationally driving the capsule knob 905, the outer sheath shaft or outer sheath subassembly 20 may be driven or slid. Additionally, the outer sheath subassembly 20 may be slidably driven in a distal-proximal direction relative to the rail subassembly 21, together with the mid-shaft subassembly 22, together with the manifold subassembly 24, together with the release subassembly 23, and / or together with the nosecone subassembly.

[0041] FIG. 3D illustrates generally an embodiment in which at least a portion of the length of one or more components of capsule subassembly 306 (e.g., inner liner 310) can include additional material such that capsule subassembly 306 includes built-in slack along a portion of its length (e.g., a portion of its length located proximal to implant holding region 316) thereby facilitating flexible bending of capsule subassembly 306 (e.g., to navigate tight bends within the heart or within the vasculature surrounding the heart).

[0042] Figure 4A shows a perspective view of the rail shaft or rail subassembly 21 of the elongate catheter or delivery device 15 of the delivery system 10 of Figure 1. Figure 4A shows a similar view to Figure 3A, but with the outer sheath subassembly 20 removed, exposing the rail subassembly 21.

[0043] 4B further illustrates a cross-sectional view of the proximal and distal ends of the rail subassembly 21, where pull wires that facilitate steering of the rail subassembly 21 can be seen. The rail subassembly 21 can include a rail shaft 402 (i.e., a rail) generally attached (and operably coupled) to the handle 14 at its proximal end. The rail shaft 402 can be comprised of a rail proximal shaft 404 attached directly to the handle 14 at its proximal end, and a rail hypotube 406 attached (e.g., via a connector, ring-like structure, or insert 407) to the distal end of the rail proximal shaft 404. The rail subassembly 21 is operably coupled to the handle 14 via a primary bending adapter 403A located at a proximal portion of the rail subassembly 21, which controls the medial-lateral trajectory of the distal end portion of the rail subassembly 21 via one or more distal pull wires 410A (shown in FIG. 4B ), a secondary bending adapter 403B located at a proximal portion of the rail subassembly 21, which controls the anterior-posterior trajectory of the distal end portion of the rail subassembly 21 via one or more proximal pull wires 410B, and a rail adapter 405 located at a proximal portion of the rail subassembly 21, which includes a side needleless injection port to facilitate flushing and degassing functions. The rail proximal shaft 404 may include an intermittent helical cut pattern along a majority of its length to facilitate compression. The rail hypotube 406 may further include an atraumatic rail tip 408 at its distal tip. The atraumatic rail tip 408, which may not include a slit, is configured to extend up to 1 inch (25.4 mm) beyond the distal end of the rail hypotube 406 and is configured not to cut into the outer shaft subassembly 20 to avoid chafing and fatigue and to extend use. These components of the rail subassembly 21 may form a lumen for passing another inner subassembly therethrough.

[0044] FIG. 4B illustrates a side cross-sectional view of the rail shaft or rail subassembly 21 of FIG. 4A. As shown in FIG. 4B, one or more pull wires 410 are attached to the inner surface of the rail hypotube 406 and can be used to apply force to the rail hypotube 406 and steer the rail subassembly 21. The pull wires 410 can extend distally from a primary actuator or bending knob 915A and a secondary actuator or bending knob 915B (shown in FIGS. 9A and 9B) in the handle 14 to the rail hypotube 406. In some examples, the pull wires 410 can be attached at different longitudinal locations on the rail hypotube 406 to provide multiple bending positions within the rail hypotube 406 to enable multi-dimensional steering. For example, the rail hypotube 406 may provide a primary bend or flex along a medial / lateral trajectory and a secondary bend or flex along a forward / backward trajectory.

[0045] The rail hypotube 406 may include multiple circumferential slots (e.g., laser cut into the hypotube) to facilitate bending and flexibility. The rail hypotube 406 may generally be divided into several different sections. At the most proximal end, corresponding to the location of the insert 407, is an uncut hypotube section (i.e., no slots). Continuing distally, the next section is the proximal slotted hypotube section 406P. This section includes multiple circumferential slots cut into the rail hypotube 406. Generally, two slots are cut at each circumferential location, forming approximately half of the circumference. Thus, two backbones are formed between the slots that run the length of the hypotube 406. This is the section that may be guided by the proximal pull wire 410B. Continuing distally, there are locations where the proximal pull wires 410 connect, thereby avoiding slots. This section is located just distal to the proximal slotted section 406P and may correspond to the location of the insert or pull wire connector 411.

[0046] Distal to the proximal pull wire connection region is the distal slotted hypotube section 406D. This section may be similar to the proximal slotted hypotube section 406P, but may have a greater number of slots cut at a comparable length. Thus, the distal slotted hypotube section 406D may bend more easily and may provide a greater bend angle compared to the proximal slotted hypotube section 406P. In some examples, the proximal slotted section 406P may be configured to experience approximately a 90 degree bend at a half inch (12.7 mm) radius, while the distal slotted hypotube section 406D may bend through approximately 180 degrees at a half inch (12.7 mm) radius. Additionally, as shown in FIGS. 4A and 4B, the spine of the distal slotted hypotube section 406D is circumferentially offset from the spine of the proximal slotted hypotube section 406P. Thus, the two sections achieve different bending patterns, which allows for three-dimensional steering of the rail subassembly 21. In some examples, the spine may be offset by 30 degrees, 45 degrees, or 90 degrees, although the particular offset is not limiting. At the most distal end of the distal slotted hypotube section 406D is the distal pull wire connection region, which is again a non-slotted section of the rail hypotube 406.

[0047] In some examples, one distal pull wire 410A can extend to the distal section of the rail hypotube 406 (e.g., to the rail tip 408) and two proximal pull wires 410B can extend to the proximal section of the rail hypotube 406, although other numbers of pull wires can be used and the particular quantity for the pull wires is not limiting. For example, two distal pull wires 410A can extend to a distal location and one proximal pull wire 410B can extend to a proximal location. In some examples, a ring-like structure or insert, known as a pull wire connector, attached to the inside of the rail hypotube 406 can be used as an attachment point, such as insert 411, for the proximal pull wire 410B. In some examples, the pull wires 410 can be directly connected to the inside surface of the rail hypotube 406.

[0048] The distal pull wire 410A can be connected entirely at the distal end of the rail hypotube 406 (either by itself or via the rail tip connector 408). The proximal pull wire 410B can be connected (by itself or via an insert 411) approximately one-quarter, one-third, or one-half of the length of the rail hypotube 406 from the proximal end. In some examples, the distal pull wire 410A can be passed through a small diameter pull wire lumen (e.g., tube, hypotube, cylinder) mounted on the interior of the rail hypotube 406. This can prevent the pull wire 410 from pulling on the rail hypotube 406 in close proximity to the distal connection area. Additionally, the lumen can include a compression coil to reinforce the proximal portion of the rail hypotube 406 and prevent undesired bending. Thus, in some examples, the lumen is located only in the proximal portion (e.g., the proximal half) of the rail hypotube 406. In some examples, multiple lumens, either longitudinally spaced apart or longitudinally adjacent, may be used per distal pull wire 410A. In some examples, a single lumen is used per distal wire 410A. In some examples, the lumen may extend into the distal portion (e.g., into the distal half) of the rail hypotube 406. In some examples, the lumen is attached on the exterior surface of the rail hypotube 406. In some examples, no lumen is used. In some examples, one or more compression coils 413 extend from the insert 407 to the insert 411. The compression coils 413 may be configured to bypass the load for a length between the distal primary bend point and the proximal secondary bend point. The compression coils 413 facilitate independent bending planes such that both bending planes are not operational when one bending plane is desired to bend. The compression coil 413 may allow the proximal slotted hypotube section 406P to remain rigid against a particular bend in the distal slotted hypotube section 406D.The compression coil 413 may isolate the force so that only the primary bending occurs.

[0049] With respect to the pair of proximal pull wires 410B, the wires can be spaced apart by approximately 180° to allow for steering in both directions. Similarly, if a pair of distal pull wires 410A is used, the wires can be spaced apart by approximately 180° to allow for steering in both directions. In some examples, the pair of distal pull wires 410A and the pair of proximal pull wires 410B can be spaced apart by approximately 90°. The use of opposing wires can provide a bending resistance mechanism. In some examples, the pair of distal pull wires 410A and the pair of proximal pull wires 410B can be spaced apart by approximately 0°. However, other arrangements for the pull wires can be used as well, and the particular arrangement for the pull wires is not limiting. In some examples, the distal pull wires 410A can pass through a lumen attached within the lumen of the rail hypotube 406. This prevents axial forces on the distal pull wire 410A from causing bending of the proximal section of the rail hypotube 406. The rail subassembly 21 is disposed to be slidable over the radially inner subassembly. When the rail hypotube 406 is bent, it presses against the other subassemblies, causing the embodiment subassemblies to bend as well, such that the other subassemblies of the delivery device 15 can be configured to be steered together with the rail subassembly 21 as a cooperative single unit, thereby providing full steerability of the distal end of the delivery device 15. Additional structural and operational details regarding the rail subassembly may be incorporated into the rail subassembly 21, such as those described with respect to the rail assemblies in U.S. Patent Application Publication Nos. 2019 / 0008640 and 2019 / 0008639, which are incorporated herein by reference.

[0050] FIG. 4C illustrates generally how the outer compression coil 413A and proximal pull wire 410B1 may have a longer length compared to the inner compression coil 413B and proximal pull wire 410B2 of the rail subassembly 21, thereby facilitating bending in one direction and reducing blockage of the lumen upon bending without occupying the same space.

[0051] Continuing radially inward, the next subassembly is the midshaft or midshaft subassembly 22. FIG. 5A shows a perspective view of the midshaft subassembly 22 in the delivery device 15 of the delivery system 10. The midshaft subassembly 22 can include a distal midshaft hypotube 502 generally attached at its proximal end to a proximal shaft 504, which can be attached at its proximal end to the handle 14 (e.g., via a midshaft adapter 505 located at a proximal portion of the midshaft subassembly 22), and a distal pusher member 506 disposed at the distal end of the midshaft hypotube 502. These components of the midshaft subassembly 22 can form a lumen for passing other inner subassemblies therethrough.

[0052] The midshaft subassembly 22 can be disposed within the lumen of the rail subassembly 21. The midshaft hypotube 502 can be formed from a metal alloy (e.g., cobalt chrome, nickel-chrome-cobalt alloy, nickel-cobalt based alloy, nickel-titanium alloy, stainless steel, and titanium). The midshaft hypotube 502 may include an intermittent spiral cut pattern. FIG. 5A shows a view similar to FIG. 4A, but with the rail subassembly 21 removed, exposing the midshaft subassembly 22.

[0053] As with the other subassemblies, the midshaft hypotube 502 and / or the midshaft proximal tube 504 can include tubing such as hypodermic tubing or hypotubes (not shown). The tubing can be made from any one of a number of different materials, including Nitinol, stainless steel, and medical grade plastics. The tubing can be a single piece of tubing or can be multiple pieces connected together. By using a tube made from multiple pieces, the tube can provide different properties, such as stiffness and flexibility, along different sections of the tube. The midshaft hypotube 502 can be a metallic hypotube. The midshaft hypotube 502 can have multiple slots / openings cut into it. In some examples, the cut pattern can be the same throughout. In some examples, the midshaft hypotube 502 can have various sections with different cut patterns. The midshaft hypotube 502 may be covered or surrounded by a layer of ePTFE, PTFE, or other material that provides a generally smooth exterior surface of the midshaft hypotube 502. At least a portion of the length of the midshaft proximal tube 504 may be covered by heat shrink tubing or a heat shrink wrap.

[0054] The pushing member 506 may be configured to radially hold a portion of the implant (e.g., prosthetic valve) 30, such as the proximal end of the implant 30, in a compressed configuration. For example, the pushing member 506 may be a ring or cover configured to radially cover a proximal end portion (e.g., a suture eyelet portion) of the implant 30. The pushing member 506 may also be considered a part of the implant holding area 316 and may be located at the proximal end of the implant holding area 316. The pushing member 506 may include a frustoconical or cup shape that is riveted or fixed to the distal end of the midshaft hypotube 502 on both sides. The pushing member 506 may be formed from a PEEK material, an iron-based material, platinum-iridium, or other fluorescent material to facilitate radiography. The midshaft subassembly 22 may be positioned in a fixed manner relative to the handle. In some examples, the midshaft subassembly 22 may be independently slidable relative to the other subassemblies. The midshaft adapter 505 may be operatively coupled to an actuator or depth knob 920 (shown in FIG. 9A). The depth knob 920 may be utilized to drive the shaft of the long catheter in a ventricular / atrial direction within the heart. Additional structural and operational details for the midshaft subassembly 22 may be incorporated into the midshaft subassembly 22, such as those described with respect to the midshaft in U.S. Patent Application Publication Nos. 2019 / 0008640 and 2019 / 0008639, which are incorporated herein by reference.

[0055] Continuing radially inward from the midshaft subassembly 22, FIG. 6A shows a perspective view of the release shaft or release subassembly 23 of the delivery device 15 of the delivery system 10. FIG. 6B shows a side cross-sectional view of the release subassembly 23 of FIG. 6A. The release subassembly 23 operates in conjunction with the manifold subassembly 24 to facilitate retention and release of the implant or prosthetic valve 30. The release subassembly 23 extends through a central lumen of the midshaft subassembly 22. The release subassembly 23 includes a release shaft 602 that includes a lumen. The manifold subassembly 24 extends through the lumen of the release subassembly 23. The midshaft subassembly 22 acts to prevent the implant 30 from retracting when the capsule subassembly 306 is retracted, and the manifold subassembly 24 prevents the distal valve from moving.

[0056] The distal portion of the release shaft 602 may include a laser cut portion with various spine patterns. For example, the most distal portion of the release shaft 602 (e.g., .about.1 cm) may include a dual spine laser cut pattern, and a portion more proximal than the most distal portion (e.g., .about.5 cm more proximal than the most distal portion) may include a universal laser cut spine pattern. The dual spine pattern portion may pass only through the primary distal bend of the rail hypotube 406, and the universal spine pattern portion may pass through both the primary and secondary bends of the rail hypotube 406. At least a portion of the length of the release shaft 602 may be surrounded by a heat shrink wrap or heat shrink liner. The proximal end of the release shaft 602 is operably coupled to the handle 14 (e.g., via a release adapter 604 at the proximal portion of the release shaft 602). The release subassembly 23 also includes a distal release tip 605 coupled to the distal end of the release shaft 602 via a coupler 607, which may be formed from PEBAX or other thermoplastic elastomer material. The distal release tip 605 may be welded to the distal end of the release shaft 602. The release adapter 604 includes release snaps 606 on both sides. The release snaps 606 engage a distal portion of the manifold adapter 704 after release of the tether or suture, thereby preventing movement of the manifold subassembly 24 and the release subassembly 23 relative to each other, which closes a window 610 (shown in FIG. 6C ) in the distal release tip 605 such that either the suture or the tether may be inadvertently retained. The release snaps 606 thus convert the release / manifold mechanism from a normally closed configuration to an open configuration, allowing the manifold subassembly 24 and the release subassembly 23 to move proximally together. The release subassembly 23 further includes a release spring 608 extending between the release adapter 604 and a location within the manifold adapter 704 of the manifold subassembly 24 .

[0057] 6C, 6D, and 6E show enlarged side, cross-sectional, and bottom views, respectively, of the distal release tip 605. The distal release tip 605 cooperates with a distal end portion of the manifold subassembly 24 to facilitate preventing premature release of the implant 30 and facilitating release (e.g., unlocking) of the implant 30 when it is ready for final implantation. The distal release tip 605 includes three windows 610 and three slots 612 spaced apart about the circumference of the distal release tip 605, where each slot 612 is disposed between two adjacent windows 610. The three windows 610 may be equally spaced circumferentially, and the slots 612 may be equally spaced circumferentially between adjacent windows 610. The distal end of each slot 612 includes an inwardly protruding retention member 614 (e.g., tab, protrusion, locking member, anchor). The inwardly protruding tabs 614 are configured to align with and extend into corresponding slots in the manifold subassembly 24, thereby controlling axial movement and preventing rotational movement of the release assembly 23 relative to the manifold subassembly 24, as described in more detail below.

[0058] Continuing radially inward, FIG. 7A shows a perspective view of the manifold shaft or manifold subassembly 24 of the elongate catheter or delivery device 15. FIG. 7B shows a side cross-sectional view of the manifold subassembly 24 of FIG. 7A. The manifold subassembly 24 extends through and along the lumen of the release subassembly 23. The manifold subassembly 24 includes a proximal subassembly 701 and a distal subassembly 703. The proximal subassembly 701 includes a proximal shaft 702 having a proximal end that extends into the handle 14 of the delivery device 15 and is operably coupled to the handle 14 at a proximal portion of the manifold shaft or manifold subassembly 24 via a manifold adapter 704. The proximal shaft 702 may be coupled to the distal subassembly 703 by a manifold cable 705. The manifold cable 705 may include a multi-layer cable with two, three, four, five, or more layers. In some implementations, the manifold cable 705 includes a three-layer cable in which the two outer layers function for tension and act together to prevent unwinding of the outer layers, and the inner layer includes a single filler coil that provides compression to prevent collapse. In some implementations, each layer is wound in an opposite direction to the adjacent layer (e.g., clockwise, counterclockwise, clockwise or counterclockwise, clockwise, counterclockwise). The wire size, wire tension, pitch, number of fillers in each layer, material, and material properties may be different. The inner coil may include 1 to 10 fillers tightly wound with gaps of 0 inches to 0.005 inches (0 mm to 0.127 mm). Each of the middle and outer coils may include 1-10 fillers and may be tightly wound with gaps of 0 inch to 0.010 inch (0 mm to 0.254 mm). The manifold cable 705 may be formed from one or more materials including, for example, iron-based materials such as Nitinol, stainless steel, and / or cobalt chrome materials.The temper (e.g., strength) of the wire may range from 100 KSI to 420 KSI. The cross section of the wire may be flat or round. The three-layer cable may be configured to have a constant diameter upon extension. In other implementations, the proximal shaft 702 extends to and is bonded to the proximal end of the distal subassembly 703.

[0059] FIG. 7C illustrates an enlarged view of distal subassembly 703 of manifold subassembly 24. FIG. 7D illustrates a bottom view of distal subassembly 703 of manifold subassembly 24. As shown, distal subassembly 703 includes a proximal tether retaining member 706 and a distal tether retaining member 707. Distal tether retaining member 707 may be bonded (e.g., permanently bonded, welded) to a distal end of proximal tether retaining member 706. As shown most clearly in FIG. 7D, distal tether retaining member 707 may include a cog that includes outwardly extending tether cleats 708 spaced circumferentially about the periphery of the cog. Openings or gaps 709 exist between adjacent tether cleats 708 to receive a portion of a tether or suture 710. The distal tether retaining member 707 may include a proximal seal member 711 (e.g., retaining ring) and a distal seal member 713 (e.g., retaining ring) that are sealed (e.g., welded, glued, or otherwise attached) to opposing top and bottom ends of the distal tether retaining member 707 during manufacture to seal openings or gaps 709 between the tether cleats 708 and prevent the tether or suture 710 from being removed or uncoupled from the distal tether member 707. According to some examples, the tether 710 is intended to be permanently coupled to the distal tether retaining member 707 (i.e., non-removable from the distal tether retaining member 707). The number of tether cleats 708 may correspond to the number of eyelets on the implant 30 (e.g., the upper eyelets of the outer frame 34). In the illustrated example, the number of tether cleats 708 is nine, although other numbers of tether cleats 708 may be used.

[0060] The tether or suture 710 may be a continuous piece of tether or suture that, when assembled during manufacture, forms offset proximal and distal loops along its continuous length, with the proximal loop wrapped around the tether cleat 708 and the distal loop fed through a corresponding eyelet on the proximal end of the implant or prosthetic valve 30 (e.g., the upper eyelet of the outer frame 34) and then releasably coupled to the delivery device 15 (e.g., to the proximal tether retaining member 706 of the manifold subassembly 24).

[0061] During assembly, the continuous tether or suture 710 may be coupled to the distal tether retaining member 707 according to the following exemplary implementation. One end of the continuous tether or suture 710 may start at a location spaced distal to the distal tether retaining member 707. With one end remaining there, the tether 710 is then wrapped around the first tether cleat 708 and then fed back through an opening or gap 709 on the opposite side of the first tether cleat 708 to form a first proximal loop, and then fed back to a location spaced distal to the distal tether member 707 to begin forming a first distal loop. This process is repeated for each of the tether cleats 708 until all proximal and all distal loops are formed, and the second end of the continuous tether 710 is pulled adjacent to the first end of the continuous tether 710 and the two ends are tied and glued together to form a single continuous strand. The tether assembly process may be facilitated by an assembly component that may be positioned at an appropriate spacing distal to distal tether retaining member 707, including a peg around which a portion of continuous tether 710 may be wound to form a distal loop at a uniform spacing from distal tether member 707. The proximal loop may be prevented from dislodging from tether cleat 708 by proximal seal member 711 and distal seal member 713.

[0062] 7E illustrates a flat cut pattern in the proximal tether retaining member 706 of the distal subassembly 703. As illustrated, the proximal portion of the proximal tether retaining member 706 includes a dual spine laser cut pattern. The dual spine laser cut pattern of the proximal tether retaining member 706 may match the dual spine laser cut pattern of the rail subassembly 21 and the release subassembly 23. The distal end portion of the proximal tether retaining member 706 includes three circumferentially spaced apart slots 714 and three apertures or windows 715. The slots 714 are configured to be circumferentially aligned with the slots 612 of the distal release tip 605, and the apertures or windows 715 are configured to be circumferentially aligned with the windows 610 of the distal release tip 605. In other examples, other numbers of slots 714 and apertures 715 (e.g., two, four, five, six, seven, eight, nine) may also be used. Each opening 715 includes a tab, finger, or peg 716 that extends a certain distance into the corresponding opening 715 from the distal edge of the corresponding opening 715. The length of each tab 716 is sufficient to allow one or more distal tether loops to be looped onto the top (or proximal end) of the corresponding tab 716 and to be pushed distally to retain one or more distal tether loops. As shown, each of the three tabs 716 has a different length to facilitate the initial tether assembly process. Each tab 716 may receive one or more distal tether loops. In one implementation where there are nine distal tether loops, each tab 716 may retain three distal tether loops. The slots 714 may be equally spaced circumferentially about the longitudinal axis of the proximal tether retaining member 706 and may be sized and spaced to align with corresponding slots 612 of the release subassembly 23 to receive corresponding inwardly protruding retaining members 614.

[0063] 8A and 8B show the distal end portions of the release shaft or release subassembly and manifold shaft or manifold subassembly in locked and unlocked configurations, respectively. The locked configuration shown in FIG. 8A is the default configuration after assembly. The release subassembly and manifold subassembly are intended to remain in the locked configuration until the clinician determines that the implant 30 is in the final desired implantation location. In the locked configuration, the proximal end of the tab 716 is located proximal to the proximal edge of the release window 610, so that the distal tether loop wrapped around the tab 716 cannot disengage from the tab 716, thereby preventing premature release of the tether 710. Although only one distal tether loop is shown wrapped around one tab 716 for simplicity, two, three, or more tether loops may be locked onto or wrapped around each tab 716. The spring 608 (biased to a compressed configuration) shown in Figure 6A keeps the release adapter 604 and the manifold adapter 704 spaced apart and compresses the release subassembly 23 distally, thereby maintaining the release subassembly 23 and the manifold subassembly 24 in the locked configuration shown in Figure 8A. As described with respect to Figures 9A and 9B, a safety member (e.g., pin) 927 also prevents the manifold shaft, or manifold subassembly 24, from moving distally out of the locked configuration until ready.

[0064] Once the clinician has determined that the implant 30 is in the final desired implantation location and all verification processes have been performed and confirmed, the safety member 927 is removed and the spring 608 is actuated to a further compressed state. When the actuator knob or release knob 925 is actuated in a distal rotational direction, the spring 608 is further compressed, pushing the manifold shaft or manifold subassembly 24 distally away from the release subassembly 23 to the unlocked configuration shown in FIG. 8B. As shown in FIG. 8B, the manifold subassembly 24 has been actuated distally sufficiently such that the proximal end of at least one tab 716 is within the release window 610, thereby allowing the distal tether loop of the tether 710 to be unlocked from the tab 716, particularly when the manifold subassembly 24 is subsequently actuated forward distally.

[0065] 8C illustrates how one of the tethers or suture loops transitions from a locked state to an unlocked or released state as the release subassembly and manifold subassembly transition between the locked and unlocked configurations, and as shown in FIG. 8C, the corresponding slots 612, 714 are aligned to prevent rotation of the manifold subassembly 24 relative to the release subassembly 23 (due to the inwardly protruding retaining members 614), thereby maintaining the alignment of the tabs 716 within the windows 610 of the release subassembly 23.

[0066] 8D shows the implant 30 fully locked between an eyelet on the proximal end of the implant (e.g., an upper eyelet of the outer frame 34 of the prosthetic valve 30) and the manifold subassembly 24 of the delivery device 15. As shown, there are nine tether loops or tether portions connected to nine eyelets, although that number may be varied as desired and / or needed. The suture or tether retention mechanisms described herein advantageously do not require that the tether or suture 710 extend through and along a long portion of the length of the delivery device 15.

[0067] FIG. 9A shows a perspective view of the housing or handle 14 of the delivery device 15. FIG. 9B shows a side cross-sectional view of the handle 14. The handle 14 includes a control mechanism for driving one or more shafts of the elongate catheter. The control mechanism may include actuators, such as rotatable knobs, that can operate different components of the delivery system 10 (e.g., drive corresponding shafts or subassemblies of the shaft assembly 12). The distal end of the handle 14 includes an actuator in the form of a capsule knob 905. Rotationally driving the capsule knob 905 in a certain direction drives the outer sheath subassembly 20 axially in a proximal direction, which releases and deploys a distal portion (e.g., ventricular portion) of the implant 30 from the capsule subassembly 306. Driving the capsule knob 905 rotationally in the opposite direction drives the outer sheath subassembly 20 (including the capsule subassembly 306) distally, thereby recapturing, retrieving, or re-stowing the implant 30 within the capsule subassembly 306. The outer sheath subassembly 20 may be driven translationally independently relative to the other subassemblies within the delivery device 15. The distal end of the implant 30 may be released first, in which case the proximal end of the implant 30 may remain radially compressed within the pusher member 506 of the mid-shaft subassembly 22.

[0068] Continuing proximally, the handle 14 includes a stabilizing attachment region 910 configured to cooperate with a clamp of the stabilizing assembly 1100 configured to control the medial / lateral position of the delivery device 15. Continuing proximally, an actuator in the form of a primary bending rail knob 915A and a secondary bending rail knob 915B are provided. Rotationally driving the primary bending rail knob 915A causes bending of the primary bending portion, i.e., the distal slotted hypotube section 406D of the rail hypotube 406, which changes the medial / lateral trajectory. Rotationally driving the secondary bending rail knob 915B causes bending of the primary bending portion, i.e., the proximal slotted hypotube section 406P of the rail hypotube 406, which changes the anterior / posterior trajectory. However, the number of bending rail knobs 915A,B may be varied depending on the number of pull wires being used.

[0069] Proximal to the secondary bend rail knob 915B is a depth knob 920 which controls the actuation of the outer sheath subassembly 20, the mid shaft subassembly 22, the release subassembly 23, and the manifold subassembly 24 relative to the rail subassembly 21. The depth knob 920 may also, in some configurations, actuate other subassemblies together relative to the rail subassembly 21.

[0070] Further proximally, an actuator in the form of an actuator knob or release knob 925 is provided. The release knob 925 may be rotated proximally to apply tension onto the manifold subassembly 24 during loading, recapture or retrieval of the implant 30. The release knob 925 may be rotated distally to deploy a proximal portion of the implant 30 (e.g., the atrial portion) or a distal portion of the implant 30 (e.g., the ventricular portion) (after the capsule subassembly 306 has been retracted). Driving the release knob 925 distally releases the tension on the manifold subassembly 24. As discussed above, the safety lock 927 prevents sufficient distal movement of the release knob 925 to allow release of the implant 30 until the safety lock 927 is removed from the handle 14. After the safety lock member 927 is released, continued distal actuation of the release knob 925 drives the manifold subassembly 24 distally relative to the release subassembly 23, facilitating release of the tether 710 from the manifold subassembly 23 (e.g., the distal tether loop can be pushed out of the tab 716 of the proximal tether retaining member 706 of the manifold subassembly 23 by the window 610 of the release assembly 23). The most proximal knob is the nosecone knob 930, which is rotationally actuated to drive the nosecone subassembly in a proximal-distal direction.

[0071] The nosecone subassembly may include a nosecone shaft having a distal end connected to the radially innermost subassembly, the nosecone 87 (shown in FIG. 13C). For example, the knob 930 may be part of the nosecone subassembly extending from the proximal end of the handle 14. Thus, a user may pull or push the knob 930 and rotate the knob 930 to translate the nosecone shaft in a distal-proximal direction independent of the other shafts. This may advantageously translate the nosecone 87 proximally into the outer sheath assembly 20 / capsule subassembly 306, facilitating withdrawal of the delivery device 15 from the patient. The nosecone 87 may have a tapered tip. The nosecone 87 can be formed from a thermoplastic or elastomeric material, or from a material such as PEBAX®, to allow for atraumatic entry and minimize damage to the venous vasculature. The nosecone 87 can also be radiopaque to provide visibility under fluoroscopy. The nosecone assembly is preferably disposed within a lumen of the manifold subassembly 24. The nosecone assembly may include a lumen for passing a guidewire therethrough. Additional structural and operational details regarding the handle and nosecone assembly, such as those described with respect to the handle and nosecone assembly in U.S. Patent Application Publication Nos. 2019 / 0008640 and 2019 / 0008639, which are incorporated herein by reference, may be incorporated into the handle 14 and nosecone subassembly herein.

[0072] FIG. 10A illustrates how the handle 14 of the elongate catheter or delivery device 15 cooperates with an example stabilization assembly 1100 in the delivery system 10. FIG. 10B illustrates a perspective view of the stabilization assembly 1100 without the delivery device 15 attached. FIG. 10C illustrates a top view of the stabilization assembly 1100 of FIG. 10A. The stabilization assembly 1100 includes a clamp 1105, a guide assembly 1110, a rail 1115, and a base 1120. The clamp 1105 is configured to couple to a stabilization attachment region 910 on the handle 14 of the delivery device 15. The guide assembly 1110 is configured to cause a medial / lateral positional change of the delivery device 15 by movement along the rail 1115. The rail 1115 may be mounted on the base 1120 and may be fixed relative to the base 1120. Additional details regarding the stabilization assembly 1100 may be found in U.S. Patent Application Publication No. 2020 / 0108225, published January 10, 2020, the entire contents of which are incorporated herein by reference.

[0073] FIG. 11 illustrates a schematic diagram of a transseptal delivery approach. As shown in FIG. 11, in one example, the delivery system 10 can be placed in the ipsilateral femoral vein 1074 and driven forward toward the right atrium 1076. Access to the left atrium 1078 can then be gained by performing a septal puncture using known techniques. The delivery system 10 can then be driven forward into the left atrium 1078 and into the left ventricle 1080. FIG. 11 illustrates the delivery system 10 extending from the ipsilateral femoral vein 1074 to the left atrium 1078. Although in the example of the present disclosure, a guidewire is not required to properly position the delivery system 10, in other examples, one or more guidewires may be used.

[0074] Thus, advantageously, a user may steer the delivery system 10 through complex regions of the heart to place a replacement mitral valve in alignment with the native mitral valve. This may be accomplished with or without the use of a guidewire using the system disclosed above. The distal end of the delivery system 10 may be driven forward into the left atrium 1078. The user may then manipulate the rail subassembly 21 to direct the distal end of the delivery system 10 to the appropriate region. The user may then continue to pass the bent delivery system 10 through the transseptal puncture and into the left atrium 1078. The user may then further manipulate the delivery system 10 to bend the rail subassembly 21 even more. Additionally, the user may further manipulate and control the position of the delivery system 10 by applying a torque to the entire delivery system 10. In the fully bent configuration, the user may then place the replacement valve in the proper position. This advantageously allows the replacement valve to be delivered in situ to an implantation site, such as the native mitral valve, via a more diverse approach, such as a transseptal approach.

[0075] FIG. 12 illustrates a schematic diagram of a portion of an example replacement heart valve (implant 30) as positioned within a native mitral valve of a heart 83. Further details regarding how the implant 30 may be positioned at the native mitral valve are described in U.S. Patent Application Publication No. 2015 / 032800, published November 19, 2005, the entirety of which is incorporated herein by reference, including, but not limited to, FIGS. 13A-15 and paragraphs

[0036] -

[0045] . A portion of a native mitral valve is shown diagrammatically, depicting typical anatomical structures including a left atrium 1078 positioned above an annulus 1106 and a left ventricle 1080 positioned below the annulus 1106. The left atrium 1078 and the left ventricle 1080 communicate with each other via the annulus 1106. 12 is a schematic representation of a natural mitral valve leaflet 1108 having chordae tendineae 1111 that connect the downstream ends of the mitral valve leaflets 1108 to the papillary muscles of the left ventricle 1080. The portion of the implant 30 disposed upstream of the annulus 1106 (towards the left atrium 1078) can be referred to as being supranulnarly disposed. The portion disposed generally within the annulus 1106 is referred to as being intraannularly disposed. The portion disposed downstream of the annulus 1106 is referred to as being infranularly disposed (towards the left ventricle 1080).

[0076] As illustrated in FIG. 12 , the implant 30 can be positioned such that an end or tip of the distal anchor 37 is on the ventricular side of the mitral valve annulus 1106. The distal anchor 37 can be positioned such that an end or tip of the distal anchor 37 is on the ventricular side of the native leaflet beyond where the chordae tendineae 1111 are connected to the free ends of the native leaflet. The distal anchor 37 can extend between at least some of the chordae tendineae 1111 and, in some circumstances, can contact or engage the ventricular side of the annulus 1106. It is also envisioned that, in some circumstances, the distal anchor 37 may not contact the annulus 1106, but the distal anchor 37 may still contact the native leaflet 1108. In some circumstances, the distal anchor 37 can contact tissue of the left ventricle 1080 beyond the annulus 1106 and / or beyond the ventricular side of the leaflet 1108.

[0077] 13A-13F illustrate various steps in deploying and recapturing an implant (e.g., a replacement heart valve) 30 using the elongated catheter or delivery device 15 described herein. The capsule subassembly 306 advantageously facilitates recapture of the implant 30 after initial deployment. FIG. 13A illustrates the initial deployment of the implant 30 from the elongated catheter or delivery device 15. For example, the initial deployment may occur within the mitral annulus after a transfemoral and / or transseptal approach. Note that upon initial full deployment of the implant 30 to a fully expanded configuration, the implant 30 remains anchored relative to the elongated catheter or delivery device 15. In some instances, the clinician may determine after various tests (e.g., using various imaging and measurement modalities) that the initial deployment location is not ideal. For example, the ideal location may be a higher or lower location compared to the initial deployment location. In order to prevent damage to the implant 30 and to the heart, the implant 30 may be recaptured before moving the implant 30 to a new implantation location. Recapture of the implant 30 may be performed by driving the capsule subassembly 306 of the outer sheath subassembly 20 distally forward onto the implant 30 to transition the implant 30 to a compressed configuration.

[0078] Figures 13B and 13C show various stages in the recapture of the implant 30. As shown in Figure 13B, the capsule subassembly 306 has been driven forward distally to capture a proximal portion of the implant 30. Figure 13C shows complete recapture of the implant 30 where the capsule subassembly 306 has been driven fully forward distally until it contacts the nosecone 87 of the nosecone subassembly.

[0079] After moving the distal end of the delivery device 15 to the new location, the capsule subassembly 306 of the outer sheath subassembly 20 can again be retracted proximally to release the distal portion of the implant 30 (e.g., at the new implantation location within the mitral or tricuspid annulus), as shown in FIG 13D. The manifold subassembly 23 and the release subassembly 24 can then be driven distally to deploy the proximal portion of the implant 30 from the pushing member 506 of the midshaft subassembly 22, as shown in FIG 13E. After confirming that the fully deployed implant 30 is in the ideal and proper final implantation location, the tether 710 can be released from the manifold subassembly 24, as shown in FIG 13F, allowing the delivery device 15 to be retracted and removed from the heart, and further removed from the subject.

[0080] During a deployment procedure, it may be advantageous to reduce tension or compression on at least one shaft of the elongate catheter or delivery device 15. For example, during a deployment procedure, driving one of the shafts (e.g., the shaft of the outer sheath subassembly 20, etc.) in a retracted manner may provide a tension force in the shaft. Similarly, driving one of the shafts in an advanced manner may provide a compression force in the shaft (e.g., the shaft of the outer sheath subassembly 20, etc.). Actions that may create a tension force in a shaft, such as the outer sheath subassembly 20, may include retraction of the capsule subassembly 306 during an implant release procedure. Actions that may create a compression force in a shaft, such as the outer sheath subassembly 20, may include distal advancement of the capsule subassembly 306 during an implant recapture procedure.

[0081] Similarly, a tensile or compressive force in one of the shafts may create a tensile or compressive force in another shaft. Forces from one shaft may apply a load onto one or more other shafts in the elongate catheter or delivery device 15. For example, a tensile force in the outer sheath subassembly 20 may create a tensile force in another subassembly, such as the manifold subassembly 24. Too much tensile force in the manifold subassembly 24 may impede the ability of the manifold subassembly 24 to operate properly or, in some instances, may damage the manifold subassembly 24. Thus, it may be beneficial to reduce the tensile or compressive force in at least one shaft, thereby reducing the force in that shaft and also reducing the tensile or compressive force in another shaft in the elongate catheter. Such a reduction may reduce damage to the shaft.

[0082] A method for reducing the tensile or compressive force in the shaft may include manually manipulating a control mechanism (e.g., a handle knob, as disclosed herein, etc.) to reduce the tensile or compressive force in the shaft. The control mechanism may control all or a fewer number of shafts in the elongate catheter (e.g., one or more shafts). For example, referring to FIG. 9A, the capsule subassembly 306 may be retracted by manually rotating the capsule knob 905, which may generate a tensile force in the capsule subassembly 306. To reduce such a tensile force, the user may "backdrive" or "backoff" the retraction of the capsule subassembly 306 by rotating the capsule knob 905 in the opposite direction by an amount that reduces the residual tensile force in the shaft. The user may reduce the tensile force such that the tensile force in the capsule subassembly 306 may be zero or neutral with respect to the other shafts of the delivery device 15, i.e., the elongate catheter. A similar operation of "backdrive" or "backoff" may occur when the capsule subassembly 306 is driven forward in a recapture procedure. A user may "backdrive" or "backoff" the capsule subassembly 306 by rotating the capsule knob 905 in the opposite direction, thereby reducing the amount of residual compressive force in the shaft.

[0083] However, manually "backdriving" or "backing off" can be tedious for the user. Additionally, a user may forget to "backdrive" or "back off" manually, which can result in residual tension or compression forces in the shaft, potentially damaging or rendering inoperable one or more shafts in the long catheter. For example, tension in the outer sheath subassembly 20 can cause difficulty in manipulating the rail subassembly 21, creating excessive tension in the manifold subassembly 24, which can damage the tether or suture 710 coupled to the implant, the manifold cable 705, or another component of the manifold subassembly 24. A variety of other adverse effects can occur.

[0084] Thus, a force reduction mechanism may be provided that may be configured to automatically reduce a tensile or compressive force in at least one shaft of an elongate catheter. The force reduction mechanism may be for automatically reducing a tensile or compressive force in at least one of the one or more shafts upon a corresponding threshold tensile or compressive force in at least one of the one or more shafts, respectively. The force reduction mechanisms disclosed herein may be configured to reduce the tensile or compressive force, thereby reducing the tensile or compressive force, and / or may be configured to completely eliminate the tensile or compressive force, and / or may be configured to equalize the tensile or compressive force across multiple shafts of an elongate catheter. In an example, the forces across multiple shafts may be equalized or neutralized.

[0085] The force reduction mechanisms disclosed herein may be configured to reduce tensile or compressive forces in a shaft being driven by the control mechanism, or in another shaft of the elongate catheter that is not being driven by the control mechanism but is experiencing tensile or compressive forces. With respect to the shaft of the elongate catheter, the tensile or compressive forces that the force reduction mechanism may reduce may be generated by an external or other force applied to that shaft during deployment, or may be generated by movement or tension or compression of another shaft in the elongate catheter. For example, actuation of the outer sheath subassembly 20 by the control mechanism may generate a tensile force in the outer sheath subassembly 20, which may generate a corresponding tensile force in the manifold subassembly 24. The force reduction mechanism may be configured to reduce tensile forces in either or both of the outer sheath subassembly 20 and the manifold subassembly 24, such as those generated by actuation of the outer sheath subassembly 20. The force reduction mechanism may be configured to automatically allow at least one of the one or more shafts to be driven in a distal direction to reduce a tensile force generated by the one or more shafts being driven in a proximal direction by the control mechanism. Similarly, the force reduction mechanism may be configured to automatically allow at least one of the one or more shafts to be driven in a proximal direction to reduce a compressive force generated by the one or more shafts being driven in a distal direction by the control mechanism.

[0086] The force reduction mechanism may be configured to automatically reduce the tension or compression on a shaft being driven by the control mechanism or on another shaft not being driven by the control mechanism. For example, when the control mechanism is driving a first shaft, the force reduction mechanism may automatically reduce the tension or compression in the first shaft. When the control mechanism is driving a first shaft, the force reduction mechanism may automatically reduce the tension or compression on a second shaft, which may or may not be driven by the control mechanism. Various other shafts or subassemblies in an elongate catheter may have tension or compression reduced by the force reduction mechanisms disclosed herein.

[0087] In examples, reducing forces within a shaft, such as the outer sheath subassembly 20 or the manifold subassembly 24, may improve the movement of other shafts in the elongate catheter or delivery device 15. For example, improved movement for the rail subassembly 21 may occur when forces are reduced within other shafts in the elongate catheter or delivery device 15, resulting in improved flexibility of the rail subassembly 21. Improved movement of multiple shafts in the elongate catheter or delivery device 15 may occur when forces between the shafts are neutralized.

[0088] 14, for example, illustrates an example force reduction mechanism 1200 configured to automatically enable a control mechanism actuator in the form of a release knob 925 to drive the manifold subassembly 24 forward in a distal direction or backward in a proximal direction when a corresponding tensile or compressive force is applied to the manifold subassembly 24. The force reduction mechanism 1200 may be configured to automatically enable the release knob 925 to be rotationally actuated relative to the handle, for example, to reduce the tensile or compressive force in the manifold subassembly 24. The release knob 925 may be configured to be rotationally actuated about the threads 1202 in a direction to drive the manifold adapter 704 forward in a distal direction (to release the tether or suture 710) or may be configured to be rotationally actuated in the opposite direction to drive the manifold adapter 704 backward in a proximal direction (to secure the tether or suture 710). For example, the safety locking member 927 shown in FIG. 14 may be rotatably driven to an unlocked position, thereby rotatably driving the release knob 925 to drive the manifold adapter 704.

[0089] FIG. 15 illustrates a cross-sectional view of the handle taken along line AA shown in FIG. The handle 14 may include an internal bore 1204 for disposing the manifold adapter 704 therein. The handle 14 may include an internal flat surface 1205 along which the manifold adapter 704 is driven to slide longitudinally. The handle 14 may include a protrusion 1207 for threading into a channel 1206 of the manifold adapter 704. The handle 14 may include an opening 1214 or channel extending from an inner surface of the handle 14 to an outer surface 1209 of the handle 14. The opening 1214 may extend longitudinally along the handle 14. The outer surface 1209 of the handle 14 may include a thread 1202.

[0090] The manifold adapter 704 may be disposed within the interior lumen 1204 of the handle 14 and may be located at a proximal portion of the manifold subassembly 24. The manifold adapter 704 may include a guide in the form of a channel 1206 that may be configured to receive a protrusion 1207 of the handle 14. The manifold adapter 704 may include a flat portion 1208 that may slide along an interior flat surface 1205 of the handle 14. The flattened portion 1208 and the channel 1206 may function to prevent rotation of the manifold adapter 704 within the interior lumen 1204 of the handle when the manifold adapter 704 moves longitudinally.

[0091] The manifold adaptor 704 may further include a central body 1212 and an engagement surface 1210 that may extend radially outward from the central body 1212. The engagement surface 1210 may include one or more protrusions or wings or be otherwise configured to be engageable with the release knob 925. The one or more protrusions or wings may extend radially outward from the manifold adaptor 704 to engage with the release knob 925. The engagement surface 1210 may be configured to pass through an opening 1214 or channel in the handle and may slide longitudinally along the opening 1214 or channel.

[0092] The release knob 925 may be configured to be rotationally driven about the threads 1202 on the outer surface 1209 of the handle 14 and may engage an engagement surface 1210 of the manifold adapter 704. The release knob 925 may thus drive the manifold adapter 704 longitudinally due to the engagement between the engagement surface 1210 and the release knob 925. Due to the ability of the manifold adapter 704 to be slidably driven along the handle 14 but not rotationally driven, the manifold adapter 704 may be able to translate the rotational movement of the release knob 925 into linear or longitudinal movement of the manifold adapter 704 and the manifold subassembly 24.

[0093] When a tensile or compressive force is experienced within the manifold subassembly 24, the tensile or compressive force may be transferred directly to the manifold adapter 704 in the form of a corresponding distal or proximal drive force, respectively, on the manifold adapter 704. Thus, the tensile or compressive force may be transferred to the release knob 925 via the engagement surface 1210. Thus, the rotatable release knob 925 may reduce the tensile or compressive force within the manifold subassembly 24.

[0094] 16, the force reduction mechanism 1200 may include a configuration of the threads 1202 and / or the release knob 925 that may automatically allow for "backdriving" or "backing off" of the release knob 925 when an axial load (e.g., tensile or compressive force) is applied to the release knob 925. Features of the force reduction mechanism 1200 that may allow for automatic "backdriving" or "backing off" may include screw lead and inverse efficiency. The following equation describes the backdrive torque (T) as a function of the axial load (F) in Newtons, the screw lead (P) in meters, and the inverse efficiency (η2): b ) (unit: Newton-meter).

number

[0095] By utilizing screw lead, inverse efficiency, or a combination of these factors, a desired "backdrive" or "backoff" can be created for the release knob 925. The threads 1202 may have a pitch angle 1216 that creates a screw lead that can automatically rotate the release knob 925 relative to the handle when an axial load is applied, thereby relieving tension or compression forces within the manifold subassembly 24. Thus, when the user releases the release knob 925, the release knob 925 can automatically be rotated, thereby reducing tension or compression forces within the manifold subassembly 24.

[0096] The use of an actuator configured to automatically drive rotation to reduce tensile or compressive forces in a subassembly is not limited to manifold subassembly 24, but may be utilized with any subassembly disclosed herein. For example, FIG. 17 illustrates a view of a distal portion of handle 14, and in particular, a view of capsule knob 905.

[0097] Figure 18 illustrates a cross-sectional view of the handle 14 taken along line BB in Figure 17. The handle 14 includes a longitudinally extending internal lumen 1220. A beam 1228 may extend through the internal lumen 1220 and may have a "U" shape (as shown more clearly in Figure 37).

[0098] The capsule knob 905 is shown coupled to a rotating body 1218 that may extend longitudinally along an interior lumen 1220 of the handle 14. The rotating body 1218 may have a cylindrical shape and may include an inner surface with threads 1222. The threads 1222 may engage with corresponding threads 1224 on the outer sheath adapter 303.

[0099] The outer sheath adapter 303 may be disposed at a proximal portion of the outer sheath subassembly 20 and may include a guide in the form of a flange 1226 extending outwardly from the outer sheath adapter 303 and contacting a beam 1228 within the internal lumen 1220. The "U" shape of the beam 1228 may prevent rotation of the outer sheath adapter 303. The outer sheath adapter 303 is rotationally constrained and may be slidably driven longitudinally, i.e. linearly, along the beam 1228 upon rotation of the rotating body 1218 due to engagement of the threads 1222, 1224.

[0100] FIG. 19 illustrates a side cross-sectional view of a distal portion of the handle 14, for example, taken along line BB shown in FIG. 17. Similar to the force reduction mechanism 1200 in FIG. 16, the force reduction mechanism 1230 may be provided such that the capsule knob 905 may be similarly rotationally actuated to automatically reduce tension or compression of the outer sheath. Similar to the force reduction mechanism 1200 in FIG. 16, a desired "backdrive" or "backoff" on the capsule knob 905 may be created by utilizing screw lead, reverse efficiency, or a combination of these factors. Various other actuators in the delivery system may be configured to create the desired "backdrive" or "backoff."

[0101] In an example, components may be provided such that the inverse efficiency (η2) may be adjusted. FIG. 20 illustrates, for example, a friction member that may be utilized to change the inverse efficiency (η2). The friction member may include a clamp 1240 that may be positioned along the handle 14 to change the inverse efficiency relative to the release knob 925.

[0102] FIG. 21 illustrates a cross-sectional view of the handle, for example, taken along line CC as shown in FIG. 20. The clamp 1240 is shown passing through the opening 1214 with the outer clamp body 1242 positioned outside the handle 14 and the inner clamp body 1244 positioned inside the handle 14. The outer clamp body 1242 may include a rotatable body configured to tighten against the inner clamp body 1244, thereby increasing the frictional force between the clamp 1240 and the handle 14. The variation in frictional force may be controlled by the degree of tightening of the outer clamp body 1242. The clamp 1240 may include an engagement portion 1246 configured to engage the release knob 925 and transfer the increased friction provided by the clamp 1240 to the release knob 925.

[0103] In an example, the amount of friction, and therefore the variation in inverse efficiency (η2), and also the amount of “backdrive” or “backoff” may be controlled by adjusting the clamp 1240. For example, tightening the clamp 1240 may increase friction and loosening the clamp 1240 may decrease friction. Thus, by controlling the inverse efficiency (η2), a user may increase or decrease the responsive drive or rotational drive on the release knob 925 in response to an axial load applied onto the manifold subassembly, that is, in response to an axial load, which may be a proximal axial load, i.e., a compressive axial load, or a distal axial load, i.e., a tensile axial load.

[0104] Other frictional members may be utilized in combination or alone. For example, a frictional member such as a friction ring 1248 or an O-ring may be provided that may modify the inverse efficiency (η2). The friction ring 1248 may be provided to slide along the inner surface of the handle 14 or along another portion of the elongate catheter 15. The friction ring 1248 may be located on the manifold adapter 704 or may have another location as desired.

[0105] The use of one or more friction members may be implemented for the manifold subassembly 24 or any other subassembly or shaft disclosed herein. The features described with respect to Figures 16-21 may be utilized for the manifold shaft or manifold subassembly 24 or any other shaft or assembly or subassembly in a delivery system. For example, the example of Figures 16-21 may be implemented for the outer sheath or outer sheath subassembly 20 or any other shaft or assembly or subassembly disclosed herein. The rail subassembly 21, the midshaft subassembly 22, the release subassembly 23, or the nosecone assembly may utilize the example of Figures 16-21. Any feature of the control mechanism, such as the control knob, disclosed herein may be utilized in combination with or in place of the example of Figures 16-21. Any feature of the adapter disclosed herein may be utilized in combination with or in place of the example of Figures 16-21.

[0106] Other configurations for a force reduction mechanism configured to automatically reduce tensile or compressive forces in the shaft may be utilized. Figures 22-23, for example, illustrate one implementation in which the force reduction mechanism may be configured to automatically reduce tensile or compressive forces in the shaft as the shaft may be driven proximally or distally relative to the control mechanism. A displacement body 1260 may be utilized that may disengage the shaft from the control mechanism.

[0107] FIG. 22 illustrates a cross-sectional view of the handle 14 taken along a centerline, such as line CC in FIG. 20. Although the configuration of the handle 14 has been modified from that shown in FIG. 20, the features of the configuration shown in FIG. 20 may be utilized with the features of FIG. 22. The manifold adaptor 1262 is provided with an engagement surface 1264 in the form of a displacement body 1260 configured to be displaced inwardly when a sufficient axial force is applied to the manifold adaptor 1262. The displacement body, configured to enable the manifold subassembly 24 to be driven proximally or distally relative to the control mechanism 1268, may further include a spring 1266 that may bias the displacement body 1260 outwardly from a central body 1265 of the manifold adaptor 1262. The spring 1266 may be disposed on the manifold adaptor 1262. The spring 1266 may bias the displacement body 1260 of the manifold adapter 1262 towards an actuator in the form of an actuator or release knob 1269 .

[0108] The actuator or release knob 1269 may be for driving the shaft or manifold subassembly 24 forward or backward when the actuator or release knob 1269 is engaged with the shaft or manifold subassembly 24 .

[0109] 15, may include one or more wings or protrusions, but may be configured to displace inwardly due to the compressibility of the spring 1266. The one or more wings or protrusions may extend radially outward from the manifold adapter 1262 for engaging with an actuator or release knob 1269.

[0110] The control mechanism 1268 may include an actuator in the form of an actuator knob or release knob 1269 that may include one or more engagement portions 1270 that may be configured to engage the engagement surface 1264. The actuator knob or release knob 1269 may include an inner surface for engaging the engagement surface 1264. The engagement portion 1270 may include a recess in the inner surface of the release knob 1269 configured to receive the engagement surface 1264 of the manifold adapter 1262, or may have another configuration as desired.

[0111] The displacement body 1260 may be configured to automatically reduce tensile or compressive forces within at least one of the one or more shafts by allowing the manifold subassembly 24 to be driven proximally or distally relative to the control mechanism 1268.

[0112] When a threshold axial load on the manifold adapter 1262 is reached, the spring 1266 may be compressed inwardly, allowing the displacement body 1260 to be displaced inwardly. This displacement may cause the engagement surface 1264 of the adapter 1262 to disengage from an actuator in the form of a release knob 1269, and allow the manifold adapter 1262 to slide axially relative to the release knob 1269. Such axial movement may reduce tension or compression forces in the manifold subassembly 24, for example.

[0113] The force reduction mechanism may allow the shaft or manifold subassembly 24 to disengage from the actuator knob or release knob 1269, thereby reducing the pulling force in the shaft.

[0114] FIG. 23, for example, illustrates the manifold adapter 1262 being released from the release knob 1269. The spring 1266 may be compressed inwardly and the engagement surface 1264 may be disengaged from the engagement portion 1270 of the release knob 1269. The adapter may automatically reduce tension or compression forces in at least one of the shafts or shafts by disengaging from the actuator. The manifold adapter 1262 and manifold subassembly 24 may be configured to be slidably driven relative to the release knob 1269. The force reduction mechanism may disengage the shaft or manifold subassembly 24 from the actuator knob or release knob 1269 when a threshold tension force is reached to allow the shaft or manifold subassembly 24 to be slidably driven longitudinally relative to the actuator knob or release knob 1269.

[0115] In an example, the release knob 1269 may include a plurality of engagement portions 1270 that may be configured to engage with the engagement surface 1264. The engagement portions 1270 may be adjacently disposed in a linear series along the release knob 1269. Thus, the engagement surface 1264 may be configured to sequentially engage the engagement portions 1270 when a compressive or tensile force displaces the manifold adapter 1262 relative to the release knob 1269.

[0116] Indicators may be utilized that may indicate tension or compression forces within at least one of the one or more shafts. For example, an audible indicator may be utilized with the manifold adapter 1262 to indicate displacement of the manifold adapter 1262 relative to the release knob 1269. Sequential engagement may produce a clicking sound, such as a "click" or another sound that may indicate to a user that the manifold adapter 1262 is disengaged from the release knob 1269. In the examples herein, other forms of indicators may be utilized. For example, displacement of the manifold adapter 1262 relative to the release knob 1269 may produce a vibration, which may include a tactile indicator.

[0117] Any of the subassemblies disclosed herein may utilize force reduction mechanisms such as those disclosed with respect to Figures 22-23.

[0118] 24-26 illustrate an example where a portion of the release knob 1280 may be displaced relative to another portion of the release knob to reduce tensile or compressive forces within the manifold subassembly. With reference to FIG. 24, the release knob 1280 may include a first or outer portion 1282 and a second or inner portion 1284. The outer portion 1282 may include, for example, a shell extending around the inner portion 1284. The outer portion 1282 may surround the inner portion 1284 or may have another configuration. The inner portion 1284 may be configured to displace relative to the outer portion 1282 when a tensile or compressive force is applied to the release knob 1280.

[0119] 25 illustrates a cross-sectional view of release knob 1280 taken along the centerline. Inner portion 1284 may engage with manifold adapter 704. Inner portion 1284 may include an engagement portion 1285, which may be configured to receive engagement surface 1210 of manifold adapter 704, for example. Engagement portion 1285 may include a recess in an inner surface of inner portion 1284 configured to receive engagement surface 1210 of manifold adapter 704, or may have another configuration as desired.

[0120] The inner portion 1284 may be configured to displace with the manifold adapter 704 in response to a tensile or compressive force. A displacement body 1286, such as a spring, may be disposed within the actuator in the form of the release knob 1280 and configured to bias the inner portion 1284 proximally towards the outer portion 1282. The displacement body 1286 may be configured to automatically allow the inner portion 1284 to displace relative to the outer portion 1282 when a compressive or tensile force is applied to the manifold adapter 704, thereby reducing the tensile or compressive force on the manifold adapter 704. The displacement body 1286 may be configured to automatically reduce the tensile or compressive force in at least one of the one or more shafts by allowing the manifold subassembly 24 to be driven proximally or distally relative to the control mechanism.

[0121] 26, for example, illustrates the tension forces in the manifold adapter 704 as the manifold adapter 704 is displaced distally. The inner portion 1284 may be displaced distally along with the manifold adapter 704. The displacement body 1286 may be compressed between the outer portion 1282 of the release knob 1280 and the inner portion 1284 of the release knob 1280.

[0122] In an example, the spring force of the displacement body 1286 may be set to determine the amount of force that displaces the manifold adapter 704 and the inner portion 1284. For example, a smaller spring force may cause a smaller tensile or compressive force to cause displacement of the inner portion 1284 relative to the outer portion 1282. A larger spring force may cause a larger tensile or compressive force to cause displacement of the inner portion 1284 relative to the outer portion 1282.

[0123] In an example, the displacement of the outer portion 1282 relative to the inner portion 1284 may include a visual indicator of the applied tensile or compressive force against the manifold subassembly 24. The indicator may include at least the displacement of the body including the outer portion 1282 of the actuator from the body including the inner portion 1284 of the actuator and the displacement of the adapter 704 from the outer portion 1282 of the release knob 1280. For example, the outer surface 1288 of the inner portion 1284 may include a visual indicator of the applied force against the manifold subassembly 24. The amount or length of the outer surface 1288 of the inner portion 1284 that is exposed from beneath the outer portion 1282 may indicate the magnitude of the force. FIG. 24, for example, illustrates the exposure of the inner portion 1284 from the outer portion 1282. In an example, scales or other configurations of indicia may be placed on the outer surface 1288 to indicate the magnitude of the force. For example, a greater amount of graduations may be indicated by a greater amount or length exposed on the outer surface 1288 based on the force applied to the manifold subassembly 24. The indicator may further include a displacement body 1286 in the form of a spring coupling the inner portion 1284 to the outer portion 1282.

[0124] 27-28 illustrate a cross-sectional view along a centerline of an example where the release knob 1290 is configured to split when a tensile force is applied to the manifold subassembly 24. The release knob 1290 may include, for example, a first or proximal portion 1292 and a second or distal portion 1294. The release knob 1290 may be split along a center portion of the release knob 1290 located between the proximal portion 1292 and the distal portion 1294, and a displacement body 1296, such as a spring, pulls the distal portion 1294 toward the proximal portion 1292. The displacement body 1296 may be disposed on an actuator configured for the release knob 1290. A connector 1298, such as a pin, may connect the proximal portion 1292 and the distal portion 1294 and may include a piston head 1300 that may engage with the displacement body 1296.

[0125] The displacement body 1296 may be configured to automatically reduce tensile or compressive forces within at least one of the one or more shafts by allowing the manifold subassembly to be driven proximally or distally relative to the control mechanism.

[0126] The second or distal portion 1294 may include an engagement portion 1302 that may be configured to engage with the engagement surface 1210 of the manifold adapter 704. The first or proximal portion 1292 may include threads 1304 that may be configured to engage with the threads 1202 of the handle 14.

[0127] The release knob 1290 may split when a pulling force is applied to the manifold subassembly 24. The release knob 1290 may split in response to the release knob 1290 being rotationally driven proximally, which may create a pulling force in the manifold subassembly 24, or the release knob 1290 may split due to a pulling force otherwise created in the manifold subassembly 24 (e.g., via driving another shaft in the elongate catheter 15 or via another force applied to the manifold subassembly 24). The splitting of the release knob 1290 may automatically reduce the pulling force in the shaft that includes the manifold subassembly 24.

[0128] FIG. 28 illustrates the separation of the proximal and distal portions 1292, 1294 when a tensile force is applied to the manifold subassembly 24.

[0129] In an example, separation of the proximal portion 1292 and the distal portion 1294 may result in exposure of the connector 1298. The connector 1298 need not be covered, for example, by either the proximal portion 1292 or the distal portion 1294, and the exposed length of the connector 1298 may serve as a visual indicator of the pulling force. The indicator may include at least a displacement of a body including the proximal portion 1292 of the actuator from a body including the distal portion 1294 of the actuator, and a displacement of the adapter 704 from the proximal portion 1292. The indicator may further include a displacement body 1296 in the form of a spring coupling the proximal portion 1292 to the distal portion 1294. The exposed amount or length of the connector 1298 may serve as an indicator of the pulling force. In an example, scales or other configured indicia may be placed on the connector 1298 to indicate the magnitude of the force. For example, a greater amount or length of connector 1298 exposed based on the force applied against manifold subassembly 24 may indicate a greater amount of scale.

[0130] In an example, the displacement body 1296 may be configured to allow the portions 1292, 1294 of the release knob 1290 to be drawn toward one another when a compressive force is applied to the manifold adapter 704. The space between the portions 1292, 1294 in the displacement body 1296 may be reduced. Thus, the release knob 1290 may allow for a reduction in tensile and / or compressive forces on the manifold adapter 704.

[0131] 29-30 illustrate a centerline cross-sectional view of an example where an actuator in the form of a release knob 1310 is configured to disengage from the manifold adapter 704 using a releasable coupler 1312. The release knob 1310 may include, for example, a proximal portion 1316 and a distal portion 1314, where the proximal portion 1316 may be coupled to the distal portion 1314 using the releasable coupler 1312. The proximal portion 1316 may include threads 1323 configured to engage with the threads 1202 of the handle 14. The distal portion 1314 may include an engagement portion 1321 configured to engage with the engagement surface 1210 of the manifold adapter 704. The distal portion 1314 may include a displacement body configured to automatically reduce a tensile or compressive force in at least one of the one or more shafts by allowing the manifold subassembly to be driven proximally or distally relative to the control mechanism.

[0132] The releasable coupler 1312 may include a pin with a wide end 1318 or may have another configuration. The releasable coupler 1312 may extend from a proximal portion 1316 of the release knob 1310 to a distal portion 1314 of the release knob 1310. The releasable coupler 1312 may engage with a coupling body 1319, which may be disposed on the distal portion 1314. The coupling body 1319 may include a surface against the wide end 1318 of the releasable coupler 1312 to engage and hold the proximal portion 1316 of the release knob 1310 against the distal portion 1314 of the release knob 1310.

[0133] In an example, the coupling body 1319 may include a deformable body, such as an elastomeric body, that may be configured to deform when sufficient force is applied to the releasable coupler 1312. Deformation of the coupling body 1319 may allow the releasable coupler 1312 to disengage from the distal portion 1314 and may allow the proximal portion 1316 to disengage from the distal portion 1314 of the release knob 1310. The coupling body 1319 may be configured such that a threshold force may cause the coupling body 1319 to deform, causing the releasable coupler 1312 to disengage.

[0134] In examples, other configurations for the releasable coupler 1312 may allow disengagement of the releasable coupler 1312, such as, for example, a spring arm or a detent, or other configurations of the releasable coupler 1312 may be utilized. The configuration of the releasable coupler 1312 shown in FIG. 29 may be inverted in examples, where the releasable coupler 1312 extends from the distal portion 1314 to a coupling body 1319 disposed on the proximal portion 1316.

[0135] Upon receiving a threshold tensile force within the manifold adapter 704, the distal portion 1314 may be released from the proximal portion 1316 by releasing the releasable coupler 1312. The distal portion 1314 may be released in response to the release knob 1310 being rotationally actuated proximally, which may create a tensile force within the manifold subassembly 24, or may be released by a tensile force otherwise created within the manifold subassembly 24 (e.g., via actuation of another shaft in the elongate catheter 15 or via another force applied to the manifold subassembly 24). The splitting of the release knob 1310 may automatically reduce the tensile force within the shaft that includes the manifold subassembly 24.

[0136] 30, when the releasable coupler 1312 is released, the distal portion 1314 may be configured to slide with the adapter 704 to reduce the tension force in the adapter 704. The adapter may automatically reduce the tension or compression force in at least one of the one or more shafts by disengaging from the actuator. The disengagement and separation of a portion of the actuator (a body including the distal portion 1314 from a body including the proximal portion 1316) may include a visual indicator of the tension or compression force in at least one of the one or more shafts.

[0137] In the examples of Figures 24-30, the actuator of the control mechanism includes a first portion and a second portion configured to automatically reduce a tensile or compressive force in at least one of the one or more shafts upon displacement relative to the first portion.

[0138] In an example, the adapter may be configured to have multiple portions that are displaced relative to one another to reduce tension or compression in a shaft coupled to the adapter. FIGS. 31-32, for example, illustrate an example where an adapter 1320 includes a first or proximal portion 1322 and a second or distal portion 1324. The displacement body 1326 and connector 1328 may be utilized in a manner similar to that of the release knobs disclosed herein to reduce tension or compression in a shaft coupled to the adapter 1320. The displacement body 1326 may be configured to automatically reduce tension or compression in at least one of the one or more shafts by allowing the manifold subassembly to be driven proximally or distally relative to the control mechanism. The displacement body 1326 may be disposed on the adapter 1320.

[0139] The second or distal portion 1324 may be configured to be displaced relative to the first or proximal portion 1322 to reduce tension or compression in a shaft coupled to the second or distal portion 1324. The distal portion 1324 may be driven distally relative to the proximal portion 1322 to reduce tension in the shaft, and may be driven proximally relative to the proximal portion 1322 to reduce compression in the shaft. The connector 1328 may allow the portions 1322, 1324 to remain engaged with one another when they are driven relative to one another. FIG. 32, for example, illustrates how the distal portion 1324 may be displaced relative to the proximal portion 1322.

[0140] In an example, the second or distal portion 1324 of the adapter 1320 may be configured to disengage from the first or proximal portion 1322 of the adapter 1320 in a manner similar to that described with respect to the examples of Figures 29 and 30, or in another manner.

[0141] 22-32, the force reduction mechanism may be configured to automatically reduce tensile or compressive forces in at least one of the one or more shafts of the elongate catheter 15 or delivery device by allowing at least one of the shafts to be driven proximally or distally relative to the control mechanism. The one or more shafts may be configured to automatically reduce tensile or compressive forces in at least one of the one or more shafts by displacing relative to one or more of the actuator and the adapter.

[0142] The examples of Figures 22-32 may be utilized for the manifold shaft or manifold subassembly 24, or any other shaft or assembly or subassembly in a delivery system. For example, the examples of Figures 22-32 may be implemented for the outer sheath or outer sheath subassembly 20, or any other shaft or assembly or subassembly disclosed herein. The rail subassembly 21, the midshaft subassembly 22, the release subassembly 23, or the nosecone assembly may utilize the examples of Figures 22-32. Any features of the control mechanism, such as the control knob, disclosed herein may be utilized in combination with or in place of the examples of Figures 22-32. Any features of the adapter disclosed herein may be utilized in combination with or in place of the examples of Figures 22-32.

[0143] In an example, the force reduction mechanism may include an electric drive. The electric drive may be configured to automatically reduce tensile or compressive forces in at least one of the one or more shafts by driving at least one of the one or more shafts. FIG. 33 illustrates an example, for example, where the electric drive may include a controller 1350 that may include a motor 1354. The controller 1350 may include an electric device and may include a power source 1352 for powering components of the controller 1350 or for powering other components of the system. The power source 1352 may include, for example, a battery, a capacitor, or a power input to the controller 1350 (e.g., a power plug), among other forms for the power source 1352.

[0144] The controller 1350 may include a motor 1354 that may be configured to apply a force to a portion of the system, such as, for example, an adapter 1356 of the system, or directly to a shaft of the system. The force applied by the motor 1354 may reduce a tensile or compressive force in at least one of the one or more shafts of the system. The motor 1354 may include, for example, a piston or screw drive 1358, or may include other forms of motors configured to apply a force to a portion of the system. The motor 1354 may be powered by a power source 1352.

[0145] The controller 1350 may include a processor 1360. The processor 1360 may include a central processing unit (CPU) and may include a single CPU or multiple CPUs utilized in combination. The processor 1360 may be located within the handle or may be located remotely and may be utilized in an internet or cloud computing environment as desired. Other forms of processors may be utilized as desired. The processor 1360 may be powered by a power source 1352.

[0146] The processor 1360 may be configured to control the motor 1354. The processor 1360 may control the motor 1354 in response to sensor signals received by the processor 1360. For example, a sensor 1362 may be provided and may sense a tensile or compressive force applied to the adapter 1356 or other force present in a shaft coupled to the adapter 1356. A signal from the sensor 1362 may be communicated to the processor 1360 via a signal conduit 1364.

[0147] The adapter 1356 may include, for example, a proximal portion 1366 and a distal portion 1368, where the proximal portion 1366 is configured to be actuated relative to the distal portion 1368 in response to a tensile or compressive force applied to a shaft coupled to the adapter 1356, similar to the example shown in FIGS. 31-32. The connector 1370 may be slidably actuated relative to the proximal portion 1366, similar to the connector 1328 shown in FIGS. 31-32, and the sensor 1362 may sense the force applied to the connector 1370, and thus the force applied to the adapter 1356, and further, the force applied to the shaft coupled to the adapter 1356.

[0148] The signal from the sensor 1362 may be communicated via signal conduit 1364 to the processor 1360. The processor 1360 may process the signal from the sensor 1362 to determine the amount of load on the adapter 1356 and also the amount of load on a shaft coupled to the adapter 1356. The processor 1360 may provide various functions in response.

[0149] In an example, the processor 1360 may operate the motor 1354 to cause the motor 1354 to drive the adapter 1356, thereby reducing the tensile or compressive force in the adapter 1356. The motor 1354 may control the adapter 1356 when an increase in tensile or compressive force is sensed by the sensor 1362. The processor 1360 and the motor 1354 may operate automatically to reduce the tensile or compressive force.

[0150] 33, the motor 1354 may apply the force to a proximal portion 1366 of the adapter 1356, or may apply the force to a distal portion 1368 of the adapter 1356, or in examples, may apply the force directly to a shaft coupled to the adapter 1356. In examples, the motor 1354 may apply the force to an actuator of a control mechanism, such as a release knob 925, or to another actuator, as desired.

[0151] In the example shown in FIG. 33 , the processor 1360 and motor 1354 may act as an override to manual control provided by a user. For example, the user may manually operate an actuator such as release knob 925. If an increase in tensile or compressive force is detected via sensor 1362, the processor 1360 may override the manual control and reduce the tensile or compressive force in the adapter 1356 and in the shaft coupled to the adapter 1356 by operating the motor 1354. The processor 1360 may operate based on a feedback signal from the sensor 1362, which may be real-time feedback from the sensor 1362 to the processor 1360. The controller 1350 may automatically drive the shaft coupled to the adapter 1356 in a distal direction to reduce the tensile force or automatically drive the shaft coupled to the adapter 1356 in a proximal direction to reduce the compressive force.

[0152] In an example, a memory may be provided that may store tensile or compressive force thresholds for the processor 1360. The processor 1360 may determine whether the threshold amount of tensile or compressive force is being received based on a signal from the sensor 1362, and may drive the motor 1354 when the threshold amount is being received. The memory may be programmed with user-alterable thresholds or may include preset thresholds.

[0153] In an example, the processor 1360 may provide a signal to the display 1371 regarding the amount of force sensed by the sensor 1362. The user may determine the amount of force sensed by the sensor 1362 and applied to the adapter 1356 by viewing the display 1371 as a visual indicator. Other forms of indicators may be utilized, such as an audible indicator or a tactile indicator. The indicator may include an electrical indicator. For example, an electrical speaker may be provided to generate a sound as an audible indicator. A vibration motor (e.g., an eccentric motor) may be utilized as a tactile indicator, among other forms of indicators that may be utilized.

[0154] Fig. 34 illustrates an example where the controller 1372 operates automatically without the user manually operating the release knob 925 as shown in Fig. 33. The processor 1374 may control the motor 1376 to drive the adapter 1378 and a shaft coupled to the adapter 1378. A power source 1373 may be provided, which may be similar to the power source 1352. The controller 1372 may be configured to operate according to a programmed operating profile or may receive control signals from a control device operated by a user, which may be a control on the handle or a remotely provided control.

[0155] When a threshold tensile or compressive force is sensed in the motor 1376, the processor 1374 may take action to automatically reduce the tensile or compressive force in the adapter 1378 and in the shaft coupled to the adapter 1378. For example, a force greater than a threshold experienced by the motor 1376 may indicate a compressive or tensile force in the adapter 1378. The motor 1376 may take action to reduce the compressive or tensile force. The controller 1372 may automatically drive the shaft coupled to the adapter 1378 in a distal direction to reduce the tensile force, or may automatically drive the shaft coupled to the adapter 1378 in a proximal direction to reduce the compressive force.

[0156] In examples, the controller 1372 may operate in response to feedback signals received from one or more sensors.

[0157] FIG. 35 illustrates a side view of a display 1380 that may be utilized as a visual indicator of tension or compression in a shaft of the system. The shaft may include, for example, the manifold subassembly 24 or another shaft in the system. The display 1380 may include an electronic display of the amount of tension or compression the shaft is experiencing. An electronic scale may be provided on the display 1380 (e.g., the amount of the display is illuminated or otherwise indicated to indicate the force) or a numerical or other form of visual indicator may be utilized. The electronic scale may include, for example, a colored scale or a series of graduated lights (e.g., light emitting diodes or other lights) that indicate a safety or danger zone for each corresponding shaft. A user may determine the tension or compression based on the display 1380 and may reduce the tension or compression by operating an actuator such as the release knob 925. The display 1380 may be operated by a controller in a manner similar to the display 1371 described with respect to FIGS. 33 and 34.

[0158] Thus, examples herein may utilize indicators such as visual, audible, or tactile indicators. Although examples are described with respect to a manifold subassembly, the force reduction mechanisms disclosed herein may be utilized with other shafts or subassemblies. For example, the examples of Figures 33-35 may be utilized with the manifold shaft or manifold subassembly 24, or with any other shaft or assembly or subassembly in a delivery system. For example, the examples of Figures 33-35 may be implemented with the outer sheath or outer sheath subassembly 20, or with any other shaft or assembly or subassembly disclosed herein. The rail subassembly 21, the midshaft subassembly 22, the release subassembly 23, or the nosecone assembly may utilize the examples of Figures 33-55. Any feature of the control mechanism, such as the control knob, disclosed herein may be utilized in combination with or in place of the examples of Figures 33-35. Any of the features relating to the adapters disclosed herein may be used in combination with or in place of the examples of FIGS.

[0159] In the examples of Figures 16-35, the force reduction mechanism may be configured to automatically reduce the tensile or compressive force in at least one of the one or more shafts upon receiving a corresponding threshold tensile or compressive force.

[0160] In examples, the force reduction mechanism may be user actuated. FIGURE 36 illustrates an example adapter 1400 that may be actuated by a user, for example, to reduce tension or compression on a shaft coupled to the adapter 1400. The adapter 1400 may include an engagement body 1402 and a slide body 1404 coupled to the engagement body 1402.

[0161] The engagement body 1402 may be coupled to the slide body 1404 by a displacement body 1406 in the form of a spring. The displacement body 1406 may be disposed on the adapter 1400. The displacement body 1406 may be configured to urge the engagement body 1402 of the adapter 1400 toward the actuator and to disengage the adapter 1400 from the actuator when actuated. The displacement body 1406 may bias the engagement body 1402 away from the slide body 1404, and the bias may be overcome by urging the engagement body 1402 toward the slide body 1404. The displacement body 1406 may be configured to automatically reduce tension or compression forces in at least one of the shafts coupled to the adapter 1400 by allowing the shaft to be actuated proximally or distally relative to the control mechanism.

[0162] The engagement body 1402 may include threads 1408 that may be configured to engage with the threads 1222 of the rotating body 1218 shown in FIG. 18. When the engagement body 1402 is pressed towards the sliding body 1404, the threads 1408 may disengage from the threads 1222 such that the sliding body 1404 may be slidably driven within the internal lumen 1220 shown in FIG.

[0163] Figure 37, for example, illustrates a cross-sectional view of the adapter 1400 within the internal lumen 1220 shown in Figure 18. The engagement body 1402 is shown engaging with the threads 1222 of the rotating body 1218.

[0164] In an example, the actuator 1410 may be utilized to press the engagement body 1402, such that the engagement body 1402 is pressed toward the sliding body 1404, disengaging the threads 1408 from the threads 1222 of the rotating body 1218. The actuator 1410 may include, for example, a pressing body 1413 that presses against the engagement body 1402. As shown in FIG. 38 , the pressing body 1413 may include, for example, an elongated bar disposed within the internal lumen 1220. The elongated bar may be configured to press against the adapter 1400 at various longitudinal positions of the adapter 1400. The actuator 1410 may be configured to be actuated by a user to activate the force reduction mechanism.

[0165] A user may have access to a button 1412 or other form of actuator and may press the push body 1413 against the engagement body 1402. The displacement body 1406 may provide resistance to the force applied by the push body 1413.

[0166] 38, in operation, a user may control an actuator, such as the capsule knob 905, to slide the adapter 1400 to drive the outer sheath subassembly 20 forward or backward. After performing the desired operation, the user may press the actuator 1410 to drive the push body 1413 downward. The push body 1413 may push down the engagement body 1402 to disengage the threads 1408 of the engagement body 1402 from the threads 1222 of the rotating body 1218. The adapter 1400 may be freely slidable independent of the capsule knob 905, which may automatically reduce any tensile or compressive forces within the outer sheath subassembly 20.

[0167] The user may release the actuator 1410 to re-engage the engagement body 1402 with the rotating body 1218 .

[0168] 39-42 illustrate an example in which a cam 1419 or other form of actuator may be utilized to engage and disengage the adapter 1420 from, for example, the threads 1222 shown in FIG. 18. Thus, the cam 1419 may engage and disengage the adapter 1420 from an actuator (such as the capsule knob 905). The cam 1419 may be configured to be operated by a user to activate a force reduction mechanism. The cam 1419 may include a displacement body that may be configured to automatically reduce a tensile or compressive force in at least one of the shafts or shafts by allowing a shaft coupled to the adapter 1420 to be driven proximally or distally relative to the control mechanism.

[0169] The cam 1419 may include a cam shaft that may extend longitudinally along the length of the interior bore 1220 shown in FIG. 18. The cam 1419 may be transposed onto the bottom surface of the beam 1228 shown in FIG. 18, with the rod 1422 extending along the side of the adapter 1420.

[0170] The cam 1419 may be user actuated, and a control device 1423 is provided to rotate the cam 1419 as desired. The control device 1423 may be configured to be operated by a user and may include a knob, or a button, or other form of control device 1423. In the raised position, as shown in FIGS. 39 and 40, the cam 1419 may press the adapter 1420 against the threads 1222. By rotating the rotating body 1218, the adapter 1420 and the outer sheath subassembly 20 may be slidably actuated.

[0171] At a desired time, the user may rotate the cam 1419, as shown in Figures 41 and 42. The user may, for example, rotate the control device 1423 to lower the cam 1419. The adapter 1420 may be disengaged from the threads 1222 and slidably driven along the rod 1422, automatically reducing any tension or compression forces within the outer sheath subassembly 20.

[0172] At a desired time, the cam 1419 may be rotationally driven back to the position shown in FIGS. 39 and 40 to re-engage the threads 1222.

[0173] The force reduction mechanisms disclosed herein may include a clutch, a mechanical push button, an electronic driver, and / or a magnet.

[0174] 36-42, the force reduction mechanism may be configured to automatically reduce the tensile or compressive force in at least one of the one or more shafts of the elongate catheter 15 or delivery device by allowing at least one of the shafts to be driven proximally or distally relative to the control mechanism. The one or more shafts may be configured to automatically reduce the tensile or compressive force in at least one of the one or more shafts by displacing relative to the actuator. The adapter may automatically reduce the tensile or compressive force in at least one of the one or more shafts by disengaging from the actuator.

[0175] Any of the subassembly or shaft examples disclosed herein may utilize the user-actuated force reduction mechanism. For example, the examples of Figures 36-42 may be utilized for the outer sheath or outer sheath subassembly 20, or any other shaft or assembly or subassembly in the delivery system. For example, the examples of Figures 36-42 may be implemented for the manifold shaft or manifold subassembly 24, or any other shaft or assembly or subassembly disclosed herein. The rail subassembly 21, the midshaft subassembly 22, the release subassembly 23, or the nosecone assembly may utilize the examples of Figures 36-42. Any of the features of the control mechanism, such as the control knob, disclosed herein may be utilized in combination with or in place of the examples of Figures 36-42. Any of the features of the adapter disclosed herein may be utilized in combination with or in place of the examples of Figures 36-42.

[0176] 43-59 illustrate implementations including a control mechanism for driving one or more shafts in an elongate catheter or delivery device. The control mechanism may include an actuator knob having a first portion and a second portion, the second portion configured to be rotationally driven relative to the first portion to automatically limit a tensile or compressive force in the at least one shaft transmitted by the actuator knob to the at least one shaft. The rotational drive may prevent the tensile or compressive force in the at least one shaft from exceeding a threshold. For example, the rotational drive may prevent a user from exceeding a corresponding threshold tensile or compressive force in the at least one shaft.

[0177] The rotary drive may prevent a user from applying excessive force (e.g., torque) to the actuator knob, thereby pulling or compressing the at least one shaft too much, thereby reducing the likelihood of damaging the shaft due to over-tensioning or over-compressing.

[0178] 43, for example, a perspective view of an actuator knob 1500 of a control mechanism is shown. The actuator knob 1500 may include a control knob of a delivery system, which may include a release knob as disclosed herein, or may include another configured knob in the delivery system as desired. In examples, other configured actuators may be utilized as desired.

[0179] The actuator knob 1500 may include a first or inner portion 1504 and a second or outer portion 1502. The outer portion 1502 may include an outer body extending about the inner portion 1504. The outer portion 1502 may include an outer shell extending about the inner portion 1504. The outer portion 1502 may surround the inner portion 1504 or may have another configuration. The outer portion 1502 may be configured to displace relative to the inner portion 1504. The displacement may include a rotational displacement. The displacement may automatically limit tension or compression forces in the at least one shaft.

[0180] The inner portion 1504 may include an inner body that may be disposed within the outer portion 1502. The inner portion 1504 may include a sleeve configured to extend over an outer surface of the handle 14, for example, as shown in FIG. 14. The inner portion 1504 may include a central channel 1506 within which the handle 14 may be disposed. The inner portion 1504 may have an inner surface 1508 that may face toward the central channel 1506 and an outer surface 1510 (shown in FIG. 44) that may face opposite the inner surface 1508.

[0181] 44 illustrates a side view on the inner portion 1504. The inner portion 1504 may include multiple portions, including an upper shell 1512 and a lower shell 1514, where the upper shell 1512 and the lower shell 1514 may be joined together via couplers (e.g., screws or snaps) extending through coupler channels 1516 (e.g., threaded holes) in the outer surface 1510 of the inner portion 1504.

[0182] 44, the outer surface 1510 of the inner portion 1504 may have a non-uniform diameter. For example, a central portion 1518 of the inner portion 1504 may have a larger outer diameter as compared to a distal portion 1520 and a proximal portion 1522 of the inner portion 1504. The outer surface 1510 may have a tapered shape. The distal portion 1520 may taper radially inward from the central portion 1518 in a direction toward a distal end 1524 of the inner portion 1504. The proximal portion 1522 may taper radially inward from the central portion 1518 in a direction toward a proximal end 1526 of the inner portion 1504.

[0183] The configuration of the outer surface 1510 of the inner portion 1504 having a non-uniform outer diameter may help reduce longitudinal or axial movement of the outer portion 1502 relative to the inner portion 1504. For example, the outer portion 1502 may have an inner surface 1528 (shown in FIG. 45 ) that matches the shape of the outer surface 1510 of the inner portion 1504. The outer portion 1502 may have, for example, a central portion 1530 that has a larger inner diameter as compared to the distal and proximal portions 1532, 1534 of the outer portion 1502. The shape of the inner surface 1528 may match the shape of the outer surface 1510 of the inner portion 1504 such that longitudinal or axial movement of the outer portion 1502 may be resisted by the larger diameters at the corresponding central portions 1518, 1530, respectively.

[0184] 45, a cross-sectional view is shown for the outer portion 1502. The outer portion 1502 may include multiple portions, including an upper shell 1536 and a lower shell 1538, where the upper shell 1536 and the lower shell 1538 may be joined together via couplers 1540 (e.g., screws) extending through coupler channels 1542 (e.g., screw holes) in the outer portion 1502 (shown in FIG. 43).

[0185] The outer portion 1502 may have an outer surface 1544 that may face opposite the inner surface 1528. The outer surface 1544 may include a portion of the actuator knob 1500 for a user to grasp to apply a rotational driving force (i.e., torque) to the actuator knob 1500.

[0186] FIG. 46 illustrates a cross-sectional view of the outer portion 1502 disposed on the inner portion 1504. The inner portion 1504 may include an engagement portion 1546 that may be configured to receive an engagement surface 1210 (shown in FIG. 47) of an adaptor, such as a manifold adaptor 704. The inner portion 1504 may be configured to engage an adaptor 704 coupled to a proximal end portion of one of the shafts. The inner portion 1504 may be configured to rotate about the adaptor 704 and may be configured to transfer rotational movement of the actuator knob 1500 to longitudinal or axial movement of the adaptor 704. The engagement portion 1546 may be configured to transfer rotational movement of the actuator knob 1500 to longitudinal or axial movement of the adaptor 704 in a manner similar to that described with respect to other actuators disclosed herein. The inner portion 1504 may further include threads 1548 that may engage with threads 1550 (shown in FIG. 47) on the handle to generate rotational movement of the actuator knob 1500 about the handle, thereby generating longitudinal or axial movement of the actuator knob 1500 relative to the handle. FIG. 47, for example, illustrates an exemplary configuration for the actuator knob 1500 on a handle. Driving the actuator knob 1500 proximally may drive the adapter 704 proximally, resulting in proximal movement of the shaft 24 or a tension force in the shaft 24. Driving the actuator knob 1500 distally may drive the adapter 704 distally, resulting in distal movement of the shaft 24 or a compression force in the shaft 24.

[0187] The actuator knob 1500 may include a bearing surface, which may include one or more of an outer surface 1510 of the inner portion 1504 and an inner surface 1528 of the outer portion 1502. The bearing surface may allow the outer portion 1502 to be rotationally driven relative to the inner portion 1504. The bearing surface may include a friction surface that may create friction between the outer surface 1510 of the inner portion 1504 and the inner surface 1528 of the outer portion 1502. The bearing surfaces may have a non-uniform diameter in a manner similar to that described with respect to the respective corresponding surfaces 1510, 1528.

[0188] Friction may allow the inner portion 1504 to be rotationally driven with the outer portion 1502 and may maintain the rotational position of the inner portion 1504 relative to the outer portion 1502. Such a configuration may allow the outer portion 1502 to transmit rotational movement to the inner portion 1504 and, correspondingly, to transmit rotational movement to longitudinal or axial movement of the adapter 704.

[0189] However, longitudinal movement of the inner portion 1504 may be resisted, and thus rotational movement of the inner portion 1504 may be resisted, when a threshold tensile or compressive force is experienced within the shaft 24. The threshold tensile or compressive force within the shaft 24 may be experienced in a variety of ways, as disclosed herein. For example, forces on the shaft 24 from other shafts of the delivery system, or forces on the shaft 24 due to an implant deployment procedure, may generate the threshold tensile or compressive force. The threshold tensile or compressive force may result, for example, from friction between the shafts of the delivery system, or due to the forces of implant deployment or recapture, among other reasons. The shaft may be impeded from longitudinal or axial movement, such that the threshold tensile or compressive force may be experienced by a user's force on the actuator knob 1500.

[0190] Upon receiving a threshold tensile or compressive force, friction between the outer surface 1510 of the inner portion 1504 and the inner surface 1528 of the outer portion 1502 may be overcome and the outer portion 1502 may be rotationally driven relative to the inner portion 1504. The surfaces 1510, 1528 may be, for example, slidably driven relative to one another to prevent the outer portion 1502 from transmitting further rotational movement relative to the inner portion 1504. Longitudinal or axial movement of the inner portion 1504 and adapter 704, and correspondingly, of the shaft 24, may be reduced. When the tensile or compressive force in the shaft 24 is reduced, the surfaces 1510, 1528 may re-engage relative to one another, thereby allowing the outer portion 1502 to transmit rotational movement relative to the inner portion 1504.

[0191] In an example, the threshold tensile or compressive force that may drive the outer portion 1502 in rotation relative to the inner portion 1504 may be adjustable. For example, with reference to FIG. 43, the compression of the outer portion 1502 relative to the inner portion 1504 may be adjusted. The compression applied by the coupler 1540 may be adjusted, for example (e.g., by tightening or loosening a screw or by other techniques). The outer portion 1502 may include an outer shell having an inner shell 1512 and a lower shell 1514. The compression of the outer shell relative to the inner portion 1504 may be adjusted by adjusting the tightness of the coupler 1540. Greater compression of the outer portion 1502 relative to the inner portion 1504 may increase friction between the surfaces 1510, 1528, and therefore may increase the threshold tensile or compressive force that may drive the outer portion 1502 in rotation relative to the inner portion 1504. Less compression of the outer portion 1502 relative to the inner portion 1504 may reduce friction between the surfaces 1510, 1528, and therefore may reduce the threshold tensile or compressive force at which the outer portion 1502 may be rotationally driven relative to the inner portion 1504. Thus, a user may set a threshold tensile or compressive force at which the outer portion 1502 may be rotationally driven relative to the inner portion 1504.

[0192] In examples, various other configurations may be utilized.

[0193] For example, Figures 48-52 illustrate an example having a displacement body 1560 configured to maintain a rotational position of a first or inner portion 1562 relative to a second or outer portion 1564. The displacement body 1560 may be configured to be released to allow the outer portion 1564 to be rotationally driven relative to the inner portion 1562. The displacement body 1560 is shown, for example, in Figure 49.

[0194] 48, a perspective view of an actuator knob 1570 of the control mechanism is shown. The actuator knob 1570 may include a control knob of the delivery system, which may include a release knob as disclosed herein, or may include another configured knob in the delivery system, as desired. In examples, other configured actuators may be utilized, as desired.

[0195] The actuator knob 1570 may include an inner portion 1562 and an outer portion 1564. The outer portion 1564 may include an outer body extending about the inner portion 1562. The outer portion 1564 may include an outer shell extending about the inner portion 1562. The outer portion 1564 may surround the inner portion 1562 or may have another configuration. The outer portion 1564 may be configured to displace relative to the inner portion 1562. The displacement may include a rotational displacement. The displacement may automatically limit a tensile or compressive force in the at least one shaft.

[0196] The inner portion 1562 may include an inner body that may be disposed within the outer portion 1564. The inner portion 1562 may include a sleeve configured to extend over an outer surface of the handle 14, for example, as shown in FIG. 14. The inner portion 1562 may include a central channel 1572 within which the handle 14 may be disposed. The inner portion 1562 may have an inner surface 1574 that may face toward the central channel 1572 and an outer surface 1576 (shown in FIG. 49) that may face opposite the inner surface 1574.

[0197] 49 illustrates a perspective view of the inner portion 1562 separated from the outer portion 1564. The inner portion 1562 may include multiple portions, including an upper shell 1578 and a lower shell 1580, where the upper shell 1578 and the lower shell 1580 may be joined together via couplers (e.g., screws) extending through coupler channels 1582 (e.g., screw holes) in an outer surface 1576 of the inner portion 1562.

[0198] The displacement body 1560 may protrude from an outer surface 1576 of the inner portion 1562. The displacement body 1560 may extend radially outward from the inner portion 1562, for example. The displacement body 1560 may include a detent configured to maintain a rotational position of the inner portion 1562 relative to the outer portion 1564. The displacement body 1560 may be configured to maintain a rotational position of the outer portion 1564 relative to the inner portion 1562 by engaging the outer portion 1564 relative to the inner portion 1562. The detent may include a protrusion 1584 configured to engage a surface of the outer portion 1564. The protrusion 1584 may include a tab disposed at an end of a lever arm 1586. The lever arm 1586 may be configured to flex radially inwardly to disengage from the outer portion 1564 when a force between the protrusion 1584 and the outer portion 1564 is exceeded.

[0199] In an example, the inner portion 1562 may include a mating surface 1589 that may be configured to mate with a coupler 1591 (shown in FIG. 50 ) of the outer portion 1564. The coupler 1591 may include a rotating coupler 1591 configured to allow rotation of the outer portion 1564 relative to the inner portion 1562. The coupler 1591 may include, for example, a hook configured to hook onto the mating surface 1589 of the inner portion 1562, allowing rotation of the mating surface 1589 relative to the coupler 1591.

[0200] 50 shows a perspective view of the outer portion 1564 separated from the inner portion 1562. The outer portion 1564 may include multiple portions, including an upper shell 1588 and a lower shell 1590, where the upper shell 1588 and the lower shell 1590 may be joined together via a coupler (e.g., a screw). The coupler may extend, for example, through a coupler channel (e.g., a screw hole) in the outer portion 1564.

[0201] The outer portion 1564 may have an outer surface 1592. The outer surface 1592 may include a portion of the actuator knob 1570 for a user to grasp to apply a rotational driving force (i.e., torque) to the actuator knob 1570.

[0202] The outer portion 1564 may have an inner surface 1594 that may face opposite the outer surface 1592. The inner surface 1594 may face the outer surface 1576 of the inner portion 1562. The inner surface 1594 may include an engagement surface 1596 that the displacement body 1560 may be configured to engage. The engagement surface 1596 may include, for example, a raised surface for the displacement body 1560 to engage.

[0203] FIG 51 illustrates a cross-sectional view of outer portion 1564 disposed on inner portion 1562. Coupler 1591 is shown engaging mating surface 1589. In an example, multiple couplers 1591 may be provided. For example, FIG 51 illustrates at least two couplers 1591 being utilized. More or fewer couplers may be utilized as desired.

[0204] 52 illustrates a cross-sectional view of the outer portion 1564 disposed on the inner portion 1562, taken perpendicular to the view shown in FIG. 51. Engagement of the displacement body 1560 with the engagement surface 1596 is shown. The displacement body 1560 extends radially toward the engagement surface 1596. The displacement body 1560 may be engaged against the engagement surface 1596 due to the displacement body 1560 being biased toward the engagement surface 1596. For example, the lever arm 1586 may be biased to press the displacement body 1560 against the engagement surface 1596.

[0205] The displacement body 1560 may be released from the engagement surface 1596 when a threshold tensile or compressive force is generated in the shaft (e.g., shaft 24). Longitudinal or axial movement of the inner portion 1562 may be resisted, resulting in rotational movement of the inner portion 1562 being resisted. Thus, the force of the displacement body 1560 against the engagement surface 1596 may be overcome, and the outer portion 1564 may be rotationally driven relative to the inner portion 1562. The displacement body 1560 may be released from the engagement surface 1596 to allow the surfaces 1576, 1594 to be slidably driven relative to one another. Thus, the outer portion 1564 may prevent further rotational movement from being transmitted to the inner portion 1562. Longitudinal movement of the inner portion 1562 and the adapter (e.g., adapter 704), and the corresponding shaft, may be reduced. When the tensile or compressive force in the shaft is reduced, the displacement body 1560 may re-engage against the engagement surface 1596, thereby allowing the outer portion 1564 to transmit rotational movement relative to the inner portion 1562.

[0206] In examples, the number of displacement bodies 1560 may be varied and the orientation of the displacement bodies 1560 may be varied. For example, in examples, multiple displacement bodies 1560 may be utilized. In examples, the displacement bodies 1560 may be configured to protrude radially inward (e.g., the engagement surface 1596 is located on the inner portion 1562 and one or more displacement bodies 1560 are located on the outer portion 1564 and extend radially inward toward the inner portion 1562). Other configurations may be utilized.

[0207] In an example, a threshold tensile or compressive force that may drive the outer portion 1564 to rotate relative to the inner portion 1562 may be adjustable. The engagement force of the displacement body 1560 relative to the outer portion 1564 and relative to the inner portion 1562 may be adjusted. For example, with reference to FIG. 52, one or more configurations of the displacement body 1560 and the engagement surface 1596 may be adjusted. For example, the size or shape of the ridges on the engagement surface 1596 may be changed to adjust the force that must be overcome to allow the portions 1562, 1564 to rotate relative to one another. The number of ridges may be changed as desired. In an example, the size, shape, or number of the displacement body 1560 may be adjusted. For example, the angle of the protrusions may be changed. The stiffness of the lever arm 1586 may be changed. Multiple displacement bodies 1560 may be positioned in various locations as desired.

[0208] In examples, the configuration of the displacement body 1560 may be changed.

[0209] 53-56, for example, illustrate implementations in which a plurality of displacement bodies 1600 (shown in FIG. 54) may be provided. The plurality of displacement bodies 1600 may be spaced apart from one another in the circumferential direction and in the longitudinal direction. For example, a plurality of rows of displacement bodies 1600 may be provided. The rows may include a plurality of displacement bodies 1600 that are longitudinally aligned with one another. Each row may be spaced apart from adjacent rows in the circumferential direction.

[0210] 53 illustrates a perspective view of an actuator knob 1602 of the control mechanism. The actuator knob 1602 may include a control knob for the delivery system, which may include a release knob as disclosed herein, or may include another configured knob for the delivery system, as desired. In examples, other configured actuators may be utilized, as desired.

[0211] The actuator knob 1602 may include a first or inner portion 1606 and a second or outer portion 1604. The outer portion 1604 may include an outer body extending about the inner portion 1606. The outer portion 1604 may include an outer shell extending about the inner portion 1606. The outer portion 1604 may surround the inner portion 1606 or may have another configuration. The outer portion 1604 may be configured to displace relative to the inner portion 1606. The displacement may include a rotational displacement. The displacement may automatically limit tension or compression forces in the at least one shaft.

[0212] The inner portion 1606 may include an inner body that may be disposed within the outer portion 1604. The inner portion 1606 may include a sleeve configured to extend over an outer surface of the handle 14, for example, as shown in FIG. 14. The inner portion 1606 may include a central channel 1608 within which the handle 14 may be disposed. The inner portion 1606 may have an inner surface 1610 that may face toward the central channel 1608 and an outer surface 1612 (visible in the see-through view of FIG. 55) that may face opposite the inner surface 1610.

[0213] The outer surface 1612 may include an engagement surface for engagement with the displacement body 1600. The outer surface 1612 may include, for example, a raised surface for engagement with the displacement body 1600.

[0214] The exterior portion 1604 may have an exterior surface 1614. The exterior surface 1614 may include a portion of the actuator knob 1602 or control knob for a user to grasp to apply a rotational driving force (i.e., torque) to the actuator knob 1602.

[0215] The outer portion 1604 may include an inner surface 1618 that may face opposite the outer surface 1614. The inner surface 1618 may face the outer surface 1612 of the inner portion 1606. The plurality of displacement bodies 1600 may project radially inward from the inner surface 1618 of the outer portion 1604. The displacement bodies 1600 may extend radially toward an engagement surface or the outer surface 1612 of the inner portion 1606. The displacement bodies 1600 may be configured such that engagement of the outer portion 1604 relative to the inner portion 1606 maintains a rotational position of the outer portion 1604 relative to the inner portion 1606.

[0216] The displacement bodies 1600 may include detents configured to maintain a rotational position of the inner portion 1606 relative to the outer portion 1604. The detents may include protrusions (e.g., balls) configured to engage against the outer surface 1612. The protrusions may be spring biased toward the outer surface 1612. For example, each of the displacement bodies 1600 may include a spring that urges the protrusions against an engagement surface of the inner portion 1606.

[0217] 56 illustrates a cross-sectional view of the outer portion 1604 disposed on the inner portion 1606, taken perpendicular to the view shown in FIG. 54. The engagement of the displacement body 1600 with the outer surface 1612 is shown. The displacement body 1600 may remain engaged against the outer surface 1612 due to the displacement body 1600 being biased toward the outer surface 1612.

[0218] The displacement body 1600 may be released from the outer surface 1612 when a threshold tensile or compressive force is generated in the shaft (e.g., shaft 24). Longitudinal movement of the inner portion 1606 may be resisted, resulting in rotational movement of the inner portion 1606 being resisted. Thus, the force of the displacement body 1600 against the outer surface 1612 may be overcome, and the outer portion 1604 may be rotationally driven relative to the inner portion 1606. The displacement body 1600 may be released from the outer surface 1612 to allow the surfaces 1612, 1618 to be slidably driven relative to one another. Thus, the outer portion 1604 may prevent further rotational movement from being transmitted to the inner portion 1606. Longitudinal movement of the inner portion 1606 and the adapter (e.g., adapter 704), and the corresponding shaft, may be reduced. When the tensile or compressive force in the shaft is reduced, the displacement body 1600 may re-engage against the outer surface 1612, thereby allowing the outer portion 1604 to transmit rotational movement to the inner portion 1606.

[0219] In an example, a threshold tensile or compressive force that may drive the outer portion 1604 to rotate relative to the inner portion 1606 may be adjustable. The engagement force of the displacement body 1600 relative to the outer portion 1604 and relative to the inner portion 1606 may be adjusted. For example, one or more configurations of the displacement body 1600 and the outer surface 1612 may be adjusted. The size or shape of the ridges on the outer surface 1612 may be changed, for example, to adjust the force that must be overcome to allow the portions 1604, 1606 to rotate relative to one another. The number or angle of the ridges may be changed, as desired. In an example, the configuration of the displacement body 1600 may be adjusted. For example, the force of the springs of the displacement body 1600 may be changed to change the magnitude of the force on the outer surface 1612. The number or position of the displacement bodies 1600 may be adjusted.

[0220] In examples, the configuration of the displacement body may be changed.

[0221] 57-59 illustrate, for example, an implementation in which a plurality of displacement bodies 1620 (shown in a transparent view in FIG. 59) may be provided. The plurality of displacement bodies 1620 may be spaced apart from one another in a circumferential direction. Each displacement body 1620 may extend in a longitudinal direction and may face in a longitudinal direction. An engagement surface 1622 may face in a longitudinal direction.

[0222] 57 illustrates a perspective view of the actuator knob 1624 of the control mechanism. The actuator knob 1624 may include a control knob for the delivery system, which may include a release knob as disclosed herein, or may include another configured knob for the delivery system, as desired. In examples, other configured actuators may be utilized, as desired.

[0223] The actuator knob 1624 can include a first or inner portion 1628 and can include a second or outer portion 1626. The outer portion 1626 can include an outer body extending about the inner portion 1628. The outer portion 1626 can include an outer shell extending about the inner portion 1628. The outer portion 1626 can surround the inner portion 1628 or can have another configuration. The outer portion 1626 can be configured to displace relative to the inner portion 1628. The displacement can include a rotational displacement. The displacement can automatically limit tension or compression forces in the at least one shaft.

[0224] The inner portion 1628 may include an inner body that may be disposed within the outer portion 1626. The inner portion 1628 may include a sleeve configured to extend over an outer surface of the handle 14, for example, as shown in FIG. 14. The inner portion 1628 may include a central channel 1630 within which the handle 14 may be disposed. The inner portion 1628 may have an inner surface 1632 that may face toward the central channel 1630 and an outer surface 1633 (shown in FIG. 58) that may face opposite the inner surface 1632.

[0225] The inner portion 1628 may include a longitudinally facing surface 1634 (shown in transparent view in FIG. 59 ) that may include an engagement surface 1622 for engagement by the displacement body 1620. The longitudinally facing surface 1634 may include, for example, a raised surface for engagement by the displacement body 1620.

[0226] The exterior portion 1626 may have an exterior surface 1636. The exterior surface 1636 may include a portion of the actuator knob 1624 or control knob for a user to grasp to apply a rotational driving force (i.e., torque) to the actuator knob 1624.

[0227] The outer portion 1626 may include a longitudinally facing surface 1638 that may face the longitudinally facing surface 1634 of the inner portion 1628. The displacement body 1620 may protrude from the longitudinally facing surface 1638 of the outer portion 1604 to engage the inner portion 1628. The displacement body 1620 may extend longitudinally toward the engagement surface 1622.

[0228] The engagement force of the displacement body 1620 against the outer portion 1626 and against the inner portion 1628 may be adjusted. For example, the shape of the engagement surface 1622 may be altered to engage the displacement body in a different manner. Such features may allow the threshold force to be altered and may provide additional options for rotational orientation. The spring force of the displacement body 1620 or the position or number of the displacement bodies 1620 may be adjusted as desired.

[0229] The displacement body 1620 may be configured similarly to, and may operate in a similar manner as, the displacement body 1600 described with respect to Figures 53-56. The displacement body 1620 may be configured such that engagement of the outer portion 1626 with the inner portion 1628 maintains a rotational position of the outer portion 1626 relative to the inner portion 1628.

[0230] Various other configurations may be used as desired. Features in the examples of Figures 43-59 may be used in combination between the examples. For example, features used in one example may be used in any other example. Features may be modified or combined as desired.

[0231] The examples in Figures 43-59 may be used with the manifold shaft or manifold subassembly 24, or with any other shaft or assembly or subassembly in a delivery system. For example, the examples in Figures 43-59 may be implemented with the outer sheath or outer sheath subassembly 20, or with any other shaft or assembly or subassembly disclosed herein. The rail subassembly 21, the midshaft subassembly 22, the release subassembly 23, or the nosecone assembly may be used with the examples in Figures 43-59. Any feature of the control mechanism, such as the knob, disclosed herein may be used in combination with or in place of the examples in Figures 43-59. Any feature of the adapter disclosed herein may be used in combination with or in place of the examples in Figures 43-59.

[0232] From the foregoing, it will be understood that an apparatus, device, system, and method have been disclosed. Although certain components, techniques, and aspects have been described in some detail, it will be apparent that many changes can be made to the specific designs, structures, and methodologies described hereinabove without departing from the spirit and scope of the present disclosure.

[0233] For purposes of this specification, certain aspects, advantages, and novel features of the embodiments of the present disclosure are described herein. The disclosed methods, devices, and systems should not be construed as limiting in any manner. Instead, the present disclosure is directed to all novel and non-obvious features and aspects of the various disclosed embodiments in various combinations with each other and in various subcombinations with each other. The methods, devices, and systems are not limited to any particular aspect or feature, or combination thereof, nor do the disclosed embodiments require that any one or more particular advantages exist or problems be solved. Features, elements, or combinations of one embodiment may be combined in other embodiments herein. [Example]

[0234] Example 1: 1. A delivery system for an implant, comprising: a long catheter including an implant holding region for holding the implant, the long catheter including one or more shafts; a control mechanism for driving the one or more shafts; and a force reduction mechanism configured to automatically reduce tensile or compressive forces within at least one of the one or more shafts.

[0235] Example 2: A delivery system as described in any embodiment herein, particularly as described in embodiment 1, wherein the force reduction mechanism is configured to automatically reduce tensile or compressive forces within at least one of the one or more shafts by enabling at least one of the one or more shafts to be driven proximally or distally relative to the control mechanism.

[0236] Example 3: A delivery system as described in any embodiment herein, particularly as described in embodiment 1 or 2, wherein the force reduction mechanism includes a displacement body configured to automatically reduce tensile or compressive forces within at least one of the one or more shafts by enabling at least one of the one or more shafts to be driven proximally or distally relative to the control mechanism.

[0237] Example 4: The delivery system as described in any embodiment herein, particularly as described in embodiment 3, wherein the displacement body comprises a spring.

[0238] Example 5: A delivery system as described in any embodiment herein, particularly embodiment 4, wherein the control mechanism includes an actuator, the force reduction mechanism includes an adapter configured to engage with the actuator at a proximal portion of at least one of the one or more shafts, and the spring is disposed on the adapter.

[0239] Example 6: The delivery system as described in any embodiment herein, particularly as described in embodiment 4 or 5, wherein the control mechanism comprises an actuator, and the spring is disposed on the actuator.

[0240] Example 7: A delivery system as described in any embodiment herein, particularly any one of embodiments 1 to 6, wherein the control mechanism includes an actuator and the force reduction mechanism includes an adapter configured to engage with the actuator at a proximal portion of at least one of the one or more shafts, and the one or more shafts are configured to automatically reduce tensile or compressive forces within at least one of the one or more shafts by displacing relative to one or more of the actuator and the adapter.

[0241] Example 8: A delivery system as described in any embodiment herein, particularly any one of embodiments 1 to 7, wherein the control mechanism includes an actuator, the actuator including a first portion and a second portion configured to automatically reduce tensile or compressive forces in at least one of the one or more shafts by displacing relative to the first portion.

[0242] Example 9: A delivery system as described in any embodiment herein, particularly any one of embodiments 1 to 8, wherein the control mechanism includes an actuator and the force reduction mechanism includes an adapter engaged to the actuator at a proximal portion of at least one of the one or more shafts, the adapter being configured to automatically reduce tensile or compressive forces within at least one of the one or more shafts upon disengagement from the actuator.

[0243] Example 10: The delivery system as described in any embodiment herein, particularly embodiment 9, wherein the force reduction mechanism includes a cam configured to disengage the adapter from the actuator.

[0244] Example 11: A delivery system as described in any embodiment herein, particularly embodiment 9 or 10, wherein the force reduction mechanism includes a spring that urges the adapter toward the actuator, the spring being configured to be actuated to disengage the adapter from the actuator.

[0245] Example 12: The delivery system according to any embodiment herein, particularly any one of embodiments 1 to 11, wherein the force reduction mechanism is configured to be user-actuated.

[0246] Example 13: A delivery system as described in any embodiment herein, particularly any one of embodiments 1-12, wherein the force reduction mechanism is configured to automatically reduce the tensile or compressive force within at least one of the one or more shafts when a corresponding threshold tensile or compressive force is received.

[0247] Example 14: A delivery system as described in any embodiment herein, particularly any one of embodiments 1-13, further comprising an indicator indicating tensile or compressive force within at least one of the one or more shafts.

[0248] Example 15: A delivery system as described in any embodiment herein, particularly any one of embodiments 1 to 14, wherein the force reduction mechanism includes an electric drive configured to automatically reduce tensile or compressive forces in at least one of the one or more shafts by driving at least one of the one or more shafts.

[0249] Example 16: A delivery system as described in any embodiment herein, particularly embodiment 15, wherein the electric drive device is configured to automatically drive at least one of the one or more shafts in a distal direction to reduce tensile forces or to automatically drive at least one of the one or more shafts in a proximal direction to reduce compressive forces.

[0250] Example 17: A delivery system as described in any embodiment herein, particularly any one of embodiments 1-16, wherein the force reduction mechanism is configured to automatically reduce tensile or compressive forces within at least one shaft including an outer sheath covering the implant holding region.

[0251] Example 18: A delivery system as described in any embodiment herein, particularly any one of embodiments 1-17, wherein the force reduction mechanism is configured to automatically reduce tensile or compressive forces within at least one shaft, including a manifold shaft coupled to one or more sutures for coupling to the implant.

[0252] Example 19: A delivery system as described in any embodiment herein, particularly any one of embodiments 1-18, wherein the long catheter includes a handle, the control mechanism includes an actuator knob disposed on the handle, and the force reduction mechanism is configured to automatically enable the actuator knob to be rotationally actuated relative to the handle, thereby reducing tensile or compressive forces within at least one of the one or more shafts.

[0253] Example 20: A delivery system as described in any embodiment herein, particularly any one of embodiments 1-19, wherein the force reduction mechanism is configured to automatically enable at least one of the one or more shafts to be driven distally, thereby reducing the pulling force generated by at least one shaft being driven proximally by the control mechanism.

[0254] Example 21: A delivery system as described in any embodiment herein, particularly any one of embodiments 1-20, wherein the force reduction mechanism is configured to automatically enable at least one of the one or more shafts to be driven proximally, thereby reducing the compressive force generated by at least one shaft being driven distally by the control mechanism.

[0255] Example 22: A delivery system as described in any embodiment herein, particularly any one of embodiments 1-21, wherein the control mechanism is for driving a first shaft of the one or more shafts, and the force reduction mechanism is configured to automatically reduce the tensile or compressive force in the first shaft.

[0256] Example 23: A delivery system as described in any embodiment herein, particularly any one of embodiments 1-22, wherein the long catheter includes multiple shafts, the control mechanism is for driving a first shaft of the multiple shafts, and the force reduction mechanism is configured to automatically reduce the tensile or compressive force in a second shaft of the multiple shafts.

[0257] Example 24: The delivery system as described in any embodiment herein, particularly as described in embodiment 23, wherein the control mechanism is for driving each of the plurality of shafts.

[0258] Example 25: A delivery system as described in any embodiment herein, particularly any one of embodiments 1-24, wherein the long catheter is configured to deliver an implant including a prosthetic heart valve to a heart valve in a patient's body.

[0259] Example 26: A delivery system for an implant, comprising: a long catheter including an implant holding region for holding the implant, the long catheter including one or more shafts; a control mechanism for driving the one or more shafts; and an indicator that indicates tensile or compressive force within at least one of the one or more shafts.

[0260] Example 27: The delivery system of any embodiment herein, particularly embodiment 26, wherein the indicator comprises a displacement of the at least two bodies relative to one another.

[0261] Example 28: The delivery system as described in any embodiment herein, particularly embodiment 27, wherein the indicator comprises a spring for coupling the at least two bodies together.

[0262] Example 29: The delivery system according to any embodiment herein, particularly embodiment 27 or 28, wherein the control mechanism comprises an actuator and the at least two bodies comprise a portion of the actuator.

[0263] Example 30: A delivery system as described in any embodiment herein, particularly any one of embodiments 27 to 29, wherein the control mechanism includes an actuator, an adapter is disposed at a proximal portion of at least one of the one or more shafts for engaging with the actuator, and the at least two bodies include an actuator and an adapter.

[0264] Example 31: The delivery system as described in any embodiment herein, particularly as described in embodiment 29 or 30, wherein the actuator comprises an actuator knob.

[0265] Example 32: The delivery system according to any embodiment herein, particularly any one of embodiments 26-31, wherein the indicator comprises one or more of a visual indicator, an audible indicator, or a tactile indicator.

[0266] Example 33: The delivery system according to any embodiment herein, particularly any one of embodiments 26-32, wherein the indicator comprises an electrical indicator.

[0267] Example 34: The delivery system as described in any embodiment herein, particularly as described in embodiment 33, wherein the electrical indicator comprises an electrical display.

[0268] Example 35: A delivery system as described in any embodiment herein, particularly any one of embodiments 26-34, wherein the long catheter is configured to deliver an implant including a prosthetic heart valve to a heart valve in a patient's body.

[0269] Example 36: 1. A method, comprising: deploying an implant into a patient's body by utilizing a delivery system, the delivery system comprising: an elongated catheter including an implant holding region for holding the implant, the elongated catheter including one or more shafts; a control mechanism for driving the one or more shafts; and a force reduction mechanism configured to automatically reduce tensile or compressive forces within at least one of the one or more shafts.

[0270] Example 37: The method of any embodiment herein, particularly embodiment 36, wherein the force reduction mechanism is configured to automatically reduce tensile or compressive forces within at least one of the one or more shafts by enabling at least one of the one or more shafts to be driven proximally or distally relative to the control mechanism.

[0271] Example 38: The method of any embodiment herein, particularly embodiment 36 or 37, wherein the force reduction mechanism includes a displacement body configured to automatically reduce tensile or compressive forces within at least one of the one or more shafts by enabling at least one of the one or more shafts to be driven proximally or distally relative to the control mechanism.

[0272] Example 39: The method of any embodiment herein, particularly embodiment 38, wherein the displacement body comprises a spring.

[0273] Example 40: The method of any embodiment herein, particularly embodiment 39, wherein the control mechanism includes an actuator, the force reduction mechanism includes an adapter configured to engage with the actuator at a proximal portion of at least one of the one or more shafts, and the spring is disposed on the adapter.

[0274] Example 41: The method of any embodiment herein, particularly embodiment 39 or 40, wherein the control mechanism comprises an actuator and the spring is disposed on the actuator.

[0275] Example 42: The method of any of the embodiments herein, particularly any one of embodiments 36-41, wherein the control mechanism includes an actuator and the force reduction mechanism includes an adapter configured to engage with the actuator at a proximal portion of at least one of the one or more shafts, and the one or more shafts are configured to automatically reduce tensile or compressive forces in at least one of the one or more shafts by displacing relative to one or more of the actuator and the adapter.

[0276] Example 43: The method of any embodiment herein, particularly any one of embodiments 36-42, wherein the control mechanism includes an actuator, the actuator including a first portion and a second portion configured to automatically reduce tensile or compressive forces in at least one of the one or more shafts by displacing relative to the first portion.

[0277] Example 44: The method described in any embodiment herein, particularly any one of embodiments 36 to 43, wherein the control mechanism includes an actuator and the force reduction mechanism includes an adapter engaged to the actuator at a proximal portion of at least one of the one or more shafts, the adapter being configured to automatically reduce the tensile or compressive force within at least one of the one or more shafts upon disengagement from the actuator.

[0278] Example 45: The method of any embodiment herein, particularly embodiment 44, wherein the force reduction mechanism includes a cam configured to disengage the adapter from the actuator.

[0279] Example 46: The method of any embodiment herein, particularly embodiment 44 or 45, wherein the force reduction mechanism includes a spring that urges the adapter toward the actuator, the spring being configured to compress and disengage the adapter from the actuator.

[0280] Example 47: The method of any of the embodiments herein, particularly any one of embodiments 36-46, wherein the force reduction mechanism is configured to be user-actuated.

[0281] Example 48: The method of any embodiment herein, particularly any one of embodiments 36-47, wherein the force reduction mechanism is configured to automatically reduce the tensile or compressive force in at least one of the one or more shafts when a corresponding threshold tensile or compressive force is received.

[0282] Example 49: The method described in any embodiment herein, particularly any one of embodiments 36-48, wherein the indicator is configured to indicate tensile or compressive force within at least one of the one or more shafts.

[0283] Example 50: The method of any embodiment herein, particularly any one of embodiments 36-49, wherein the force reduction mechanism includes an electric drive configured to drive at least one of the one or more shafts to automatically reduce tensile or compressive forces in at least one of the one or more shafts.

[0284] Example 51: The method of any embodiment herein, particularly embodiment 50, wherein the electric drive device is configured to automatically drive at least one of the one or more shafts in a distal direction to reduce tensile forces or to automatically drive at least one of the one or more shafts in a proximal direction to reduce compressive forces.

[0285] Example 52: The method of any embodiment herein, particularly any one of embodiments 36-51, wherein the force reduction mechanism is configured to automatically reduce tensile or compressive forces within at least one shaft including an outer sheath covering the implant holding region.

[0286] Example 53: The method of any embodiment herein, particularly any one of embodiments 36-52, wherein the force reduction mechanism is configured to automatically reduce tensile or compressive forces within at least one shaft, including a manifold shaft coupled to one or more sutures for coupling to the implant.

[0287] Example 54: The method of any of the embodiments herein, particularly any one of embodiments 36-53, wherein the long catheter includes a handle, the control mechanism includes an actuator knob disposed on the handle, and the force reduction mechanism is configured to automatically enable the actuator knob to be rotationally actuated relative to the handle, thereby reducing tensile or compressive forces within at least one of the one or more shafts.

[0288] Example 55: The method of any of the embodiments herein, particularly any one of embodiments 36-54, wherein the force reduction mechanism is configured to automatically enable at least one of the one or more shafts to be driven distally, thereby reducing the tensile force generated by at least one shaft being driven proximally by the control mechanism.

[0289] Example 56: The method of any of the embodiments herein, particularly any one of embodiments 36-55, wherein the force reduction mechanism is configured to automatically enable at least one of the one or more shafts to be driven proximally, thereby reducing the compressive force generated by at least one shaft being driven distally by the control mechanism.

[0290] Example 57: The method of any embodiment herein, particularly any one of embodiments 36-56, wherein the control mechanism is for driving a first shaft of the one or more shafts, and the force reduction mechanism is configured to automatically reduce the tensile or compressive force in the first shaft.

[0291] Example 58: The method of any of the embodiments herein, particularly any one of embodiments 36-57, wherein the long catheter includes a plurality of shafts, the control mechanism is for driving a first shaft of the plurality of shafts, and the force reduction mechanism is configured to automatically reduce the tensile or compressive force within a second shaft of the plurality of shafts.

[0292] Example 59: The method of any embodiment herein, particularly embodiment 58, wherein the control mechanism is for driving each of the plurality of shafts.

[0293] Example 60: The method of any of the embodiments herein, particularly any one of embodiments 36-59, wherein the long catheter is configured to deliver an implant comprising a prosthetic heart valve to a heart valve in the patient's body.

[0294] Example 61: 1. A method, comprising: deploying an implant into a patient's body by utilizing a delivery system, the delivery system comprising: an elongated catheter including an implant holding region for holding the implant, the elongated catheter including one or more shafts; a control mechanism for driving the one or more shafts; and an indicator for indicating tensile or compressive forces within at least one of the one or more shafts.

[0295] Example 62: The method of any embodiment herein, particularly embodiment 61, wherein the indicator comprises a displacement of at least two bodies relative to one another.

[0296] Example 63: The method of any embodiment herein, particularly embodiment 62, wherein the indicator comprises a spring for coupling the at least two bodies together.

[0297] Example 64: The method of any embodiment herein, particularly embodiment 62 or 63, wherein the control mechanism comprises an actuator and the at least two bodies comprise a portion of the actuator.

[0298] Example 65: A method described in any embodiment of the present specification, particularly any one of embodiments 62 to 64, wherein the control mechanism includes an actuator, an adapter is disposed at a proximal portion of at least one of the one or more shafts for engaging with the actuator, and the at least two bodies include an actuator and an adapter.

[0299] Example 66: The method of any embodiment herein, particularly embodiment 64 or 65, wherein the actuator comprises an actuator knob.

[0300] Example 67: The method of any embodiment herein, particularly any one of embodiments 61-66, wherein the indicator comprises one or more of a visual indicator, an audible indicator, or a tactile indicator.

[0301] Example 68: The method of any embodiment herein, particularly any one of embodiments 61-67, wherein the indicator comprises an electrical indicator.

[0302] Example 69: The method of any embodiment herein, particularly embodiment 68, wherein the electrical indicator comprises an electrical display.

[0303] Example 70: The method of any of the embodiments herein, particularly any one of embodiments 61-69, wherein the long catheter is configured to deliver an implant comprising a prosthetic heart valve to a heart valve in the patient's body.

[0304] Example 71: 1. A delivery system for an implant, comprising: a long catheter including an implant holding region for holding the implant, the long catheter including one or more shafts; and a control mechanism for driving the one or more shafts, the actuator knob having a first portion and a second portion configured to be rotationally driven relative to the first portion to automatically limit a tensile or compressive force transmitted by the actuator knob to at least one of the one or more shafts within at least one of the one or more shafts.

[0305] Example 72: The delivery system as described in any embodiment herein, particularly embodiment 71, wherein the first portion comprises an inner body and the second portion comprises an outer body extending around the inner body.

[0306] Example 73: The delivery system as described in any embodiment herein, particularly embodiment 72, wherein the outer body comprises an outer shell.

[0307] Example 74: A delivery system as described in any embodiment herein, particularly embodiment 72 or 73, wherein the inner body is configured to engage with an adapter coupled to a proximal end portion of at least one of the one or more shafts.

[0308] Example 75: A delivery system as described in any embodiment herein, particularly embodiment 74, wherein the inner body is configured to be rotationally driven around the adapter and configured to transmit rotational movement of the actuator knob into longitudinal movement of the adapter.

[0309] Example 76: A delivery system as described in any embodiment herein, particularly any one of embodiments 71 to 75, wherein the first or second part includes a bearing surface configured to enable the first part to be rotationally driven relative to the second part.

[0310] Example 77: The delivery system as described in any embodiment herein, particularly embodiment 76, wherein the bearing surface has a non-uniform diameter.

[0311] Example 78: A delivery system as described in any embodiment herein, particularly any one of embodiments 71 to 77, further comprising a displacement body configured to maintain a rotational position of the second part relative to the first part by engaging the second part with the first part.

[0312] Example 79: The delivery system of any embodiment herein, particularly embodiment 78, wherein the displacement body is biased toward the engagement surface of the first part or the second part.

[0313] Example 80: The delivery system as described in any embodiment herein, particularly embodiment 79, wherein the displacement body is biased by a spring.

[0314] Example 81: A delivery system as described in any embodiment herein, particularly embodiment 79 or 80, wherein the displacement body extends radially toward the engagement surface.

[0315] Example 82: The delivery system according to any embodiment herein, particularly any one of embodiments 79-81, wherein the displacement body extends longitudinally toward the engagement surface.

[0316] Example 83: A delivery system as described in any embodiment herein, particularly any one of embodiments 71 to 82, wherein the second portion is configured to be rotationally driven relative to the first portion when subjected to a threshold tensile force or a threshold compressive force.

[0317] Example 84: A delivery system as described in any embodiment herein, particularly as described in embodiment 83, wherein the threshold tensile or compressive force is adjustable.

[0318] Example 85: A delivery system as described in any embodiment herein, particularly embodiment 84, wherein the first portion includes an inner body and the second portion includes an outer shell extending around the inner body, and the threshold tensile force or threshold compressive force is adjustable by adjusting compression of the outer shell relative to the inner body.

[0319] Example 86: A delivery system as described in any embodiment herein, particularly embodiment 84 or 85, further comprising a displacement body configured to engage the second portion with the first portion to maintain a rotational position of the second portion relative to the first portion, wherein the threshold tensile force or threshold compressive force is adjustable by adjusting the engagement force of the displacement body with respect to the first portion and with respect to the second portion.

[0320] Example 87: A delivery system as described in any embodiment herein, particularly any one of embodiments 71 to 86, wherein the second portion is configured to be rotationally driven relative to the first portion to prevent a user from exceeding a corresponding threshold tensile or compressive force within at least one of the one or more shafts.

[0321] Example 88: A delivery system as described in any embodiment herein, particularly any one of embodiments 71 to 87, wherein at least one of the one or more shafts includes a manifold shaft attached to one or more sutures for attaching to the implant.

[0322] Example 89: A delivery system as described in any embodiment herein, particularly any one of embodiments 71 to 88, wherein at least one of the one or more shafts includes an outer sheath covering an implant holding region.

[0323] Example 90: A delivery system as described in any embodiment herein, particularly any one of embodiments 71-89, wherein the long catheter is configured to deliver an implant including a prosthetic heart valve to a heart valve in a patient's body.

[0324] Example 91: 1. A method, comprising: deploying an implant into a patient's body by utilizing a delivery system, the delivery system comprising: an elongated catheter including an implant holding region for holding the implant, the elongated catheter including one or more shafts; and a control mechanism for driving the one or more shafts, the actuator knob having a first portion and a second portion configured to be rotationally driven relative to the first portion to automatically limit a tensile or compressive force transmitted by the actuator knob to at least one of the one or more shafts within at least one of the one or more shafts.

[0325] Example 92: The method of any embodiment herein, particularly embodiment 91, wherein the first portion comprises an inner body and the second portion comprises an outer body extending around the inner body.

[0326] Example 93: The method of any embodiment herein, particularly embodiment 91 or 92, wherein the first part or the second part includes a bearing surface configured to enable the first part to be rotationally driven relative to the second part.

[0327] Example 94: The method described in any embodiment herein, particularly any one of embodiments 91 to 93, wherein the displacement body is configured to maintain a rotational position of the second part relative to the first part by engaging the second part with the first part.

[0328] Example 95: The method of any embodiment herein, particularly embodiment 94, wherein the displacement body extends radially toward the engagement surface.

[0329] Example 96: The method of any one of the embodiments herein, particularly embodiment 94 or 95, wherein the displacement body extends longitudinally toward the engagement surface.

[0330] Example 97: The method of any embodiment herein, particularly any one of embodiments 91-96, wherein the second portion is configured to be rotationally driven relative to the first portion when subjected to a threshold tensile force or a threshold compressive force.

[0331] Example 98: The method of any embodiment herein, particularly embodiment 97, wherein the threshold tensile or compressive force is adjustable.

[0332] Example 99: The method of any embodiment herein, particularly any one of embodiments 91 to 98, wherein the second portion is configured to be rotationally driven relative to the first portion to prevent a user from exceeding a corresponding threshold tensile or compressive force in at least one of the one or more shafts.

[0333] Example 100: The method of any of the embodiments herein, particularly any one of embodiments 91-99, wherein the long catheter is configured to deliver an implant comprising a prosthetic heart valve to a heart valve in the patient's body.

[0334] Example 101: 1. A delivery system for an implant, comprising: a long catheter including an implant holding region for holding the implant, the long catheter including at least one shaft; an actuator knob located on a handle for driving the at least one shaft forward or backward, the actuator knob engaged with the at least one shaft; and a force reduction mechanism for reducing a pulling force in the at least one shaft by allowing the at least one shaft to disengage from the actuator knob when a threshold pulling force is reached, the force reduction mechanism disengaging the at least one shaft from the actuator knob to allow the at least one shaft to be slidably driven longitudinally relative to the actuator knob, the force reduction mechanism reducing damage to the at least one shaft.

[0335] Example 102: A delivery system as described in any embodiment herein, particularly embodiment 101, wherein the force reduction mechanism includes an adapter at a proximal portion of at least one shaft for engaging with the actuator knob.

[0336] Example 103: A delivery system as described in any embodiment herein, particularly embodiment 102, wherein the force reduction mechanism includes one or more protrusions extending radially outward from the adapter for engagement with the actuator knob.

[0337] Example 104: A delivery system as described in any embodiment herein, particularly embodiment 103, wherein the force reduction mechanism includes one or more springs that bias one or more protrusions radially outward toward the actuator knob.

[0338] Example 105: The delivery system of any embodiment herein, particularly embodiment 103 or 104, wherein the actuator knob comprises an inner surface for engaging with one or more protrusions.

[0339] Example 106: A delivery system as described in any embodiment herein, particularly embodiment 105, wherein the one or more protrusions displace inward from the inner surface to disengage at least one shaft from the actuator knob.

[0340] Example 107: The delivery system according to any embodiment herein, particularly any one of embodiments 101-106, further comprising an indicator for indicating tension in at least one shaft.

[0341] Example 108: A delivery system as described in any embodiment herein, particularly any one of embodiments 101-107, wherein the force reduction mechanism automatically reduces tensile forces within at least one shaft including an outer sheath covering an implant holding region.

[0342] Example 109: A delivery system as described in any embodiment herein, particularly any one of embodiments 101-108, wherein the force reduction mechanism automatically reduces tensile forces within at least one shaft, including a manifold shaft coupled to one or more sutures for coupling to the implant.

[0343] Example 110: A delivery system as described in any embodiment herein, particularly any one of embodiments 101-109, wherein the long catheter is for delivering an implant including a prosthetic heart valve to a heart valve in a patient's body.

[0344] Any feature in any of the above-mentioned embodiments, including but not limited to any of the above-mentioned embodiments 1-110, is applicable to all other aspects and embodiments identified herein, including but not limited to any of the above-mentioned embodiments 1-110. Moreover, any feature in any of the above-mentioned embodiments, including but not limited to any of the above-mentioned embodiments 1-110, can be combined independently in any manner with other embodiments described herein, either in part or in whole, and the embodiments, for example, one, two, or three or more embodiments, can be combined in whole or in part. Furthermore, any feature in any of the above-mentioned embodiments, including but not limited to any of the above-mentioned embodiments 1-110, can be made optional with respect to other embodiments. Any of the above-mentioned embodiments relating to a method can be performed by a system or device constituting another embodiment, and any of the above-mentioned embodiments relating to a system or device can be configured to perform a method constituting another embodiment or another embodiment, including but not limited to any of the above-mentioned embodiments 1-110.

[0345] Certain features that are described in the present disclosure in the context of separate implementations can also be implemented in combination in a single implementation. Conversely, various features that are described in the context of a single implementation can also be implemented in multiple implementations separately or in any suitable subcombination. Moreover, although features may be described above as functioning in a particular combination, in some cases one or more features from a claimed combination can be excluded from that combination, and the combination may be claimed as any subcombination or as a variation of any subcombination.

[0346] Moreover, although methods may be illustrated in the drawings or described in the specification in a particular order, such methods need not be performed in the particular order illustrated or in sequential order to achieve desirable results, and not all methods need to be performed. Other methods not illustrated or described can be incorporated into the illustrated methods and processes. For example, one or more additional methods can be performed before any of the described methods, after any of the described methods, simultaneously with any of the described methods, or between any of the described methods. Furthermore, in other implementations, the methods may be rearranged or reordered. It should also be understood that the separation of various system components in the above-described implementations should not be understood as requiring such separation in all implementations, and that the described components and systems may generally be integrated together in a single product or packaged into multiple products. Additionally, other implementations are within the scope of the present disclosure.

[0347] Conditional language such as "may," "could," "could be," "might," and "could be" are generally intended to convey that a particular example includes or does not include certain features, components, and / or steps, unless specifically stated otherwise or understood otherwise within the context in which they are used. Thus, such conditional language is not generally intended to imply that the features, components, and / or steps are in any manner required with respect to one or more examples.

[0348] Conjunctive language such as the phrase "at least one of X, Y, and Z," unless specifically stated otherwise, is to be understood in context as being generally used to convey that an item, term, etc. can be either X, Y, or Z. Thus, such conjunctive language is not generally intended to imply the necessity for the presence of at least one X, at least one Y, and at least one Z in a particular instance.

[0349] As used herein, degree statements such as the terms "approximately", "about", "entirely", and "substantially" refer to a value, amount, or characteristic that is close to the stated value, amount, or characteristic while still performing a desired function or achieving a desired result. For example, the terms "approximately", "about", "entirely", and "substantially" may refer to an amount that is within 10%, within 5%, within 1%, within 0.1%, and within 0.01% of the stated amount. When the stated amount is 0 (e.g., none, having nothing), the ranges described above can be specific ranges, not within a specific percentage of the value. For example, within 10% by weight / volume, within 5% by weight / volume, within 1% by weight / volume, within 0.1% by weight / volume, and within 0.01% by weight / volume of the stated amount.

[0350] Some examples are described in conjunction with the accompanying drawings. Although the figures are drawn to scale, such scale is not limiting, as dimensions and proportions other than those shown are contemplated and are within the scope of the disclosed invention. Distances, angles, etc. are merely illustrative and do not necessarily bear precise relationship to the actual dimensions and layout of the devices shown. Components can be added, removed, and / or rearranged. Furthermore, disclosures herein of any particular features, aspects, methods, properties, attributes, qualities, attributes, members, or the like, associated with various examples can be used in all other examples described herein. Additionally, it will be recognized that any method described herein can be implemented using any device suitable for performing the described steps.

[0351] Although certain examples and variations thereof have been described in detail, other modifications and methods of use thereof will be apparent to those skilled in the art. It is therefore understood that various applications, modifications, materials, and substitutions may be made from equivalents without departing from the original and inventive disclosure herein or without departing from the scope of the claims.

Claims

1. 1. A delivery system for an implant, comprising: The handle and an elongate catheter coupled to the handle, the elongate catheter including one or more shafts and an implant holding region for holding the implant; a control mechanism on the handle for sliding the one or more shafts longitudinally; a force reduction mechanism selectively actuable to reduce a force within at least one of the one or more shafts, the force reduction mechanism configured to reduce the force upon receiving a threshold longitudinal force within the at least one of the one or more shafts; A delivery system comprising:

2. A delivery system as described in claim 1, wherein the control mechanism includes an actuator for controlling longitudinal sliding of the one or more shafts.

3. 3. The delivery system of claim 2, wherein the force reduction mechanism includes an adapter engaged with the at least one of the one or more shafts, the adapter selectively engageable with the actuator, and the adapter capable of disengaging from the actuator, thereby providing relative movement between the actuator and the at least one of the one or more shafts.

4. The delivery system of claim 3 , wherein the actuator comprises a knob.

5. A delivery system as described in claim 3, further comprising a control device for disengaging the adapter from the actuator.

6. A delivery system as described in claim 1, further comprising an indicator for indicating the longitudinal force within at least one of the one or more shafts.

7. A delivery system as described in claim 1, wherein at least one of the one or more shafts is an outer sheath for covering the implant holding area.

8. A delivery system as described in claim 1, wherein at least one of the one or more shafts is a manifold shaft coupled to one or more sutures for coupling to the implant.

9. The delivery system comprising: an actuator knob on the handle engaged with at least one of the one or more shafts for driving the at least one of the one or more shafts forward or backward, the actuator knob including a proximal portion and a distal portion; a releasable coupler configured to engage an elastomeric body to releasably couple the proximal portion of the actuator knob to the distal portion of the actuator knob, the releasable coupler extending between the proximal portion and the distal portion; further comprising 2. The delivery system of claim 1, wherein the releasable coupler is configured to disengage from the elastomeric body to allow the proximal portion to disengage from the distal portion upon receiving a longitudinal threshold force within the at least one of the one or more shafts engaged with the actuator knob.

10. The delivery system of claim 1, wherein the long catheter is for delivering the implant, including an artificial heart valve, to a heart valve in the patient's body.

11. A delivery system for an implant, comprising: an elongate catheter including an implant holding region for holding the implant, the elongate catheter including one or more shafts; a control mechanism for moving the one or more shafts, the control mechanism including an actuator knob having an inner body and an outer body extending around the inner body, the outer body configured to slip relative to the inner body to limit tension or compression forces on the at least one of the one or more shafts transmitted to the at least one of the one or more shafts by the actuator knob; A delivery system comprising:

12. The delivery system of claim 11 , wherein the outer body comprises an outer shell.

13. The delivery system of claim 11 , wherein the inner body is for engaging an adapter coupled to a proximal end portion of the at least one of the one or more shafts.

14. 14. The delivery system of claim 13, wherein the inner body is for rotating about the adapter and for transmitting rotational movement of the actuator knob into longitudinal movement of the adapter.

15. 12. The delivery system of claim 11, wherein the inner body or the outer body includes a bearing surface to allow the inner body to be rotated relative to the outer body.

16. The delivery system of claim 11, further comprising a displacement body for engaging the outer body with the inner body to maintain a rotational position of the outer body relative to the inner body, the displacement body being biased toward an engagement surface of the outer body or the inner body.

17. A delivery system as described in claim 16, wherein the displacement body extends radially toward the engagement surface.

18. A delivery system for implanting a medical device within a body, comprising: The handle and an elongate catheter coupled to the handle, the elongate catheter including an inner shaft and an outer shaft, the inner shaft being coupled to the medical device, the outer shaft having an implant retaining region along a distal end portion for retaining the medical device in a compressed configuration; an actuator on the handle for sliding the outer shaft longitudinally relative to the handle via a threaded engagement; a force reduction mechanism selectively operable to reduce axial tension or compression on the outer shaft by disengaging the threaded engagement between the actuator and the outer shaft; A delivery system comprising:

19. The delivery system of claim 18, wherein the force reduction mechanism comprises an adapter coupled to a proximal end portion of the outer shaft and having a threaded surface sized to engage with the actuator, and the adapter is operable to disengage from the actuator.

20. A delivery system as described in claim 19, wherein the threaded surface of the adapter is spring-biased to engage with the actuator during movement of the outer shaft, and the threaded surface of the adapter is configured to disengage from the actuator when a control device adjusts the position of the adapter.

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