Blow-molded balloon shoulder assembly for a transcatheter delivery device

Abstract

A balloon shoulder assembly for a transcatheter delivery device, such as a balloon catheter, is disclosed. The balloon shoulder assembly includes a proximal balloon shoulder having a proximal collar portion extending radially outward from a proximal shaft portion relative to a central axis of the balloon shoulder assembly, and a distal balloon shoulder having a distal collar portion extending radially outward from a distal shaft portion. Each of the proximal and distal balloon shoulders is hollow and comprises a compressible blow-molded material.

Description

[Technical Field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims the benefit of U.S. Provisional Patent Application No. 62 / 928,951, filed October 31, 2019, entitled "BLOW MOLDED BALLOON SHOULDER ASSEMBLY FOR A TRANSCATHETER DELIVERY DEVICE," which is incorporated herein by reference in its entirety.

[0002] The present disclosure relates to embodiments of a blow molded balloon shoulder assembly for a balloon catheter for implanting a medical device, such as a prosthetic heart valve. [Background technology]

[0003] Intravascular delivery devices are used in a variety of 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, blood vessels, the esophagus, the trachea, any portion of the gastrointestinal tract, and lymphatic vessels, to name a few. In one specific example, a prosthetic heart valve can 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 an implantation site within the heart. The prosthetic valve is then expanded to its functional size, such as by inflating a balloon to which it is attached or by deploying the prosthetic valve from a sheath in the delivery device so that the prosthetic valve can self-expand to its functional size.

[0004] Balloon-expandable prosthetic valves may be preferred for replacing calcified native valves because the catheter balloon can apply sufficient expansive force to expand and anchor the prosthetic valve frame against the surrounding calcified tissue. In one known technique for delivering a prosthetic heart valve, the prosthetic heart valve can be crimped onto a valve-retaining portion of a delivery catheter balloon before insertion into a patient. The valve-retaining portion can be formed with distal and proximal balloon shoulders located inside the balloon and attached to the shaft of the delivery catheter. The distal and proximal balloon shoulders can help retain the prosthetic heart valve on the valve-retaining portion of the balloon during delivery through the patient's vasculature. The balloon shoulders are typically formed by injection molding, resulting in a stiff, inflexible, and thick part. These characteristics of the balloon shoulders make it difficult to insert the balloon shoulders into the legs of the balloon during balloon catheter manufacturing. Additionally, the increased stiffness and thickness of the injection-molded balloon shoulder can result in gaps forming between the shoulder and the valve during successful navigation of the delivery catheter through the sheath of the delivery system within bends in the patient's vasculature on the way to the targeted treatment site, resulting in potential damage to the sheath. Still further, the increased stiffness and size of the injection-molded shoulder can result in greater force being used to withdraw the delivery catheter through the sheath after deployment of the valve. [Prior art documents] [Patent documents]

[0005] [Patent Document 1] U.S. Patent No. 6,730,118 [Patent Document 2] WIPO International Patent Application Publication No. 2018 / 222799 [Patent Document 3] U.S. Patent Application Publication No. 2012 / 0239142 [Patent Document 4] U.S. Patent Application Publication No. 2018 / 0028310 [Patent Document 5] U.S. Patent Application Publication No. 2007 / 0005131 [Patent Document 6] U.S. Patent Application Publication No. 2009 / 0281619 [Patent Document 7] U.S. Patent Application Publication No. 2013 / 0030519 [Patent Document 8] U.S. Patent Application Publication No. 2017 / 0065415 [Patent Document 9] U.S. Patent No. 8,007,992 [Patent Document 10] U.S. Patent No. 8,357,387 Summary of the Invention [Problem to be solved by the invention]

[0006] Therefore, it is desirable to have an improved balloon shoulder on a balloon catheter for delivering implantable medical devices such as prosthetic heart valves. [Means for solving the problem]

[0007] Disclosed herein are balloon catheters, balloon shoulder assemblies for balloon catheters, and related methods for forming the balloon shoulder assemblies and balloon catheters. The balloon catheters can be used to deliver medical devices, tools, drugs, or other therapies to a location within a subject's body. In some embodiments, the balloon catheters can be used to deliver implantable medical devices, such as prosthetic heart valves, to a target site in a patient, such as the heart. In some embodiments, the balloon catheters 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. The balloon catheter can include a balloon shoulder assembly that is positioned within the main balloon of the balloon catheter and forms a valve-retaining portion onto which a prosthetic heart valve (or other implantable medical device, such as a stent) can be crimped. In some embodiments, the balloon shoulder assembly can include a proximal balloon shoulder and a distal balloon shoulder, which can be blown molded as a unitary piece with a central connecting portion or can be blown molded as separate proximal and distal balloon shoulders. Additionally, in some embodiments, the blown balloon shoulder can be inflatable with various fluids. In other embodiments, the blown balloon shoulder can be non-inflatable and instead configured to provide structural support for a balloon placed therein when the blown balloon shoulder is uninflated.

[0008] In one exemplary embodiment, a balloon shoulder assembly for a balloon catheter can include a proximal balloon shoulder including a proximal collar portion extending radially outward from a proximal shaft portion relative to a central axis of the balloon shoulder assembly, and a distal balloon shoulder including a distal collar portion extending radially outward from a distal shaft portion, hi some embodiments, each of the proximal and distal balloon shoulders is hollow and comprises a compressible blow-molded material.

[0009] In some embodiments, the outer wall of the proximal balloon shoulder and the outer wall of the distal balloon shoulder are configured to compress or expand under an applied pressure and return to a non-compressed or non-expanded state when the applied pressure is removed.

[0010] In some embodiments, the proximal collar portion is spaced axially from the distal collar portion relative to the central axis.

[0011] In some embodiments, the proximal balloon shoulder and the distal balloon shoulder are molded as a unitary piece with a central connecting portion that is disposed between and connects the proximal and distal collar portions.

[0012] In some embodiments, the proximal balloon shoulder extends between the proximal collar portion and the central connecting portion and further comprises a proximal transition portion connecting the proximal collar portion and the central connecting portion, the proximal transition portion reducing in diameter from the proximal collar portion to the central connecting portion, and the distal balloon shoulder extends between the distal collar portion and the central connecting portion and further comprises a distal transition portion connecting the distal collar portion and the central connecting portion, the distal transition portion reducing in diameter from the distal collar portion to the central connecting portion.

[0013] In some embodiments, the proximal balloon shoulder and the distal balloon shoulder are molded separately as two separate pieces.

[0014] In some embodiments, each of the proximal and distal balloon shoulders is inflatable.

[0015] In some embodiments, the proximal and distal balloon shoulders are not fluidly connected to one another and are independently inflatable.

[0016] In some embodiments, each of the proximal and distal balloon shoulders is non-inflatable.

[0017] In some embodiments, the proximal and distal balloon shoulders each have a wall thickness in the range of 0.0001 inches to 0.010 inches.

[0018] In some embodiments, the proximal collar portion has an open end opposite the open end of the distal collar portion.

[0019] In some embodiments, each of the proximal and distal collar portions is funnel-shaped with a wider end that flares radially outward from the narrower end, the narrower end of the proximal collar portion being connected to the proximal shaft portion, the narrower end of the distal collar portion being connected to the distal shaft portion, and the wider ends of the proximal and distal collar portions being positioned opposite each other and perpendicular to the central axis.

[0020] In some embodiments, the proximal and distal collar portions each have a bulbous shape with a wider central portion that narrows to two opposite ends.

[0021] In some embodiments, one or both of the proximal and distal collar portions comprise a central cylinder disposed between first and second tapered end portions, the first and second tapered end portions tapering in opposite directions from the central cylinder to one of the central connecting portion or the corresponding one of the proximal or distal shaft portions.

[0022] In some embodiments, one or both of the proximal and distal collar portions include a curved central portion disposed between a first tapered end portion and a second tapered end portion, the first tapered end portion and the second tapered end portion tapering in opposite directions from the central portion to one of the central connecting portion or the corresponding one of the proximal or distal shaft portions.

[0023] In some embodiments, one or both of the proximal and distal collar portions comprises an elongated tapered portion, a shorter tapered portion, and a central ring portion disposed between the elongated tapered portion and the shorter tapered portion.

[0024] In some embodiments, the balloon catheter is part of a transcatheter heart valve delivery system.

[0025] In some embodiments, the proximal and distal balloon shoulders are disposed within and configured to support an inflatable main balloon of the balloon catheter.

[0026] In another exemplary embodiment, a method of manufacturing a balloon catheter can include blow molding a balloon shoulder assembly comprising a proximal balloon shoulder and a distal balloon shoulder, and mounting the blow molded balloon shoulder assembly within the balloon catheter by placing the balloon shoulder assembly within an inflatable main balloon of the balloon catheter.

[0027] In some embodiments, the proximal balloon shoulder and the distal balloon shoulder are spaced apart axially relative to the central axis of the balloon catheter.

[0028] In some embodiments, the balloon shoulder assembly is positioned within the main balloon to form a device retention portion on the main balloon in the space separating the proximal and distal balloon shoulders.

[0029] In some embodiments, the device holding portion is adapted to receive a prosthetic medical device thereon.

[0030] In some embodiments, the prosthetic medical device is a prosthetic heart valve.

[0031] In some embodiments, blow molding the balloon shoulder assembly includes blow molding the proximal balloon shoulder and the distal balloon shoulder as a unitary piece together with a central connecting portion of the balloon shoulder assembly, the central connecting portion being disposed between the proximal balloon shoulder and the distal balloon shoulder.

[0032] In some embodiments, blow molding the balloon shoulder assembly includes blow molding the proximal balloon shoulder and the distal balloon shoulder as separate pieces.

[0033] In some embodiments, blow molding the balloon shoulder assembly includes forming a proximal balloon shoulder and a distal balloon shoulder to be fully inflatable, with ends adapted to be sealed around one or more shafts of the balloon catheter during manufacture and contain pressure within the proximal and distal balloon shoulders.

[0034] In some embodiments, blow molding the balloon shoulder assembly includes forming each of the proximal and distal balloon shoulders to be non-inflatable in an at least partially open state.

[0035] In some embodiments, the method may further include attaching the balloon shoulder assembly to one or more shafts of the balloon catheter prior to the step of placing the balloon shoulder assembly within the main balloon.

[0036] In some embodiments, attaching the balloon shoulder assembly to one or more shafts of the balloon catheter includes attaching a proximal balloon shoulder to the outer shaft of the balloon catheter and attaching a distal balloon shoulder to the inner shaft of the balloon catheter.

[0037] In some embodiments, attaching the balloon shoulder assembly to one or more shafts of the balloon catheter includes attaching a proximal balloon shoulder to the outer shaft of the balloon catheter and attaching a distal balloon shoulder to the nosecone of the balloon catheter.

[0038] In some embodiments, attaching the balloon shoulder assembly to one or more shafts of the balloon catheter includes attaching a proximal balloon shoulder to the inner shaft of the balloon catheter and attaching a distal balloon shoulder to the nosecone of the balloon catheter.

[0039] In some embodiments, attaching the balloon shoulder assembly to one or more shafts of the balloon catheter includes attaching a proximal balloon shoulder to the inner shaft of the balloon catheter and attaching a distal balloon shoulder to the inner shaft.

[0040] In some embodiments, the method can further include, after disposing the balloon shoulder assembly within the main balloon, inflating the proximal and distal balloon shoulders from a deflated state to an inflated state. In some embodiments, inflating the proximal and distal balloon shoulders includes delivering a fluid to the interior of the proximal and distal balloon shoulders. In some embodiments, the fluid includes at least one of saline, a contrast mixture, a biocompatible medium, a curable material, and a non-curable material.

[0041] In some embodiments, the balloon catheter is part of a transcatheter heart valve delivery system, and the step of positioning the balloon shoulder assembly within the main balloon of the balloon catheter includes creating a valve seating pocket for the prosthetic heart valve on the main balloon in a space between the proximal balloon shoulder and the distal balloon shoulder, the valve seating pocket reducing migration of the prosthetic heart valve during an implantation procedure using the transcatheter heart valve delivery system.

[0042] In another exemplary embodiment, a balloon catheter for an intravascular delivery system can include a proximal balloon shoulder attached to an inner shaft of the balloon catheter, the proximal balloon shoulder comprising a compressible hollow shell, a distal balloon shoulder attached to the inner shaft, the distal balloon shoulder comprising a compressible hollow shell, and an inflatable main balloon sealing the proximal and distal balloon shoulders.

[0043] In some embodiments, the proximal and distal balloon shoulders are blow molded together as a single piece, with a central connecting portion extending between the proximal and distal balloon shoulders.

[0044] In some embodiments, the proximal balloon shoulder and the distal balloon shoulder are each blow molded as separate pieces.

[0045] In some embodiments, the proximal and distal balloon shoulders are each completely enclosed, sealed around the inner shaft, and inflatable.

[0046] In some embodiments, the proximal and distal balloon shoulders each have an open, unsealed end around the inner shaft and a wall having a thickness ranging from 0.001 inches to 0.010 inches that is adapted to support the main balloon.

[0047] In some embodiments, the proximal and distal balloon shoulders each comprise a collar portion and a shaft portion, the collar portion extending radially outward from the shaft portion.

[0048] In some embodiments, the collar portion has one of the following shapes: a funnel, a cone, an ellipse, or a spheroid.

[0049] In some embodiments, the collar portion comprises a central portion disposed between the tapered ends, the central portion having one of a cylindrical, ring-like, or bulbous curved shape.

[0050] In some embodiments, the main balloon is adapted to receive a prosthetic heart valve crimped onto the main balloon between the proximal balloon shoulder and the distal balloon shoulder.

[0051] In some embodiments, the inner shaft extends distally beyond the outer shaft of the balloon catheter and through the main balloon.

[0052] In another exemplary embodiment, a balloon catheter for an intravascular delivery system can include a proximal balloon shoulder attached to an outer shaft of the balloon catheter, the proximal balloon shoulder comprising a compressible hollow shell, a distal balloon shoulder attached to an inner shaft of the balloon catheter, the distal balloon shoulder comprising a compressible hollow shell, and an inflatable main balloon sealing the proximal and distal balloon shoulders.

[0053] In some embodiments, the proximal and distal balloon shoulders are blow molded together as a single piece, with a central connecting portion extending between the proximal and distal balloon shoulders.

[0054] In some embodiments, the proximal and distal balloon shoulders are each blow molded as separate pieces and are axially spaced apart from one another.

[0055] In some embodiments, the proximal balloon shoulder is fully enclosed, sealed around the outer shaft and inflatable, and the distal balloon shoulder is fully enclosed, sealed around the inner shaft and inflatable.

[0056] In some embodiments, the proximal balloon shoulder is open and has an end that is not sealed around the outer shaft, and the distal balloon shoulder is open and has an end that is not sealed around the inner shaft.

[0057] In some embodiments, the proximal and distal balloon shoulders each comprise a collar portion and a shaft portion, the collar portion extending radially outward from the shaft portion.

[0058] In some embodiments, the collar portion has one of the following shapes: a funnel, a cone, an ellipse, or a spheroid.

[0059] In some embodiments, the collar portion comprises a central portion disposed between the tapered ends, the central portion having one of a cylindrical, ring-like, or bulbous curved shape.

[0060] In some embodiments, the main balloon is adapted to receive a prosthetic heart valve crimped onto the main balloon between the proximal balloon shoulder and the distal balloon shoulder.

[0061] In some embodiments, the inner shaft extends distally beyond the outer shaft of the balloon catheter and through the main balloon.

[0062] In another exemplary embodiment, a balloon catheter for an intravascular delivery system can include a proximal balloon shoulder attached to an outer shaft of the balloon catheter, the proximal balloon shoulder comprising a compressible hollow shell, a distal balloon shoulder attached to a nosecone of the balloon catheter, the distal balloon shoulder comprising a compressible hollow shell, and an inflatable main balloon sealing the proximal and distal balloon shoulders.

[0063] In some embodiments, the proximal and distal balloon shoulders are blow molded together as a single piece, with a central connecting portion extending between the proximal and distal balloon shoulders.

[0064] In some embodiments, the proximal and distal balloon shoulders are each blow molded as separate pieces and are axially spaced apart from one another.

[0065] In some embodiments, the proximal balloon shoulder is fully enclosed, sealed around the outer shaft, and inflatable, and the distal balloon shoulder is fully enclosed, sealed around the nosecone, and inflatable.

[0066] In some embodiments, the proximal balloon shoulder is open and has an end that is not sealed around the outer shaft, and the distal balloon shoulder is open and has an end that is not sealed around the nosecone.

[0067] In some embodiments, the proximal and distal balloon shoulders each comprise a collar portion and a shaft portion, the collar portion extending radially outward from the shaft portion.

[0068] In some embodiments, the collar portion has one of the following shapes: a funnel, a cone, an ellipse, or a spheroid.

[0069] In some embodiments, the collar portion comprises a central portion disposed between the tapered ends, the central portion having one of a cylindrical, ring-like, or bulbous curved shape.

[0070] In some embodiments, the main balloon is adapted to receive a prosthetic heart valve crimped onto the main balloon between the proximal balloon shoulder and the distal balloon shoulder.

[0071] In some embodiments, an inner shaft extends distally beyond the outer shaft of the balloon catheter and through the main balloon, and a nosecone is coupled to the distal end of the inner shaft.

[0072] In another exemplary embodiment, a balloon catheter for an intravascular delivery system can include a proximal balloon shoulder attached to an inner shaft of the balloon catheter, the proximal balloon shoulder comprising a compressible hollow shell, a distal balloon shoulder attached to a nosecone of the balloon catheter, the distal balloon shoulder comprising a compressible hollow shell, and an inflatable main balloon sealing the proximal and distal balloon shoulders.

[0073] In some embodiments, the proximal and distal balloon shoulders are blow molded together as a single piece, with a central connecting portion extending between the proximal and distal balloon shoulders.

[0074] In some embodiments, the proximal and distal balloon shoulders are each blow molded as separate pieces and are axially spaced apart from one another.

[0075] In some embodiments, the proximal balloon shoulder is fully enclosed, sealed around the inner shaft, and inflatable, and the distal balloon shoulder is fully enclosed, sealed around the nosecone, and inflatable.

[0076] In some embodiments, the proximal balloon shoulder is open and has an end that is not sealed around the inner shaft, and the distal balloon shoulder is open and has an end that is not sealed around the nosecone.

[0077] In some embodiments, the proximal and distal balloon shoulders each comprise a collar portion and a shaft portion, the collar portion extending radially outward from the shaft portion.

[0078] In some embodiments, the collar portion has one of the following shapes: a funnel, a cone, an ellipse, or a spheroid.

[0079] In some embodiments, the collar portion comprises a central portion disposed between the tapered ends, the central portion having one of a cylindrical, ring-like, or bulbous curved shape.

[0080] In some embodiments, the main balloon is adapted to receive a prosthetic heart valve crimped onto the main balloon between the proximal balloon shoulder and the distal balloon shoulder.

[0081] In some embodiments, an inner shaft extends distally beyond the outer shaft of the balloon catheter and through the main balloon, and a nosecone is coupled to the distal end of the inner shaft.

[0082] The foregoing, as well as 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]

[0083] [Figure 1] FIG. 1 is a perspective view of a prosthetic heart valve, according to one embodiment. [Figure 2A] FIG. 1 is a perspective view of a prosthetic heart valve according to another embodiment. [Figure 2B]FIG. 2B is a perspective view of the prosthetic valve of FIG. 2A, with components outside the frame shown in transparent lines for illustrative purposes. [Figure 3] 1 is a perspective view of a delivery device for a prosthetic heart valve, according to an embodiment. FIG. [Figure 4] 4 is a cross-sectional view of an embodiment of a distal end portion of the delivery device of FIG. 3. [Figure 5] FIG. 1 is a side view of an assembly including a prosthetic valve crimped onto a balloon attached to the distal end portion of a balloon catheter, according to one embodiment. [Figure 6] FIG. 1 is a side view of a blow molded balloon shoulder assembly for a balloon catheter according to a first embodiment. [Figure 7] FIG. 10 is a side view of a blow molded balloon shoulder assembly for a balloon catheter according to a second embodiment. [Figure 8] FIG. 1 is a side view of a balloon shoulder of a balloon shoulder assembly for a balloon catheter, according to one embodiment. [Figure 9] FIG. 10 is a side view of a balloon shoulder of a balloon shoulder assembly for a balloon catheter according to another embodiment. [Figure 10] FIG. 10 is a side view of a balloon shoulder of a balloon shoulder assembly for a balloon catheter according to yet another embodiment. [Figure 11] FIG. 1 is a side view of an inflatable balloon shoulder assembly in an uninflated state, according to one embodiment. [Figure 12] FIG. 12 is a side view of the inflatable balloon shoulder assembly of FIG. 11 in an inflated state. [Figure 13] FIG. 1 is a side view of a non-inflatable balloon shoulder assembly, according to one embodiment. [Figure 14] 1 is a flow chart of a method of manufacturing a balloon catheter comprising a blow-molded balloon shoulder assembly. [Figure 15A] 10A-10C illustrate various ways of attaching a balloon shoulder assembly to a balloon catheter. [Figure 15B]10A-10C illustrate various ways of attaching a balloon shoulder assembly to a balloon catheter. [Figure 15C] 10A-10C illustrate various ways of attaching a balloon shoulder assembly to a balloon catheter. DETAILED DESCRIPTION OF THE INVENTION

[0084] Described herein are examples of blow-molded balloon shoulder assemblies for transcatheter delivery systems (e.g., transcatheter heart valve delivery systems), as well as methods of manufacturing blow-molded balloon shoulder assemblies and balloon catheters comprising blow-molded balloon shoulder assemblies. The balloon shoulder assembly can include a proximal balloon shoulder comprising a collar portion (e.g., a flared end) and a shaft portion (e.g., a shaft end), and a distal balloon shoulder comprising a collar portion and a shaft portion. Each of the proximal and distal balloon shoulders can be hollow and comprise a compressible blow-molded material. The balloon shoulder assembly can be inserted into an inflatable main balloon of a balloon catheter of the delivery system. In some examples, the collar portions of the proximal and distal balloon shoulders can be spaced apart from one another within the main balloon to form valve (or other implantable device) retaining portions on the balloon, which, in some embodiments, are adapted to receive a crimped prosthetic heart valve. In other embodiments, the valve retaining portion may be a device retaining portion adapted to receive another type of implantable medical device, such as a stent. The balloon shoulder assembly may be formed by blow molding, thereby creating a hollow, compressible balloon shoulder. For example, the outer wall of a balloon shoulder formed by blow molding can be compressed (or stretched) under pressure and return to an uncompressed or unstretched state when the applied pressure is removed. Blow molding the balloon shoulder creates a balloon shoulder that has similar structural strength but is less bulky and more resilient (e.g., flexible) compared to conventional injection-molded balloon shoulders. As a result, the blow-molded balloon shoulder assembly can adequately support the main balloon of the balloon catheter while being compressed during insertion into the balloon and during the retrieval process when the balloon catheter is withdrawn from the implantation site and the patient's body.Thus, a balloon catheter with a blow-molded balloon shoulder assembly is easier to manufacture and easier to navigate successfully through a patient's lumen while reducing degradation of delivery system components.

[0085] In some embodiments, the balloon catheter is adapted to deliver a prosthetic heart valve crimped onto a valve-retaining portion of a main balloon between a distal balloon shoulder and a proximal balloon shoulder. FIG. 1 illustrates a prosthetic heart valve 10 according to one embodiment. While the illustrated prosthetic valve is adapted for implantation in a native aortic valve annulus, in other embodiments, it may be adapted for implantation in other native heart valve annuli (e.g., pulmonary, mitral, and tricuspid valves). The prosthetic valve may also be adapted for implantation in other tubular organs or passageways within the body. The prosthetic valve 10 may comprise four main components: a stent or frame 12, a valve structure 14, an inner skirt 16, and a perivalvular outer sealing member or outer skirt 18. The prosthetic valve 10 may comprise an inflow end portion 15, an intermediate portion 17, and an outflow end portion 19.

[0086] The valve structure 14 may include three leaflets 40, collectively forming a leaflet structure that may be collapsed and arranged into a tricuspid valve arrangement, although other embodiments may have more or fewer leaflets (e.g., one or more leaflets 40). The leaflets 40 may close together at adjacent sides to form commissures 22 of the leaflet structure 14. The lower edge of the valve structure 14 may have an undulating, curved sail shape and may be secured to the inner skirt 16 by sutures (not shown). In some embodiments, the leaflets 40 may be formed from pericardial tissue (e.g., bovine pericardial tissue), a biocompatible synthetic material, or a variety of 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.

[0087] The frame 12 may be formed with a plurality of circumferentially spaced slots or commissural windows 20 adapted to attach the commissures 22 of the valve structure 14 to the frame. The frame 12 may be made of any 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) 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 onto 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 through the delivery sheath, allowing the prosthetic valve to expand to its functional size.

[0088] 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 a specific embodiment, the frame 12 is made of a nickel-cobalt-chromium-molybdenum alloy, such as MP35N® alloy (SPS Technologies, Jenkintown, Pennsylvania), which is equivalent to UNS R30035 alloy (covered by ASTM F562-02). The MP35N® alloy / UNS R30035 alloy contains, by weight, 35% nickel, 35% cobalt, 20% chromium, and 10% molybdenum. Further details regarding the prosthetic valve 10 and its various components are described in WIPO International Patent Application Publication No. 2018 / 222799, which is incorporated herein by reference.

[0089] Figure 2A is a perspective view of a prosthetic heart valve 50 according to another embodiment. Valve 50 can include three main components: a stent or frame 52, a valve structure 54, and a sealing member 56. Figure 2B is a perspective view of prosthetic valve 50, with components outside of frame 52 (including sealing member 56) shown with transparent lines for illustrative purposes.

[0090] The valve structure 54, like the valve structure 14 of FIGURE 1, can include three leaflets 60, collectively forming a leaflet structure that can be collapsed and arranged into a tricuspid valve arrangement. Each leaflet 60 can be coupled to the frame 52 along its inflow edge 62 (the lower edge, also called the "cusp edge") and at a commissure 64 of the valve structure 54 where adjacent portions of two leaflets are connected to one another. To couple the leaflet edges to the frame, a reinforcing element (not shown), such as a fabric strip, can be connected directly to the leaflet edges and to the struts of the frame.

[0091] Frame 52, like frame 12 of FIG. 1, can be made of any of a variety of suitable plastically expandable or self-expanding materials known in the art and described above. Frame 52 in the illustrated embodiment comprises a plurality of circumferentially extending, angled struts 72 that define a row of frame cells or openings 74. Frame 52 can have a cylindrical or substantially cylindrical shape, having a constant diameter from the inflow end 66 to the outflow end 68 of the frame, as shown, or the frame can 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.

[0092] The sealing member 56 in the illustrated embodiment is attached to the outside of the frame 52 and functions to create a sealing mechanism against surrounding tissue (e.g., the native valve leaflets and / or the native valve annulus) to prevent or at least minimize perivalvular leakage. The sealing member 56 may include an inner layer 76 (which may be in contact with the outer surface of the frame 52) and an outer layer 78. The sealing member 56 may be connected to the frame 52 using any suitable technique or mechanism. The sealing member 56 may be sutured to the frame 52, for example, by 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.

[0093] The outer layer 78 may be configured or shaped to extend radially outward from the inner layer 76 and 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, which may then allow the outer layer 78 to expand and contact the surrounding tissue when implanted within the body.

[0094] Further details regarding the prosthetic valve 50 and various components of the prosthetic valve 50 are described in U.S. Patent Application Publication No. 2018 / 0028310, which is incorporated herein by reference.

[0095] 3-5 illustrate various embodiments and components of a delivery system, such as a transcatheter delivery system, that includes a delivery device, which in one embodiment may be a balloon catheter. FIG. 3 illustrates a delivery device (e.g., instrument) 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 (e.g., a stent), according to embodiments. In some embodiments, delivery device 100 is specifically adapted for use in introducing a prosthetic valve into the heart.

[0096] 3, delivery device 100 in the illustrated embodiment 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 outer shaft 104, an inflatable balloon 108 extending from a distal end of the midshaft 105, and a nosecone 110 disposed at the distal end of delivery device 100. A distal end portion 112 of delivery device 100 includes balloon 108, nosecone 110, and a balloon shoulder assembly. As further described 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 balloon 108. As described further below, the balloon shoulder assembly is configured to maintain a prosthetic heart valve or other medical device in a fixed position on the balloon 108 during delivery through the patient's vasculature.

[0097] The inner shaft 106 can define a lumen configured to receive a guidewire within the inner shaft 106. The delivery device 100 can be advanced over a guidewire to a targeted implantation site, for example, when an implantable medical device (e.g., a prosthetic heart valve) is delivered to the targeted implantation site using the delivery device 100.

[0098] The handle 102 can include a steering mechanism configured to adjust the curvature of the distal end portion of the delivery device. In the illustrated embodiment, the handle 102 includes an adjustment member, such as the illustrated rotatable knob 134, operably coupled to a proximal end portion of a pull wire (not shown). The pull wire extends distally from the handle 102 through the outer shaft 104 and includes a distal end portion secured 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 portion of the delivery device.

[0099] Figure 4 illustrates an embodiment of a distal end portion 112 of a delivery device 100. As shown in Figure 4, the delivery device 100 is configured to mount a prosthetic valve (e.g., a prosthetic heart valve) 114 in a crimped state onto the balloon 108 for insertion of the delivery device 100 and prosthetic valve 114 into a patient's vasculature.

[0100] As shown in FIG. 4 , the inner shaft 106 extends distally at the proximal end of the distal end portion 112, over the steerable outer shaft 104 and mid-shaft 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 mid-shaft 105 and a distal shoulder 122 attached to the inner shaft 106. The balloon 108 includes a proximal end portion 126 that surrounds and / or is wrapped over the proximal shoulder 120, and a distal end portion 128 that surrounds and / or is wrapped over the distal shoulder 122. In some embodiments, the proximal end portion 126 of the balloon 108 may be secured to the outer surface of the mid-shaft 105. In some embodiments, the distal end portion 128 of the balloon 108 may be secured to the exterior surface of the nosecone 110 , which may be attached or coupled to the inner shaft 106 .

[0101] In the illustrated embodiment, the nosecone 110 and the distal shoulder 122 may be a unitary piece or a single component. That is, the nosecone 110 is the distal portion of the single component and the distal shoulder 122 is the proximal portion of the single component. In other embodiments, the nosecone 110 and the distal shoulder 122 may be separate components, each attached to the inner shaft 106 adjacent to one another or at axially spaced locations.

[0102] The proximal shoulder 120 and the distal shoulder 122 are axially spaced apart 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 and distal shoulders 120, 122 (e.g., between the flared ends of the proximal and distal shoulders 120, 122). As shown in FIG. 4 , the prosthetic valve 114 can be crimped against the valve-retaining portion 130 (which may also be referred to as a valve seating pocket) of the balloon 108 between the proximal and distal shoulders 120, 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 targeted implantation site.

[0103] 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 passageways of the delivery device 100, which can be fluidly connectable to a fluid source (e.g., a syringe) that can inject inflation fluid (e.g., saline) into the delivery device. In this manner, fluid from the fluid source can flow through the one or more fluid passageways, through the annular space 132, and into the balloon 108, inflating the balloon 108 and expanding and deploying the prosthetic valve 114. For example, the handle 102 can have a fluid port 103 (see FIG. 3 ) configured to be coupled to a fluid source. During use, inflation fluid from the fluid source can be injected into the fluid port 103, through one or more fluid passageways in the handle 102, through the annular space 132, and into the balloon 108.

[0104] 4 illustrates the flow of fluid (indicated by arrows 109) through the annular space 132 and through channels in the proximal and distal shoulders 120, 122. The fluid can then flow into the proximal and distal end portions 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.

[0105] 5 shows an exterior side view of the distal end portion 112 of the delivery device 100, which includes a prosthetic valve 114 crimped onto a balloon 108 attached to the distal end portion 112 of a balloon catheter. As explained above, the balloon shoulder assembly, which includes a proximal shoulder 120 and a distal shoulder 122, supports the balloon 108 on the balloon shoulder assembly.

[0106] 5, balloon 108 includes a proximal end portion 126 that surrounds and / or wraps over proximal shoulder 120, a distal end portion 128 that surrounds and / or wraps over distal shoulder 122, and a valve-retaining portion 130 located between proximal end portion 126 and distal end portion 128. As shown in FIG. 5, prosthetic valve 114 is crimped onto the balloon catheter on and around valve-retaining portion 130.

[0107] Traditionally, injection-molded balloon shoulder assemblies, such as the balloon shoulder shown in FIG. 5, can be relatively hard and thick (e.g., comprise a solid, hard plastic material). Injection-molded balloon shoulders can generally be bulky, thereby requiring a relatively long length to accommodate the increased mass. As a result of the hard, thick, and rigid nature of injection-molded balloon shoulders, they can be difficult to insert into the relatively narrow legs of a balloon catheter's balloon during manufacturing. Furthermore, these characteristics can also create gaps between the injection-molded balloon shoulder and a valve (or other implantable device) that is crimped around the balloon, and between the proximal and distal balloon shoulders, which can result in damage to a sheath or alternative medical instrument through which the balloon catheter is inserted while navigating bends in a patient's vasculature. Furthermore, due to the bulky and rigid nature of the injection-molded shoulder, the user may exert greater withdrawal force when attempting to withdraw (e.g., remove) the balloon catheter through the sheath following deployment of the valve at the target site in the patient.

[0108] As described further below with reference to FIG. 14 , a balloon shoulder and / or balloon shoulder assembly for a balloon catheter may instead be formed by blow molding (rather than injection molding). Blow molding produces a hollow plastic part with reduced mass (e.g., bulk), similar structural strength, reduced stiffness, reduced hardness, and increased compressibility (e.g., resilience) compared to an injection-molded part. Furthermore, blow molding potentially allows for faster and cheaper changes to the design, such as part size and shape, than injection molding (e.g., due to the higher cost of the molds required for injection molding). As a result, a blow-molded balloon shoulder may be more resilient, allowing it to compress and return to its expanded shape while still providing sufficient structural support for the main balloon, thereby facilitating easier insertion of the blow-molded balloon shoulder into the main balloon of the balloon catheter and reducing sheath degradation during successful navigation of the balloon catheter through the sheath during the implantation procedure. Additionally, a balloon catheter comprising a blow-molded balloon shoulder and / or balloon shoulder assembly may be easier to retrieve (e.g., with reduced force or resistance) through a sheath and / or a patient's vasculature after implantation of the prosthetic medical device. Additionally, as described further below, because the blow-molded parts are hollow and compressible, the blow-molded balloon shoulder may be configured to expand and contract (e.g., function as an additional balloon).

[0109] Figures 6 and 7 show an embodiment of a blow-molded balloon shoulder assembly included on an exemplary balloon catheter 200 (which may also be referred to as a delivery apparatus or delivery device). The balloon catheter 200 may be similar to the delivery device (e.g., balloon catheter) 100 shown in Figures 3-5, as described above. Accordingly, components similar to those of the delivery device (e.g., balloon catheter) 100 of Figures 3-5 are numbered the same in the balloon catheter 200 of Figures 6-7.

[0110] Turning first to FIG. 6 , a first embodiment of a blow-molded balloon shoulder assembly 202 for a balloon catheter 200 is shown. As introduced above with reference to FIG. 5 , the balloon catheter 200 includes an inflatable main balloon 108 (shown in a deflated state in FIGS. 4-7 ), an outer shaft 104, and an inner shaft 106 extending through the outer shaft 104 and the main balloon 108. As described above with reference to FIGS. 4-5 , the balloon 108 includes a proximal end portion 126, a distal end portion 128, and a valve-retaining portion 130 disposed between the proximal end portion 126 and the distal portion 128. In the illustrated embodiment, the distal end portion 128 of the balloon may be connected to the nosecone 110, and the proximal end portion 126 of the balloon may be connected to the outer shaft 104. A prosthetic medical device (e.g., a prosthetic heart valve) 210 is crimped onto the deflated balloon 108 and is shown in box form in FIGS. 6-7 for illustrative purposes. In some embodiments, prosthetic medical device 210 may be one of prosthetic heart valve 10 shown in Figure 1, prosthetic heart valve 50 shown in Figures 2A-2B, or prosthetic heart valve 114 shown in Figures 4-5. In alternative embodiments, prosthetic medical device 210 may be another type of implantable medical device, such as a stent or a graft.

[0111] The balloon shoulder assembly 202 may be attached to the inner shaft 106. In some embodiments, the balloon shoulder assembly 202 is formed as a unitary piece extending from the proximal end 204 to the distal end 206 of the balloon shoulder assembly 202 and surrounding the entire circumference of the inner shaft 106, as shown in FIG. 6. In alternative embodiments, the balloon shoulder assembly 202 may not be formed as a unitary piece, and a portion of the inner shaft 106 (e.g., a central portion in the area of ​​the valve retaining portion 130) may not be surrounded by the balloon shoulder assembly 202, as described further below.

[0112] 6, the balloon shoulder assembly 202 comprises a proximal balloon shoulder 208, a distal balloon shoulder 212, and a central connecting portion 214 connecting the proximal balloon shoulder 208 and the distal balloon shoulder 212. In some embodiments, the central connecting portion 214 is formed as a unitary piece with the proximal balloon shoulder 208 and the distal balloon shoulder 212. In other embodiments, the proximal balloon shoulder 208, the distal balloon shoulder 212, and the central connecting portion 214 are formed (e.g., blow molded) as separate pieces and then coupled together (e.g., by adhesive or alternative joining techniques).

[0113] As noted above, in some embodiments, the entire balloon shoulder assembly 202 may be attached to the inner shaft 106. In other embodiments, such as those discussed further below with reference to Figures 15A-15C, the proximal balloon shoulder 208 may be attached to or on the inner shaft 106 or outer shaft 104, and the distal balloon shoulder 212 may be attached to or on the inner shaft 106 or nosecone 110.

[0114] The proximal balloon shoulder 208 includes a proximal collar portion (e.g., a member or flared end) 216 and a proximal shaft portion (e.g., a member or shaft end) 218. The proximal collar portion 216 specifically extends radially outward from the proximal shaft portion 218 relative to a central axis 220 of the balloon catheter 200 and the balloon shoulder assembly 202. The proximal shaft portion 218 has a smaller diameter than the remainder of the proximal balloon shoulder 208 (e.g., the proximal collar portion 216), and this smaller diameter of the proximal shaft portion 218 can be similar to (or, in some embodiments, slightly larger than) the diameter of the inner shaft 106. Furthermore, the proximal collar portion 216 is disposed at a first, more distal end of the proximal balloon shoulder 208 (adjacent the central connecting portion 214), and the proximal shaft portion 218 is disposed at a second, more proximal end opposite the proximal balloon shoulder 208. In some embodiments, the length of the proximal shaft portion 218 can be longer than the length of the proximal collar portion 216. In some embodiments, the proximal shaft portion 218 can extend at least partially through the interior of the proximal collar portion 216.

[0115] The distal balloon shoulder 212 similarly includes a distal collar portion (e.g., a member or flared end) 222 and a distal shaft portion (e.g., a member or shaft end) 224. The distal collar portion 222 specifically extends radially outward from the distal shaft portion 224 relative to the central axis 220. The distal shaft portion 224 has a smaller diameter than the remainder of the distal balloon shoulder 212 (e.g., the distal collar portion 222), and this smaller diameter of the distal shaft portion 224 can be similar to (or, in some embodiments, slightly larger than) the diameter of the inner shaft 106. Furthermore, the distal collar portion 222 is disposed at a first, more proximal end of the distal balloon shoulder 212 (adjacent the central connecting portion 214), and the distal shaft portion 224 is disposed at a second, more distal end opposite the distal balloon shoulder 212. In some embodiments, the length of the distal shaft portion 224 can be longer than the length of the distal collar portion 222. In some embodiments, the distal shaft portion 224 can extend at least partially through the interior of the distal collar portion 222.

[0116] In some embodiments, as shown in FIG. 6 , the central connecting portion 214 is an elongated hollow shaft that extends between and connects the distal collar portion 222 and the proximal collar portion 216.

[0117] In some embodiments, the balloon shoulder assembly 202 may further include a transition portion extending between and connecting each collar portion to the central connecting portion 214, as shown in FIG. 6 . In some embodiments, the transition portion may also be formed as a unitary piece with the remainder of the balloon shoulder assembly 202. In some embodiments, the transition portion may be part of the central connecting portion 214 or part of the corresponding collar portion. The balloon shoulder assembly 202 may include, for example, a proximal transition portion 226 extending axially between the proximal collar portion 216 and the central connecting portion 214 and connecting them, as shown in FIG. 6 , and a distal transition portion 228 extending axially between the distal collar portion 222 and the central connecting portion 214 and connecting them. Each of the transition portions 226 and 228 may decrease in diameter from the corresponding collar portion to the central connecting portion 214. In alternative embodiments, the balloon shoulder assembly 202 may not include a transition portion, or the transition portion may have a different shape (e.g., stepped) than that shown in FIG. 6.

[0118] 6 , each of the proximal collar portion 216 and the distal collar portion 222 has a funnel shape (e.g., a cone shape with a wider end and a narrower end). The proximal collar portion 216, for example, has a wider end 230 that flares radially outward from a narrower end 232 of the proximal collar portion 216. The wider end 230 is connected to the central connecting portion 214, and the narrower end 232 is connected to the proximal shaft portion 218. The distal collar portion 222 similarly has a wider end 234 that flares radially outward from a narrower end 236 of the distal collar portion 222. The wider end 234 is connected to the central connecting portion 214, and the narrower end 236 is connected to the distal shaft portion 224.

[0119] As introduced above, the balloon shoulder assembly 202 is formed by blow molding. Thus, the balloon shoulder assembly 202, including the proximal balloon shoulder 208 and the distal balloon shoulder 212, is hollow and comprises a compressible blow-molded material. The blow-molded material, in some embodiments, can be a polymer. In some embodiments, the blow-molded material can be any of a variety of polymers, such as polyethylene, polypropylene, polyurethane, nylon, PET, PBT, etc. As described above and further below, having a hollow, compressible blow-molded balloon shoulder allows the balloon shoulder to provide structural support to the main balloon 108 while making it easier to insert the balloon shoulder into the main balloon 108 and navigate it through the patient's vasculature during assembly.

[0120] In some embodiments, as shown in FIG. 6, the proximal balloon shoulder 208, the distal balloon shoulder 212, the central connecting portion 214, and the transition portions 226 and 228 (if present) may be integrally blow molded and formed as a single piece. In alternative embodiments, the proximal balloon shoulder 208 and the distal balloon shoulder 212 may be blow molded separately as two separate parts (not formed as a single piece). In some of these embodiments, the balloon shoulder assembly may not include a central connecting portion; instead, the separately blow molded proximal and distal balloon shoulders may be spaced apart from one another. Thus, in some embodiments, the balloon shoulder assembly 202 may include the proximal balloon shoulder 208 and the distal balloon shoulder 212 shown in FIG. 6, but without the central connecting portion 214. In other such embodiments, the separately molded proximal and distal balloon shoulders 208, 212 may be joined to a central connecting portion after blow molding and before insertion into the main balloon of the balloon catheter.

[0121] Referring again to FIG. 6, in some embodiments, the proximal shaft portion 218 and the distal shaft portion 224 may be secured to the inner shaft 106 using a variety of techniques and mechanisms, such as by welding or with adhesives.

[0122] In some embodiments, the balloon shoulder assembly 202 may be fully sealed and inflatable (e.g., capable of being inflated from a deflated state). As used herein, “fully sealed” may refer to a sealed or sealed structure that is free of holes or openings and capable of retaining pressure (e.g., fluid pressure). For example, the ends of the proximal and distal shaft portions 218 and 224 that are not connected to the corresponding collar portions, as well as both ends of the collar portions, may be closed or sealed relative to the respective shafts to which they are attached. For example, the proximal and distal shaft portions 218 and 224 may each form a fluid-tight seal with the outer surface of the inner shaft 106. In this manner, the balloon shoulder assembly 202 may be fully sealed and capable of containing inflation fluid introduced into the balloon shoulder assembly 202. Thus, in addition to the main balloon 108, the balloon shoulder assembly 202 or portions of the balloon shoulder assembly (e.g., the proximal balloon shoulder 208 and the distal balloon shoulder 212) may be balloons.

[0123] For example, in some embodiments, one or more shafts running through the interior of the balloon catheter 200 can fluidly connect an external fluid source to the balloon shoulder assembly 202. In some embodiments, the inner shaft 106 can have one or more side openings 107 in the region of the balloon shoulder assembly 202, as shown in FIG. 6 . Inflation fluid can then be supplied from a fluid source (e.g., a syringe containing inflation fluid) to a fluid port in the handle of the delivery instrument. The fluid port is fluidly connected to a fluid passage formed in the inner shaft 106 and is in fluid communication with the balloon shoulder assembly 202 via the one or more side openings 107. Thus, the inflation fluid can be supplied to one or more balloons of the balloon shoulder assembly 202 to inflate the balloon shoulder assembly 202.

[0124] In some embodiments, the inner surface of the central connecting portion 214 can be spaced radially outward from the outer surface of the inner shaft 106 to define an annular space through which inflation fluid can flow from the proximal balloon shoulder 208 to the distal balloon shoulder 212. Thus, inflation fluid can flow outward from the side opening 107, into the proximal balloon shoulder 208, through the annular space, and into the distal balloon shoulder 212.

[0125] The side openings 107 shown in Figure 6 (and Figure 7) are for illustrative purposes, and in alternative embodiments, there may be more or fewer side openings 107 than those shown in Figures 6-7. In some embodiments, the side openings 107 may also be located at additional or alternative locations along the inner shaft 106 than those shown in Figures 6-7. The side openings 107 may also extend into the interior of the balloon shoulder assembly or may be flush with the outer surface of the inner shaft 106.

[0126] In some embodiments, the balloon shoulder assembly 202 can be inflated after inserting the deflated balloon shoulder assembly 202 into the main balloon 108 during assembly of the balloon catheter 200. The main balloon 108 is pleated around the balloon shoulder assembly 202 when the balloon shoulder assembly 202 is inflated, and optionally, a protective cover or case can be placed around the main balloon for transport and storage until use by a healthcare provider, as disclosed in U.S. Patent Application Publication No. 2017 / 0065415. The prosthetic valve (e.g., valve 10 or 50) can be stored in a container or jar that contains a hydration fluid. At the time of use, a user can remove the prosthetic valve from its container, place the prosthetic valve around the main balloon, and crimp the prosthetic valve onto the main balloon between the proximal and distal balloon shoulders 208 and 212, respectively.

[0127] In alternative embodiments, the prosthetic valve may comprise dry or substantially dry leaflets that may be stored without hydration fluid, such as those disclosed in U.S. Patent Nos. 8,007,992 and 8,357,387, which are incorporated herein by reference. In such cases, the prosthetic valve may be crimped onto the main balloon during the assembly process, and the assembly, including the delivery device and crimped prosthetic valve, may be placed in sterile packaging for transport and storage until use by a healthcare provider.

[0128] In an alternative embodiment, the balloon shoulder assembly 202 may be inflated at the point of use, such as before crimping the prosthetic valve onto the main balloon.

[0129] Furthermore, in some embodiments where the proximal and distal balloon shoulders are separately molded as separate pieces, the proximal and distal balloon shoulders may each be additional balloons in addition to the main balloon 108.

[0130] In alternative embodiments, the balloon shoulder assembly 202 may not be completely sealed and therefore may not be able to contain pressure and allow inflation (e.g., may be non-inflatable). As described further below, inflatable and non-inflatable blow-molded balloon shoulder embodiments are shown in Figures 11-13.

[0131] FIG. 7 illustrates a second embodiment of a blow-molded balloon shoulder assembly 302 for a balloon catheter 200. The balloon shoulder assembly 302 can be attached to the inner shaft 106 of the balloon catheter 200, similar to the balloon shoulder assembly 202 of FIG. 6. In some embodiments, the balloon shoulder assembly 302 is formed as a single piece extending from the proximal end 304 to the distal end 306 of the balloon shoulder assembly 302 and surrounding the entire circumference of the inner shaft 106, as shown in FIG. 7. Thus, the inner shaft 106 is not visible in FIG. 7. In alternative embodiments, the balloon shoulder assembly 302 may not be formed as a single piece, as described further below, and a portion of the inner shaft 106 (e.g., the central portion in the region of the valve retaining portion 130) may not be surrounded by the balloon shoulder assembly 302.

[0132] 7, the balloon shoulder assembly 302 comprises a proximal balloon shoulder 308, a distal balloon shoulder 312, and a central connecting portion 314 connecting the proximal balloon shoulder 308 and the distal balloon shoulder 312. In some embodiments, the central connecting portion 314 is formed as a unitary piece with the proximal balloon shoulder 308 and the distal balloon shoulder 312. In other embodiments, the proximal balloon shoulder 308, the distal balloon shoulder 312, and the central connecting portion 314 are formed (e.g., blow molded) as separate pieces and then coupled together (e.g., by adhesive or alternative joining techniques).

[0133] The proximal balloon shoulder 308 includes a proximal collar portion (e.g., member) 316 and a proximal shaft portion (e.g., member) 318. The proximal collar portion 316 specifically extends radially outward from the proximal shaft portion 318 relative to the central axis 220 of the balloon catheter 200 and the balloon shoulder assembly 302. The proximal shaft portion 318 has a smaller diameter than the remainder of the proximal balloon shoulder 308 (e.g., the outer diameter of the proximal collar portion 316), and this smaller diameter of the proximal shaft portion 318 can be similar to (or, in some embodiments, slightly larger than) the diameter of the inner shaft 106. Furthermore, the proximal collar portion 316 is disposed at a first, more distal end of the proximal balloon shoulder 308 (adjacent the central connecting portion 314), and the proximal shaft portion 318 is disposed at a second, more proximal end opposite the proximal balloon shoulder 308. In some embodiments, the length of the proximal shaft portion 318 in the axial direction relative to the central axis 220 can be longer than the length of the proximal collar portion 316. In some embodiments, the proximal shaft portion 318 can extend at least partially through the interior of the proximal collar portion 316.

[0134] The distal balloon shoulder 312 similarly includes a distal collar portion (e.g., member) 322 and a distal shaft portion (e.g., member) 324. The distal collar portion 322 specifically extends radially outward from the distal shaft portion 324 relative to the central axis 220. The distal shaft portion 324 has a smaller diameter than the remainder of the distal balloon shoulder 312 (e.g., the outer diameter of the distal collar portion 322), and this smaller diameter of the distal shaft portion 324 can be similar to (or, in some embodiments, slightly larger than) the diameter of the inner shaft 106. Furthermore, the distal collar portion 322 is disposed at a first, more proximal end of the distal balloon shoulder 312 (adjacent the central connecting portion 314), and the distal shaft portion 324 is disposed at a second, more distal end opposite the distal balloon shoulder 312. In some embodiments, the (axial) length of the distal shaft portion 324 can be greater than the length of the distal collar portion 322. In some embodiments, the distal shaft portion 324 can extend at least partially through the interior of the distal collar portion 322.

[0135] In some embodiments, as shown in FIG. 7, the central connecting portion 314 is an elongated hollow shaft that extends between and connects the distal collar portion 322 and the proximal collar portion 316.

[0136] In some embodiments, the balloon shoulder assembly 302 may further include a transition portion extending between and connecting each collar portion to the central connecting portion 314, as shown in FIG. 7 . In some embodiments, the transition portion is formed as a unitary piece with the remainder of the balloon shoulder assembly 302. In some embodiments, the transition portion may be part of the central connecting portion 314 or part of the corresponding collar portion. The balloon shoulder assembly 302 may include, for example, a proximal transition portion 326 extending between and connecting the proximal collar portion 316 and the central connecting portion 314, as shown in FIG. 7 , and a distal transition portion 328 extending between and connecting the distal collar portion 322 and the central connecting portion 314. Each of the transition portions 326 and 328 may decrease in diameter from the corresponding collar portion to the central connecting portion 314. In alternative embodiments, the balloon shoulder assembly 302 may not include a transition portion, or the transition portion may have a different shape (e.g., stepped) than that shown in FIG.

[0137] As shown in FIG. 7 , each of the proximal and distal collar portions 316, 322 has a bulbous shape with a central portion having a maximum outer diameter 340 (relative to the remainder of the collar portion) and ends having smaller diameters that taper down to the diameter of the corresponding shaft portion or central connecting portion 314. In some embodiments, the proximal and distal collar portions 316, 322 can be shaped as ellipsoids. In some embodiments, the proximal and distal collar portions 316, 322 can be shaped as spheroids. The main balloon 108 can be structurally supported by each of the proximal and distal collar portions 316, 322 in the region of the central portion having the outer diameter 340. In this manner, the radially widest portion of each of the proximal and distal collar portions 316, 322 is at the central portion, and the radially narrowest portion of each of the proximal and distal collar portions 316, 322 is at the end of the proximal and distal collar portions 316, 322.

[0138] As introduced above, the balloon shoulder assembly 302 is formed by blow molding. Thus, the balloon shoulder assembly 302, including the proximal balloon shoulder 308 and the distal balloon shoulder 312, is hollow and comprises a compressible blow-molded material. The blow-molded material may be a polymer, in some embodiments. As explained above and further below, by having a hollow, compressible balloon shoulder, the balloon shoulder can provide structural support to the main balloon 108 while making it easier to insert the balloon shoulder into the main balloon 108 and navigate it through the patient's vasculature.

[0139] In some embodiments, as shown in FIG. 7, the proximal balloon shoulder 308, the distal balloon shoulder 312, the central connecting portion 314, and the transition portions 326 and 328 (if present) may be integrally blow molded and formed as a single piece. In alternative embodiments, the proximal balloon shoulder 308 and the distal balloon shoulder 312 may be blow molded separately as two separate parts (not formed as a single piece). In some of these embodiments, the balloon shoulder assembly may not include a central connecting portion; instead, the separately blow molded proximal and distal balloon shoulders may be spaced apart from one another. Thus, in some embodiments, the balloon shoulder assembly 302 may include the proximal balloon shoulder 308 and the distal balloon shoulder 312 shown in FIG. 7, but without the central connecting portion 314. In other such embodiments, separately molded proximal and distal balloon shoulders 308, 312 may be coupled to a central connecting portion 314 after blow molding and before insertion into the main balloon of the balloon catheter.

[0140] In some embodiments, the balloon shoulder assembly 302 may be completely sealed and inflatable (e.g., capable of being inflated from a deflated state). For example, the ends of the proximal and distal shaft portions 318, 324 that are not connected to the corresponding collar portions, as well as both ends of the collar portions, may be closed. In this manner, the balloon shoulder assembly 302 may be completely sealed and contain pressure, thereby allowing the balloon shoulder assembly 302 to be inflated. Thus, in addition to the main balloon 108, the balloon shoulder assembly 302 or portions of the balloon shoulder assembly (such as the proximal balloon shoulder 308 and the distal balloon shoulder 312) may be balloons. Furthermore, in some embodiments in which the proximal and distal balloon shoulders are separately molded as separate parts, the proximal and distal balloon shoulders may each be additional balloons in addition to the main balloon 108. In alternative embodiments, the balloon shoulder assembly 302 may not be completely sealed and therefore may not be able to contain pressure and allow inflation (e.g., may be non-inflatable). As described further below, inflatable and non-inflatable blow molded balloon shoulder embodiments are shown in Figures 11-13.

[0141] 8-10 show alternative embodiments of a balloon shoulder assembly for a balloon catheter, such as balloon catheter 200. Any one or combination of the embodiments shown in FIGS. 8-10 may be used in place of balloon shoulder assembly 302 of balloon catheter 200. Each of the embodiments shown in FIGS. 8-10 may be formed as a one-piece balloon shoulder assembly with a central connecting portion connecting the proximal and distal portions, or as a balloon shoulder assembly with two separately molded balloon shoulders (similar to the arrangement of balloon shoulder assemblies along the inner shaft as shown in FIG. 5, but with blow-molded balloon shoulders).

[0142] In each of Figures 8-10, two differently shaped and / or sized balloon shoulders are shown connected by a central connecting portion, each comprising a body or collar portion and a shaft portion. The shaft portion may be secured to the shaft, nosecone, or other component of the delivery device, such as by welding or adhesive. The collar portion extends radially outward from the shaft portion and is adapted to support the main balloon of the balloon catheter into which the balloon shoulder is inserted. However, in some embodiments, the two differently shaped and / or sized balloon shoulders shown in each of Figures 8-10 need not be included in the same balloon shoulder assembly. Instead, each individual balloon shoulder shown in Figures 8-10 can be used as a separately molded balloon shoulder within a balloon shoulder assembly, or can be molded as an integral part of another, similarly sized and / or shaped balloon shoulder (e.g., a mirror image of the illustrated shoulder design) and central connecting portion, as shown in Figures 6 and 7. 8-10 can be used in combination with any of the other balloon shoulders to form a balloon shoulder assembly. For example, a balloon shoulder assembly can include balloon shoulder 802 of FIG. 8, balloon shoulder 1004 of FIG. 10, and a connecting portion extending between balloon shoulder 802 and balloon shoulder 1004. Furthermore, any of the individual balloon shoulders can be used as the proximal or distal balloon shoulder of a balloon shoulder assembly.

[0143] 8, a first balloon shoulder 802 and a second balloon shoulder 804 are shown. The balloon shoulder assembly can include a first balloon shoulder 802, a second balloon shoulder 804, and a central connecting portion 820. In some embodiments, the first balloon shoulder 802 is a distal balloon shoulder and the second balloon shoulder 804 is a proximal balloon shoulder. In other embodiments, the first balloon shoulder 802 is a proximal balloon shoulder and the second balloon shoulder 804 is a distal balloon shoulder.

[0144] The first balloon shoulder 802 includes a collar portion (e.g., body) 806 and a shaft portion 808. The collar portion 806 includes a central cylindrical body 810 disposed between a first tapered end portion 812 and a second tapered end portion 814 of the collar portion 806. The cylindrical body 810 has a radially aligned outer diameter 816 and an axially aligned length 818. As shown in FIG. 8 , the outer diameter 816 is longer than the length 818. However, in alternative embodiments, the outer diameter 816 and the length 818 may be the same size, or the length 818 may be longer than the outer diameter 816 (e.g., as shown in the embodiment of the second balloon shoulder 804, described further below).

[0145] As shown in FIG. 8 , the length 818 of the cylindrical body 810 may be longer than the respective lengths of the first tapered end portion 812 and the second tapered end portion 814. Each of the first tapered end portion 812 and the second tapered end portion 814 includes a wider end directly connected to the cylindrical body 810 and a narrower (e.g., tapered) end. The narrower end of the first tapered end portion 812 is shown connected to a first end of the central connecting portion 820. However, as described above, in a balloon shoulder assembly for a balloon catheter, the second end of the central connecting portion 820 may be connected to a balloon shoulder similar in size and shape to the narrower end of the first tapered end portion 812 of the first balloon shoulder 802 (instead of the second balloon shoulder 804 shown in FIG. 8 ). Furthermore, in some embodiments, the narrow end of the first tapered end portion 812 may not be connected to any central connecting portion, and may instead be unattached to any additional parts (e.g., may be open) or may be closed around the inner shaft to which the first balloon shoulder 802 is attached. The narrow end of the second tapered end portion 814 is directly connected to / around the shaft portion 808.

[0146] In some embodiments, the lengths (axial) of the first tapered end portion 812 and the second tapered end portion 814 can be the same. In other embodiments, the length (axial) of the first tapered end portion 812 can be different from the length of the second tapered end portion 814. For example, as shown in FIG. 8 , the length of the second tapered end portion 814 is longer than the length of the first tapered end portion 812.

[0147] The second balloon shoulder 804 shown in FIG. 8 includes a collar portion (e.g., body) 822 and a shaft portion 824. The collar portion 822 includes a central cylindrical body 826 disposed between a first tapered end portion 828 and a second tapered end portion 830 of the collar portion 822. The cylindrical body 826 has a radially aligned outer diameter 832 and an axially aligned length 834. As shown in FIG. 8, the outer diameter 832 is shorter than the length 834. Thus, the second balloon shoulder 804 has a longer cylindrical body, a longer overall length, and a smaller outer diameter compared to the first balloon shoulder 802.

[0148] The shaft portion 824 of the second balloon shoulder 804 also has a larger diameter 836 than the shaft portion 808 of the first balloon shoulder 802. Furthermore, the diameter 836 of the shaft portion 824 is larger than the diameter of the central connecting portion 820. In this manner, the diameter of the shaft portion of the balloon shoulder may be larger (or, in some embodiments, smaller) than the diameter of the central connecting portion.

[0149] As shown in FIG. 8 , the length 834 of the cylindrical body 826 may be longer than the respective lengths of the first tapered end portion 828 and the second tapered end portion 830. Each of the first tapered end portion 828 and the second tapered end portion 830 includes a wider end connected directly to the cylindrical body 826 and a narrower (e.g., tapered) end. The narrower end of the first tapered end portion 828 is shown connected to the second end of the central connecting portion 820. However, as described above, in a balloon shoulder assembly for a balloon catheter, the first end of the central connecting portion 820 may be connected to a balloon shoulder similar in size and shape to the narrower end of the first tapered end portion 828 of the second balloon shoulder 804 (instead of the first balloon shoulder 802 shown in FIG. 8 ). Furthermore, in some embodiments, the narrow end of the first tapered end portion 828 may not be connected to any central connecting portion, and may instead be unattached to any additional parts (e.g., may be open) or may be closed around the inner shaft to which the second balloon shoulder 804 is attached. The narrow end of the second tapered end portion 830 is directly connected to the shaft portion 824.

[0150] Similar to what was described above with respect to the first balloon shoulder 802, the lengths (axially) of the first tapered end portion 828 and the second tapered end portion 830 of the second balloon shoulder 804 may be the same (in some embodiments) or different from one another (in other embodiments).

[0151] 9 shows a further balloon shoulder embodiment comprising a third balloon shoulder 902. FIG. 9 also shows a second balloon shoulder 804 for comparison with the size and shape of the third balloon shoulder 902. The balloon shoulder assembly can comprise a third balloon shoulder 902, a second balloon shoulder 804, and a central connecting portion 920. In some embodiments, the third balloon shoulder 902 is a distal balloon shoulder and the second balloon shoulder 804 is a proximal balloon shoulder. In other embodiments, the third balloon shoulder 902 is a proximal balloon shoulder and the second balloon shoulder 804 is a distal balloon shoulder.

[0152] The third balloon shoulder 902 includes a collar portion 906 and a shaft portion 908. The collar portion 906 is bulbous in shape, with a curved central portion 910 located between a first tapered end portion 912 and a second tapered end portion 914. The widest portion of the central portion 910 has an outer diameter 916. The central portion 910 then curves inward relative to the central axis of the third balloon shoulder 902 toward the first tapered end portion 912 and the second tapered end portion 914, respectively. Each of the first tapered end portion 912 and the second tapered end portion 914 includes a wider end connected to the central portion 910 and a narrower end connected to a central connecting portion 920 (or in some embodiments, not connected to the central connecting portion and instead closed or connected to the inner shaft of the balloon catheter) or the shaft portion 908, respectively.

[0153] In some embodiments, the first tapered end portion 912 and the second tapered end portion 914 can have different axial lengths, as shown in Figure 9. In alternative embodiments, the first tapered end portion 912 and the second tapered end portion 914 can have the same length.

[0154] 9, the length 922 of the central portion 910 is shorter than the length 834 of the cylindrical body 826. However, the outer diameter 916 of the central portion 910, which is the maximum diameter of the third balloon shoulder 902, is greater than the outer diameter 832 of the cylindrical body 826, which is the maximum diameter of the second balloon shoulder 804.

[0155] 10 illustrates a further balloon shoulder embodiment comprising a fifth balloon shoulder 1002 and a sixth balloon shoulder 1004. The fifth balloon shoulder 1002 and the sixth balloon shoulder 1004 have similar shapes but different sizes and dimensions, as described further below. The balloon shoulder assembly can comprise a fifth balloon shoulder 1002, a sixth balloon shoulder 1004, and a connecting portion 1020. In some embodiments, the fifth balloon shoulder 1002 is a distal balloon shoulder and the sixth balloon shoulder 1004 is a proximal balloon shoulder. In other embodiments, the fifth balloon shoulder 1002 is a proximal balloon shoulder and the sixth balloon shoulder 1004 is a distal balloon shoulder.

[0156] The fifth balloon shoulder 1002 specifically includes a collar portion 1006 and a shaft portion 1008, as shown in FIG. 10 . The collar portion 1006 includes an elongated tapered portion 1010, a shorter tapered portion 1012, and a central ring portion 1014 disposed between (and separating) the elongated tapered portion 1010 and the shorter tapered portion 1012. The outer diameter of the collar portion 1006 and the fifth balloon shoulder 1002 is greatest at the central ring portion 1014, as indicated by outer diameter 1016. The elongated tapered portion 1010 includes a wider end connected to the central ring portion 1014 and then tapers inwardly from the wider end to a narrower end connected to the shaft portion 1008. The short tapered section 1012 has a wider end connected to the central ring portion 1014, and then tapers inward from the wider end to a narrower end connected to the central connecting portion 1020 (or in some embodiments, not connected to the central connecting portion, but instead is closed end or connected to the inner shaft of a balloon catheter). The elongated tapered section 1010 has a length 1018, which may be the longest length of all sections of the collar portion 1006.

[0157] The sixth balloon shoulder 1004 includes a collar portion 1022 and a shaft portion 1024 (having a larger diameter than the shaft portion 1008 of the fifth balloon shoulder 1002). The collar portion 1022 includes an elongated tapered portion 1026, a shorter tapered portion 1028, and a central ring portion 1030 disposed between (and separating) the elongated tapered portion 1026 and the shorter tapered portion 1028. The outer diameter of the collar portion 1022 and the sixth balloon shoulder 1004 is greatest at the central ring portion 1030, as indicated by outer diameter 1032. The elongated tapered portion 1026 includes a wider end connected to the central ring portion 1030 and then tapers inwardly from the wider end to a narrower end connected to the shaft portion 1024. The short tapered portion 1028 has a wider end connected to the central ring portion 1030 and then tapers inward from the wider end to a narrower end connected to the central connecting portion 1020 (or in some embodiments, not connected to the central connecting portion and instead is a closed end or connected to the inner shaft of a balloon catheter). The elongated tapered portion 1026 has a length 1034, which may be the longest length of any portion of the collar portion 1022.

[0158] 10 , the length 1034 of the elongated tapered portion 1026 of the sixth balloon shoulder, as well as the overall length of the collar portion 1022, are longer than the corresponding components of the fifth balloon shoulder 1002. Additionally, the outer diameter 1032 of the central ring portion 1030 of the sixth balloon shoulder is smaller than the outer diameter 1016 of the central ring portion 1014 of the fifth balloon shoulder 1002.

[0159] The varying lengths and / or diameters of the different portions of the fifth and sixth balloon shoulders can be configured for different applications (e.g., different balloon catheter designs and / or sizes). For example, in various embodiments, the length of the elongated tapered portion and / or the length and / or outer diameter of the shorter tapered portion and / or central ring portion of the collar portion of the balloon shoulder can be adjusted based on the size of the main balloon of the balloon catheter or the size of the balloon catheter itself into which the balloon shoulder (or balloon shoulder assembly) is adapted to be mounted. Similarly, the dimensions of the various portions of the other balloon shoulder embodiments shown in FIGS. 8-10 can also be adapted based on the intended application or balloon catheter. As introduced above, blow molding the balloon shoulder and / or balloon shoulder assembly allows for the relatively easy and inexpensive production of a wide variety of shapes and sizes (compared to injection molding similar parts). Furthermore, forming the balloon shoulder by blow molding creates a hollow balloon shoulder (e.g., with an outer wall that forms a hollow shell with a void within the outer wall), making the blow molded balloon shoulder less bulky and reducing mass compared to an injection molded shoulder. This reduced mass can result in a reduced overall length of the blow molded balloon shoulder, thereby allowing for a shorter delivery system (e.g., balloon catheter).

[0160] In some embodiments, as shown in Figures 8-10, the blow-molded balloon shoulder and balloon shoulder assembly may be closed (sealed) and therefore inflatable. The balloon shoulder (if formed separately) and / or the balloon shoulder assembly (if formed as a single piece) may be completely enclosed, with all ends and walls closed / sealed, for example, so that pressure (air or liquid) can be contained within the balloon shoulder and / or balloon shoulder assembly. For example, as shown in the embodiment of Figures 6-7, if the balloon shoulder assembly is formed as a single piece with a central connecting portion, the ends of the shaft portions of the proximal and distal balloon shoulders may be completely closed (sealed). In this manner, the walls of the balloon shoulder and / or balloon shoulder assembly can be expanded (e.g., as a balloon) by inflating the balloon shoulder and / or balloon shoulder assembly with a fluid (air or liquid). Thus, such inflatable balloon shoulders and / or balloon shoulder assemblies can have a deflated (uninflated) state and an inflated state.

[0161] FIGS. 11-13 illustrate embodiments of inflatable and non-inflatable blow-molded balloon shoulder assemblies. Specifically, FIG. 11 illustrates an embodiment of an inflatable balloon shoulder assembly 1100 in an uninflated (e.g., deflated) state, FIG. 12 illustrates an embodiment of the inflatable balloon shoulder assembly 1100 in an inflated state, and FIG. 13 illustrates an embodiment of a non-inflatable balloon shoulder assembly 1300. The balloon shoulder assemblies illustrated in FIGS. 11-13 can be inserted into the main balloon of a balloon catheter, such as the balloon catheter 200 illustrated in FIGS. 6 and 7. Furthermore, as illustrated in FIGS. 11-13, the balloon shoulder assembly is formed as a unitary piece including a central connecting portion. However, in alternative embodiments, the proximal and distal balloon shoulders of the balloon shoulder assemblies illustrated in FIGS. 11-13 may be formed separately without a central connecting portion and separately mounted within the main balloon of the balloon catheter. In yet another embodiment, the proximal and distal balloon shoulders and central connecting portion of Figures 11-13 may all be formed separately (by blow molding) and then joined together as a balloon shoulder assembly after blow molding.

[0162] 11 and 12 , the inflatable balloon shoulder assembly 1100 includes a proximal balloon shoulder 1102, a distal balloon shoulder 1104, and a central connecting portion 1106. The proximal balloon shoulder 1102 includes a collar portion 1108 and a shaft portion 1110, the proximal end 1112 of which forms the proximal end of the proximal balloon shoulder 1102, and the distal end 1114 of the collar portion 1108 forms the distal end of the proximal balloon shoulder 1102. Each of the distal end 1114 and the proximal end 1112 is a closed end (e.g., includes a sealed wall to contain pressure). The shaft portion 1110 extends through the center of the collar portion 1108 and may be connected to or continuous with the central connecting portion 1106 (if formed as an integral piece). 11, collar portion 1108 is conical in shape with a wider end located at distal end 1114 and a narrower end located closer to proximal end 1112. However, in alternative embodiments, collar portion 1108 may have another shape, such as one of the shapes described above with reference to FIGS. 6-10.

[0163] The distal balloon shoulder 1104 has a similar (e.g., the same) shape and arrangement as the proximal balloon shoulder 1102. The distal balloon shoulder specifically includes a collar portion 1116 and a shaft portion 1118 extending outwardly from and through the collar portion 1116 along a central axis of the inflatable balloon shoulder assembly 1100. A proximal end 1120 of the collar portion 1116 forms the proximal end of the distal balloon shoulder 1104, and a distal end 1122 of the shaft portion 1118 forms the distal end of the distal balloon shoulder 1104. Each of the distal end 1122 and the proximal end 1120 is a closed end (e.g., includes a wall to contain pressure).

[0164] Thus, the inflatable balloon shoulder assembly 1100 is configured to inflate by virtue of the closed end and completely sealed portion of the balloon shoulder, as described above. Specifically, one or more portions of the inflatable balloon shoulder assembly 1100 can receive and retain an inflation fluid (e.g., air or liquid) to inflate (e.g., expand outward relative to the central axis of the inflatable balloon shoulder assembly 1100).

[0165] For example, as shown in FIG. 12 , the sealed proximal balloon shoulder 1102 and the sealed distal balloon shoulder 1104 are inflated. Thus, the inflatable balloon shoulder assembly 1100 is in its inflated state. As shown in FIG. 12 , the outer walls 1124 of the proximal balloon shoulder 1102 and the distal balloon shoulder 1104, respectively, expand outward as they receive inflation fluid therein and inflate. As a result, the largest (e.g., maximum) outer diameter 1126 of the proximal balloon shoulder 1102 and the distal balloon shoulder 1104, respectively, increases compared to the uninflated state shown in FIG. 11 .

[0166] The balloon shoulder of the balloon shoulder assembly, in its inflated state, provides structural support to the main balloon of the balloon catheter and can also form the end (e.g., shoulder) of the valve-retaining portion of the main balloon, as shown in Figure 12. As a result, a prosthetic medical device, such as a prosthetic valve, crimped around the valve-retaining portion of the main balloon is held in place and cannot move axially beyond either the proximal or distal balloon shoulder. In some embodiments, after deployment of the prosthetic medical device from the balloon catheter, the balloon shoulder can be deflated to the deflated state shown in Figure 11, for example, to aid in removal of the balloon catheter from the patient's body.

[0167] In some embodiments, as shown in Figure 13, the balloon shoulder assembly may be configured to provide structural support for the main balloon of a balloon catheter even if it is not inflatable. For example, Figure 13 shows a blow-molded, non-inflatable balloon shoulder assembly 1300 including a proximal balloon shoulder 1302 and a distal balloon shoulder 1304, each of which is blow-molded and non-inflatable (e.g., not configured to be inflated, as described further below). The balloon shoulder assembly 1300 further includes a central connecting portion 1306 disposed between and connecting the proximal and distal balloon shoulders 1302 and 1304. However, in alternative embodiments, the balloon shoulder assembly 1300 may not include the central connecting portion 1306, and the proximal and distal balloon shoulders 1302 and 1304 may be formed separately as two pieces. Each of the proximal and distal balloon shoulders 1302, 1304 includes a collar portion 1308 and a shaft portion 1310. The shaft portion 1310 passes through the center of the collar portion 1308 and can be continuous with the central connecting portion 1306 or can connect to the central connecting portion 1306 at the innermost end of the collar portion 1308. The shaft portion 1310 can alternatively connect to the outermost narrow end of the collar portion 1308, and the central connecting portion 1306 can extend to the narrow end of the collar portion 1308, in some embodiments.

[0168] As shown in FIG. 13 , the collar portion 1308 has a funnel shape with a tapered outer wall 1312 extending between an open, wider end 1314 and a narrower end 1316 of the collar portion 1308. In alternative embodiments, the collar portion 1308 may have another shape, such as one of the shapes shown in the embodiments of FIGS. 6-10 , as described above. The narrower end 1316 can close around the shaft portion 1310, while at least the wider end 1314 is open and not sealed around the shaft portion 1310 or the central connecting portion 1306. Thus, the proximal and distal balloon shoulders 1302, 1304 are not completely sealed, cannot retain fluid pressure, and are therefore not inflatable. The outer wall 1312 can have a thickness that provides structural support for the main balloon surrounding the balloon shoulder assembly 1300 (when inserted into the main balloon of a balloon catheter). The outer wall 1312 may be thicker than, for example, the outer wall of an inflatable balloon shoulder assembly (such as the inflatable balloon shoulder assembly 1100 shown in FIGS. 11 and 12 ). In some embodiments, the increased thickness of the outer wall 1312 may range from 0.001 inches to 0.01 inches. In some embodiments, the wall thickness of an inflatable shoulder (including any of the embodiments described above) may range from 0.0001 inches to 0.01 inches. The increased wall thickness of the outer wall 1312 allows the balloon shoulder of the balloon shoulder assembly 1300 to structurally support the main balloon of the balloon catheter without being inflated.

[0169] In this manner, a blow-molded balloon shoulder assembly for a balloon catheter can be configured to be inflatable or non-inflatable, as shown in FIGS. 11-13. Furthermore, the balloon shoulder assembly can be formed as a unitary piece including both a proximal balloon shoulder and a distal balloon shoulder, or as two or more pieces (e.g., the proximal and distal balloon shoulders can be formed separately and not integrally with one another). Furthermore, as shown in FIGS. 6-10, the balloon shoulder of the balloon shoulder assembly can have various shapes and / or sizes. The various shapes and / or sizes of the balloon shoulder can be selected and adapted based on the type, size, and / or shape of the delivery system (e.g., the main balloon and / or balloon catheter) into which the balloon shoulder will be inserted and used. In still other embodiments, the balloon shoulder assembly can include an inflatable shoulder (including any of the above-described embodiments) and a non-inflatable shoulder (including any of the above-described embodiments), which can optionally be connected by a connecting portion.

[0170] In yet other embodiments, the balloon shoulder assembly can include a single shoulder, such as a single inflatable shoulder (including any of the above embodiments) or a single non-inflatable shoulder (including any of the above embodiments). The single shoulder can be used as a proximal or distal shoulder and can include a connecting portion (e.g., central connecting portion 214), but the connecting portion in such embodiments functions as an attachment portion for the single shoulder since the connecting portion does not connect two shoulders. The attachment portion can be secured to the shaft or other component of the delivery device by welding, adhesives, or the like. In other implementations, no attachment portion need be used, and the single shoulder can be attached directly to a component of the balloon catheter, such as the inner shaft 106, outer shaft 104, or nosecone 110.

[0171] In some embodiments, the prosthetic valve may be first crimped onto the delivery device at a location offset from the main balloon 108, as disclosed in U.S. Patent Application Publication Nos. 2009 / 0281619 and 2013 / 0030519, which are incorporated herein by reference, and then slid onto the balloon after insertion into the patient's vasculature. For example, the prosthetic valve may first be crimped onto a location proximal to the balloon 108 on the delivery device (such as on the outer shaft 104), and then slid onto the balloon 108 after insertion into the patient's vasculature. The shoulder assembly, in such a case, may comprise a single shoulder, or one of the shoulders may be much smaller than the other to easily position the prosthetic valve crimped onto the balloon 108 within the patient's body. For example, in one particular embodiment, the shoulder assembly may comprise a single shoulder, which may be the distal shoulder, and the prosthetic valve may first be crimped at a location proximal to the main balloon 108. In another embodiment, the single shoulder may be the proximal shoulder, and the prosthetic valve may be initially crimped at a location distal to the main balloon 108 .

[0172] FIG. 14 shows a flow chart of a method 1400 for manufacturing (e.g., forming) a balloon catheter comprising a blow-molded balloon shoulder assembly. The balloon shoulder assembly may be one of the balloon shoulder assemblies described herein with reference to FIGS. 6-13. The balloon catheter may be similar to one or more of the balloon catheters described herein with reference to FIGS. 3-7. In some embodiments, the balloon catheter may be part of a delivery system (e.g., an intravascular delivery system) configured to deliver a prosthetic medical device to a targeted location within a patient's body, such as a transcatheter heart valve delivery system. The blow-molded balloon shoulder of the balloon shoulder assembly may be configured to support the main balloon of the balloon catheter to which it is attached and to form a device seating pocket on the main balloon to reduce movement (e.g., axial movement) of the prosthetic medical device during the insertion (e.g., implantation) process, as described above.

[0173] Method 1400 begins at step 1402 with forming a balloon shoulder assembly by blow molding. The balloon shoulder assembly can include a proximal balloon shoulder and a distal balloon shoulder spaced apart axially relative to a central axis of the balloon shoulder assembly. In some embodiments, the proximal and distal balloon shoulders can be blow molded as a single piece with a central connector disposed between the proximal and distal balloon shoulders. In other embodiments, the proximal and distal balloon shoulders can be blow molded as separate pieces.

[0174] Additionally, in some embodiments, blow molding the balloon shoulder assembly can include forming a fully inflatable balloon shoulder assembly adapted to contain pressure (e.g., fluid pressure). In such embodiments, at least the proximal and distal balloon shoulders of the balloon shoulder assembly (and in some embodiments, the entire balloon shoulder assembly) can be fully sealed during assembly, with ends adapted to be sealed around one or more shafts of a balloon catheter. Examples of fully sealed inflatable balloon shoulder assemblies formed by blow molding are shown in Figures 11-12, as discussed above.

[0175] In other embodiments, blow molding the balloon shoulder assembly can include forming a non-inflatable balloon shoulder assembly in an at least partially open state. For example, at least one end or portion of the proximal and / or distal balloon shoulder can be open so that fluid pressure can escape or cannot be fully contained even after attachment to one or more shafts of a balloon catheter. An example of a non-inflatable balloon shoulder assembly formed by blow molding is shown in FIG. 13, as described above.

[0176] As introduced above, blow molding the balloon shoulder assembly in step 1402 results in a balloon shoulder assembly with a compressible outer wall and a hollow interior. Blowing the balloon shoulder assembly in step 1402 can include blowing the balloon shoulder assembly with an outer wall of a desired (e.g., predetermined) thickness. The thickness can be selected to be thicker for a non-inflatable balloon shoulder assembly and thinner for an inflatable balloon shoulder assembly. Furthermore, in some embodiments, blow molding the balloon shoulder assembly in step 1402 can include blowing the balloon shoulder assembly to provide a balloon shoulder of a predetermined size and / or shape. As noted above, blow molding the balloon shoulder assembly can enable balloon shoulder assemblies with a wider variety of shapes and / or sizes to be produced more cheaply and easily (compared to injection molding).

[0177] The method 1400 proceeds at 1404 with attaching the blown balloon shoulder assembly to one or more shafts of a delivery system (e.g., a balloon catheter). In some embodiments, the method may include attaching the entire blown balloon shoulder to one or more shafts or other components of a balloon catheter (e.g., the inner shaft 106 shown in FIG. 5) at 1404. In one particular implementation, the entire balloon shoulder assembly, including the proximal and distal balloon shoulders, may be attached to the innermost shaft of a delivery device (e.g., the inner shaft 106 shown in FIGS. 4 and 6-7).

[0178] In another embodiment, as shown in Figure 15A, balloon shoulder assembly 1500 can be arranged such that proximal shoulder 1502 is attached to the delivery device outer shaft 104 and distal shoulder 1504 is attached to the delivery device inner shaft 106. In another embodiment, as shown in Figure 15B, balloon shoulder assembly 1600 can be arranged such that proximal shoulder 1602 is attached to the delivery device outer shaft 104 and distal shoulder 1604 is attached to the delivery device nosecone 110. In another embodiment, as shown in Figure 15C, balloon shoulder assembly 1700 can be arranged such that proximal shoulder 1702 is attached to the delivery device inner shaft 106 and distal shoulder 1704 is attached to the delivery device nosecone 110. It should be understood that shoulder assemblies 1500, 1600, and 1700 can represent any of the embodiments of shoulder assemblies disclosed herein. That is, any of the shoulder assembly embodiments disclosed herein may be attached to a delivery device in any of the ways shown in Figures 15A-15C.

[0179] The method 1400 includes, at 1406, disposing a blow-molded balloon shoulder assembly within a main balloon of a delivery system (e.g., a balloon catheter). In some embodiments, the main balloon can be similar to the main balloon 108 shown in FIGS. 3-7. For example, in some embodiments, the method can include, at 1406, inserting a blow-molded balloon shoulder assembly attached to one or more shafts of a balloon catheter into the main balloon such that the main balloon surrounds at least a portion of the balloon shoulder assembly (e.g., at least the proximal and distal balloon shoulders). In some embodiments, if the balloon shoulder assembly is inflatable (e.g., adapted to be inflated by fluid pressure), the method can include, at 1406, inserting the blow-molded balloon shoulder assembly into the main balloon with the balloon shoulder assembly in a deflated state. As such, inserting the uninflated proximal and distal balloon shoulders into the main balloon can be easier (e.g., offering reduced resistance compared to injection-molded balloon shoulders). Furthermore, in some embodiments, a blow-molded balloon shoulder assembly may be easier to insert into a main balloon when uninflated due to the increased compressibility and hollowness of the blow-molded balloon shoulder assembly compared to an injection-molded balloon shoulder assembly. For example, the outer wall of the blow-molded balloon shoulder assembly may contract as the balloon shoulder assembly is pushed into and inserted into the main balloon, and then expand back to its uncompressed state after insertion into the main balloon. Such flexible (temporary) deformation may not be possible with an injection-molded balloon shoulder assembly.

[0180] Method 1400 can optionally proceed to 1408, where the balloon shoulder assembly or a portion of the balloon shoulder assembly can be inflated. For example, after disposing the balloon shoulder assembly within the main balloon, if the balloon shoulder assembly is configured to be inflated (e.g., sealed to contain pressure, i.e., inflatable), the method can optionally include inflating the balloon shoulder assembly at 1408 from an uninflated (e.g., deflated) state to an inflated state. In some embodiments, inflating the balloon shoulder assembly can include inflating the assembly of the proximal and distal balloon shoulders such that the outer walls of the proximal and distal balloon shoulders expand outward and press against the wall of the main balloon. In some embodiments, inflating the balloon shoulder assembly can include delivering a fluid to the interior of the balloon shoulder assembly (e.g., the interior of the proximal and distal balloon shoulders). In some embodiments, the fluid can be saline, a contrast mixture, or another type of biocompatible medium. In other embodiments, the fluid may be a hardening or non-hardening material that can cause the balloon shoulder to become a dense, rigid component. After the step of inflating the balloon shoulder assembly, the main balloon (e.g., balloon 108) is pleated around the contours of the balloon shoulder assembly, so that the balloon shoulder assembly is ready to receive a prosthetic valve. In alternative embodiments, the step of inflating the balloon shoulder assembly 1408 may not occur until the assembled balloon catheter is delivered to the end user. For example, the balloon shoulder assembly within the balloon catheter may be delivered to the end user in a deflated state and then inflated by the user just prior to the step of placing a prosthetic medical device (e.g., a prosthetic valve) onto the main balloon of the balloon catheter.

[0181] However, in some embodiments, method 1400 can proceed directly from 1406 to 1410 if the blow-molded balloon shoulder assembly is not configured to inflate. The method includes, at 1410, crimping a prosthetic medical device (e.g., a prosthetic heart valve) onto a device-retaining portion of a main balloon of the balloon catheter formed between the proximal and distal balloon shoulders of the blow-molded balloon shoulder assembly. In one embodiment, the prosthetic medical device may be crimped onto the balloon catheter during assembly and before shipping the assembled balloon catheter to an end user. In another embodiment, the assembled balloon catheter may be shipped to an end user without the prosthetic medical device being crimped onto the balloon catheter. After receiving the assembled balloon catheter and prior to treatment, the end user can then crimp a prosthetic medical device onto the device-retaining portion of the main balloon of the balloon catheter.

[0182] As explained above, the inner ends (e.g., the ends facing each other) of the collar portions of the proximal and distal balloon shoulders can structurally support the main balloon and, in the space separating the inner ends, form a natural pocket for crimping a prosthetic medical device. As a result, the prosthetic medical device can remain within the device retention portion during the implantation procedure as the balloon catheter is pushed through the patient's lumen, without axially migrating beyond the proximal or distal balloon shoulders. As explained above, in some embodiments, the balloon shoulder of the balloon shoulder assembly can reduce resistance when the prosthetic medical device is deployed (after inflating the main balloon and implanting it in the patient), deflated (at 1408 and / or if inflated during insertion), and the balloon catheter is withdrawn from within the patient.

[0183] The balloon shoulder assembly for a balloon catheter of the delivery system can thus include a proximal balloon shoulder including a collar portion and a shaft portion, and a distal balloon shoulder including a collar portion and a shaft portion. Each of the proximal and distal balloon shoulders can be hollow and include a compressible blow-molded material. The proximal and distal balloon shoulders can be axially spaced apart from one another relative to the central axis of the balloon catheter within the main balloon of the balloon catheter. Thus, a device (e.g., valve) retaining portion of the main balloon is created and adapted to receive a prosthetic medical device. In some embodiments, the delivery system is a transcatheter heart valve delivery system, and the prosthetic medical device is a prosthetic heart valve. In some embodiments, the balloon shoulder assembly can include a central connecting portion disposed between the proximal and distal balloon shoulders, and the entire balloon shoulder assembly can be formed as a single piece. In other embodiments, the balloon shoulder assembly need not be formed as a single piece, and the proximal and distal balloon shoulders can be individually blow-molded as separate pieces.

[0184] Forming the balloon shoulder assembly by blow molding creates a hollow, compressible balloon shoulder that can have reduced hardness, reduced mass, reduced stiffness, improved compressibility, and comparable structural strength compared to a similar injection-molded balloon shoulder assembly. As a result, the blow-molded balloon shoulder assembly can be more resilient, allowing the blow-molded balloon shoulder assembly to be compressed back into its expanded shape while still providing sufficient structural support for the main balloon of the balloon catheter, thereby facilitating easier insertion of the blow-molded balloon shoulder assembly into the main balloon of the balloon catheter and reducing sheath degradation during successful navigation of the balloon catheter through the sheath during the implantation procedure. Furthermore, a balloon catheter comprising a blow-molded balloon shoulder and / or balloon shoulder assembly can be more easily retrieved (e.g., with reduced force or resistance) through a sheath and / or a patient's vasculature after implantation of a prosthetic medical device. Furthermore, blow molding may allow for easier and cheaper modification of designs such as the size and shape of the balloon shoulder assembly than injection molding (e.g., due to the high cost of the molds required for injection molding).

[0185] Additionally, in some embodiments, the balloon shoulder assembly may be inflatable (and may exist in either a deflated or inflated state). In other embodiments, the balloon shoulder assembly may be non-inflatable. An inflatable balloon shoulder may further facilitate retrieval of the balloon catheter after implantation of the prosthetic medical device. For example, after implantation of the prosthetic medical device and during retrieval of the balloon catheter from the implantation site, the balloon shoulder may be deflated, thereby reducing the resistance of the balloon catheter to the sheath or the patient's vasculature as it is withdrawn from the patient.

[0186] Additionally, also in other embodiments, any of the balloon shoulder assemblies disclosed herein can be made using manufacturing techniques other than blow molding, including but not limited to injection molding, dipping, compression molding, and the like.

[0187] General Considerations It should be understood that the disclosed embodiments can be adapted to deliver and implant prosthetic devices into any of the heart's native valve annulus (e.g., the pulmonary, mitral, and tricuspid valve annulus) and can be used with any of a variety of delivery approaches (e.g., retrograde, antegrade, transseptal, transventricular, transatrial, etc.).

[0188] For purposes of this description, certain aspects, advantages, and novel features of embodiments of the disclosure have been described herein. The disclosed methods, apparatus, and systems should not be construed as limiting in any way. Rather, the present disclosure is directed to all novel and non-obvious features and aspects of the various disclosed embodiments, 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 embodiments do not require that any one or more particular advantages be present or problems be solved. The techniques in any example may be combined with the techniques described in any other example or examples. In view of the many possible embodiments to which the principles of the disclosed technology may be applied, it should be recognized that the illustrated embodiments are merely preferred examples and should not be construed as limiting the scope of the disclosed technology.

[0189] Although some operations of the disclosed embodiments are described in a specific sequential order for convenience of presentation, it should be understood that this description approach encompasses rearrangement unless a specific order is required by specific language set forth below. For example, operations described in sequence may, in some cases, be rearranged or performed simultaneously. Moreover, the accompanying figures, for simplicity's sake, may not show the various ways in which the disclosed methods can be used in combination with other methods. Furthermore, the description may use terms such as "provide" or "achieve" to describe the disclosed methods. 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 specific implementation and are readily discernible by those skilled in the art.

[0190] As used herein, with respect to transcatheter delivery systems, balloon catheters, introducer sheaths (e.g., sheaths), balloon shoulder assemblies, and balloon shoulders, "proximal" refers to a position, direction, or portion of a component that is closer to the handle of the delivery system that is outside the patient, while "distal" refers to a position, direction, or portion of a component that is farther from the handle. The terms "longitudinal" and "axial," unless expressly defined otherwise, refer to axes extending in the proximal and distal directions.

[0191] As used in this application and the claims, the singular forms "a," "an," and "the" include the plural forms unless the context clearly dictates otherwise. Furthermore, the term "comprises" means "comprising." Furthermore, the terms "coupled" and "connected" generally mean electrically, electromagnetically, and / or physically (e.g., mechanically or chemically) coupled or connected and do not exclude the presence of intermediate elements between coupled or associated items, unless specifically stated to the contrary.

[0192] Directions and other relative descriptions (e.g., inner, outer, upper, lower, etc.) may be used to facilitate discussion of the figures and principles herein, but are not intended to be limiting. For example, several terms such as "inner," "outer," "upper," "lower," "internal," "external," etc. may be used. Such terms are used, where applicable, to add some clarity to the description, particularly when dealing with relative relationships with respect to the illustrated embodiments. However, such terms are not intended to imply absolute relationships, positions, and / or orientations. For example, with respect to an object, an "upper" part may become a "lower" part simply by flipping the object over. Nevertheless, it is still the same part, and the object remains the same. As used herein, "and / or" means "and" or "or," as well as "and" and "or."

[0193] In view of the many possible embodiments to which the principles of the disclosed invention may be applied, it is recognized that the illustrated embodiments are merely preferred examples of the invention and should not be construed as limiting the scope of the invention. Rather, the scope of the invention is defined by the following claims. The inventors therefore claim as their invention all that comes within the scope and spirit of these claims. [Explanation of symbols]

[0194] 10 Artificial valve 12 frames 14 Valve structure 15 Inlet end part 16 Inner skirt 17 Middle part 18 Outer Skirt 19 Outflow end part 20 Commissural window 22 commissure 40 leaflets 50 Artificial Valve 52 frames 54 Valve structure 56 Sealing material 60 leaflets 62 Apical edge 64 commissure 66 Inlet end 68 Outflow end 72 Strut 74 Aperture 76 Inner layer 78 Outer layer 100 Delivery Device 102 Handle 103 Fluid Port 104 outer shaft 105 Intermediate shaft 106 Inner Shaft 107 Side opening 108 Main Balloon 109 Arrow 110 Conical head 112 Distal end section 114 Artificial Valves 118 Balloon shoulder assembly 120 Proximal Shoulder 122 Distal Shoulder 124 Longitudinal Axis 126 Proximal end portion 128 Distal end section 130 Valve holding part 132 Annular Space 134 Knob 200 Balloon Catheter 202 Balloon shoulder assembly 204 proximal end 206 Distal end 208 Proximal Balloon Shoulder 210 Artificial Medical Devices 212 Distal Balloon Shoulder 214 Central connection part 216 Proximal collar portion 218 Proximal shaft portion 220 Center axis 222 Distal collar portion 224 Distal shaft portion 226 Proximal transition section 228 Distal transition section 230 wide end 232 Narrow end 234 Wider end 236 Narrow End 302 Balloon shoulder assembly 304 Proximal end 306 Distal end 308 Proximal Balloon Shoulder 312 Distal Balloon Shoulder 314 Central connection part 316 Proximal collar part 318 Proximal shaft portion 322 Distal collar portion 324 Distal shaft portion 326 Proximal transition section 328 Distal transition section 340 Maximum outer diameter 802 First Balloon Shoulder 804 Second Balloon Shoulder 806 Color part 808 shaft part 810 Cylinder 812 first tapered end portion 814 Second tapered end portion 816 outer diameter 818 length 820 Central connection part 822 Color part 824 shaft part 826 Cylinder 828 First tapered end portion 830 Second tapered end portion 832 outer diameter 834 length 836 diameter 902 Third Balloon Shoulder 906 Color part 908 shaft part 910 Central part 912 First tapered end portion 914 Second tapered end 916 outer diameter 920 Central connection part 922 length 1002 5th Balloon Shoulder 1004 6th Balloon Shoulder 1006 Color part 1008 shaft part 1010 Long, tapered section 1012 Shorter tapered part 1014 Central ring part 1016 outer diameter 1018 length 1020 Central connection part 1022 Color part 1024 shaft part 1026 Long, tapered section 1028 Shorter tapered part 1030 Central ring part 1032 outer diameter 1034 length 1100 Balloon shoulder assembly 1102 Proximal Balloon Shoulder 1104 Distal Balloon Shoulder 1106 Central connection part 1108 Color part 1110 Shaft part 1112 proximal end 1114 distal end 1116 Color part 1118 Shaft part 1120 Proximal end 1122 distal end 1124 Exterior wall 1126 Maximum outer diameter 1300 Balloon shoulder assembly 1302 Proximal Balloon Shoulder 1304 Distal Balloon Shoulder 1306 Central connection part 1308 Color part 1310 Shaft part 1312 Exterior wall 1314 wide end 1316 Narrow end 1500 Balloon shoulder assembly 1502 Proximal Shoulder 1504 Distal Shoulder 1600 Balloon shoulder assembly 1602 Proximal Shoulder 1604 Distal Shoulder 1700 Balloon shoulder assembly 1702 Proximal Shoulder 1704 Distal Shoulder

Claims

1. A balloon shoulder assembly (118; 202; 302; 1100; 1300; 1500; 1600; 1700) for a balloon catheter (100; 200), comprising: a proximal balloon shoulder (120; 208; 308; 802; 1002; 1102;, 1302; 1502; 1602; 1702) comprising a proximal collar portion (216; 316; 806; 1006; 1108) extending radially outward from a proximal shaft portion relative to a central axis of the balloon shoulder assembly (118; ... 1700); a distal balloon shoulder (122; 212; 312; 804; 902; 1004; 1104; 1304; 1504; 1604; 1704) having a distal collar portion (222; 322; 1022; 1116) extending radially outward from a distal shaft portion (224; 324); Equipped with each of the proximal balloon shoulder (120; ... 1702) and the distal balloon shoulder (122; ... 1704) is hollow, comprises a compressible blow-molded material, and is configured to be disposed within and support an inflatable main balloon (108) of the balloon catheter (100; 200); the proximal balloon shoulder (120; ... 1702) and the distal balloon shoulder (122; ... 1704) are molded as a single piece together with a central connecting portion (214; 314; 820; 920; 1020; 1106; 1306), the central connecting portion (214; ... 1306) being disposed between the proximal collar portion (216; ... 1108) and the distal collar portion (222; ... 1116) and connecting the proximal collar portion (216; ... 1108) and the distal collar portion (222; ... 1116); The proximal balloon shoulder (120; ... 1702) extends between the proximal collar portion (216; ... 1108) and the central connecting portion (214; ... 1306) and further comprises a proximal transition portion (226; 326) connecting the proximal collar portion (216; ... 1108) and the central connecting portion (214; ... 1306), the proximal transition portion reducing in diameter from the proximal collar portion (216; ... 1108) to the central connecting portion (214; ... 1306), and the distal balloon shoulder (122; ... 1704) extends between the distal collar portion (222; ... 1116) and the central connecting portion (214; ... 1306) and further comprises a proximal transition portion (226; 326) connecting the proximal collar portion (216; ... 1108) and the central connecting portion (214; ... 1306), the proximal transition portion reducing in diameter from the proximal collar portion (216; ... 1108) to the central connecting portion (214; ... 1306). 1116) and said central connecting portion (214; ... 1306), said distal transition portion reducing in diameter from said distal collar portion (222; ... 1116) to said central connecting portion (214; ... 1306).

2. 17. The balloon shoulder assembly (118; ... 1700) of claim 1, wherein the outer wall of the proximal balloon shoulder (120; ... 1702) and the outer wall of the distal balloon shoulder (122; ... 1704) are configured to compress or expand under an applied pressure and to return to a non-compressed or non-expanded state when the applied pressure is removed.

3. 3. A balloon shoulder assembly (118; ... 1700) according to any one of claims 1 to 2, wherein the proximal collar portion (216; ... 1108) is spaced apart from the distal collar portion (222; ... 1116) in an axial direction relative to the central axis (220).

4. 4. A balloon shoulder assembly (118; ... 1700) according to any one of claims 1 to 3, wherein each of the proximal balloon shoulder (120; ... 1702) and the distal balloon shoulder (122; ... 1704) is inflatable.

5. 5. A balloon shoulder assembly (118; ... 1700) according to any one of claims 1 to 4, wherein the proximal balloon shoulder (120; ... 1702) and the distal balloon shoulder (122; ... 1704) are not fluidly connected to each other and are individually inflatable.

6. each of the proximal balloon shoulder (120; ... 1702) and the distal balloon shoulder (122; ... 1704) is non-inflatable; each of the proximal balloon shoulder (120; ... 1702) and the distal balloon shoulder (122; ... 1704) has a wall thickness in the range of 0.0001 inches to 0.01 inches; and / or 4. A balloon shoulder assembly (118; ... 1700) according to any one of claims 1 to 3, wherein the proximal collar portion (216; ... 1108) has an open end facing the open end of the distal collar portion (222; ... 1116).

7. 7. The balloon shoulder assembly (118; ... 1116) according to claim 1, wherein each of the proximal collar portion (216; ... 1108) and the distal collar portion (222; ... 1116) is funnel-shaped with a wider end (230) flaring radially outward from a narrower end (232), the narrower end (232) of the proximal collar portion (216; ... 1108) is connected to the proximal shaft portion (218; 318), and the narrower end (232) of the distal collar portion (222; ... 1116) is connected to the distal shaft portion (224; 324), and the wider ends (230) of the proximal collar portion (216; ... 1108) and the distal collar portion (222; ... 1116) are disposed opposite each other and perpendicular to the central axis. 1700).

8. 7. A balloon shoulder assembly (118; ... 1700) according to any one of claims 1 to 6, wherein each of the proximal collar portion (340) and the distal collar portion (222; ... 1116) has a bulbous shape with a wider central portion (340) that narrows to two opposite ends.

9. One or both of the proximal collar portion (216; ... 1108) and the distal collar portion (222; ... 1116) comprises a central cylindrical body (810; 826; 910) disposed between a first tapered end portion (812; 828; 912) and a second tapered end portion (814; 830; 914), and the first tapered end portion (812; 828; 912) and the second tapered end portion (814; 830; 914) extend from the central cylindrical body (810; 826; 910) to the central connecting portion (214; ... 1306), or the proximal shaft portion or the distal shaft portion (224; 7. A balloon shoulder assembly (118; ... 1700) according to any one of claims 1 to 6, wherein the first and second ends of the balloon shoulder assembly (118; ... 1700) are tapered in opposite directions to one of the corresponding ends of the balloon shoulder assembly (118; ... 1700).

10. 7. The balloon shoulder assembly (118; ... 1700) according to any one of claims 1 to 6, wherein one or both of the proximal collar portion (216; ... 1108) and the distal collar portion (222; ... 1116) comprise a curved central portion disposed between a first tapered end portion (812; 828; 912) and a second tapered end portion (814; 830; 914), the first tapered end portion (812; 828; 912) and the second tapered end portion (814; 830; 914) tapering in opposite directions from the central portion (810; 826; 910) to one of the central connecting portion (214; ... 1306) or a corresponding one of the proximal or distal shaft portions (224; 324).

11. 7. A balloon shoulder assembly (118; ... 1700) according to any one of claims 1 to 6, wherein one or both of the proximal collar portion (1006) and the distal collar portion (1022) comprises an elongated tapered portion (1010; 1026), a shorter tapered portion (1012; 1028), and a central ring portion (1014; 1030) disposed between the elongated tapered portion (1010; 1026) and the shorter tapered portion (1012; 1028).

12. A method for manufacturing a balloon catheter (100; 200), comprising the steps of: Blow molding a balloon shoulder assembly (118; ... 1700) comprising a proximal balloon shoulder (120; ... 1702) and a distal balloon shoulder (122; ... 1704); mounting the blow-molded balloon shoulder assembly (118; ... 1700) within the balloon catheter (100; 200) by placing the balloon shoulder assembly (118; ... 1700) within the inflatable main balloon (108) of the balloon catheter (100; 200); Including, A device retention portion is formed on the main balloon in a space separating the proximal balloon shoulder and the distal balloon shoulder.

13. A balloon catheter (100; 200) for an intravascular delivery system, comprising: a proximal balloon shoulder (120; ... 1702) attached to the inner shaft of the balloon catheter (100; 200), the proximal balloon shoulder (120; ... 1702) including a proximal collar portion extending radially outward from the inner shaft; a distal balloon shoulder (122; ... 1704) attached to the inner shaft, the distal balloon shoulder (122; ... 1704) including a distal collar portion extending radially outward from the inner shaft; an inflatable main balloon (108) enclosing said proximal balloon shoulder (120; ... 1702) and said distal balloon shoulder (122; ... 1704); Equipped with each of the proximal balloon shoulder and the distal balloon shoulder is hollow and comprises a compressible blow-molded material; the proximal balloon shoulder (120; ... 1702) and the distal balloon shoulder (122; ... 1704) are molded as a single piece together with a central connecting portion (214; 314; 820; 920; 1020; 1106; 1306), the central connecting portion (214; ... 1306) being disposed between the proximal collar portion (216; ... 1108) and the distal collar portion (222; ... 1116) and connecting the proximal collar portion (216; ... 1108) and the distal collar portion (222; ... 1116); The proximal balloon shoulder (120; ... 1702) extends between the proximal collar portion (216; ... 1108) and the central connecting portion (214; ... 1306) and further comprises a proximal transition portion (226; 326) connecting the proximal collar portion (216; ... 1108) and the central connecting portion (214; ... 1306), the proximal transition portion reducing in diameter from the proximal collar portion (216; ... 1108) to the central connecting portion (214; ... 1306), and the distal balloon shoulder (122; ... 1704) extends between the distal collar portion (222; ... 1116) and the central connecting portion (214; ... 1306) and further comprises a proximal transition portion (226; 326) connecting the proximal collar portion (216; ... 1108) and the central connecting portion (214; ... 1306), the proximal transition portion reducing in diameter from the proximal collar portion (216; ... 1108) to the central connecting portion (214; ... 1306). 1116) and said central connecting portion (214; ... 1306), wherein said distal transition portion reduces in diameter from said distal collar portion (222; ... 1116) to said central connecting portion (214; ... 1306).

Images