Steerable system

Abstract

Steerable devices (1000) and systems in which a steerable elongate member (100) positioned within a steerable tubular elongate member can be steered independently of the steerable tubular elongate member. The steerable tubular elongate member can be steered in a first plane in which the steerable elongate member also curves within the steerable tubular elongate member. A steering mechanism (120) operably associated with the steerable elongate member has a distal portion operably associated with the steerable region of the steerable elongate member to steer the steerable region in a second plane transverse to the first plane. The steering mechanism is independently movable relative to a portion of the steerable elongate member proximal to the steerable region so as not to affect the orientation of the steerable region steered in the second plane transverse to the first plane.

Description

[Technical field]

[0001] The present disclosure relates generally to the field of medical devices and systems, and more specifically to steerable devices and systems that typically include elongate members such as catheters, and methods of using and making the same. [Background technology]

[0002] Devices, systems and methods for delivering and / or placing medical devices using minimally invasive techniques, such as percutaneous and / or transluminal, are desirable in order to avoid relatively complicated and invasive open surgery. Various techniques that do not require open surgery utilize systems and devices having various flexible elongate members that can be guided from a small insertion opening in the patient's body to an anatomical site within the body and transluminally through the body (e.g., through the vascular system) to the anatomical site. A wide variety of intracorporeal medical devices have been developed for transluminal medical applications, such as intravascular applications. Some of these systems and devices include guidewires, catheters, medical device delivery systems (e.g., for implantable devices such as tissue anchors, stents, grafts, replacement valves, etc.), and the like. Such systems may be multi-catheter / stacked catheter assemblies that include multiple tubular elongate members stacked one within the other (coaxially and / or in common area within another flexible tubular elongate member). One or more such devices may be independently steerable through the body and to a desired anatomical site. However, when the outer tubular elongate member is curved, the elongate members generally curve within the outer tubular elongate member along with such outer tubular elongate member. More specifically, the inner elongate members within the outer tubular elongate member follow a curve, specifically a shortest path, within the outer curved steerable flexible tubular elongate member, thereby transitioning to an inner region of the curve (i.e., a region on the inner curve closer to an imaginary point or axis about which the inner elongate members are curved). Any steering mechanism of such inner elongate member will also typically follow the curve of the outer tubular elongate member, and will also shift or transition to the shortest path of the curve. If the steering mechanism extends longitudinally along only a portion of the circumference of the inner elongate member (i.e., does not extend completely around), the steering mechanism will impart a torque to the steerable region of the inner elongate member to which it is coupled. Such torquing or realignment of the steering mechanism may interfere with the subsequent control by such steering mechanism to steer at least the steerable region of the inner elongate member to a desired anatomical location.Thus, an improved steering mechanism for multiple elongate members guided within an outer steerable tubular elongate member would be welcomed in the art. Summary of the Invention

[0003] This Summary of the disclosure is provided to aid in understanding, and those skilled in the art will appreciate that each of the various aspects and features of the disclosure may be used advantageously separately in some cases, or in combination with other aspects and features of the disclosure in other cases. No limitation is intended as to the scope of the claimed subject matter, whether or not the inclusion of elements, components, etc. in this Summary.

[0004] In accordance with various principles of the present disclosure, a steerable system for accessing an anatomical site within a patient's body includes an elongate member having a steerable region along a portion of the elongate member, a steering mechanism having a distal portion operatively associated with the steerable region to effect movement of the steerable region, and a proximal portion axially and radially movable relative to the steerable region.

[0005] In some embodiments, the distal portion of the steering mechanism is embedded within the distal portion of the elongate member. In some embodiments, the steering mechanism comprises a two-part tensioning mechanism with an inner puller wire that is axially movable within an outer sheath, a portion of the outer sheath being fixed relative to the steerable region of the elongate member, and a distal end of the puller wire being coupled to the outer sheath such that axial movement of the puller wire steers the outer sheath.

[0006] In some embodiments, the elongate member has a tubular wall defining a lumen therein, the distal portion of the steering mechanism is operably associated with the tubular wall of the elongate member flexible along the steerable region to steer the steerable region, and the proximal portion of the steering mechanism extends within the lumen defined by the tubular wall of the elongate member and is radially movable independent of the steerable region. In some embodiments, the tubular wall of the elongate member comprises an outer layer, an inner layer, and a reinforcement layer between the outer layer and the inner layer, and the steering mechanism is operably associated with one of the layers of the tubular wall. In some embodiments, the steering mechanism is operably associated with the reinforcement layer. In some embodiments, the reinforcement layer comprises a plurality of woven filaments, and the distal portion of the steering mechanism is interwoven with the plurality of woven filaments of the reinforcement layer. In some embodiments, the steering mechanism comprises a two-part tensioning mechanism having an inner pull wire axially movable within an outer sheath, a portion of the outer sheath operably associated with a plurality of filaments of the reinforcement layer along the steerable region, a distal end of the pull wire coupled to the outer sheath such that axial movement of the pull wire steers the steerable region, and in some embodiments, the portion of the outer sheath operably associated with the plurality of filaments along the steerable region is fixed relative to the steerable region.

[0007] In some embodiments, a distal end of the steering mechanism is fixed relative to the steerable region. In accordance with various principles of the present disclosure, a steerable system includes at least one steerable tubular member; an inner steerable member extending through and along the at least one steerable tubular member and having a steerable portion along a distal end of the inner steerable member; and a steering mechanism having a distal portion operably associated with the steerable region of the inner steerable member to effect movement of the steerable region and a proximal portion radially movable relative to the steerable region, wherein the at least one steerable tubular member is steered in a first plane and the steering mechanism is operably associated with the inner steerable member to steer the inner steerable member in a second plane transverse to the first plane.

[0008] In some embodiments, the at least one steerable tubular member comprises a bi-directional steerable delivery catheter, and the inner steerable member is extendable axially out of a distal end of the bi-directional steerable delivery catheter and is steered in the second plane by the steering mechanism.

[0009] In some embodiments, the inner steerable member has a tubular wall defining a lumen therein, the distal portion of the steering mechanism is operably associated with the tubular wall of the inner steerable member along the steerable region to steer the steerable region, and the proximal portion of the steering mechanism extends within the lumen defined by the tubular wall of the inner steerable member and is radially movable independent of the steerable region. In some embodiments, the tubular wall of the inner steerable member comprises an outer layer, an inner layer, and a reinforcement layer between the outer layer and the inner layer, and the steering mechanism is operably associated with one of the layers of the tubular wall. In some embodiments, the reinforcement layer comprises a plurality of woven filaments, and the distal portion of the steering mechanism is interwoven with the plurality of woven filaments of the reinforcement layer. In some embodiments, the steering mechanism comprises a two-part tensioning mechanism having an inner pull wire axially movable within an outer sheath, a portion of the outer sheath operably associated with a plurality of filaments of the reinforcement layer along the steerable region, and a distal end of the pull wire fixed to the outer sheath such that axial movement of the pull wire steers the steerable region. In some embodiments, the portion of the outer sheath operably associated with the plurality of filaments along the steerable region is fixed relative to the steerable region.

[0010] In some embodiments, a distal end of the steering mechanism is fixed relative to the steerable region. In accordance with various principles of the present disclosure, a method of guiding a steerable delivery system / placement system relative to a steerable delivery catheter comprises curving a tubular steerable delivery catheter and the steerable delivery system / placement system in a first plane to deliver the steerable delivery system / placement system to a region of an anatomical site, and operating a steering mechanism to steer a steerable region of the steerable delivery system / placement system in a second plane transverse to the first plane, the steering mechanism having a distal portion fixed relative to the steerable region to steer the steerable region and a proximal portion radially movable relative to the steerable region to conform to the curvature of the steerable delivery catheter in the first plane.

[0011] In some embodiments, the method further comprises allowing the proximal portion of the steering mechanism to conform to the curvature of the steerable delivery catheter without the steering mechanism applying torque to the steerable region of the steerable delivery / placement system out of position to be curved in the second plane.

[0012] These features and advantages of the present disclosure will become readily apparent from the following detailed description, and the scope of the claimed invention is set forth in the appended claims. Although the following disclosure is presented in terms of aspects or embodiments, it should be understood that each aspect may be claimed separately or in combination with aspects and features of that embodiment or any other embodiment. [Brief description of the drawings]

[0013] Non-limiting embodiments of the present disclosure are described by way of example with reference to the accompanying drawings, which are schematic and not intended to be drawn to scale. The accompanying drawings are provided for illustrative purposes only, and the dimensions, positions, order and relative size reflected in the drawing figures may vary. For example, the devices may be enlarged to make details discernible, but it is intended that the devices are reduced in size in relation to fitting within, for example, a delivery catheter or working channel of an endoscope. It will be understood that common features are identified by common reference elements, and descriptions of common features are generally not repeated for brevity and convenience and without any intention of limitation. Where illustration is not necessary to enable a person skilled in the art to understand the disclosure, not all elements are labeled in every figure and not all elements of each embodiment are shown for clarity and conciseness.

[0014] The detailed description will be better understood in conjunction with the accompanying drawings, in which like reference numerals represent like elements and in which: [Figure 1] 1 illustrates a perspective view of an example of an embodiment of a steerable system formed in accordance with various principles of the present disclosure illustrated in a schematic diagram of the heart. [Diagram 2] 1 shows a perspective view of a portion of a steerable flexible tubular elongate member, with the outer layer of the elongate member shown in dashed lines. [Diagram 3] 1 shows a perspective detailed view of the exterior of a steerable flexible tubular elongate member including a steering mechanism operatively associated with a reinforcing layer of the steerable flexible tubular elongate member according to various principles of the present disclosure. [Figure 4] 1 shows a perspective detail view of the inside of a steerable flexible tubular elongate member including a steering mechanism operatively associated with a reinforcing layer of the steerable flexible tubular elongate member according to various principles of the present disclosure. [Diagram 5] 1 shows a partial cross-sectional detail view of the exterior of a steerable flexible tubular elongate member formed in accordance with various principles of the present disclosure. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0015] The following detailed description should be read with reference to the drawings illustrating exemplary embodiments. It should be understood that the disclosure is not limited to the specific embodiments described and may therefore be modified. All devices and systems and methods discussed herein are examples of devices and / or systems and / or methods implemented according to one or more principles of the disclosure. Each example embodiment is provided for illustrative purposes and is merely an example, not the only way to implement these principles. Thus, references to elements or structures or features in the drawings should be recognized as references to example embodiments of the disclosure and should not be understood as limiting the disclosure to the specific elements, structures or features shown. Upon reading this disclosure, examples of other ways of implementing the disclosed principles will occur to those skilled in the art. Indeed, it will be apparent to those skilled in the art that various modifications and variations can be made in the present disclosure without departing from the scope or spirit of the subject matter. For example, features illustrated or described as part of one embodiment can be used with another embodiment to yield still further embodiments. Thus, it is intended that the subject matter encompass such modifications and variations as come within the scope of the appended claims and their equivalents.

[0016] It will be understood that the present disclosure is described in this application with various levels of detail. In some instances, details that are not necessary for one of ordinary skill in the art to understand the present disclosure or that obscure other details may be omitted. The terms used herein are for the purpose of describing particular embodiments only and are not intended to be limiting to the scope of the appended claims. Unless otherwise defined, technical terms used herein should be understood as commonly understood by one of ordinary skill in the art to which the present disclosure belongs. All of the devices and / or methods disclosed and claimed herein can be made and executed without undue experimentation in light of the present disclosure.

[0017] As used herein, "proximal" refers to a direction or location closest to a user, etc. (medical professional or clinician or technician or operator or physician, etc., such terms are used interchangeably herein without any limitation and include automated control systems, etc.) and / or closest to a delivery device when the device is used (e.g., when introducing the device into a patient or during implantation, positioning or delivery), and "distal" refers to a direction or location furthest from a user and / or closest to a delivery device when the device is used (e.g., when introducing the device into a patient or during implantation, positioning or delivery). "Longitudinal" means that an element extends along a longer or greater dimension. A "longitudinal axis" extends along the longitudinal extent of an element, but is not necessarily straight or necessarily maintains a fixed configuration when the element bends or curves. "Center" means at least approximately bisecting the center point and / or approximately equidistant from an exterior surface or boundary, and "central axis" means, with respect to an opening, a line at least approximately bisecting the center point of the opening, the central axis extending longitudinally along the length of the opening when the opening includes, for example, a tubular element, a strut, a channel, a cavity, or a bore. As used herein, a "channel" or "bore" is not limited to a circular cross section. As used herein, a "free end" of an element is an end beyond which the element does not extend. Terms such as engage (and other grammatical forms) may be used interchangeably herein with terms such as connect, grasp, hold, fasten, clip, mount, attach, affix, fasten (and other grammatical forms) and are understood to include direct and indirect engagement unless otherwise indicated, without any limitation intended. Terms such as portion, region, section, segment, etc. may be used interchangeably herein without any limitation intended, unless otherwise indicated. It will be understood that terms such as procedure, surgery, therapy, treatment, diagnosis (including all grammatical forms thereof) may be used interchangeably herein without any intended limitation.Anatomical site, delivery site, placement site, implant / implantation site, target site, treatment site, etc. may be referred to interchangeably and without limitation.

[0018] Accessing regions within the body without incising the body (i.e., transluminally accessing such regions) often requires steering an elongate member to intricate locations. For example, a procedure may involve guiding an elongate member in multiple directions in a first plane, then in a second plane transverse to the first plane, and then in additional third, fourth, fifth, etc. planes. Various procedures, such as, but not limited to, mitral valve treatment, utilize systems with two or more steerable elongate members, for example nested and / or stacked one within the other (coaxially and / or side-by-side, and optionally within another tubular elongate member). The elongate members of such systems may need to be independently steered in different planes transverse to one another. For example, an outer steerable tubular elongate member (such as a delivery catheter) is steered in one or more planes to position the distal end of the steerable system at the anatomical site where the procedure will be performed using such steerable system. The distal portion of the outer steerable tubular elongate member can be steered and / or curved in the delivery plane so that the system can place another system or device at a desired location relative to the anatomical site (e.g., to center the distal end of the system on the mitral valve to repair the mitral valve with another system or device). The other system or device may be delivered and / or positioned by the inner steerable elongate member, with the inner elongate member extending within the outer steerable tubular elongate member, telescopically exiting the outer tubular elongate member and steered to another location. For example, the inner steerable elongate member may be curved in a plane transverse to the delivery plane in which the outer tubular elongate member remains generally curved by the inner steerable elongate member to maintain the distal end of the outer tubular elongate member in a position for initial delivery of the other system or device.

[0019] The configuration of the outer steerable tubular elongate member biases and influences the configuration of the elongate members in the outer steerable tubular elongate member, as understood from a fundamental physics perspective. For example, a curve in the steerable tubular elongate member pulls, drives and biases the elongate members in the tubular elongate member into the bend radius of the outer steerable tubular elongate member to take the shortest path around the curve. The outer steerable tubular elongate member thus predefines a plane in which the elongate members in the outer tubular elongate member can articulate. An inner steerable elongate member delivered by the outer steerable tubular elongate member for the purpose of delivering or placing an additional system or device may therefore be limited in its ability to be steered out of the delivery plane of the outer steerable tubular elongate member, e.g., curved into or within another plane, and to apply a torque to the outer steerable tubular elongate member. For example, multiple steerable elongate members may utilize one or more steering mechanisms coupled to the steerable region of each steerable elongate member. Such steering mechanisms are coupled generally along a portion of the circumference of the steerable elongate member to bend the steerable elongate member in the direction of the region to which the steering mechanism is coupled. For example, when more than one steering mechanism is used, such steering mechanisms are typically spaced apart from one another on the circumference, such as extending along opposite sides of the steerable elongate member, to control bending of the elongate member in opposite directions. When a steering mechanism is actuated (e.g., pulled) to steer the steerable elongate member, the associated steerable region of the steerable elongate member bends / curves generally toward the region where the steering mechanism is coupled to the steerable region of the steerable elongate member. The region where the steerable region is coupled to the steering mechanism will be driven inside the bending radius of the steerable region to take the shortest path. However, any steering mechanism of a steerable elongate member that is curved within an already curved outer steerable tubular elongate member will cause the curves of the steerable elongate member and the outer steerable tubular elongate member to align, specifically, the steering mechanism will be pulled by the curves in the outer steerable elongate member and will be driven and urged inside the radius of such curve to take the shortest path around the curve.Such alignment of the steering mechanism will impart a torque to the region where the steering mechanism couples with the steering region of the steerable elongate member. If the steerable region is retracted in such a position, then one would encounter difficulties in steering the inner elongate member with a standard steering mechanism out of the plane in which the outer steerable tubular elongate member curves. For some therapies, the inner steerable elongate member must be capable of being steered out of the plane delivered by the outer steerable tubular elongate member, such as to access the anatomical region to be treated.

[0020] The principles of the present disclosure may be applied to a variety of systems having at least one steerable elongate member within another steerable tubular elongate member. Such steerable elongate members are generally flexible, either due to the nature of the material of the steerable elongate member or as a result of joints formed within the steerable elongate member. For convenience and without any intention of limitation, reference may be made herein to a delivery / deployment system having two or more steerable elongate members for delivering and / or deploying medical devices and / or systems. However, it will be understood that the principles of the present disclosure may be applied to systems other than those for delivering and / or deploying medical devices and / or systems. It should be understood that the terms elongate member or tubular elongate member are used generally herein for convenience and without any intention of limitation to refer to elements such as catheters, shafts, cannulas, sheaths, tubes, stylets, and the like. It will further be understood that terms such as steer (and other grammatical forms) may be used interchangeably herein with terms such as actuate, articulate, control, pilot, manipulate, move, guide, operate, shift, transition, drive, advance, pull, retract, rotate, move, and the like (and other grammatical forms) without any intended limitation.

[0021] According to various principles of the present disclosure, the steerable system includes at least one outer steerable tubular elongate member and at least one inner steerable elongate member, such as an inner steerable tubular elongate member. Although various embodiments may be described herein with reference to a tubular inner steerable elongate member, the principles of the present disclosure are applicable to steerable elongate members that are not necessarily tubular / hollow. For simplicity and brevity, and without any intent of limitation, the outer steerable member and the inner steerable member are generally referred to in a simplified manner with the understanding that the outer steerable member and the inner steerable member are generally elongate, optionally (and generally advantageously) flexible, and optionally (and generally advantageously) tubular. The outer steerable member can be steered in one or more directions in one or more planes, such as by using a steering mechanism such as a tensioning mechanism. The inner steerable member is configured to be steerable, such as in a different steering plane, independent of the outer steerable member in accordance with various principles of the present disclosure (e.g., if the outer steerable member is curved in a first plane, the inner steerable member may be curved in another plane transverse to the first plane). In some aspects, a steering mechanism is coupled to a portion of the inner steerable member to steer, such as to curve, the inner steerable member in a desired direction, such that the inner steerable member can be guided in a desired direction independent of the outer steerable member (e.g., without being influenced by the curve of the outer steerable member, such as being pulled in the direction of the curve of the outer steerable member through which the inner steerable member extends). The portion of the inner steerable member to which the steering mechanism is operatively engaged is typically along a distal region of the inner steerable member, but need not be so limited. For convenience and without any intent to be limiting, the region of the inner steerable member to which the steering mechanism is operatively engaged and steered (e.g., by curving) is referred to herein as the steerable region.

[0022] In some embodiments, the steering mechanism is operatively associated (e.g., coupled or engaged for operation) with a portion of the wall of the inner steerable member along the steerable region of the inner steerable member in any of a variety of ways that result in movement of the steerable region, such as by pulling or otherwise manipulating the steering mechanism. The steering mechanism may be coupled to a portion of the wall of the inner steerable member, such as by being glued, joined, welded, or embedded (e.g., embedded) in the portion of the wall of the inner steerable member. In some embodiments, the steering mechanism is a tensioning mechanism, such as a tensioning element. In some embodiments, the tensioning mechanism is a two-part mechanism, such as a Bowden cable, with an outer tubular sheath and an inner tensioning element, such as a flexible elongated tensioning element (e.g., a pull wire). The outer tubular sheath allows movement of the inner tensioning element relative to the inner steerable member to steer the inner steerable member even when the outer tubular sheath is fixed relative to the inner steerable member (e.g., as a result of fixing or operatively associating the steering mechanism with the inner steerable member). Typically, the distal end of the inner pulling element is fixed to the outer tubular sheath (which is fixed relative to the inner steerable member) such that pulling the inner pulling element proximally pulls the steerable region of the inner steerable member, thereby causing the inner steerable member to move in the desired manner.

[0023] Other manners of operably associating a steering mechanism with a steerable member such that manipulation of a proximal end of the steering mechanism results in movement of the steerable region of the steerable member in a desired manner are within the scope and spirit of the present disclosure. For example, instead of a steering mechanism extending along the entire length of the steerable region, the steerable region may be made stiffer than adjacent regions of the steerable member. The steering mechanism need only be operably engaged to a proximal end or region of a stiffened steerable region such that it can steer such a stiffened steerable region (e.g., pulling on a proximal region of such a stiffened steerable region will cause the entire stiffened steerable region to curve).

[0024] It may be desirable to allow an inner steerable member within an outer steerable member of a steerable system to be steered in a plane different from the plane in which the outer steerable member is positioned. In other words, it may be desirable for the inner steerable member to be steered outside of such first plane within an outer steerable member curved in a first plane. Such a first plane may be a delivery plane in which the outer steerable member delivers the inner steerable member to a general anatomical region, and the inner steerable member is further guided from the general anatomical region to a specific anatomical site in a plane transverse to the delivery plane of the outer steerable member. In accordance with various principles of the present disclosure, the steering mechanism of the inner steerable member is coupled only to the steerable region of the inner steerable member to allow steering of the inner steerable member independent of the outer steerable member (through which the inner steerable member extends), even when the outer steerable member (and thus at least a portion of the inner steerable member) is curved in a first plane. A portion of the steering mechanism proximal to the steerable region is free to move at least radially relative to the inner steerable member, e.g., in or into a first plane. For example, the steering mechanism of a tubular inner steerable member is coupled only to the steerable region of such tubular inner steerable member (e.g., a distal portion of the tubular wall of the inner steerable member), and a portion of the steering mechanism proximal to such steerable region is radially movable relative to the steerable region. In some embodiments, the proximal portion of the steering mechanism is movable within a lumen defined by the tubular wall of the tubular inner steerable member. In some embodiments, the steering mechanism is operably associated with the inner steerable member only at a distal region or extent of the inner steerable member. The remaining portion of the steering mechanism proximal to the steerable region of the inner steerable member is independently movable at least in a radial direction relative to the steerable region so that such proximal portion of the steering mechanism can follow the inner curve of the inner steerable member without affecting (e.g., applying torque to) the distal portion of the steering mechanism operably associated with the steerable region of the inner steerable member.A proximal portion of the steering mechanism (e.g., in a first plane) can be decoupled from the inner steerable member so as not to affect the orientation of the steerable region, thereby allowing it to be steered into a second plane transverse to the first plane. In other words, because the steering mechanism is fixed only to the steerable region and not along the longitudinal extent of the inner steerable member proximal to the steerable region, the steerable region is not torqued by the proximal portion of the steering mechanism (which is not itself fixed to the inner steerable member) being pulled toward the inside of the bend radius of the curved outer steerable member with which the inner steerable member is positioned and curved.

[0025] A steering mechanism formed according to various principles of the present disclosure can steer the steerable region without being affected by a region of the steering mechanism proximal to the steerable region. In some embodiments, a proximal portion of the steering mechanism operatively associated with the inner steerable member defines the steerable region of the inner steerable member. For example, according to various principles of the present disclosure, a steering mechanism in the form of a tensioning mechanism can steer a proximal portion of the inner steerable member, where the proximal portion of the inner steerable member and the tensioning mechanism are substantially fixed against radial movement (as opposed to another portion of the inner steerable member where the tensioning mechanism is free to move radially). In some examples, the steering mechanism can be a two-part tensioning mechanism having an outer sheath that includes a portion (e.g., a portion that is fixed and not movable relative to the steerable region) that couples the steering mechanism and the steerable region of the inner steerable member to provide the steering movement. The inner tensioning element is generally movable (at least longitudinally movable) relative to such a generally radially fixed extent of the outer sheath. The distal end of the inner tension element is coupled to the outer sheath of the tension mechanism such that steering (e.g., pulling) the inner tension element moves the outer sheath, thereby moving the steerable region of the inner steerable member coupled to the outer sheath. The steering mechanism proximal to the steerable region is free to move radially relative to the inner steerable member, such that movement of the inner steerable member caused by movement of the steering mechanism (e.g., the inner tension element) is limited to the steerable region. The extent of the outer sheath coupled to the inner steerable member can thus be considered to define the steerable region of the inner steerable member. The portion of the steering mechanism proximal to the steerable region moves independently of the inner steerable member, such that the portion of the inner steerable member proximal to the steerable region is not affected by (e.g., is not steered by) movement of the steering mechanism. It will be appreciated that the outer sheath and inner pull element of the described example of a two-piece steering mechanism embodiment are generally movable independently of the inner steerable member proximal to the steerable region.

[0026] It is understood that an inner steerable member that is independently steerable within an outer steerable member of a steerable system may be useful in a variety of steerable systems for a variety of methods of operation or use. For purposes of this disclosure, the description of example embodiments provided below conveniently refers to the treatment of a native mitral valve to provide an example of an environment in which the principles of the present disclosure may be applied. However, one skilled in the art will readily appreciate that the principles of the present disclosure may be fully applicable to other heart valves, regions of the heart, and other anatomical regions with no or minimal changes to the structure and / or extent of the steering mechanisms and / or steerable members of the present disclosure. For example, the devices, systems, and methods disclosed herein may include applications and uses in other parts of a patient's anatomy, such as, but not limited to, arteries, veins, and / or other body lumens or organs.

[0027] Various embodiments of the steerable members, systems and associated methods of making and using will now be described with reference to examples shown in the accompanying drawings. References herein to "an embodiment," "one embodiment," "several embodiments," "other embodiments," and the like indicate that one or more particular features, structures, concepts, and / or characteristics in accordance with the principles of the present disclosure may be included in connection with the embodiment. However, such references do not necessarily mean that all embodiments include the particular features, structures, concepts, and / or characteristics, and do not necessarily mean that an embodiment includes all features, structures, concepts, and / or characteristics. Some embodiments may include one or more such features, structures, concepts, and / or characteristics in various combinations thereof. It should be understood that one or more of the features, structures, concepts, and / or characteristics described with reference to an embodiment may be combined with one or more of the features, structures, concepts, and / or characteristics of any other embodiment provided herein. That is, any features, structures, concepts, and / or characteristics described herein may be mixed and matched to create hybrid embodiments, and such hybrid embodiments are within the scope of the present disclosure. Furthermore, references in various places herein to "an embodiment," "one embodiment," "several embodiments," "other embodiments," etc., do not necessarily all refer to the same embodiment, and separate or alternative embodiments do not necessarily mutually exclude other embodiments. Furthermore, it should be understood that the various features, structures, concepts, and / or properties of the disclosed embodiments are independent and separate from one another and may be used or exist individually or in various combinations with one another to create alternative embodiments that are considered part of the present disclosure. Thus, it would be extremely cumbersome to describe all of the many possible combinations and subcombinations of features, structures, concepts, and / or properties, and the present disclosure is not limited to only the embodiments specifically described herein, and the example embodiments disclosed herein are not intended to limit the broader aspects of the present disclosure. The following description is merely an illustrative example of an embodiment and is not intended to limit the broader aspects of the present disclosure.

[0028] Referring now to the drawings, it will be understood that common features are identified by common reference elements, and for brevity and convenience, and without any intention of limitation, the description of the common features will generally not be repeated. For clarity, not all components having the same reference number are numbered. Furthermore, a group of similar elements may be indicated by numbers and letters, and generally one or more such elements, or such elements as a group, may be referred to by numbers only (without including the letters associated with each of the similar elements). It will be understood that in the following description, similar elements or components among the various embodiments shown will generally be designated by the same reference numbers, and redundant descriptions may generally be omitted for brevity. Furthermore, certain features in one embodiment may be used throughout different embodiments, and are not necessarily labeled separately even when appearing in different embodiments.

[0029] The principles of the present disclosure may be applied to a steerable member 100 used in an example of a system embodiment such as a multi-catheter stack-up assembly 1000 as shown in Figure 1. The multi-catheter stack-up assembly 1000 (for simplicity, referred to herein instead as system 1000) is shown in an exemplary cardiac environment, but it will be understood that other environments are within the scope and spirit of the present disclosure. The principles of the present disclosure are particularly useful in devices and systems for accessing anatomical sites within a patient's body via transluminal access within the body without incising the body.

[0030] The steerable member 100, to which the principles of the present disclosure may be applied, is shown extending through (and projecting distally outward from) any other device catheter 200, with both the steerable member 100 and the device catheter 200 extending within and out of the distal end 301 of a delivery catheter 300, which in turn extends within and out of the distal end 401 of a delivery sheath 400. The steerable member 100 can assist in delivering additional devices (such as an implantable device 510) that are delivered onto or to the distal end 501 of a stylet 500 that extends through the inner steerable member 100. The steerable member 100 is referred to herein as the inner steerable member 100 to distinguish it from other elongate members through which it extends. The illustrated example embodiment of the inner steerable member 100 may be flexible and elongate, and therefore may also be referred to herein as a steerable flexible elongate member 100. One or more of the flexible tubular elongate members 200, 300, 400 may be steerable as well. As will be appreciated, the location through which one or more of the flexible tubular elongate members 200, 300, 400 extend will typically affect the location of the inner steerable member 100 through which it extends. For example, a bend in one or more of the flexible tubular elongate members 200, 300, 400 may cause the inner steerable member 100 to bend in a similar direction. In accordance with various principles of the present disclosure, a steering mechanism is operatively associated with the inner steerable member 100 for steering at least the steerable region 102 of the inner steerable member 100 (e.g., by a curved portion of a steerable tubular elongate member, such as the flexible tubular elongate member 300 through which the inner steerable member 100 extends) in a plane different from the plane in which the flexible tubular elongate members 200, 300, 400 lie. An example of one embodiment of a steering mechanism 120 capable of steering the inner steerable member 100 in the manner illustrated in FIG. 1 is illustrated in FIGs. 2, 3, 4 and 5, as described in further detail below.

[0031] In one example embodiment of the multi-catheter stack-up assembly 1000 shown in FIG. 1, the outermost of the illustrated flexible tubular elongate members 200, 300, 400 may be a delivery guide sheath 400 (also known as an introducer) that is steered into the body, for example, through the femoral artery, across the septal wall, and into the ventricle with a dilator (not shown, but may be any known dilator). The delivery guide sheath 400 may be steerable (either unidirectionally steerable in a single plane, or bidirectionally steerable in two planes, for example perpendicular planes) to guide and deliver the remaining devices and systems therein to a desired anatomical site, such as the heart (and more specifically the mitral valve in the example embodiment of the environment shown in FIG. 1). The delivery catheter 300 may extend distally and out of the delivery guide sheath 400 to deliver the devices and / or systems to the anatomical site to be treated. Thus, the delivery catheter 300 is generally steerable to position such devices and / or systems relative to the anatomical site as desired for and / or indicated by the procedure or treatment. For example, in the illustrated embodiment, the delivery catheter 300 is steerable to be substantially centered above the mitral valve MV. The delivery catheter 300 may be articulated and coupled with one-way or two-way steering mechanisms as known to those skilled in the art, the details of which do not limit the scope of this disclosure. The optional device catheter 200 and the inner steerable member 100 (which extends through the optional device catheter 200) are configured to move axially (e.g., telescope) relative to the delivery catheter 300, e.g., to extend distally out of the delivery catheter 300 to deliver and / or position the device or system at the anatomical site. The device catheter 200 and the inner steerable member 100 can be retracted back into the delivery catheter 300 and withdrawn once the procedure is completed.

[0032] As described above, the example embodiment of the system 1000 shown in FIG. 1 includes systems and devices for repairing a heart valve, such as repairing the leaflet function of the heart valve. In one illustrated example embodiment, a device catheter 200 delivers a system such as a leaflet clip spreader 210 having spreader arms 212 that can grasp the heart valve leaflets L to clamp a device such as a leaflet clip 220 to the heart valve leaflets L (as shown). Such a device catheter 200 may alternatively be referred to as a grasper shaft 200 for convenience and without any intention of limitation. The illustrated example embodiment of the inner steerable member 100 delivers an implant delivery system such as an anchor garage 110 (e.g., carried by the distal end 101 of the inner steerable member 100) within which an implantable device is delivered to an anatomical site. The distal end 101 of the inner steerable member 100 may be coupled to the proximal end 113 of the anchor garage 510 (e.g., fitted into a counterbore in the proximal end 113). In one illustrated example embodiment, the stylet 500 movably extends through the anchor garage 110 and out the distal end 111 of the anchor garage 510, thereby positioning an implantable device, such as an anchor 510, carried at the distal end 501 of the stylet 500. Optionally, the stylet 500 controls the delivery of the anchor 510 to the leaflet clip 220, thereby tensioning the leaflet clip 220 via the artificial chordae 530. The stylet 500 is further used to control an artificial chordae tensioning and locking device 520 to adjust the tension of the artificial chordae 530 extending between the anchor 510 and the leaflet clip 220 and / or release the anchor 510 from the anchor garage 110.

[0033] As will be readily understood by those skilled in the art, the force vector that the artificial chordae 530 exerts on the leaflet clip 220 is selected and set to effect the desired restoration of the heart valve leaflet L to which the artificial chordae 530 is coupled, i.e., to achieve the desired closure of such heart valve leaflet L relative to the other heart valve leaflets, for example. The direction of the force vector of the artificial chordae 530 is generally determined by the location at which the anchor 510 is implanted in the ventricle V (e.g., in the papillary muscle tissue of the ventricle V). It is therefore important to be precisely controllable to steer the inner steerable member 100 in order to implant the anchor 510 in the desired location for exerting the desired force vector on the leaflet L via the artificial chordae 530 coupled between the anchor 510 and the leaflet clip 220.

[0034] In accordance with various principles of the present disclosure, a steering mechanism 120 is operatively associated with the inner steerable member 100, allowing the inner steerable member 100 to be steered unimpeded, for example, out of the delivery plane of the delivery catheter 300 through which the inner steerable member 100 is delivered. Example embodiments of steering mechanism 120 formed in accordance with various principles of the present disclosure can be understood with reference to Figures 2, 3, 4 (which are oriented in the opposite direction to that in Figure 1 in which steering mechanism 120 is oriented), and 5. The illustrated example embodiment of steering mechanism 120 is associated with the distal steerable region 102 of the inner steerable member 100 and extends proximally from the distal end 101 of the steerable member 100. However, other placements or associations are within the scope and spirit of the present disclosure.

[0035] In accordance with various principles of the present disclosure, the steering (e.g., bending) of the steerable region 102 of the inner steerable member 100 is controlled by / with a distal portion 122 of the steering mechanism 120. The distal portion 122 of the steering mechanism 120 is operatively associated with the steerable region 102 of the inner steerable member 100 to impart movement to the steerable region 102. For example, the distal portion 122 of the steering mechanism 120 is substantially radially and longitudinally fixed to at least a portion of the steerable region 102 of the inner steerable member 100 such that proximal movement of the steering mechanism 120 causes the steerable region 102 to bend (e.g., toward a position where the steering mechanism 120 is fixed to the steerable region 102). In contrast, the proximal portion 124 of the steering mechanism 120 is not radially fixed relative to the proximal portion 104 of the inner steerable member 100 (which is proximal to the proximal end 103 of the steerable region 102 where the inner steerable member 100 is curved by the steering mechanism 120 as shown in FIG. 1 ). For example, the proximal portion 124 of the steering mechanism 120 is substantially free floating within a lumen 105 defined within the inner steerable member 100 and is at least radially movable relative to the proximal portion 104 of the inner steerable member 100 and independently of the steerable region 102. Thus, while longitudinal movement (e.g., pulling) of the steering mechanism 120 causes movement (e.g., steering, bending) of the steerable region 102, radial movement of the substantially free-floating proximal portion 124 of the steering mechanism 120 (e.g., to align with a radially inner portion of a curve in the inner steerable member 100 through which the steering mechanism 120 extends) does not cause or torque radial movement of the steerable region 102. The proximal portion 124 of the steering mechanism 120 is thus free to move (e.g., radially) relative to the proximal portion 104 of the inner steerable member 100, for example, to follow a curve 303 in the delivery catheter 300 that delivers (and imparts a corresponding curve to) the inner steerable member 100.The proximal portion 124 of the steering mechanism 120 is thus free to follow the shortest path of the curve in the inner steerable member 100 proximal to the steerable region 102 (e.g., as drawn to a radially inner portion of the curve) without reorienting and otherwise affecting the position of the steerable region 102 of the inner steerable member 100. The steerable region 102 is therefore steerable to a particular treatment site by steering a delivery catheter 300 that delivers the inner steerable member 100 generally near the treatment site and independent of the orientation of the delivery catheter 300.

[0036] The distal portion 122 of the steering mechanism 120 may be operably engaged to the inner steerable member 100 in any desired manner that allows the steering mechanism 120 to control the movement of the steerable region 102 of the inner steerable member 100 without being affected by the movement of the proximal portion 124 of the steering mechanism 120 that is proximal to the steerable region 102. For example, a portion of the steering mechanism 120 may be coupled to a wall of the inner steerable member 100 along which the steerable region 102 is formed, the more proximal portion of the steering mechanism 120 being free to move radially relative to the inner steerable member 100 for the purpose of moving such that the inner steerable member 100 curves without affecting the position of the steerable region 102. The steering mechanism 120 may be coupled to an outer surface, an inner surface, or within the wall of the inner steerable member 100. When the steering mechanism 120 is coupled to the outer surface of the steerable region 102 , it extends through the wall of the inner steerable member 100 into the inside of the inner steerable member 100 and is thereby radially movable relative to the inner steerable member 100 .

[0037] In accordance with various principles of the present disclosure, steering mechanism 120 may be associated with reinforcement layer 130 of inner steerable member 100, although other configurations are within the scope and spirit of the present disclosure. For example, in embodiments of inner steerable member 100 that do not have an inner reinforcement layer, steering mechanism 120 may be positioned within the wall of inner steerable member 100, or may be coupled to an inner surface of inner steerable member 100, or may be coupled to an outer surface of inner steerable member 100 and extend through the wall of inner steerable member 100 into the interior of inner steerable member 100, thereby free floating, for example, within lumen 105 defined within inner steerable member 100.

[0038] In the example embodiment of steering mechanism 120 illustrated in Figures 2, 3, 4 and 5, the distal portion 122 of steering mechanism 120 is operatively associated with the inner steerable member 100 by being operatively associated with the longitudinal extent of a reinforcing layer 130 provided between an outer layer or jacket 140 and an inner layer or liner 150 of the inner steerable member 100. The longitudinal extent of the distal portion 122 of steering mechanism 120 can define the longitudinal extent of the steerable region 102. The longitudinal extent of the steerable region 102 will be determined by the bend radius desired to be achieved upon actuation of steering mechanism 120. For example, if a bend radius of 38.1 millimeters (1.5 inches) is desired, then steerable region 102 may be formed to be 76.2 millimeters (3 inches) long. The proximal portion 124 of the steering mechanism 120 is not operably connected to the inner steerable member 100 or the reinforcement layer 130 of the inner steerable member 100 and extends proximally through the lumen 135 of the reinforcement layer 130, extending freely within the inner steerable member 100 and thereby unhindered from moving within the inner steerable member 100 (e.g., within the lumen 105 defined by the tubular wall of the inner steerable member 100). The steering mechanism 120 transitions radially inward from a proximal portion 124 of the steering mechanism 120 (operably associated with the reinforcement layer 130 along the steerable region 102 of the inner steerable member 100) along a transition portion 127 of the steering mechanism 120 (along the proximal end 103 of the steerable region 102) to a distal portion 122 of the steering mechanism 120 (which is movable at least radially independent of the proximal portion 104 of the inner steerable member 100).

[0039] Steering mechanism 120 formed according to various principles of the present disclosure may be operatively associated with inner steerable member 100 in any of a variety of ways, such as with reinforcement layer 130 of inner steerable member 100. For example, in some embodiments, reinforcement layer 130 is formed of one or more filaments 132. Steering mechanism 120 may be operatively associated with filaments 132 forming reinforcement layer 130. Filaments 132 of reinforcement layer 130 may extend longitudinally and / or circumferentially around inner steerable member 100. In the example embodiment shown in FIG. 2, reinforcement layer 130 includes one or more connecting filaments 134 configured and arranged to connect steering mechanism 120 to reinforcement layer 130. In some embodiments, the filaments 132 of the reinforcement layer 130 may be braided, interengaged, entangled, interwoven, knitted, knotted, looped (e.g., bobbinette style), weaved, woven, wrapped, or the like, and such terms (and other grammatical forms) are used interchangeably herein without any intended limitation. In such embodiments, the steering mechanism 120 may be operatively associated with the filaments 132 of the reinforcement layer 130 in any of a variety of manners. For example, the steering mechanism 120 may be interwoven with the braided filaments 132 of the reinforcement layer 130, such as in the example embodiment shown in Figures 3, 4, and 5. For example, the steering mechanism 120 may be interwoven with the filaments 132 of the reinforcement layer 130, such as woven through the braid of the filaments 132, as shown in Figures 3, 4, and 5. More specifically, the steering mechanism 120 may be interwoven within the braided reinforcement layer 130 with outer filaments 132o of the braid above the steering mechanism 120 (radially outward, closer to the outer layer 140 of the steerable member 100) and inner filaments 132i below the steering mechanism 120 (radially inward, closer to the inner layer 150 of the steerable member 100).

[0040] As will be readily understood with reference to the example embodiment shown in Figures 4 and 5, the steering mechanism 120 is operatively associated only with the steerable region 102 of the inner steerable member 100 to steer the steerable region 102 and move therewith. The proximal portion 124 of the steering mechanism 120 is positioned within the lumen 105 of the inner steerable member 100 such that it is relatively freely movable relative to the proximal portion 104 of the inner steerable member 100 (without imparting motion to the inner steerable member 100). However, other arrangements and configurations that allow the steering mechanism 120 to move radially independent of the configuration of the inner steerable member 100 proximal to the steerable region 102, such as created or caused by a tubular member within which the inner steerable member 100 is positioned, are within the scope and spirit of the present disclosure. Thus, the proximal portion 124 of the steering mechanism 120 can be moved without affecting the position of the steerable region 102 of the inner steerable member 100. The steering mechanism 120 therefore remains in a desired position for steering to a desired anatomical site where a procedure (e.g., delivery, placement and implantation of an implantable device such as anchor 510) will be performed by or with the inner steerable member 100. The inner steerable member 100 may therefore be considered a steerable placement / delivery system.

[0041] In accordance with various principles of the present disclosure, the steering mechanism 120 may advantageously be a two-part steering mechanism 120 having a pulling element 126 (e.g., pull wire 126) within a lumen 125 defined within an outer sheath 128. Such a configuration allows a distal portion 122 of the steering mechanism 120 to be coupled to the steerable region 102, and further allows a portion of the steering mechanism 120 to move relative to the steerable region 102, thereby steering the steerable region 102. For example, the outer sheath 128 may be coupled to the steerable region 102 of the inner steerable member 100 (e.g., bonded, interwoven, or otherwise coupled with filaments 132 of a reinforcing layer 130 of the inner steerable member 100) with only a portion of the pull wire 126 fixed to a portion of the outer sheath 128. In some embodiments, only the distal end of the pull wire 126 is coupled (in any desired manner) to the outer sheath 128. The combined outer sheath 128 and inner puller wire 126 are not attached to the inner steerable member 100 along the proximal portion 124 of the steering mechanism 120, thereby allowing for independent (at least radial) movement of the tensioning mechanism 120 as described above. In some embodiments, the outer sheath 128 of the two-part steering mechanism 120 has an outer diameter of at least about 0.022 inches ± 0.002 inches (0.559 mm ± 0.051 mm) and an inner diameter of about 0.020 inches ± 0.001 inches (0.508 mm ± 0.02 mm), allowing the puller wire 126 to be routed through the outer sheath 128 and to be easily moved axially within the outer sheath 128 along the longitudinal axis LA of the inner steerable member 100. The steerable member 100 in such an embodiment may have an outer diameter of about 0.08 inches ± 0.02 inches (2.03 mm ± 0.5 mm) to about 0.3 inches ± 0.02 inches (7.62 mm ± 0.5 mm).

[0042] In embodiments in which the steering mechanism 120 is operably engaged to the reinforcement layer 130 of the inner steerable member 100 as illustrated in Figures 2, 3, 4 and 5, the steering mechanism 120 may be operably engaged to the inner steerable member 100 during the manufacture of the reinforcement layer 130 in various manners. The inner steerable member 100 may be formed according to various principles of the present disclosure with the reinforcement layer 130 provided or formed between the outer layer 140 and the inner layer 150. The inner layer 150, which may also be known as a liner, may be made of a lubricious material to facilitate the insertion and transport of a medical device into and through the inner layer 150. Such an inner layer 150 may be formed from materials such as, but not limited to, polytetrafluoroethylene (PTFE), perfluoroalkyl vinyl ether (PFA) and tetrafluoroethylene, perfluoropropyl vinyl ether, perfluoromethyl vinyl ether, fluorinated ethylene propylene (FEP), polyether block amide (PEBA), polyurethane, nylon or copolymers or mixtures thereof. The inner layer 150 can be formed in a variety of ways, such as an extrusion process, or by molding or coating a material onto a mandrel or into another layer (relatively outer layer) of the flexible tubular elongate member. The outer layer 140, which may be known as a jacket, may be formed from a generally lubricious material that provides the inner steerable member 100 with a frictionless (or at least reduced friction) biocompatible outer surface, thereby facilitating steering of the inner steerable member 100 within the flexible tubular elongate member 200 through which it extends and / or within a passageway / lumen in the patient's body without damaging the flexible tubular elongate member 200 / surrounding tissue. Such an outer layer 140 may be formed using any of a variety of biocompatible materials, such as nylon, polyurethane, polyether block amide (PEBA), PTFE, high density polyethylene (HDPE), liquid crystal polymer (LCP), or copolymers or blends thereof, by any desired method, such as extruding, dipping, painting, brushing, spraying, molding, or the like, the material overlying the other layers of the flexible tubular elongate member.It will be appreciated that the inner steerable member 100 may have different properties (eg, flexibility, stiffness, wall thickness, elasticity, durometer, etc.) along the length of the inner steerable member 100.

[0043] The reinforcing layer 130 may be configured to impart one or more properties or characteristics to the inner steerable member 100, such as strength, flexibility (or a desired degree of stiffness), enhanced maneuverability, tensile strength, torque transmission, steerability, stability, durability, resilience, fracture resistance, etc., to impart various capabilities to the inner steerable member 100, such as the ability to navigate within a complex system, such as the multi-catheter stack-up assembly 1000, and / or within the body, the ability to deliver a device or system or treatment or therapy, the ability to implant a device or system, the ability to steer a device or system, or other capabilities selected for the intended use of the inner steerable member 100. It will be understood that not all properties or characteristics of the reinforcing layer 130 are considered "reinforced," and references and uses of the term reinforcing and other grammatical forms herein are for convenience and are not necessarily limited to the conventional concept of "reinforcing."

[0044] The reinforcing layer 130 of the inner steerable member 100 formed according to various principles of the present disclosure may be formed over the inner layer 150 or may be formed independent of the inner layer 150 material applied to the inner layer 150 to form the inner layer 150. In some embodiments, the reinforcing layer 130 may be embedded within the inner layer 150. In some embodiments, the outer layer 140 is provided over the reinforcing layer 130, such that, for example, it surrounds or encapsulates the reinforcing layer 130 within the wall of the inner steerable member 100. The outer layer 140 may fill voids or gaps within the reinforcing layer 130, such as to embed the reinforcing layer 130 within the outer layer 140 and / or form a sandwich-like structure including the inner layer 150, the reinforcing layer 130, and the outer layer 140.

[0045] The reinforcing layer 130 may be formed, shaped, and configured in any desired configuration along the length of the inner steerable member 100 (extending along the longitudinal axis of the inner steerable member 100) and / or along a portion of the circumference of the flexible tubular elongate member (about the longitudinal axis of the inner steerable member 100) to provide or impart desired properties to the inner steerable member 100 and to allow the steering mechanism 120 to be operatively associated with the inner steerable member 100. In some embodiments, the reinforcing layer 130 is formed of a plurality of elongate elements 132, such as wires (filaments, fibers, threads, ribbons, etc., referred to herein for convenience and without limitation as filaments), that extend longitudinally along the length of the inner steerable member 100. The filaments 132 may be formed from any of a variety of materials, including, but not limited to, metals, metal alloys (such as stainless steel, nickel-titanium alloys or other nickel alloys, tungsten alloys, chromium alloys, etc.), polymers, metal-polymer composites, etc. The filaments 132 may be formed from linear elastic or superelastic or non-superelastic or shape memory materials as selected based on the intended use of the inner steerable member 100. The filaments 132 may have any of a variety of cross-sectional shapes to impart desired characteristics or properties to the reinforcement layer 130. The diameter or thickness of the filaments 132 is selected based on the intended use of the inner steerable member 100 so that the inner steerable member 100 has a desired overall diameter and desired wall thickness. At least a portion of the reinforcement layer 130 may be coated, for example with a polymer coating material, to impart additional desired properties or characteristics to one or more of the filaments 132 of the reinforcement layer 132. Such coating may be done in any desired manner, such as by extrusion, dipping, painting, brushing, spraying (e.g., on each filament), etc., but is not intended to be limited thereto.

[0046] In some embodiments, filaments 132 (single, or in pairs, or in bundles of more than two) are braided with other filaments 132 (single, or in pairs, or in bundles of more than two) in any of a variety of patterns, the details of which are not important to this disclosure. It will be understood that the terms braided, interengaged, entangled, interwoven, knitted, knotted, looped (e.g., bobbinette style), overlapped, weaved, woven, wrapped, and the like (including their various grammatical forms) may be referred to interchangeably herein, without any intention of limitation.

[0047] In accordance with various principles of the present disclosure, steering mechanism 120 (e.g., in the form of tension mechanism 120) may be interwoven into a distal portion of reinforcement layer 130, such as by being woven with woven filaments 132 of reinforcement layer 130. Once reinforcement layer 130 is formed to a desired length for steerable region 102, steering mechanism 120 may be pulled out of the braiding process and out of filaments 132 of reinforcement layer 130. For example, the braiding process during which reinforcement layer 130 is formed may be interrupted, and steering mechanism 120 may be redirected out of (e.g., pulled out of alignment or otherwise withdrawn from) reinforcement layer 130. Once the reinforcement layer 130 is formed over the already formed inner layer 150, the inner layer 150 may be breached, i.e., for example, punctured (e.g., with an instrument such as a scalpel), thereby allowing the steering mechanism 120 to be extended or positioned within the lumen 135 of the reinforcement layer 130 and within the inner steerable member 100 (e.g., lumen 105 within the inner steerable member 100).

[0048] In view of the above, an inner steerable member 100 formed according to various principles of the present disclosure with a steering mechanism 120 proximal to the steerable region 102 of the inner steerable member 100 and having a free-floating proximal portion 124 allows the inner steerable member 100 to be steered out of the plane in which it would be curved (e.g., by virtue of the curved portion of the flexible tubular elongate member or members through which it extends). In some instances, it may be desirable to steer the inner steerable member 100 in a plane different from the plane of the outer flexible tubular elongate member or members 200, 300, 400 through which it extends and through which it is delivered to the treatment site. An example of a desirable location of the inner steerable member 100 within the heart H is shown in FIG. 1. Various therapies performed on regions of the heart H, such as the heart valves, may require access to cardiac tissue at a location beneath the leaflets L of the valves. However, devices and systems delivered transluminally to a heart valve, e.g., through the septum, may be in a position that does not readily facilitate steering the repair device and system out of the plane in which the delivery catheter 300 for such devices and systems extends. For example, repair of a heart valve, e.g., the mitral valve MV, to restore proper function of the mitral valve, e.g., to treat a condition such as mitral regurgitation (and avoid its potentially fatal consequences), may include extending an artificial chordae 530 from the leaflet L to an anchor 510 positioned on the ventricular wall V below the leaflet L, such as below the posterior leaflet of the mitral valve MV. Such a position on the ventricular wall V generally does not lie in or otherwise intersect the plane in which the delivery system 1000 extends to deliver the inner steerable member 100 used to deliver the anchor 510. Furthermore, the configuration of the system 1000 and delivery catheter 300 in the delivery plane generally constrains the movement of the delivered device and system to within such delivery plane.The inner steerable member 100 formed according to various principles of the present disclosure may be telescopically extended out of the delivery catheter 300 and steered out of the delivery plane at any angle between 0 and 180 degrees, such as, but not limited to, 45, 90, or 135 degrees, into a second plane (e.g., transverse or perpendicular to the delivery plane), within which the inner steerable member 100 can be steered as shown in FIG. 1 .

[0049] It will be appreciated that the steerable member 100 formed according to various principles of the present disclosure can deliver and / or deploy devices other than anchors with or without a delivery device such as the anchor garage 110. For example, the delivery catheter 100 may deliver a device by itself without the need for an additional device such as the stylet 500 as in the example embodiment illustrated in FIG. 1. It will further be appreciated that the principles of the present disclosure may be applied to devices and systems other than mitral valve repair, such as other areas of the cardiovascular system. Delivering and properly positioning the steerable member through a separate steerable tubular member may be desirable in various other anatomical areas or systems, such as the gastrointestinal and / or digestive system, the abdominal cavity, the urinary tract, the reproductive tract, the respiratory system, the circulatory system, etc. The disclosed medical devices and systems may be inserted via different access points and approaches, for example percutaneously, endoscopically, laparoscopically, or combinations thereof. In addition to those described above, various further advantages of the various aspects, features, components and structures of the steerable member as described above will be appreciated by those skilled in the art.

[0050] It should be understood by those skilled in the art that the present discussion is merely a description of exemplary examples of embodiments and is not intended as a limitation to the broader aspects of the present disclosure. All devices and methods described herein are examples of devices and / or methods implemented according to one or more principles of the present disclosure. These examples are merely examples, not the only ways to implement these principles, and are not intended as a limitation to the broader aspects of the present disclosure. Thus, references to elements or structures or features in the drawings should be recognized as references to examples of embodiments of the present disclosure, and should not be understood as limiting the present disclosure to the specific elements, structures or features shown. Other examples of ways to implement the disclosed principles will occur to those skilled in the art upon reading this disclosure.

[0051] As used herein, the singular forms "a," "an," and "the" are intended to include the plural forms unless the context clearly indicates otherwise. As used herein and in the appended claims, the term "or" is generally used in its sense including "and / or" unless the context clearly indicates otherwise. As used herein, the conjunction "and" includes each of the structures, components, features, etc. connected by the conjunction unless the context clearly indicates otherwise, and the conjunction "or" includes one or the other of the structures, components, features, etc. connected by the conjunction alone and in any combination and number unless the context clearly indicates otherwise. The terms "comprises" and / or "comprising", or "includes" and / or "including", when used in this specification, specify the presence of stated features, regions, steps, elements and / or components, but do not exclude the presence and addition of one or more other features, regions, integers, steps, operations, elements, components and / or groups thereof.

[0052] The foregoing discussion is broadly applicable and is presented for purposes of illustration and description, and is not intended to limit the disclosure to the forms disclosed herein. It will be understood that various additions, modifications, and substitutions may be made to the embodiments disclosed herein without departing from the concept, spirit, and scope of the disclosure. In particular, it will be apparent to those skilled in the art that the principles of the disclosure may be embodied in other forms, structures, arrangements, proportions, and with other elements, materials, and components without departing from the concept, spirit, scope, or characteristics thereof. For example, various features of the disclosure are categorized into a group in one or more aspects, embodiments, or configurations for the purpose of streamlining the disclosure. However, it will be understood that various features in a particular aspect, embodiment, or configuration of the disclosure may be combined in another aspect, embodiment, or configuration. The disclosure is presented in terms of embodiments, and it will be understood that the various separate features of the subject matter need not necessarily all be present to achieve the desired properties and / or advantages of the subject matter or at least some of such features individually. Those skilled in the art will appreciate that the present disclosure may be used with many changes or modifications to the structure, arrangement, proportions, materials, components, and the like, to be specifically adapted to a particular environment and operational requirements and used in the practice of the disclosure, without departing from the principles or spirit or scope of the disclosure. For example, elements shown as integrally formed may be constructed from multiple pieces, or elements shown as multiple pieces may be integrally formed, the operation of elements may be varied, such as by reversal, and the size or dimensions of elements may be changed. Similarly, although operations or acts or steps are described in a particular order, this should not be construed as requiring such a particular order to achieve desired results, and not all operations or acts or steps should be performed. Still other implementations are within the scope of the following claims. In some cases, the acts recited in the claims may be performed in a different order and still achieve desirable results.The embodiments disclosed herein are therefore to be considered in all respects as illustrative and not restrictive, the scope of the claimed subject matter being indicated by the appended claims and not limited to the foregoing description or the specific embodiments or configurations described or illustrated herein. In view of the above, individual features of any embodiment may be employed and claimed separately or in combination with features of a particular embodiment or any other embodiment, and the scope of the subject matter being indicated by the appended claims and not limited to the foregoing description.

[0053] It will be understood in the foregoing description and in the claims that follow: The terms "at least one," "one or more," and "and / or," as used herein, are open-ended expressions that operate both conjunctively and disjunctively. Terms such as "a," "an," "the," "first," "second," etc. do not preclude a plurality. For example, the term "a" or "an" entity, as used herein, refers to one or more of that entity. Thus, the terms "a" (or "an"), "one or more," and "at least one" can be used interchangeably herein. All directional references (e.g., proximal, distal, upper, lower, upward, downward, left, right, lateral, longitudinal, front, rear, top, bottom, up, down, vertical, horizontal, radial, axial, clockwise, counterclockwise, etc.) are used solely for identification purposes to aid in the reader's understanding of this disclosure and / or serve to distinguish regions of related elements from one another and do not limit the related elements with respect to their location, orientation or use, particularly in this disclosure. Connection references (e.g., attached, coupled, connected, engaged and joined) should be interpreted broadly and may include intermediate members between a set of elements and relative movement between multiple elements unless otherwise indicated. Thus, connection references do not necessarily mean that two elements are directly connected and in a fixed relationship to one another. Identification references (e.g., primary, secondary, first, second, third, fourth, etc.) are not intended to imply importance or priority, but are used to distinguish one feature from another.

[0054] The following claims are incorporated by reference into this detailed description, with each claim standing on its own as a separate embodiment of the present disclosure. In the claims, the term "comprises / comprising" does not exclude the presence of other elements, components, features, regions, integers, steps, operations, etc. Furthermore, although individual features may be included in different claims, they may in some cases be advantageously combined, and their inclusion in different claims does not imply that a combination of several features is not feasible and / or advantageous. Furthermore, a reference to the singular does not exclude a plurality. Reference signs in the claims are provided merely as a clarifying example and should not be interpreted as limiting the scope of the claims in any way.

Claims

1. 1. A steerable system for accessing an anatomical site within a patient's body, the steerable system comprising: an elongate member having a steerable region along a portion of the elongate member; a steering mechanism having a distal portion operatively associated with the steerable region to effect movement of the steerable region, and a proximal portion axially and radially movable relative to the steerable region.

2. The steerable system of claim 1 , wherein the distal portion of the steering mechanism is embedded within a distal portion of the elongate member.

3. The elongate member has a tubular wall defining a lumen therein; the distal portion of the steering mechanism is operatively associated with the tubular wall of the elongate member that is flexible along the steerable region to steer the steerable region; 3. The steerable system of claim 1 or 2, wherein the proximal portion of the steering mechanism extends within the lumen defined by the tubular wall of the elongate member and is radially movable independently of the steerable region.

4. 4. The steerable system of claim 3, wherein the tubular wall of the elongate member comprises an outer layer, an inner layer, and a reinforcing layer between the outer layer and the inner layer, and the steering mechanism is operably associated with one of the layers of the tubular wall.

5. The steerable system of claim 4 , wherein the steering mechanism is operatively associated with the stiffening layer.

6. the reinforcing layer comprises a plurality of woven filaments; The steerable system of claim 4 or 5, wherein the distal portion of the steering mechanism is interwoven with the plurality of woven filaments of the reinforcing layer.

7. the steering mechanism comprises a two-part tensioning mechanism having an inner puller wire axially movable within an outer sheath; a portion of the outer sheath operatively associated with a plurality of filaments of the reinforcement layer along the steerable region; The steerable system of any one of claims 4 to 6, wherein distal ends of the puller wires are coupled to the outer sheath such that axial movement of the puller wires steers the steerable region.

8. 8. The steerable system of claim 7, wherein the portion of the outer sheath operatively associated with the plurality of filaments along the steerable region is fixed relative to the steerable region.

9. A steerable system according to any preceding claim, wherein a distal end of the steering mechanism is fixed relative to the steerable region.

10. at least one steerable tubular member; an inner steerable member extending through and along the at least one steerable tubular member and having a steerable portion along a distal end of the inner steerable member; a steering mechanism having a distal portion operatively associated with the steerable region of the inner steerable member to effect movement of the steerable region and a proximal portion radially movable relative to the steerable region; a steering mechanism operatively associated with the inner steerable member to steer the inner steerable member in a second plane transverse to the first plane;

11. the at least one steerable tubular member comprises a bi-directional steerable delivery catheter; The steerable system of claim 10 , wherein the inner steerable member is extendable axially out of a distal end of the bi-directional steerable delivery catheter and is steerable in the second plane by the steering mechanism.

12. the inner steerable member has a tubular wall defining a lumen therein; the distal portion of the steering mechanism is operatively associated with the tubular wall of the inner steerable member along the steerable region to steer the steerable region; 12. The steerable system of claim 11, wherein the proximal portion of the steering mechanism extends within the lumen defined by the tubular wall of the inner steerable member and is radially movable independently of the steerable region.

13. 13. The steerable system of claim 12, wherein the tubular wall of the inner steerable member comprises an outer layer, an inner layer, and a reinforcing layer between the outer layer and the inner layer, the steering mechanism being operably associated with the reinforcing layer.

14. 1. A method of guiding a steerable delivery / placement system relative to a steerable delivery catheter, the method comprising: bending the tubular steerable delivery catheter and the steerable delivery system / deployment system in a first plane to deliver the steerable delivery system / deployment system to a region of an anatomical site; and operating a steering mechanism to steer a steerable region of the steerable delivery / placement system in a second plane that intersects the first plane, the steering mechanism having a distal portion fixed relative to the steerable region to steer the steerable region and a proximal portion radially movable relative to the steerable region to conform to the curvature of the steerable delivery catheter in the first plane.

15. 15. The method of claim 14, further comprising allowing the proximal portion of the steering mechanism to conform to the curvature of the steerable delivery catheter without the steering mechanism applying torque to the steerable region of the steerable delivery / placement system out of position to be curved in the second plane.

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