Intravascular delivery device having a variable length balloon

Abstract

The delivery device includes a handle, a first shaft, and a second shaft. The first shaft extends through the second shaft and is axially movable relative to the second shaft. The delivery device includes an inflatable balloon having a proximal end coupled to the second shaft and a balloon distal end coupled to the first shaft. The inflation hub assembly includes an inflation manifold and a piston. The inflation manifold has a body defining a main lumen and an inflation port defining an inflation port lumen. The piston extends within the main lumen and is slidable relative to the inflation manifold. The proximal end of the first shaft is coupled to the piston. The piston is movable proximally and distally relative to the inflation manifold to cause movement of the first shaft and adjust the length of the balloon.

Description

[Technical Field]

[0001] [Show Related Application] This application claims the benefit of U.S. Provisional Patent Application No. 63 / 009,072, filed April 13, 2020, which is incorporated herein by reference.

[0002] The present disclosure relates to embodiments of an intravascular delivery device for a delivery device having a variable length balloon, such as for implanting a prosthetic heart valve or other implantable medical device. [Background technology]

[0003] Intravascular delivery devices are used in various procedures to deliver prosthetic medical devices or instruments to locations within the body that are not easily accessible by surgery or where non-surgical access is desirable. Access to the target location within the body can be achieved by inserting and guiding the delivery device through a passageway or lumen within the body, including, but not limited to, a blood vessel, the esophagus, the trachea, any portion of the gastrointestinal tract, or a lymphatic vessel, to name a few. In one particular example, a prosthetic heart valve may be crimped onto the distal end of the delivery device and advanced through the patient's vascular system (e.g., through the femoral artery and aorta) until the prosthetic valve reaches the implantation site in the heart. The prosthetic valve is then expanded to its functional size by inflating a balloon to which it is attached or by deploying the prosthetic valve from a sheath in the delivery device, allowing the prosthetic valve to self-expand to its functional size.

[0004] Expandable balloon prosthetic valves may be preferred for replacing calcified native valves because the catheter balloon can apply sufficient expansion force to expand and secure the prosthetic valve frame against the surrounding calcified tissue. In one known technique for delivering a prosthetic heart valve, the prosthetic heart valve may be crimped onto a valve-retaining portion of a delivery catheter's balloon before insertion into the patient's body. Once the target site is reached, the balloon is inflated to deliver the prosthetic valve. The balloon is then deflated so that the catheter can be removed from the patient's body.

[0005] Typically, the distal end of the balloon is attached to the inner shaft of the delivery catheter, and the proximal end of the balloon is attached to the outer shaft of the delivery catheter. The proximal end of the inner shaft is fixed at a designated location along the delivery catheter (e.g., at the inflation hub of the catheter). During the manufacturing process, the balloon may be tightly folded into a compact, deflated state to minimize the overall crimping profile of the delivery device when the prosthetic valve is crimped onto the balloon. However, after the prosthetic valve is expanded inside the patient's body and the balloon is deflated, the balloon may not refold efficiently. This can result in high retraction forces when the delivery catheter is withdrawn from the patient's body through the introducer sheath, making removal of the delivery catheter difficult.

[0006] Therefore, a need exists for new and improved delivery catheters for prosthetic valves. [Prior art documents] [Patent documents]

[0007] [Patent Document 1] U.S. Patent No. 6,730,118 [Patent Document 2] International Publication No. 2018 / 222799 [Patent Document 3] US Patent Application Publication No. 2012 / 0239142 [Patent Document 4] US Patent Application Publication No. 2018 / 0028310 [Patent Document 5] US Patent Application Publication No. 2007 / 0005131 [Patent Document 6] US Patent Application Publication No. 2009 / 0281619 [Patent Document 7] US Patent Application Publication No. 2013 / 0030519 [Patent Document 8] US Patent Application Publication No. 2017 / 0065415 [Patent Document 9] U.S. Patent Application No. 63 / 069,567 [Patent Document 10] U.S. Patent Application No. 63 / 138,890 Summary of the Invention

[0008] Disclosed herein are balloon catheters that can be used to deliver medical devices, tools, medications, or other therapies to a location within a subject's body. Methods of using balloon catheters to deliver therapy to a target location within a subject's body are also disclosed. In some embodiments, the balloon catheter can be used to deliver an implantable medical device, such as a prosthetic heart valve, to a target site in a patient, such as the heart. In some embodiments, the balloon catheter can be a component of a delivery system (e.g., an intravascular or transcatheter delivery system) that can be used to deliver the prosthetic heart valve or other implantable medical device.

[0009] In one exemplary embodiment, a delivery apparatus for an implantable prosthetic device includes a handle, a first shaft extending distally from the handle, a second shaft extending distally from the handle, the first shaft extending through the second shaft and axially movable relative to the second shaft, an inflatable balloon having a proximal end and a distal end, the proximal end of the balloon coupled to the distal end of the second shaft and the distal end of the balloon coupled to the distal end of the first shaft, an inflation hub assembly including an inflation manifold and a piston, the inflation manifold including a body defining a main lumen extending therethrough and an inflation port lumen in fluid communication with the main lumen. a port; and an inflation manifold having a piston extending into the main lumen and slidable relative to the inflation manifold, wherein the proximal end of the first shaft is coupled to the piston and the proximal end of the second shaft is coupled to a body of the inflation manifold or the handle, and the piston is movable proximally and distally relative to the inflation manifold such that distal movement of the piston causes distal movement of the first shaft relative to the second shaft, which increases a length of a balloon, and proximal movement of the piston causes proximal movement of the first shaft relative to the second shaft, which decreases a length of a balloon.

[0010] In another exemplary embodiment, a delivery apparatus for an implantable prosthetic device comprises a handle, a first shaft extending distally from the handle, a second shaft extending distally from the handle, the first shaft extending through the second shaft and being axially movable distally and distally relative to the second shaft, and an inflatable balloon having a proximal end and a distal end, the proximal end of the balloon being coupled to the distal end of the second shaft and the distal end of the balloon being coupled to the distal end of the first shaft, wherein distal movement of the first shaft relative to the second shaft moves the distal end of the balloon away from the proximal end of the balloon, increasing a length of the balloon, and proximal movement of the first shaft relative to the second shaft moves the distal end of the balloon toward the proximal end of the balloon, decreasing a length of the balloon.

[0011] In another exemplary embodiment, a delivery apparatus for an implantable prosthetic device comprises a handle, a first shaft extending distally from the handle, a second shaft extending distally from the handle, the first shaft extending through the second shaft and being axially movable distally and distally relative to the second shaft, a biasing member configured to apply a biasing force that biases the first shaft to move distally relative to the second shaft, and an inflatable balloon having a proximal end and a distal end, the proximal end of the balloon coupled to the distal end of the second shaft and the distal end of the balloon coupled to the distal end of the first shaft, wherein distal movement of the first shaft relative to the second shaft moves the distal end of the balloon away from the proximal end of the balloon, increasing a length of the balloon, and proximal movement of the first shaft relative to the second shaft moves the distal end of the balloon toward the proximal end of the balloon, decreasing a length of the balloon.

[0012] In another exemplary embodiment, a method of implanting a prosthetic heart valve using a delivery device, which can be any of the embodiments described above, is provided, comprising the steps of delivering a prosthetic heart valve to a patient's heart while the prosthetic heart valve is in a radially compressed state on a balloon of the delivery device, inflating the balloon to radially expand the prosthetic heart valve against surrounding tissue within the heart, deflating the balloon after radially inflating the balloon onto the prosthetic heart valve, and increasing the length of the balloon during or after deflating the balloon.

[0013] In another exemplary embodiment, a method of implanting a prosthetic heart valve comprises inserting a distal end of a delivery device and a prosthetic heart valve into a patient's vascular system, wherein the prosthetic heart valve is radially compressed on a balloon of the delivery device, the delivery device comprising a first shaft and a second shaft, the first shaft extending through the first shaft, the proximal end of the balloon coupled to the distal end of the second shaft and the distal end of the balloon coupled to the distal end of the first shaft; advancing the prosthetic heart valve to an implantation location in the heart; inflating the balloon to radially expand the prosthetic heart valve against surrounding tissue within the heart; deflating the balloon after radially expanding the balloon to the prosthetic heart valve; and, while deflating the balloon, moving the first shaft distally relative to the second shaft to increase the length of the balloon.

[0014] The foregoing and other objects, features, and advantages of the present invention will become more apparent from the following detailed description which proceeds with reference to the accompanying drawings. [Brief explanation of the drawings]

[0015] [Figure 1] 1A and 1B are perspective views illustrating embodiments of prosthetic heart valves that can be implanted using any of the delivery devices disclosed herein. [Figure 2A] FIG. 1 is a perspective view illustrating another embodiment of a prosthetic heart valve that can be implanted using any of the delivery devices disclosed herein. [Figure 2B] 2B is a perspective view of the prosthetic heart valve of FIG. 2A, with components outside the frame shown in transparent lines for illustrative purposes. [Figure 3] FIG. 1 is a perspective view illustrating a delivery device for a prosthetic heart valve, according to one embodiment. [Figure 4] 4 is a cross-sectional view of an embodiment of the distal end of the delivery device of FIG. 3. [Figure 5] 4 is a side view of the distal end of the delivery device of FIG. 3 shown with a prosthetic heart valve mounted in a radially crimped state on the balloon of the delivery device. [Figure 6] FIG. 10 is a cross-sectional view showing a handle of a delivery device, according to one embodiment. [Figure 7] FIG. 10 is a cross-sectional view of a handle of a delivery device according to another embodiment. [Figure 8A] FIG. 8 is a side view of the inflation hub assembly of the delivery device of FIG. 7. [Figure 8B] FIG. 8B is a cross-sectional side view of the inflation hub assembly of FIG. 8A. [Figure 9A] FIG. 8C is a side view of the inflation manifold of the inflation hub assembly shown in FIGS. 8A and 8B. [Figure 9B] FIG. 9B is a cross-sectional side view of the inflation manifold of FIG. 9A. [Figure 10A] FIG. 8C is a side view of the piston of the inflation hub assembly shown in FIGS. 8A and 8B. [Figure 10B] FIG. 10B is a cross-sectional view showing a side of the piston of FIG. 10A. [Figure 11A] 8C is a perspective view of an embodiment of a cap member of the inflation hub assembly shown in FIGS. 8A and 8B. FIG. [Figure 11B] FIG. 11B is a cross-sectional view showing a side surface of the cap member of FIG. 11A. [Figure 12A]FIG. 8 is another side view showing the inflation hub assembly of the delivery device of FIG. 7. [Figure 12B] FIG. 12B is a cross-sectional side view of the inflation hub assembly of FIG. 12A. [Figure 13A] 13B shows the distal and proximal ends, respectively, of the delivery device of FIG. 7 when the piston (FIG. 13B) is in a proximal position and the balloon (FIG. 13A) is in a corresponding axially shortened state. [Figure 13B] 13B shows the distal and proximal ends, respectively, of the delivery device of FIG. 7 when the piston (FIG. 13B) is in a proximal position and the balloon (FIG. 13A) is in a corresponding axially shortened state. [Figure 14A] 14B shows the distal and proximal ends, respectively, of the delivery device of FIG. 7 when the piston (FIG. 14B) is in a distal position and the balloon (FIG. 14A) is in a corresponding axially extended state. [Figure 14B] 14B shows the distal and proximal ends, respectively, of the delivery device of FIG. 7 when the piston (FIG. 14B) is in a distal position and the balloon (FIG. 14A) is in a corresponding axially extended state. [Figure 15] FIG. 10 is a cross-sectional view of a distal end of a delivery device according to another embodiment. [Figure 16] FIG. 10 is a cross-sectional view of the proximal end of a delivery device according to another embodiment. [Figure 17] 1 is a flowchart of a method for implanting a prosthetic heart valve with a delivery device having an adjustable length balloon. [Figure 18A] 10 illustrates an alternative embodiment of a piston for use in an inflation hub assembly. [Figure 18B] 10 illustrates an alternative embodiment of a piston for use in an inflation hub assembly. [Figure 18C] 10 illustrates an alternative embodiment of a piston for use in an inflation hub assembly. [Figure 19A] 1 shows a delivery device for delivering a prosthetic heart valve according to another embodiment. [Figure 19B] 1 shows a delivery device for delivering a prosthetic heart valve according to another embodiment. [Figure 20] FIG. 10 is a cross-sectional view illustrating an inflation manifold that can be implemented in any of the delivery devices disclosed herein, according to another embodiment. DETAILED DESCRIPTION OF THE INVENTION

[0016] [General Considerations] For purposes of explanation herein, certain aspects, advantages, and novel features of examples of the present disclosure are described herein. The disclosed methods, apparatus, and systems should not be construed as limiting in any way. Instead, the present disclosure may be directed to all novel and non-obvious features and aspects of the various disclosed examples, both alone and in various combinations and subcombinations with one another. The methods, apparatus, and systems are not limited to any particular aspect or feature or combination thereof, and the disclosed examples do not require that any one or more particular advantages be present or problems be solved.

[0017] Although some operations in the disclosed examples are described in a particular sequential order for convenience, the described methodology includes rearrangement unless a particular order is required by specific descriptions below. For example, operations described in sequence may in some cases be rearranged or performed simultaneously. Moreover, for simplicity, the accompanying figures may not show the various ways in which the disclosed methodology may be used in combination with other methods. Furthermore, terms such as "provide" or "achieve" may be used herein to describe the disclosed methodology. These terms are high-level abstractions of the actual operations that are performed. The actual operations corresponding to these terms may vary depending on the particular implementation and are readily discernible by those skilled in the art.

[0018] For brevity and for continuity of description, the same or similar reference characters may be used for the same or similar elements in different figures, and the description of an element in one figure will be considered carried over when that element appears in another figure with the same or similar reference characters. In some cases, the term "corresponding" may be used to describe the correspondence between elements in different figures. In use, if an element in a first figure is described as corresponding to another element in a second figure, the element in the first figure will be considered to have the characteristics of the other element in the second figure, and vice versa, unless otherwise stated.

[0019] The word "comprise" and its derivatives such as "comprise" and "including" are to be interpreted in an open and inclusive sense, i.e., "including, but not limited to." The singular forms "a," "an," "at least one," and "the" include plural referents unless the context dictates otherwise. The term "and / or," when used between the last two elements of a list of elements, means any one or more of the listed elements. The term "or" is generally used in its broadest sense, i.e., meaning "and / or," unless the context clearly dictates otherwise.

[0020] As used herein, the term "proximal" refers to a position, direction, or portion of a device that is closer to the user and further from the implantation site. As used herein, the term "distal" refers to a position, direction, or portion of a device that is further from the user and closer to the implantation site. Thus, for example, proximal movement of a device is movement of the device away from the implantation site toward the user (e.g., outside the patient's body), while distal movement of a device is movement of the device away from the user and toward the implantation site (e.g., into the patient's body). The terms "longitudinal" and "axial" refer to axes extending proximally and distally, unless expressly specified otherwise.

[0021] Described herein are examples of transcatheter delivery devices and methods for using same.

[0022] In some embodiments, the delivery device is adapted to deliver a prosthetic heart valve crimped onto the valve-retaining portion of the balloon. Figure 1 shows a prosthetic heart valve 10 according to one embodiment. While the illustrated prosthetic valve is adapted to be implanted into the native aortic valve annulus, in other embodiments, it may be adapted to be implanted into other native valve annulus of the heart (e.g., the pulmonary, mitral, and tricuspid valves). The prosthetic valve may also be adapted to be implanted into other tubular organs or passageways within the body. The prosthetic valve 10 may have four main components: a stent or frame 12, a valve leaflet structure 14, an inner skirt 16, and a perivalvular outer sealing member or outer skirt 18. The prosthetic valve 10 may have an inflow end 15, an intermediate portion 17, and an outflow end 19.

[0023] The valvular structure 14 includes three leaflets 40, collectively forming a valve leaflet structure, which may be arranged to collapse in a tricuspid valve arrangement, although in other embodiments there may be a greater or lesser number of leaflets (e.g., one or more leaflets 40). The leaflets 40 may be secured to each other on adjacent sides, forming commissures 22 of the valve leaflet structure 14. The lower end of the valve leaflet structure 14 has an undulating, curved, scalloped shape and may be secured to the inner skirt 16 by sutures (not shown). In some embodiments, the leaflets 40 may be formed of pericardial tissue (e.g., bovine pericardial tissue), a biocompatible synthetic material, or various other suitable natural or synthetic materials known in the art and described in U.S. Pat. No. 6,730,118, which is incorporated herein by reference.

[0024] The frame 12 may be formed with a plurality of circumferentially spaced slots or commissure windows 20 adapted to attach the commissures 22 of the valvular structure 14 to the frame. The frame 12 may be made of a variety of suitable plastically expandable materials (e.g., stainless steel, etc.) or self-expanding materials (e.g., nickel-titanium alloys (NiTi) such as Nitinol), as known in the art. If constructed of a plastically expandable material, the frame 12 (and thus the prosthetic valve 10) may be crimped into a radially collapsed configuration on a delivery catheter and then expanded inside the patient by an inflatable balloon or equivalent expansion mechanism. If constructed of a self-expanding material, the frame 12 (and thus the prosthetic valve 10) may be crimped into a radially collapsed configuration and constrained in the collapsed configuration by insertion into a delivery catheter sheath or equivalent mechanism. Once inside the body, the prosthetic valve can be advanced from the delivery sheath, which allows the prosthetic valve to expand to its functional size.

[0025] Suitable plastically expandable materials that can be used to form the frame 12 include, but are not limited to, stainless steel, biocompatible, high-strength alloys (e.g., cobalt-chromium or nickel-cobalt-chromium alloys), polymers, or combinations thereof. In certain embodiments, the frame 12 is made of a nickel-cobalt-chromium-molybdenum alloy, such as MP35N® alloy (SPS Technologies, Jenkintown, PA), which is equivalent to UNS R30035 alloy (covered by ASTM F562-02). MP35N® alloy / UNS R30035 alloy is composed of 35% nickel, 35% cobalt, 20% chromium, and 10% molybdenum by weight. Additional details regarding the prosthetic valve 10 and its various components are described in International Publication No. WO 2018 / 222799, which is incorporated herein by reference.

[0026] Figure 2A is a perspective view of a prosthetic heart valve 50 according to another embodiment. The valve 50 can have three main components: a stent or frame 52, a valvular structure 54, and a sealing member 56. Figure 2B is a perspective view of the prosthetic valve 50 with the components outside the frame 52 (including the sealing member 56) shown with transparent lines for illustrative purposes.

[0027] Like the valvular structure 14 of FIGURE 1, the valvular structure 54 includes three leaflets 60, collectively forming a valvular structure that can be arranged to collapse into a tricuspid valve arrangement. Each leaflet 60 can be coupled to the frame 52 along its inflow edge 62 (bottom edge of the illustration; also called the "cusp edge") and at the commissures 64 of the valvular structure 54 where adjacent portions of two leaflets are connected to one another. Reinforcing elements (not shown), such as fabric strips, can be connected directly to the cusp edges of the leaflets and to the struts of the frame to couple the cusp edges of the leaflets to the frame.

[0028] 1, frame 52 may be made of any of a variety of suitable plastically or self-expanding materials, as known in the art and described above. The frame 52 of the illustrated embodiment includes a plurality of circumferentially extending rows of angled struts 72 that define rows of cells or openings 74 in the frame. The frame 52 may have a cylindrical or substantially cylindrical shape with a constant diameter from the inlet end 66 to the outlet end 68 of the frame, as shown, or the frame may have a varying diameter along the height of the frame, as disclosed in U.S. Patent Application Publication No. 2012 / 0239142, which is incorporated herein by reference.

[0029] The seal member 56 in the illustrated embodiment is attached to the outside of the frame 52 and functions to form a seal against surrounding tissue (e.g., the native valve leaflets and / or the native valve annulus) to prevent or at least minimize paravalvular leakage. The seal member 56 may include an inner layer 76 (which may contact the outer surface of the frame 52) and an outer layer 78. The seal member 56 may be connected to the frame 52 using any suitable technique or mechanism. For example, the seal member 56 may be sutured to the frame 52 via sutures that may extend around the struts 72 and through the inner layer 76. In an alternative embodiment, the inner layer 76 may be attached to the inner surface of the frame 52, while the outer layer 78 is on the outside of the frame 52.

[0030] The outer layer 78 may be configured or shaped to extend radially outward from the inner layer 76 and the frame 52 when the prosthetic valve 50 is deployed. When the prosthetic valve is fully expanded outside the patient's body, the outer layer 78 may expand away from the inner layer 76, creating a space between the two layers. Thus, when implanted within the body, this allows the outer layer 78 to expand and contact the surrounding tissue.

[0031] Additional details regarding the prosthetic valve 50 and its various components are provided in U.S. Patent Application Publication No. 2018 / 0028310, which is incorporated herein by reference.

[0032] FIG. 3 illustrates a delivery device (also referred to as a delivery apparatus) 100 that may be used to implant an expandable prosthetic heart valve (e.g., heart valve 10 or 50) or another type of expandable prosthetic medical device (such as a stent), according to one embodiment. In some embodiments, delivery device 100 is particularly adapted for use in introducing a prosthetic valve into a patient's heart. The delivery device of FIG. 3 may include an inflation hub assembly according to the present disclosure, as further described below with respect to FIGS. 7-16.

[0033] Referring to FIG. 3 , the illustrated embodiment of a delivery device 100 is a balloon catheter including a handle 102, a steerable outer shaft 104 extending from the handle 102, a midshaft 105 (see FIG. 4 ) extending coaxially from the handle 102 through the steerable outer shaft 104, an inner shaft 106 extending coaxially from the handle 102 through the midshaft 105 and the steerable shaft 104, an inflatable balloon 108 extending from the distal end of the midshaft 105, and a nosecone 110 disposed at the distal end of the delivery device 100. The distal end 112 of the delivery device 100 includes the balloon 108, the nosecone 110, and a balloon shoulder assembly. As described further below with reference to FIG. 4 , a prosthetic medical device, such as a prosthetic heart valve, can be attached to a valve-retaining portion of the balloon 108. The balloon shoulder assembly can be configured to maintain the prosthetic heart valve or other medical device in a fixed position on the balloon 108 during delivery through a patient's vasculature.

[0034] The handle 102 may include a steering mechanism configured to adjust the curvature of the distal end of the delivery device. In the illustrated embodiment, for example, the handle 102 includes an adjustment member, such as the illustrated rotatable knob 344, operably coupled to the proximal end of a pull wire (not shown). The pull wire extends distally from the handle 102 through the outer shaft 104 and has a distal end attached to the outer shaft at or near the distal end of the outer shaft 104. Rotating the knob 134 is effective to increase or decrease the tension in the pull wire, thereby adjusting the curvature of the distal end of the delivery device.

[0035] 3, the delivery device 100 may also include an inflation hub 200 at the proximal end of the delivery device. The inflation hub 200 in the illustrated embodiment is partially housed within the handle 102 and includes an inflation port 202 and a proximal leg portion 204 extending from the handle 102.

[0036] Figure 4 illustrates an embodiment of the distal end 112 of the delivery device 100. As shown in Figure 4, the delivery device 100 is configured to mount a crimped prosthetic valve 114 (which may be, for example, a prosthetic heart valve 10 or 50) onto a balloon 108 for insertion of the delivery device 100 and prosthetic valve 114 into a patient's vasculature.

[0037] As shown in FIG. 4 , proximal to the distal end 112, the inner shaft 106 extends distally beyond the steerable shaft 104 and midshaft 105 and through the balloon 108. The balloon 108 may be supported on a balloon shoulder assembly 118. The balloon shoulder assembly 118 includes a proximal shoulder 120 connected to the distal end of the midshaft 105 and a distal shoulder 122 attached to the inner shaft 106. The balloon 108 includes a proximal end 126 that surrounds and / or folds over the proximal shoulder 120 and a distal end 128 that surrounds and / or folds over the distal shoulder 122. In some embodiments, the proximal end 126 of the balloon 108 may be secured to the outer surface of the midshaft 105. In some embodiments, the distal end 128 of the balloon 108 may be secured to the outer surface of the nosecone 110 and attached or coupled to the inner shaft 106.

[0038] In the illustrated embodiment, the nosecone 110 and the distal shoulder 122 are integral or unitary components, i.e., the nosecone 110 is the distal portion of the integrated component and the distal shoulder 122 is the proximal portion of the integrated component. In other embodiments, the nosecone 110 and the distal shoulder 122 are separate components and may be attached to the inner shaft 106 adjacent to each other or in an axially spaced-apart arrangement.

[0039] The proximal shoulder 120 and the distal shoulder 122 are spaced apart axially relative to a central longitudinal axis 124 of the delivery device 100. As a result, the balloon 108 defines a valve-retaining portion 130 in the space separating the proximal shoulder 120 and the distal shoulder 122 (e.g., between the flared end of the proximal shoulder 120 and the distal shoulder 122). As shown in FIG. 4 , the prosthetic valve 114 is crimped onto the valve-retaining portion 130 of the balloon 108 between the proximal shoulder 120 and the distal shoulder 122, thereby preventing or reducing axial movement of the prosthetic valve 114 relative to the balloon 108 during insertion of the delivery device 100 into a patient and delivery of the prosthetic valve 114 to a target implantation site. In an alternative embodiment, the delivery device 100 does not have the proximal shoulder 120 and the distal shoulder 122, respectively.

[0040] The outer diameter of the inner shaft 106 can be sized to define an annular space 132 between the inner shaft 106 and the midshaft 105 along the entire length of the midshaft 105. The annular space 132 can be fluidly coupled to one or more fluid passages of the delivery device 100 that are fluidly connectable to a fluid source (e.g., a syringe) that can inject inflation fluid (e.g., saline) into the delivery device. In the illustrated embodiment, for example, the inflation port 202 of the inflation hub 200 can be fluidly connected to the annular space 132. In this manner, inflation fluid from the fluid source flows through the inflation port 202, through the annular space 132, and into the balloon 108, inflating the balloon 108 and expanding and deploying the prosthetic valve 114.

[0041] 4 illustrates the flow of inflation fluid (indicated by arrows 109) through the annular space 132 and through passages in the proximal and distal shoulders 120, 122. The fluid may then flow into the proximal and distal ends 126, 128 of the balloon 108, expanding the valve 114. Further details of the balloon shoulder assembly, steering mechanism, and other components of the delivery device are disclosed in U.S. Patent Application Publication Nos. 2007 / 0005131, 2009 / 0281619, 2013 / 0030519, and 2017 / 0065415, which are incorporated herein by reference. Other examples of delivery devices for prosthetic valves (e.g., valves 10 or 50) are disclosed in U.S. Patent Application No. 63 / 069,567, filed August 24, 2020, and U.S. Patent Application No. 63 / 138,890, filed January 19, 2021, which are incorporated herein by reference. Any of the devices described herein for adjusting the length of the balloon of the delivery device can be incorporated into the delivery devices disclosed in the aforementioned applications.

[0042] 5 shows an exterior side view of the distal end 112 of the delivery device 100, including the prosthetic valve 114 crimped onto the balloon 108. As shown in FIG. 5, the balloon 108 includes a proximal end 126 that surrounds and / or folds over a proximal shoulder 120, a distal end 128 that surrounds and / or folds over a distal shoulder 122, and a valve retaining portion 130 disposed between the proximal end 126 and the distal end 128.

[0043] 6 shows a cross section of the handle 102 and a known inflation hub 600 partially housed in the handle 102. The inflation hub 600 includes a shaft-form body 602 that extends outwardly from the handle 102 and includes a distal end 604 and a proximal end 606. An inflation port 608 extends outwardly from the distal end 604 of the shaft 602 and through the handle.

[0044] The proximal end 150 of the midshaft 105 extends into the distal end 604 of the shaft 602 and is secured thereto with an adhesive, welding, or the like. The proximal end 152 of the inner shaft 106 extends into the shaft 602 beyond the proximal end 150 of the midshaft 105 and into the narrower bore region of the proximal end 606 of the shaft, thereby being secured thereto with an adhesive, welding, or the like to form an airtight seal.

[0045] The inflation port 608 has an inflation lumen 610 that is in fluid communication with the main lumen 612 of the shaft 602, and thereby in fluid communication with the annular space 132 between the inner shaft 106 and the intermediate shaft 105. In use, a source of inflation fluid (e.g., a syringe) is connected to one end of a tube or conduit (e.g., flexible medical tubing) connected to the inflation port 608 and the other end of the tube connected to the source of inflation fluid.

[0046] To inflate the balloon and deploy the prosthetic valve, inflation fluid from a source is introduced into inflation port 608 and flows through inflation lumen 610, into main lumen 612, and through annular space 132 to the balloon. The proximal end 606 of shaft 602 may have a proximal opening 620 through which a guidewire (not shown) may extend. During use, delivery device 100 may be advanced over a guidewire (previously inserted into the patient's vasculature) that extends through the guidewire lumen of inner shaft 106, through shaft 602 of hub 600, and outward through proximal opening 620.

[0047] As described above with respect to FIG. 4 , the proximal end 126 of the balloon 108 is connected to the midshaft 105, and the distal end 128 of the balloon 108 is connected to the nosecone 110, which is then connected to the inner shaft 106, such as by adhesive or welding, to form an airtight seal. The fixed locations of the proximal end 150 of the midshaft 105 and the proximal end 152 of the inner shaft 106 fix the length of the balloon 108. Prior to insertion into the patient's vasculature, the balloon 108 is deflated and folded into a compact, low-profile configuration, as best shown in FIG. 4 . However, after the balloon is deflated following deployment of a prosthesis, such as a prosthetic heart valve, the balloon does not automatically return to its pre-deployment, folded configuration. Therefore, the uninflated profile of the balloon after deployment is relatively large. An example of a larger than desired balloon profile is shown in FIG. 13A . The fixed locations of the proximal ends of the midshaft and inner shaft may prevent the balloon profile from being further reduced. A larger than desired balloon profile may result in increased balloon withdrawal forces when the delivery device 100 is withdrawn from the patient's body.

[0048] Problems associated with a larger-than-desired deflated balloon are addressed by a delivery device having an inflation hub assembly that allows for adjustment of the overall length of the balloon, thus reducing the balloon profile prior to removing the delivery device from the patient's body. FIG. 7 shows the interior region of a handle 102 and inflation hub assembly 700 for a delivery device, such as delivery device 100, according to one embodiment. The inflation hub assembly 700 in the illustrated embodiment includes an inflation manifold 706 and a piston 708 slidably coupled to the inflation manifold 706. As described further below, the piston 708 can move in and out of the inflation manifold 706 to adjust the length of the balloon 108.

[0049] The inflation manifold 706 comprises a body, which in the illustrated embodiment is in the form of a central shaft 710 defining a main lumen 712. The manifold 706 further includes an inflation port 714 defining an inflation lumen 716 in fluid communication with the main lumen 712 of the shaft 710. The central shaft 710 includes a distal end 718 and a proximal end 720. The distal end 718 defines a distal section 724 (or distal bore) of the main lumen 712. The proximal end 720 defines a proximal section 726 (or proximal bore) of the main lumen 712.

[0050] The proximal end 150 of the midshaft 105 may be coupled to the inflation manifold 706 so that the midshaft is in a fixed position and does not move axially relative to the inflation manifold 706. For example, as best shown in FIG. 12B , the proximal end 150 of the midshaft 105 may extend into a distal bore 724 of the distal end 718 of the central shaft 710 and be fixed in position relative to the distal bore 724. The shaft distal end 718 may include an adhesive porthole 740 (also shown in FIGS. 8A and 8B ) for receiving an adhesive to bond the proximal end 150 of the midshaft 105 with the inner surface of the distal bore 724. The midshaft 105 may be secured to the shaft 710 using still other techniques and mechanisms, such as an interference fit, welding, chemical bonding, mechanical fasteners, snap-fit mechanisms, and / or other fastening means. In some embodiments, shaft 105 may be the outermost shaft of the delivery device (ie, shaft 104 may be omitted).

[0051] The proximal end 152 of the inner shaft 106 may be coupled to the piston 708 such that the inner shaft 106 is axially fixed relative to the piston 708, and axial movement of the piston in the proximal and distal directions causes corresponding axial movement of the inner shaft 106. For example, as best shown in FIG. 12B , the proximal end 152 of the inner shaft may extend into and be fixed relative to a bore 914 of the piston 708. The piston 708 may include an adhesive porthole 916 (also shown in FIGS. 8A and 8B ) for receiving an adhesive to bond the proximal end 152 of the inner shaft 106 to the interior surface of the bore 914. The inner shaft 106 may be secured to the piston 708 using still other techniques and mechanisms, such as an interference fit, welding, chemical bonding, mechanical fasteners, snap-fit mechanisms, and / or other fastening means.

[0052] 7, inflation hub assembly 700 may further include a cap member 730 that retains the distal end of piston 708 within bore 726, as described further below. In certain embodiments, cap 730 may also maintain the rotational orientation of piston 708 within bore 726, as described further below.

[0053] The proximal bore 726 is sized to receive at least the distal end 902 (also referred to as the piston head) of the piston 708 and allow sliding movement of the piston within the proximal bore. As a result of the ability of the piston 708 to slide longitudinally within the bore 726 of the central shaft 706, the distal end of the piston 708 can be adjusted to any position in a range R ( FIG. 12B ) between its most distal and most proximal positions. Correspondingly, the axial position of the inner shaft 106, which is coupled to the piston 708, moves as the piston 708 moves. The distal end of the balloon 108 is coupled to the distal end of the inner shaft 106 (via the nosecone 110 in the illustrated embodiment), while the proximal end of the balloon is coupled to the proximal end of the inner shaft 105, and changing the position of the inner shaft's proximal end (via adjustment of the piston position) results in a corresponding change in the length of the balloon.

[0054] As an example, when a balloon is deflated after delivery and deployment of a prosthetic device, such as a prosthetic heart valve, the balloon profile can be reduced by moving the piston 708 and inner shaft 106 distally relative to the manifold 706 and midshaft 105. This moves the distal end 128 of the balloon 108 distally relative to the proximal end 126 of the balloon, which effectively increases the overall length of the balloon 108 and reduces its profile in a plane perpendicular to the longitudinal axis 124, thereby reducing the balloon's retraction force. Additionally, the increased length and reduced profile promotes refolding of the balloon as inflation fluid is withdrawn from it, further reducing the balloon's retraction force.

[0055] 7, the manifold 706 may include a flange or gusset 728 to strengthen the connection between the inflation port 714 and the central shaft 710. Except for the mouth portion 744 of the inflation port 714, which may extend from the handle 102 of the delivery device for access by the user. The piston 708 in the illustrated embodiment extends outward from the manifold 706 through a proximal opening in the handle, and the proximal end of the piston 708 may be manipulated by the user.

[0056] In an alternative embodiment, inflation hub assembly 700, including manifold 706 and piston 708, may be positioned entirely outside of handle 102. For example, manifold 706 and piston 708 may be positioned proximal to handle 102, with inner shaft 106 and intermediate shaft 105 extending completely through the handle and outwardly through a proximal opening in the handle to couple to the piston and manifold, respectively.

[0057] As discussed above with respect to FIG. 6 , inflation fluid may be delivered to the balloon 108 during balloon inflation via the inflation port 714. In particular, fluid delivered into the inflation port 714 flows through the lumen 716 into the main lumen 712 of the central shaft 710, and from there into the annular space 132 between the inner shaft 106 and the midshaft 105, as discussed above. Similarly, fluid may be withdrawn from the balloon during deflation via the inflation port. One or more grooves or external threads 746 ( FIG. 8A ) may be provided in the mouth portion 744 to facilitate coupling of the inflation port to a conduit (e.g., medical tubing) extending from a source of inflation fluid, such as a syringe. The lumen 716 of the inflation port 714 may taper from the mouth portion 744 toward the gusset 728 at the junction with the central shaft 710.

[0058] 9A and 9B, the proximal end 720 of the central shaft may include a plurality of protrusions 748 and at least one slot 750 that allow for coupling of the cap member 730 with the proximal end 720 of the shaft 710. During assembly, after the piston 708 is inserted into the proximal bore 726, the cap member 730 may slide relative to the proximal end of the shaft 710.

[0059] A plurality of protrusions 748 extend radially outward from the outer surface of the proximal end of the shaft 710 and are circumferentially spaced apart from one another on the outer surface distal to the slots 750. In the illustrated example, the protrusions 748 are triangular prism-shaped, although the protrusions may have other shapes. The protrusions 748 are configured to function as snap-fit retainers. Specifically, when the cap 730 is slid onto the proximal end 720 of the shaft 710, the protrusions 748 extend into corresponding windows (or openings) 1004 of the cap 730, forming a snap-fit connection, thereby holding the cap 730 in place on the proximal end 720 of the shaft 710. As a result of the snap-fit connection, axial movement of the cap 730 relative to the shaft 710 is prevented. Engagement of the ribs 1002 of the cap 730 within the slots 750 of the shaft 710 may prevent rotation of the cap relative to the shaft, as described further below. As described in more detail below, in certain embodiments, cap 730 also holds piston 708 in place to prevent rotation of the piston relative to shaft 710 .

[0060] 10A and 10B, the piston 708 has a piston head 902 and a piston stem 904 extending from the piston head 902. The piston head 902 includes a seal gland or annular groove 903 that separates the piston head into a distal piston head region 905a and a proximal piston head region 905b. At least one seal 752 (see FIG. 8B) may be received within the seal gland 903 of the piston head 902 and seal against the inner surface of the bore 726 to maintain pressurization of the inflation lumen. By way of non-limiting example, the seal 752 may be an X-ring, an O-ring, a washer, or the like. While only one seal 726 is shown in the illustrated embodiment, in other embodiments, multiple seals 726 may be disposed within the groove 903. In an alternative embodiment, multiple axially spaced grooves 903 may be provided along the piston head 902, with one or more seals disposed in each groove 903.

[0061] The piston stem 904 extends proximally from the proximal piston head region 905b. A plurality of ridges 914 protrude outward from the outer surface of the piston stem 904. The ridges are distributed circumferentially, with each ridge extending longitudinally from the proximal head region 905b at least partially along the length of the piston stem. In one example, the ridges 914 are rectangular in shape and uniformly distributed around the circumference of the piston stem. As a result of the plurality of ridges 914, a series of grooves 906 are defined on the outer surface of the piston stem 904 between adjacent ridges. The rectangular ridges 914 result in the formation of rectangular grooves 906 interspersed with the ridges. In other examples, the ridges 914 and grooves 906 may have other cross-sectional profiles, such as triangular, semicircular, etc. The grooves 906 also extend longitudinally at least partially along the length of the piston stem 904.

[0062] As described in more detail below, the rotational orientation of the piston 708 within the shaft 710 of the manifold 706 can be maintained via the cap 730. During assembly, the piston head 902 is inserted into the proximal end 720 of the shaft 710, and then the cap 730 is placed over the proximal end 720 as previously described. This mating causes a rib 1002 (see FIG. 11A ) on the inner surface of the cap 730 to be inserted into the groove 906 and one of the slots 750. The engagement of the rib 1002 with the slot 750, in conjunction with the circumferential juxtaposition of the rib 1002 between two adjacent ridges 914, prevents rotational movement of the piston. This prevents rotation of the piston inserted inside the proximal end 720 of the shaft 710, which in turn prevents rotation of the inner shaft 106 and a guidewire (not shown) extending therethrough. In an alternative embodiment, the cap 730 is fixed against rotation relative to the manifold 706, such as through engagement of the ribs 1002 with the slots 750, and the piston 708 can rotate relative to the cap 730 and the manifold 706. In such an embodiment, the inner shaft 106 is fixed against axial movement relative to the piston 708, but the piston can rotate relative to the inner shaft 106. In this way, rotation of the piston 708 in normal use does not cause rotation of the inner shaft 106 and the guidewire extending therethrough.

[0063] The ribs 1002 also limit the proximal displacement of the piston within the shaft 710, as described in more detail below. As the piston 708 moves proximally inside the manifold 706, the piston head moves toward the ribs until they abut. The ribs then act as hard stops, preventing further proximal movement of the piston within the manifold. In this way, complete withdrawal of the piston from the manifold may be avoided.

[0064] As the piston 708 moves distally inside the proximal bore portion 726 of the shaft 710, the distal piston head region 905a extends through the proximal bore portion 726 until it reaches an annular shoulder or edge 727 of the proximal bore portion 726. Beyond the distal shoulder 727, the lumen 712 has a narrower width or diameter, thus preventing further distal movement of the piston within the lumen 712 of the shaft 710. As described in more detail below, movement of the piston 708 is effective to adjust the length of the balloon 108. The amount of distal piston movement (dimension R) can be selected to prevent overstretching of the balloon 108, which could result in balloon rupture.

[0065] The piston stem 904 may have a stepped diameter with a narrower distal stem region 904a that gradually transitions to a wider proximal stem region 904b at a taper junction 908. The groove 906 in the illustrated embodiment does not necessarily extend the entire length of the piston stem 904. Thus, the outer surface of the proximal end 910 of the piston stem may not have the groove 906.

[0066] As shown in FIGS. 18A and 18B, the proximal end 910 of the piston stem 904 can have a finger grip mechanism to facilitate manual actuation of the piston by a user. In one example shown in FIG. 18A, the finger grip mechanism can include one or more protrusions or flanges 913 extending radially outward from the piston stem. As shown in FIG. 18B, the finger grip mechanism can include one or more detents or notches 917 formed on the outer surface of the piston stem. A user can manually displace the piston 708 proximally and distally relative to the manifold 706 via the grip mechanisms 913, 917. As shown in FIG. 7, at least the proximal end 910 of the piston stem 904, including the grip mechanism 913, can extend from the catheter handle 102 for access by a user. The proximal end 910 may also be formed with external threads 912 for connecting a luer fitting to the piston for injecting a liquid (e.g., saline) into the lumen of the piston, and an inner shaft 106 for flushing these components.

[0067] Still other features may be provided on the exterior surface of the piston stem 904 to aid in manually actuating the piston to change the length of the balloon. These include, by way of non-limiting example, a textured feature (e.g., the piston stem may be textured along the proximal end 910) and a locking feature (e.g., by including a twist, snap, bayonet mount, etc., on the proximal end 910 of the piston stem).

[0068] As best shown in FIG. 10B, the piston 708 includes a central bore or lumen 915 that extends the entire length of the piston along a central longitudinal axis AA'. The lumen 915 may be narrower in the distal stem region 904a. Beyond the junction 908, in the proximal stem region 904b, the lumen may transition to a flared portion 918 having a maximum diameter at the proximal end of the piston stem 904. As mentioned above, the lumen 915 is sized such that the proximal end 152 of the inner shaft 106 can be received within the lumen of the proximal stem region 904a, as shown in FIG. 12B.

[0069] 11A-11B, cap 730 includes a cylindrical wall 1001 of thickness "t" that defines a hollow interior space 1003. Cap 730 has a diameter greater than the diameter of proximal end 720 of shaft 710 to allow the cap to be placed over proximal end 720. Cap 730 has a distal end 1012 and a proximal end 1010.

[0070] At the proximal end 1010 of the cap, the wall 1001 may be continuous, while at the distal end 1012, the wall 1001 may be segmented. In some embodiments, as best shown in FIG. 12B , the proximal end 1010 of the cap 730 may be formed with a radially extending flange 1011 to increase the circumferential strength of the cap. The distal end 1012 of the cap may include a plurality of rectangular notches or slots 1006 formed in the wall. The plurality of slots or notches 1006 may be circumferentially arranged and uniformly distributed around the circumference of the cap at the distal end 1012. In other examples, the notches may be non-uniformly distributed.

[0071] Each notch 1006 extends through the wall from the distal end 1012 toward the proximal end 1010. In the illustrated example, the notches 1006 extend half the length of the cap, from the distal end to the proximal end. However, in other examples, the notches 1006 may extend more than half the distance or less than half the distance. Each notch 1006 extends coaxially with respect to the central axis BB' of the cap 730.

[0072] As a result of the notches, the distal end 1012 of the cap is divided into a plurality of segments 1008. The number of segments 1008 is equal to the number of notches 1006. In the illustrated example, the distal end 1012 includes four notches that divide the distal end of the cap into four segments. In other examples, a greater or lesser number of notches and segments may be provided. The segmented structure allows the distal end 1012 of the cap to be flexible, as opposed to the more rigid nature of the proximal end 1010 of the cap. Specifically, the segmented structure allows for easier coupling of the cap 730 to the proximal end 720 of the shaft 710, as described further below.

[0073] Each segment 1008 includes a window (or opening) 1004. The window 1004 is shaped and sized to form a snap-fit connection with the protrusion 748 on the proximal end 720 of the shaft 710 when the cap 730 is coupled thereto. In the illustrated example, the window is rectangular shaped to form a snap-fit connection with the triangular prism-shaped protrusion 748. Thus, when the cap 730 is positioned distally onto the proximal end 720 of the shaft 710, the segments 1008 can flex outward as they move over the protrusions 748 until the protrusions 748 extend into the corresponding windows 1004, at which point the segments 1008 can return to their undeflected state, thereby retaining the cap 730 on the proximal end 720 of the shaft 710.

[0074] As further shown in FIGS. 11A and 11B , an axially extending rib 1002 may be provided on the inner surface of the wall 1001. In one example, a single rib 1002 is provided. In other examples, additional ribs may be provided. The rib 1002 is coaxial with the central axis BB′ of the cap. The rib 1002 may be sized to be received within one of the grooves 906 on the piston stem 904. The rib 1002 extends along the proximal end 1010 of the cap toward the distal end. In one example, the rib extends halfway down the length of the cap as shown, but in other examples, the rib 1002 may extend less than halfway down the length of the cap or more than halfway down the length of the cap.

[0075] The dimensions of the rib 1002 are selected to allow the rib to mate with one of the grooves 906 formed in the outer surface of the piston 708 and the slot 750. Specifically, when the cap 730 is placed over the proximal end 720 of the shaft 710, the rib 1002 is inserted into and engages with the groove 906 provided in the outer surface of the piston 708. The rib 1002 allows axial movement of the piston 708 in the proximal and distal directions relative to the cap 730 and manifold 706 and functions as a stop to limit the proximal movement of the piston 708. Thus, when the piston 708 is moved proximally, such as through a pulling action on the piston stem 904 or pressurization during balloon inflation, the piston head 902 moves toward the rib 1002. When the piston head abuts the rib 1002, further proximal movement of the piston is prevented. Thus, the rib 1002 functions as a hard stop to prevent the piston 708 from being withdrawn from the shaft 710.

[0076] Additionally, the engagement of the rib 1002 of the piston 708 with the groove 906 prevents rotational movement of the piston 708 relative to the cap 730, which in turn prevents rotation relative to the manifold 706 via the connection between the rib 1002 and the slot 750. Because the inner shaft 106 is fixed relative to the piston 708, the engagement of the rib 1002 with the groove 906 and the engagement of the rib 1002 with the slot 750 may prevent rotation of the shaft 106 and piston 708 relative to the manifold 706 and prevent undesired rotation of the guidewire extending through the inner shaft 106. In an alternative embodiment, as previously described, the inner shaft 106 is fixed against axial movement only relative to the piston 708, and the piston 708 may rotate relative to the cap 730, manifold 706, inner shaft 106, and guidewire.

[0077] Figure 13A shows an exemplary balloon profile 1200 of a balloon catheter. The profile in Figure 13A corresponds to the proximal position of the piston 708 shown in Figure 13B. In one example, the piston position and balloon profile in Figures 13A and 13B may correspond to the profile provided when the balloon is deflated after valve delivery but there is no distal piston movement (similar to the balloon profile after balloon deflation using the fixed design hub assembly of Figure 6).

[0078] As described above and shown in FIG. 4 , when the prosthetic valve 114 is initially crimped onto the balloon 108 ready for implantation, the balloon 108 is deflated and tightly folded around the proximal and distal stops 120 and 121, respectively. After the prosthetic valve 114 is deployed at the desired implantation site and the balloon is deflated, the balloon 108 may not return to its pre-deployment state of being tightly folded around the stops with a small profile. As a result, the balloon 108 may have a radially expanded profile 1200, as shown in FIG. 13A . A larger or higher balloon profile may result in the need for a relatively high balloon withdrawal force back through the introducer sheath, which can shear the balloon. For example, when using a 14 French (Fr) introducer sheath, the withdrawal force required with a higher balloon profile may be approximately 63.6 N.

[0079] During or after balloon deflation, a lower balloon profile, such as profile 1300 in FIG. 14A, can be achieved by moving the piston to a distal position, as shown in FIG. 14B. This results in elongation of the balloon 108 between the shoulders 120, 122 of the balloon shoulder assembly, resulting in a reduction in the overall balloon profile. Advantageously, this reduces the withdrawal force required to retract the delivery device through the introducer sheath and out of the patient's body. For example, using the same 14 French introducer sheath, a lower balloon profile requires a withdrawal force of approximately 18.2 N or less. Thus, by adjusting the position of the piston within the bore of the proximal hub component, the proximal end of the inner shaft can be varied to provide the desired degree of balloon profile elongation.

[0080] As mentioned above, distal actuation of the inner shaft 106 may be desired during or immediately after the balloon deflation step (and after expansion of the prosthetic valve via the balloon). In one example, distal movement of the piston may be performed manually, such as by a catheter operator. For example, a user may grasp and push the gripping feature 912 on the piston stem to manually displace the piston a desired distance.

[0081] In another example, the distal movement of the piston can be vacuum actuated. The vacuum required for actuation can be provided from a vacuum source external to the delivery device. Alternatively, the vacuum required for vacuum actuation of the piston can be generated internal to the delivery device during removal of fluid from the balloon. For example, as described above, a source of inflation fluid (e.g., a syringe) can be fluidly connected to the inflation port 714, such as via medical tubing. When the balloon is filled with inflation fluid and the prosthetic valve is expanded, a positive pressure is established within the lumen 712 of the manifold 706. During balloon deflation, inflation fluid is drawn from the annular space 132 and the manifold 706 back into the syringe. This creates a vacuum within the lumen 712 of the manifold 706, which can draw the piston 708 distally within the proximal bore portion 726 without applying manual force to the piston 708. In certain embodiments, the vacuum is sufficient to move the piston to the distal position shown in FIG. 14B. Advantageously, this results in distal piston displacement and resulting balloon elongation and a lower balloon profile when fluid is removed to deflate the balloon.

[0082] In some embodiments, a larger vacuum can be achieved by increasing the diameter of piston 708 and the diameter of bore 726. In certain embodiments, piston 708 has a diameter D (FIG. 10A), measured at head portions 905a, 905b, ranging from 0.375 inches to 0.75 inches or more, which has been found to create a vacuum sufficient to move piston 708 from a proximal position (FIG. 13B) to a distal position (FIG. 14B) without applying manual force to the piston. More desirably, a diameter D of at least 0.5 inches has been found to create a vacuum sufficient to begin moving piston 708 toward its distal position immediately after the balloon is deflated, which facilitates refolding of the balloon as it is deflated.

[0083] In still other embodiments, instead of or in addition to vacuum actuation, the hub assembly may include various features to enable automatic distal actuation of the piston. By way of example, as shown in the delivery device 1400 of FIG. 15 , a biasing element, such as the illustrated compression spring 1402, may be mounted within the balloon and configured to apply a biasing force that biases the inner shaft 106 toward a distal position. The spring 1402 may be coaxially mounted to the inner shaft 106 at least partially within the inner bore of the proximal shoulder 1404. The proximal end of the spring 1402 may abut the inner surface 1406 of the shoulder 1404, and the distal end of the spring 1402 may abut a stop member or collar 1408 secured to the inner shaft 106. The distal end of the balloon 108 is secured to the distal shoulder 122 and / or nosecone 110, as previously described, and the proximal end of the balloon is secured to the proximal shoulder. In this manner, the biasing force of the spring 1402 urges the inner shaft 106 and distal end of the balloon distally relative to the outer shaft 104, handle 102, and proximal end of the balloon, thereby stretching the balloon.

[0084] Note that the delivery device 1400 may include any of the features described above in FIGS. 3-5 and 7-14B, including the hub assembly 700 with the manifold 706, piston 708, and cap 730. Unlike the embodiment shown in FIG. 4, the midshaft 705 is omitted in the embodiment of FIG. 15. Thus, the proximal shoulder 1404 is attached to the distal end of the outer shaft 104, and an inflation fluid flow path is defined between the outer shaft 104 and the inner shaft 106. The fluid path may be in fluid communication with the inflation lumen 716 of the inflation manifold 706 in the handle 102. At the distal end of the outer shaft 104, inflation fluid flows through the proximal shoulder 1404 and spring 1402 into the balloon, inflating the balloon. The proximal shoulder 1404 may further include an inflation port or opening 1410 that allows inflation fluid within the proximal shoulder to flow radially outward into the interior of the balloon. In an alternative embodiment, the spring 1402, proximal shoulder 1404, and stop member 1408 may be implemented in a delivery device having an intermediate shaft 105, as shown in FIG.

[0085] The biasing force of the spring 1402 can be selected to be low enough so that the inner shaft 106 can be manually moved to a proximal position (as shown in FIGS. 13A and 13B ) to collapse the balloon 108 around the shoulders 122, 1402 and crimp the prosthetic valve (e.g., valve 10, 50) onto the balloon between the shoulders. The compressive force of the prosthetic valve against the balloon and inner shaft can maintain the inner shaft 106 in a proximal position (and prevent balloon stretching) against the bias of the spring 1402 as the prosthetic valve advances to the desired implantation site. Once the balloon is inflated at the implantation site to deploy the prosthetic valve, the compressive force on the prosthetic valve is released, and the spring 1402 automatically moves the inner shaft 106 to a distal position (as shown in FIGS. 14A and 14B ), stretching the balloon. The balloon can then be deflated and withdrawn from the patient's body.

[0086] In some embodiments, the inflated balloon 108 can hold the inner shaft 106 in a proximal position against the biasing force of the spring (preventing the balloon from stretching), but allow distal movement of the inner shaft 106 when the balloon contracts under the force of the spring. Thus, in this manner, when the balloon contracts, it stretches.

[0087] In an alternative embodiment, a biasing element can be provided at the proximal end of the delivery device to bias the inner shaft 106 toward a distal position. As shown in FIG. 16 , the hub assembly 700 can be similar to the hub assembly 700, except for a tension spring 1450 attached to the piston 708. The distal end of the spring 1450 can be connected to the cap member 730, and the proximal end of the spring 1450 can be connected to a rib 1452 (or another surface) of the piston 708. The spring 1450 is configured to apply a force to the piston 708 and inner shaft 106, biasing the inner shaft to move to a distal position (as shown in FIGS. 14A and 14B ) and stretching the balloon under the force of the spring. Similar to the spring 1402, the force of the spring 1450 can be selected to move the inner shaft 106 toward a proximal position to collapse the balloon 108 and crimp the prosthetic valve thereon. The crimped prosthetic valve can hold the inner shaft 106 in a proximal position until the balloon is inflated, at which point the inner shaft 106 can be moved to a distal position to stretch the balloon under the biasing force of the spring. In other embodiments, the inflated balloon 108 can hold the inner shaft 106 in a proximal position (preventing the balloon from stretching) against the biasing force of the spring 1450, but allow distal movement of the inner shaft 106 as the balloon contracts under the spring force. Thus, in this manner, the balloon stretches as it contracts.

[0088] In some examples, piston displacement can be passively and / or actively actuated. For example, during balloon deflation, the piston is displaced distally by a passive force (e.g., from a biasing device (e.g., spring 1402 or 1450) or a vacuum force) to a first distal position, thereby resulting in a first amount of balloon stretch. If further balloon stretch and a lower balloon profile are desired, a user can displace the piston further distally, for example, to a second distal position, by active manual adjustment. In one example, this can allow for maximum balloon stretch.

[0089] FIG. 17 illustrates an exemplary method 1700 of manipulating the inflation hub assembly to adjust the balloon profile of a balloon catheter during delivery of a prosthetic valve and subsequent balloon retrieval.

[0090] The method includes, in step 1702, actuating or moving a piston of the hub assembly while the balloon is deflated prior to crimping the prosthetic valve 114 onto the balloon 108. In one example, the proximal position includes the piston head 902 abutting the inner rib 1002 of the cap 730 (e.g., as shown in FIG. 13B ). Actuating or moving the piston to the proximal position includes providing the balloon with a larger (more elongated) balloon profile.

[0091] In some embodiments, the initial proximal position of the piston 708 can be one in which the piston head 902 is spaced slightly distally from the rib 1002 so that the piston head does not abut the rib 1002. This allows for proximal movement of the piston 708 at certain times during the implantation procedure, as described further below.

[0092] In this state, the balloon 108 may be folded around the proximal and distal stops 120, 122, as shown in step 1704, and the prosthetic valve 114 may be radially crimped around the balloon 108, as shown in step 1706. In some embodiments, the balloon 108 may be pre-folded during manufacturing and shipped to the end user in the folded state. The end user (e.g., a physician) may remove the delivery device from its sterile packaging and then crimp the prosthetic valve onto the folded, deflated balloon. In other embodiments, the prosthetic valve 114 may be crimped onto the balloon 108 at the manufacturing site and shipped to the end user with the prosthetic valve pre-crimped onto the balloon.

[0093] Once the prosthetic valve 114 is crimped onto the balloon, the physician may insert the prosthetic valve and delivery catheter into the patient's vasculature and advance the prosthetic valve to the desired implantation site, as shown in step 1708. For example, if replacing a native aortic valve, the prosthetic valve and delivery device may be inserted into the aorta via an incision in the femoral artery and advanced through the descending aorta, the aortic arch, and the ascending aorta to the prosthetic valve 114, which may be positioned within the native aortic valve. Prior to crossing the native aortic valve, if the initial position of the piston head 902 is away from the ribs 1002, the user may pull the piston proximally to bring the shoulders 120, 122 closer to the adjacent ends of the prosthetic valve, thereby minimizing or closing the gap between the ends of the prosthetic valve and the shoulders 120, 122, which may facilitate crossing the native valve.

[0094] At the desired implantation site, the prosthetic valve may be expanded by inflating the balloon 108, as shown in step 1710. If the initial position of the piston head 902 is spaced away from the ribs 1002, positive pressure within the manifold 706 may move the piston proximally until it contacts the ribs 1002, thereby facilitating full inflation of the balloon.

[0095] After deploying the prosthetic valve, the balloon 108 is then deflated by withdrawing the inflation fluid from the balloon, as shown in step 1712 .

[0096] At step 1714, the method includes actuating a piston of the hub assembly to a distal position during or after the balloon is deflated to extend the balloon. Actuating the piston to a distal position may include a user (e.g., a physician or technician) manually and / or actively actuating the piston via a biasing element and / or vacuum force within manifold 706, as previously described. At step 1716, the delivery device may be removed from the body.

[0097] In some embodiments, piston 708 and / or cap 730 can have a locking mechanism that can be selectively actuated to hold the piston in a distal position during removal of the delivery device from the patient's body. In one embodiment, as shown in FIG. 18C , piston stem 904 can include a notch 919 that communicates with groove 906 in which rib 1002 of cap 730 is located. As shown in FIG. 18C , when piston 708 is moved distally (in the direction of arrow 921) to expand the balloon, groove 906 moves relative to rib 1002 until rib 1002 is located at the distal end of the groove adjacent notch 919. Piston 708 can then be rotated relative to cap 730 (in the direction of arrow 923) to position rib 1002 within notch 919. When the rib 1002 enters the notch 919, the notch 919 prevents axial movement of the piston 708 relative to the cap 730 (and manifold 706), thereby fixing the position of the inner shaft 152 and holding the balloon in an extended state when the delivery device is withdrawn from the body.

[0098] Figures 19A and 19B show another embodiment of a delivery device 1500. The delivery device 1500 includes many of the same features as the delivery devices described above in Figures 3-5 and 7-14B. Accordingly, like components in Figures 19A and 19B and Figures 3-5 and 7-14B are given the same reference numerals and will not be described in detail here.

[0099] The delivery device 1500 in the illustrated embodiment includes an inflation hub assembly with a manifold 1502, a cap 1504, a seal member 1506, and a hub 1508. The manifold 1502 includes a body in the form of a central shaft 1510 defining a main lumen 1512. The manifold further includes an inflation port 1514 defining an inflation lumen 1516 in communication with the main lumen 1512. In some embodiments, the manifold 1502 can be disposed within a handle (e.g., handle 102) similar to the configuration shown in FIG. 7, with the inflation port 1514, the proximal end of the shaft 1510, the cap 1504, the proximal end of the shaft 106, and the hub 1508 positioned outside the handle for user access. In other embodiments, the manifold 1502 can function as the handle.

[0100] The proximal end of the outer shaft 104 extends into the enlarged distal section of the main lumen 1512 and may be secured thereto by press fit, welding, adhesives, etc. The inner shaft 106 extends through the main lumen 1512, the seal member 1506, and the cap 1504 and may be secured to a hub 1508 proximal to the cap 1504. Similar to FIG. 15 , the midshaft 105 may be omitted and the proximal shoulder 120 may be attached to the outer shaft 104, defining an inflation pathway between the inner shaft 106 and the outer shaft 104. The main lumen 1512 may be in fluid communication with a fluid pathway through which inflation fluid may be delivered to the balloon 108 from an inflation port 1514.

[0101] The inner shaft 106 can move proximally and distally relative to the outer shaft 104 and manifold 1502 to adjust the length of the balloon 108, as previously described. The cap 1504 is attached to the proximal end of the shaft 1510 and is configured to selectively actuate the seal member 1506 to resist movement of the inner shaft 106 as needed during the implantation procedure. In the illustrated embodiment, the cap 1504 is threadably coupled to the proximal end of the shaft 1510; for example, the cap 1504 can have female threads that engage with male threads on the proximal end of the shaft 1510, as shown. Alternatively, the cap can have male threads that engage with female threads on the proximal end of the shaft 1510. In either case, rotation of the cap 1504 relative to the shaft 1510 moves the cap axially relative to the shaft (proximally or distally, depending on the direction of rotation).

[0102] The cap 1504 has an inner portion 1520 (which may be a cylindrical wall) that supports a seal member 1506. The seal member 1506 is disposed in the proximal section of the main lumen 1512 and is captured between the cap's inner portion 1520 and a radially extending wall or shoulder 1522 of the main lumen. The seal member 1506 is cylindrical as shown and may be formed from an elastomeric material that allows for linear and radial compression of the seal member. The seal member 1506 may be made from any of a variety of elastomers, such as silicone rubber.

[0103] To secure the axial position of the inner shaft 106 relative to the outer shaft 104, the cap 1504 is rotated in a first direction (e.g., clockwise) to move the cap distally on the shaft 1510, forcing the inner portion 1520 against the seal member 1506. This causes the seal member to be linearly compressed between the inner portion 1520 and the shoulder 1522 and radially inward relative to the inner shaft 106. The force of the seal member 1506 against the outer surface of the inner shaft 106 holds the inner shaft 106 against axial movement relative to the outer shaft 104, thus preventing adjustment of the balloon length. In this manner, the cap functions as a retention mechanism for selectively holding the inner shaft 106 against axial movement relative to the outer shaft 106.

[0104] Rotating the cap 1504 in a second direction opposite the first direction (e.g., counterclockwise) may move the cap proximally on the shaft 1510 and away from the seal member 1506, returning the seal member to its undeformed state. In the undeformed state, the inner shaft 106 can easily move relative to the outer shaft 104 to adjust the length of the balloon 108.

[0105] 19A shows the seal member 1506 in a locked (deformed) state holding the inner shaft 106 in a proximal position; as previously described, the balloon may be folded about the shoulders 120, 122, and a prosthetic valve (not shown) may be crimped onto the balloon. In this state, the delivery device and prosthetic valve may be inserted into the patient's vasculature and advanced to the intended implantation site (e.g., the native aortic valve). Prior to inflating the balloon 108 to deploy the prosthetic valve, the cap 1504 may be loosened to return the seal member to its undeformed state, allowing the inner shaft to move during balloon inflation.

[0106] After expanding the prosthetic valve, or during inflation of the balloon, the inner shaft 106 can be moved to a distal position (FIG. 19B) to stretch the balloon, and then the cap 1504 can be tightened to compress the seal member 1506 and hold the position of the inner shaft 106 during removal of the delivery device from the patient's body, as shown in FIG.

[0107] In an alternative embodiment, instead of rotating the cap, the cap 1504 can be configured to translate relative to the shaft 1510 by manually pushing or pulling the cap relative to the shaft 1510. Pushing the cap 1504 distally deforms the seal member and holds the inner shaft, and pulling the cap 1504 proximally returns the seal member to its undeformed state, allowing movement of the inner shaft.

[0108] In alternative embodiments, the cap 1504 and the seal member 1506 may be mounted to the hub assembly 700 to selectively retain movement of the piston 708. For example, the cap 730 may be configured to be rotatable relative to the shaft 710 to compress the seal member 1506 (disposed in the lumen 726) against the piston 708 and retain the piston 708 (and inner shaft 106) against axial movement.

[0109] FIG. 20 shows an inflation hub assembly 1600 according to another embodiment, which may be implemented in any of the delivery devices disclosed herein. The hub assembly 1600 comprises an inflation manifold 1602. The manifold 1602 includes a body in the form of a central shaft 1610 defining a main lumen 1612. The manifold further includes an inflation port 1614 defining an inflation lumen 1616 in communication with the main lumen 1612. In some embodiments, the manifold 1602 may be disposed in a handle (e.g., handle 102) with the inflation port 1614 and the proximal end of the shaft 1610 disposed outside the handle for access by a user, similar to the configuration shown in FIG. 7. In other embodiments, the manifold 1602 may function as the handle.

[0110] The proximal end 152 of the inner shaft 106 may be secured, such as by adhesive, welding, or a press fit, to a movable piston 1618 disposed in the proximal section 1620 of the main lumen 1612. The proximal end of the shaft 104 may be secured, such as by adhesive, welding, or a press fit, to the distal end of the shaft 1610 of the manifold 1602. One or more seal members 1622 may be disposed around the piston 1618 to form a fluid-tight seal with the inner surface of the proximal section 1620 of the lumen 1612. The seal members 1622 may be X-rings, O-rings, or other suitable configurations. The distal ends of the shafts 104, 106 may be coupled to respective ends of the balloon 108, for example, as shown in FIGS. 19A-19B and described above. The piston 1618 is movable proximally and distally within the proximal section 1620 of the lumen 1612, causing corresponding movement of the shaft 106 relative to the shaft 104 and correspondingly changing the length of the balloon 108.

[0111] In the illustrated embodiment, the proximal end 152 of the inner shaft 106 and the piston are not accessible for manipulation by the user. For example, as shown in FIG. 20 , the proximal end 152 of the inner shaft 106 terminates at a location within the manifold 1602, and the piston 1618 is disposed entirely within the manifold 1602. In some embodiments, the manifold 1602 is disposed within a handle (e.g., the handle 102), and the proximal end 152 of the inner shaft 106 may extend outside of the manifold 1602 but terminate at a location within the handle such that it is not accessible to the user during normal use.

[0112] Thus, in this embodiment, movement of the piston 1618 (i.e., adjustment of the balloon length) is completely passive; e.g., movement of the piston occurs through normal use of the delivery device and does not require manual application of force by the user. For example, during balloon inflation, positive pressure within the lumen 1612 may move the piston 1618 proximally to facilitate full balloon inflation. During balloon deflation, negative pressure (vacuum) within the lumen 1612 may move the piston 1618 distally, thereby stretching the balloon 108. Additionally, withdrawing the delivery device through the introducer sheath may create a frictional force against the balloon 108, pulling the distal end of the balloon distally against the proximal end of the balloon, further stretching the balloon and / or helping to maintain the balloon's stretched state as it is withdrawn from the introducer sheath.

[0113] [Additional Examples of the Disclosed Technology] In view of the above-described implementations of the disclosed subject matter, the present application discloses the following additional examples: It should be noted that one feature of an example alone, or two or more features of an example taken in combination, and optionally in combination with one or more features of one or more additional examples, are additional examples included in this application.

[0114] Example 1: A delivery apparatus for an implantable prosthetic device, comprising: The handle and a first shaft extending distally from the handle; a second shaft extending distally from the handle, the first shaft extending through the second shaft and being axially movable relative to the second shaft; an inflatable balloon having a proximal end and a distal end, the proximal end of the balloon being coupled to the distal end of the second shaft and the distal end of the balloon being coupled to the distal end of the first shaft; an inflation hub assembly including an inflation manifold and a piston, the inflation manifold including a body defining a main lumen extending therethrough and an inflation port defining an inflation port lumen in fluid communication with the main lumen, the piston extending within the main lumen and slidable relative to the inflation manifold; 1. A delivery apparatus for an implantable prosthetic device comprising: a proximal end of the first shaft coupled to the piston, and a proximal end of the second shaft coupled to the inflation manifold body or the handle; A delivery device wherein the piston is movable proximally and distally relative to the inflation manifold such that distal movement of the piston causes distal movement of the first shaft relative to the second shaft, which increases the length of the balloon, and further such that proximal movement of the piston causes proximal movement of the first shaft relative to the second shaft, which decreases the length of the balloon.

[0115] [Example 2] Any of the examples described herein, wherein the piston includes a piston head and a piston stem, the piston head includes an annular groove, an annular sealing member is disposed within the annular groove, and the sealing member establishes a seal against the inner surface of the main lumen of the inflation manifold.

[0116] [Example 3] Any of the examples described herein, wherein the proximal end of the first shaft extends within the lumen of the piston and is fixed within the lumen of the piston, as described in Example 1 or 2.

[0117] [Example 4] Any of the examples described herein, wherein the main lumen of the inflation manifold includes a radially protruding inner wall shaped to limit distal movement of the piston within the main lumen.

[0118] [Example 5] Any of the examples described herein, further comprising a cap member disposed at the proximal end of the inflation manifold body, the cap member including a protrusion disposed to limit proximal movement of the piston within the main lumen.

[0119] [Example 6] Any of the examples described herein, wherein the protrusion extends radially into the main lumen of the inflation manifold.

[0120] [Example 7] Any of the examples described herein, wherein the protrusion includes a rib disposed within and extending into an axially extending groove formed in the outer surface of the piston, the rib preventing rotation of the piston relative to the cap member.

[0121] [Example 8] Any of the examples described herein, a delivery device described in any one of Examples 5 to 7, wherein the cap member forms a snap-fit connection with the proximal end of the body of the inflation manifold.

[0122] [Example 9] Any of the examples described herein, wherein the cap member includes a plurality of openings, and the proximal end of the inflation manifold body includes a plurality of protrusions dimensioned to extend into the openings to form a snap-fit connection.

[0123] [Example 10] Any of the examples described herein, wherein the delivery device is described in any one of Examples 1 to 4, further comprising a cap member disposed at the proximal end of the inflation manifold body, the cap member configured to allow axial movement of the piston and first shaft relative to the cap member in proximal and distal directions and to resist rotational movement of the piston and first shaft relative to the cap member.

[0124] [Example 11] Any of the examples described herein, wherein the main lumen is fluidly connected to a fluid pathway between the first shaft and the second shaft, and is in turn fluidly connected to the balloon such that inflation fluid introduced into the inflation port lumen can flow through the main lumen, the fluid pathway, and into the balloon, thereby inflating the balloon.

[0125] [Example 12] Any of the examples described herein, wherein the inflation hub assembly is configured such that drawing inflation fluid from the balloon through the inflation port is effective to establish a vacuum within the inflation manifold that moves the piston and first shaft distally.

[0126] [Example 13] Any of the examples described herein, a delivery device described in any one of Examples 1 to 12, further comprising a biasing member configured to bias the first shaft to move distally relative to the second shaft.

[0127] [Example 14] Any of the examples described herein, the delivery device of Example 13, wherein the bias member comprises a spring.

[0128] [Example 15] Any of the examples described herein, wherein the spring is disposed around a first shaft within the balloon.

[0129] [Example 16] Any of the examples described herein, wherein the spring is disposed around the piston.

[0130] [Example 17] Any of the examples described herein, a delivery device described in any one of Examples 1 to 16, wherein the main body of the inflation manifold is disposed within the handle.

[0131] [Example 18] A delivery device for an implantable prosthetic device, comprising: The handle and a first shaft extending distally from the handle; a second shaft extending distally from the handle, the first shaft extending through the second shaft and being axially movable distally and distally relative to the second shaft; an inflatable balloon having a proximal end and a distal end, the proximal end of the balloon being coupled to the distal end of the second shaft and the distal end of the balloon being coupled to the distal end of the first shaft; 1. A delivery apparatus for an implantable prosthetic device comprising: A delivery device wherein distal movement of the first shaft relative to the second shaft moves the distal end of the balloon away from the proximal end of the balloon, increasing the length of the balloon, and proximal movement of the first shaft relative to the second shaft moves the distal end of the balloon toward the proximal end of the balloon, decreasing the length of the balloon.

[0132] [Example 19] Any of the examples described herein, further including an inflation hub assembly having an inflation manifold and a piston, the inflation manifold having a main lumen extending therethrough, the piston extending within the main lumen and slidable relative to the inflation manifold, and the proximal end of the first shaft coupled to the piston, and the proximal end of the second shaft coupled to the inflation manifold or the handle such that axial movement of the piston relative to the inflation manifold is effective to cause axial movement of the first shaft relative to the second shaft.

[0133] [Example 20] Any of the examples described herein, the delivery device of Example 19 further includes a cap member disposed at the proximal end of the inflation manifold body, the cap member configured to allow axial movement of the piston and first shaft relative to the cap member in the proximal and distal directions and to resist rotational movement of the piston and first shaft relative to the cap member.

[0134] [Example 21] Any of the examples described herein, wherein the cap member includes a first engagement mechanism, the piston includes a second engagement mechanism configured to engage with the first engagement mechanism, and engagement of the first and second engagement mechanisms allows axial movement of the piston relative to the cap member and resists rotational movement of the piston relative to the cap member.

[0135] [Example 22] Any of the examples described herein, wherein the delivery device of Example 21, wherein the first engagement feature includes a radially protruding rib and the second engagement feature includes an axially extending groove on the outer surface of the piston, the groove shaped to receive the rib.

[0136] [Example 23] Any of the examples described herein, the delivery device of Example 22, wherein the rib limits proximal movement of the piston relative to the cap member.

[0137] [Example 24] Any of the examples described herein, wherein the delivery device is described in any one of Examples 19 to 23, wherein the main lumen includes a proximal lumen portion having a first diameter, a distal lumen portion having a second diameter smaller than the first diameter, and an internal lip between the proximal lumen portion and the distal lumen portion, the internal lip limiting distal movement of the piston within the proximal lumen portion.

[0138] [Example 25] Any of the examples described herein, wherein the delivery device of Example 19, wherein the main lumen is in fluid communication with the fluid pathway between the first shaft and the second shaft and is in fluid communication with the balloon such that inflation fluid introduced into the inflation port lumen of the inflation manifold can flow through the main lumen, the fluid pathway, into the balloon and inflate the balloon.

[0139] [Example 26] Any of the examples described herein, wherein the delivery device of Example 25 is configured such that drawing inflation fluid from the balloon through the inflation port lumen is effective to establish a vacuum within the inflation manifold that moves the piston and first shaft distally.

[0140] [Example 27] Any of the examples described herein, the delivery device of any one of Examples 18 to 26 further comprising a biasing member configured to bias the first shaft to move distally relative to the second shaft.

[0141] [Example 28] Any of the examples described herein, wherein the bias member comprises a spring. The delivery device of Example 27.

[0142] [Example 29] Any of the examples described herein, wherein the delivery device of Example 28, wherein the spring is disposed around the first shaft within the balloon.

[0143] [Example 30] Any example described in this specification, the delivery device described in Example 28, wherein a spring is disposed around the piston.

[0144] [Example 31] A handle and a first shaft extending distally from the handle; a second shaft extending distally from the handle, the first shaft extending through the second shaft and being axially movable distally and distally relative to the second shaft; a biasing member configured to apply a biasing force to bias the first shaft to move distally relative to the second shaft; an inflatable balloon having a proximal end and a distal end, the proximal end of the balloon being coupled to the distal end of the second shaft and the distal end of the balloon being coupled to the distal end of the first shaft; 1. A delivery apparatus for an implantable prosthetic device comprising: A delivery device wherein distal movement of the first shaft relative to the second shaft moves the distal end of the balloon away from the proximal end of the balloon, increasing the length of the balloon, and proximal movement of the first shaft relative to the second shaft moves the distal end of the balloon toward the proximal end of the balloon, decreasing the length of the balloon.

[0145] [Example 32] Any of the examples described herein, wherein the bias member comprises a spring.

[0146] [Example 33] Any of the examples described herein, wherein the delivery device of Example 32, wherein the spring is disposed around the first shaft within the balloon.

[0147] [Example 34] Any of the examples described herein, wherein the delivery device of Example 33, wherein the spring is positioned within a proximal shoulder within the balloon, and the proximal shoulder is coupled to a second shaft.

[0148] [Example 35] Any of the examples described herein, including a delivery device as described in Example 34, wherein one end of the spring is supported on the proximal shoulder and the other end of the spring is supported on a collar disposed on the first shaft.

[0149] [Example 36] Any of the examples described herein, further comprising an inflation hub assembly including an inflation manifold and a piston, wherein the inflation manifold has a main lumen extending therethrough, the piston extends within the main lumen and is slidable relative to the inflation manifold, the proximal end of the first shaft is coupled to the piston, and the proximal end of the second shaft is coupled to the inflation manifold or the handle such that axial movement of the piston relative to the inflation manifold is effective to axial movement of the first shaft relative to the second shaft.

[0150] [Example 37] Any of the examples described herein, wherein the delivery device is described in Example 36, which cites Example 32, and wherein the spring is disposed around the piston.

[0151] [Example 38] In any of the examples described herein, a method of implanting a prosthetic heart valve using the delivery device of any one of Examples 1 to 37, comprising: delivering the prosthetic heart valve to the patient's heart while the prosthetic heart valve is in a radially compressed state on a balloon of a delivery device; inflating the balloon to radially expand the prosthetic heart valve against surrounding tissue within the heart; inflating the balloon radially to the prosthetic heart valve and then deflating the balloon; Increasing the length of the balloon during or after the operation of deflating the balloon; A method comprising:

[0152] [Example 39] A method for implanting a prosthetic heart valve, comprising: inserting a distal end of a delivery device and a prosthetic heart valve into a patient's vascular system, the prosthetic heart valve being radially compressed on a balloon of the delivery device, the delivery device comprising a first shaft and a second shaft, the first shaft extending through the first shaft, a proximal end of the balloon coupled to a distal end of the second shaft, and a distal end of the balloon coupled to a distal end of the first shaft; advancing the prosthetic heart valve to an implantation site in the heart; inflating the balloon to radially expand the prosthetic heart valve against surrounding tissue within the heart; radially expanding the balloon to the prosthetic heart valve and then deflating the balloon; moving the first shaft distally relative to the second shaft while deflating the balloon to increase the length of the balloon; The method comprising:

[0153] [Example 40] Any of the examples described herein, wherein the movement of the first shaft in the distal direction relative to the second shaft is caused by a biasing force of a biasing element.

[0154] [Example 41] The method of Example 40, in any example described herein, wherein the biasing element comprises a spring.

[0155] [Example 42] Any of the examples described herein, wherein the spring is disposed within a balloon.

[0156] [Example 43] Any of the examples described herein, wherein the spring is disposed on a piston coupled to the proximal end of the first shaft.

[0157] [Example 44] Any of the examples described herein, wherein the delivery device further includes a handle and an inflation hub assembly having an inflation manifold and a piston, the inflation manifold having a main lumen extending therethrough, the piston extending within the main lumen and slidable relative to the inflation manifold, and further wherein the proximal end of the first shaft is coupled to the piston and the proximal end of the second shaft is coupled to the inflation manifold or the handle. A method according to any one of Examples 39 to 43.

[0158] [Example 45] Any of the examples described herein, wherein the movement of the first shaft distally relative to the second shaft is caused by manually moving the piston relative to the inflation manifold, as described in Example 44.

[0159] [Example 46] Any of the examples described herein, wherein the movement of the first shaft distally relative to the second shaft is caused by drawing inflation fluid from the balloon through the inflation manifold to establish a vacuum within the inflation manifold, moving the piston and the first shaft distally. The method of Example 44 or 45.

[0160] [Example 47] Any of the examples described herein, wherein the piston includes a piston head and a piston stem, the piston head includes an annular groove, an annular sealing member is disposed in the annular groove, and the sealing member establishes a seal against the inner surface of the main lumen of the expansion manifold.

[0161] [Example 48] Any of the examples described herein, wherein the proximal end of the first shaft extends within the lumen of the piston and is fixed within the lumen of the piston, as described in any one of Examples 44 to 47.

[0162] [Example 49] Any of the examples described herein, wherein the main lumen of the inflation manifold includes a radially protruding inner wall shaped to limit distal movement of the piston within the main lumen, as described in any one of Examples 44 to 48.

[0163] [Example 50] Any of the examples described herein, further comprising a cap member disposed at the proximal end of the inflation manifold, the cap member comprising a protrusion disposed to limit proximal movement of the piston within the main lumen, as described in any one of Examples 44 to 49.

[0164] [Example 51] Any of the examples described herein, wherein the protrusions extend radially into the main lumen of the inflation manifold.

[0165] [Example 52] Any of the examples described herein, wherein the protrusion includes a rib extending into an axially extending groove formed in the outer surface of the piston, the rib preventing rotation of the piston relative to the cap member.

[0166] [Example 53] A method according to any one of 50 to 52, in any example described herein, wherein the cap member is configured to allow axial movement of the piston and first shaft relative to the cap member in the proximal and distal directions and to resist rotational movement of the piston and first shaft relative to the cap member.

[0167] [Example 54] A handle and a first shaft extending distally from the handle; a second shaft extending distally from the handle, the first shaft extending through the second shaft and being axially movable distally and distally relative to the second shaft; an inflatable balloon having a proximal end and a distal end, the proximal end of the balloon being coupled to the distal end of the second shaft and the distal end of the balloon being coupled to the distal end of the first shaft; a retention mechanism configured to selectively retain the first shaft against distal and proximal movement relative to the second shaft; 1. A delivery apparatus for an implantable prosthetic device comprising: A delivery device wherein distal movement of the first shaft relative to the second shaft moves the distal end of the balloon away from the proximal end of the balloon, increasing the length of the balloon, and proximal movement of the first shaft relative to the second shaft moves the distal end of the balloon toward the proximal end of the balloon, decreasing the length of the balloon.

[0168] [Example 55] Any of the examples described herein, further including an inflation hub assembly having an inflation manifold and a piston, the inflation manifold having a main lumen extending therethrough, the piston extending within the main lumen and slidable relative to the inflation manifold, and the proximal end of the first shaft coupled to the piston, and the proximal end of the second shaft coupled to the inflation manifold or the handle such that axial movement of the piston relative to the inflation manifold is effective to cause axial movement of the first shaft relative to the second shaft.

[0169] [Example 56] Any of the examples described herein, wherein the retention mechanism includes a cap member disposed at the proximal end of the inflation manifold, the cap member configured to allow axial movement of the piston and the first shaft relative to the cap member in proximal and distal directions when the piston is in a first rotational orientation relative to the cap member, and the cap member configured to resist axial movement of the piston and the first shaft relative to the cap member when the piston is in a second rotational orientation relative to the cap member.

[0170] [Example 57] Any of the examples described in this specification, further comprising an inflation manifold containing a seal member, wherein the retention mechanism includes a cap member disposed at a proximal end of the inflation manifold, the first shaft extends through the inflation manifold, the seal member, and the cap member, and the cap member is configured to selectively compress the seal member relative to the inner shaft to retain the inner shaft against axial movement relative to the second shaft.

[0171] In view of the many possible embodiments to which the principles of the disclosed invention may be applied, it should be recognized that the illustrated embodiments are merely preferred examples of the invention and should not be considered as limiting the scope of the invention. Rather, the scope of the invention is defined by the following claims. We therefore claim as our invention all that comes within the scope and spirit of the following claims. [Explanation of symbols]

[0172] 10 Artificial heart valves 12 Stents, frames 14 Valvular structure 15 Inlet end 16 Inner skirt 17 Middle part 18 Outer sealing member, outer skirt 19 Outflow end 22 commissure 22 40 Leaflets 50 Artificial Valve 52 Stents, frames 54 Valvular Structure 56 Sealing material 60 leaflets 62 incoming edges 64 commissure 66 Inlet end 68 Outlet end 72 Pillars 74 columns, opening 76 Inner layer 78 Outer layer 100 Delivery device 102 Handle 104 outer shaft 105 Intermediate shaft 106 Inner Shaft 108 Balloon 109 Inflation Fluid 110 Nosecone 112 distal end 114 Artificial Valves 118 Balloon Shoulder Assembly 120 Proximal Shoulder 122 Distal Shoulder 124 central longitudinal axis 126 Proximal end 128 Distal end 130 Valve holding part 132 Annular Space 134 Knob 150 proximal end 200 Inflation Hub 202 Inflation port 204 Proximal Leg 600 Inflation Hub 602 Main Unit 604 Distal end 606 Proximal end 608 Inflation Port 610 Inflation Lumen 612 Main lumen 700 Inflation Hub Assembly 706 Inflation manifold 708 Piston 710 Central Shaft 712 Main lumen 714 Inflation Port 716 Inflation Lumen 718 Distal end 720 Proximal end 724 Distal Section, Distal Bore 726 Proximal Section, Proximal Bore 728 Flanges, gussets 730 Cap parts, caps 740 Adhesive Porthole 744 Mouth part 746 Male thread 748 Protrusion 750 slots 752 stickers 902 Piston head 903 Seal gland, annular groove 904 Piston stem 905a Distal piston head area 905b Proximal piston head area 910 Proximal end 912 Male thread 913 Flange, grip mechanism 914 Bore, Ridge 916 Adhesive Porthole 917 Notch 1001 Cylindrical Wall 1002 Rib 1003 Hollow interior space 1004 Windows and openings 1006 Notch, Slot 1008 segments 1010 proximal end 1012 distal end 1200, 1300 balloon profile 1400 Delivery Device 1402 Spring 1404 Proximal Shoulder 1406 Interior 1450 Tension spring 1452 Rib 1500 delivery device 1502 Manifold 1504 Cap 1506 Sealing material 1508 Hub 1510 Central Shaft 1512 Main lumen 1514 Inflation Port 1516 Inflation Lumen 1520 Inner part 1522 Wall, Shoulder 1600 Inflation Hub Assembly 1602 Inflation manifold 1610 Central Shaft 1612 Main lumen 1614 Inflation Port 1616 Inflation Lumen 1618 Piston 1620 Proximal Section

Claims

1. A handle (102); a first shaft (106) extending distally from said handle (102); a second shaft (104; 105) extending distally from the handle (102), wherein the first shaft (106) extends through the second shaft (104; 105) and is axially movable relative to the second shaft (104; 105); an inflatable balloon (108) having a proximal end (126) and a distal end (128), the proximal end (126) of the balloon (108) being coupled to the distal end of said second shaft (104; 105) and the distal end (128) of the balloon (108) being coupled to the distal end of said first shaft (106); an inflation hub assembly (700; 700'; 1600) comprising an inflation manifold (706; 1502; 1602) and a piston (708; 1618), said inflation manifold (706; 1502; 1602) comprising a body defining a main lumen (712; 1512; 1612) extending therethrough, and an inflation port defining an inflation port lumen in fluid communication with said main lumen (712; 1512; 1612), said piston (708; 1618) extending within said main lumen (712; 1512; 1612) and slidable relative to said inflation manifold (706; 1502; 1602); A delivery apparatus (100; 1400; 1500) for an implantable prosthetic device (10; 50; 114), comprising: a proximal end of the first shaft (106) coupled to the piston (708; 1618), and a proximal end of the second shaft (104; 105) coupled to the body of the inflation manifold (706; 1502; 1602) or the handle (102); A delivery device (100; 1400; 1500), characterized in that the piston (708; 1618) is movable proximally and distally relative to the inflation manifold (706; 1502; 1602), such that distal movement of the piston (708; 1618) causes distal movement of the first shaft (106) relative to the second shaft (104; 105), which increases the length of the balloon (108), and further, proximal movement of the piston (708; 1618) causes proximal movement of the first shaft (106) relative to the second shaft (104; 105), which decreases the length of the balloon (108).

2. 2. The delivery device (100; 1400; 1500) of claim 1, wherein the piston (708; 1618) comprises a piston head (902) and a piston stem (904), the piston head (902) comprises an annular groove (903), an annular sealing member (752) is disposed in the annular groove (903), and the annular sealing member (752) establishes a seal against an inner surface of a main lumen (712; 1512; 1612) of the inflation manifold (706; 1502; 1602).

3. 3. A delivery device (100; 1400; 1500) as described in claim 1 or 2, characterized in that the proximal end of the first shaft (106) extends into the lumen (915) of the piston (708; 1618) and is fixed within the lumen (915) of the piston (708; 1618).

4. 4. A delivery device (100; 1400; 1500) according to any one of claims 1 to 3, characterized in that the main lumen (712; 1512; 1612) of the inflation manifold (706; 1502; 1602) includes a radially protruding inner wall shaped to limit distal movement of the piston (708; 1618) within the main lumen (712; 1512; 1612).

5. 5. A delivery device (100; 1400; 1500) as claimed in any one of claims 1 to 4, further comprising a cap member (730; 1504) disposed at the proximal end of the body of the inflation manifold (706; 1502; 1602), the cap member (730; 1504) including a protrusion arranged to limit proximal movement of the piston (708; 1618) within the main lumen (712; 1512; 1612), the protrusion extending radially into the main lumen (712; 1512; 1612) of the inflation manifold (706; 1502; 1602).

6. 6. The delivery device (100; 1400; 1500) of claim 5, wherein the cap member (730; 1504) includes a rib (1002) disposed and extending within an axially extending groove (903) formed in the outer surface of the piston (708; 1618), the rib (1002) preventing rotation of the piston (708; 1618) relative to the cap member (730; 1504).

7. 7. A delivery device (100; 1400; 1500) according to claim 5 or 6, characterized in that the cap member (730; 1504) forms a snap-fit connection with the proximal end of the body of the inflation manifold (706; 1502; 1602).

8. 8. The delivery device (100; 1400; 1500) of claim 7, wherein the cap member (730; 1504) includes a plurality of openings (1004), and the proximal end of the body of the inflation manifold (706; 1502; 1602) includes a plurality of protrusions (748) dimensioned to extend into the openings (1004) to form a snap-fit connection.

9. 5. The delivery device (100; 1400; 1500) of any one of claims 1 to 4, further comprising a cap member (730; 1504) disposed at a proximal end of the body of the inflation manifold (706; 1502; 1602), the cap member (730; 1504) configured to allow axial movement of the piston (708; 1618) and the first shaft (106) relative to the cap member (730; 1504) in proximal and distal directions and to resist rotational movement of the piston (708; 1618) and the first shaft (106) relative to the cap member (730; 1504).

10. 10. The delivery device (100; 1400; 1500) of any one of claims 1 to 9, wherein the main lumen (712; 1512; 1612) is in fluid communication with a fluid pathway between the first shaft (106) and the second shaft (104; 105), and is in turn in fluid communication with the balloon (108) such that inflation fluid introduced into the inflation port lumen can flow through the main lumen (712; 1512; 1612), the fluid pathway, and into the balloon (108) to inflate the balloon (108).

11. 11. The delivery device (100; 1400; 1500) of claim 10, wherein the inflation hub assembly (700; 700'; 1600) is configured such that drawing inflation fluid from the balloon (108) through the inflation port is effective to establish a vacuum within the inflation manifold (706; 1502; 1602) that moves the piston (708; 1618) and first shaft (106) distally.

12. 12. The delivery device (100; 1400; 1500) of any one of claims 1 to 11, further comprising a biasing member (1402; 1450) configured to bias the first shaft (106) to move distally relative to the second shaft (104; 105).

13. 13. The delivery device (100; 1400; 1500) of claim 12, wherein the biasing member (1402; 1450) comprises a spring (1402; 1450).

14. 14. The delivery device (100; 1400; 1500) of claim 13, wherein the spring (1402; 1450) is arranged around the first shaft (106) within the balloon (108) or around the piston (708; 1618).

15. A delivery device (100; 1400; 1500) according to any one of claims 1 to 14, characterized in that the body of the inflation manifold (706; 1502; 1602) is arranged within the handle (102).

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