Flexible Shunt Implant

Abstract

The delivery system includes a catheter configured to be delivered through a blood flow pathway of the heart, and an implant configured to maintain an opening in a tissue wall to allow blood flow through the opening and into the blood flow pathway and to be delivered via the catheter, The implant is constructed at least in part from a flexible material that allows the implant to bend with the catheter.

Description

[Technical Field]

[0001] (Related Applications) This application claims priority to U.S. Provisional Patent Application No. 63 / 199,323, filed December 18, 2020, and entitled "SHUNT IMPLANT DEVICES AND PROCESSES," the complete disclosure of which is incorporated herein by reference in its entirety.

[0002] The present invention relates generally to the field of medical devices and procedures. [Background technology]

[0003] In percutaneous delivery systems for delivering certain medical implant devices at least partially to a target location through a patient's vascular system, certain anatomical and device dimensions may limit the size, shape, and / or configuration of the medical implant device delivered using such systems. Summary of the Invention

[0004] For purposes of summarizing the disclosure, certain aspects, advantages, and novel features have been described herein. It is to be understood that not all such advantages may necessarily be achieved in accordance with any particular embodiment. Thus, the disclosed embodiments may be practiced in a manner that achieves or optimizes one advantage or group of advantages as taught herein without necessarily achieving other advantages that may be taught or suggested herein.

[0005] Some implementations of the present disclosure relate to a delivery system including a catheter configured to be delivered through a blood flow pathway of a heart, and an implant configured to maintain an opening in a tissue wall to allow blood flow through the opening and into the blood flow pathway, the implant being at least partially constructed from a flexible material that allows the implant to bend with the catheter.

[0006] The implant may be configured to be crimped around an outer surface of a catheter. In some embodiments, the implant is at least partially constructed from a braided cord. The implant may be at least partially constructed from a coiled cord.

[0007] In some embodiments, the implant includes a piercing element configured to pierce through the tissue wall to form an opening in the tissue wall. The piercing element may be further configured to secure the implant to the tissue wall. In some embodiments, the implant further includes a fixation element, wherein the piercing element and the fixation element are configured to secure on opposite sides of the tissue wall.

[0008] The implant can include a first tubular portion and a second tubular portion. In some embodiments, the first tubular portion is configured to bend away from the second tubular portion to allow the first tubular portion to enter the opening in the tissue wall. The second tubular portion can be configured to extend along the blood flow pathway and beyond the opening in the tissue wall.

[0009] In some embodiments, the first tubular portion and the second tubular portion are separate devices. The first tubular portion and the second tubular portion may extend from a common base portion. In some embodiments, the first tubular portion is at least partially constructed from a shape memory material.

[0010] The delivery system may further comprise a sheath configured to at least partially encapsulate the implant and to retract to at least partially expose the implant and allow the implant to expand. In some embodiments, the blood flow pathway is the coronary sinus and the opening creates a flow pathway between the left atrium and the coronary sinus.

[0011] Some implementations of the present disclosure relate to a method that includes delivering an implant at least partially enclosed by a sheath to the coronary sinus via the right atrium, the implant being at least partially comprised of a braided or coiled cord that allows the implant to flex into the coronary sinus. The method further includes puncturing a tissue wall of the coronary sinus to form an opening between the left atrium and the coronary sinus, retracting the sheath to expose the implant, and securing the implant in the opening. The implant is configured to maintain the opening.

[0012] The implant may include a piercing element. The piercing of the tissue wall may be performed using the piercing element.

[0013] In some embodiments, securing the implant in the opening includes contacting the tissue wall with a piercing element. The piercing element may be configured to establish a single point of contact with the tissue wall.

[0014] The implant may include a first tubular portion and a second tubular portion. Retracting the sheath may allow the first tubular portion to bend away from the second tubular portion.

[0015] According to some implementations of the present disclosure, the medical implant includes a means for maintaining an opening through a tissue wall of the heart. The opening forms a blood flow path from a first chamber of the heart to a blood flow pathway of the heart. The means for maintaining the opening is configured to flex to facilitate delivery to the blood flow pathway and the first chamber. The medical implant further includes a means for anchoring to the tissue wall at the opening.

[0016] The medical implant may further include means for puncturing the tissue wall to form the opening. [Brief explanation of the drawings]

[0017] Various embodiments are depicted in the accompanying drawings for illustrative purposes and should not be construed as limiting the scope of the present invention in any way. In addition, various features of different disclosed embodiments may be combined to form additional embodiments that are part of the present disclosure. Throughout the drawings, reference numerals may be reused to indicate correspondence between referenced elements. However, it should be understood that the use of similar reference numerals in relation to multiple drawings does not necessarily imply similarity between the respective embodiments associated therewith. Furthermore, it should be understood that features in the respective drawings are not necessarily drawn to scale, and that their illustrated sizes are presented for the purpose of illustrating aspects of the invention. In general, some of the illustrated features may be relatively smaller than illustrated in some embodiments or configurations.

[0018] [Figure 1] FIG. 1 illustrates several access routes for manipulating guidewires and / or catheters in and around the heart to deploy compressible implants, according to some embodiments. [Figure 2] FIG. 2 depicts a procedure for deploying an implant according to some embodiments. [Figure 3A] FIG. 3A illustrates a flexible shunt implant according to some embodiments. [Figure 3B] FIG. 3B illustrates a flexible shunt implant according to some embodiments. [Figure 4-1] FIG. 4 (FIG. 4-1) is a flow diagram illustrating a process for delivering and / or securing an implant at a treatment site according to one or more embodiments of the present disclosure. [Figure 4-2] FIG. 4 (FIG. 4-2) is a flow diagram illustrating a process for delivering and / or securing an implant at a treatment site according to one or more embodiments of the present disclosure. [Figure 5-1] FIG. 5 (FIG. 5-1) provides several images related to the process of FIG. 4 and illustrates aspects of the process according to one or more implementations thereof. [Figure 5-2]FIG. 5 (FIG. 5-2) provides several images related to the process of FIG. 4 and illustrates aspects of the process according to one or more implementations thereof. [Figure 6] FIG. 6 illustrates another exemplary shunt implant according to an embodiment of the present disclosure. [Figure 7-1] FIG. 7 (FIG. 7-1) is a flow diagram illustrating a process for delivering and / or securing an implant at a treatment site according to one or more embodiments of the present disclosure. [Figure 7-2] FIG. 7 (FIG. 7-2) is a flow diagram illustrating a process for delivering and / or securing an implant at a treatment site according to one or more embodiments of the present disclosure. [Figure 8-1] FIG. 8 (FIG. 8-1) provides several images related to the process of FIG. 7 and illustrates aspects of the process according to one or more implementations thereof. [Figure 8-2] FIG. 8 (FIG. 8-2) provides several images related to the process of FIG. 7 and illustrates aspects of the process according to one or more implementations thereof. [Figure 9A] FIG. 9A illustrates another exemplary shunt implant according to an embodiment of the present disclosure. [Figure 9B] FIG. 9B illustrates another exemplary shunt implant according to an embodiment of the present disclosure. [Figure 10] FIG. 10 illustrates another exemplary shunt implant according to an embodiment of the present disclosure. [Figure 11] FIG. 11 is a flow diagram illustrating a process for delivering and / or securing an implant at a treatment site in accordance with one or more embodiments of the present disclosure. [Figure 12] FIG. 12 provides images related to the process of FIG. 11 and illustrates aspects of the process according to one or more implementations thereof. DETAILED DESCRIPTION OF THE INVENTION

[0019] The headings provided herein are for convenience only and do not necessarily affect the scope or meaning of the claimed invention.

[0020] Abstract Heart failure is a common and potentially fatal condition affecting humans, and despite maximal treatment, suboptimal clinical outcomes often result in symptoms, morbidity, and / or mortality. In particular, "diastolic heart failure" refers to the clinical syndrome of heart failure that occurs in the setting of preserved left ventricular systolic function (ejection fraction) and in the absence of major valvular disease. This condition is characterized by a stiff left ventricle with reduced compliance and impaired relaxation, which leads to increased end-diastolic pressure. Approximately one-third of heart failure patients have diastolic heart failure, and there are very few, if any, proven effective treatments.

[0021] Symptoms of diastolic heart failure are due, at least in large part, to elevated pressure in the left atrium. Elevated left atrial pressure (LAP) is present in several abnormal cardiac conditions, including heart failure (HF). In addition to diastolic heart failure, several other medical conditions, including left ventricular systolic dysfunction and valvular disease, can result in elevated pressure in the left atrium. Both heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) can present with elevated LAP. It is hypothesized that both HF subpopulations would benefit from a reduction in LAP, which in turn reduces left ventricular systolic preload, left ventricular end-diastolic pressure (LVEDP). It can also relieve pressure in the pulmonary circulation, reduce the risk of pulmonary edema, improve breathing, and improve patient comfort.

[0022] Pulmonary hypertension (PH) is defined as an increase in mean pressure in the main pulmonary artery. PH can result from many different causes, but it has been shown to increase mortality in all patients. A fatal form of PH occurs in the very small branches of the pulmonary arteries and is known as pulmonary arterial hypertension (PAH). In PAH, cells inside the small arteries grow due to injury or disease, reducing the area inside the arteries and thickening the arterial walls. As a result, these small pulmonary arteries narrow and stiffen, restricting blood flow and increasing upstream pressure. This increase in pressure in the main pulmonary artery is commonly associated with all forms of PH, regardless of the underlying cause. Despite previous attempts, improved methods are needed to reduce the pressure increase in the left atrium, as well as other susceptible heart chambers, such as the pulmonary artery.

[0023] The present disclosure provides methods and apparatus (including various implants) for shunting blood within the human body. The term "implant" is used herein according to its plain and ordinary meaning and may refer to any medical implant, frame, valve, shunt, stent, anchor, and / or similar device for use in treating various conditions of the human body. Implants may be delivered via a catheter (i.e., transcatheter) for various medical procedures and may generally have a rigid and / or flexible structure. The term "catheter" is used herein according to its broad and ordinary meaning and may include any tube, sheath, steerable sheath, steerable catheter, and / or any other type of elongated tubular delivery device with an inner lumen configured to slidably receive an instrument, such as for positioning within the atrium or coronary sinus, including, for example, a delivery catheter and / or cannula. In some cases, the implant may be constructed of a shape memory alloy (e.g., Nitinol) and / or may have a predefined shape and / or configuration. The implant may be configured to be molded and / or compressed to fit within and / or around a catheter. In some cases, the implant may have an oval and / or cylindrical shape and / or may include an interwoven pattern of material.

[0024] Some embodiments described herein provide methods and / or systems for shunting blood within a patient's body. While some embodiments may be directed to delivery of a shunt system from the superior vena cava to the coronary sinus ostium (CSO), the methods and / or systems described herein may also be applied to other regions of the body. For example, some methods and / or devices described herein may be advantageously configured for delivery of shunt devices to a variety of difficult cardiovascular anatomies.

[0025] Some known and / or conventional shunt devices may include pre-formed stents and / or similar devices. Such devices may have a generally rigid and / or difficult to manipulate structure, especially when collapsed during the delivery process. Some embodiments herein advantageously provide a flexible and / or maneuverable shunt device that can facilitate delivery through various pathways within a patient's body.

[0026] The following includes a general description of human cardiac anatomy that is relevant to certain inventive features and embodiments disclosed herein and is included to provide context for certain aspects of the present disclosure. In humans and other vertebrates, the heart is a hollow, muscular organ with four pumping chambers, with the left and right atria and left and right ventricles each equipped with their own one-way valves. The natural heart valves are identified as the aortic, mitral (or bicuspid), tricuspid, and pulmonary valves, each attached to an annulus comprising a dense fibrous ring that is directly or indirectly attached to atrial and ventricular muscle fibers. Each annulus defines a flow orifice. The four valves ensure that blood does not flow in the wrong direction during the cardiac cycle, i.e., blood does not backflow through the valves. Blood flows from the venous system and the right atrium through the tricuspid valve to the right ventricle, and then from the right ventricle through the pulmonary valve to the pulmonary artery and lungs. The oxygenated blood then flows from the left atrium through the mitral valve into the left ventricle and finally from the left ventricle through the aortic valve into the aortic / arterial system.

[0027] 1 illustrates several access routes for manipulating guidewires and catheters in and around the heart 1 to deploy a compressible medical implant (e.g., frame) of the present application. For example, access can be gained from above into the superior vena cava (SVC) 15, the right atrium (RA) 5, and from there into the coronary sinus ostium (CSO) 17 via either the subclavian or jugular vein. Alternatively, an access route can begin in the femoral vein and pass through the inferior vena cava (IVC) 14 into the heart 1. Other access routes can also be used, and each typically utilizes a percutaneous incision through which a guidewire and catheter are inserted into the vascular system, usually through a sealed introducer, from which the physician controls the distal end of the device from outside the body.

[0028] 2 depicts an exemplary method for deploying a medical implant in which a guidewire and / or catheter 16 is introduced through the subclavian or jugular vein, through the SVC 15, and into the coronary sinus 19. In some instances, a guidewire can be used to provide a pathway, after which an introducer sheath (not shown) can be routed along the guidewire into the patient's vasculature, typically with the use of a dilator 9 and / or an atraumatic tip. FIG. 2 shows the deployment catheter 16 extending from the SVC 15 to the CSO 17 and into the coronary sinus 19 of the heart 1. The deployment catheter 16 can pass through the introducer sheath, which can provide a hemostatic valve to prevent blood loss.

[0029] The deployment catheter 16 may be approximately 30 cm in length, with the guidewire being slightly longer for ease of use. In some embodiments, the deployment catheter may function to create and / or prepare an opening in the wall of the left atrium 2, and a separate placement or delivery catheter may be used for delivery of the expandable implant. In other embodiments, the deployment catheter may be used as both a fully functional puncture preparation and implant placement catheter. In this application, the terms "deployment catheter" or "delivery catheter" are used to refer to a catheter or introducer that has one or both of these functions.

[0030] Because the coronary sinus 19 is largely continuous around the left atrium 2, there are a variety of possible acceptable placements for the implant. The site selected for placement of the implant (e.g., shunt) may be within an area of ​​thin or sparse tissue in a particular patient, as predetermined by non-invasive diagnostic means, such as CT scan or radiography, fluoroscopy, or intravascular coronary ultrasound (IVUS).

[0031] Some methods of reducing LAP involve utilizing an implant between the left atrium 2 and the right atrium 5 through the interatrial septum between them. This is a convenient approach because the two structures are adjacent and transseptal access is a common method. However, there is a risk of emboli migrating from the right side of the heart to the left, creating a risk of stroke. This should only occur when right atrial pressure exceeds left atrial pressure, primarily during discrete events such as coughing, sneezing, the Valsalva maneuver, or bowel movements. The anatomical location of the septum would naturally allow emboli to move freely between the atria when the implant is present and the pressure gradient is reversed. This can be mitigated by a valve or filter element in the implant, but there is still a risk of emboli crossing over.

[0032] Implantation into the coronary sinus 19 offers several distinct advantages, including a much lower likelihood of emboli present in the coronary sinus 19 for several reasons. First, blood draining from the coronary vasculature into the right atrium 5 has just passed through the capillaries and is essentially filtered blood. Second, the coronary sinus 19 CSO 17 in the right atrium 5 is often partially covered by a false valve called the Thebesian valve. While not always present, the Thebesian valve is present in >60% of hearts and some studies have shown that it acts as a natural "watchdog" for the coronary sinus, preventing emboli from entering when right atrial pressure spikes. Third, the pressure gradient between the coronary sinus 19 and the right atrium 5 through which it exits is very low, meaning that thrombi in the right atrium 5 are likely to remain there. Fourth, if an embolus enters the coronary sinus 19, a much greater gradient exists between the right atrium 5 and the coronary vasculature than between the right atrium 5 and the left atrium 2. The embolism will most likely travel further down the coronary vasculature until right atrial pressure returns to normal and the embolism then returns directly to the right atrium 5.

[0033] Some additional advantages of positioning the implant between the left atrium 2 and the coronary sinus 19 may be that this anatomical structure is less mobile and / or more stable than the septum, preserving the septum for later transseptal access for alternative therapies and potentially having other therapeutic benefits. By shunting left atrial blood into the coronary sinus 19, sinus pressure may be increased by a small amount. This may cause blood in the coronary vasculature to move more slowly through the heart, increasing perfusion and oxygen transfer, which may be more efficient and may also help dying myocardium recover. Preserving transseptal access is also a significant advantage, as HF patients often have many other comorbidities, such as atrial fibrillation (AF) and mitral regurgitation (MR), and several therapies to treat these conditions require a transseptal approach.

[0034] The implant may also be positioned within a chamber and / or blood vessel, and / or between other ventricular chambers, such as between the pulmonary artery and the right atrium 5. The implant may be desired to be implanted within the wall of the pulmonary artery using a catheter approached from above and threaded through the pulmonary artery using a deployment tool described herein. As explained above, pulmonary hypertension (PH) is defined as an increase in mean pressure in the main pulmonary artery. If a pressure difference causes flow in that direction, blood flows from the pulmonary artery to the right atrium 5 through the shunt implant, thereby attenuating pressure and reducing damage to the pulmonary artery. The goal is to attenuate pressure spikes in the pulmonary artery. The implant may also extend from the pulmonary artery to other heart chambers (e.g., the left atrium 2) and / or blood vessels. In some embodiments, the implant may further include a one-way valve to prevent backflow, or a check valve that allows blood to pass only above a specified pressure.

[0035] Tracking a shunt delivery system (e.g., over a guidewire) from the superior vena cava 15 to the coronary sinus ostium (CSO) 17 can often be difficult due, at least in part, to the CSO level insertion (CSLI) distance, which can measure the distance between the bottom of the CSO 17 and the bottom of the right atrium 5. If the implant is at least partially rigid and / or creates a rigid section within a portion of the catheter 16, it can be difficult for the surgeon to track the catheter 16 through the CSO 17 and / or other anatomical structures. In some cases, the catheter 16 can get caught on a bulge below the CSO 17 when tracking the catheter 16 over the guidewire, and / or the catheter must form a significant "arch" shape in the right atrium 5 (shown in FIG. 2 ). In some cases, arching of the catheter 16, as shown in FIG. 2 , can result in loss of guidewire access, for example, because the guidewire extends from the catheter 16 beyond the access point within the coronary sinus 19.

[0036] Some implants described herein may be at least partially compressible and / or expandable. The implants described herein may have various features to simplify and / or improve the delivery procedure for the surgeon. For example, the implants may be at least partially flexible, compressible, and / or resilient so that the implant can be shaped and / or molded as needed and / or desired to fit within / on delivery catheters having various sizes and / or shapes.

[0037] Additionally, the implant can be configured to fit into various openings created in tissue walls having various sizes and / or shapes. The tissue wall can be located between a first anatomical chamber (e.g., coronary sinus 19) and a second anatomical chamber (e.g., left atrium 2). In some embodiments, an opening can be created through the tissue wall, and the implant can be configured to fit at least partially within the opening. The opening can represent a blood flow path between the first anatomical chamber and the second anatomical chamber. In some embodiments, the implant can be configured to maintain an opening and / or a blood flow path from the first anatomical chamber to the second anatomical chamber.

[0038] Expandable Shunt Implant 3A and 3B illustrate a flexible shunt implant 300 according to some embodiments. The implant 300 may comprise any of a variety of features and / or components configured to treat various medical conditions. For example, the implant 300 may be configured to maintain an opening in a tissue wall and / or allow blood flow through a tissue wall. In some embodiments, the implant 300 may comprise a central flow portion 302 that may be configured to at least partially reside within the opening in the tissue wall. The central flow portion 302 may be configured to create and / or maintain an opening between two anatomical chambers. In some embodiments, the implant 300 may comprise multiple separate components that may be attached, connected, and / or otherwise joined to form a single device. For example, the central flow portion 302 may comprise multiple components forming a generally tubular shape that may approximate the shape of the opening in the tissue wall.

[0039] The implant 300 may be at least partially constructed from a braided material, which may include stainless steel, nitinol, and / or other metals. At least a portion of the implant 300 may be configured to be collapsed to a smaller diameter for delivery while maintaining the flexibility of the implant 300. In some embodiments, at least a portion of the implant 300 may be configured for delivery into the body onto the outer surface and / or outer diameter of the catheter 16, as shown in FIG. 3B. For example, the implant 300 may be configured to be crimped onto the outer surface of the catheter 16. The implant 300 may be crimped onto the catheter as tightly as possible to minimize the increase in diameter of the catheter 16 caused by the implant 300. In some embodiments, at least a portion of the implant 300 may be covered by a tubular sheath (not shown) configured to surround at least a portion of the implant 300. The sheath may be configured to prevent the implant 300 from expanding from the crimped configuration. In some embodiments, additional and / or alternative devices and / or methods may be used to prevent the expansion of the implant 300. For example, one or more wires may be attached to the implant 300 to hold the implant 300 securely to the catheter 16 during delivery into the body.

[0040] The implant 300 may be configured to have maximum flexibility during delivery into the body to prevent the implant 300 from interfering with the flexibility of the catheter 16. In some embodiments, the implant 300 may be configured to maintain a level of flexibility while being crimped onto the catheter 16. The flexible shunt implant 300 may include a central flow portion 302 comprised of a network of braided and / or interlocking cords 307, which may include wires, sutures, strings, fibers, and / or various other elongated devices. One or more cords 307 may interact with one another in a weaving / interlacing and / or braiding pattern. For example, a first cord may pass through a second cord, a third cord, a fourth cord, etc. Thus, one or more cords 307 may have at least some flexibility such that the cords 307 may be configured to bend over and / or under the other cords 307. For example, one or more cords 307 may be comprised of nitinol and / or another material that may be configured to bend and / or stretch at least in part.

[0041] The flow portion 302 may include any number of cords 307. In some embodiments, the flow portion 302 may comprise a single cord 307 configured to interweave with itself. By increasing the number of cords 307 and / or the amount of interweaving of one or more cords 307, gaps between the cords 307 and / or different sections of a single cord 307 may be minimized to improve the prevention and / or reduction of tissue ingrowth. Additionally, each of the cords 307 may have any thickness and may be designed to minimize gaps while maximizing the expandability of the flow portion 302.

[0042] The flow portion 302 can be configured to be positioned at least partially within an opening in a tissue wall. The tissue wall can have a first side and a second side, and the opening can represent a gap through the tissue wall. The "thickness" of the tissue wall can refer to the distance between the first side and the second side of the tissue wall.

[0043] One or more cords 307 of flow portion 302 may form a cylindrical or other shape that approximates the shape of the opening in the tissue wall. In some embodiments, the opening may widen approximately evenly in all directions from the puncture point to form a generally circular opening having a particular diameter. Thus, flow portion 302 may have an at least partially rounded and / or circular configuration.

[0044] In some embodiments, the flexible shunt implant 300 may be in a compacted and / or otherwise flexible form upon delivery. For example, upon delivery, one or more cords 307 may be positioned relatively close together with minimal gaps between the one or more cords 307. As the tissue wall expands, the one or more cords 307 may gradually separate and / or stretch to create a longer length of the flexible shunt implant 300. In some embodiments, the one or more cords 307 may be configured to stretch in response to the expansion of the tissue wall. For example, upon delivery, the one or more cords 307 may be in a natural, resting state and / or may only be minimally stretched. As the tissue wall expands, at least a portion of the one or more cords 307 may stretch and / or at least partially separate to create a longer length of the flexible shunt implant 300.

[0045] The flexible shunt implant 300 may include one or more anchoring arms 304, which may include any means for anchoring the shunt implant to the catheter 16 and / or a region of tissue within the body. The one or more anchoring arms 304 (e.g., including first anchoring arm 304a and / or second anchoring arm 304b) may be configured to anchor to / within a tissue wall. While the flexible shunt implant 300 is shown having two pairs of anchoring arms 304, the flexible shunt implant 300 may have any number of anchoring arms 304. In some embodiments, the flexible shunt implant 300 may include one or more anchoring arms 304 at a first end of the flexible shunt implant 300 and / or one or more anchoring arms 304 at or near a second end of the flexible shunt implant 300. The anchoring arms 304 may be attached to and / or extend from any portion of the implant 300, including one or more cords 307.

[0046] In some embodiments, the cord 307 and / or each of the anchoring arms 304 may be constructed from a common material or different materials. In some embodiments, either the cord 307 and / or the anchoring arms 304 may be constructed from nitinol and / or other metals, plastics, polymers, and / or other materials.

[0047] Various features of the shunt implant 300, including the central flow portion 302 and / or anchoring arms 304, described herein may be applied to shunt devices described and / or illustrated in other figures of the present application. For example, any description regarding the shunt implant 300 shown in FIGS. 3A and 3B may equally be applied to the shunt implant 601 of FIG. 6 and / or the shunt implant 901 of FIGS. 9A and / or 9B. Furthermore, as shown in FIGS. 3A and 3B, other shunts shown and / or described with respect to other figures may not include the cord 307, although it will be understood that shunts described with respect to other figures may include the cord 307. Similarly, various features described with respect to other figures herein may be added to the shunt implant 300 of FIGS. 3A and 3B or other figures herein, even if not shown or described with respect to each figure. While the shunt implant 300 is shown including both the central flow portion 302 and anchoring arms 304, in some embodiments, the shunt implant 300 may not include the anchoring arms 304.

[0048] In some embodiments, the implant 300 may be configured to be movable between an expanded configuration and a collapsed configuration to facilitate passage through a lumen of a catheter. For example, the central flow portion 302 may be configured to be crimped and / or otherwise compacted to fit around the exterior surface of the catheter 16. Crimping may involve reducing the diameter of the central flow portion 302 and / or increasing the length of the implant 300. When the implant 300 is crimped, at least a portion of the implant 300 may generate a resistive force in response to the crimping pressure.

[0049] The central flow portion 302 can be configured to expand to a predefined shape (e.g., the shape and / or size shown in FIG. 3A ) and / or size during and / or after removal from the delivery device (e.g., catheter 16). The implant 300 can further include one or more anchoring arms 304, which can include flanges, arms, anchors, and / or other devices. In some embodiments, the one or more anchoring arms 304 (e.g., first anchoring arm 304 a and / or second anchoring arm 304 b) can be configured to extend generally perpendicularly from the central flow portion (i.e., forming a T-shape). For example, the first anchoring arm 304 a and the second anchoring arm 304 b can be configured to lie flat along a common plane. The one or more anchoring arms 304 can have a generally flat, curved, and / or wavy configuration. In some embodiments, one or more anchoring arms 304 may be configured to at least partially fold and / or compress to facilitate passage through a catheter lumen and / or to expand during and / or after delivery within the body to contact and / or adhere to tissue walls. Expansion of implant 300 may be initiated, for example, by retraction of the catheter's outer sheath relative to the inner support sheath. Implant 300 may be collapsed (e.g., crimped) into a generally tubular configuration. In some embodiments, anchoring arms 304 may be configured to spring open when the outer sheath's constraints retract. As opposed to expanding in a circular manner, anchoring arms 304 may expand in generally opposite directions in a common plane to form a T-shape (see FIG. 3B). Radiopaque markers on anchoring arms 304 and / or central flow portion 302 may be provided to facilitate immediate positioning within the body.

[0050] The pair of anchor arms 304 (e.g., first anchor arm 304a and second anchor arm 304b) can be configured to form a clamping (i.e., pinching) pair of anchor arms 304. The pair of anchor arms 304 can be configured to apply a compressive force to the tissue wall to hold the implant 300 in place. The amount of compressive force can be sufficient to hold the implant 300 in place, while being relatively small to avoid damage to the tissue wall. For example, the gap separating the pair of anchor arms can be calibrated to avoid over-clamping and / or necrosis of tissue. The anchor arms 304 can be configured to secure the implant 300 to generally opposite sides of the tissue wall and / or to generally opposite sides of an opening in the tissue wall. The central flow portion 302 can be configured to align generally perpendicular to the tissue wall to maintain an open flow path between chambers on either side of the tissue wall.

[0051] Components of implant 300 may be configured to naturally self-expand due to the inherent springiness and / or flexibility of the components. For example, various components (e.g., central flow section 302 and / or anchor arms 304) may be at least partially constructed from a resilient material such as Nitinol. In some embodiments, central flow section 302 may be fabricated by laser cutting a Nitinol tube.

[0052] Figure 4 (Figures 4-1 and 4-2) is a flow diagram illustrating a process 400 for delivering and / or securing an implant at a treatment site according to one or more embodiments of the present disclosure. Figure 5 (Figures 5-1 and 5-2) provides several images related to the process of Figure 4 and illustrates aspects of process 400 according to one or more implementations thereof.

[0053] In step 402, process 400 involves delivering implant 501 to a passageway within the body, as shown in image 500a of FIG. 5 . For example, implant 501 may be delivered via the right atrium 5 into the coronary sinus 19. Implant 501 may be at least partially compressed onto the outer surface of catheter 16. In some embodiments, implant 501 may be at least partially surrounded by a sheath and / or other covering during delivery (see sheath in FIGS. 9A and 9B ) to prevent implant 501 from expanding and / or otherwise obstructing delivery to the target location within the body. In some embodiments, a wire and / or other mechanism may be used to hold implant 501 in a collapsed and / or crimped configuration. In such embodiments, a sheath may not be required to hold implant 501 in a collapsed and / or crimped configuration.

[0054] The implant 501 may have a generally flexible structure so that the catheter 16 can bend as needed to enter the coronary sinus 19 and / or other passageways with minimal restriction from the implant 501. In some embodiments, the catheter 16 may include and / or be attached to an atraumatic tip 509 configured to dilate various passageways and / or otherwise guide the catheter 16 and / or implant 501 to a desired location. Additionally, a guidewire 511 and / or similar device may be delivered to guide the catheter and / or implant 501 to a target location. In some embodiments, an opening 513 in the tissue wall 508 (e.g., the wall of the coronary sinus 19) may be formed during the implant 501 delivery process 400 and / or a previous process. The opening 513 may be created in any of a variety of ways. One example of a method is as follows.

[0055] First, a guidewire 511 may be advanced, for example, from the right atrium through its ostium or opening into the coronary sinus 19. A catheter 16 may be advanced over the guidewire. The catheter 16 may be introduced into the body through the proximal end of an introducer sheath. The introducer sheath may provide access to a particular vascular pathway (e.g., the jugular vein or subclavian vein) and may have a hemostatic valve therein. While holding the introducer sheath in a fixed position, the surgeon may manipulate the puncture catheter to the implantation site. A puncture sheath having a sharp-tipped puncture needle may be advanced along the catheter 16 and puncture through the wall 508, for example, into the left atrium 2. A puncture dilator may be advanced along the guidewire and through the tissue wall 508 into the left atrium 2. The puncture dilator may be, for example, an elongated inflatable balloon. The puncture dilator may be expanded radially outward to widen the puncture through the tissue wall 508.

[0056] At block 404, process 400 involves passing implant 501 at least partially through and / or to an opening 513 in a tissue wall 508 (e.g., coronary sinus 19), as shown in image 500b of FIG. 5. A guidewire 511 may be at least partially positioned distal to the tissue wall 508 (e.g., within the left atrium 2) to guide the atraumatic tip 509 and / or implant 501 at least partially to the distal side of the tissue wall 508. Delivery of implant 501 may involve displacing implant 501 from catheter 16 as catheter 16 is delivered to the implant location. For example, when implant 501 is at least partially positioned at or near opening 513, a sheath covering implant 501 and / or one or more wires holding implant 501 in place may be at least partially retracted to allow implant 501 to expand and / or displace from catheter 16. The implant 501 may be configured to bend at least partially into the opening 513 in the catheter 16 .

[0057] When the implant 501 is exposed from the catheter 16, the implant 501 may at least partially expand and / or the anchoring arms 504 may at least partially bend. In some embodiments, the implant 501 may be manually expanded and / or configured to expand naturally upon at least partial removal from the catheter 16. However, the expansion of the implant 501 may be at least partially assisted. For example, the catheter 16 and / or another surgical instrument may be used to push and / or pull the implant 501 to move it towards its expanded shape and / or position.

[0058] In block 406, process 400 involves securing implant 501 within opening 513 in tissue wall 508 of coronary sinus 19 and / or other blood vessel, as shown in image 500c of FIG. 5. Implant 501 may include one or more anchoring arms 504 configured to pinch and / or otherwise form from attachment to tissue wall 508. Implant 501 may be configured to be positioned such that blood can flow through central flow portion 502 of implant 501 (e.g., from left atrium 2 to coronary sinus 19).

[0059] The implant 501 may include a central flow portion 502 configured to fit at least partially within an opening 513 in a tissue wall. The central flow portion 502 may be configured to extend along the sides of the opening 513 to maintain the opening 513 and / or prevent tissue ingrowth. The central flow portion 502 may be configured to allow blood flow through the implant 501. In some embodiments, the anchoring arms 504 may be configured to continue to extend from the central flow portion 502 and / or to maintain the opening 513. The central flow portion 502 and / or anchoring arms 504 may comprise a network and / or pattern of struts and / or cords configured to form a suitable pattern and / or shape to allow blood flow through the central flow portion 502 and / or anchoring arms 504.

[0060] In some embodiments, the first anchor arm 504a can be configured to contact and / or attach to a first side 508a of the tissue wall 508, and / or the second anchor arm 504b can be configured to contact and / or attach to a second side 508b of the tissue wall 508. The first anchor arm 504a and the second anchor arm 504b can be configured to establish a pincer grip on the tissue wall 508 by simultaneously pressing against the first side 508a of the tissue wall 508 and the second side 508b of the tissue wall 508, respectively.

[0061] Implant 501 may include two sets of anchor arms 504, each configured to secure to a different portion of tissue wall 508. For example, a first set of anchor arms 504 (including first anchor arm 504a and second anchor arm 504b) may be configured to establish a pincer grip on a first portion of tissue wall 508, while a second set of anchor arms may be configured to establish a pincer grip on a second portion of tissue wall 508.

[0062] In some embodiments, one or more anchoring arms 504 can be configured to pierce and / or hook the tissue wall 508. For example, one or more anchoring arms 504 can include one or more hooks extending therefrom that are configured to pierce the tissue wall 508 to establish a more secure attachment to the tissue wall 508.

[0063] One or more anchoring arms 504 may be configured to naturally bend toward the tissue wall 508 upon delivery at the opening 513 in the tissue wall 508. For example, when the implant 501 is removed from a delivery device (e.g., a catheter), the implant 501 may naturally assume the configuration shown in image 500c. In some embodiments, the implant 501 may be shape-set and / or may be at least partially constructed from a shape-memory alloy (e.g., Nitinol). For example, the implant 501 may be shape-set such that when the tissue wall 508 is positioned between the first anchoring arm 504a and the second anchoring arm 504b, the first anchoring arm 504a and the second anchoring arm 504b may be configured to be pressed together and / or near each other, and the first anchoring arm 504a and the second anchoring arm 504b may be configured to securely sandwich the tissue wall 508.

[0064] FIG. 6 illustrates another exemplary shunt implant 601 according to embodiments of the present disclosure. In some embodiments, the implant 601 can include a central flow section 602 having a coiled and / or braided structure. For example, the central flow section 602 can comprise one or more coiled cords, wires, and / or other elongated devices. One or more cords can be formed into a coil to form an inner lumen that allows blood flow through the central flow section 602. While the implant 601 having a coiled central flow section 602 is shown in FIG. 6, the implant 601 can additionally or alternatively include a braided section, similar to the implant 300 of FIGS. 3A and 3B. Furthermore, the implant 300 of FIGS. 3A and 3B can additionally or alternatively include a coiled section, similar to the implant 601 of FIG. 6.

[0065] In some embodiments, implant 601 may comprise a piercing element 620 configured to pierce through and / or anchor in a tissue wall. Puncturing element 620 may advantageously allow a surgeon to deliver implant 601 without having to deliver a separate piercing element (e.g., a needle) prior to delivering implant 601. In other words, forming an opening in a tissue wall and delivering implant 601 into the opening in the tissue wall may be performed as a single-step process without having to remove the device from the body prior to delivering implant 601.

[0066] 6, the piercing element 620 may be configured to extend from the central flow portion 602. In some embodiments, the piercing element 620 and / or one or more anchoring arms 604 may be configured to extend from the central flow portion 602. For example, the piercing element 620 may replace the anchoring arm 604 and / or may be used in conjunction with one or more anchoring arms 604. The piercing element 620 may be configured to perform a function similar to that of the anchoring arm 604. For example, the piercing element 620 may be configured to establish a pincer grip on the tissue wall together with the first anchoring arm 604a. The second anchoring arm 604b and / or the third anchoring arm 604c may be configured to establish a pincer grip on a different portion of the tissue wall.

[0067] The piercing element 620 may have any of a variety of forms and / or structures. In some embodiments, the piercing element 620 may have a generally conical shape with a pointed tip 621 at one end and increasing in diameter and / or width from the pointed tip 621 to the central flow portion 602. The piercing element 620 may additionally or alternatively have a generally cylindrical structure (e.g., similar to a needle) and form a pointed tip 621 at the end. In another example, the piercing element 620 may have a generally flat structure and / or may increase in width from the pointed tip 621 to the central flow portion 602. The piercing element 620 may be configured to form an opening in the tissue wall having an appropriate size for the crimped / compressed implant 601 and / or catheter to fit through the opening. Thus, the piercing element 620 may be configured to increase in width and / or diameter at least partially from the pointed tip to increase the size of the opening formed by the piercing element 620. After delivery through the opening in the tissue wall, the piercing elements 620 can be configured to contact the surface of and / or at least partially penetrate the tissue wall to secure the implant 601 in the opening. For example, the pointed tips 621 can be configured to establish a single point of contact with the tissue wall. By establishing a single point of contact with the tissue wall, the piercing elements 620 can be configured to help secure the implant 601 to the tissue wall while minimizing surface contact to minimize tissue ingrowth around the piercing elements and / or central flow portion 602.

[0068] Implant 601 may have a generally flexible structure. While implant 601 is shown having a coiled structure, implant 601 may additionally or alternatively include braided and / or interwoven elements to provide a measure of flexibility to implant 601. Furthermore, piercing element 620 may be constructed at least in part from a flexible material (e.g., a thin section of nitinol and / or stainless steel) to allow piercing element 620 to at least partially flex during delivery to a target location.

[0069] Figure 7 (Figures 7-1 and 7-2) is a flow diagram illustrating a process 700 for delivering and / or securing an implant at a treatment site according to one or more embodiments of the present disclosure. Figure 8 (Figures 8-1 and 8-2) provides several images related to process 700 of Figure 7 and illustrates aspects of process 700 according to one or more implementations thereof.

[0070] At step 702, process 700 involves delivering implant 801 to one or more flow paths within the body, as shown in image 800a of FIG. 8 . For example, implant 801 may be delivered via right atrium 5 into coronary sinus 19. Implant 801 may be at least partially compressed onto the outer surface of catheter 16. While implant 801 is shown in FIG. 8 as having a coiled structure, implant 801 may have any suitable structure, which may include one or more at least partially braided sections. In some embodiments, implant 801 may be at least partially surrounded by a sheath and / or other covering during delivery (see sheaths in FIGS. 9A and 9B ) to prevent implant 801 from expanding and / or otherwise obstructing delivery to a target location within the body. In some embodiments, wires and / or other mechanisms may be used to hold implant 801 in a collapsed and / or crimped configuration.

[0071] The implant 801 may have a generally flexible structure to allow the catheter 16 to bend as needed and enter the coronary sinus 19 and / or other passageways with minimal restriction from the implant 801. In some embodiments, the implant 801 may include at least one piercing element 820 configured to pierce and / or anchor into a tissue wall. The piercing element 820 may extend from a central portion and / or anchoring arms of the implant 801. In some embodiments, the piercing element 820 may be used in place of an anchoring arm and / or in combination with other anchoring arms. The piercing element 820 may be made of any suitable material and / or combination of materials, which may include nitinol and / or other metals. In some embodiments, the piercing element 820 may be configured to bend at least partially to allow the piercing element 820 and / or the implant 801 to more easily navigate to a target location (e.g., the wall of the coronary sinus 19).

[0072] In some embodiments, the piercing element 820 may have a generally tapered configuration and / or may be configured to expand various pathways and / or otherwise guide the catheter 16 and / or implant 801 to a desired location. The piercing element 820 may have a generally conical shape such that the piercing element 820 may be configured to form a circular opening 813 in the tissue wall 808. Additionally, as shown in image 800b of FIG. 8 , a guidewire and / or similar device may be delivered to guide the catheter and / or implant 801 to a target location.

[0073] At block 704, process 700 involves passing implant 801 at least partially through and / or into an opening 813 in a tissue wall 808 (e.g., coronary sinus 19) formed by a puncturing element 820, as shown in image 800b of FIG. 8 . The puncturing element 820 may be configured to be forced through the tissue wall to form the opening 813. In some embodiments, the puncturing element 820 may be configured to form the opening 813 having an appropriate size and / or width such that the catheter 16 and / or implant 801 body can fit at least partially through the opening 813. A guidewire may be located at least partially distal to the tissue wall 808 (e.g., within the left atrium 2) to guide the catheter 16 and / or implant 801 distal to the tissue wall 808. Delivery of the implant 801 may involve displacing the implant 801 from the catheter 16 as the catheter 16 is delivered to the implant location. For example, when implant 801 is at least partially positioned at or near opening 813, a sheath covering implant 801 and / or one or more wires holding implant 801 in place may be at least partially retracted to allow implant 801 to expand and / or be displaced from catheter 16. Implant 801 may be configured to at least partially bend into opening 813 in catheter 16.

[0074] When implant 801 is removed from catheter 16, implant 801 may be configured to at least partially expand and / or anchoring arms 804 may at least partially bend. In some embodiments, implant 801 may be manually expanded and / or configured to expand naturally upon at least partial removal from catheter 16. However, expansion of implant 801 may be at least partially assisted. For example, catheter 16 and / or another surgical instrument may be used to push and / or pull implant 801 to move implant 801 toward its expanded shape and / or position.

[0075] At block 706, process 700 involves securing implant 801 within opening 813 in tissue wall 808, as shown in image 800c of FIG. 8. Implant 801 may include one or more anchoring arms 804 configured to pinch and / or otherwise form from attachment to tissue wall 808. Implant 801 may be configured to be positioned such that blood can flow through central flow portion 802 of implant 801 (e.g., from left atrium 2 to coronary sinus 19).

[0076] Implant 801 may include a central flow portion 802 configured to fit at least partially within an opening 813 in a tissue wall. Central flow portion 802 may be configured to extend along the sides of opening 813 to maintain opening 813 and / or prevent tissue ingrowth. Central flow portion 802 may be configured to allow blood flow through implant 801. In some embodiments, anchoring arms 804 may be configured to continue to extend from central flow portion 802 and / or may be configured to maintain opening 813.

[0077] In some embodiments, first anchor arm 804a can be configured to contact and / or adhere to second side 808b of tissue wall 808, and / or piercing element 820 can be configured to contact and / or adhere to first side 808a of tissue wall 808. First anchor arm 804a and piercing element 820 can be configured to establish a pincer grip on tissue wall 808 by simultaneously pressing against first side 808a of tissue wall 808 and second side 808b of tissue wall 808, respectively. Implant 801 can also include a set of anchor arms (e.g., second anchor arm 804b and / or third anchor arm 804c) opposite first anchor arm 804a and piercing element 820, each configured to anchor to a different portion of tissue wall 808.

[0078] In some embodiments, one or more anchoring arms 804 can be configured to pierce and / or hook the tissue wall 808. For example, one or more anchoring arms 804 can include one or more hooks extending therefrom that are configured to pierce the tissue wall 808 to establish a more secure attachment thereto.

[0079] One or more anchoring arms 804 may be configured to naturally bend toward the tissue wall 808 upon delivery at the opening 813 in the tissue wall 808. For example, when the implant 801 is removed from a delivery device (e.g., a catheter), the implant 801 may naturally assume the configuration shown in image 800c. In some embodiments, the implant 801 may be shape-set and / or may be at least partially constructed of a shape-memory alloy (e.g., Nitinol). For example, the implant 801 may be shape-set such that when the tissue wall 808 is positioned between the first anchoring arm 804a and the piercing element 820, the first anchoring arm 804a and the piercing element 820 may be configured to be pressed together and / or near each other, and the first anchoring arm 804a and the piercing element 820 may be configured to securely sandwich the tissue wall 808.

[0080] In some embodiments, the piercing element 820 may be configured to establish a single point of contact with the tissue wall 808. For example, a pointed tip of the piercing element 820 may be configured to penetrate the tissue wall. In this manner, the piercing element 820 may advantageously limit tissue growth on the piercing element 820 and / or the implant 801 due to the relatively low amount of surface contact between the piercing element 820 and the tissue wall 808.

[0081] 9A and 9B illustrate another exemplary shunt implant 901 according to embodiments of the present disclosure. In some embodiments, the implant 901 may include a bidirectional structure including two or more portions, including a first portion 931 (e.g., a first shunt) and a second portion 933 (e.g., a second shunt). The first portion 931 and / or the second portion 933 may comprise a generally tubular device having an inner lumen configured to receive and / or allow blood flow. In some embodiments, the first portion 931 and / or the second portion 933 may be at least partially fluid-tight and / or configured to allow blood flow through the tubular wall of the portion. For example, the first portion 931 and / or the second portion 933 may be formed at least in part from a braided and / or coiled network of cords and / or other devices that provide gaps to allow blood flow.

[0082] The first portion 931 may be configured to allow shunting of blood flow from a first chamber (e.g., the left atrium) to a second chamber and / or blood pathway (e.g., the coronary sinus). Additionally, the first portion 931 may advantageously be configured to maintain an opening in a tissue wall. The second portion 933 may be configured to allow normal blood flow through the blood pathway (e.g., the coronary sinus). Additionally, the second portion 933 may be configured to at least partially prevent blood flow through the flow pathway from entering the first chamber. The first portion 931 and / or the second portion 933 may have a generally tubular shape such that the first portion 931 and / or the second portion 933 can bend and / or otherwise maintain a relatively high level of flexibility to simplify delivery of the implant 901 into the body.

[0083] In some embodiments, at least a portion of first portion 931 and / or second portion 933 may be at least partially fluid-tight and / or may include one or more regions (e.g., first region 932) at least partially constructed from a material configured to prevent blood flow through the one or more regions. For example, first region 932 and / or other regions of first portion 931 and / or second portion 933 may be at least partially constructed from a generally solid material that may form a gap, thereby preventing blood flow through first region 932. First region 932 and / or other regions may be configured to at least partially underlie an opening in a tissue wall and / or to redirect blood flow through the opening. For example, blood may flow generally vertically through the opening due to the pressure characteristics of the chambers on either side of the opening. Such blood flow may have a relatively high velocity and / or may cause damage to various tissue walls, especially if the blood flows directly into the tissue wall. First portion 931 and / or second portion 933 may be advantageously configured to prevent at least a portion of the blood flow from flowing directly to the tissue wall by redirecting the blood along a flow path (e.g., along the coronary sinus) rather than directly to the tissue wall. For example, blood flow may be deflected and / or redirected by first region 932 of first portion 931.

[0084] The first portion 931 and / or the second portion 933 may be configured to be at least partially surrounded by a sheath 939, which may be configured to hold the first portion 931 and / or the second portion 933 together. The sheath may be at least partially constructed from fabric and / or other material. FIG. 9B provides a cross-sectional view showing the first portion 931 and / or the second portion 933 within the sheath 939. In some embodiments, the sheath 939 may be configured to extend completely over the first portion 931 and / or the second portion 933. When the implant 901 is delivered to a target location within the body, the sheath 939 may be configured to at least partially retract to expose at least a portion of the first portion 931 and / or the second portion 933. When the first portion 931 is exposed and / or removed from the sheath 939, the first portion 931 may be configured to at least partially bend, forming a separation angle 935 between the first portion 931 and the second portion 933. The separation angle 935 can be any value between 0° and 90°.

[0085] In some embodiments, at least a portion of first portion 931 can be configured to naturally bend away from second portion 933. For example, first portion 931 can be at least partially constructed from a shape memory alloy (e.g., Nitinol) and / or can be shaped to assume the bent configuration shown in FIG. 9A when removed from sheath 939.

[0086] One or more fixation elements may be attached to the first portion 931 and / or the second portion 933 to secure the first portion 931 and / or the second portion 933 to the tissue wall. For example, the one or more fixation elements may extend from an end portion of the first portion 931 to allow the first portion 931 to be secured to the tissue wall after passing through an opening in the tissue wall.

[0087] Second portion 933 may be configured for retention of first portion 931 within the opening in the tissue wall. For example, second portion 933 may be configured to remain within the blood flow pathway while first portion 931 extends away from second portion 933 (e.g., generally perpendicular from second portion 933) and enters the opening. Second portion 933 may be sized and / or positioned such that second portion 933 is configured to press against the wall of the blood flow pathway to prevent first portion 931 from falling and / or retracting from the opening after first portion 931 enters the opening.

[0088] 10 illustrates another exemplary shunt implant 1001 according to an embodiment of the present disclosure. The implant 1001 is shown in FIG. 10 within a blood flow pathway between tissue walls 1008. In some embodiments, the implant 1001 may comprise a first portion 1031 and / or a second portion 1033 configured to extend from a common base portion 1030.

[0089] First portion 1031 and / or second portion 1033 may comprise a generally tubular device having an inner lumen configured to permit blood flow. In some embodiments, first portion 1031 and / or second portion 1033 may be at least partially fluid-tight and / or configured to permit blood flow through the tubular walls of the portions. For example, first portion 1031 and / or second portion 1033 may be at least partially formed from a braided and / or coiled network of cords and / or other devices that provides gaps to permit blood flow. In some embodiments, at least a portion of first portion 1031 and / or second portion 1033 may be at least partially fluid-tight and / or may include one or more regions at least partially constructed from a material configured to prevent blood flow through one or more regions (see, e.g., first region 932 in FIGS. 9A and 9B ).

[0090] The first portion 1031 and / or the second portion 1033 may be configured to be at least partially surrounded by a sheath 1039, which may be configured to hold the first portion 1031 and / or the second portion 1033 together. In some embodiments, the sheath 1039 may be configured to extend completely over the first portion 1031 and / or the second portion 1033. When the implant 1001 is delivered to a target location within the body, the sheath 1039 may be configured to at least partially retract to expose at least a portion of the first portion 1031 and / or the second portion 1033. When the first portion 1031 is exposed and / or removed from the sheath 1039, the first portion 1031 may be configured to at least partially bend, forming a separation angle between the first portion 1031 and the second portion 1033. The separation angle may be any value between 0° and 90°.

[0091] In some embodiments, first portion 1031 may be configured to extend through an opening 1013 formed in tissue wall 1008. Opening 1013 may be formed prior to delivery of implant 1001 as described herein. In some embodiments, second portion 1033 and / or base portion 1030 may be sized and / or positioned to retain first portion 1031 within opening 1013 and / or to prevent first portion 1031 from completely retracting and / or falling into a blood flow pathway in which second portion 1033 may be located.

[0092]

[0013] Figure 11 is a flow diagram illustrating a process 1100 for delivering and / or securing an implant at a treatment site according to one or more embodiments of the present disclosure. Figure 12 provides several images related to process 1100 of Figure 11 and shows aspects of process 1100 according to one or more implementations thereof.

[0093] In step 1102, process 1100 involves delivering an implant to one or more passageways within the body, as shown in image 1200a of FIG. 12 . For example, the implant may be delivered via the right atrium 5 into the coronary sinus 19. The implant may be configured to be delivered via a catheter 16. In some embodiments, the implant may be configured to be at least partially surrounded by a sheath 1239 and / or other covering during delivery (see image 1200b of FIG. 12 ), which may prevent the implant from expanding and / or otherwise obstructing delivery to the target location within the body. In some embodiments, wires and / or other mechanisms may be used to hold the implant in a collapsed and / or crimped configuration. The implant may include one or more tubular portions (e.g., shunts) having lumens configured to receive blood flow and / or facilitate blood flow through and / or into the passageway. The implant may be delivered near (e.g., below) an opening 1213 in a tissue wall 1208. The opening 1213 may be formed during an earlier stage of the delivery process and / or the guidewire 1211 may be delivered through the opening 1213 to guide the catheter 16 .

[0094] In step 1104, the process 1100 includes retracting the sheath 1239 and / or the catheter 16 to expose at least a portion of the first (e.g., upper) shunt 1231 and / or the second (e.g., lower) shunt 1233 and / or at least partially separate the first shunt 1231 from the second shunt 1233, as shown in image 1200b of FIG. 12 . The sheath 1239 and / or the catheter 16 may be configured to prevent expansion and / or separation of the first shunt 1231 and / or the second shunt 1233. When the first shunt 1231 and / or the second shunt 1233 are exposed and / or at least partially removed from the sheath 1239 and / or catheter 16, the first shunt 1231 and / or the second shunt 1233 may be configured to assume a native, predetermined shape. For example, the first shunt 1231 and / or the second shunt 1233 may be at least partially constructed from one or more shape memory materials (e.g., nitinol) that can naturally pull the first shunt 1231 and / or the second shunt 1233 toward a predetermined shape. In some embodiments, at least a portion of the first shunt 1231 may be configured to naturally bend away from the second shunt 1233 when the first shunt 1231 is exposed.

[0095] At step 1106, the process 1100 includes extending the first shunt 1231 through the opening 1213 in the tissue wall 1208. For example, the first shunt 1231 may be configured to bend away from the second shunt 1233, creating some separation between the first shunt 1231 and the second shunt 1233. The first shunt 1231 may be configured to extend through the opening 1213 formed in the tissue wall 1208. In some embodiments, the first shunt 1231 and / or the catheter 16 may be configured to track along a guidewire 1211 that was previously delivered into the body.

[0096] The second shunt 1233 may be configured to remain within the blood flow pathway (e.g., coronary sinus 19) while the first shunt 1231 extends from the blood flow pathway and / or into a chamber distal to the tissue wall 1208 (e.g., left atrium 2). In some embodiments, the second shunt 1233 may be configured to at least partially stabilize the first shunt 1231 and / or prevent the first shunt 1231 from backing out of the opening 1213 in the tissue wall 1208. For example, the second shunt 1233 may be configured to press against one or more walls of the blood flow pathway to prevent the first shunt 1231 from falling out of the opening 1213.

[0097] Additional Embodiments Depending on the embodiment, certain acts, events, or functions of any of the processes or algorithms described herein may be performed in a different order, added, combined, or omitted entirely. Thus, in a particular embodiment, not all described acts or events may be required to practice a process.

[0098] In particular, conditional language used herein, such as "can," "could," "might," "may," "e.g.," and the like, unless specifically stated otherwise or understood otherwise within the context in which it is used, is intended to have its ordinary meaning and is generally intended to convey that certain embodiments include certain features, elements, and / or steps, while other embodiments do not. Thus, such conditional language is generally not intended to imply that features, elements, and / or steps are required in any way by one or more embodiments, or that one or more embodiments necessarily include logic for determining whether those features, elements, and / or steps are included or performed in any particular embodiment, with or without authorial input or prompting. Terms such as "comprise," "include," "have," and the like are synonymous and used in their ordinary sense, and are used in an inclusive, non-limiting manner and do not exclude additional elements, features, acts, operations, etc. Also, the term "or" is used in its inclusive sense (and not its exclusive sense), so that, for example, when used to connect a list of elements, the term "or" means one, some, or all of the elements in the list. Unless specifically stated otherwise, conjunctive language such as "at least one of X, Y, and Z" is understood with context as used generally to convey that an item, term, element, etc., can be either X, Y, or Z. Thus, such conjunctive language is generally not intended to imply that a particular embodiment requires that at least one of X, at least one of Y, and at least one of Z, each be present.

[0099] In the description of the above embodiments, it should be understood that various features may be grouped together in a single embodiment, figure, or description thereof for the purpose of streamlining the disclosure and aiding in the understanding of one or more of the various inventive aspects. However, this method of disclosure should not be interpreted as reflecting an intention that any claim requires more features than are expressly recited in that claim. Moreover, any component, feature, or step illustrated and / or described in a particular embodiment herein may be applied to or used in conjunction with any other embodiment. Moreover, no component, feature, step, or group of components, features, or steps is necessary or essential to each embodiment. Accordingly, it is intended that the scope of the invention(s) herein, as disclosed and claimed below, should not be limited by the specific embodiments described above, but should be determined solely by a fair reading of the following claims.

[0100] It should be understood that certain sequential terms (e.g., "first" or "second") may be provided for ease of reference and do not necessarily imply physical characteristics or order. Thus, as used herein, sequential terms (e.g., "first," "second," "third," etc.) used to modify elements such as structures, components, operations, etc., do not necessarily indicate a priority or order of the element relative to any other elements, but rather may generally distinguish the element from other elements having a similar or identical name (other than the use of sequential terms). Additionally, as used herein, the indefinite articles ("a" and "an") may indicate "one or more" rather than "one." Furthermore, an action performed "based on" a condition or event may also be performed based on one or more other conditions or events not expressly recited.

[0101] Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by one of ordinary skill in the art to which the exemplary embodiments belong. Furthermore, terms such as those defined in commonly used dictionaries should be interpreted as having a meaning consistent with their meaning in the context of the relevant art, and are not to be interpreted in an idealized or overly formal sense unless explicitly defined herein.

[0102] Although certain preferred embodiments and examples are disclosed below, the inventive subject matter extends beyond the specifically disclosed embodiments to other alternative embodiments and / or applications, as well as modifications and equivalents thereof. Accordingly, the scope of claims that may arise from this specification is not limited by any of the specific embodiments described below. For example, in any method or process disclosed herein, the acts or operations of the method or process may be performed in any suitable order and are not necessarily limited to any particular disclosed order. Although various operations may be described sequentially as multiple separate operations in a manner that may be useful for understanding particular embodiments, the order of description should not be construed as implying that these operations are order-dependent. Additionally, structures, systems, and / or devices described herein may be embodied as integrated or separate components. For purposes of comparing various embodiments, certain aspects and advantages of these embodiments are described. Not all such aspects or advantages are necessarily achieved by any particular embodiment. Thus, for example, various embodiments may be implemented in a manner that achieves or optimizes one advantage or group of advantages as taught herein without necessarily achieving other aspects or advantages that may also be taught or suggested herein.

[0103] Spatially relative terms such as "outside," "inside," "top," "bottom," "below," "upper," "vertical," "horizontal," and similar terms may be used herein for ease of description to describe the relationship between one element or component and another, as illustrated in the figures. It should be understood that spatially relative terms are intended to encompass different orientations of the device in use or operation in addition to the orientation depicted in the figures. For example, if a device shown in the figures is turned over, a device positioned "below" or "directly below" another device may be positioned "above" another device. Thus, the illustrative term "below" can include both a lower and an upper position. Devices may also be oriented in other directions, and thus spatially relative terms may have different interpretations depending on the orientation.

[0104] Unless expressly stated otherwise, comparative and / or quantitative terms such as "less," "more," "greater than," and the like are intended to encompass the concept of equality. For example, "less" can mean "less than" as well as "less than" in the strict mathematical sense.

[0105] The delivery systems described herein can be used to position catheter tips and / or catheters in various regions of the human heart. For example, the catheter tips and / or catheters can be configured to pass from the right atrium to the coronary sinus. However, the descriptions can refer to or generally apply to positioning a catheter tip and / or catheter from a first body chamber or lumen to a second body chamber or lumen, where the catheter tip and / or catheter can bend when positioned within the first body chamber or lumen. A body chamber or lumen can refer to any one of a number of fluid channels, blood vessels, and / or organ chambers (e.g., heart chambers). Furthermore, references herein to "catheters," "tubes," "sheaths," "deliverable sheaths," and / or "deliverable catheters" can generally refer to or apply to any type of elongated tubular delivery device that includes an inner lumen configured to slidably receive an instrument, such as for positioning within the atria or coronary sinus, including, for example, delivery catheters and / or cannulas. It will be appreciated that other types of medical implant devices and / or procedures can be delivered to the coronary sinus using the delivery systems described herein, including, for example, ablation procedures, drug delivery, and / or coronary sinus lead placement. [Explanation of symbols]

[0106] 16 Catheter 300, 501, 601, 801, 901 Implants

Claims

1. A delivery system comprising: a catheter configured to be delivered through a blood flow pathway of the heart; An implant, maintaining an opening in a tissue wall to allow blood flow through the opening and into the blood flow pathway; an implant configured to be delivered through the catheter and constructed at least in part from a flexible material that allows the implant to bend with the catheter; Including, A delivery system, wherein the implant includes a piercing element configured to pierce through a tissue wall to form the opening in the tissue wall.

2. The delivery system of claim 1 , wherein the implant is configured to be crimped around an outer surface of the catheter.

3. 3. The delivery system of claim 1 or claim 2, wherein the implant is constructed at least in part from a braided cord.

4. 3. The delivery system of claim 1 or 2, wherein the implant is constructed at least in part from a coiled cord.

5. The delivery system of any one of claims 1 to 4, wherein the piercing element is further configured to anchor the implant to the tissue wall.

6. The delivery system of any one of claims 1 to 5, wherein the implant further comprises an anchoring element, the piercing element and the anchoring element configured to anchor on opposite sides of the tissue wall.

7. 7. The delivery system of claim 1, further comprising a sheath configured to at least partially enclose the implant and to retract to at least partially expose the implant and allow it to expand.

8. 8. The delivery system of claim 1, wherein the blood flow pathway is the coronary sinus, and the opening forms a blood flow pathway between the left atrium and the coronary sinus.

9. 1. A medical implant comprising: means for puncturing through a tissue wall of the heart to form an opening in said tissue wall; means for maintaining the opening through the tissue wall, the opening forming a blood flow path from a first chamber of the heart to a blood flow pathway of the heart and configured to flex to facilitate delivery to the blood flow pathway and the first chamber; means for anchoring to the tissue wall at the opening; medical implants, including

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