Expandable sheath for introducing an intravascular delivery device into a body

Abstract

Aspects of the expandable sheath can be used in conjunction with a catheter assembly to introduce a prosthetic device, such as a heart valve, into a patient.SOLUTION: Such aspects can minimize trauma to the vessel by allowing temporary expansion of a portion of the introducer sheath to accommodate the delivery apparatus and then return to its original diameter once the prosthetic device has passed. Some aspects can include a sheath comprising an inner layer and an outer layer having at least one folded portion of the inner liner. Some aspects include an inner liner having an etched portion, an un-etched portion, and an otherwise surface modified portion. The expandable sheath aspect of the present invention can avoid the need for multiple insertions to enlarge the vessel, thus providing an advantage over conventional introducer sheaths.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] Cross-reference to related applications This application claims the benefit of U.S. Provisional Patent Application No. 63 / 059,764, filed July 31, 2020, and U.S. Provisional Patent Application No. 63 / 021,945, filed May 8, 2020, the entire contents of which are incorporated herein by reference.

[0002] The present application relates to aspects of a sheath for use with catheter-based techniques for repairing and / or replacing heart valves and for delivering prosthetic devices, such as prosthetic valves, to the heart via a patient's vasculature. [Background technology]

[0003] Intravascular delivery catheter assemblies are used to implant prosthetic devices, such as prosthetic valves, in locations within the body that are not easily accessible by surgery or where access without invasive surgery is desirable. For example, aortic, mitral, tricuspid, and / or pulmonary valve prosthetic valves can be delivered to treatment sites using minimally invasive surgical techniques.

[0004] An introducer sheath can be used to safely introduce a delivery device into a patient's vascular system (e.g., the femoral artery). The introducer sheath generally includes an elongated sleeve that is inserted into the vascular system and a housing that houses one or more sealing valves, allowing the delivery device to be placed in fluid communication with the vascular system with minimal blood loss. Conventional introducer sheaths typically require a tubular loader inserted through a seal within the housing to provide an unobstructed path through the housing for a valve mounted on the balloon catheter. Because the conventional loader extends from the proximal end of the introducer sheath, it reduces the available working length of the delivery device that can be inserted through the sheath and into the body.

[0005] Prior to introducing a delivery system, conventional methods of accessing a vessel, such as the femoral artery, involve dilating the vessel using multiple dilators or sheaths of progressively increasing diameter. This repeated insertion and vessel dilation increases the time required for the procedure and can increase the risk of injury to the vessel.

[0006] Radially expanding intravascular sheaths have been disclosed, and such sheaths tend to have complex mechanisms, such as ratcheting mechanisms, that maintain the shaft or sheath in an expanded configuration when a device of a diameter larger than the original diameter of the sheath is introduced.

[0007] However, delivering and / or removing prosthetic devices and other materials into and from patients still poses significant risks to the patient. Additionally, accessing the vessel remains a challenge due to the relatively large profile of the delivery system, which can cause longitudinal and radial tearing of the vessel during insertion. The delivery system can also detach calcified plaque within the vessel, posing an additional risk of blood clots caused by the detached plaque. [Prior art documents] [Patent documents]

[0008] [Patent Document 1] U.S. Patent Application Serial No. 12 / 249,867 [Patent Document 2] U.S. Patent Application No. 13 / 312,739 [Patent Document 3] U.S. Patent Application Serial No. 14 / 248,120 [Patent Document 4] U.S. Patent Application Serial No. 14 / 324,894 [Patent Document 5] U.S. Patent Application No. 15 / 057,953 [Patent Document 6] U.S. Patent Application No. 15 / 997,587 [Patent Document 7] U.S. Patent Application No. 16 / 149,953 [Patent Document 8] U.S. Patent Application Serial No. 16 / 149,956 [Patent Document 9] U.S. Patent Application No. 16 / 149,960 [Patent Document 10] U.S. Patent Application Serial No. 16 / 149,969 [Patent Document 11] U.S. Patent Application Publication No. 2010 / 0094392 Summary of the Invention [Problem to be solved by the invention]

[0009] Thus, there remains a need in the art for improved introducer sheaths for endovascular systems used to implant valves and other prosthetic devices. [Means for solving the problem]

[0010] As disclosed herein, in some embodiments, the expandable sheath of the present invention can minimize trauma to the vessel by allowing a portion of the introducer sheath to temporarily expand to accommodate a delivery system and then return to its original diameter once the delivery system has passed. In some embodiments, sheaths are disclosed that have a smaller profile than that of prior art introducer sheaths. Furthermore, the embodiments disclosed herein require only one sheath rather than several different sizes, thereby reducing the risk of longitudinal or radial vessel rupture or plaque detachment in addition to shortening the procedure time. The disclosed embodiments of the expandable sheath of the present invention can require only a single vessel insertion rather than multiple insertions for vessel expansion.

[0011] In one aspect, disclosed herein is a sheath for introducing a prosthetic device, including an inner liner (layer) and an outer layer. At least a portion of the sheath can be designed or configured to locally expand from a first diameter to a second diameter when the prosthetic device is pushed through the lumen of the sheath, and then return to the first diameter once the prosthetic device has at least partially passed. In some embodiments, a resilient outer cover can also be disposed around the outer layer.

[0012] In some embodiments, a sheath is disclosed that includes opposing proximal and distal ends. Some embodiments disclosed herein can include a hemostatic valve at or near the proximal end of the sheath. In some embodiments, the outer diameter of the sheath can decrease along a gradient from the proximal end to the distal end of the sheath. In still other embodiments, the outer diameter of the sheath can be substantially constant along at least a majority of the length of the sheath.

[0013] One aspect described herein is a sheath for delivering a medical device having a proximal end and a distal end, the sheath comprising: an expandable inner liner having an inner surface and an outer surface, the inner surface of the expandable inner liner defining a lumen, the inner liner including at least one folded portion having an inner portion and an outer portion; and an outer layer having an inner surface and an outer surface, wherein a first portion of the outer surface of the outer layer is disposed adjacent to an inner portion of the at least one folded portion of the inner liner, while the first portion of the inner surface of the outer layer is disposed adjacent to at least an inner portion of the folded portion of the inner liner. a sheath including an outer layer extending at least partially around an inner liner so as to be disposed adjacent an outer portion of at least one folded portion, the inner liner including at least one first portion and at least one second portion, the outer surface of the at least one first portion having a substantially different composition and / or morphology than the outer surface of the at least one second portion, wherein an outward radial force from a prosthetic device moving through the lumen unfolds the at least one folded portion to allow expansion of the sheath, wherein at least a portion of the sheath is configured to expand to conform to the prosthetic device.

[0014] In some embodiments, at least a first portion of the inner liner is etched, while in other embodiments, at least a second portion of the inner liner is not etched.

[0015] In some embodiments, the at least one second portion can be etched and subsequently surface modified such that the composition of the outer surface of the at least one second portion is substantially different from the composition of the outer surface of the at least one first portion.

[0016] In any of the embodiments disclosed herein, the outer layer can be configured such that the overlapping portion overlaps the underlying portion, and it is understood that at least a portion of the folded portion of the inner tubular layer is disposed between the overlapping portion and the underlying portion. In some embodiments, at least a portion of the sheath is configured such that multiple segments of the sheath each locally expand, one at a time, from a resting configuration having a first diameter to an expanded configuration having a second diameter larger than the first diameter to facilitate passage of a prosthetic device through the lumen of the inner liner. Each segment can have a defined length along the longitudinal axis of the sheath, and each sheath segment can be configured to at least partially return to the first diameter upon passage of a prosthetic device. In some embodiments, when each sheath segment is in the expanded configuration, a length of the folded portion corresponding to the length of the segment at least partially unfolds (e.g., by separating and / or straightening). A length of the overlapping portion corresponding to the length of the segment can be configured to move relative to the underlying portion when each sheath segment expands from the resting configuration to the expanded configuration.

[0017] In certain embodiments, methods of fabricating a sheath are also disclosed. One method may include, for example, without limitation, providing a mandrel having a first diameter, providing a first tube having a second diameter larger than the first diameter, attaching the first tube to the mandrel, collecting excess material from the first tube, and folding the excess material to one side to form a folded portion of the inner liner. A second tube may then be provided, and the second tube may be cut to form a coiled layer. An adhesive may be applied to at least a portion of the coiled layer, and the coiled layer may be attached to the first tube such that the adhesive is disposed between the first tube and the coiled layer. The folded portion may be elevated to position a portion of the coiled layer under the folded portion.

[0018] In some embodiments, some methods can also include applying heat to the first tube, the coiled layer, and the mandrel to thermally fuse the first tube and the coiled layer together. In other embodiments, a resilient outer covering can be secured to the outer surface of the coiled layer. In a further exemplary, non-limiting embodiment, a soft tip portion can be coupled to the distal end of the expandable sheath to facilitate passing the expandable sheath through a patient's vasculature.

[0019] In another aspect, a method of manufacturing a sheath for delivering a medical device includes the steps of providing an inner liner having an inner surface and an outer surface, the inner surface defining a lumen therethrough, the inner liner including at least one first portion and at least one second portion, the outer surface of the at least one first portion having a composition and / or morphology substantially different from the outer surface of the at least one second portion, the inner liner including at least one folded portion having an inner portion and an outer portion; and providing an outer layer having an inner surface and an outer surface, the outer layer at least partially overlapping the inner liner. providing an outer layer extending around the inner liner, wherein at least a first portion of an outer surface of the outer layer is disposed adjacent an inner portion of the at least one folded portion of the inner liner, while a first portion of an inner surface of the outer layer is disposed adjacent an outer portion of the at least one folded portion of the inner liner; and forming an expandable sheath, the expandable sheath configured to expand when an outward radial force from a prosthetic device moving through the lumen deploys the at least one folded portion.

[0020] In yet another embodiment, the at least one first portion and the at least one second portion of the inner liner can be formed by selective etching. In such exemplary embodiment, the selective etching is performed around the circumference, linearly along the length of the sheath, or a combination thereof.

[0021] Disclosed herein are aspects in which at least one first portion can be formed by masking a portion of the inner liner to form a masked portion and then etching the remaining unmasked portion of the inner liner with an etchant. In yet another aspect, the method disclosed herein can further include forming at least one second portion by unmasking the masked portion after etching.

[0022] In this aspect, the method includes selective etching as disclosed herein. In such exemplary aspects, the selective etching can be performed using an etchant. In such aspects, the etchant can include a liquid, a fluid, a gas, a plasma, or a combination thereof.

[0023] The foregoing and other features and advantages of the present disclosure will become more apparent from the following detailed description which proceeds with reference to the accompanying figures. [Brief explanation of the drawings]

[0024] [Figure 1] FIG. 1 is an elevational view of a sheath according to the present disclosure together with an intravascular delivery device for implantation of a prosthetic valve. [Figure 2A] FIG. 2A is a cross-sectional view of one embodiment of a sheath for introducing a prosthetic device into a patient. [Figure 2B] FIG. 2B is a cross-sectional view of a sheath, in one embodiment, for introducing a prosthetic device into a patient. [Figure 2C] FIG. 2C is a perspective view of one component of a sheath, in one embodiment, for introducing a prosthetic device into a patient. [Figure 2D] FIG. 2D is a cross-sectional view of a sheath, in one embodiment, for introducing a prosthetic device into a patient. [Figure 3] FIG. 3 is an elevational view of the sheath shown in FIG. [Figure 4A]FIG. 4A is an elevational view of one embodiment of a sheath according to the present disclosure having a varying outer diameter. [Figure 4B] FIG. 4B is an elevational view of one embodiment of a sheath according to the present disclosure having a varying outer diameter. [Figure 5] FIG. 5 is an elevational view of one embodiment of a sheath expanded in a first location to house a delivery system. [Figure 6] FIG. 6 is an elevational view of the sheath in one embodiment expanded at a second location further from the sheath. [Figure 7] FIG. 7 is a cross-sectional view of another embodiment of a sheath further comprising an outer covering or shell. [Figure 8] FIG. 8 is an elevational view of one embodiment of a sheath with an outer covering or shell. [Figure 9] FIG. 9 is a partial elevational view of one embodiment of an intermediate tubular layer that can be used to construct a sheath according to the present disclosure. [Figure 10] FIG. 10 is a partial elevation view of another embodiment of an intermediate tubular layer having a variable diamond design. [Figure 11] FIG. 11 is a partial elevation view of another embodiment of an intermediate tubular layer having a diamond design with spring struts. [Figure 12] FIG. 12 is a partial elevation view of another embodiment of an intermediate tubular layer having a diamond design with straight struts. [Figure 13] FIG. 13 is a partial elevation view of another embodiment of an intermediate tubular layer having a sawtooth design with spring struts. [Figure 14] FIG. 14 is a partial elevation view of another embodiment of an intermediate tubular layer having a sawtooth design with straight struts. [Figure 15] FIG. 15 is a partial elevation view of another embodiment of an intermediate tubular layer having a diamond design with straight struts. [Figure 16] FIG. 16 is a partial elevational view of another embodiment of an intermediate tubular layer having a helical or spiral design. [Figure 17]FIG. 17 is a partial elevation view of another embodiment of an intermediate tubular layer having a diamond design with non-straight struts. [Figure 18] FIG. 18 is a partial elevation view of another embodiment of an intermediate tubular layer having an alternative diamond design with non-straight struts. [Figure 19] FIG. 19 is a partial elevation view of another embodiment of an intermediate tubular layer having yet another diamond design with non-straight struts. [Figure 20] FIG. 20 is a partial elevation view of another embodiment of an intermediate tubular layer having a diamond design with struts. [Figure 21] FIG. 21 is a partial elevational view of another embodiment of an intermediate tubular layer having a similar design to that shown in FIG. 20, but with additional struts. [Figure 22] FIG. 22 is a partial elevation view of another embodiment of an intermediate tubular layer having a diamond design with spiral struts. [Figure 23] FIG. 23 is a partial elevation view of another embodiment of an intermediate tubular layer having a diamond design with adjacent struts. [Figure 24] FIG. 24 is a cross-sectional view of one embodiment of a sheath having a longitudinal notch. [Figure 25] FIG. 25 is a cross-sectional view of one embodiment of a sheath having a longitudinal cut in the inner liner. [Figure 26] FIG. 26 is a cross-sectional view of one embodiment of a sheath having multiple notches or cuts in the outer tubular layer. [Figure 27A] FIG. 27A is a cross-sectional view of one embodiment of a sheath in which the outer tubular layer includes a longitudinal cut and in the unexpanded configuration, the inner liner extends into the gap created by the cut in the outer tubular layer. [Figure 27B] FIG. 27B is a cross-sectional view of one embodiment of a sheath in an unexpanded configuration. [Figure 27C] FIG. 27C is a cross-sectional view of one embodiment of a sheath in an unexpanded configuration. [Figure 27D] FIG. 27D is a cross-sectional view of one embodiment of a sheath in an unexpanded configuration. [Figure 27E] FIG. 27E is a cross-sectional view of one embodiment of a sheath in an unexpanded configuration. [Figure 28] FIG. 28 is a cross-sectional view of the sheath of FIG. 27A in an expanded configuration. [Figure 29A] FIG. 29A is a cross-sectional view of one embodiment of a sheath having overlapping sections. [Figure 29B] FIG. 29B is a cross-sectional view of one embodiment of a sheath having overlapping sections. [Figure 29C] FIG. 29C is a cross-sectional view of one embodiment of a sheath having overlapping sections. [Figure 29D] FIG. 29D is a cross-sectional view of one embodiment of a sheath having overlapping sections. [Figure 30] FIG. 30 is a block diagram of one embodiment of a method of fabricating a sheath according to the present disclosure. [Figure 31] FIG. 31 is a block diagram of another embodiment of a method of fabricating a sheath according to the present disclosure. [Figure 32A] FIG. 32A is a cross-sectional view of one method step of the method shown in FIGS. [Figure 32B] FIG. 32B is a cross-sectional view of one method step of the method shown in FIGS. [Figure 32C] FIG. 32C is a cross-sectional view of one method step of the method shown in FIGS. [Figure 32D] FIG. 32D is a cross-sectional view of one method step of the method shown in FIGS. [Figure 32E] FIG. 32E is a cross-sectional view of one method step of the method shown in FIGS. [Figure 32F] FIG. 32F is a cross-sectional view of one method step of the method shown in FIGS. [Figure 32G] FIG. 32G is an elevational view of one method step of the method shown in FIGS. [Figure 32H] FIG. 32H is a cross-sectional view of one method step of the method shown in FIGS. [Figure 33]FIG. 33 is a plan view of one embodiment of a sheath having partial slits or score lines. [Figure 34] FIG. 34 is a plan view of another embodiment of a sheath having partial slits or score lines. [Figure 35] FIG. 35 is an elevational view of an expandable sheath and exemplary housing according to the present disclosure. [Figure 36] 36 is an enlarged cutaway view of the distal end of the sheath of FIG. 35. FIG. [Figure 37] 37 is a cross-sectional view of the distal end of the sheath of FIG. 35 taken along line 37-37 in FIG. [Figure 38] 38 is a cross-sectional view of the proximal end of the sheath of FIG. 35 taken along line 38-38 in FIG. [Figure 39] 39 is a cross-sectional view of the sheath of FIG. 35 in the resting (unexpanded) configuration taken along line 39-39 in FIG. [Figure 40] FIG. 40 is a cross-sectional view of the sheath of FIG. 39 in an expanded configuration. [Figure 41] FIG. 41 is a cross-sectional view of an expandable sheath having a resilient outer covering according to another embodiment. [Figure 42] 42 is a cross-sectional view of the sheath of FIG. 41 taken along line 42-42 in FIG. [Figure 43] FIG. 43 is a cross-sectional view of the sheath shown in FIG. 42 in an expanded configuration. [Figure 44] FIG. 44 is a cross-sectional view of another embodiment of an expandable sheath. [Figure 45] FIG. 45 shows the sheath of FIG. 44 in an expanded configuration. [Figure 46] FIG. 46 is a cross-sectional view of another embodiment of an expandable sheath. [Figure 47] FIG. 47 shows the sheath of FIG. 46 in an expanded configuration. [Figure 48] FIG. 48 is a cross-sectional view of another embodiment of an expandable sheath in accordance with the present disclosure. [Figure 49]FIG. 49 is a cross-sectional view of another embodiment of an expandable sheath. [Figure 50] FIG. 50 is a cross-sectional view of an exemplary sheath in an unexpanded configuration. [Figure 51] FIG. 51 is a cross-sectional view of the sheath of FIG. 50 in an expanded configuration. [Figure 52] FIG. 52 is a cross-sectional view of the sheath of FIG. 50, including an outer jacket. [Figure 53] 53 is a cross-sectional view of the sheath of FIG. 35 in a resting (unexpanded) configuration, including the outer jacket, taken along line 39-39 in FIG. [Figure 54] 54 is a cross-sectional view of the sheath of FIG. 53 in the resting (unexpanded) configuration taken along line 39-39 in FIG. [Figure 55] FIG. 55 is a cross-sectional view of the sheath of FIG. 54 in an expanded configuration. [Figure 56] FIG. 56 is a cross-sectional view of the sheath of FIG. 54 in a rest (unexpanded) configuration, including a lubricant between the outer layer and the outer jacket. [Figure 57] FIG. 57 is a cross-sectional view of the sheath of FIG. 54 in a resting (unexpanded) configuration, including a lubricant and a bonding strip. [Figure 58] 58 is a bottom perspective view of the sheath of FIG. 57. FIG. [Figure 59] 59 is a bottom perspective view of the sheath of FIG. 57. FIG. [Figure 60] FIG. 60 is a top perspective view of the sheath of FIG. [Figure 61A] FIG. 61A is a schematic illustration of an inner liner having first and second portions, as disclosed in one embodiment. [Figure 61B] FIG. 61B is a schematic illustration of an inner liner having first and second portions, as disclosed in one embodiment. [Figure 62A] FIG. 62A is a schematic illustration of an inner liner having first and second portions, as disclosed in one embodiment. [Figure 62B]FIG. 62B is a schematic illustration of an inner liner having first and second portions, as disclosed in one embodiment. [Figure 63A] FIG. 63A is a schematic illustration of an inner liner having first and second portions, as disclosed in one embodiment. [Figure 63B] FIG. 63B is a schematic illustration of an inner liner having first and second portions, as disclosed in one embodiment. DETAILED DESCRIPTION OF THE INVENTION

[0025] The present disclosure may be more readily understood by reference to the following detailed description, examples, drawings, and claims, as well as the accompanying description. However, before the present articles, systems, and / or methods are disclosed and described, it should be understood that, unless otherwise specified, the disclosure is not limited to particular or exemplary embodiments of the disclosed articles, systems, and / or methods, which can, of course, vary. It should also be understood that the terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting.

[0026] The following description of the present disclosure is provided as an enabling teaching for the present disclosure in its best currently known mode. To this end, those skilled in the art will recognize and appreciate that many changes can be made to the various aspects of the disclosure described herein while still obtaining the beneficial results of the present disclosure. It will also be apparent that some of the desired benefits of the present disclosure can be obtained by selecting some of the features of the present disclosure without utilizing other features. Thus, those skilled in the art will recognize that many modifications and adaptations to the present disclosure are possible and may even be desirable in certain circumstances and are a part of this disclosure. Thus, to reiterate, the following description is provided as an illustration of the principles of the present disclosure, not as a limitation thereof.

[0027] definition As used in this application and the claims, the singular forms "a," "an," and "the" include the plural forms unless the context clearly dictates otherwise. Thus, for example, reference to a "polymer" includes embodiments having two or more such polymers unless the context clearly dictates otherwise.

[0028] It will be appreciated that certain features of the disclosure that are, for clarity, described in the context of separate embodiments, may also be provided in combination or in a single embodiment. Conversely, various features of the disclosure that are, for brevity, described in the context of a single embodiment, may also be provided separately or in any suitable combination.

[0029] As used herein, the term "optionally" or "optionally" means that the subsequently described event or circumstance may or may not occur, and that the description includes cases where said event or circumstance occurs and cases where it does not occur.

[0030] It is also to be understood that the terminology used herein is for the purpose of describing particular aspects only, and is not intended to be limiting. As used in the specification and claims, the term "comprising" can include the aspects "consisting of" and "consisting essentially of." Additionally, the term "includes" means "comprises."

[0031] The terms "for example" and "such as," and their grammatical equivalents, are understood to be followed by the phrase "without limitation," unless otherwise specified.

[0032] References in the specification and concluding claims to parts by weight of a particular element or component in a composition or article indicate the weight relationship between that element or component and the other elements or components in the composition or article for which the parts by weight are expressed. That is, in a composition or selected portion of a composition comprising 2 parts by weight of component X and 5 parts by weight of component Y, X and Y are present in a weight ratio of 2:5, and are present in such ratio regardless of whether additional components are included in the composition.

[0033] Notwithstanding that the numerical ranges and parameters setting forth the broad scope of the present disclosure are approximations, the numerical values ​​set forth in the specific examples are reported as precisely as possible. However, numerical values ​​inherently contain certain errors necessarily resulting from the standard deviation found in their respective testing measurements. Furthermore, when numerical ranges of varying scope are set forth herein, it is contemplated that any combination of these values ​​inclusive of the recited values ​​may be used. Furthermore, ranges may be expressed herein as from "about" one particular value and / or to "about" another particular value. When such a range is expressed, another embodiment includes from the one particular value and / or to the other particular value.

[0034] Similarly, when values ​​are expressed as approximations, by use of the antecedent "about," it is understood that the particular value forms another aspect. It will be further understood that the endpoints of each of the ranges are significant both in relation to the other endpoint, and independently of the other endpoint. Unless otherwise specified, the term "about" means within 5% (e.g., within 2% or 1%) of the particular value modified by the term "about."

[0035] Throughout this disclosure, various aspects of the disclosure may be presented in a range format. It should be understood that the description in range format is merely for convenience and brevity and should not be construed as an inflexible limitation on the scope of the present disclosure. Thus, the description of a range should be considered to have specifically disclosed all possible subranges as well as individual numerical values ​​within that range. For example, a description of a range such as 1 to 6 should be considered to have specifically disclosed subranges such as 1 to 3, 1 to 4, 1 to 5, 2 to 4, 2 to 6, 3 to 6, etc., as well as individual numerical values ​​within that range, for example, 1, 2, 2.7, 3, 4, 5, 5.3, 6, and any integer and fractional increments therebetween. This applies regardless of the width of the range.

[0036] As used herein, the term "composition" is intended to encompass products that contain specified ingredients in specified amounts, as well as any product that results, directly or indirectly, from a combination of specified ingredients in specified amounts.

[0037] Weight percentages of ingredients are based on the total weight of the formulation or composition in which the ingredient is included, unless specifically stated to the contrary.

[0038] As used herein, the term "substantially" means that the subsequently described event or circumstance occurs exactly, or that the subsequently described event or circumstance typically, usually, or approximately occurs.

[0039] As used herein, the term "substantially," when used in reference to a composition, refers to at least about 80%, at least about 85%, at least about 90%, at least about 91%, at least about 92%, at least about 93%, at least about 94%, at least about 95%, at least about 96%, at least about 97%, at least about 98%, at least about 99%, or about 100% by weight of the specified feature or component, based on the total weight of the composition.

[0040] As used herein, the term "substantially," for example, in the context of "substantially free," refers to a composition having less than about 1% by weight, e.g., less than about 0.5% by weight, less than about 0.1% by weight, less than about 0.05% by weight, or less than about 0.01% by weight of the recited material, based on the total weight of the composition.

[0041] As used herein, the terms "substantially identical reference composition" or "substantially identical reference article" refer to a reference composition or article that contains substantially the same components in the absence of the components of the present invention. In another exemplary embodiment, the term "substantially," for example, in the context of "substantially identical reference composition," refers to a reference composition that contains substantially the same components, where the components of the present invention are substituted with components known in the art.

[0042] Furthermore, the terms "coupled" and "associated" generally mean electrically, electromagnetically, and / or physically (e.g., mechanically or chemically) coupled or connected, and do not exclude the presence of intermediate elements between the coupled or associated items.

[0043] Terms such as "first," "second," and the like may be used herein to describe various elements, components, regions, layers, and / or sections, but it will be understood that these elements, components, regions, layers, and / or sections should not be limited by these terms. These terms are used only to distinguish one element, component, region, layer, or section from another element, component, region, layer, or section. That is, a first element, component, region, layer, or section discussed below could be termed a second element, component, region, layer, or section without departing from the teachings of the exemplary embodiments.

[0044] It is understood that the terms "layer" and "liner" may be used interchangeably. For example, an embodiment describing an "inner liner" also includes an embodiment describing an "inner layer." Similarly, an embodiment describing an "outer layer" also includes an embodiment describing an "outer liner."

[0045] Spatially relative terms such as "beneath," "below," "lower," "above," and "upper" may be used herein to facilitate the description of the relationship of one element or feature to another, as illustrated. It will be understood that the spatially relative terms are intended to encompass different orientations of the device during use or operation in addition to the orientation shown in the figures. For example, if the device in the figures is turned over, elements described as "below" or "below" other elements or features will be oriented "above" the other elements or features. That is, the term "below" can encompass both an orientation of above and below. The device may be oriented in other directions (rotated 90 degrees or to other orientations), and the spatially relative descriptors used herein will be interpreted accordingly.

[0046] As used herein, the term "atraumatic" is commonly known in the art and refers to a device or procedure that minimizes tissue damage.

[0047] Although the operations of exemplary embodiments of the disclosed methods may be described in a particular order for convenience of presentation, it should be understood that the disclosed embodiments may encompass orders of operations other than the particular order disclosed. For example, operations described in a sequence may, in some cases, be rearranged or performed simultaneously. Furthermore, descriptions and disclosures provided in connection with one particular embodiment are not limited to that embodiment and may apply to any disclosed embodiment.

[0048] Although aspects of the present disclosure may be described and claimed in particular statutory classes, such as system statutory classes, this is for convenience only, and those skilled in the art will understand that aspects of the present disclosure may be described and claimed in any statutory class. Unless otherwise expressly stated, no method or aspect described herein is intended to be construed as requiring its steps to be performed in a particular order. Thus, if a method claim does not specifically recite in the claim or description that the steps are limited to a particular order, no order is intended to be implied in any respect. This applies to any possible implicit principles of interpretation, including questions of logic regarding the arrangement or operational flow of steps, the apparent meaning derived from grammatical construction or punctuation, or the number or type of aspects described in the specification.

[0049] Moreover, for simplicity, the accompanying figures may not show the various ways in which the disclosed systems, methods, and apparatus can be used in combination with other systems, methods, and apparatus (which would be readily discernible by one of ordinary skill in the art based on this disclosure). Additionally, the description may use terms such as "manufacture" and "provide" to describe the disclosed methods. These terms are high-level abstractions of actual operations that may be performed. The actual operations corresponding to these terms may vary depending on the particular implementation and would be readily discernible by one of ordinary skill in the art based on this disclosure.

[0050] The present disclosure may be understood more readily by reference to the following detailed description of various aspects of the disclosure and the examples included therein, as well as the figures and their preceding and following descriptions.

[0051] The present disclosure may be understood more readily by reference to the following detailed description of various aspects of the disclosure and the examples included therein, as well as the figures and their preceding and following descriptions.

[0052] Disclosed embodiments of expandable sheaths can minimize trauma to blood vessels by temporarily expanding a portion of the introducer sheath to accommodate a delivery system and then returning to its original diameter once the device has passed. In some embodiments, disclosed herein are sheaths having a smaller profile (e.g., a smaller diameter in the resting configuration) than that of prior art introducer sheaths. Furthermore, embodiments disclosed herein can not only reduce procedure time but also reduce the risk of longitudinal or radial vessel rupture or plaque detachment because only one sheath is needed rather than several different sizes. Embodiments of the expandable sheaths of the present invention can avoid the need for multiple insertions to dilate the blood vessel. Such expandable sheaths can be useful in many types of minimally invasive procedures, such as any surgery that requires the introduction of a device into a subject's blood vessel. For example, the sheath can be used to introduce other types of delivery devices for placing various types of intraluminal devices (e.g., stents, prosthetic heart valves, stented grafts, etc.) into many types of vascular and non-vascular body lumens (e.g., veins, arteries, esophagus, ducts of the biliary tree, intestines, urethra, fallopian tubes, other endocrine or exocrine ducts, etc.).

[0053] FIG. 1 illustrates a sheath 8 according to the present disclosure used with a representative delivery apparatus 10 for delivering a prosthetic device 12, such as a bioprosthetic heart valve, to a patient. The apparatus 10 can include a steerable guide catheter 14 (also referred to as a flex catheter), a balloon catheter 16 extending through the guide catheter 14, and a nose catheter 18 extending through the balloon catheter 16. In the illustrated embodiment, the guide catheter 14, the balloon catheter 16, and the nose catheter 18 are adapted to slide longitudinally relative to one another to facilitate delivery and placement of the valve 12 at an implantation site within the patient, as described in detail below. Generally, the sheath 8 is inserted through the patient's skin into a blood vessel, such as a transfemoral vessel, so that the distal end of the sheath 8 is inserted into the vessel. The sheath 8 can include a hemostatic valve at the opposite proximal end of the sheath. The delivery apparatus 10 can be inserted into the sheath 8, and the prosthetic device 12 can then be delivered and implanted within the patient.

[0054] 2A, 2B, and 2D show cross-sectional views of an exemplary embodiment of a sheath 22 for use with a delivery device such as that shown in FIG. Exemplary expandable sheaths are also disclosed in U.S. patent application Ser. No. 12 / 249,867, filed Oct. 10, 2008 (now U.S. Patent No. 8,690,936), U.S. patent application Ser. No. 13 / 312,739, filed Dec. 6, 2011 (now U.S. Patent No. 8,790,387), U.S. patent application Ser. No. 14 / 248,120, filed Apr. 8, 2014 (now U.S. Patent No. 9,301,840), U.S. patent application Ser. No. 14 / 324,894, filed Jul. 7, 2014 (now U.S. Patent No. 9,301,841), U.S. patent application Ser. No. 15 / 057,953, filed Mar. 1, 2016 (now U.S. Patent No. 9,987,134), U.S. patent application Ser. No. 15 / 997,587, filed June 4, 2018; U.S. Patent Application No. 16 / 149,953, filed October 2, 2018 (now U.S. Patent No. 10,524,905); U.S. Patent Application No. 16 / 149,956, filed October 2, 2018 (now U.S. Patent No. 10,517,720); U.S. Patent Application No. 16 / 149,960, filed October 2, 2018 (now U.S. Patent No. 10,524,906); and U.S. Patent Application No. 16 / 149,969, filed October 2, 2018 (now U.S. Patent No. 10,524,907), the disclosures of which are incorporated herein by reference.

[0055] FIG. 2C shows a perspective view of one embodiment of an inner liner 24 for use with the sheath 22. The sheath 22 includes an inner liner, such as an inner polymeric tubular layer 24, an outer layer, such as an outer polymeric tubular layer 26, and an intermediate tubular layer 28 disposed between the inner and outer polymeric tubular layers 24, 26. The sheath 22 defines a lumen 30 through which a delivery device can be passed into a patient's vasculature to deliver, remove, repair, and / or replace a prosthetic device. Such an introducer sheath 22 may also be useful for other types of minimally invasive procedures, such as any procedure requiring the introduction of a device into a subject's vasculature. For example, the sheath 22 may also be used to introduce other types of delivery devices for placing various types of endoluminal devices (e.g., stents, stented grafts, etc.) into many types of vascular and non-vascular body lumens (e.g., veins, arteries, esophagus, ducts of the biliary tree, intestines, urethra, fallopian tubes, other endocrine or exocrine ducts, etc.).

[0056] The outer polymeric tubular layer 26 and the inner polymeric tubular layer 24 can be constructed of, for example, PTFE (e.g., Teflon®), polyimide, PEEK, polyurethane, nylon, polyethylene, polyamide, polyether block amide (e.g., PEBAX®), polyether block ester copolymer, polyester, fluoropolymer, polyvinyl chloride, thermoset silicone, latex, polyisoprene rubber, polyolefin, other medical grade polymers, or combinations thereof. The middle tubular layer 28 can be constructed of a shape memory alloy such as Nitinol, and / or stainless steel, cobalt chrome, Spectra fiber, polyethylene fiber, aramid fiber, or combinations thereof.

[0057] The inner polymeric tubular layer 24 may advantageously provide a low coefficient of friction on its inner surface. For example, the inner polymeric tubular layer 24 may have a coefficient of friction of less than about 0.1. Some embodiments of the sheath 22 may include a lubricious liner on the inner surface 32 of the inner polymeric tubular layer 24. Such a liner may facilitate passage of a delivery device through the lumen 30 of the sheath 22. Examples of suitable lubricious liners include materials that can reduce the coefficient of friction of the inner polymeric tubular layer 24, such as PTFE, polyethylene, polyvinylidene fluoride, and combinations thereof. Suitable materials for lubricious liners also include other materials for which a coefficient of friction of about 0.1 or less is desirable.

[0058] The inner diameter of the intermediate tubular layer 28 varies depending on the application and size of the delivery apparatus and prosthetic device. In some embodiments, the inner diameter ranges from about 0.005 inches to about 0.400 inches. The thickness of the intermediate tubular layer 28 can vary depending on the amount of radial expansion desired, as well as the strength required. For example, the thickness of the intermediate tubular layer 28 can be from about 0.002 inches to about 0.025 inches. The thicknesses of the inner and outer polymeric tubular layers 24, 26 can also vary depending on the particular application of the sheath 22. In some embodiments, the thickness of the inner polymeric tubular layer 24 ranges from about 0.0005 inches to about 0.010 inches, and in one particular embodiment, the thickness is about 0.002 inches. The outer polymeric tubular layer 26 can have a thickness of from about 0.002 inches to about 0.015 inches, and in one particular embodiment, the outer polymeric tubular layer 26 has a thickness of about 0.010 inches.

[0059] The hardness of each layer of sheath 22 can also vary depending on the particular application and desired properties of sheath 22. In some embodiments, outer polymeric tubular layer 26 has a Shore hardness of about 25 durometer to about 75 durometer.

[0060] Additionally, some embodiments of the sheath 22 can include an external hydrophilic coating on the outer surface 34 of the outer polymeric tubular layer 26. Such a hydrophilic coating can facilitate insertion of the sheath 22 into a patient's blood vessel. Examples of suitable hydrophilic coatings include Harmony® advanced lubricious coatings and other advanced hydrophilic coatings available from SurModics, Inc. of Eden Prairie, Minnesota. DSM Medical Coatings (available from Koninklijke DSM NV, Heerlen, The Netherlands), as well as other hydrophilic coatings, are also suitable for use with the sheath 22.

[0061] In some embodiments, the outer surface 34 of the outer polymeric tubular layer 26 can be modified. For example, a surface modification such as plasma etching can be performed on the outer surface 34. Similarly, other surfaces, both outer and inner, can be surface modified, depending on the particular embodiment and desired application. In some embodiments, the surface modification can improve adhesion between layers in the area of ​​the modification.

[0062] The sheath 22 can also include at least one radiopaque filler or marker. The radiopaque filler or marker can be associated with the outer surface 34 of the outer polymeric tubular layer 26. Alternatively, the radiopaque filler or marker can be embedded or incorporated within the outer polymeric tubular layer 24. Similarly, a radiopaque filler or marker can be associated with the surface of the inner polymeric tubular layer 24 or the intermediate tubular layer 28, or embedded within either or both of those layers.

[0063] Materials suitable for use as radiopaque fillers or markers include, for example, barium sulfite, bismuth trioxide, titanium dioxide, bismuth subcarbonate, or combinations thereof. The radiopaque filler can be mixed with or embedded in the material used to form the outer polymeric tubular layer 26 and can comprise from about 5% to about 45% by weight of the outer polymeric tubular layer. Depending on the particular application, more or less radiopaque material can be used in some embodiments.

[0064] In some embodiments, the inner polymeric tubular layer 24 can be constructed of a substantially uniform cylindrical tube. In alternative embodiments, the inner polymeric tubular layer 24 can have at least one discontinuous section along its longitudinal axis to facilitate radial expansion of the inner polymeric tubular layer 24. For example, the inner polymeric tubular layer 24 can have one or more longitudinal notches and / or cuts 36 extending along at least a portion of the length of the sheath 22. Such notches or cuts 36 can facilitate radial expansion of the inner polymeric tubular layer 24, thereby accommodating the passage of a delivery device or other device. Such notches and / or cuts 36 can be located near the inner surface 32, near the outer surface 37, and / or substantially through the entire thickness of the inner polymeric layer 24. In embodiments having multiple notches and / or cuts 36, such notches and / or cuts 36 can be positioned so that they are substantially equally spaced from one another around the circumference of the inner polymeric layer 24. Alternatively, the notches and cuts 36 can be spaced randomly relative to one another or in any other desired pattern. Some or all of the notches and / or cuts 36 can extend longitudinally along substantially the entire length of the sheath 22. Alternatively, some or all of the notches and / or cuts 36 can extend longitudinally along only a portion of the length of the sheath 22.

[0065] 2B and 2C (showing only the inner polymeric tubular layer 24), in some embodiments, the inner polymeric tubular layer 24 includes at least one notch or cut 36 that extends longitudinally and parallel to the axis defined by the lumen 30, extending substantially the entire length of the sheath 22. That is, upon introduction of a delivery device, the inner polymeric tubular layer 24 can split open along the notch and / or cut 36 and expand, thereby accommodating the delivery device.

[0066] Additionally or alternatively, as shown in FIG. 2D , the outer polymeric tubular layer 26 can include one or more notches and / or cuts 36. The notches and / or cuts 36, in some embodiments, do not extend through the entire thickness of the outer tubular layer 26. The notches and / or cuts 36 can be separable upon radial expansion of the sheath 22. The outer polymeric tubular layer 26 can be longitudinally retractable or retractable away from the intermediate tubular layer 28 and the inner polymeric tubular layer 24. In embodiments having a retractable outer polymeric tubular layer 26, the outer polymeric tubular layer 26 can be retracted to accommodate or facilitate passage of a delivery device through the lumen 30 and then replaced back into place on the sheath 22.

[0067] 2A. In this view, only the outer polymeric tubular layer 26 is visible. The sheath 22 includes a proximal end 38 and a distal end 40 opposite the proximal end 38. The sheath 22 may include a hemostatic valve inside the lumen of the sheath 22 at or near the proximal end 38 of the sheath 22.

[0068] Additionally, the sheath 22 can include a soft tip 42 at the distal end 40 of the sheath 22. Such a soft tip 42 can be provided with a lower hardness than the remainder of the sheath 22. In some embodiments, the soft tip 42 can have a Shore hardness of about 25D to about 40D.

[0069] As shown in FIG. 3 , the original unexpanded outer diameter of the sheath 22 can be substantially constant throughout the length of the sheath 22, from the proximal end 38 to the distal end 40. In alternative embodiments, such as those shown in FIGS. 4A-4B , the original unexpanded outer diameter of the sheath 22 can decrease from the proximal end 38 to the distal end 40. As shown in the embodiment in FIG. 4A , the original unexpanded outer diameter can decrease along a gradient from the proximal end 38 to the distal end 40. In alternative embodiments, such as those shown in FIG. 4B , the original unexpanded outer diameter of the sheath 22 can decrease progressively along the length of the sheath 22, with the largest original unexpanded outer diameter near the proximal end 38 and the smallest original unexpanded outer diameter near the distal end 40 of the sheath 22.

[0070] As shown in FIGS. 5-6 , the sheath 22 can be designed to locally expand when a prosthetic device is passed through the lumen of the sheath 22 and then substantially return to its original shape once the prosthetic device has passed through that portion of the sheath 22. For example, FIG. 5 shows the sheath 22 with a localized bulge 44, representing the device passing through the internal lumen of the sheath 22. FIG. 5 shows the device near the proximal end 38 of the sheath 22, near the area where the device will be introduced into the sheath 22. FIG. 6 shows the sheath 22 of FIG. 5 with the device further along the sheath 22. The localized bulge 44 is now closer to the distal end 40 of the sheath 22 and is therefore about to be introduced into the patient's vasculature. As is evident from FIGS. 5 and 6 , once the localized bulge associated with the device passes through a portion of the lumen of the sheath 22, that portion of the sheath 22 can automatically return to its original shape and size, at least in part due to the material and construction of the sheath 22.

[0071] The sheath 22 has an unexpanded inner diameter (not visible in FIGS. 5-6 ) equal to the inner diameter of the inner polymeric tubular layer and an unexpanded outer diameter 46 equal to the outer diameter of the outer polymeric tubular layer 26. The sheath 22 is designed to be expanded to expanded inner and outer diameters 48 that are larger than the unexpanded inner and outer diameters 46, respectively. In one exemplary embodiment, the unexpanded inner diameter is about 16 Fr and the unexpanded outer diameter 46 is about 19 Fr, while the expanded inner diameter is about 26 Fr and the expanded outer diameter 48 is about 29 Fr. Depending on the size requirements of the delivery device for various applications, different sheaths 22 can be provided with different expanded and unexpanded inner and outer diameters. Additionally, some embodiments may provide more or less expansion depending on the specific design parameters, materials, and / or configurations used.

[0072] In some embodiments of a sheath according to the present disclosure, as shown in cross section in FIG. 7 and in elevation in FIG. 8, the sheath 22 can further include an outer covering, such as an outer polymeric covering 50, disposed on an outer surface 52 of the outer polymeric tubular layer 26. The outer polymeric covering 50 can provide a protective covering for the underlying sheath 22. In some embodiments, the outer polymeric covering 50 can contain the self-expanding sheath in a crimped or constrained state and then release the self-expanding sheath upon removal of the outer polymeric covering 50. For example, in some embodiments of a self-expanding sheath, the intermediate layer 28 can comprise nitinol and / or other shape memory alloys, and the intermediate layer 28 can be crimped or radially compressed to a reduced diameter within the outer polymeric tubular layer 26 and the outer polymeric covering 50. Once the self-expanding sheath is at least partially inserted into the patient's blood vessel, the outer polymeric covering 50 can be slid back, peeled, or otherwise at least partially removed from the sheath. To facilitate removal of the outer polymeric covering 50, a portion of the outer polymeric covering 50 can remain outside the patient's blood vessel, and that portion can be pulled back or removed from the sheath to allow the sheath to expand. In some embodiments, substantially the entire outer polymeric covering 50 can be inserted into the patient's blood vessel along with the sheath. In these embodiments, an external mechanism attached to the outer polymeric covering 50 can be provided to enable the outer polymeric covering to be at least partially removed from the sheath once the sheath is inserted into the patient's blood vessel.

[0073] When no longer constrained by the outer polymeric covering 50, the radially compressed intermediate layer 28 can self-expand, expanding the sheath along the length of the intermediate layer 28. In some embodiments, once the sheath is withdrawn from the vessel after completion of the surgical procedure, portions of the sheath can radially collapse and at least partially return to their original crimped state. In some embodiments, such collapse can be facilitated and / or promoted by additional devices or layers that can be attached to portions of the sheath prior to insertion of the sheath into the vessel.

[0074] In some embodiments, the outer polymeric covering 50 is not adhered to other layers of the sheath 22. For example, the outer polymeric covering 50 may be slidable relative to the underlying sheath so that it can be easily removed or retracted from its initial position on the sheath 22.

[0075] As seen in FIG. 8 , the outer polymeric covering 50 can include one or more peel tabs 54 to facilitate manual removal of the outer polymeric covering 50. The outer polymeric covering 50 can be automatically or manually retractable and / or splittable to facilitate radial expansion of the sheath 22. The peel tabs 54 can be positioned approximately 90 degrees from any cuts or notches present in the outer polymeric covering 50 and approximately 180 degrees offset from each other. In an alternative embodiment, the peel tabs 54 can extend substantially around the circumference of the outer polymeric covering 50 to form a single circular peel tab 54.

[0076] Suitable materials for the outer polymeric covering 50 are similar to those suitable for the inner and outer polymeric tubular layers and can include PTFE and / or high density polyethylene.

[0077] Turning now to the intermediate tubular layer 28, several different configurations are possible. The intermediate tubular layer 28 is generally a thin-walled, hollow, substantially cylindrical tube containing a wire or strut arrangement, pattern, configuration, or arrangement, although other geometries can be used. The intermediate tubular layer 28 can extend along substantially the entire length of the sheath 22 or along only a portion of the length of the sheath 22. Suitable wires can be round, ranging from about 0.0005 inches to about 0.10 inches in thickness, or flat, ranging from about 0.0005 inches by 0.003 inches to about 0.003 inches by 0.007 inches. However, other geometries and sizes are also suitable for certain embodiments. When braided wire is used, the braid density can vary. Some embodiments have a braid density of about 30 picks per inch to about 80 picks per inch and can include up to 32 wires in various braid patterns.

[0078] One exemplary embodiment of the intermediate tubular layer comprises a braided nitinol composite, which is at least partially encapsulated by inner and outer polymeric tubular members disposed on the inner and outer surfaces of the intermediate tubular layer, respectively. Such encapsulation by the polymeric layer can be achieved, for example, by fusing the polymeric layer to the intermediate tubular layer or by dip-coating the intermediate tubular layer. In some embodiments, the inner polymeric tubular member, intermediate tubular layer, and outer polymeric tubular layer can be placed on a mandrel, and the layers can then be thermally fused or melted together by placing the assembly in an oven or otherwise heating it. The mandrel can then be removed from the resulting sheath. In other embodiments, the inner polymeric tubular member can be applied to the surface of the mandrel using dip-coating. The intermediate tubular layer can then be applied, allowing the inner polymeric tubular member to harden. The assembly can then be dip-coated again, for example, by applying a thin coating of polyurethane, which becomes the outer polymeric tubular member of the sheath. The sheath can then be removed from the mandrel.

[0079] Additionally, the intermediate tubular layer 28 can be braided or laser cut to form a pattern or structure, for example, to make the intermediate tubular layer 28 suitable for radial expansion. Figures 9-23 show partial elevational views of various intermediate tubular layer structures. Some of the illustrated structures, such as those shown in Figures 11-14 and 23, include at least one discontinuity. For example, struts 56, 58, 60, 62, and 64, shown in Figures 11, 12, 13, 14, and 23, respectively, result in a discontinuous intermediate tubular layer 28 in that struts 56, 58, 60, 62, and 64 separate adjacent sections of the intermediate tubular layer 28 from one another, where the sections are spaced apart along a longitudinal axis parallel to the sheath lumen. That is, the structure of the intermediate tubular layer 28 can vary from section to section, varying along the length of the sheath.

[0080] The structures shown in Figures 9-23 are not necessarily drawn to scale. The structural components and elements may be used alone or in combination within a single intermediate tubular layer 28. The scope of the intermediate tubular layer 28 is not intended to be limited to these particular structures, which are merely exemplary embodiments.

[0081] Alternative embodiments of sheaths for the introduction of prosthetic devices are also described. For example, Figures 24-26 show cross-sectional and perspective views, respectively, of a sheath 66 for introducing a prosthetic device into a body. The sheath 66 includes an inner liner, such as an inner polymer layer 68, an outer layer, such as a polymer tubular layer 70, and a hemostatic valve (not shown). The inner polymer layer 68 and the outer polymer tubular layer 70 at least partially enclose a lumen 72 through which a delivery device and prosthetic device can pass from outside the patient's body into the patient's vasculature. One or both of the inner polymer layer 68 and the outer polymer layer 70 can include at least one longitudinal notch and / or cut to facilitate radial expansion of the sheath.

[0082] For example, FIG. 24 illustrates longitudinal notches 74 in the inner polymer layer 68, which can facilitate radial expansion of the sheath 66. The longitudinal notches 74 can separate or split open completely upon application of a radial force from insertion of a delivery apparatus or prosthetic device. Similarly, FIG. 25 illustrates longitudinal cuts 76 in the inner polymer layer 68, which can also facilitate radial expansion of the sheath 66. The outer polymer layer 70 can additionally or alternatively include one or more longitudinal cuts 76 or notches 74. Such cuts and / or notches can extend substantially through the entire thickness of the layer in either the inner polymer layer 68 or the outer polymer layer 70, or can extend only partially through the thickness of the layer. The cuts and / or notches can be located on or near the inner or outer surface, or both, of the inner and / or outer polymer layers 68, 70.

[0083] FIG. 26 shows a perspective view of one embodiment of an inner polymeric layer 68 having longitudinal notches 74 and longitudinal cuts 76. More or fewer notches 74 and / or cuts 76 can be provided. For clarity, the outer polymeric layer 70 is not shown in FIG. 26. As shown in FIG. 26, the longitudinal notches 74 and / or cuts 76 can extend along only a portion of the length of the sheath 66. In alternative embodiments, one or more notches 74 and / or cuts 76 can extend along substantially the entire length of the sheath 66. Furthermore, the notches 74 and / or cuts 76 can be arranged randomly or in a pattern.

[0084] One particular embodiment of the sheath 66 comprises a sheath having a notch or cut in the outer polymeric layer 70 or the inner polymeric layer 68 that extends longitudinally along about 75% of the length of the sheath 66. When such a notch or cut extends only partially through the associated layer, it can have a relatively low tear force, such as a tear force of about 0.5 lbs, such that the notch splits open relatively easily during use.

[0085] The inner polymer layer 68 and the outer polymer layer 70 can optionally be bonded together or otherwise physically associated with one another. The amount of adhesion between the inner polymer layer 68 and the outer polymer layer 70 can vary across the surface of the layers. For example, there can be little or no adhesion around or near notches and / or cuts in the layers so as not to interfere with the radial expansion of the sheath 66. Adhesion between the layers can be created, for example, by thermal bonding and / or coating. In some embodiments, the sheath 66 can be formed from an extruded tube, which can serve as the inner polymer layer 68. The inner polymer layer 68 can be surface treated, for example, by plasma etching, chemical etching, or other suitable surface treatment methods. By treating the surface of the inner polymer layer 68, the outer surface of the inner polymer layer 68 can have areas with modified surface angles, which can provide better adhesion between the inner polymer layer 68 and the outer polymer layer 70. The treated inner polymer layer can be dip-coated, for example, in a polyurethane solution to form the outer polymer layer 70. In some configurations, polyurethane may not adhere well to untreated surface areas of the inner polymer layer 68. That is, by surface treating only the surface areas of the inner polymer layer 68 that are spaced from the area of ​​expansion (e.g., portions of the inner polymer layer 68 near the notches 74 and / or cuts 76), the outer polymer layer 70 can be adhered to some areas of the inner polymer layer 68, while other areas of the inner polymer layer 68 remain free to slide relative to the outer polymer layer 70, thereby allowing the diameter of the sheath 66 to expand. That is, the areas around or near the notches 74 and / or cuts 76 experience little or no adhesive force between the layers, while the other areas of the inner and outer polymer layers 68, 70 can be adhesively secured or otherwise physically associated with one another.

[0086] As with the previously disclosed embodiments, the embodiment shown in FIGS. 24-26 can be applied to sheaths having a wide range of inner and outer diameters. Applications can utilize sheaths of the present disclosure having inner polymeric layer 68 inner diameters that are expandable to expanded diameters of about 3 Fr to about 26 Fr. The expanded diameter can vary slightly along the length of the sheath 66. For example, the expanded outer diameter at the proximal end of the sheath 66 can range from about 3 Fr to about 28 Fr, while the expanded outer diameter at the distal end of the sheath 66 can range from about 3 Fr to about 25 Fr. In some embodiments, the sheath 66 can be expanded to expanded outer diameters ranging from about 10% larger than the original unexpanded outer diameter to about 100% larger than the original unexpanded outer diameter.

[0087] In some embodiments, the outer diameter of the sheath 66 gradually decreases from the proximal end of the sheath 66 to the distal end of the sheath 66. For example, in one embodiment, the outer diameter can gradually decrease from about 26 Fr at the proximal end to about 18 Fr at the distal end. The diameter of the sheath 66 can gradually transition along substantially the entire length of the sheath 66. In other embodiments, the transition or decrease in diameter of the sheath 66 can occur only along a portion of the length of the sheath 66. For example, the transition can occur along the length from the proximal end to the distal end, in which case the length can range from about 0.5 inches to the entire length of the sheath 66.

[0088] Suitable materials for the inner polymer layer 68 have high elastic strength and include those materials discussed in connection with other embodiments, particularly Teflon (PTFE), polyethylene (e.g., high-density polyethylene), fluoropolymers, or combinations thereof. In some embodiments, the inner polymer layer 68 preferably has a low coefficient of friction, such as a coefficient of friction of about 0.01 to about 0.5. Some exemplary embodiments of the sheath 66 include an inner polymer layer 68 having a coefficient of friction of about 0.1 or less.

[0089] Similarly, suitable materials for the outer polymeric layer 70 include those discussed in connection with other embodiments, as well as other thermoplastic elastomers and / or highly resilient materials.

[0090] The Shore hardness of the outer polymer layer 70 can vary for different applications and embodiments. Some embodiments include an outer polymer layer having a Shore hardness of from about 25A to about 80A, or from about 20D to about 40D. One particular embodiment includes a readily available polyurethane with a Shore hardness of 72A. Another particular embodiment includes a polyethylene inner polymer layer dipped in polyurethane or silicone to produce the outer polymer layer.

[0091] The sheath 66 may also include radiopaque fillers or markers, as described above. In some embodiments, different radiopaque markers or bands may be applied to several portions of the sheath 66. For example, radiopaque markers may be bonded to the inner polymer layer 68, the outer polymer layer 70, and / or disposed between the inner and outer polymer layers 68, 70.

[0092] 27A-27E and 28 show cross-sectional views of various embodiments of a sheath 66 in an unexpanded state (FIGS. 27A-27E) and an expanded state (FIG. 28) according to the present disclosure. The sheath 66 includes a split outer polymeric tubular layer 70 having a longitudinal cut 76 through the thickness of the outer polymeric tubular layer 70 such that the outer polymeric tubular layer 70 includes a first portion 78 and a second portion 80 separable from one another along the cut 76. An expandable inner polymeric layer 68 is associated with an inner surface 82 of the outer polymeric tubular layer 70, and in the unexpanded configuration shown in FIG. 27A, a portion of the inner polymeric layer 68 extends through the gap created by the cut 76 and can be compressed between the first and second portions 78, 80 of the outer polymeric tubular layer 70. 28 , upon expansion of the sheath 66, the first and second portions 78, 80 of the outer polymeric tubular layer 70 separate from one another and the inner polymeric layer 68 expands into a substantially cylindrical tube. In some embodiments, two or more longitudinal cuts 76 may be provided through the thickness of the outer polymeric tubular layer 70. In such embodiments, a portion of the inner polymeric layer 68 may extend through each of the longitudinal cuts 76 provided in the outer polymeric tubular layer 70.

[0093] Preferably, the inner polymeric layer 68 is composed of one or more materials that are resilient and suitable for folding and / or pleating. For example, FIG. 27A shows an inner polymeric layer 68 having a folding region 85. As can be seen in FIGS. 27A-27E, the sheath 66 can include one or more folding regions 85. Such folding regions 85 can be radially disposed and substantially conform to the circumference of the outer polymeric tubular layer 70. At least a portion of the folding region 85 can be disposed adjacent to the outer surface 83 of the outer polymeric tubular layer 70.

[0094] 27B and 27E, at least a portion of the folded region(s) 85 can be overlaid by an outer covering, such as an outer polymer covering 81. The outer polymer covering 81 can be adjacent to at least a portion of the outer surface 83 of the outer polymer tubular layer 70. The outer polymer covering 81 can serve to at least partially contain the folded region 85 of the inner polymer layer 68 and can also prevent the folded region 85 from separating from the outer polymer tubular layer 70, for example, when the sheath 66 is subjected to bending. In some embodiments, the outer polymer covering 81 can be at least partially adhered to the outer surface 83 of the outer polymer tubular layer 70. The outer polymer covering 81 can also increase the stiffness and / or durability of the sheath 66.

[0095] 27B and 27E, the outer polymer covering 81 does not have to entirely overlap the periphery of the sheath 66. For example, the outer polymer covering 81 may have a first end and a second end that do not contact each other. In these embodiments, only a portion of the folded region 85 of the inner polymer layer 68 overlaps the outer polymer covering 81.

[0096] In embodiments where multiple folding regions 85 are present, the regions can be evenly offset from one another around the circumference of the outer polymeric tubular layer 70. Alternatively, the folding regions can be off-center, differently sized, and / or randomly spaced from one another. While portions of the inner polymeric layer 68 and the outer tubular layer 70 can be glued or otherwise bonded to one another, the folding regions 85 are preferably not glued or bonded to the outer tubular layer 70. For example, adhesion between the inner polymeric layer 68 and the outer tubular layer 70 can be highest in areas of minimum expansion.

[0097] One particular embodiment of a sheath shown in Figures 27A-28 comprises a polyethylene (e.g., high-density polyethylene) outer polymeric tubular layer 70 and a PTFE inner polymeric layer 68. However, other materials are suitable for each layer, as discussed above. In general, materials suitable for use in the outer polymeric tubular layer 70 include materials with a high stiffness or strength modulus that can assist in the expansion and contraction of the inner polymeric layer 68.

[0098] In some embodiments, the outer polymeric tubular layer 70 is composed of the same material or combination of materials along the entire length of the outer polymeric tubular layer 70. In alternative embodiments, the material composition may vary along the length of the outer polymeric tubular layer 70. For example, the outer polymeric tubular layer may be provided with one or more segments that vary in composition from segment to segment. In one particular embodiment, the durometer rating of the composition varies along the length of the outer polymeric tubular layer 70, such that the segment near the proximal end comprises a stiffer material or combination of materials, while the segment near the distal end comprises a softer material or combination of materials. This may allow the sheath 66 to have a relatively stiff proximal end at the point where the delivery device is introduced, while still having a relatively soft distal tip at the point of entry into the patient's vasculature.

[0099] As with other disclosed embodiments, the embodiment of the sheath 66 shown in Figures 27A-28 can be provided in a variety of sizes and dimensions. For example, the sheath 66 can have an unexpanded inner diameter of about 3 Fr to about 26 Fr. In some embodiments, the sheath 66 has an unexpanded inner diameter of about 15 Fr to about 16 Fr. In some embodiments, the unexpanded inner diameter of the sheath 66 can range from about 3 Fr to about 26 Fr at or near the distal end of the sheath 66, while the unexpanded inner diameter of the sheath 66 can range from about 3 Fr to about 28 Fr at or near the proximal end of the sheath 66. For example, in one embodiment, the unexpanded sheath 66 can transition from an unexpanded inner diameter of about 16 Fr at or near the distal end of the sheath 66 to an unexpanded inner diameter of about 26 Fr at or near the proximal end of the sheath 66.

[0100] The sheath 66 can have an unexpanded outer diameter of about 3 Fr to about 30 Fr, and in some embodiments has an unexpanded outer diameter of about 18 Fr to about 19 Fr. In some embodiments, the unexpanded outer diameter of the sheath 66 can range from about 3 Fr to about 28 Fr at or near the distal end of the sheath 66, while the unexpanded outer diameter of the sheath 66 can range from about 3 Fr to about 30 Fr at or near the proximal end of the sheath 66. For example, in one unexpanded embodiment, the sheath 66 can transition from an unexpanded outer diameter of about 18 Fr at or near the distal end of the sheath 66 to an unexpanded outer diameter of about 28 Fr at or near the proximal end of the sheath 66.

[0101] The thickness of the inner polymeric layer 68 can vary, but in some preferred embodiments is from about 0.002 inches to about 0.015 inches. In some embodiments, expansion of the sheath 66 can result in an expansion of the unexpanded outer diameter of from about 10% or less to about 430% or more.

[0102] 27A-28, as well as the other embodiments shown and described, can be provided with a radiopaque filler and / or a radiopaque tip marker, as described above. The sheath 66 can be provided with a radiopaque tip marker at or near the distal end of the sheath 66. Such a radiopaque tip marker can be constructed of materials such as those suitable for radiopaque fillers, platinum, iridium, platinum / iridium alloys, stainless steel, other biocompatible metals, or combinations thereof.

[0103] 50 and 51 show cross-sectional views of an expandable sheath 166 having an inner tubular layer 168 with a longitudinal slit 169. In some embodiments, the longitudinal slit 169 extends the entire length of the inner tubular layer 168. An outer tubular layer 170 surrounds the inner tubular layer 168 and includes longitudinally extending folding flaps 171. In some embodiments, the folding flaps 171 extend the entire length of the outer tubular layer 170. The folding flaps 171 overlie portions of the outer surface 183 of the outer tubular layer 170 when the sheath is in an unexpanded state ( FIG. 50 ). As a prosthetic device moves through the lumen 172 of the sheath 166, it exerts an outward radial force on the inner tubular layer 168, which widens the longitudinal slit 169 and deploys the folding flaps 171. FIG. 51 shows the sheath 166 in an unexpanded state with the longitudinal slit 169 widened and the outer tubular layer 170 unfolded.

[0104] Folding flap 171 of outer tubular layer 170 has a base 173. Base 173 can be disposed radially outward from longitudinal slit 169. In some embodiments, base 173 is centered within longitudinal slit 169. Folding flap 171 further includes an overlying portion 175 that extends longitudinally from base 173 to a longitudinally extending crease 179 at the edge of flap 171. Longitudinal overlying portion 175 overlies and is separated from longitudinally extending underlying portion 177 by crease 179. Underlying portion 177 contacts outer surface 183 of outer tubular layer 170 when the sheath is in an unexpanded state, as shown in FIG. 50 .

[0105] Some embodiments of the sheath 166 may include multiple longitudinally extending folding flaps overlying portions of the outer surface 183 of the outer tubular layer 170, positioned at various locations around the circumference of the sheath 166. For example, 2, 3, 4, 5, 6, 7, 8, 9, or 10 longitudinally extending folding flaps can be positioned around the circumference. In some embodiments, the multiple folding flaps are evenly spaced around the circumference of the sheath 166.

[0106] Folding flaps 171 extend circumferentially around a portion of sheath 166. In some embodiments, longitudinally extending flaps 171 extend around about 20% to about 40% (including about 20%, about 21%, about 22%, about 23%, about 24%, about 25%, about 26%, about 27%, about 28%, about 29%, about 30%, about 31%, about 32%, about 33%, about 34%, about 35%, about 36%, about 37%, about 38%, about 39%, and about 40%) of the circumference of outer tubular layer 170 when sheath 166 is in an unexpanded state. In one example, for a sheath having a 14F (4.7 mm) unexpanded outer diameter, the folding flaps extend approximately 85 to 120 degrees, or approximately 23% to 35% of the circumference (resulting in a lumen having an expanded diameter of approximately 7.6 mm to approximately 8.4 mm, which can be used for a valve having a crimped outer diameter of 6.4 mm and an expanded outer diameter of 26 mm).

[0107] In FIG. 51 , the wall thickness of flap 171 is labeled t, and the wall thickness of the remainder of outer tubular layer 170 is labeled T. In some embodiments, a portion of flap 171 (e.g., underlying portion 177 or overlying portion 175) can have a wall thickness t that is less than the wall thickness (T) of the remainder of the outer tubular layer. Variations in wall thickness promote uniform column strength around the circumference of sheath 166, which reduces kinking and minimizes the overall outer diameter of the sheath. Wall thickness variations can also facilitate the folding process. In some embodiments, the entire flap 171 has a wall thickness t that is less than the wall thickness T of the remainder of the outer tubular layer. In one example, wall thickness t can be from about 0.003 inches to about 0.007 inches, while wall thickness T can be from about 0.008 inches to about 0.012 inches. In other embodiments, such as that shown in FIG. 51, the wall thickness t of the flap 171 is approximately equal to the wall thickness T of the remainder of the outer tubular layer 170 .

[0108] The outer tubular layer 170 is formed of a material with a low coefficient of friction, a high tensile modulus, and a high tensile strength to improve force transmission through the length of the sheath 166 while reducing kinking. Good force transmission means that the force applied by the practitioner to advance the sheath is predictable, responsive, and consistent along the length of the sheath. However, an excessively high tensile modulus can limit the ability of the longitudinally extending flaps 171 to open, which can inhibit force transmission. A desirable range of tensile modulus of elasticity for the outer tubular layer 170 is from about 300 MPa to about 2000 MPa (including about 300 MPa, about 400 MPa, about 500 MPa, about 600 MPa, about 700 MPa, about 800 MPa, about 900 MPa, about 1000 MPa, about 1100 MPa, about 1200 MPa, about 1300 MPa, about 1400 MPa, about 1500 MPa, about 1600 MPa, about 1700 MPa, about 1800 MPa, about 1900 MPa, and about 2000 MPa). In some embodiments, the tensile modulus may preferably be at least 700 MPa. High axial and radial stiffness allows the sheath to be easily inserted and to resist collapse within the body.

[0109] The tensile strength of the outer tubular layer 170 may be at least 50 MPa. High tensile strength helps prevent the material from tearing while the prosthetic device is advanced through the sheath.

[0110] Exemplary materials for forming the outer tubular layer 170 of the embodiment shown in Figures 50 and 51 include high density polyethylene (HDPE), polyamide, copolyamide, polyether block amide (PEBAX®), or a blend of polyamides. Materials with shape memory properties are advantageous because they can impart a bias to the outer tubular layer 170 toward a collapsed state (e.g., by heat setting). This facilitates refolding of the outer tubular layer 170 after passage of the prosthetic device. PEBAX® is an exemplary shape memory material that can be heat set to a collapsed state.

[0111] In some embodiments, the outer surface 183 of the outer tubular layer 170 can include a hydrophilic coating. In some embodiments, a bond can be created between the underlying portion 177 of the folding flap 171 and the outer surface 183 of the outer tubular layer 170. This bond can be a thermal bond (with portions of the contact layers fused together) or a separate layer of adhesive.

[0112] 50 and 51, the inner tubular layer 168 includes a longitudinal slit 169. The inner tubular layer 168 includes a first longitudinally extending end 178 and a second longitudinally extending end 180, with the first and second longitudinally extending ends 178, 180 defining the longitudinal slit 171.

[0113] The inner tubular layer 168 forms a low-friction barrier between a passing prosthetic device and the higher-friction outer tubular layer 170. When the sheath 166 is in an unexpanded state, the inner tubular layer 168 extends around at least 80% (or at least 85%, or at least 90%, or at least 95%) of the circumference of the lumen 172. The high degree of coverage limits contact between a passing prosthetic device and the high-friction outer tubular layer 170. In some embodiments, the coefficient of friction (static or dynamic) per ASTM D1894 of the inner tubular layer 168 is 0.30 or less. In other embodiments, the coefficient of friction is 0.25 or less.

[0114] In some embodiments, the low-friction inner tubular layer 168 includes or is formed of a material having a tensile modulus of at least about 300 MPa (and up to about 1400 MPa) to provide good push-force transmission while providing kink resistance. This material can be, for example, high-density polyethylene or a fluoropolymer. Exemplary fluoropolymers include polytetrafluoroethylene, ethylene fluorinated ethylene propylene, or perfluoroalkoxy.

[0115] A tie layer 174 can be disposed between the two layers, thereby adhering the inner tubular layer 168 to the outer tubular layer 170. In some embodiments, the tie layer 174 can be formed of polyurethane or a functionalized polyolefin. In some embodiments, the contact surface of the inner tubular layer 168 can be etched to improve bonding to the tie layer. For example, an inner tubular layer 168 including or formed of a fluoropolymer can have its surface etched to improve thermal bonding to the tie layer 174.

[0116] Some embodiments of the sheath 166 shown in FIGS. 50 and 51 can also include an outer jacket 181, as shown in FIG. 52. The outer jacket 181 is elastomeric (having a relatively low tensile modulus compared to the inner and outer tubular layers 168, 170). As mentioned above, in some embodiments, the outer tubular layer 170 can also include or be formed of a shape-memory material (e.g., a heat-set polymer such as PEBAX®) that facilitates refolding of the outer tubular layer 170 after expansion. In some embodiments, the sheath 166 can include an elastomeric outer jacket 181 that extends over and surrounds the outer tubular layer 170. The outer jacket 181 and shape-memory mechanism can be used alone or in conjunction with one another to facilitate refolding (i.e., the elastomeric outer jacket 181 can extend over the outer tubular layer 170, which includes a shape-memory material). Refolding of outer tubular layer 170 preferably allows sheath 166 to return to its original outer diameter or to a value close to its original outer diameter (e.g., within about 10%, about 20%, about 30%, about 40%, or about 50% of the original outer diameter). Elastomeric outer jacket 181 can include or be formed entirely of a material such as low durometer polyurethane (e.g., less than Shore 85A), styrene elastomer (e.g., less than Shore 85A), latex, or low durometer PEBAX® (e.g., less than Shore 35D).

[0117] 50-52 includes the first step of inserting an expandable sheath 166 into a subject's vasculature and advancing a prosthetic device through the lumen 172 of the expandable sheath 166. The prosthetic device exerts an outward radial force on the inner tubular layer 168 of the expandable sheath 166. In some embodiments, the outward radial force is transmitted through the inner tubular layer 168, the bonding layer 174, and the outer tubular layer 170. The outward radial force widens a longitudinal slit 169 in the inner tubular layer 168. In some embodiments, the widening of the longitudinal slit 169 is propagated along the entire length of the expandable sheath.

[0118] The outward radial force further deploys the longitudinally extending flaps 171 of the outer tubular layer 170, expanding the expandable sheath. Deployment of the flaps 171 can include circumferentially sliding the longitudinally extending overlying portions 175 relative to the longitudinally extending underlying portions 177 of the flaps 171. The underlying portions 177 can slide circumferentially relative to the outer surface 183 of the outer tubular layer 170. In some embodiments, deployment of the longitudinally extending flaps 171 occurs at a location radially outward from the longitudinal slits 169 in the inner tubular layer 168. In yet other embodiments, deployment of the flaps 171 can extend the entire length of the expandable sheath 166.

[0119] The longitudinal slits 169 in the inner tubular layer 168 narrow in width when the outward radial force is removed (i.e., when the prosthetic device is passed through). The slits 169 may narrow back to their original width or to a value close to their original width (e.g., within about 10% of their original width). The width reduction can occur along the entire length of the sheath 166. The prosthetic device is then delivered to the treatment site.

[0120] The longitudinally extending flaps 171 at least partially refold when the prosthetic device ceases to exert an outward radial force (i.e., it has passed). In some embodiments, the longitudinally extending flaps 171 refold on themselves due to a shape memory bias toward the folded state. In some embodiments, an inward radial force is applied to the outer surface 183 of the outer tubular layer 170 (e.g., by the elastomeric outer jacket 181) to refold the longitudinally extending flaps 171.

[0121] An exemplary method for manufacturing a sheath is as follows: These steps are not meant to be limiting. The steps given may be rearranged as needed. Other steps may be added, and in other instances, some steps may not be required. Dimensions are approximate. 1) Starting with a PTFE inner liner having an inside diameter (ID) of approximately 0.200 inches and a wall thickness of approximately 0.004 inches; 2) Loading the PTFE inner liner onto a tapered mandrel from approximately 0.200 inches to approximately 0.187 inches; 3) Stretching under heat onto a 0.187 inch outer diameter (OD) mandrel section; 4) Flaring the proximal end of the 0.200 inch ID PTFE to 0.340 inch ID under heat; 5) Loading a tie layer, such as Tecoflex 80A, having an approximately 0.200 inch ID and 0.004 inch wall thickness onto the PTFE inner liner along the body section by expanding it with air pressure (optionally, the tie layer can be applied after expanding the inner layer with air pressure); 6) Covering with, for example, FEP (fluorinated ethylene propylene) heat shrink tubing and applying heat to bond the tie layer to the inner liner; 7) 8) remove FEP heat shrink tubing, if used; 9) create a longitudinal slit along the body section of the assembly; 10) load the slitted subassembly onto a 0.187 inch OD mandrel; 11) load the outer layer onto the body; 12) heat set the folds, for example, by inserting the fold-attached subassembly inside heat shrink tubing and placing the assembly in an oven; 13) remove shrink tubing, if used; 14) remove the sheath from the mandrel. In some embodiments, an outer elastomeric jacket is applied over the heat-set outer layer before removal from the mandrel.

[0122] 29A-29D are cross-sectional views of other possible configurations of a sheath 66 for introducing a prosthetic device into a patient's vasculature. The sheath 66 includes a polymeric tubular layer 84 having an inner surface 86 and an outer surface 88. The thickness of the polymeric tubular layer 84 extends from the inner surface 86 to the outer surface 88. As shown in FIGS. 29B-29D, the polymeric tubular layer 84 can be formed with at least a first corner portion 90 of reduced thickness adjacent the inner surface 86 and a second corner portion 92 of reduced thickness adjacent the outer surface 88, with the second portion 92 at least partially overlapping the first portion 90. FIG. 29A shows a similar configuration in which the second portion 92 at least partially overlaps the first portion 90 in a partial coil configuration. In the embodiment of FIG. 29A, the second portion 92 and the first portion 90 can have the same thickness.

[0123] In preferred embodiments, the first and second portions 90, 92 are not adhered to one another. In some embodiments, there may be a small gap 94 between the first and second portions 90, 92, which can give the sheath 66 the appearance of having two lumens 72, 94, as best seen in FIG. 29A. FIGS. 29A-29D show the sheath 66 in an unexpanded configuration. Preferably, upon expansion of the sheath 66, the ends of the first and second portions 90, 92 abut or closely contact one another, reducing or eliminating the gap between them.

[0124] In some embodiments, the sheath 66 can include a partial slit or scoreline along at least a portion of its length. For example, as shown in FIG. 33, the sheath 66 can include an outer polymeric tubular layer 70 over an inner polymeric layer 68. The inner polymeric layer can extend through a cut in the outer polymeric tubular layer 70 to form a folded region 85 on the outer surface of the outer polymeric tubular layer 70, as also shown in FIG. 27C. The folded region 85 of the inner liner, in some embodiments, terminates before the outer polymeric tubular layer 70 (i.e., the outer polymeric tubular layer 70 is longer than the inner liner). As shown in FIG. 33, in these embodiments, the sheath 66 can include a partial slit or scoreline 77 that can extend from the end (distal end) 75 of the folded region 85 to the distal end 40 of the sheath 66. In some embodiments, the scoreline 77 can facilitate expansion of the sheath 66.

[0125] The scoreline 77 can be substantially centrally located relative to the folding region 85. In alternative embodiments, the scoreline 77 can be located elsewhere relative to the folding region 85. The sheath 66 can also include one or more scorelines 77. For example, as shown in FIG. 34, the one or more scorelines 77 can be peripherally located relative to the folding region 85. The one or more scorelines 77 can be located anywhere around the circumference of the outer polymeric tubular layer 70. As can be seen in FIG. 33, in embodiments including a radiopaque marker 69, the scoreline 77 can extend, for example, from the distal end of the radiopaque marker 69 substantially to the distal end 40 of the sheath 66.

[0126] 35 and 36 illustrate an expandable sheath 100 according to the present disclosure that can be used in a delivery apparatus for delivering a prosthetic device, such as a biological heart valve, into a patient. Generally, the delivery apparatus can include a steerable guide catheter (also called a flex catheter) (e.g., as shown in FIG. 1 ), a balloon catheter extending through the guide catheter, and a nose catheter extending through the balloon catheter. The guide catheter, balloon catheter, and nose catheter can be adapted to slide longitudinally relative to one another to facilitate delivery and placement of the valve at an implantation site within the patient's body. It should be noted, however, that the sheath 100 can be used with any type of elongated delivery apparatus used to implant balloon-expandable prosthetic valves, self-expanding prosthetic valves, and other prosthetic devices. Generally, the sheath 100 can be inserted into a blood vessel (e.g., the femoral or iliac artery) by passing through the patient's skin so that the soft-tip portion 102 at the distal end 104 of the sheath 100 is inserted into the blood vessel. The sheath 100 may also include a proximal flared end 114 to facilitate mating with the introducer housing 101 and the catheter described above (e.g., the proximal flared end 114 may provide a compression fit onto the housing tip and / or the proximal flared end 114 may be secured to the housing 101 via a nut or other fastening device or by joining the proximal end of the sheath to the housing). The introducer housing 101 may contain one or more valves, as known in the art, that form a seal around the outer surface of a delivery device when inserted therethrough. A delivery device may be inserted into and through the sheath 100, allowing the prosthetic device to be advanced through the patient's vasculature and implanted within the patient.

[0127] The sheath 100 can include multiple layers. For example, the sheath 100 can include an inner liner 108 and an outer layer 110 disposed around the inner liner 108. The inner liner 108 defines a lumen through which a delivery device can travel in a direction along the longitudinal axis X and into a patient's blood vessel to deliver, remove, repair, and / or replace a prosthetic device. As a prosthetic device passes through the sheath 100, the sheath locally expands from a first resting diameter to a second expanded diameter to accommodate the prosthetic device. After the prosthetic device passes through a particular location in the sheath 100, each over-expanded portion or segment of the sheath 100 at least partially returns to its smaller, resting diameter. In this manner, the sheath 100 can be considered self-expanding in that it does not require the use of a balloon, dilator, and / or obturator to expand.

[0128] The inner and outer layers 108, 110 may be constructed of any suitable material. Suitable materials for the inner liner 108 include polytetrafluoroethylene (PTFE), ethylene tetrafluoroethylene (ETFE), nylon, polyethylene, polyether block amide (e.g., PEBAX®), and / or combinations thereof. In some exemplary embodiments, the inner liner 108 may be constructed of a lubricious, low-friction, or hydrophilic material, such as PTFE. Such low coefficient of friction materials can facilitate passage of a prosthetic device through the lumen defined by the inner liner 108. In other embodiments, the inner liner 108 may have a coefficient of friction of less than about 0.1. Some embodiments of the sheath 100 may include a lubricious liner on the inner surface of the inner liner 108. Examples of suitable lubricious liners include materials that can further reduce the coefficient of friction of the inner liner 108, such as PTFE, polyethylene, polyvinylidene fluoride, and combinations thereof. Suitable materials for the lubricous liner also include other materials that desirably have a coefficient of friction of about 0.1 or less.

[0129] Suitable materials for the outer layer 110 include nylon, polyethylene, PEBAX®, HDPE, polyurethane (e.g., Tecoflex™), and other medical-grade materials. In one embodiment, the outer layer 110 can be constructed of high-density polyethylene (HDPE) and Tecoflex™ (or other polyurethane material) extruded as a composite. In some embodiments, the Tecoflex™ can act as an adhesive between the inner liner 108 and the outer layer 110 and need only be present along a portion of the inner surface of the outer layer 110. Other suitable materials for the inner and outer layers are also disclosed in U.S. Patent Application Publication No. 2010 / 0094392, which is incorporated herein by reference.

[0130] Additionally, some embodiments of the sheath 100 can include an external hydrophilic coating on the outer surface of the outer layer 110. Such a hydrophilic coating can facilitate insertion of the sheath 100 into a patient's blood vessel. Examples of suitable hydrophilic coatings include Harmony® Advanced Lubricious Coatings and other advanced hydrophilic coatings available from SurModics, Inc. of Eden Prairie, Minnesota. DSM Medical Coatings (available from Koninklijke DSM NV, Heerlen, The Netherlands), as well as other hydrophilic coatings (e.g., PTFE, polyethylene, polyvinylidene fluoride), are also suitable for use with the sheath 100.

[0131] As best seen in FIG. 36 , the soft-tip portion 102, in some embodiments, can be constructed from low-density polyethylene (LDPE) and configured to minimize trauma or damage to a patient's blood vessel as the sheath is navigated through the vasculature. For example, in some embodiments, the soft-tip portion 102 can be slightly tapered to facilitate passage through a blood vessel. The soft-tip portion 102 can be secured to the distal end 104 of the sheath 100, such as by thermally bonding the soft-tip portion 102 to an inner or outer layer of the sheath 100. Such a soft-tip portion 102 can have a lower hardness than the rest of the sheath 100. In some embodiments, the soft-tip 102 can have a Shore hardness of about 25D to about 40D. The tip portion 102 is configured to be radially expandable to allow a prosthetic device to pass through a distal opening in the sheath 100. For example, the tip portion 102 can be formed with weakened portions, such as axially extending score lines or perforation lines, which are configured to split when a prosthetic device passes through the tip portion (as shown in the embodiments of Figures 33 and 34), allowing the tip portion to expand radially.

[0132] FIG. 37 shows a cross-sectional view of the sheath 100 taken near the distal end 104 of the sheath 100. As shown in FIGS. 36 and 37, the sheath 100 can include at least one radiopaque filler or marker, such as a discontinuous or C-shaped band 112, disposed near the distal end 104 of the sheath 100. The marker 112 can be associated with the inner and / or outer layers 108, 110 of the sheath 100. For example, as shown in FIG. 37, the marker 112 can be disposed between the inner liner 108 and the outer layer 110. In alternative embodiments, the marker 112 can be associated with the outer surface of the outer layer 110. In some embodiments, the marker 112 can be embedded or incorporated within the inner or outer layers 108, 110.

[0133] The C-shaped band 112 serves as a radiopaque marker or filler, allowing the sheath 100 to be visible under fluoroscopy during use within a patient. The C-shaped band 112 can be composed of any suitable radiopaque material, such as barium sulfite, bismuth trioxide, titanium dioxide, bismuth subcarbonate, platinum, iridium, and combinations thereof. In one specific embodiment, the C-shaped band can comprise approximately 90% platinum and approximately 10% iridium. In other embodiments, the marker 112 need not be a C-shaped band. Other shapes, designs, and configurations are also possible. For example, in some embodiments, the marker 112 can extend around the entire circumference of the sheath 100. In other embodiments, the marker 112 can include multiple small markers spaced around the sheath 100.

[0134] 38 and 39 show additional cross-sections taken at different points along the sheath 100. FIG. 38 shows a cross-section of a segment of the sheath near the proximal end 106 of the sheath 100, as indicated by line 38-38 in FIG. 35. The sheath 100 at this location can include an inner liner 108 and an outer layer 110. At this location, near the proximal end of the sheath, the layers 108, 110 can be substantially tubular, with no slits or folds within the layers. In contrast, the layers 108, 110 at different locations along the sheath 100 (e.g., the point indicated by line 39-39 in FIG. 35) can have different configurations.

[0135] As shown in FIG. 39 , the inner liner 108 can be arranged to form a substantially cylindrical lumen 116 therethrough. The inner liner 108 can include one or more folded portions 118. In the embodiment shown in FIG. 39 , the inner liner 108 is arranged to have one folded portion 118 that can be located on one side of the inner liner 108. The folded portion 118 includes a first fold (e.g., a longitudinally extending fold line), a second fold, and an overlapping portion extending circumferentially therebetween (when the sheath is in the unexpanded configuration). As shown in FIG. 39 , the folded portion 118 includes a radial overlap of at least two pieces of the inner liner 108. The inner liner 108 can be continuous, in that there are no breaks, slits, or perforations in the inner liner 108. The outer layer 110 can be arranged in an overlapping manner such that the overlapping portion 120 overlaps at least a portion of the folded portion 118 of the inner liner 108. As shown in FIG. 39 , the overlapping portion 120 also overlaps an underlying portion 122 of the outer layer 110. The underlying portion 122 can be positioned to underlie both the overlapping portion 120 of the outer layer 110 and the folded portion 118 of the inner liner 108. That is, the outer layer 110 can be discontinuous in that it includes slits or cuts to form the overlapping portion 120 and the underlying portion 122. In other words, the first edge 124 of the outer layer 110 is spaced from the second edge 126 of the outer layer 110 so as not to form a continuous layer.

[0136] As shown in FIG. 39 , the sheath 100 can also include a thin layer of bonding or adhesive material 128, also referred to as a tie layer, disposed between the inner and outer layers 108, 110. In one embodiment, the adhesive material 128 can be composed of a polyurethane material such as Tecoflex® or etched PTFE tubing. The adhesive material 128 can be disposed on at least a portion of the inner surface 130 of the outer layer 110 to provide adhesion between selected portions of the inner and outer layers 108, 110. For example, the outer layer 110 can include the adhesive layer 128 only around the portion of the inner surface 130 that faces the lumen-forming portion of the inner liner 108. In other embodiments, the adhesive layer 128 can be positioned such that it does not contact the folded portion 118 of the inner liner 108. In other embodiments, the adhesive layer 128 can be arranged in different configurations as desired for a particular application. For example, as shown in FIG. 39 , the adhesive layer 128 can be disposed along the entire inner surface 130 of the outer layer 110. In an alternative embodiment, the adhesive layer can be applied to the outer surface of the inner liner 108 instead of the inner surface of the outer layer. The adhesive layer 128 can be applied to all or selected portions of the inner liner 108; for example, the adhesive layer 128 can be formed only on the portion of the inner liner facing the lumen-forming portion of the outer layer, and not on the folded portion. The configuration of FIG. 39 allows the sheath 100 to radially expand when an outward radial force is applied from within (e.g., by passing a medical device, such as a prosthetic heart valve, through the lumen 116). When the radial force is applied, the folded portion 118 at least partially separates, straightens, and / or unfolds, and / or the overlapping portion 120 and the underlying portion 122 of the outer layer 110 can slide circumferentially relative to one another, thereby expanding the diameter of the lumen 116.

[0137] In this manner, the sheath 100 is configured to expand from a resting configuration ( FIG. 39 ) to an expanded configuration shown in FIG. 40 . In the expanded configuration, an annular gap 132 can be formed between the longitudinal edge of the overlapping portion 120 and the longitudinal edge of the underlying portion 122 of the outer layer 110, as shown in FIG. 40 . When the sheath 100 expands at a particular location (i.e., expands locally at the location of the prosthetic device being passed therethrough), the overlapping portion 120 of the outer layer 110 can move circumferentially relative to the underlying portion 122 as the folded portions 118 of the inner liner 108 unfold. This movement can be facilitated by the use of a low-friction material for the inner liner 108, such as PTFE. Additionally, the folded portions 118 can at least partially separate and / or unfold to accommodate a medical device having a larger diameter than the lumen 116 in the resting configuration. As shown in FIG. 40, in some embodiments, the folded portion of the inner liner 108 is allowed to fully unfold, such that the inner liner 108 forms a cylindrical tube in the expanded configuration.

[0138] The sheath 100 can be configured to locally expand at specific locations along the length of the lumen 116 corresponding to the location of a medical device, and then locally contract once the medical device has passed that specific location. That is, as a medical device is introduced through the sheath, a bulge is visible that moves longitudinally along the length of the sheath, demonstrating successive local expansions and contractions as the device moves down the length of the sheath 100. In some embodiments, each segment of the sheath 100 can locally contract after removal of the outward radial force, thereby allowing each segment of the sheath 100 to resume its original resting diameter of the lumen 116. In some embodiments, each segment of the sheath 100 can locally contract after removal of the outward radial force, thereby at least partially returning to its original resting diameter of the lumen 116.

[0139] The layers 108, 110 of the sheath 100 can be configured along at least a portion of the length of the sheath 100, as shown in Figure 39. In some embodiments, the layers 108, 110 can be configured along a length A (Figure 35) that extends from adjacent the soft tip portion 102 to near the proximal end 106 of the sheath 100, as shown in Figure 39. In this regard, the sheath is expandable and contractible only along a portion of the sheath length corresponding to length A (which typically corresponds to the section of the sheath inserted into the narrowest cross section of the patient's vasculature).

[0140] The sheath 100 of FIG. 35 can include an outer jacket 140 that extends over the outer layer 110. FIGS. 53 and 54 show additional cross sections taken at different points along the sheath 100. Similar to FIG. 38, FIG. 53 shows a cross section of a segment of the sheath near the proximal end 106 of the sheath 100, as indicated by line 38-38 in FIG. 35. The sheath 100 at this location can include an inner liner 108, an outer layer 110, an adhesive layer 128, and an outer jacket 140. At this location near the proximal end of the sheath, the layers 108, 110, and the outer jacket 140 can be substantially tubular, without any slits or folds in the layers. In contrast, layers 108, 110 at different locations along sheath 100 (e.g., at the points indicated by line 39-39 in FIG. 35) may have different configurations, while outer jacket 140 remains substantially tubular without slits or creases.

[0141] As shown in FIG. 54 and described above with respect to FIG. 39 , the inner liner 108 can be arranged to form a substantially cylindrical lumen 116 extending therethrough. The inner liner 108 can include one or more folded portions 118. The outer layer 110 can be arranged in an overlapping manner such that, when the sheath is in an unexpanded state, the overlapping portion 120 overlaps at least a portion of the folded portion 118 of the inner liner 108, as well as an underlying portion 122 (positioned to underlie the folded portion 118 of the inner liner 108). The sheath 100 is configured to locally expand from an unexpanded configuration, in which the lumen 116 has a first diameter, to an expanded configuration, in which the lumen 116 has a second diameter greater than the first diameter. The sheath 100 expands in response to an outward radial force exerted by a medical device on the inner liner 108 when the medical device passes through the lumen 116. During expansion, the first crease / fold edge moves closer to the second crease / fold edge, shortening the folded portion 118. As shown in FIG. 55 , in some embodiments, the folded portion 118 of the inner liner 108 is allowed to fully unfold, such that the inner liner 108 forms a cylindrical tube in the expanded configuration. When the sheath is expanded, a portion of the inner liner 108 expands through an opening / gap in the outer layer 110, where the opening is formed by the longitudinally extending edge of the overlapping portion 120 and the longitudinally extending edge of the underlying portion 122. Once the prosthetic device has passed, the sheath 100 then locally contracts to at least partially return to the unexpanded configuration.

[0142] As described above, the sheath 100 includes an inner liner 108. Various exemplary embodiments of the inner liner 108 (before pleats are created) are shown in FIGS. 61-63. The liner 108 can comprise at least one first portion 6102 and at least one second portion 6104. In such embodiments, the outer surface of the at least one first portion can have a substantially different composition than the outer surface of the at least one second portion. In yet other embodiments, the outer surface of the at least one first portion can have a substantially different morphology than the outer surface of the at least one second portion. In such exemplary embodiments, the at least one first portion 6102 can be etched, while the at least one second portion 6104 of the inner liner is not etched.

[0143] It is understood that etching can be performed by any method known in the art. For example, without limitation, etching can be performed by exposing at least a portion of the inner liner to an etching agent. The selection of a specific etching agent can depend on the composition of the inner liner itself. In certain aspects, as disclosed herein, the etching agent can be a liquid, fluid, or gas, or a plasma. In yet another exemplary aspect, the etching agent can include sodium naphthalene or can include a plasma.

[0144] As described above, the inner liner 108 can be constructed of polytetrafluoroethylene (PTFE), fluorinated ethylene propylene (FEP), polyimide, polyetheretherketone (PEEK), polyurethane, nylon, polyethylene, polyamide, or a combination thereof. In yet another embodiment, the inner liner is constructed of a fluorocarbon-based polymer, such as PTFE and / or FEP. In embodiments in which the inner liner is a fluorocarbon, the etching agent can exist as a solution, fluid, or gas. It can also be accelerated by applying high temperature, electricity, or voltage, or any combination thereof. In yet other embodiments, the etching agent can be a plasma. In such exemplary embodiments, the plasma etchant can be oxygen plasma, hydrogen plasma, nitrogen plasma, argon plasma, or any combination thereof. It is understood that the extent of etching can be readily controlled by the desired masking, the temperature of the solution, the power of the plasma, etc.

[0145] In some embodiments, to create (or preserve) unetched portions of the inner liner, these portions can first be masked. It is understood that any masking method can be used. In some embodiments, masking can be performed by covering the portions that should not be etched with a material that can withstand the etching conditions without damaging the masked inner liner. In yet other embodiments, etching can be performed such that only the portions desired to be etched are exposed to the etchant.

[0146] In yet another exemplary embodiment, in which the inner liner 108 comprises PTFE, at least a portion of the inner liner can be exposed to an exemplary etchant, such as a sodium naphthalene solution. Upon exposure to the sodium naphthalene solution, a reaction can occur between the sodium naphthalene and fluorine atoms present on the outer surface of the inner liner. In such an exemplary, non-limiting embodiment, the outer surface of the at least one first portion can have a fluorine to carbon ratio that is lower than the fluorine to carbon ratio of the unetched portion.

[0147] In yet another aspect, etching can also affect the roughness of the outer surface of the inner liner in various portions, for example, the outer surface of at least one first portion of the inner liner can exhibit a lower RMS value than the RMS value of the outer surface of at least one second portion of the inner liner.

[0148] In yet another aspect, etching can also affect the surface energy of the outer surface of the inner liner in various portions.

[0149] In yet another aspect, etching may also affect the polarity of the outer surface of the inner liner in various portions.

[0150] In yet another aspect, etching can also affect the contact angle with polar solvents, such as water, on the outer surface of the inner liner.

[0151] In yet another embodiment, the inner liner 108 can be completely etched, and then a portion of the etched portion can be further surface modified to form at least one second portion 6104 that is different from the other etched (first) portion 6102. In such an embodiment, the at least one second portion can have an outer surface having a composition that is substantially different from the composition of the etched (first) portion. Similarly, in the disclosed embodiment, the at least one second portion can have an outer surface having a morphology that is substantially different from the morphology of the etched (first) portion.

[0152] Various methods of surface modification can be utilized. In certain embodiments, the surface modification can be achieved by exposing the etched portion to a desired solution to chemically modify specific portions while masking the etched portion. Chemical surface modification can also be achieved by exposing the desired portion of the etched surface to, for example, a plasma treatment. Additionally, in other embodiments, the surface modification can be a physical surface modification. It is understood that any physical surface modification known in the art can be utilized. In some embodiments, the surface can be modified by the use of a laser, for example, by laser ablation, while in other embodiments, it can be achieved by any method that removes the outermost layer of the outer surface of the inner liner.

[0153] In yet another embodiment, for example, but not by way of limitation, when laser ablation is used to surface modify the etched first portion to form a second portion, such second portion can include a gradient morphology. However, it is understood that the gradient morphology of the second portion is not limiting and any shape of ablation structure can be achieved. For example, it is understood that the laser kerf can control the actual shape. In still other embodiments, the shape of the ablation can be determined by the stability of the first (etched) portion of the inner liner. Some exemplary schematic diagrams of gradient morphology 6106 are shown in Figures 63A-63B. It is understood that the gradient morphology can have any predetermined pattern. In some exemplary, non-limiting embodiments, the gradation can have a checkerboard, striped, dotted, wavy, crisscross pattern, or any combination of these patterns, depending on the desired application. It is understood that the gradient pattern can be controlled through a masking process that allows exposure to laser ablation only in desired locations.

[0154] In yet another embodiment, the gradational morphology can be controlled by laser power, frequency, and / or speed to arrive at a pattern with a desired shape, width, spacing between liners (specific pattern), angle, direction, and / or line depth. In certain embodiments, longitudinal lines can be formed by laser ablation. In yet other embodiments, the lines formed by laser ablation can have different widths or different angles, as shown in Figure 63B.

[0155] In certain embodiments, as disclosed above, the at least one second portion, whether it is a completely unetched portion or a portion that is first etched and then surface modified by any known means, can extend longitudinally along the length of the inner liner. In yet other embodiments, for example, as shown in Figures 61A-61B, the at least one second portion, whether it is a completely unetched portion or a portion that is first etched and then surface modified by any known means, can extend circumferentially around the periphery of the inner liner.

[0156] In some exemplary embodiments, the first and / or second portions of the inner liner can have any shape. It is understood that in some exemplary, non-limiting embodiments, the shape of the etched portion, the unetched portion, or the etched and then surface-modified portion can be square, rectangular, diamond, polygonal, trapezoidal, pyramidal, circular, elliptical, triangular, star-shaped, etc. It is understood that in some embodiments, the second portion can have a combination of the unetched surface of the inner liner and the etched and then surface-modified surface of the inner liner. For example, the second portion can have an edge of any shape with a gradient feature, while the remainder of the second section is unetched.

[0157] In yet another embodiment, at least one second portion of the inner liner can extend along the inner and / or outer portions of at least one folded portion of the inner liner. In such an embodiment, the portion of the inner liner that will form the fold in the final sheath configuration remains unetched, for example, forming the second portion along the length of the inner liner that will form the fold. An example of forming such an unetched portion that can form a future fold is shown in Figures 61A-61B. In such an exemplary embodiment, the portion of the inner liner that will form the fold and crease 179 can be masked and left unetched.

[0158] In yet another embodiment, as described herein, the outer surface of the inner liner can be completely etched and then a portion of the outer surface can be surface modified by laser ablation, for example, to form a second portion of the inner liner that is substantially different from the etched (first) portion.

[0159] In yet another embodiment, the inner liner can have a wall thickness as described herein. In such exemplary embodiments, the wall thickness of the inner liner can be from about 0.002 inches to about 0.006 inches, with exemplary values ​​of about 0.0025 inches, about 0.003 inches, about 0.0035 inches, about 0.004 inches, about 0.0045 inches, about 0.005 inches, and about 0.0055 inches.

[0160] In yet another embodiment, the at least one first portion has a wall thickness that is different from the wall thickness of the at least one second portion. For example, in such exemplary embodiments where the at least one second portion is an unetched portion of the inner liner, the wall thickness of this portion can be up to about 0.1%, about 0.2%, about 0.3%, about 0.4%, about 0.5%, about 0.6%, about 0.7%, about 0.8%, about 0.9%, about 1%, about 1.1%, about 1.2%, about 1.3%, about 1.4%, about 1.5%, about 1.6%, about 1.7%, about 1.8%, about 1.9%, or about 2% greater than the wall thickness of the at least one first portion.

[0161] For example, in yet another exemplary embodiment in which the inner liner is completely etched and then at least one second portion is formed by surface modification of the desired etched portion of the inner liner, the thickness of this portion can be up to about 0.1%, about 0.2%, about 0.3%, about 0.4%, about 0.5%, about 0.6%, about 0.7%, about 0.8%, about 0.9%, about 1%, about 1.1%, about 1.2%, about 1.3%, about 1.4%, about 1.5%, about 1.6%, about 1.7%, about 1.8%, about 1.9%, or about 2% less than the thickness of the at least one first portion.

[0162] As discussed in detail herein, the inner liner can include two or more first and / or second portions. In embodiments in which there are two or more first and / or second portions, it is understood that each of the first portions can have the same or different wall thicknesses and each of the second portions can have the same or different wall thicknesses.

[0163] For example, it is further understood that if there are two or more second portions, each of these portions can be comprised of either unetched material or material that has been etched and then surface modified.

[0164] In certain embodiments, as shown in FIGS. 61A-61B, for example, a first portion can be followed by a second portion, and then the second portion can be followed by an additional first portion. It is understood that each of the two or more first portions can have, for example, the same or different lengths. Similarly, each of the two or more second portions can have the same or different lengths. For example, without limitation, as shown in FIG. 61B, a first portion 6102 can have a length of approximately 1.5 inches starting at the proximal end of the sheath. This first portion 6102 can then be followed by a second portion 6104 having an exemplary, open-ended length of approximately 2.5 inches, again followed by an additional first portion having a much greater length. Again, it is understood that this description is merely exemplary, and that any other combination of first and second portions having any desired length is possible. For example, without limitation, a second portion can be disposed at the proximal end of the sheath, followed by a first portion, and so on.

[0165] In yet another embodiment, at least one second portion, and therefore the inner liner, extends along a portion of the sheath that contacts the outer surface of the outer layer. It is understood that at least one second portion of the inner liner contacts the outer layer around the folds of the sheath. It is further understood that having such a second portion improves sheath performance by reducing adhesion to the outer layer, for example, making the deployment process easier during passage of a medical device. As disclosed in detail above, the outer layer can be composed of any well-known polymer. In some embodiments, the outer layer can be composed of high-density polyethylene (HDPE), nylon, and / or polypropylene polymers.

[0166] In yet another embodiment, the at least one second portion of the inner liner can exhibit substantially less adhesion to the outer layer compared to the adhesion of the at least one first portion of the inner liner to the outer layer.

[0167] In yet another embodiment, the outer surface of the at least one second portion exhibits a contact angle of greater than about 65° to about 140°, with exemplary values ​​of about 70°, about 75°, about 80°, about 85°, about 90°, about 95°, about 100°, about 105°, about 110°, about 115°, about 120°, about 125°, about 130°, and about 135°, while in other embodiments, the outer surface of the at least one first portion exhibits a contact angle of about 30° to about 90°, with exemplary values ​​of about 35°, about 40°, about 45°, about 50°, about 55°, about 60°, about 65°, about 70°, about 75°, about 80°, and about 85°.

[0168] In yet another embodiment, the sheath can also include an outer jacket 140, as shown in FIG. 57. In such embodiments, the outer jacket 140 includes inner and outer surfaces and proximal and distal ends, and extends at least partially around the outer layer such that the inner surface of the outer jacket overlies the outer surface of the outer layer. In some embodiments, the outer jacket can have a proximal end and a distal end. In certain embodiments, the proximal end of the outer jacket abuts the proximal end of the sheath. Yet, in other embodiments, the distal end of the outer jacket can be anywhere along the length of the sheath. Meanwhile, in some exemplary embodiments, the distal end of the outer jacket can abut the distal end of the sheath.

[0169] In some embodiments where an outer jacket is present, at least one second portion of the inner layer is disposed around at least the distal end of the outer jacket. In such exemplary embodiments, as shown in FIG. 63A, for example, the second portion can have an unetched surface 6104 and a gradient surface 6106. In this particular, non-limiting example, the gradient portion of the second portion is in the protruding area, or in other words, in the area where the outer jacket overlaps the outer layer of the sheath.

[0170] Also disclosed herein are sheaths in which the inner liner includes two or more folded portions. In such embodiments, at least one second portion of the inner liner can extend along the inner and / or outer portions of each of the two or more folded portions.

[0171] Also disclosed herein are embodiments that refer to sheaths with reduced insertion forces compared to any other commercially available sheaths. As those skilled in the art will readily recognize, reduced insertion forces for the sheath and any medical device passing therethrough result in reduced or substantially eliminated risk to the patient during a medical procedure. It is understood that the insertion forces of the sheaths of the present invention, the reference sheath, and any other commercially available sheaths are measured using the same standardized technique for proper comparison. In such embodiments, a tensile tester, such as an Instron 3366, can be used to measure the simulated insertion force required to advance a prosthetic valve into the described sheath. Additional contraction tubing can be used to simulate vascular elasticity, which contributes to the pushing force. In certain exemplary embodiments, testing can be performed in a water bath at a temperature range from room temperature to normal body temperature (e.g., without limitation, from about 20°C to less than about 40°C). The test specimen can be held in a straight configuration. Testing can be performed using a tapered mandrel to simulate a valve entering the sheath.

[0172] A sheath as disclosed herein comprising one or more first and second portions exhibits a pushing force during passage of a prosthetic device that is at least about 10% less, at least about 20% less, at least about 30% less, or at least about 50% less than a substantially identical reference sheath that does not comprise a second portion. In yet another embodiment, a sheath as described herein comprising one or more first and second portions exhibits a pushing force during passage of a prosthetic device that is less than about 50 N, less than about 45 N, or less than about 40 N, or less than about 35 N.

[0173] In yet another embodiment, as described above, unetched or etched and then surface-modified portions (second portions) of the sheath 100 can be provided along those surfaces of the inner liner 108 that contact the outer surface of the outer layer 110. In exemplary embodiments where a tie layer is also present, such as 128, those portions of the inner liner 108, excluding the tie layer 128, do not include etching. For example, it is contemplated that no etching is included between the inner surface of the folded portion 118 of the inner liner 108 and the underlying portion 122 of the outer layer 110. Excluding etching where the inner liner 108 and the outer surface of the outer layer 110 directly contact each other helps facilitate release of the inner surface of the folded portion 118 and the outer layer 110 during expansion of the sheath 100. In yet another exemplary embodiment, it is contemplated that a portion that is etched and then surface modified to form a second portion, as discussed above, is included between the inner surface of folded portion 118 of inner liner 108 and underlying portion 122 of outer layer 110. The inclusion of these disclosed second portions, which are in direct contact with the outer surface of inner liner 108 and outer layer 110, helps facilitate release of the inner surface of folded portion 118 and outer layer 110 during expansion of sheath 100.

[0174] Again, as disclosed above, the wall thickness of the inner liner can vary, but in some embodiments, the wall thickness of the inner liner 108 ranges between about 0.002 inches and about 0.006 inches (including about 0.002 inches, about 0.003 inches, about 0.004 inches, about 0.005 inches, and about 0.006 inches). In other embodiments, the wall thickness of the inner liner ranges between about 0.003 inches and about 0.005 inches. In yet other embodiments, the wall thickness of the inner liner 108 ranges between about 0.0035 inches and about 0.0045 inches (including about 0.0035 inches, about 0.0040 inches, and about 0.0045 inches).

[0175] As mentioned above, the sheath 100 includes an outer layer 110 that applies a radially inward force to the inner liner 108. Generally, the outer layer 110 can be constructed of a polymeric material. As mentioned above, the outer layer 110 can be constructed of PTFE, polyimide, PEEK, polyurethane, nylon, polyethylene, polypropylene, polyamide, polyether block amide, polyether block ester copolymer, thermoset silicone, latex, polyisoprene rubber, high density polyethylene (HDPE), Tecoflex™, or a combination thereof. In one exemplary embodiment, the inner liner 108 can be constructed of PTFE, and the outer layer 110 can be constructed of a combination of HDPE and Tecoflex™. The outer layer 110 can have a thickness ranging between about 0.007 inches and about 0.013 inches (including 0.007 inches, about 0.008 inches, about 0.009 inches, about 0.010 inches, about 0.011 inches, about 0.012 inches, and about 0.013 inches). In another embodiment, the outer layer 110 can have a thickness ranging between about 0.008 inches and about 0.012 inches. In another embodiment, the outer layer 110 can have a thickness ranging between about 0.009 inches and about 0.011 inches.

[0176] As mentioned above, the sheath 100 includes an outer jacket 140 that extends over and surrounds the outer layer 110. The outer layer 110 may be discontinuous in that it includes slits or cuts to form the overlapping and underlying portions 120, 122, as mentioned above, whereas the outer jacket 140 may include a continuous outer layer that covers the inner and outer layers 108, 110.

[0177] The outer jacket 140 can be constructed of a rubber-elastic material, such as a soft polymer material that has good elasticity while also being abrasion- and tear-resistant. Typically, the outer jacket 140 has a relatively low tensile modulus compared to the inner and outer layers 108, 110. Examples of materials for the outer jacket 140 include polyether block amides, such as PEBAX®, or thermoplastic polyurethanes, such as Neusoft® and Tecoflex™ 80A B20. In some embodiments, the outer jacket 140 is constructed of an elastomer (e.g., a elastomeric polymer) with a Shore A hardness (durometer) ranging from about 10 to about 95 Shore A. The outer jacket 140 can be composed of an elastomer having an elongation at break in the range between about 40% and about 800% (including about 40%, about 50%, about 60%, about 70%, about 80%, about 90%, about 100%, about 150%, about 200%, about 250%, about 300%, about 350%, about 400%, about 450%, about 500%, about 550%, about 600%, about 650%, about 700%, and about 800%). The outer jacket 140 can be constructed of an elastomer having a wall thickness ranging between about 0.003 inches and about 0.015 inches (including about 0.003 inches, about 0.004 inches, about 0.005 inches, about 0.006 inches, about 0.007 inches, about 0.008 inches, about 0.009 inches, about 0.010 inches, about 0.011 inches, about 0.012 inches, about 0.013 inches, about 0.014 inches, and about 0.015 inches). The wall thickness is measured radially between the inner surface of the outer jacket 140 and the outer surface of the outer jacket 140.

[0178] In some embodiments, the outer jacket 140 is constructed of a single material or combination of materials that has a constant thickness along the entire length of the outer jacket 140. In alternative embodiments, the material composition and / or wall thickness can vary along the length of the outer jacket 140. For example, the outer jacket 140 can be provided with one or more segments that vary in composition and / or thickness from segment to segment. In one exemplary embodiment, the durometer rating of the composition varies along the length of the outer jacket 140, such that the segment near the proximal end is constructed of a stiffer material or combination of materials, while the segment near the distal end is constructed of a softer material or combination of materials. Similarly, the wall thickness of the outer jacket 140 in the segment near the proximal end can be thicker / greater than the wall thickness of the outer jacket 140 near the distal end.

[0179] As shown in FIG. 35 , the sheath 100 can include a tapered segment adjacent the flared end 114 at the proximal end of the sheath 100. Referred to as a strain relief section, the tapered segment and flared end 114 help facilitate the transition between the smaller diameter portion of the sheath 100 and the housing 101. The thickness and / or composition of the outer jacket 140 can be adjusted to increase the durometer and / or stiffness along the strain relief section. Because this portion of the sheath 100 is typically outside the patient's body during a procedure, providing the outer jacket 140 with a greater durometer and / or stiffness along the strain relief section helps it withstand blood pressure that would otherwise cause the outer jacket 140 to “balloon up” with bodily fluids / blood. As a result, the sheath 100 has a relatively stiff proximal end at the point where it introduces a delivery device, yet has a relatively soft distal tip at the point of entry into the patient's vasculature.

[0180] The outer jacket 140 can be bonded to the outer layer 110 to prevent the outer jacket 140 from sliding over and “bunching up” in response to frictional forces exerted by surrounding tissue during insertion of the sheath 100 into the patient's vasculature. For example, the outer jacket 140 can be bonded to the proximal and / or distal ends of the outer layer 110. At the proximal and distal ends, the outer jacket 140 can be bonded to the outer layer 110 around the entire circumference of the outer layer. At the distal end of the sheath 100, the outer jacket 140 can alternatively be bonded to the inner liner 108. For example, the outer jacket 140 can be bonded to the distal end surface of the inner liner 108.

[0181] As shown in FIG. 57, the outer jacket 140 can be bonded 144 to the outer layer 110 at a peripheral location opposite the folded portion of the inner liner 108. As provided in FIGS. 58-59, the bond 144 can be a spot bond or a linear bond line extending along all or a portion of the outer layer 110. As provided in FIG. 57, the bond 144 line / spot will also have a width that extends around the circumference of the outer layer 110. For example, the bond line can cover from about 5° to about 90° of the circumference of the outer layer 110 (including about 5°, about 10°, about 15°, about 20°, about 25°, about 30°, about 35°, about 40°, about 45°, about 50°, about 55°, about 60°, about 65°, about 70°, about 75°, about 80°, about 85°, and about 90°).

[0182] The outer jacket 140 can be bonded to the outer layer 110 and / or inner liner 108 using mechanical and / or chemical (e.g., adhesive) fasteners known in the art. In one embodiment, the sheath 100, outer jacket 140, and outer layer 110 and / or inner liner 108 may have similar melting temperatures. Accordingly, an exemplary bonding method includes a thermally bonded bond between the outer jacket 140, outer layer 110, and / or inner liner 108. For example, the bond between the outer jacket 140 and outer layer 110 can be achieved by laser welding and / or thermal compression (e.g., using thermal compression jaws), allowing for precise control of the location of the bond line.

[0183] 54 and described with respect to FIG. 39, an adhesive layer 128 (e.g., a tie layer) is provided between the inner liner 108 and the outer layer 110 to at least partially adhere the inner liner 108 to the outer layer 110. In some embodiments, the adhesive layer 128 can be selectively provided / placed between the inner liner 108 and the outer layer 110 to bond the inner and outer layers 108, 110 at selected locations of the adhesive layer 128.

[0184] As shown in FIG. 54 (and FIG. 39 ), adhesive layer 128 is provided on the outer surface of inner liner 108 and / or on the inner surface 130 of outer layer 110. For example, adhesive layer 128 can be provided partially or completely around the outer surface of inner liner 108. Additionally or alternatively, adhesive layer 128 can be provided partially and / or completely around the inner surface 130 of outer layer 110. As shown in FIG. 54 , adhesive layer 128 extends between outer layer 110 and overlapping folded portion 118 of inner liner 108. In other embodiments, adhesive layer 128 can extend between the outer surface of folded portion 118 of inner liner 108 and the corresponding inner surface of overlapping portion 120 of outer layer 110. 54, adhesive layer 128 does not extend between the inner surface of overlapping folded portion 118 of inner liner 108 and the corresponding surface of portion 122 underlying the outer surface of outer layer 110. Eliminating adhesive layer 128 on the portion of the sheath between the inner surface of folded portion 118 and underlying portion 122 facilitates expansion of the sheath and prevents undesired adhesion / sticking between the inner and outer layers 108, 110 at this location.

[0185] The adhesive material 128 can include a material having a Shore A hardness (durometer) of less than about 90A. For example, the adhesive material 128 can include a thermoplastic polyurethane, such as an aliphatic polyether-based thermoplastic polyurethane (TPU). An example of a TPU is Tecoflex™ 80A. The adhesive layer 128 can also be composed of an aromatic polyether- or polyester-based thermoplastic polyurethane, such as Pellethane™ 80A. The adhesive layer can also be composed of a polyolefin or polyamide, including, for example, a maleic anhydride-modified polyolefin (PE, PP, or EVA), such as Orevac™ resin.

[0186] The thickness (wall thickness) of adhesive layer 128 can vary, but in some embodiments, the thickness of adhesive layer 128 ranges from about 0.002 inches to about 0.005 inches (including about 0.002 inches, about 0.003 inches, about 0.004 inches, and about 0.005 inches). In other embodiments, the thickness of adhesive layer 128 ranges from about 0.0025 inches to about 0.0040 inches (including about 0.0025 inches, about 0.0030 inches, about 0.0035 inches, and about 0.0040 inches). In yet other embodiments, the thickness of adhesive layer 128 ranges from about 0.0025 inches to about 0.0035 inches (including about 0.0025 inches, about 0.0030 inches, and about 0.0035 inches).

[0187] In some embodiments, the sheath 100 can include a lubricant to reduce friction and facilitate expansion / contraction between the outer layer 110 and the outer jacket 140. The lubricant 142 allows the outer layer 110 and inner liner 108 to easily expand under the outer jacket 140, ensuring that the hemostatic and atraumatic benefits provided by the addition of the outer jacket 140 do not impair the pushing performance of the sheath 100. In some embodiments, the lubricant 142 can reduce the pushing force required to move a prosthetic device through the central lumen 116 of the inner liner 108 during delivery of the prosthetic device and corresponding local expansion of the sheath 100.

[0188] As shown in FIG. 56 , the lubricant 142 can be selectively applied along the outer surface of the outer layer 110 near the longitudinally extending edge 126 of the overlapping portion 120. In some embodiments, a portion of the folded portion 118 of the inner liner 108 extends along the outer surface of the outer layer 110 beyond the longitudinally extending edge 126 of the overlapping portion 120. In this embodiment, the lubricant 142 is also provided along the protruding portion of the folded portion 118 of the inner liner 108 that extends along the outer surface of the outer layer 110 (beyond the edge 126). In this location, the lubricant 142 also reduces friction between the outer jacket 140 and the inner liner 108 during expansion of the sheath 100. As shown in FIG. 56 , the lubricant 142 extends around the circumference of the outer layer 110 beyond the protruding portion of the folded portion 118.

[0189] The lubricant is applied as a band (or spot) that extends both circumferentially and longitudinally along the outer layer 110 (and the protruding portion of the inner liner 108). In the exemplary sheath 100, the lubricant 142 is applied as a band that extends both circumferentially around the outer layer 110 and longitudinally along the length of the outer layer 110. To prevent migration, the lubricant 142 can be composed of a thermosetting material, such as a material that hardens at room temperature. As a result, the material is applied in the desired location along the outer layer 110 and will not migrate during assembly and / or use of the sheath 100. The lubricant 142 can be composed of a medical-grade lubricant, such as silicone. Exemplary lubricants include medical-grade curable silicone lubricants, including platinum-catalyzed thermoset silicone lubricants such as NuSil™ MED10-6670 (thermoset), PTFE lubricants such as Duraglide™ (room temperature curable) and / or CHRISTO-LUBE™.

[0190] FIG. 60 illustrates an additional embodiment of the sheath 100 of FIG. 35. In this embodiment, the sheath 100 can include a coiled wire 160, or a coiled wire mesh, along the length of the sheath 100. The coiled wire 160 provides uniform bending of the sheath and prevents kinking. The coiled wire 160 can be embedded in the outer layer 110. For example, the coiled wire 160 can be co-extruded with the outer layer 110. Alternatively, the coiled wire 160 can be disposed between the outer layer 110 and the adhesive layer 128. In another embodiment, the coiled wire 160 is at least partially embedded within both the outer layer 110 and the adhesive layer 128. For example, the coiled wire 160 can be disposed on the outer surface of the adhesive layer 128, with the outer layer 110 reflowed on top.

[0191] 60, the coiled wire 160 defines a helical path around the longitudinal axis of the sheath 100. This example of the coiled wire 160 includes overlapping helical paths around the longitudinal axis of the sheath 100, resulting in a continuous diamond-shaped pattern along the length of the sheath.

[0192] The coiled wire 160 can be comprised of a metal or polymer wire. For example, the coiled wire 160 can be comprised of PET, PEEK, stainless steel, and / or Nitinol. The coiled wire 160 can be comprised of a flat wire, a round wire, or a combination thereof. The diameter / thickness of the individual wires of the coiled wire 160 ranges from about 0.002 inches to about 0.008 inches (including about 0.002 inches, about 0.003 inches, about 0.004 inches, about 0.005 inches, about 0.006 inches, about 0.007 inches, and about 0.008 inches). In another example, the diameter / thickness of the individual wires of the coiled wire 160 ranges from about 0.004 inches to about 0.007 inches. In yet another example, the diameter / thickness of the individual wires of the coiled wire 160 is about 0.006 inches. The pitch / distance between adjacent coils of the coiled wire 160 can correspond to the diameter / thickness of the coiled wire. For example, if the diameter / thickness of a single coil of the coiled wire is approximately 0.006 inches, then the spacing / pitch between that wire and the next adjacent coiled wire is approximately 0.006 inches.

[0193] 53-60 includes initially inserting the expandable sheath 100 into the vasculature of a subject and advancing a prosthetic device through the inner liner 108 / lumen 116 of the sheath 100. The prosthetic device exerts an outward radial force on the inner liner 108 of the expandable sheath 100. In some embodiments, the outward radial force is transmitted through the inner liner 108, the adhesive layer 128, and the outer layer 110. The lumen 116 of the sheath 100 expands at the axial location of the prosthetic device due to the outward radial force exerted by the prosthetic device against the inner surface of the lumen during advancement. During expansion of lumen 116, the first fold (folded edge) of folding portion 118 is moved circumferentially closer to the second fold (folded edge), shortening the overlapping portion of folding portion 118 that extends circumferentially between the first and second folds, thereby increasing the circumference of lumen 116.

[0194] As the sheath 100 expands at a particular location (i.e., expands locally at the location of the prosthetic device being passed), the overlapping portion 120 of the outer layer 110 can move circumferentially relative to the underlying portion 122 as the folded portion 118 of the inner liner 108 at least partially separates and / or unfolds, widening / expanding an elongated gap 132 provided in the outer layer 110. The sheath thereby expands to accommodate a medical device having a diameter larger than the diameter of the lumen 116 in the resting (unexpanded) configuration. As shown in FIG. 55 , in some embodiments, the folded portion of the inner liner 108 can fully unfold, resulting in the inner liner 108 forming a cylindrical tube at the location of the expanded configuration. As shown in FIGS. 54 and 55 , during expansion, the elongated gap 132 is generally aligned with the longitudinal axis of the lumen 116 such that the unfolded portion of the inner liner 108 expands into the gap 132.

[0195] In the unexpanded configuration, the outer diameter of the sheath 100 can be less than about 0.030 inches (including less than about 0.029 inches, less than about 0.028 inches, less than about 0.027 inches, less than about 0.026 inches, less than about 0.025 inches, and less than about 0.024 inches). Preferably, the outer diameter of the unexpanded sheath ranges between about 0.024 inches and about 0.026 inches. In the fully expanded configuration, the inner diameter of the sheath 100 can be greater than 0.040 inches. Preferably, the inner diameter of the expanded sheath 100 ranges between 0.046 inches and 0.054 inches (including about 0.046 inches, about 0.047 inches, about 0.048 inches, about 0.049 inches, about 0.050 inches, about 0.051 inches, about 0.052 inches, about 0.053 inches, and about 0.054 inches).

[0196] As described above, the inner and outer layers 108, 110 can be bonded to one another using an adhesive layer 128. The adhesive layer 128 prevents both longitudinal and radial movement between the inner and outer layers 108, 110. As a result, expansion of the sheath 100 can be limited to these regions, excluding the adhesive layer 128. For example, as shown in FIG. 54 , because the adhesive layer 128 is not provided between the inner surface of the folded portion 118 and the underlying portion 122 of the outer layer, expansion of the sheath results in the inner surface of the folded portion expanding into the gap 132 created between the first and second edges 124, 126 of the expanded outer layer 110.

[0197] Once the prosthetic device has passed through the lumen 116 (or a particular location along the lumen), the sheath lumen 116 can at least partially contract and return to its unexpanded configuration. The outer layer 110 can exert an inward radial force on the inner liner 108, urging them to return to their original, collapsed configuration. Similarly, if a coiled wire 160 is included, the coiled wire can exert an inward radial force on the outer layer 110 and the inner liner 108, urging them to return toward their unexpanded configuration. Similarly, if an outer jacket 140 is included, the outer jacket 140 can exert an inward radial force on the outer layer 110 and the inner liner 108, urging them to return to their unexpanded configuration.

[0198] A prosthetic device can be delivered to a delivery site within a patient through the distal end of the sheath 100. The prosthetic device can include a self-expanding heart valve or a stented heart valve. At the delivery site, the heart valve can be expanded through the distal end of the elongated lumen 116. Once outside the lumen 116, the heart valve can be expanded and the sheath 100 can be removed from the treatment site.

[0199] An exemplary method of fabricating a sheath is as follows. These steps are not meant to be limiting. Given steps can be reordered as needed. Other steps may be added, and in other embodiments, some steps may not be required. A continuous inner liner 108 is provided that defines a lumen therethrough. The inner liner 108 is formed to include first folds, second folds, and overlapping folds 118 that extend circumferentially between the first and second folds. The overlapping folds 118 are formed to include radial overlaps of at least two pieces of the inner liner 108. The inner liner 108, including the folds 118, can be extruded. Alternatively, the folds 118 can be formed after the inner liner 108 is extruded (e.g., formed onto a cylindrical tubular structure).

[0200] A discontinuous outer layer 110 is disposed (at least partially) around the inner liner 108. The outer layer 110 is formed such that it includes an overlapping portion 120 and an underlying portion 122, with at least a portion of the folded portion 118 of the inner liner 108 disposed between the overlapping portion 120 and the underlying portion 122. In some embodiments, the inner liner 108 and the outer layer 110 are coextruded. In alternative embodiments, the inner liner 108 and the outer layer 110 are formed separately and then interconnected.

[0201] An adhesive layer 128 is provided between the inner liner 108 and the outer layer 110 to (at least partially) bond the inner liner 108 to the outer layer 110. The adhesive layer 128 can be applied to and bond the inner and outer layers 108, 110 axially along the length of the sheath, for example, along a portion of the entire length of the sheath or along the entire length of the sheath. In one embodiment, the adhesive layer 128 is coextruded with the outer layer 110. In yet another embodiment, the adhesive layer 128 is coextruded with the inner liner 108. In an alternative exemplary method, the adhesive layer 128 can be applied to the outer surface of the inner liner 108 and / or the inner surface of the outer layer 110.

[0202] After the adhesive layer 128 is applied at desired locations along the inner and / or outer layer 110, the outer layer 110 is applied over the inner liner 108. The outer layer 110 can then be bonded to the inner liner 108 by heat-curing the adhesive layer 128. The adhesive layer 128 can be composed of a material that can be cured at temperatures above room temperature, in which case a heat treatment can be applied to the assembled inner liner 108 / outer layer 110. The adhesive layer 128 can also be composed of a material that cures at room temperature. Thus, after application of the adhesive layer 128 (at a temperature below room temperature) and assembly of the outer layer 110 onto the inner liner 108, the temperature of the combined layers can be raised to room temperature.

[0203] As shown in FIG. 56 , the lubricant 142 can be selectively applied to desired locations along the length of the outer layer 110 and / or the outer jacket 140. As described above, the lubricant 142 can be placed on the outer surface of the outer layer 110 near the longitudinally extending edge 126 of the overlapping portion 120, on any portion of the folded portion 118 that extends / protrudes beyond the edge 126, and / or on any portion of the outer surface of the outer layer 110 adjacent the protruding portion of the folded portion 118. The lubricant 142 can be applied as a band extending around a portion of the circumference of the outer layer, the band of lubricant 142 also extending longitudinally along the length of the outer layer 110. After the lubricant 142 has been selectively applied to the outer surface of the outer layer 110, the outer jacket 140 can be applied over the outer layer 110. As outlined above, the lubricant 142 can be comprised of a thermosetting material, in which case a heat treatment can be applied to the outer layer 110 / outer jacket 140. The lubricant 142 can also be comprised of a material that hardens at room temperature. Thus, after application of the lubricant 142 (which may be below room temperature), the temperature of the outer layer 110 can be raised to room temperature (either separately or in combination with the outer jacket 140).

[0204] The outer jacket 140 can then be applied over / around the outer layer 110 and bonded to the outer layer 110 at at least one of the proximal and distal ends of the outer layer 110. The outer jacket 140 can also be bonded to the outer layer 110 along the length of the outer layer 110. The outer jacket 140 can be bonded to the outer layer 110 via a heat treatment process, such as a reflow process, in which the outer layer 110 and the outer jacket are heated to a sufficiently high temperature to at least partially melt the outer layer 110 and the outer jacket 140, and then fused together as the heat is removed and the assembly cools. The entire sheath 100 assembly may be reflowed to reduce the overall outer diameter and restore / ensure a circular shape in cross section.

[0205] As described above, select portions of the outer surface of the inner liner 108 may include a surface treatment, such as a surface etch. In an exemplary method, the surface treatment of the inner liner 108 is performed before applying the outer layer 110. It is contemplated that it may be desirable to exclude etching from those surfaces of the inner liner 108 that contact the outer surface of the outer layer 110. For example, etching may not be included between the inner surface of the folded portion 118 of the inner liner 108 and the underlying portion 122 of the outer layer 110. Excluding etching from the portion where the outer surfaces of the inner liner 108 and the outer layer 110 are in direct contact facilitates release of the inner surface of the folded portion 118 and the outer layer 110 during expansion of the sheath 100.

[0206] In some cases, it may be necessary to release ("break") an undesirable bond that occurs between the outer layer 110 and the inner liner 108. This bond can occur due to etching on the outer surface of the inner liner 108 that allows it to adhere directly to the outer layer 110 (with or without the adhesive layer 128). Undesirable bonding can also occur if the outer layer 110 is able to flow over the folded inner liner 108 and "grabs" it during the reflow process.

[0207] However, when the inner liner 108 is not etched along those locations that exclude the adhesive layer 128, e.g., those portions adjacent to the underlying portion of the outer layer 110, undesired bonding between the outer layer 110 and the inner liner 108 at these locations is limited. Thus, preconditioning the sheath to release undesired bonding between the inner liner 108 and the outer layer 110 may not be necessary because bonding has not yet occurred (or is unlikely to occur).

[0208] Nonetheless, any undesired bond between the inner liner 108 and the underlying portion 122 of the outer layer 110 can be released while maintaining the desired bond at the proximal and distal ends of the sheath 100. For example, a mandrel can be passed at least partially through the lumen 116 of the inner liner 108 to expand the inner liner 108 and the outer layer 110 and break / release any undesired bond between the inner liner 108 and the underlying portion 122 of the outer layer 110.

[0209] Figures 41-49 illustrate additional embodiments and variations on the general sheath 100 described above. It should be understood that the variations (e.g., materials and alternative configurations) described above with reference to Figures 35-40 also apply to the embodiment shown in Figures 41-49. Additionally, the variations described below with reference to Figures 41-49 are also applicable to the sheaths described in Figures 35-40.

[0210] 41-43 illustrate a sheath 700 that further includes a strain relief covering, also referred to as an elastic outer covering, or elastic covering 702, disposed around at least a portion of the inner liner 704 and the outer layer 706. As shown in FIG. 41 , the elastic covering 702 can extend a length L along at least a portion of the body of the sheath 700. In some embodiments, the elastic covering 702 can extend from the proximal end 708 of the sheath 700 toward the distal end 709 of the sheath. In some embodiments, the elastic covering 702 extends only partway along the length of the sheath 700. In alternative embodiments, the elastic covering 702 can extend to a point adjacent the distal end 709 or can extend all the way to the distal end 709 of the sheath 700. Additionally, the elastic outer covering 702 need not extend all the way to the proximal end 708 of the sheath 700. In some embodiments, the elastic outer covering 702 can extend only partway toward the proximal end 708. In some embodiments, the longitudinal length L of the elastic covering 702 can range from about 10 cm to the entire length of the sheath 700.

[0211] As shown in FIGS. 42 and 43 , the elastic covering 702 can be a continuous tubular layer without slits or other discontinuities. The elastic covering 702 can be positioned to surround the entire circumference of the outer layer 706 and can extend longitudinally along any portion of the length of the sheath 700. The elastic outer covering 702 can be constructed of any flexible, resilient material that preferably expands and contracts at a high expansion ratio. Preferably, materials used include low-durometer polymers with high elasticity, such as PEBAX®, polyurethane, silicone, and / or polyisoprene. The material for the elastic outer covering 702 can be selected so that it does not interfere with the expansion of the sheath 700. Indeed, the elastic outer covering 702 can stretch and expand as the sheath 700 expands, such as by a folded or scored inner liner moving relative to itself.

[0212] The elastic outer covering 702, in some embodiments, can provide hemostasis (e.g., prevent blood loss during implantation of the prosthetic device). For example, the elastic outer covering 702 can be sized or configured to form a seal with the patient's artery when inserted, thereby substantially preventing blood from flowing between the elastic outer covering 702 and the vessel wall. The elastic outer covering 702 can be inserted such that it passes through an arteriotomy. For example, in embodiments in which the elastic outer covering 702 does not extend all the way to the distal end 709 of the sheath 700, the elastic covering 702 can extend distally far enough such that at least a portion of the elastic outer covering extends through the arteriotomy site when the sheath 700 is fully inserted into the patient.

[0213] The thickness of the resilient outer cover can range, for example, from about 0.001 inches to about 0.010 inches. In some embodiments, the outer cover can have a thickness of from about 0.003 inches to about 0.006 inches. The resilient outer cover can be configured to expand as the sheath expands, as shown in the expanded configuration in FIG. 43.

[0214] FIG. 42 shows a cross-section of sheath 700 in a resting configuration having an inner diameter D1. FIG. 43 shows a cross-section of sheath 700 in an expanded configuration having an inner diameter D2, where D2 is greater than D1. Similar to the embodiment of FIGS. 35-40, sheath 700 can include an inner liner 704 having a folded portion 710 and an outer layer 706 having an overlapping portion 712 and an underlying portion 714. Overlapping portion 712 overlaps at least a portion of folded portion 710 of the inner liner, and underlying portion 714 underlies at least a portion of folded portion 710. As shown in FIGS. 42-43, in some embodiments, overlapping portion 712 does not overlap the entire folded portion 710 of inner liner 704, and thus a portion of folded portion 710 can be directly adjacent to elastic outer cover 702 where elastic cover 702 is present. Where elastic covering 702 is not present, a portion of folded portion 710 may be visible from the outside of sheath 700, as can be seen in FIG. 41 . In these embodiments, sheath 700 may include a longitudinal seam 722 where overlapping portion 712 terminates at folded portion 710. In use, the sheath can be positioned so that seam 722 is behind a point on the sheath that is 180 degrees from seam 722 (e.g., facing downward in the view of FIG. 41 ). Seam 722 is also visible in FIG. 41 , which illustrates that seam 722 need not extend the entire length of the sheath. In some embodiments, the proximal end portion of the sheath includes two layers without folded portions (e.g., similar to FIG. 38 ), while the distal end portion of the sheath includes two layers with folded portions (e.g., similar to FIG. 39 ). In some embodiments, the seam 722 can terminate at a transition point between the portion of the sheath that has a folded inner liner and the portion of the sheath that does not have a folded inner liner.

[0215] In some embodiments, the folded portion 710 can include a weakened portion, such as a longitudinal perforation, score line, and / or slit 716, along at least a portion of the length of the inner liner 704. The slit 716 can allow two adjacent ends 718, 720 of the folded portion 710 to move relative to one another as the sheath 700 expands to the expanded configuration shown in FIG. 43. As a device having an outer diameter larger than the initial resting inner diameter of the sheath 700 is inserted through the sheath 700, the device can cause localized expansion of the sheath 700, expanding the sheath 700 at the partial score line location or split line location 716. The weakened portion 716 can extend longitudinally along any portion of the expandable sheath 700.

[0216] 44 and 45 show another embodiment of an expandable sheath 800 having an initial diameter in a resting configuration ( FIG. 44 ) and a larger expanded diameter in an expanded configuration ( FIG. 45 ). The sheath 800 can include a resilient outer cover 802, an inner liner 804, and an outer layer 806. The inner liner 804 can include first and second folded portions 808, 810. The folded portions 808, 810 can be arranged to fold away from each other in opposite directions around the circumference of the sheath 800. For example, the folded portion 808 can be folded to the right in the view of FIG. 44 , and the folded portion 810 can be folded to the left such that they do not overlap each other but share a common segment 812 that is part of both folded portions 808, 810. In contrast to the previous embodiment, the outer layer 806 does not include an overlapping portion in this embodiment, but rather has first and second underlying portions 814, 816 that respectively underlie the first and second folded portions 808, 810. The inner liner 804 can extend through the gaps between the ends of adjacent underlying portions 814, 816 (e.g., between the first and second ends of the discontinuous outer layer 806).

[0217] Each folded portion 808, 810 can include weakened portions 818, such as slits, score lines, and / or perforations. The weakened portions 818 can allow the expandable sheath 800 to easily expand without high radial forces. As the sheath 800 expands, segments 812 along the top of the folded portions 808, 810 of the inner liner 804 can be configured to split away from the rest of the folded portions 808, 810, and the first and second underlying portions 814, 816 can move away from each other to create an enlarged lumen within the inner liner 804. The weakened portions 818 can allow the segments 812 to easily split away from the inner liner 804 as the sheath 800 expands.

[0218] 46-47 show another embodiment of an expandable sheath 900. The sheath 900 can include an inner liner 902 and a resilient cover 904 surrounding the inner liner 902. Although not shown, the sheath 900 can further include an intermediate layer disposed between the inner liner 902 and the resilient cover 904. If present, the intermediate layer can closely follow the contours of the inner liner 902.

[0219] The inner liner 902 can be molded to include one or more folded portions 906 arranged to form a generally horseshoe-shaped lumen 908 that extends longitudinally through the sheath 900 along the inner surface of the inner liner 902. The folded portions 906 can be arranged to form an area 910 that is disposed with the lumen 908 and located radially inward from the resilient covering 904. In some embodiments, the area 910 can include one or more voids (e.g., smaller lumens or openings extending through the portion 910). In some embodiments, the area 910 can be filled with material (e.g., HDPE) reflowed from an intermediate layer while the sheath is being fabricated. In some embodiments, the area 910 can be filled with material reflowed from the resilient covering 904 during the sheath manufacturing process.

[0220] The inner liner 902 can include one or more weakened portions 912, such as score lines, perforations, or slits. The weakened portions 912 can be configured to split, separate, or widen in the presence of a radial force as the sheath expands from its initial, resting configuration ( FIG. 46 ) to its expanded configuration ( FIG. 47 ). As the sheath 900 expands, material from the areas 910 can cover gaps 914 formed in the weakened portions 912, thereby keeping the lumen 908 substantially sealed.

[0221] FIG. 48 illustrates another embodiment of an expandable sheath 1000 having an inner liner 1002 and a discontinuous outer layer 1004. The sheath 1000 is similar to the sheath 800 of FIG. 44, except that the sheath 1000 is shown without an elastic outer covering and further, the inner liner 1002 is continuous without weakened portions at the folds 1006. As shown in FIG. 48, the inner liner 1002 can be configured with one or more folds 1006 (e.g., two folds disposed on the outer surface of the outer layer 1004), with a portion 1008 of the outer layer 1004 extending between the folds 1006 and an outer surface 1010 of the inner liner 1002 that underlies the folds 1006.

[0222] Figure 49 shows another embodiment of an expandable sheath 1100 having an inner liner 1102 and an outer layer 1104. The sheath 1100 is similar to the sheath 100 shown in Figure 39 in that the inner liner 1102 can be continuous with the folded portion 1106 and the outer layer 1104 can be discontinuous with an overlapping portion 1108 that overlaps at least a portion of the folded portion 1106 and an underlying portion 1110 that is underlying at least a portion of the folded portion 1106. Thus, the underlying portion 1110 can be disposed between the outer surface 1112 of the lumen-forming portion of the inner liner 1102 and the folded portion 1106.

[0223] The inner liners 1002, 1102 of the sheaths 1000, 1100 of Figures 48-49, respectively, can be optimized to operate slightly differently from the inner liners of the sheaths described above. For example, different materials can be used for the inner liners to enhance seam durability and softness (although such materials can also be used in other embodiments of the expandable sheaths described above). For example, materials such as woven or braided filaments can be used. Such fabrics, filaments, or threads can be composed of, for example, PTFE, PET, PEEK, and / or nylon threads or filaments. These materials can advantageously provide a soft, flexible layer that can be easily formed into a desired shape or fold. Furthermore, such materials can withstand high temperatures as well as have high tensile strength and tear resistance. Nevertheless, these materials can also be resilient and provide a soft distal edge to minimize kinking and reduce traumatic insertion into a patient's vessel.

[0224] Various methods can be used to manufacture the sheaths discussed above and below throughout this disclosure. For example, a method for making the sheaths shown in FIGS. 2A-2D can include providing a mandrel and attaching an inner liner to the mandrel, such as by spray coating or dip coating the mandrel. An intermediate layer, such as a mesh structure, can then be attached to the inner liner. An outer layer can be attached over the intermediate layer, such as by a second spray coating or dip coating step. The method can also include etching or surface treating at least a portion of the inner liner. The method can also include providing one or more notches and / or cuts in the inner liner and / or outer layer. The cuts and / or notches can be provided, for example, by laser cutting or etching one or more layers.

[0225] In some embodiments of methods for making a sheath, such as the sheath shown in Figures 2A-2D, the layers can be pre-formed and placed on a mandrel, then fused or heat-bonded together. For example, in one method, an inner liner is attached to a mandrel. An intermediate layer can be attached to the outer surface of the inner liner. An outer layer can be attached to the outer surface of the intermediate layer. Heat shrink tubing can be applied, and the assembly can be heated to heat-bond and compress the inner liner, intermediate layer, and / or outer layer together under the heat shrink tubing.

[0226] FIG. 30 shows a block diagram of one method for manufacturing a sheath for use with a delivery device in minimally invasive surgery. One or more mandrels can be provided (step 300). The mandrel can be coated with an external coating, such as a Teflon coating, and the diameter of the mandrel can be predetermined based on the desired size of the resulting sheath. A liner, which will become the inner polymer layer of the sheath, such as a PTFE liner or a high-density polyethylene liner, can be attached to the mandrel (step 302). The liner can be etched and / or surface treated using conventional etching and surface treatment methods before being attached to the mandrel. FIG. 32A shows a cross-sectional view of the sheath at steps 300 and 302 of FIG. 30. The coated mandrel 96 is inserted within the lumen 72 of the inner polymer layer 68. The circumference of the inner polymer layer 68 is greater than the circumference of the mandrel 96, allowing the excess inner polymer layer 68 to gather above the mandrel 96.

[0227] The layer of material that will become the outer polymeric tubular layer, such as a layer comprising polyurethane or polyolefin, can be cut or notched through all, substantially all, or a portion of its thickness (step 304). Such cuts or notches can extend longitudinally along the length of the layer and can extend along substantially the entire length of the outer polymeric tubular layer. In alternative embodiments, the cuts or notches can be provided only along a portion of the outer polymeric tubular layer. For example, the outer polymeric tubular layer can be cut starting at the distal end of the outer polymeric tubular layer, with the cut terminating before the proximal end of the outer polymeric tubular layer. In one embodiment, the cuts can terminate at a transition where the outer diameter of the outer polymeric tubular layer increases or decreases. In one particular embodiment, the cuts or notches can extend longitudinally along approximately 75% of the length of the sheath.

[0228] The cut or notched outer polymeric tubular layer can be applied, positioned, glued, attached, heat fused or bonded, dip coated, and / or otherwise bonded to the etched inner liner (step 306). Figure 32B shows a cross-sectional view of the sheath at step 306 of Figure 30, where the outer polymeric tubular layer 70 has been attached to the inner polymeric layer 68 such that a portion of the inner polymeric layer 68 extends through the cut formed between the first and second portions 78, 80 of the outer polymeric tubular layer 70.

[0229] In alternative embodiments, the outer polymeric tubular layer can be notched or cut after being attached to the inner liner / mandrel assembly. The outer polymeric tubular layer can optionally be provided with additional layers, such as a hydrophilic coating and / or a polyurethane dip coating. After the outer polymeric tubular layer is attached to the inner liner / mandrel arrangement, a portion of the inner liner can protrude through the notch in the outer polymeric tubular layer. For example, a splitting tool can be used to fold the protruding portion of the inner liner onto the outer surface of the outer polymeric tubular layer (step 308). In some embodiments, the protruding portion of the inner liner is folded along the entire length of the resulting sheath, while in other embodiments, the protruding portion of the inner liner is only present along a portion of the length of the sheath or is only folded along a portion of the length of the resulting sheath. FIG. 32C shows a cross-sectional view of the sheath at step 308 of FIG. 30. Using a split tool 98, the excess portion of the inner polymeric layer 68 is folded over a portion of the outer surface 83 of the outer polymeric tubular layer 70. Figure 32D shows a cross-sectional view of the sheath after completion of step 308 of Figure 30. The split tool 98 has been removed, completing the folding of the excess portion of the inner polymeric layer 68. Figure 32E shows a cross-sectional view of an outer covering, such as an outer polymeric covering 99, that may be attached to overlap a portion of the folded portion of the inner polymeric layer 68. The outer polymeric covering 99 contacts at least a portion of the outer surface 83 of the outer polymeric tubular layer 70.

[0230] A soft, atraumatic tip can be provided at the distal end of the resulting sheath (step 310). Additional outer layers can be applied, if desired. A layer of heat shrink tubing, such as fluorinated ethylene propylene (FEP) heat shrink tubing, can then be placed over the entire assembly (step 312). An appropriate amount of heat is applied, thereby shrinking the heat shrink tubing and compressing the sheath layers together, thereby allowing the sheath components to be thermally bonded or fused together, if desired. Once the sheath components are bonded together, the heat shrink tubing can be removed (step 314). Finally, the proximal end of the sheath can be glued or otherwise attached to the housing of the catheter assembly, and the sheath can be removed from the mandrel (step 316).

[0231] FIG. 31 shows a block diagram of an alternative embodiment of a method for fabricating a sheath. An inner liner, such as an etched PTFE tube, can be attached to a tapered mandrel, such as a 16 Fr tapered mandrel, and trimmed to the appropriate length (step 200). A second mandrel, such as a 0.070-inch diameter mandrel, can be inserted into the lumen of the inner liner so that the mandrels are disposed side-by-side within the inner liner (step 202). FIG. 32F shows a cross-sectional view of the sheath at steps 200 and 202 of FIG. 31. The inner liner or inner polymer layer 68 is applied over the first tapered mandrel 96. A second mandrel 97 is inserted into the lumen 72 of the inner polymer layer 68, created by the excess portion of the inner polymer layer 68, as described.

[0232] A notched or cut outer polymeric tubular layer, such as a high-density polyethylene tube with a longitudinal notch or cut, can be slid over the tapered mandrel and a portion of the inner liner, starting at the distal end of the tapered mandrel (step 204). The second mandrel can then be removed (step 206). FIG. 32G shows a perspective view of the sheath at steps 204 and 206 of FIG. 31. An outer polymeric tubular layer 70 with a longitudinal cut is applied over the tapered mandrel 96 and the inner polymeric layer 68. The outer tubular layer fits over the portion of the inner polymeric layer around the tapered mandrel 96, and the portion of the inner polymeric layer 68 around the second mandrel 97 extends through the longitudinal cut in the outer polymeric tubular layer 70.

[0233] A split tool can be inserted into the portion of the lumen of the inner liner previously occupied by the second mandrel (step 208). The split tool can then be used to form folds and / or pleats in the excess portion of the inner liner, which now extends through the longitudinal cut in the outer polymeric tubular layer (step 210). A radiopaque marker band can optionally be applied at the distal end of the sheath (step 212). Heat shrink tubing, such as EEP heat shrink tubing, can be applied over the entire sheath, and heat can be applied to compress the sheath components and bond or fuse them together (step 214). The split tool, heat shrink tubing, and second mandrel can then be removed (step 216). The sheath can then be utilized with a delivery device, such as by bonding the proximal end of the sheath to the polycarbonate housing of the delivery device or to a catheter assembly (step 218).

[0234] Figure 32H shows an elevational view of the sheath at step 218 of Figure 31. Once fabricated by the methods and processes described, the sheath 66 can be attached or joined to the housing 101, such as by joining the proximal end of the sheath 66 to the polycarbonate housing 101.

[0235] In another embodiment, the disclosed expandable sheath can be fabricated using a reflowed mandrel process. A mandrel can be provided, with the size of the mandrel defining the inner diameter of the sheath lumen in the resting configuration. A tube of material, such as PTFE tubing, that will become the inner liner of the sheath can be given an inner diameter larger than that of the mandrel (e.g., a 9 mm PTFE tube can be fitted onto a 6 mm mandrel). The PTFE tube can be prepared into its final folded configuration by fitting it onto the mandrel and folding the excess material of the PTFE tube over one or both sides. An HDPE tube, which serves as the outer layer, can then be placed over the PTFE liner. This two-layer assembly can then be heat-fused together. For example, a reflow process can be performed, in which the assembly is heated to a sufficiently high temperature to at least partially melt the inner and / or outer layers, which then fuse together as the heat is removed and the assembly cools.

[0236] The resilient covering can be placed over at least a portion of the fused layer (e.g., over the proximal portion of the sheath) and held in place using a thermal process. In some embodiments, the same thermal process can bond the sheath layers and the resilient covering. In other embodiments, a first thermal process can be used to fuse the sheath layers together, and a second thermal process can be used to secure the resilient covering to the sheath. In some embodiments, the resilient covering can be heat shrink tubing that is applied over the expandable sheath and heated to a temperature high enough to shrink the tubing around the sheath. Then, in some embodiments, a distal soft tip can be attached to the shaft of the expandable sheath.

[0237] In some embodiments, the outer layer can be coextruded with an adhesive layer, such as a layer formed of Tecoflex™, whereby the Tecoflex™ is disposed on the inner surface of the outer layer—thus disposing the Tecoflex™ between the inner and outer layers in the finished sheath. In these embodiments, the HDPE tube can be provided with a coating of Tecoflex™ on its inner surface. The HDPE tube can be slit along its length, opened, flattened, and then cut, in some embodiments, using a template. For example, for certain applications, a template can be used to cut and remove portions of the outer layer. The cut HDPE can then be placed on an inner liner on a mandrel. In some embodiments, only a portion of the outer layer has adhesive Tecoflex™. In these embodiments, the Tecoflex™-free section is only partially fused to the inner liner. In some embodiments, the entire inner surface of the outer layer has Tecoflex™, and the inner surface of the outer layer can be positioned so that it contacts the inner liner on the mandrel. To position the inner and outer layers, as shown in the sheath of Figure 39, the fold of the inner liner can be lifted and the edges of the outer layer can be tucked under the folds.

[0238] The sheaths of the present disclosure can be used in a variety of methods for introducing a prosthetic device into a patient's vasculature. One such method includes placing an expandable sheath within the patient's blood vessel, passing the device through an introducer sheath, expanding the portion of the sheath surrounding the device to conform to the profile of the device, and automatically retracting the expanded portion of the sheath to its original size after the device has passed through the expanded portion. In some embodiments, the expandable sheath can be sutured to the patient's skin at the insertion site, so that once the sheath is inserted an appropriate distance into the patient's vasculature, the sheath will not move as the implantable device begins to pass through it.

[0239] The disclosed embodiments of the expandable sheath can be used with other delivery and minimally invasive surgical components, such as introducers and loaders. In one embodiment, the expandable sheath can flush and purge air from within the sheath, for example, using a flush port 103 (FIG. 35). An introducer can be inserted into the expandable sheath, and the introducer / sheath combination can be inserted fully into the vasculature over a guide device, such as a 0.35-inch guidewire. Preferably, the seam formed by the intersection of the folded portion of the inner liner and the overlapping portion of the outer layer can be oriented downward (rearward). Once the sheath and introducer are fully inserted into the patient's vasculature, in some embodiments, the expandable sheath can be sutured in place at the insertion site. In this manner, the expandable sheath can be substantially prevented from migrating once positioned within the patient.

[0240] The introducer can then be removed, and a medical device, such as a transcatheter heart valve, can be inserted into the sheath, optionally using a loader. Such methods further include placing a crimped biological heart valve onto a distal end portion of an elongate delivery device and inserting the crimped valved elongate delivery device through an expandable sheath. The delivery device can then be advanced through the patient's vasculature to the treatment site where the valve will be implanted.

[0241] Typically, the medical device has an outer diameter larger than the diameter of the sheath in its original configuration. The medical device can be advanced toward the implantation site through the expandable sheath, and the expandable sheath can locally expand to accommodate the medical device as the device passes. The radial force exerted by the medical device can be sufficient to locally expand the sheath to its expanded diameter (e.g., expanded configuration) only in the area where the medical device is currently located. Once the medical device has passed a specific location in the sheath, the sheath can at least partially contract to the smaller diameter of its original configuration. Thus, the expandable sheath can be expanded without the use of an inflatable balloon or other dilator. Once the medical device is implanted, the sheath and the sutures holding it in place can be removed. In some embodiments, it is preferable to remove the sheath without rotating it.

[0242] (Example) Example 1 A sheath for delivering a medical device, having a proximal end and a distal end, includes an expandable inner liner having an inner surface and an outer surface, the inner surface of the expandable inner liner defining a lumen, the inner liner including at least one folded portion having an inner portion and an outer portion; and an outer layer having an inner surface and an outer surface, wherein a first portion of the outer surface of the outer layer is disposed adjacent to an inner portion of the at least one folded portion of the inner liner, while the first portion of the inner surface of the outer layer is disposed adjacent to an inner portion of the at least one folded portion of the inner liner. and an outer layer extending at least partially around the inner liner so as to be disposed adjacent an outer portion of the folded portion, the inner liner comprising at least one first portion and at least one second portion, an outer surface of the at least one first portion comprising a composition and / or morphology substantially different from an outer surface of the at least one second portion, wherein an outward radial force from a prosthetic device moving through an internal lumen causes the at least one folded portion to unfold, thereby enabling expansion of the sheath.

[0243] Example 2 The sheath of any embodiment herein, particularly embodiment 1, wherein the at least one first portion of the inner liner is etched.

[0244] Example 3 The sheath of any embodiment herein, particularly embodiment 1 or 2, wherein the at least one second portion of the inner liner is not etched.

[0245] Example 4 The sheath of any Example herein, particularly Example 1 or 2, wherein the at least one second portion is etched and subsequently surface-modified such that the composition of the outer surface of the at least one second portion is substantially different from the composition of the outer surface of the at least one first portion.

[0246] Example 5 The sheath of any embodiment herein, particularly embodiments 1-4, wherein the outer surface of the at least one second portion has a configuration that is substantially different from the configuration of the outer surface of the at least one first portion.

[0247] Example 6 The sheath of any embodiment herein, particularly embodiments 1-5, wherein the inner liner comprises a fluorocarbon-based polymer.

[0248] Example 7 The sheath of any embodiment herein, particularly embodiments 1-6, wherein the inner liner comprises polytetrafluoroethylene (PTFE).

[0249] Example 8 The sheath of any of the Examples herein, particularly Examples 6-7, wherein the outer surface of the at least one first portion has a fluorine to carbon ratio that is lower than the fluorine to carbon ratio present on the outer surface of the at least one second portion of the inner liner.

[0250] Example 9 The sheath of any of the examples herein, particularly Examples 1-8, wherein the outer surface of the at least one first portion of the inner liner exhibits an RMS value that is lower than the RMS value of the outer surface of the at least one second portion of the inner liner.

[0251] Example 10 The sheath of any embodiment herein, particularly embodiments 4-9, wherein the at least one second portion of the inner liner is surface modified by laser ablation.

[0252] Example 11 The sheath of any of the Examples herein, particularly Examples 4-10, wherein the at least one second portion is surface-modified to include a gradient feature.

[0253] Example 12 The sheath of any embodiment herein, particularly embodiment 11, wherein the gradient form has a predetermined pattern.

[0254] Example 13 The sheath of any embodiment herein, particularly embodiments 1-12, wherein the at least one second portion extends longitudinally along the length of the inner liner.

[0255] Example 14 The sheath of any embodiment herein, particularly embodiments 1-13, wherein the at least one second portion extends circumferentially around the periphery of the inner liner.

[0256] Example 15 The sheath of any embodiment herein, particularly embodiments 1-14, wherein the inner liner comprises two or more first portions.

[0257] Example 16 The sheath of any embodiment herein, particularly embodiments 1-15, wherein the inner liner comprises two or more second portions.

[0258] Example 17 The sheath of any embodiment herein, particularly embodiment 16, wherein each of the two or more second portions has the same or a different composition and / or configuration.

[0259] Example 18 The sheath of any embodiment herein, particularly embodiment 16 or 17, wherein each of the two or more second portions has a similar or different length.

[0260] Example 19 The sheath of any of the embodiments herein, particularly embodiments 1-18, wherein the first portion of the inner liner is followed by the second portion of the inner liner.

[0261] Example 20 The sheath of any embodiment herein, particularly embodiments 1-19, wherein the second portion of the inner liner is followed by the first portion of the inner liner.

[0262] Example 21 The sheath of any embodiment herein, particularly embodiments 1-20, wherein the at least one first portion has a length that is different from a length of the at least one second portion.

[0263] Example 22 The sheath of any embodiment herein, particularly embodiment 21, wherein the length of the at least one first portion is greater than the length of the at least one second portion.

[0264] Example 23 The sheath of any of the embodiments herein, particularly Examples 1-22, wherein the inner liner has a wall thickness ranging between about 0.002 inches and about 0.006 inches.

[0265] Example 24 The sheath of any embodiment herein, particularly embodiment 23, wherein the at least one first portion has a wall thickness that is different from a wall thickness of the at least one second portion.

[0266] Example 25 The sheath of any embodiment herein, particularly embodiment 24, wherein the wall thickness of the at least one second portion is at most about 2% greater than the wall thickness of the at least one first portion.

[0267] Example 26 The sheath of any embodiment herein, particularly embodiment 24, wherein the wall thickness of the at least one second portion is up to about 2% less than the wall thickness of the at least one first portion.

[0268] Example 27 The sheath of any of the embodiments herein, particularly Examples 25-26, wherein when two or more second portions are present, each of the two or more second portions comprises the same or a different wall thickness.

[0269] Example 28 The sheath of any of the embodiments herein, particularly embodiments 1 to 27, wherein the at least one second portion of the inner liner extends along the inner portion and / or the outer portion of the at least one folded portion of the inner liner.

[0270] Example 29 The sheath of any of the embodiments herein, particularly embodiments 1-28, wherein the at least one second portion of the inner liner extends along a portion that contacts the outer surface of the outer layer.

[0271] Example 30 The sheath of any of the examples herein, particularly Examples 1-29, wherein the outer layer comprises a high density polyethylene polymer (HDPE), nylon, or polypropylene.

[0272] Example 31 The sheath of any of the examples herein, particularly Examples 1-30, wherein the at least one second portion of the inner liner exhibits substantially less adhesion to the outer layer compared to the adhesion of the at least one first portion of the inner liner to the outer layer.

[0273] Example 32 The sheath of any embodiment herein, particularly embodiments 1-31, wherein the outer surface of said at least one second portion exhibits a contact angle of greater than about 65° to about 140°.

[0274] Example 33 The sheath of any of the embodiments herein, particularly embodiments 1-32, wherein the outer surface of the at least one first portion exhibits a contact angle of from about 30° to about 90°.

[0275] Example 34 The sheath of any of the embodiments herein, particularly embodiments 1 to 33, wherein the inner liner comprises the at least one second portion at a proximal end of the sheath.

[0276] Example 35 The sheath of any of the embodiments herein, particularly embodiments 1-33, wherein the second portion of the inner liner is separated from the proximal end of the sheath by the first portion of the inner liner.

[0277] Example 36 The sheath of any embodiment herein, particularly embodiment 35, wherein the length of the first portion is substantially similar to or shorter than the length of the second portion.

[0278] Example 37 The sheath of any embodiment herein, particularly embodiment 35 or 36, wherein the second portion of the inner liner is followed by an additional first portion of the inner liner.

[0279] Example 38 The sheath of any embodiment herein, particularly embodiment 37, wherein the length of the second portion of the inner liner is shorter than the length of the additional first portion of the inner liner.

[0280] Example 39 The sheath of any of the embodiments herein, particularly embodiments 1-38, wherein the sheath further comprises an outer jacket, the outer jacket having inner and outer surfaces and a proximal end and a distal end, the outer jacket extending at least partially around the outer layer such that the inner surface of the outer jacket overlies the outer surface of the outer layer.

[0281] Example 40 The sheath of any embodiment herein, particularly embodiment 39, wherein the outer jacket extends from the proximal end of the sheath along at least a portion of the length of the sheath.

[0282] Example 41 The sheath of any embodiment herein, particularly embodiment 39 or 40, wherein the outer jacket has a first predetermined length.

[0283] Example 42 The sheath of any of the embodiments herein, particularly embodiment 41, wherein the second portion extends from the proximal end of the sheath, and the length of the at least one second portion is substantially similar to the first predetermined length of the outer jacket.

[0284] Example 43 The sheath of any of the embodiments herein, particularly embodiment 42, wherein the second portion extends from the proximal end of the sheath, and the length of the at least one second portion is greater than the first predetermined length of the outer jacket.

[0285] Example 44 The sheath of any of the embodiments herein, particularly embodiment 41, wherein the second portion of the inner liner is separated from the proximal end of the sheath by the first portion, and the total length of the first portion of the inner liner and the second portion of the inner liner is substantially similar to the first predetermined length of the outer jacket.

[0286] Example 45 The sheath of any of the embodiments herein, particularly embodiment 41, wherein the second portion of the inner liner is separated from the proximal end of the sheath by the first portion of the inner liner, and the total length of the first portion of the inner liner and the second portion of the inner liner is greater than the first predetermined length of the outer jacket.

[0287] Example 46 The sheath of any of the embodiments herein, particularly embodiments 39-45, wherein the distal end of the outer jacket is substantially sealed by the outer layer of the sheath.

[0288] Example 47 The sheath of any of the embodiments herein, particularly embodiments 39-46, wherein the outer jacket extends from the proximal end of the sheath to the distal end of the sheath.

[0289] Example 48 The sheath of any of the embodiments herein, particularly embodiment 47, wherein the at least one second portion of the inner liner extends along the inner portion and / or the outer portion of the at least one folded portion of the inner liner.

[0290] Example 49 The sheath of any embodiment herein, particularly embodiment 47 or 48, wherein the at least one second portion of the inner liner extends along a portion of the inner liner that contacts the outer surface of the outer layer.

[0291] Example 50 The sheath of any embodiment herein, particularly embodiments 1-49, wherein the inner liner comprises two or more folds.

[0292] Example 51 The sheath of any of the embodiments herein, particularly embodiment 50, wherein the at least one second portion of the inner liner extends along the inner and / or outer portions of each of the two or more folded portions.

[0293] Example 52 The sheath of any of the embodiments herein, particularly embodiments 1-51, wherein the sheath exerts a pushing force during passage of a prosthetic device that is at least about 10% lower than a substantially identical reference sheath that does not include the second portion.

[0294] Example 53 The sheath of any of the embodiments herein, particularly Examples 1-52, wherein the sheath exerts a pushing force upon passage of the prosthetic device of less than about 50 N.

[0295] Example 54 1. A method of manufacturing a sheath for delivering a medical device, comprising: providing an inner liner having an inner surface and an outer surface, the inner surface defining a lumen therethrough, the inner liner including at least one first portion and at least one second portion, the outer surface of the at least one first portion having a composition and / or morphology substantially different from the outer surface of the at least one second portion, the inner liner including at least one folded portion having an inner portion and an outer portion; providing an outer layer having an inner surface and an outer surface such that the outer layer extends at least partially around the inner liner, wherein at least a first portion of the outer surface of the outer layer is disposed adjacent an inner portion of the at least one folded portion of the inner liner, while a first portion of the inner surface of the outer layer is disposed adjacent an outer portion of the at least one folded portion of the inner liner; forming an expandable sheath, the expandable sheath configured to expand when an outward radial force from a prosthetic device moving through an internal lumen deploys the at least one folded portion.

[0296] Example 55 The method of any embodiment herein, particularly embodiment 54, wherein the at least one first portion and the at least one second portion are formed by selective etching.

[0297] Example 56 The method of any embodiment herein, particularly embodiment 55, wherein the selective etching is performed around the periphery, linearly along the length of the sheath, or a combination thereof.

[0298] Example 57 The method of any embodiment herein, particularly embodiment 55 or 56, wherein the at least one first portion is formed by masking a portion of the inner liner to form a masked portion, and then etching a remaining, unmasked portion of the inner liner with an etchant.

[0299] Example 58 The method of any example herein, particularly example 57, further comprising, after the etching, forming the at least one second portion by unmasking the masked portion.

[0300] Example 59 The method of any embodiment herein, particularly embodiments 54-58, wherein the inner liner comprises a fluorocarbon-based polymer.

[0301] Example 60 The method of any example herein, particularly Examples 54-59, wherein the inner liner comprises polytetrafluoroethylene (PTFE).

[0302] Example 61 The method of any one of any examples herein, particularly examples 57-60, wherein the etching solution comprises a liquid, a fluid, a gas, a plasma, or a combination thereof.

[0303] Example 62 The method of any example herein, particularly Examples 57-61, wherein the etching solution comprises a sodium naphthalene solution.

[0304] Example 63 The method of any embodiment herein, particularly embodiments 57-62, wherein the etchant comprises oxygen plasma, hydrogen plasma, nitrogen plasma, argon plasma, or any combination thereof.

[0305] Example 64 The method of any embodiment herein, particularly embodiment 55 or 56, wherein the at least one first portion is formed by etching at least a portion of the inner liner to form an etched inner liner.

[0306] Example 65 The method of any embodiment herein, particularly embodiment 64, further comprising abrading at least a portion of the etched inner liner, thereby forming the at least one second portion of the inner liner.

[0307] Example 66 The method of any embodiment herein, particularly embodiment 65, wherein the ablating step comprises forming a gradient having a predetermined pattern.

[0308] Example 67 The method of any example herein, particularly Examples 54-66, wherein the outer surface of the at least one second portion of the inner liner comprises a composition that is substantially different from the composition of the outer surface of the at least one first portion of the inner liner.

[0309] Example 68 The method of any embodiment herein, particularly embodiments 54-67, wherein the outer surface of the at least one second portion has a morphology that is substantially different from the morphology of the outer surface of the at least one first portion.

[0310] Example 69 The method of any example herein, particularly Examples 54-63, wherein the outer surface of the at least one first portion has a lower fluorine to carbon ratio than the fluorine to carbon ratio present on the outer surface of the at least one second portion of the inner liner.

[0311] Example 70 The method of any example herein, particularly Examples 65-69, wherein the outer surface of the at least one first portion of the inner liner exhibits an RMS value that is lower than the RMS value of the outer surface of the at least one second portion of the inner liner.

[0312] Example 71 The method of any embodiment herein, particularly embodiments 54-70, wherein the at least one second portion extends longitudinally along the length of the inner liner.

[0313] Example 72 The method of any embodiment herein, particularly embodiments 54-71, wherein the at least one second portion extends circumferentially around the periphery of the inner liner.

[0314] Example 73 The method of any embodiment herein, particularly embodiments 54-72, wherein the inner liner comprises two or more first portions.

[0315] Example 74 The method of any embodiment herein, particularly embodiments 54-73, wherein the inner liner comprises two or more second portions.

[0316] Example 75 The method of any example herein, particularly example 74, wherein each of the two or more second portions comprises a similar or different composition or morphology.

[0317] Example 76 The method of any embodiment herein, particularly embodiment 74 or 75, wherein each of the two or more second portions has a similar or different length.

[0318] Example 77 The method of any embodiment herein, particularly embodiments 74-76, wherein the first portion of the inner liner is followed by the second portion of the inner liner.

[0319] Example 78 The method of any embodiment herein, particularly embodiments 74-77, wherein the second portion of the inner liner is followed by the first portion of the inner liner.

[0320] Example 79 The method of any example herein, particularly Examples 74-78, wherein the at least one first portion has a length that is different from the length of the at least one second portion.

[0321] (Example 80) The method of any example herein, particularly example 79, wherein the length of the at least one first portion is greater than the length of the at least one second portion.

[0322] Example 81 The method of any embodiment herein, particularly embodiments 54-80, wherein the inner liner has a wall thickness ranging between about 0.002 inches and about 0.006 inches.

[0323] Example 82 The method of any embodiment herein, particularly embodiment 81, wherein the at least one first portion has a wall thickness that differs from a wall thickness of the at least one second portion.

[0324] Example 83 The method of any embodiment herein, particularly embodiment 82, wherein the wall thickness of the at least one second portion is at most about 2% greater than the wall thickness of the at least one first portion.

[0325] Example 84 The method of any embodiment herein, particularly embodiment 82, wherein the wall thickness of the at least one second portion is up to about 2% less than the wall thickness of the at least one first portion.

[0326] Example 85 The method of any example herein, particularly example 83 or 84, wherein when two or more second portions are present, each of the two or more second portions comprises the same or a different wall thickness.

[0327] Example 86 The method of any embodiment herein, particularly embodiments 54-85, wherein the at least one second portion of the inner liner extends along an inner portion and / or an outer portion of the at least one folded portion of the inner liner.

[0328] Example 87 The method of any embodiment herein, particularly embodiments 54-86, wherein the at least one second portion of the inner liner extends along a portion of the inner liner that contacts the outer surface of the outer layer.

[0329] Example 88 The method of any example herein, particularly Examples 54-87, wherein the outer layer comprises a high density polyethylene polymer (HDPE), nylon, or polypropylene.

[0330] Example 89 The method of any example herein, particularly Examples 54-88, wherein the at least one second portion of the inner liner exhibits substantially less adhesion to the outer layer compared to the adhesion of the at least one first portion of the inner liner to the outer layer.

[0331] Example 90 The method of any embodiment herein, particularly embodiments 54-89, wherein the outer surface of the at least one second portion exhibits a contact angle of greater than about 65° to about 140°.

[0332] Example 91 The method of any embodiment herein, particularly embodiments 54-90, wherein the outer surface of the at least one first portion exhibits a contact angle of from about 30° to about 90°.

[0333] Example 92 The method of any of the embodiments herein, particularly embodiments 54-91, wherein the inner liner comprises the at least one second portion of the inner liner at a proximal end of the sheath.

[0334] Example 93 The method of any of the embodiments herein, particularly embodiments 54-92, wherein the second portion of the inner liner is separated from the proximal end of the sheath by the first portion of the inner liner.

[0335] Example 94 The method of any example herein, particularly example 93, wherein the length of the first portion is substantially similar to or shorter than the length of the second portion.

[0336] Example 95 The method of any embodiment herein, particularly embodiment 93 or 94, wherein the second portion of the inner liner is followed by an additional first portion of the inner liner.

[0337] Example 96 The method of any embodiment herein, particularly embodiment 95, wherein the length of the second portion of the inner liner is less than the length of the additional first portion of the inner liner.

[0338] Example 97 The method of any example herein, particularly examples 54-96, further comprising the step of providing an outer jacket, the outer jacket having inner and outer surfaces and proximal and distal ends, the outer jacket extending at least partially around the outer layer such that the inner surface of the outer jacket overlies the outer surface of the outer layer.

[0339] Example 98 The method of any embodiment herein, particularly embodiment 97, wherein the outer jacket extends from the proximal end of the sheath along at least a portion of the length of the sheath.

[0340] Example 99 The method of any embodiment herein, particularly embodiments 97-98, wherein the outer jacket has a first predetermined length.

[0341] Example 100 The method of any of the embodiments herein, particularly embodiment 98 or 99, wherein the second portion extends from the proximal end of the sheath, and the length of the at least one second portion is substantially similar to the first predetermined length of the outer jacket.

[0342] Example 101 The method of any of the embodiments herein, particularly embodiment 98 or 99, wherein the second portion extends from the proximal end of the sheath, and the length of the at least one second portion is greater than the first predetermined length of the outer jacket.

[0343] Example 102 The method of any of the examples herein, particularly example 98 or 99, wherein the second portion of the inner liner is separated from the proximal end of the sheath by the first portion of the inner liner, and the combined length of the first portion of the inner liner and the second portion of the inner liner is substantially similar to the first predetermined length of the outer jacket.

[0344] (Example 103) The method of any of the embodiments herein, particularly embodiment 98 or 99, wherein the second portion of the inner liner is separated from the proximal end of the sheath by the first portion of the inner liner, and the combined length of the first portion of the inner liner and the second portion of the inner liner is greater than the first predetermined length of the outer jacket.

[0345] Example 104 The method of any embodiment herein, particularly embodiments 96-103, wherein the distal end of the outer jacket is substantially sealed by the outer layer of a sheath.

[0346] Example 105 The method of any embodiment herein, particularly embodiments 96-104, wherein the outer jacket extends from the proximal end of the sheath to the distal end of the sheath.

[0347] Example 106 The method of any embodiment herein, particularly embodiment 105, wherein the at least one second portion of the inner liner extends along an inner portion and / or an outer portion of the at least one folded portion of the inner liner.

[0348] (Example 107) The method of any embodiment herein, particularly embodiment 105 or 106, wherein the at least one second portion of the inner liner extends along a portion of the inner liner that contacts the outer surface of the outer layer.

[0349] Example 108 The method of any embodiment herein, particularly embodiments 54-107, wherein the inner liner comprises two or more folds.

[0350] Example 109 The method of any embodiment herein, particularly embodiment 107, wherein the at least one second portion of the inner liner extends along the inner and / or outer portions of each of the two or more folded portions.

[0351] Example 110 The method of any embodiment herein, particularly embodiments 54-109, wherein the sheath exerts a pushing force during passage of the prosthetic device that is at least about 10% lower than a substantially identical reference sheath that does not include the second portion.

[0352] Example 111 The method of any embodiment herein, particularly embodiments 54-110, wherein the sheath exerts a pushing force upon passage of the prosthetic device of less than about 50 N.

[0353] In view of the many ways in which the principles of the present disclosure can be applied, it should be recognized that the illustrated aspects are merely preferred embodiments of the present disclosure and should not be considered as limiting the scope of the present disclosure. Rather, the scope of the present disclosure is defined by the following claims. Accordingly, the present disclosure is claimed in its entirety to be within the scope and spirit of these claims. [Explanation of symbols]

[0354] 8 Sheath 10 Delivery device 12 Prosthetic Devices 14 Guide catheter 16 Balloon catheter 18 Nose Catheter 22 Sheath 24 Inner liner 26 outer polymer tubular layer 28 Intermediate tubular layer 30 lumen 34 Outer surface 36 Notches or Cuts 38 Proximal end 40 distal end 42 Soft Tip 44 Bulge 46 Unexpanded Outer Diameter 48 Expanded Outer Diameter 50 outer polymer covering 54 Peel Tab 56, 58, 60, 62, 64 struts 66 Sheath 68 Inner polymer layer 69 Radiopaque Marker 70 outer polymer tubular layer 72 Lumen 74 Longitudinal notch 76 Longitudinal cut 77 scoreline 81 outer polymer covering 83 External surface 85 folding regions 90 First corner 92 Second corner 94 Lumen, gap 96 Mandrel 100 sheath 101 Introducer housing 102 Soft tip part 104 Distal end 108 Inner liner 110 Outer layer 112 Marker, C-band 114 Proximal Flared End 116 Lumen 118 Folding part 120 overlapping area 122 Bottom part 124 The First Edge 126 The Second Edge 128 Adhesive materials, adhesive layers 130 Inner surface 132 Gap 140 outer jacket 142 Lubricants 144 Junction 160 coiled wire 166 Expandable Sheath 168 Inner tubular layer 169 Longitudinal slit 170 Outer tubular layer 171 Folding flap 172 Lumen 173 base 174 Binding layer 175 Upper part 177 Bottom part 179 creases 183 External surface 700 sheath 702 Elastic Cover 704 Lumen 706 Outer layer 708 Proximal end 709 Distal end 710 Folding part 712 overlapping part 714 Lower part 716 Weakened Part 722 seam 800 sheath 802 outer cover 804 Inner liner 806 outer layer 808 First Fold 810 Second Folding Section 900 sheath 902 Inner liner 904 Elastic Cover 906 Folding part 908 Lumen 910 Area 1000 sheath 1002 Inner liner 1004 Outer layer 1006 Pleats 1100 Sheath 1102 Inner liner 1104 Outer layer 1106 Folding part 1108 overlapping part 1110 Bottom part 6102 First part 6104 Second part 6106 Gradation Form

Claims

1. A sheath having a proximal end and a distal end for delivering a medical device, An expandable inner layer comprising an inner surface, an outer surface, and a longitudinal cut extending along at least a portion of the length of the sheath, An outer tubular layer having an inner surface and an outer surface, wherein the outer tubular layer extends at least partially around the outer surface of the inner layer, A binding layer located between at least a portion of the expandable inner layer and the outer tubular layer, thereby adhering the expandable inner layer to the outer tubular layer, A strain release section located at the proximal end of the sheath, Equipped with, A sheath in which an outward radial force from a prosthesis device moving through the lumen of the sheath expands the sheath.

2. The sheath according to claim 1, wherein the strain release section is tapered.

3. The sheath according to claim 1, wherein the longitudinal cut extends through the entire thickness of the inner layer.

4. The sheath according to claim 1, wherein the longitudinal cut extends along the entire length of the sheath.

5. The sheath according to claim 1, wherein the inner layer comprises a first portion and a second portion, the second portion at least partially overlapping the first portion in a partial coil configuration.

6. The sheath according to claim 1, further comprising a lubricant between the inner layer and the outer tubular layer.

7. The sheath according to claim 1, wherein the binding layer comprises at least one of polyolefin and polyamide.

8. The sheath according to claim 1, wherein the binding layer has a Shore A hardness of less than 90A.

9. The sheath according to claim 6, wherein the lubricant comprises a medical-grade lubricant.

10. The sheath according to claim 6, wherein the lubricant comprises silicone.

11. The sheath according to claim 6, wherein the lubricant comprises a PTFE lubricant.

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