filter apparatus and methods

专利摘要:
the present invention relates to catheter-based devices, such as components used with or as part of catheters, or as catheters or sets of catheters. as it can be implemented according to one or more modalities, a method and / or apparatus involves a filter with a frame that forms a perimeter of the filter and separates its opposite surfaces. an articulated arm is connected to the frame and configured with it so that, when implanted inside a tubular organ, engage with opposite parts of the inner side wall of the tubular organ and use the parts of the inner side wall to seal the filter to the inner side wall, applying strength to the board.
公开号:BR112019020142A2
申请号:R112019020142
申请日:2018-03-27
公开日:2020-04-22
发明作者:Zandi Abdolrahim；Eric Goslau J；Fariabi Seperh
申请人:Transverse Medical Inc；
IPC主号:

专利说明:

“FILTER APPLIANCES AND METHODS”
TECHNICAL FIELD [001] Aspects of various modalities are directed to catheter-based devices and methods for them.
BACKGROUND OF THE INVENTION [002] Various treatments can be useful for treating a variety of medical conditions, such as coronary heart disease, aneurysm and the like. Such treatments often involve tissue intervention, such as in order to remove, repair or treat the tissue. For example, coronary heart disease can sometimes involve disorders of the heart valves, which can be addressed through intervention techniques in which the valves are repaired or replaced.
[003] One way that has been useful for the treatment of various conditions involves using a catheter to enter a patient's arteries and provide access to a variety of techniques. For example, various procedures can be performed using catheters, such as repairing or removing tissue, or implanting tissue or other devices. Such an approach to treat heart disease involves replacement therapies or implementation of the aortic valve - transcatheter (TAVR / TAVI). These and other transvascular approaches may involve the delivery of artificial or animal flaps / valves to the patient's heart via catheters.
[004] Although many treatment approaches have been useful, there have been many challenges to their safe implementation. It is common to introduce, cross and exchange a variety of percutaneous devices, such as guidewires, catheters, sheaths, guide catheters and adjuvant technologies to gain access to and treat a coronary vessel, coronary valve or other vascular anatomy. These and other approaches to tissue repair or replacement can dislodge particles / debris (plungers) that are released from vessel walls and frames, causing plungers
Petition 870190096293, of 26/09/2019, p. 12/122
2/55 uncontrolled and unprotected floats move freely. These released and freely floating and uncontrolled emboli can be transported distally (away) through the bloodstream and cause problems, such as blocking or occluding the coronary, peripheral and neurovascular vessels. For example, during the procedure (TAVR / TAVI), native tissue can be compressed on the wall of the aorta to make room for replacement devices. This action can cause displacement or displacement of the arterial plaque, calcium or thrombus as the devices pass through the aortic arch. These particles can have adverse effects, such as causing a spill. These and other issues presented challenges to a variety of treatment approaches.
SUMMARY OF THE INVENTION [005] Several exemplary modalities are directed to devices based on filters and their implementation.
[006] According to an exemplary embodiment, an apparatus and / or method involves an extension arm, a frame connected to the extension arm, and a filter having opposite surface areas ending around a perimeter of the filter. The filter is connected to the frame at the perimeter and configured and arranged with the frame and the extension arm to expand with the frame in an implanted state and, in the implanted state, adapt one of the opposite surface areas to an internal side wall of an organ tubular engaging the extension arm with the respective surfaces of an internal side wall of the tubular organ and, through the engagement, apply force to the frame, which seals the frame and the perimeter of the filter to the internal side wall. The device can be implemented as part of a catheter, and manipulated to expand while extended from a sheath, and contract (for example, and retain particles in the filter) to retract into the sheath. Wires or other control mechanisms that extend through the sheath can be implemented to control the expansion / contraction and conformity of the filter.
Petition 870190096293, of 26/09/2019, p. 12/13
3/55 [007] Several modalities are aimed at an embolic protection device designed to protect the brain from stroke during left heart procedures, such as those involving TAVR. The functional aspects of the dynamic and double-edge sealing of the device are facilitated by control over the behavior of the system during the cardiac output cycle and by the precise and predictable filtration behavior before and after implantation.
[008] Various modalities can be implemented with an apparatus that includes a catheter that extends from a proximal end to a distal end, an internal and operable axis to move in the catheter, and a filter component that is connected to the axis and operable to retract into the distal end of the catheter. The filter component includes filters such as a mesh and internal and external frames connected by supports, with an extension arm connected to the frame. A filter perimeter is attached to the inner frame (and, in some cases, to the outer frame), with the inner and outer frames extending along one another. The supports operate to translate a force between the outer frame and the inner frame, applied through the extension arm, such as applying a force that applies the inner frame and the mesh against the tissue (for example, within the vascular tissue).
[009] In several implementations, a catheter having a frame, filter and extension arm, as characterized here, is inserted into a human aortic arch and the filter component is implanted over at least one opening of the artery in the aortic arch. The filter material is sealed to part of an inner wall of the aortic arch around at least one opening of the artery, and used to capture blood particles that flow into at least one opening of the artery. In other implementations, the filter material, frames and supports are contracted with the captured particles, and the mesh, frames, supports and particles are retracted into the catheter, which can then be removed.
Petition 870190096293, of 26/09/2019, p. 12/142
4/55 [010] The above summary discussion is not intended to describe each modality or implementation of the present description. The following figures and detailed description also exemplify various modalities.
BRIEF DESCRIPTION OF THE DRAWINGS [011] Several exemplary modalities can be more fully understood considering the detailed description together with the attached drawings, in the Appendix deposited here, as well as in the included figures, in which:
[012] Figure 1 shows a filter support apparatus, according to one or more exemplary embodiments of the present description.
[013] Figure 2 shows a catheter apparatus, according to one or more exemplary embodiments of the present description.
[014] Figures 3A-3D show respective views of a catheter device, according to one or more exemplary embodiments of the present description.
[015] Figure 4 shows a filter support apparatus, according to one or more exemplary embodiments of the present description.
[016] Figures 5A-5C show respective views of a filter support apparatus, according to one or more exemplary embodiments of the present description.
[017] Figure 6 shows a catheter device with a retracted mesh, according to one or more exemplary modalities of the present description.
[018] Figures 7A-7G show respective views of a filter support manufacturing apparatus, according to one or more exemplary embodiments of the present description.
[019] Figure 8 shows a filter component, as it can be implemented with several modalities.
[020] Figure 9 shows brush characteristics of an appliance that can
Petition 870190096293, of 26/09/2019, p. 12/152
5/55 be implemented with one or more modalities.
[021] Figure 10 shows a device implanted within a human aortic arch, with an extension arm applying force to a filter / frame, according to one or more modalities.
[022] Figure 11 shows a view of an extension arm, as can be implemented according to one or more modalities.
[023] Figure 12 shows the positioning of a device within a human aortic arch, according to one or more modalities.
[024] Figure 13 shows a frame, extension arm and filter components, as they can be implemented according to one or more modalities.
[025] Figure 14 shows graphs of aortic pressure, as can be implemented in conjunction with one or more modalities of this document.
[026] Figure 15 shows an application of force modeled from a frame, according to one or more modalities.
[027] Figures 16A-16D show assembly views of a catheter device, according to one or more modalities.
[028] Figure 17 shows a frame and mesh filter, according to one or more modalities.
[029] Figure 18 shows the respective filter configurations and related porosity aspects, as can be defined according to one or more modalities.
[030] Figure 19 shows a graph of factors that can be used to facilitate the selection of pores, according to one or more modalities.
[031] Figure 20 shows pore shape factors that can be used to facilitate pore selection, according to one or more modalities.
[032] Figure 21 shows a graph of shape factors, pore diameter, and maximum particle size, as can be implemented according to one or more
Petition 870190096293, of 26/09/2019, p. 12/162
Q / 55 more modalities.
[033] Figure 22 shows pore stretching characteristics, as can be implemented according to one or more modalities.
[034] Figure 23 shows characteristics of biological filter response, as can be implemented according to one or more modalities.
[035] Figure 24 shows biomaterial response, as can be implemented with a filter according to one or more modalities.
[036] Figure 25 shows surface activation effects that can be implemented with a filter material, according to one or more modalities.
[037] Figure 26 shows clotting times for the materials, as they can be implemented according to one or more modalities.
[038] Figure 27 shows aspects corresponding to the respective filtering materials, according to one or more modalities.
[039] Figure 28 shows an accessory for frame manufacturing, according to one or more modalities.
[040] Figure 29 shows an apparatus including a frame and an extension arm, as can be implemented according to one or more modalities.
[041] Figure 30 shows a manufacturing component to form a framework, as it can be implemented according to one or more modalities.
[042] Figure 31 shows a manufacturing component to form a framework, as it can be implemented according to one or more modalities.
[043] Figure 32 shows a manufacturing accessory to form an extension arm, as can be implemented according to one or more modalities.
[044] Figure 33 shows an extension arm and a frame, as can be implemented according to one or more modalities.
[045] Figure 34 shows a manufacturing accessory to form an extension arm, as can be implemented according to one or more modalities.
Petition 870190096293, of 26/09/2019, p. 12/172
7/55 [046] Figure 35 shows a manufacturing accessory, as it can be implemented according to one or more modalities.
[047] Although several modalities discussed in this document are subject to modifications and alternative forms, their aspects have been shown by way of example in the drawings and will be described in detail. It should be understood, however, that the intention is not to limit the invention to the particular modalities described. On the contrary, the intention is to cover all modifications, equivalents and alternatives that fall within the scope of the description, including aspects defined in the claims. In addition, the term “example”, used throughout this application, is merely illustrative, and not limiting.
DETAILED DESCRIPTION [048] Aspects of the present description are believed to be applicable to a variety of different types of devices, systems and methods involving filters, such as those that can be implanted using catheter-based devices and methods. Several exemplary modalities are aimed at filtering blood flow in vascular tissue, which can be useful for capturing particles while allowing blood to flow. In a specific embodiment, a device includes a filter-type material that filters particles from the blood flow, which is connected to a frame. An extension arm operates to apply force to the frame, and then seal the frame and filter-like material to a surface, such as an inner side wall of a vessel. In the context of these and other modalities, it has been recognized / discovered that the use of the frame and the extension arm facilitates the sealing of the frame and the filter to a side wall, and that this approach can be particularly useful to adapt and seal the filter in volume of the openings in the vascular tissue. This approach can therefore be used to attenuate the passage of particles through such openings, which can be particularly useful during surgical procedures. In addition, using stiffness aspects, the filter can be
Petition 870190096293, of 26/09/2019, p. 12/182
8/55 accurately sealed to the side wall without necessarily obstructing or filtering the material that flows within the vessel itself. This approach may involve providing a variable compression gasket seal to function both as hemostasis and as external fixation (“locking”) via compression. The stiffness can be varied through the frame and / or the extension arm, to facilitate the application of the desired force and the sealing of the filter. Although it is not necessarily so limited, several aspects can be appreciated through a discussion of examples using this context.
[049] Several modalities are characterized here, in the figures and in the Appendix (and, as they may include figures in the Appendix), with dimensions, materials and other specific characteristics, as listed. It is noted that these characteristics are exemplary of specific applications, and may be representative of others, with a variety of such aspects considered to be consequently implemented.
[050] According to one or more modalities, a device includes an extension arm, a frame connected to the extension arm, and a filter with opposite surface areas (for example, a mesh or other material) ending around a perimeter of the filter. The filter is connected to the frame at the perimeter and configured and arranged with the frame and the extension arm to expand with the frame in an implanted state and, in the implanted state, adapt one of the opposite surface areas to an internal side wall of an organ tubular engaging the extension arm with the respective surfaces of an internal side wall of the tubular organ and, through the engagement, apply force to the frame, which seals the frame and the perimeter of the filter to the internal side wall. An axis can be connected to the extension arm and can be operable to slide into a catheter, and to position the extension arm, frame and filter in relation to the inner side wall of the tubular organ to apply force to the frame. The axis can also operate with the frame to contract
Petition 870190096293, of 26/09/2019, p. 12/192
9/55 the frame and filter to a contracted state, and remove the frame and filter to the catheter in the contracted state. This can facilitate the capture and removal of particles such as those dislodged during surgical procedures. For example, with the filter sealed to an opening in the side wall of an aortic arch, a part of the filter facing an internal region of the aortic arch can capture particles from the blood flowing through the filter and into an artery through the side wall , and these particles can be removed accordingly.
[051] As noted, a variety of filters can be used. Several implementations involve a filter with opposite surfaces, with a perimeter edge that limits an outer periphery of the filter. For example, a mesh or other sheet of material can be used for the filter. Such material may, when placed flat, have lower and upper surfaces that are along a perimeter of the filter edge. This edge perimeter can be attached to a frame and used to seal against the inner side wall of a vessel.
[052] The framework can be implemented in several ways. In some implementations, the frame includes an internal frame configured and arranged to seal the filter to an internal side wall, an external frame, and a plurality of supports that connect the internal frame to the external frame. The supports operate to translate the force, applied through the extension arm to the outer frame, to the inner frame and to flexibly adapt the inner frame to the inner side wall. The supports can be operable to facilitate the flexing of the internal frame, in relation to the external frame, providing a spring force and facilitating the adaptation of the external frame to the physical characteristics of the internal side wall.
[053] The filter can be coupled in several ways. In some implementations, the filter extends within a perimeter of the inner frame and between the inner frame and the outer frame. The brackets apply force between the outer frame and the inner frame and seal an opening in an inner wall of the vessel
Petition 870190096293, of 26/09/2019, p. 12/20
10/55 pressing the inner frame and the outer frame against the inner wall of the vessel and around an opening in it. As discussed in this document, supports can facilitate sealing under varying pressure conditions, such as that which may result from fluid flow, and with movement of the vessel wall. For example, the inner frame and the outer frame can be maintained at an offset distance from each other that varies according to the applied force.
[054] Various embodiments as characterized above and otherwise described herein may include some or all of the various sets of components described. For example, some modalities involve a framework that is operable according to the frameworks discussed here. Other modalities involve a frame and a filter attached to the frame, or the frame and an extension arm attached to the frame, or the frame, filter and extension arm. Still other embodiments also include an operable shaft for moving within a catheter and coupling a frame as noted above. Still other modalities also include a catheter that extends from a proximal end to a distal end and is operable to accept the axis, frame and any other component. Several functionalities, in relation to the implantation of the frame, sealing the frame to an internal side wall, and retraction of the frame inside the catheter, can be integrated between the various components. For example, with an extension arm having at least two folds along a part of the extension arm that connects an axle to a frame, the folds can be used to engage with the inner side walls and apply pressure to the frame and the an associated filter. The side walls can thus be used with characteristics similar to the spring of the extension arm to facilitate the sealing of an opening in the side wall.
[055] Several aspects are addressed to an apparatus for use with a catheter, and including a filter with a frame and an articulated arm connected to the frame. The frame forms a perimeter of the filter and separates the opposite surfaces from the
Petition 870190096293, of 26/09/2019, p. 12/21
11/55 filter. The articulated arm is operable to, when implanted inside a tubular organ, engage with opposite parts of the inner side wall of the tubular organ and use the parts of the inner side wall to seal the filter to the inner side wall applying force to the frame.
[056] Several modalities target the catheter components, and provide control over filter entities and vector-based isolation zones to facilitate their insertion into the delivery catheter lumen, mitigating potential damage to the catheter components, which can involve washing the filter / frame, maintaining an air-free state, packaging a vector-based device in a restricted state for transfer to the delivery catheter, which can be automated. Such approaches may involve a protective component that houses the catheter components, including the filter and the frame. A loader component restricts the catheter components to a state that can be controlled and transferred to the lumen of the delivery catheter, and is operable with the protective component to provide an air-free environment with a visual indicator that characterizes the presence of air retained within the component. This can provide protection during assembly against improper handling during sterilization, transportation and handling. A loop component facilitates insertion of the catheter components from the carrier component into the delivery catheter lumen. The loop component can also be operable to lock and unlock an axis of the catheter components, move axially along the axis and, when locked, transfer torque, pressure force and traction from an operator through the handle to the axis and finally the filter / frame. Such approaches can be implemented with loop components, as shown in the figures (for example, as shown in Figure 16).
[057] Some modalities involve applications based on methods with several components, as characterized here, as they may involve methods of manufacture and / or methods of use. According to one or more modalities, a
Petition 870190096293, of 26/09/2019, p. 12/22
12/55 method of manufacturing an appliance is implemented as follows. An extension arm, frame connected to the extension arm, and filter are provided. The filter has opposite surface areas (for example, a mesh or other material) ending around a perimeter of the filter, with the filter being connected to the frame at the perimeter. The filter operates with the frame and the extension arm to expand the filter with the frame in an implanted state. In the implanted state, one of the opposite surface areas is suitable for an inner side wall of a tubular organ, engaging the extension arm with the respective surfaces of an inner side wall of the tubular organ and, through the engagement, applying force to the frame that seal the frame and the perimeter of the filter to the inner side wall. In some embodiments, the mechanical properties of the frame are optimized by the thermomechanical processing of the frame to define a degree of rigidity that facilitates the implantation of the frame and filter within the tubular organ, and sealing the frame and filter to an internal side wall of the organ tubular. Thermomechanical processing of the frame may include defining the degree of stiffness through a combination of one or more of the following: cold working of the frame (eg Nitinol), applying a shape-adjusting heat treatment temperature, and selecting the chemistry of an alloy from which the frame is formed.
[058] One or more modalities of use cases involve the use of a filter and a frame as characterized here, to filter the blood or other flow as follows. The filter is expanded with the frame in an implanted state and, in the implanted state, one of the opposite surface areas is suitable for an internal side wall of a tubular organ, engaging an extension arm with the respective surfaces of an internal side wall of the tubular organ. Through the engagement, the force is applied to the frame and seals the frame and the perimeter of the filter to the inner side wall. Such operable features can be implemented according to one or more modalities of this document, such as using an
Petition 870190096293, of 26/09/2019, p. 12/23
13/55 extension to engage the side walls.
[059] Several modalities are directed at an embolic protection device designed to protect the brain from stroke and embolic debris during left heart procedures, such as TAVR. Dynamic double-edge sealing of the device is achieved by controlling the system stiffness and natural frequency during the cardiac output (CO) cycle. The natural frequency, for implementation in a hemodynamic environment, can be set higher compared to the heart cycle frequency. This higher natural frequency can facilitate a smaller displacement of the frame and, in it, a greater seal. The device has a frame with a natural frequency (N) that is a function of its maximum displacement (Ds) (at the distal end) in relation to an anchor point (La), articulation of the extension arm and its properties. In various implementations, the characteristics of the stiffness spring and other aspects of the frame are operable to flex during the CO cycle, so that the frame and the coupled filter are kept in place to seal an opening in the side wall of an aortic arch. A variety of different filters can be attached to the frame, and used to filter material that passes through an opening in a side wall of the aortic arch. In some implementations, brackets are used between the respective frame components, together with the frame stiffness to seal that filter against the side wall, and to maintain the seal under varying pressure conditions, while moving flexibly with the aortic arch. The extension arm can articulate to interact with an internal side wall of the aortic arch to provide pressure against the frame and keep it flexibly in place.
[060] Turning now to the figures, and with respect to Figure 10 first, a set / frame / filter system and extension arm (EA) are shown. Anchor points A, B and C support the EA, creating force (F) and torque (T). The system includes a frame set, having a fine filter, rolled around its
Petition 870190096293, of 26/09/2019, p. 12/24
14/55 perimeter and a support extension, at its proximal end. This creates a mechanical force that can overcome the hemodynamic forces exerted on the frame / filter assembly. The supporting EA connects the proximal end of the frame assembly. The main functions of the extension arm and shaft are: a) transferring pressure and torque force to push, pull and rotate the frame assembly through the catheter; b) implant and position the frame / mesh assembly in the location destined for sealing and filtration; c) provide the necessary sealing force against the wall of the Aortic Arch (AA); d) provide sufficient rigidity to the frame / filter assembly during cycles of cardiac output and arterial pulse; e) provide several anchor points along the descending aorta, so that it can support and reduce the displacement of the frame / filter. Figure 10 shows the frame / filter set and its articulated extension implanted in the AA and in the descending aorta. The anchor points: A, B and C support the frame assembly and create the necessary sealing force (F) and the supporting torque (T) during implantation. A variety of possible combinations can be implemented in Type I, Type, II or Type III arc geometries.
[061] The articulation can be implemented in several ways, to adapt to particular modalities. In some implementations, the EA anchors at various points (A, B, C, etc.) in the descending aorta and provides physical support and mechanical spring force for the sealing surfaces of the picture. The EA includes short, angled segments of specific width, as shown in Figure 11, which are connected to form a continuous entity. Each segment can articulate and rotate in relation to the other, as each contributes to the total rigidity of the AE.
[062] The total spring force (F) and torque (T) of the EA are the sum of all the individual force and torque of each articulated section. The articulation of each segment is characterized by the segment length (L), segment stiffness (Ks) and segment geometry (width and thickness). The articulated sections of the EA, in
Petition 870190096293, of 26/09/2019, p. 12/25
15/55 together with the curved and twisted segments of the EA, allow the transition section between the axis and the proximal end of the maneuver frame set and adapt more precisely to the curvilinear structure of the descending aorta. The total stiffness (K), tip displacement (D), sealing force (F), torque (T) and, eventually, the natural frequency (N) of the frame / filter are controlled by the articulation properties of the AE .
[063] Referring again to Figure 11, the articulated segments of the extension arm provide the necessary seal F and T to minimize Ds. The design parameters of the extension arm that control its properties include: 1) segment lengths (L1, L2, L3, etc.); 2) relative rotation angle (Φ1, Φ2, etc.); 3) relative segment stiffness (Ks); and 4) rotational trend of each segment, as it can be clockwise / counterclockwise (CW / CCW) in relation to the axis. In addition, the physical properties of the arm material, linearity and corrosion can affect the application. The ideal design can be implemented to ensure that the EA (given the correct combination and sequence of La) always has a positive net F and T available to seal the frame / filter against the AA wall.
[064] Aspects of rigidity and natural frequency can be implemented to effect the sealing, as noted. The main functions include creating a dynamic double-edge seal against the AA wall and filtering embolic debris from the circulation of the three vessels of the arch. To achieve this goal, K (F to Ds ratio) of the articulated AE must overcome the net forces due to cardiac output (CO) and impulsive flow / pressure profiles during each cycle. It is desirable that the frame / filter assembly behaves so that, when subjected to external forces, it approaches zero Ds without oscillation or AA separation. The total stiffness (K) of the EA can be set to control how far the frame / filter assembly is displaced from its sealing position. High N of the frame / filter set indicates a corresponding high K of the EA (in relation to La) and therefore
Petition 870190096293, of 26/09/2019, p. 12/26
16/55 no minimum Ds or Ds. A lower total stiffness coefficient of EA, in relation to La, indicates a lower frequency and, therefore, a higher Ds, as can be consistent with Figure 12.
[065] Any separation between the frame / filter assembly and the AA wall is potential for leakage. N of the frame in a CO environment is an indication of how well the K of the EA supports the frame / filter. The stiffness and damping properties of the AE determine how gracefully the frame structure would return to its stable sealing position after being subjected to a sudden CO force or arterial pulse [Eq-1]. For example, the fundamental natural frequency of any structure can be roughly approximated by:
r - JL / Σ -Α, ίΣ '“2ttV ^m -η [066] where fn is equal to the natural frequency in radians per second, K is the stiffness (force / displacement) and is the balanced mass of the structure. The term under the radical can also be expressed as a ratio of dynamic acceleration to maximum displacement (for purely static displacement) Δ, subjected to the gravitational acceleration (g) of the Earth: fn = 3.13 (1 / Δ) 0.5 ). However, true and real N and K of the frame / filter structure that is subjected to various hemodynamic forces must be determined experimentally. The position of La in relation to the distal end (Ls) is also an important parameter. As Ls gets shorter, Ds gets smaller and the N of the frame / filter and the K of the EA increase, and the possibility of resonance and therefore the leakage decreases.
[067] The stability, therefore, the sealing efficiency, of the frame / filter structure in the AA environment is a direct function of its stiffness and natural frequency. An articulated extension arm as characterized here allows the framework to anchor firmly in the descending aorta, pass through a complex geometry, and create sufficient strength and sealing torque to overcome the natural hemodynamic forces of human cardiac output.
Petition 870190096293, of 26/09/2019, p. 12/27
17/55 [068] The natural frequency (N), stiffness (K) and time constant (Tau) of a frame set, as implemented in this document, are used to facilitate application in the body's aortic arch environment human. In several modalities, an embolic device that uses these aspects is implemented to protect the brain from stroke during left heart procedures focused on TAVR. The functional requirements of the device's dynamic double-edge sealing require control over the system time constant as a response to the cardiac output cycle. The response of the picture is directly related to the natural frequency of the structure and its rigidity. The system includes a frame set, having a thin film filtration mesh, wrapped around its perimeter, and a support extension at its proximal end to create mechanical strength. In its expanded (or implanted) state, it covers the three main human arteries of the aortic arch, deflecting the received plunger. In the contracted (or packaged) state, it fits completely inside the catheter, before implantation. The frame and mesh set, when implanted in AA, is subjected to various vector forces. They include: a) Hemodynamic forces due to cardiac output (CO), b) Dynamic and structural forces of an oscillating AA wall, c) Fluctuation force of the thin film mesh and d) Spring mechanical forces of the frame assembly and its extension that create the sealing force against the wall. Figure 13 shows an implementation of a device in free space, experimenting with the main mechanical and hemodynamic vector forces.
[069] Functional aspects may include, for example, those that: 1. Create a dynamic double-edge seal against the walls of the aortic arch, 2. Filter or deflect embolic debris away from the circulation of the arch vessel, 3. They resist the hemodynamic forces of flow, pressure, buoyancy of the mesh and drag in the film of the filtration mesh. 4. Adequate the variation of the anatomical folding of the typical aortic arch. 5. Minimize the flow of unfiltered blood around
Petition 870190096293, of 26/09/2019, p. 12/28
18/55 of the device, 6. Provide adequate filtration area and coverage for large arc vessels and 7. Provide adequate spring force and stiffness that can reduce system response time during each CO cycle pulse and 8. Prevent the phase resonance of the CO system, with reduced amplification.
[070] The net balance of transmitted forces (for example, frame set and filtration mesh), FNET, during each cardiac cycle, results in the system adhering and sealing to the superior aspect of AA, where the three main arteries arise. The aortic walls are expanding and contracting radially during each cycle. This oscillation results in the consequent increase or decrease in the arc diameter. The frame dynamically adapts to the cardiac cycle, so that the sealing of the frame edges to the walls remains intact, preventing leaks.
[071] In addition to the dynamic sealing of the edges, mentioned above, an adequate coverage is guaranteed around the perimeter of the combined arteries of the arc, so that a small displacement of the frame / mesh set, due to the variation of FNET, over each cycle cardiac output (CO), do not create blood leaks through the sealing interfaces. The vector forces of the system (mechanical and non-mechanical), FNET, are configured to push against the AA frame / wall sealing interfaces, so that the filtration mesh can perform its functions without loss of fluid due to leaks.
[072] The pressure-time profile in the aorta is not a continuously smooth curve; several modalities address this aspect, while maintaining a seal against a side wall of a vessel, such as the aortic arch. Each CO cycle (AP line) produces, three distinct pressure profiles are produced in the aorta, resulting in step or force pressure functions against the frame / mesh assembly. The pressure change in each zone (PD) results in blood flow (Q) in the aorta and flow rate (V). The flow (Liter / Min) can be approximated as Q = VA, where
Petition 870190096293, of 26/09/2019, p. 12/29
19/55
A is the transverse area of the aorta at the point of interest.
[073] Figure 14 shows an exemplary aortic pressure (AP) curve in which zones “2-3”, “3-5” and “5-6” can be identified as having different profiles, for which several modalities are targeted. Step pressure functions in the aorta occur when: a) The aortic valve opens and pressure from the LV is pumped into the aorta (approximately 0.15 s; 100 Mm-Hg; Zone “2-4” ). b) The aortic valve closes to a closed state and the pressure in the aorta increases slightly above the pressure value in LV due to the elastic energy of the expanded wall and (Dicrotic notch - approximately 0.1 s, zone “4-5” ) and c) isovolumetric expansion in which the pressure decreases gradually (approximately 0.2 seconds, 90 Mm-Hg sec., Zone “5-6”). The dicrotic notch represents the interruption of the smooth flow due to the brief flow of blood return that closes the semilunar valve of the aorta when the ventricles relax. Each zone produces a force function in the frame set. The absolute value of each force function is (| FCO |). When | FCO | interacts with the frame / mesh set, the net result must be such that | FCO | <FNET without being amplified around its natural frequency. Each step force input can be described mathematically as:
[074] In several modalities, the behavior of the frame / mesh set, due to the effect of combined forces, FNET, can be expressed as a second order system. The system's response, the system can be displayed by stimulating a series of step pressure (or force) functions in each zone. Step inputs are characterized by a fast initial rise time (t) and a flat plateau (F0 = 0; F1 = | FCO |). The behavior of the second order system can be modeled as a combination of parameters of acceleration, mass, damping factor and stiffness. The system reacts to the rapidly growing entry force, establishing itself within a time constant (Tau) and
Petition 870190096293, of 26/09/2019, p. 12/30
20/55 reduced amplification or no oscillation at higher / lower amplitudes. The behavior (response) of the frame / mesh set in the aorta can be modeled using mass (m), a damping factor (c) and stiffness coefficient (k), as shown in Figure 15. If the zero value of Ύ0 ”corresponds to the position of the frame (spring) when it is discharged (immediately after being released from the catheter), so a force Fs needed to move the frame / mesh assembly by a distance y is given by Fs = k Y, in that k is called the spring constant or system stiffness. The parameter Ύ ”corresponds to the displacement of the distal end of the switchgear. Equation (2) defines the system's frequency response to a step force input (| FCO |), where “wn” is the natural frequency of the system's non-damped (free state) system and “ζ” is the damping coefficient, related to the damping factor (C). In one or more modalities, a stabilized state is reached, without direct or cyclical displacement (change in Y) and in the shortest possible time. The “critically damped” systems (ζ = 1) represent the fastest path to the point of stability (minimum frame shift, no cyclic movement and shortest time). These factors alone, however, can be increased, as other design factors can be considered before selecting the correct damping coefficient, natural frequency and, finally, stiffness parameters, for system stability.
[075] It is desirable that the system behaves in such a way that, when subjected to a step pressure input, it approaches a zero displacement (Dy = 0) faster and without oscillation. This condition can be called "critically damped" and can be expressed as:
(2)
Petition 870190096293, of 26/09/2019, p. 12/31
21/55 V: · [076] The main stiffness (K) of the I mesh frame assembly can be implemented by incorporating a series of short-length bending sections into the extension arm (hinged sections). A force-based system that depends on the mechanical spring force, and not on the hemodynamic fluid forces (such as the fluid pressure differential across the mesh), can therefore be used to create a sealing force against the aortic wall . The hinged sections have sharp angles to each other and the frame. This allows for better maneuverability of the frame and simultaneously controls the rigidity of the system in the desired direction. Directionality and stiffness value are implemented to balance functional and mechanical requirements. System rigidity (k) is applied with an appropriate force and direction to facilitate navigation and adaptation to the dimensional limitations of a catheter when the frame / mesh assembly is residing within it (for example, pre-implantation packaged in AA ). The length and angularity of the hinged section are adapted to provide a desirable amount of friction within the catheter, and to facilitate adaptation with small radii within the AA and its curvilinear and serpentine path, as it guides its way through the catheter. A constant sealing force against the cyclically dilated aortic wall is consequently maintained. The natural frequency is defined so that it is not amplified and its stiffness, when responding to the step force functions, is compatible with a wall that changes dynamically. In addition, the time to reach the stability point can be adjusted so that it does not overlap with the start of the next force function. The time to achieve stabilization can therefore be defined as less than the minimum time of the force function (t).
[077] The stiffness can be defined to adapt in a variable way to
Petition 870190096293, of 26/09/2019, p. 12/32
22/55 specific implementations. Functionality can be defined by the way the upper (frame) and lower (extension) parts work and complement each other during operation. Both the frame and the extension part of a set have directional rigidity and points of articulation in different planes. The frame section includes a number of rails and clamps on both sides of its center line, forming a wider surface area compared to a single round wire. The clamps connect the rails, forming a dynamic spring coefficient that is always in contact with the aortic wall, as it expands and contracts due to the cardiac cycle. At the same time, this combination of “series” and “parallel” (clamps) springs that are embedded in the frame set, can adapt to varying degrees of freedom in three-dimensional space. The extension part of the set also has exclusive functionality. Its function is to navigate at the bottom of the arch and support the upper part (frame). It includes several continuous folds of large and small radius, having several geometric and material properties (therefore, stiffness) along its length. By controlling the stiffness of the extension along its curvilinear path and controlling its spatial location (that is, directing the anchor points to the side walls) and the torsional behavior, the natural frequency of the frame itself can remain within the design range. The natural frequency range of the frame can be between 2 to 15 Hz, however, a narrower bandwidth can be achieved by controlling the stiffness in different sections of the frame and the extension. The frame and extension can function as an integrated system; however, a certain operational independence (isolation) can be implemented to avoid interference between them. The natural frequency and stiffness of the frame are set so that the frame and seal are not adversely (significantly) affected by disorders that the extension section experiences due to cardiac output or user input after the frame has been placed in the desired location . The function of the hinged section, as shown in
Petition 870190096293, of 26/09/2019, p. 12/33
23/55
Figure 13, can be configured to “loosely” connect the general frame stiffness and extension and, simultaneously, allow a smooth transition between the two, so that connectivity remains strong (for example, as universal coupling of an axis by car).
[078] In general, when controlling stiffness, any part of the extension or frame can be defined according to one or more of the following factors: a) Material properties and chemical / physical composition, b) Geometric stiffness which is a function of shape and size and c) the processes and parameters of shape adjustment and that can produce a projected material stiffness. The combination and selection of each category can result in continuous and articulated properties of both the frame and the extension in each section.
[079] In some implementations, a desired project can be achieved by defining characteristics so that the system does not oscillate, but approaches its final stable value (y = KF1) slowly and monotonically, while satisfying the requirements functional. The speed at which y approaches its final value depends on the value of ζ. The higher ζ, the more slowly the y value changes without oscillation. The damping coefficients are adjusted according to the damping factor (c), the mass of the frame / filtration mesh and the stiffness coefficient. However, the damping factor (c) can be implemented as a variable factor, with a value being a factor of mesh density, porosity and buoyancy of the mesh in a hemodynamic environment. The buoyancy force (in this case) is also a function of the volume of blood displaced in the aorta and the surface area of the filtration mesh. The hemodynamic drag forces exerted on the filtration mesh are a function of the blood viscosity, the mesh surface area and the drag coefficient. The smaller the mesh surface area, the lower the drag force during each step force function and creates less friction within the catheter. Filtration meshes, having a higher density than blood, create
Petition 870190096293, of 26/09/2019, p. 12/34
24/55 forces against the spring force of the frame. Lighter meshes can be implemented to reinforce the sealing force against the walls. Equation (3) is a representative of a “over-damping” system where ζ> 1. The system does not oscillate when subjected to a step input. F1 = | FCO | is the initial force due to the step force function when the aortic valve opens.
¹ y · ^{1 h} (3) [080] Higher values of wn would bring the system faster to its final resting point, with the coefficient “Tau = ζ wn” being the system time constant. A time constant (1 x Tau) is defined as the time required for the displacement value of the system to reach 62.8% of its final value. Therefore, by carefully controlling and selecting the values of K, ζ and wn, the system can be optimized when the effects of frictional forces and buoyancy are also considered.
[081] The total time period from zone 2 to zone 6 of the AP profile shown in Figure 14 is about 0.50 seconds. During each CO cycle, the time contribution from each AA zone is therefore about 0.15, 0.10 and 0.25 seconds. The total time constant of the system (Tau) must be such that it is always less than the shortest rise time of the force function in the aorta (<0.10 seconds, here). In addition, an additional safety margin can be defined so that the system is completely stabilized before the next force function is initiated. This can prevent fluctuations, for example, when FNET is in the same order of magnitude as FCO. (| FCO | = FNET).
[082] Various aspects of the frame and / or extension arm can also be adapted to meet specific needs, such as loading the structure into a catheter, reducing friction within the tube, expanding the mesh for greater coverage, negotiating for flexion and folding of the catheter, resistance to pressure / traction force of the delivery shaft, overcoming the fluctuation forces of the
Petition 870190096293, of 26/09/2019, p. 12/22
25/55 mesh, when deployed, and overcoming the drag forces of the mesh while moving inside the catheter. The frame can be scalable, so that its shape and properties can be maintained from one size to another (that is, the shape remains the same, going from 8F to 10F, etc., as well as for different implementations). The shape can be achieved by starting the flat material (eg nitinol) or starting a hypotube followed by laser cutting or other cutting methods. The shape of the frame set can also have additional characteristics, such as additional deformations in the middle or on the sides of the frame set. The shape of AF can also include various sizes and angulations in the axial and transverse directions to accommodate various anatomies and sizes of aortic arch. The framework can be implemented to provide / direct one or more torsional forces (for example, resist twisting of the AA), vertical forces (push against the coverage area of the three arteries to create a seal), lateral forces (for example, perpendicular to AA), hemodynamic / lateral fluid forces in the direction of the transverse axis, and lateral forces tangent to an AA plane, and resistance to fluid forces due to cardiac output / hemodynamic forces, and in the axial direction.
[083] With regard to filters, as noted here, a variety of manufacturing and treatment approaches can be employed to achieve the desired results. In some implementations, an austenite finish transition temperature above room temperature is used aiming at Af = 32 ° C. Various properties of the nitinol axis can be achieved by controlling the cold work and the heat treatment of the nitinol wire / rod for achieve a specific austenite finish temperature and therefore the desired stiffness and mobility capability of the shaft.
[084] The axles, as characterized here, can be designed with flexibility characteristics to meet particular needs. For example, the axis can be formed to negotiate around a tight radius, resist the force
Petition 870190096293, of 26/09/2019, p. 12/36
26/55 pressure I traction I drag force inside the tube, provide torque capacity, provide desired stiffness (K value) in relation to the combined stiffness of the frame and the isolation zone, provide reduced superelasticity to obtain ideal stiffness to negotiate and better provide the frame set through tortuous anatomy, create a primary vertical force against the coverage area, provide an anchor point for the mesh connection, and torsional force on the frame.
[085] In a specific manufacturing approach, a superelastic nitinol flat plate with a desired final frame thickness is used, as in the range of 0.203 mm to 0.5 mm (0.008 ”to 0.020”). Then, by laser ablation, electroplating process or other similar technique, the thickness of the nitinol sheet is selectively reduced to approximately 0.025 mm (0.001 ”) to create the mesh surface coverage before creating the final mesh patterns. Finally, either by laser cutting or electrochemical processes, the final mesh pattern is created. This provides a one-piece nitinol frame set prior to final shape configuration. The final shape adjustment process can be carried out by the appropriate thermal adjustment device and by the heat transmitted at about 400 ° C to 600 ° C, such as the temperature of around 500 ° C.
[086] The filter set can be supplied with asynchronous movement (out of phase) in relation to the CO, which can help to eliminate the amplification of the frame displacement due to the CO. Pivot points can be defined to provide changes in foldability and stiffness to adapt to a geometry confined to various types of aortic arches. This can facilitate dynamic adaptation / sealing to a variable diameter of the AA. For example, a CW force can be exerted on AA after implantation. The joint can also counterbalance the effects of movement of the delivery shaft (reduce the effect of the user's movement), and adapt to the maximum foldability of the AA, in addition to minimizing its size and reducing its shape during recovery inside the catheter.
Petition 870190096293, of 26/09/2019, p. 37/122
27/55 [087] As noted here, the supports can be implemented to facilitate the sealing of a filter to a side wall, as characterized here. The ratio between the height of the cross section and the width can be called alpha and used to characterize the general stiffness of the frame, and the directionality of the forces created by the frame. For rigid frame applications, an alpha> 2 can be used. For medium stiffness, the alpha can be between 1.5 and 2, just as it can be applied where there is moderate cardiac output (CO: 4 to 5 L / min) and / or the geometry is less confined and the transition area through arteries is smooth (less sharp curves in AA). The stiffer frames can handle moderate fluctuation forces of the mesh, thinner / lighter meshes, and friction within the catheter. For low stiffness, alpha between 1.25 and 1.5 can be used, for applications such as those involving low cardiac output (CO: <, 5 L / min) and / or the geometry has a very sharp transition area in arteries and, providing low friction inside the catheter and greater sensitivity to forces caused by the mesh in a hemodynamic environment.
[088] Therefore, the combined axial, lateral and torsional forces of the frame set can create an isolated / damping system so that the frame set can work to seal against hemodynamic forces of the blood (for example, similar to the system suspension system). The combination of sealing rails and supports controls lateral and torsional forces. The shape and size of the insulation zone controls axial and vertical forces. The natural frequency of the frame set can be used as an indicator of how the damping system works. The higher the natural frequency of AF, the better the arc seal. Continuously variable stiffness can be used with FA from the beginning of the isolation zone to the proximal end in relation to the stiffness of the delivery axis to provide more natural cushioning during cardiac output and the resulting aortic pulse. It would also provide “proximity” to the actual folding of the aortic arch. The value of FA stiffness increases from the delivery axis to the end
Petition 870190096293, of 26/09/2019, p. 12/38
28/55 distal, so that the combined stiffness of the frame assembly is always less than the stiffness of the delivery shaft. The combined mechanical forces of AF and the hemodynamic strength of the mesh may be greater than the hemodynamic forces due to cardiac output and may be out of phase in relation to the frequency of cardiac output.
[089] Various types of articulation characteristics can be used to promote the implantation of AF and better sealing. One involves the mechanical articulation of AF by itself, which can better adapt to the shorter, more confined length of the aortic arch. Another is the articulation of the isolation zone or extension arm from the proximal end of the frame to the connection with the axis. The joint can be provided to better navigate against folding and provide positive hourly force against the aortic wall. Yet another involves the stiffness of the material. The combined axial and vertical forces of the frame determine the rigidity of the supports, therefore, the resistive force against hemodynamic forces.
[090] Various aspects of frames, as characterized here, can be implemented with axial characteristics as follows. The nominal longitudinal radius of the frame accepts shape restraining forces when implanted in the anatomy of the curved aortic arch. The radius of the aortic arch is less than the radius of the frame. This provides a restricted state, through the smallest folding radius of the aortic arch, which is used to create potential energy within the frame structure. When anatomy allows, through the movement of the arc, the potential energy is released for kinetic energy, resulting in the straightening of the picture. This movement works to maintain the sealing contact with the anatomy and longitudinal stiffness in the blood flow.
[091] Various aspects of frames, as characterized here, can be implemented with radial characteristics as follows. The specified width of the frame originates from two points of articulation, respectively at each
Petition 870190096293, of 26/09/2019, p. 12/39
29/55 end of the frame structure. These points of articulation initiate a spreading movement for radial coverage of the filter. The nominal width of the picture is greater than the diameter of the aorta. When the picture is restricted by anatomy, the potential energy is stored. When anatomy allows, by aortic dilation, the potential energy is released in kinetic energy, resulting in the enlargement of the condition up to its nominal state. This movement works to keep the filter cover along the width and supports the sealing contact with the anatomy.
[092] Various aspects of the frames, as characterized here, can be implemented with elevation characteristics as follows. The axis, the extension arm and the frame structures are configured to provide, respectively, a lifting force to the frame, which facilitates interaction with the lateral wall of the aortic arch. The component specifications are such that they use the material properties of the shaft and the dimensions of the anatomy to generate this stored energy. When anatomy allows, through the movement of the arc, the potential energy is released in kinetic energy, resulting in support of the frame structure.
[093] Various aspects of the frames, as characterized here, can be implemented with pulse characteristics as follows. As an extension of the radial vector, the nominal shape of the frame structure exerts force on the aortic wall for sealing. During the cardiac cycle and related dilation and constriction of the aorta, resistance (kinetic potential) maintains force-based contact with the aortic wall and thus maintains sealing throughout the dynamic cardiac environment.
[094] A variety of filter types can be used with several modalities. Filter meshes can be implemented with behavior, physical and mechanical properties, porosity and chemical and hemodynamic effects as follows. In addition, chemical, biological and geometric aspects of a mesh can be combined with general mesh properties to meet
Petition 870190096293, of 26/09/2019, p. 40/122
30/55 specific applications. Such a mesh may involve a thin metallic or plastic film wrapped and / or glued around the perimeter of a frame assembly, as characterized herein. The mesh can be wrapped around the perimeter of the frame and a support extension, at its proximal end. This creates a mechanical sealing force that can overcome the hemodynamic forces exerted on the frame / mesh assembly. The filtration mesh is used to provide a reinforcement and containment structure to the frame set and a filtration mechanism that blocks and deflects the improperly sized piston particles from the main arteries. A plastic mesh can be extruded, oriented, expanded, woven or tubular. It can be manufactured from polypropylene, polyethylene, nylon, PVC or PTFE, thermosetting or thermoplastics. A metal mesh can be woven, knitted, welded, expanded, etched photochemically or electroformed (screen filter) from steel or other exotic metals for TAVR applications. The thickness of the mesh is also important and attributes to its weakness or strength against the tensile strength or pressure of the frame assembly.
[095] The functions of the filtration mesh for TAVR applications include: a) blocking and deflecting unwanted plungers; b) allow minimal blockage of flow and resistance to three arteries; c) provide sufficient flexibility inside the catheter (to obtain minimum volume / contracted size) and outside the catheter (to allow and not limit the movements of the picture); d) provide sufficient strength against the shear force (rupture); e) provide maximum porosity to reduce resistance to flow; f) have strong self-bonding strength; g) resist bio-encrustation while in the blood flow; h) fluctuating in relation to the blood density (so that it can increase the sealing force of the picture; i) be elastic (in relation to the picture's structure, following its dynamic movements in the cardiac cycle and inside the catheter); j) hydrophobicity; and k) be physically and chemically inert to the hemodynamic environment.
Petition 870190096293, of 26/09/2019, p. 41/122
31/55 [096] Figure 17 shows a relevant modality, which can be implemented with a frame and a porous filter set. The mesh film can finally be attached to the frame without impeding its dynamic mobility and sealing functionality. The flexibility of the frame and mesh set will allow to seal many subassemblies and combinations that can occur in the geometry of the type I, type, II or type III aortic arch.
[097] Figure 18 shows shapes of perforating cells and the percentage of the area open to the total (% porosity) of the films, which can be implemented according to one or more modalities. For example, for the hexagonal cell shape of a thin perforated film, when standardized in one direction, it is possible to obtain a porosity of 50% or more. Various implementations provide maximum available porosity, so resistance to blood flow and speed can be minimized as blood enters the arteries. As the porosity value increases, the distance between each cell is reduced and, consequently, the shear stress is created, due to stretching or tensile forces, it increases and can result in a break in the thin film. The shear stress has an inverse relationship with the mesh film thickness. The smaller and narrower the spacing between each cell, the higher shear stresses will develop in the mesh due to traction, stretching, folding, in addition to sliding contact and friction against the metal frame. As such, several implementations use films that are defined according to these aspects.
[098] A variety of particle sizes that can be filtered according to the modalities of this document can be differentiated into groups, each of which is defined by its size in relation to the pores of the membrane. One group includes larger particles (too large to fit into any distributed pores or fiber arrays), and another group includes particles small enough to penetrate the larger pores of a membrane or the interstices of
Petition 870190096293, of 26/09/2019, p. 42/122
32/55 fiber, but not the smallest. In filtration, the dimensional axis of a particle that coincides with the pore is functionally defined to adapt to the desired particle size for filtration. The probability factors (for example, the axial orientations of a particle) governed by the speed, viscosity and drag of blood flow can cause more elongated (needle-like) shapes to pass or meet between the pore openings. Thus, in a mixture of particles generally characterized as too large to permeate an interstice of fiber matrix or pores, some forms may do so depending on how their flow pattern is driven by filtration conditions or by chance.
[099] Therefore, Figure 18 shows regular geometric patterns in which the size, pattern and porosity of the cells, according to the filters that can be modified by functional need of a plunger capture scheme. The particle size and shape can therefore be used to define the efficiency of the filter for specific particle sizes, where an effective filtration area (EFA) is marked by a pore size or retention distribution that is faced with a particle size distribution. The efficiency of the filter, h, is related to the beta rate, BX, which can be defined as the number of particles before (NIN) and after NOIIT filtration, related to a specific particle size (x):
BX = BIN / BOUT [0100] Consequently, the filter efficiency, h (%), is related to the Beta ratio (BX) as:
η (%) = 100- (100 / BX) [0101] As BX increases, the effectiveness consequently increases. For example, for BX = 200, h = 99.50% and for BX = 1000, h = 99.90%. The distribution density function determines the average and maximum number of particles (BX). THE
Petition 870190096293, of 26/09/2019, p. 43/122
33/55 probability distribution function (PDF) for a property defines quantitatively how the values of that property are distributed among the particles throughout the population. Various empirical distribution functions can be implemented to represent the size distribution of many particle populations quite accurately in practice, and these are useful in several modalities.
Exemplary functions implemented according to one or more modalities include:
The. Rosin-Rammler distribution function defined where D = 63.2 is the size in which the distribution function has the value 0.632.
B. Log-Normal distribution defined by: í wmo '
FW) «Gl ---- where G (x) is, the function defined as:
Ιδ- [0102] which is called the Gaussian or Normal distribution function. It is tabulated in many reference books on mathematics and statistics and it is easy to obtain values for this function. In this distribution, D50 is the particle size where P50 = 0.5. It is called medium size.
ç. Logistical distribution defined by:
ACT ---—— [0103] These three distributions are functions of two parameters and can be adjusted closely to the measured size and how they are distributed by curve fitting techniques. Therefore, determining the distribution of the particles to their
Petition 870190096293, of 26/09/2019, p. 44/122
34/55 respective properties (size, shape, mass, speed, etc.), the most likely particle distribution can be determined to estimate the efficiency of the filter, and used as such to define characteristics for various modalities.
[0104] Figure 19 shows factors that are considered in the definition of pore size, according to one or more modalities. The pore structure of a fine textile or plastic material may vary depending on the application of the film. The pore cross section can be elliptical with the minor axis, d, and the major axis, n * d. By assigning different numbers to the axial ratio, n, a variety of pore cross sections can be represented. For a pore having an elliptical section, the measured pore diameter is D, and can be estimated as:
D = '-si tr] [0105] For example, for pore sizes of 125 microns and for n = 1, 1.5 and 2, the particle sizes that may not pass are consequently 125, 147 and 158 microns. The largest particle that can pass through the elliptical pore is d. The ratio between the diameter, d, of the largest particle that can pass and the measured pore diameter, D, is the pore shape factor, and is given by:
λ [dZD] - [(ΙΉή / 2 [0106] Figure 20 shows pore shape factors that approximate various cell shapes, which can be implemented according to one or more modalities. Figure 21 shows a comparison of maximum particle diameter that can pass through the pores obtained from a fiber diameter and tissue mesh count and the pore diameter measured by a porometer.The performance of the mesh inside a catheter and its reaction to friction and dynamic loading can be resolved before the implantation of the frame and mesh set in the aortic arch.According to one or more experimental type modalities, the average sizes of openings in polyamide fabrics calculated from fiber diameters and mesh counts are in good agreement with the greater
Petition 870190096293, of 26/09/2019, p. 45/122
35/55 particle that can pass calculated from the pore diameters measured by a porometer. The measured pore diameters can be comparable with d including a multiplication factor.
[0107] The mechanical properties of a film (or woven / non-woven material) can be used to determine a first aspect of the filter's properties. These properties include: yield stress, strength (area under the stress / strain curve), stress, resilience modulus (resilience modulus = (yield stress) ² over 2 * Young's modulus), strength (energy of the mechanical strain on volume) and Density. The properties related to the perforated film or fabric can include: elasticity, flexibility and resistance to breaking. The properties of the film related to one or both physical and geometric aspects (related to the mesh) can be defined to adapt to specific applications.
[0108] The elasticity of a film or perforated fabric can be defined as the combined percentage of elongation of the film, direction in relation to its original length (e), before exceeding a linear stress limit of the material. Reaching this stress limit can result in shear stress and rupture close to the cell sites, in addition to the maximum shape change (β) of the meshed cell due to elongation (s = ε + β). The material stress, (ε), is defined as the displacement ratio divided by the reference length and is related to the intrinsic property of the film material. The change in shape, β, is related to the mesh geometry and how much it is stretched / stretched in relation to the original pore size (β = 1- L0 / LS) before reaching the maximum stress that creates a rupture in the nearby material to cell sites. Several modalities are aimed at consequently attenuating shear and rupture.
[0109] Figure 22 shows pore stretching characteristics, as can be implemented according to one or more modalities. The break can
Petition 870190096293, of 26/09/2019, p. 46/122
36/55 occurs or due to β or ε, depending on the amount of elongation or the strain value. For thicker films, with higher flow values, maximum strength, toughness and low porosity (below 25%), the possibility of shear stress and breakage due to material deformation is high (polyester mesh with low porosity) . On the contrary, if the mechanical properties of the material are lower, but the porosity remains the same, having the same thickness, the cell may rupture due to the deformation and stretching of the cellular form (β). Consequently, filter designs are implemented accordingly to solve possible problems in this regard.
[0110] The flexibility of the filters, as implemented with the modalities of this document, can be configured to adapt to specific applications. The flexibility of thin perforated film is the ability of a material to deform elastically and return to its original shape when the applied force is either removed or reversed. The film adapts to external changes (folding, flexing, twisting) elastically. The more flexible an object, the less rigid it would be. The flexibility of a thin perforated film will cause very little deformation in the material (ε = 0) during the shape change (where the internal stresses in the film are negligible). This can be attributed to the shape change of the film and its ability to flex and navigate within many degrees of freedom. Flexibility can be quantified, mechanically, as the inverse of stiffness (1 / k), where k = force / deformation. However, for thin and perforated films, flexible, other factors may be included. Thin thermoplastic or thermosetting films, for example, fold under their own weight. If held on one side, a thin perforated film will bend, bend and change shape due to the force of gravity. It can be twisted several times, while being held at one end, before stretching and stresses take over, causing shear stress and
Petition 870190096293, of 26/09/2019, p. 47/122
37/55 break. Therefore, the definition of foldability (NF), flexibility (NB) and twist can be incorporated to define how flexible a perforated thin film can be. It is also clear that, as the percentage of porosity increases, the thin film will be able to adapt to more external changes (adapt to more degrees of freedom). The specific gravity of the film material is also a factor of buoyancy in the fluid or gravitational environment. Flexibility (NB = r / 1) is defined as the ratio between the minimum folding radius (r) and the thickness of the film (t) without causing permanent breakage or deformation in the film. Foldability (NC) is defined as the maximum number of times that a strip length (L) of a thin film can be folded in half, in the same direction. For a single direction fold, the exact strip length required (L) is
[0111] where "t" represents the thickness of the material to be folded, "L" is the length of the film to be folded in only one direction, and n represents the number of desired folds.
[0112] An upper limit and an approximation of the actual paper width required for folding in the alternating direction is [0113] where W is the width of a square piece of paper with a thickness of t, and n is the desired number of folds to be performed in alternate directions. The above equations provide an approximate NF value for the width and length of a thin material. The actual value, however, can be determined experimentally.
[0114] Twist (NT) is the maximum number of times that a thin film strip can be twisted in the same direction before causing the film to stretch or strain. A twist is equivalent to 360 degrees of rotation around the axis of symmetry of the film. During twisting, the initial length of the film decreases as the number
Petition 870190096293, of 26/09/2019, p. 48/122
38/55 of twist increases until the film can no longer be twisted without the entire twisted article starting to bend. In summary, the flexibility (FL) of the perforated fine mesh can be defined as the product of the factors mentioned above, in which õ and rare porosity and specific gravity of the thin film, as follows:
FL = õ * r * NF * NB * NT [0115] Tensile strength is the material's ability to withstand shear stress. Thermosetting materials can have a higher yield stress and elastic modulus and, therefore, their resistance to breakage can be higher compared to thermoplastic materials. When analyzing the maximum shear stress of the material due to external forces, the stress intensity factor (KF) due to the shape of the pore can be considered. A circular shaped pore has less stress intensity factor compared to a hexagonal shaped one. A hexagonal pore, with six vertices, is more susceptible to high stress during shape changes (for example, folding, flexing and elongation) than a circular pore. The breaking force (F) can be estimated as:
F = (1 / KF) * S * t * L [0116] where s = shear strength of the film, t = thickness, L = length of the film and KF = stress intensity factor (which can be determined analytically or experimentally ).
[0117] The biodegradation characteristics of the filter material can be defined to address certain modalities and implementations. Biodegradation in a biological environment can be defined as a gradual degradation of a material mediated by a specific biological activity. The oxidation, hydrolytic and enzymatic mechanisms can occur with biodegradation. When materials are exposed to body fluids, they can undergo changes in their physical-chemical properties due to chemical, physical, mechanical and biological interactions between the material and the surrounding environment. Biodegradation processes
Petition 870190096293, of 26/09/2019, p. 49/122
39/55 can be driven by chemical, physical and biological interactions. The rate of biodegradation within an organism is related to the characteristics of the filter (for example, polymer) and the location in the body where the filter will be exposed. Chemical degradation is influenced by molecular composition and structure, polydispersity, crystallinity, surface area, hydrophilic or hydrophobic characteristics. In general, chemical degradation causes the deterioration of the main polymer chains by random dividing of covalent bonds, depolymerization or crosslinking of linear polymers, interfering in a regularly ordered chain with crystallinity, decreasing certain mechanical properties. The degradation can be by surface or mass degradation. In the case of mass degradation, the uptake of water by hydrophilic polymers is faster than the rate of conversion of polymer into water-soluble materials, mass degradation causes the contraction of all material, since the degradation process occurs in its entire volume. Surface degradation appears in hydrophobic polymers, leaving the internal structure intact; these polymers offer better control of degradation rates. Biodegradation characteristics can be defined to facilitate interaction with the immune system and its specialized cells.
[0118] Figure 23 shows the biological responses of the material, which can be considered in conjunction with the selection and implementation of filter materials. The hemocompatibility of a biomaterial can be defined to facilitate the overall success of the biomaterial in the body. The implanted biomaterial can cause an immune response by the host tissue. The mechanical and physical properties of a film can therefore be defined as inert in the presence of PH and blood viscosity. Polymeric materials that can be implemented for various modalities can generally be classified into three different classes, depending on their source: natural polymers, obtained from natural sources, including plant and animal origin; synthetic polymers, based on sources
Petition 870190096293, of 26/09/2019, p. 50/122
40/55 fully synthetic; and bioinspired polymers that include materials synthesized to simulate a naturally occurring polymer, but not necessarily identical to it. Blood-material interactions can trigger a complex series of events, including protein adsorption, platelet adhesion and activation, coagulation, and thrombosis. For example, platelet adhesion and activation on surfaces of biomaterials are influenced by surface properties such as energy, charge and composition. The intensity of the response depends on many factors, including the properties of the material itself. The hemodynamic response to the biomaterial follows different paths. Coagulation, thrombin formation and platelet adhesion quickly follow the protein absorption by the film. This is influenced by the amount of fibrinogen adsorption, which can occur spontaneously in biomaterials, such as platelets, leukocyte adhesion is influenced by the layer of adsorbed proteins, but they are also recruited by the signals released by activated platelets and damaged cells.
[0119] Figure 24 shows an approximate time scale for protein adsorption, platelet adhesion and leukocyte adhesion during an immune response to an implanted biomaterial, which can be used to define material characteristics, according to one or more modalities . Figure 25 shows the surface compatibility of a single molecular layer deposition of various activators on the surface of a polymer, and the effects of various surface activations on the hemocompatibility of a polymer, as can be seen in the design of filters for various implementations. The two different coagulation pathways (complement and platelets) are not independent of each other. When coagulation is induced by the extrinsic pathway, the intrinsic pathway will still contribute to the formation of thrombin, playing a significant role in the propagation of the response. Leukocytes and platelets co-stimulate each other. Activated leukocytes promote greater platelet aggregation, which, in turn, increases activation
Petition 870190096293, of 26/09/2019, p. 51/122
41/55 of leukocytes. Thus, leukocyte adhesion and activation affect platelet adhesion and activation, which in turn affects the coagulation cascade. With biomaterials, however, this reaction causes degradation of the material and a prolonged inflammatory response. Therefore, polymeric films can be activated (superficial or in mass) against coagulation and the creation of blood sludge on the surface or blocking the pores of the filtration mesh. The surface wettability and its affinity to attract and attach blood particles to itself is another aspect of compatibility that can be considered in the design of the filter. The functionalization of the surface can thus be chosen to allow the capture or continuous bombardment of the porous medium by the pistons, but it attenuates or prevents biodegradation.
[0120] Approaches for modifying polymeric membranes with better blood compatibility include: a. mass modification of the polymeric material and then prepare the modified membrane; B. surface modification of the prepared membrane; and c. blend, which can also be considered a surface modification. A cross-linked polymerization in situ can be used for the modification of a PES membrane using different AA, VP and NaSS monomers with the same weight ratios.
[0121] Figure 26 shows the clotting times of the materials, as they can be implemented according to one or more modalities. An anticoagulant property of the membranes can thus be assessed by the activated partial thromboplastin time (APTT) and thrombin time (TT). The activated partial thromboplastin times (APTTs) and thrombin times (TTs) for PAA, PNVP, NaSS and copolymer modified membranes are shown.
[0122] Figure 27 shows the comparison between the mechanical properties of selected polymers, which can be implemented according to one or more modalities. Exemplary properties include breaking strength, higher final strength, elongation before breaking and modulus of elasticity. In addition to
Petition 870190096293, of 26/09/2019, p. 52/122
42/55 properties mentioned above, the volume, surface and geometry dependent properties are important for the application involving piston protection devices. These additional properties include resistance to bio-encrustation, biocompatibility, flexibility, foldability and the material's ability to adhere to itself without the aid of secondary coatings. The latter category can facilitate the assembly of the polymer to anchor to the frame structure without creating additional connection and joint volume.
[0123] A variety of approaches and devices can be implemented for the manufacture and implementation of a filter set, as featured here. Figure 28 shows an accessory for frame manufacturing, as it can be implemented according to one or more modalities. The accessory includes respective parts corresponding to a frame and extension arm for geometry that can facilitate the application of the filter to adapt to a side wall of a tubular organ, such as the aortic arch.
[0124] Figure 29 shows an apparatus including a frame and an extension arm, as can be implemented according to one or more modalities. The apparatus in Figure 29 can be manufactured, for example, using the apparatus as shown in Figure 28. A top view in the upper left corner shows filter parts (internal / external) with supports between them. A side view in the lower left corner shows the frame and the extension arm, as it can be inserted into an aortic arch, so that the folds in the extension arm interact with the side walls. Detailed cross sections are shown in the lower left corner.
[0125] Figures 30, 31 and 32 show manufacturing components to form a framework, as can be implemented according to one or more modalities. Figures 30 and 31 show respective aspects of an accessory (for example, lower / upper parts in relation to Figure 28) that can be
Petition 870190096293, of 26/09/2019, p. 53/122
43/55 implemented together to form the framework, and Figure 32 shows a curved part that can be implemented with an extension arm. Figure 33 shows an extension arm and frame in a flat state, as can be implemented according to one or more modalities.
[0126] Figure 34 shows views and several cross sections of an apparatus including aspects for the formation of an extension arm. Figure 35 shows a manufacturing accessory, how it can be implemented according to one or more modalities to support one or more aspects for the manufacture of frame and extension arm, how it can be implemented according to one or more modalities.
[0127] Consistent with one or more modalities, a filter device attenuates or prevents the plunger from traveling to the great vessels (brachiocephalic / innominate arteries, left common carotid, and left subclavian) and can be implemented during surgery from the arch aortic, which is the part of the main artery that folds between the ascending and descending aorta. The aortic arch leaves the heart and rises, then descends back to create the arch. The aorta distributes blood from the left ventricle of the heart to the rest of the body, and exhibits variable flow characteristics, with the hemodynamics of the region of the aortic arch often exhibiting a non-uniform distribution of pressure and speed. Particles, such as pistons, can be filtered under such conditions, using a filter component that adapts to the variable geometry of the aortic arch during cyclical pressure variations, acting as a filtration umbrella. The collected plungers are extracted and removed through a delivery tube out of the body, such as by contracting and pulling the filter component into a sheath.
[0128] In a specific embodiment, a filter mechanism, as noted above, includes a main frame assembly (FA) and a mesh umbrella, firmly attached to the frame. The frame and mesh can be integrated as a single part / component or with two or more parts / components. O
Petition 870190096293, of 26/09/2019, p. 54/122
44/55
FA operates to provide a mechanical seal around an opening in an internal wall of vascular tissue with the FA adapted to the wall. Therefore, it is possible to prevent micro-emboli and other particles from entering the opening, allowing unrestricted blood flow within the vascular tissue to which the AF is suitable. In various implementations, the FA is operable to maintain adaptation and mechanical sealing under cyclical variations in blood pressure for humans in various conditions, including those involving surgery, and for various anatomies and conditions, such as those involving variations in diameter and / or the size of the aortic arch or the accumulation of plaques. For example, a mesh can be deployed with an area that is at least twice as large as any opening or openings to be covered. As such, several aspects of the AF can be implemented to facilitate this capture during surgery via catheter implantation, with the AF being operable to contract / capture particles such as micro-emboli and remove the particles into the catheter for removal after surgery is completed. In addition, by controlling the pressure by means of spring mechanical force, the application of too much pressure can be avoided, as it can be useful in cases where the stiffening of the vessel wall or aneurysm may be present.
[0129] According to another exemplary embodiment, an apparatus includes a catheter extending from a proximal end to a distal end, an internal and operable axis for moving in the catheter, and a filter component connected to an end of the axis and operable to extend and retract within the distal end of the catheter. The filter component includes a mesh and inner and outer frames connected by brackets, with the mesh attached to one or both the inner and outer frames. The outer frame extends along the inner frame (for example, in a concentric arrangement). The supports operate to apply a force between the outer frame and the inner frame, along a direction usually between the frames (tending to push the frames away one
Petition 870190096293, of 26/09/2019, p. 55/122
45/55 on the other). Frames can be oval, round or rectangular, with the latter approach facilitating the implementation of a flat surface to apply pressure to the fabric. One or more of the mesh, frames and supports can be made of a contiguous material. In various embodiments, the supports apply a force that presses the inner frame and the mesh against the tissue, such as against an inner region of the vascular tissue. Brush-like structures can be used in a perimeter region to facilitate sealing.
[0130] As noted here, such approaches can be particularly useful for implanting the mesh against an internal wall of the aortic arch, sealing the mesh around one or more artery openings. The implantation may involve, for example, restricting the movement of the filter assembly to the rotation movement, via the catheter / axis, which facilitates the application of pressure in the mesh against the tissue walls. In addition, these approaches can facilitate insertion and filtration, adapting almost the entire mesh and supporting structure to a side wall of the aortic arch, allowing blood to flow freely in it, as well as capturing particles that might otherwise enter in the artery or covered arteries. For example, human red blood cells can be passed while attenuating the passage of particles with a larger dimension than human red blood cells. These particles can be captured within the mesh / frames, so that they can be removed without allowing the particles to escape further back into the blood stream.
[0131] The mesh can be sealed to an inner wall of the vase or other fabric in several ways. In some modalities, the supports operate with the internal frame, the external frame and the mesh to, in an implanted state, seal a perimeter region of the mesh to an internal wall of the vessel, using a force applied to press the perimeter region of the vessel. mesh on the inner wall of the vase. This may involve, for example, applying a force across multiple supports and between
Petition 870190096293, of 26/09/2019, p. 56/122
46/55 different adjacent regions of the internal and external frames, so that the distance between the frames varies in relation to the adaptation of one or both frames to the anatomy of the tissue. This flexibility allows the application of sufficient sealing force along the perimeter region, in addition to accommodating anatomical differences.
[0132] In several implementations, the mesh has opposite surfaces and is configured and arranged with the axis, frames and supports to adapt to an internal wall of the vascular tissue and to cover at least one opening in the vascular tissue. Substantially all the opposing surfaces can be placed in contact with the wall or extending over at least one opening. This facilitates the placement of the mesh predominantly out of the blood flow in the vascular tissue.
[0133] The implantation of the mesh, in these and other contexts, can be carried out by the filter component, shaft and catheter, expanding the mesh in a first state in response to the filter component being extended outside the distal end of the catheter, and contracting the mesh in a second state in response to the filter component being retracted into the catheter. Therefore, the mesh can be contracted to fit the catheter and expanded after implantation with a much wider coverage for filtration (for example, two or more times the diameter of the catheter).
[0134] The forces can be translated into the filter component in several ways. In some embodiments, the filter component includes a mechanical spring coupled to the distal end of the shaft. The mechanical spring operates with the shaft and the catheter as a base, to apply a spring force that directs the mesh against the tissue. For example, the mechanical spring can operate with the catheter and shaft to apply a spring force to the outer frame towards the inner frame, with the force being translated from the outer frame to the inner frame through the supports. In some implementations, the spring directly applies a force to the internal frame. The spring can be separated or integrated into a support structure that connects the
Petition 870190096293, of 26/09/2019, p. 57/122
47/55 filter to the shaft (or as part of the filter component). Such approaches can be used to apply the catheter within a human aortic arch, seal the mesh to an internal wall of the aortic arch, and cover at least one opening in the human aortic arch with the mesh.
[0135] The mesh or other filter material, as characterized here, can be implemented in several ways. In some embodiments, a mesh includes a reinforcement structure and is operable to fold and unfold in overlapping layers, respectively for retraction in the catheter and for implantation. The reinforcement structure can, for example, include additional material on or in the mesh and regions that exhibit less stiffness to bend. For example, the mesh can be patterned with pores of different sizes and / or with pore density that facilitates longitudinal or lateral folding / stacking behavior. A spiral pattern can facilitate certain opening or closing behaviors. Areas with less pores or no pores can be implemented to induce a moment of stiffness.
[0136] With reference to Figure 1, an apparatus 100 is shown, as it can be implemented to support a filter or mesh, according to one or more exemplary modalities. Apparatus 100 includes an inner frame 110 and an outer frame 120 coupled by brackets 130 that operate to apply a force that pushes the inner frame and outer frame away from each other. A proximal end 140 is operable for coupling to an axis, and is coupled to a distal end 150 through the frames. As an example, the distal end 150 is shown extending at an angle to the inner frame 110, which can facilitate positioning within a vessel wall (for example, with the inner frame 110 pressed against an inner wall within the aortic arch). This angle can facilitate the placement of the device in the aortic arch with the distal end 150, preventing intervention in the arteries in the walls. In certain
Petition 870190096293, of 26/09/2019, p. 58/122
48/55 implementations, a cover, such as a thermoplastic, can be placed over the distal end 150 and facilitate interaction with the vascular tissue.
[0137] In certain implementations, the proximal end 140 includes a mechanical spring (for example, which can be integrated within the frame shown), which provides an upward spring force (as shown) which can also facilitate pressure from the inner frame 110 against an inner wall of a vase. For example, with the proximal end 140 coupled to an axis and inserted into the vascular tissue through a catheter, the axis and proximal end 140 can apply a spring force that tends to push the inner frame 110 up and against an inner wall vascular tissue. This approach is particularly useful, for example, within an aortic arch. In some cases, both frames are pressed against the inner wall of the vascular tissue. With a mesh coupled through the perimeter of the inner frame 110 (and, in some cases, through an overlying perimeter of the outer frame 120), the blood that flows through the openings in the inner wall within the perimeter of the inner frame is thus filtered through the mesh. Such a mesh can, for example, be implemented with a frame as shown in 160 (partially shown, with that mesh filling the entire internal area within the perimeter of the internal frame 110). In addition, a spring force at the proximal end 140 can be used to maintain a seal against a vessel wall under various conditions of blood flow and for various anatomies.
[0138] In various implementations, the mechanical force applied by means of this spring and / or of the supports 130 can be implemented as a primary force that adapts the structure against the inner wall (for example, with a mechanical force that is many times greater than that the fluidic force of blood that passes through a vessel). This force can be adjusted, for example, during a manufacturing process to adapt the application to a specific use. For example, the force can be scaled based on the patient's age and the condition of the wall against which the
Petition 870190096293, of 26/09/2019, p. 59/122
49/55 mesh will be implanted, as it may be related to the size or presence of plaques. Controlling an adhesion force can facilitate optimization of the mesh size, so that the mesh does not need to be oversized to compensate for that force.
[0139] The device 100 can be made of one or more components. In some embodiments, the inner frame 110, the outer frame 120 and the supports 130 are formed of a contiguous material, eliminating any need for joints. In various implementations, a mesh (e.g., 160) coupled through the inner frame 110 is also formed with at least the inner frame of a contiguous material. For example, a contiguous nitinol material can be used to form one or all of the components in the apparatus 100. In some embodiments, a thin thermoplastic material is used as a mesh and attached to the inner frame. When two components are used, they can be joined using joining methods that involve one or more of heat and pressure, adhesive and lasers. Frames and supports can also be made using polymeric material and / or metallic material. The mesh can be attached directly to the frames and / or to itself.
[0140] In several modalities, a mesh such as mesh 160 includes brush-like teeth and grooves that increase the mesh's adhesion in rough terrain (for example, on the surface of the aortic arch). These brush features can be located in the frame area. Small resources, such as micro resources (related to the vessel wall structures), receive spring force and are highly compressible against the vessel, sealing it against the vessel.
[0141] In various implementations, the apparatus 100 is operable to keep the tissue under tension (for example, along and within the vascular tissue) when the internal and external frames 110/120 are implanted. In this context, sufficient sealing pressure is applied to keep the frame sealed against the wall under conditions in which blood is passing and through the mesh. This involves
Petition 870190096293, of 26/09/2019, p. 60/122
50/55 provide a smooth interaction surface along an interface between the device and the tissue surface (for example, the aortic arch). Such an approach can be implemented with little or no protrusion or elevated section due to welding, gluing, overlapping and reduction / minimization features such as “gutters”, thus facilitating a firm seal with the vascular tissue.
[0142] Figure 2 shows an apparatus 200, according to one or more exemplary embodiments of the present description. Apparatus 200 includes a filter component 210, which can be implemented with internal and external frames with connection brackets, as shown in Figure 1. The filter component is connected to a shaft 220 that extends through a catheter 230 (for example, with the shaft and catheter being many times larger than the parts shown). A proximal end 240 of the filter component 210 is attached to the shaft 220 and provides upward spring force, as shown in the figure, sealing a perimeter of the filter component 210 against a vessel wall when implanted therein.
[0143] Figures 3A-3D show respective views of an apparatus 300, according to one or more exemplary embodiments of the present description. As shown in Figure 3A, apparatus 300 includes a filter component 310 coupled to an axis 320 within a catheter 330, with the filter component being retractable in the catheter. A mesh can be coupled and / or integrated to the filter component 310, through the respective rails (for example, as shown in Figure 1). Figure 3B shows a "AA" cross-sectional view of Figure 3A, with Figure 3C showing a view of a distal end of the catheter and the axis coupled to a proximal end 340 of filter component 310. In various implementations, a portion of the end proximal 340 is locked in place on axis 320 so that it does not extend beyond end 350 of catheter 330. This keeps the set of components inside the catheter and out of the blood stream when implanted in tissue
Petition 870190096293, of 26/09/2019, p. 61/122
51/55 vascular. Figure 3D shows an alternative view of the apparatus 300.
[0144] In various implementations, a part of the proximal end 340 is locked in place on axis 320 so that it does not extend beyond the end of catheter 330. This keeps the set of components inside the catheter and out of the blood flow when implanted in vascular tissue.
[0145] Figure 4 shows an apparatus 400 as can be implemented to support a mesh or filter, according to one or more exemplary embodiments of the present description. The dimensions shown in Figure 4 are exemplary, as they can be implemented for certain modalities. Apparatus 400 includes an inner frame 410, an outer frame 420 and supports 430 that separate the frames. Detail “A” provides an example view of these components. A distal end 440 and a proximal end 450 are coupled to the frames, as shown.
[0146] Figures 5A-5C show respective views of an apparatus 500 that can be implemented to support a mesh or filter, according to one or more exemplary embodiments of the present description. Apparatus 500 can be implemented in a manner similar to that shown in Figure 4. As noted in the detailed “A” part of Figure 5A, the inner (510) and outer (520) frames are connected by the brackets 530 that push the inner frame away the outer frame and the vessel wall. Figures 5B and 5C show, respectively, side and end views of the apparatus 500.
[0147] Figure 6 shows a catheter apparatus 600 with a retracted mesh 610 within a sheath 620, according to one or more exemplary embodiments of the present description. The 610 mesh can, for example, be implemented with filter components, as shown in Figures 1 and 2, and operable to bend and retract on a catheter. For example, after implantation in an internal wall of the aortic arch and use to filter particles from the blood that
Petition 870190096293, of 26/09/2019, p. 62/122
52/55 flows to the arteries sealed by the 610 mesh, the mesh can be folded and retracted into the 620 sheath, as shown to capture and remove the particles. In several implementations, the 610 mesh has a reinforcement / rib structure that allows it to fold and unfold in the desired direction when it is deployed or retracted within the 620 sheath.
[0148] Figures 7A-7G show respective views of a filter holder manufacturing apparatus 700, as can be implemented according to one or more exemplary embodiments of the present description. The respective dimensions shown are exemplary, with the understanding that the apparatus 700 can be constructed to a variety of dimensions. Apparatus 700 can, for example, be used to manufacture one or more filter components, as shown in other figures in this document. Referring to Figure 7A, an upper fitting 710 and a lower fitting 720 are shown in perspective view, with a formed region 722 shown on the lower fitting and operable to form a filter component.
[0149] Figures 7B and 7C show, respectively, end and top views of the device 700, with the upper and lower accessories 710 and 720 positioned in a formation stage. Section A-A of Figure 7B is also shown with a region 730 providing a space between the top and bottom fittings 710/720 to form the filter component. This approach can be facilitated for a variety of molding approaches.
[0150] Figures 7D and Figure 7E show, respectively, top and perspective views of the lower attachment 720. As part of Figure 7D, sections AA, BB, DD and detail C are shown for various cross sections and related details . The region 730 is recessed to form part of a filter component.
[0151] Figures 7F and Figure 7G show, respectively, top and perspective views of the top accessory 710. As part of Figure 7F, sections A-A
Petition 870190096293, of 26/09/2019, p. 63/122
53/55 and B-B are shown for the respective cross sections. The region 740 is recessed to form part of a filter component.
[0152] Several other manufacturing approaches can be implemented to adapt to particular modalities. In some embodiments, a starting material is processed to generate a mesh. For example, in some cases, a flat nitinol material is used, in which a mesh area is first reduced to less than 0.127 mm (0.005 ”) (or less than 0025 mm (0.001”)) using electro-discharge machining ( EDM) or other technique. The frame and mesh set patterns are then cut using, for example, a laser. In some cases, the order of the process is reversed, so that a set of frames (frames) is laser cut followed by EDM and laser standardization.
[0153] In various embodiments, a frame assembly, as can be implemented with the frame / mesh support components shown in one or more of Figures 1-5C, has a rectangular cross section that provides directional rigidity and also greater strength in relation to a circular cross section. The rectangular cross section provides a desirable surface contact area and more distributive strength, which facilitates sealing. The structure of the flat and rectangular frame can be implemented with a double frame and supports to keep the fabric under tension (without sagging) in the lateral and axial directions. This can facilitate uniform fluid pressure in the mesh and artery openings in the tissue.
[0154] With respect to Figure 8, an apparatus 800 is shown, as it can be implemented with several modalities involving filtration. The apparatus 800 includes internal and external frames 810 and 820 and a mesh 860 that covers a main zone within a perimeter defined by the internal frame and in a region 862 between the internal and external frames. In several modalities, two layers of mesh are implemented, with a first mesh having a perimeter that aligns with the perimeter of the inner frame 810, a second mesh overlapping the first mesh and
Petition 870190096293, of 26/09/2019, p. 64/122
54/55 having a perimeter that aligns with the perimeter of the outer frame 820. In various embodiments, the inner frame 810 and the outer frame 820 are operable to press against the inner wall of the vascular tissue, forming a flat or double seal to filter the blood flowing through an artery in the inner wall. The device 800 can also be implemented with supports between the inner frame and the outer frame, as shown in Figure 4.
[0155] In various embodiments, a frame assembly is designed to provide spring constant (s) of the frame assembly with a double flat seal around the main zone. This can increase the reliability of the seal, provide greater contact force to the internal walls of the tissue (eg, aorta) and greater adhesion / bond strength between the tissue and the layers. The frame structure can be implemented with spring components that facilitate the implantation and contraction of the mesh. The frame set can be made of four layers to withstand the sealing, implantation, lateral, torsion, traction and restraint forces. These aspects can, for example, be implemented with the apparatus 800 in Figure 8, as well as with other filter components, as shown in the other figures.
[0156] Figure 9 shows brush features of a 900 device, as they can be implemented with one or more modalities. For example, the features shown in Figure 9 can be implemented with mesh 160 in Figure 1. The apparatus 900 includes internal and external frames 910 and 920, coupled by supports 930 that tend to separate the frames from each other. A 940 mesh (a part shown) is attached to the frames and the 950 brush-like features are attached to the mesh near the frames. Frames 910 and 920, together with supports 930, apply pressure to the 940 mesh and brush-like features 950 in an upward direction, as shown in the figure, such as to seal the mesh to an internal wall of vascular tissue (for example , on a surface of the aortic arch). Features similar to 950 brushes, which can be formed from a material
Petition 870190096293, of 26/09/2019, p. 65/122
55/55 common with the 940 mesh, are compressible to facilitate the sealing of the mesh against an internal wall.
[0157] Based on the above discussion and illustrations, those skilled in the art will readily recognize that various modifications and changes can be made to the various modalities without strictly following the exemplary modalities and applications illustrated and described here. For example, different types of materials can be used for the various components mentioned here, and other ways of expanding / contracting mesh-like structures with similar effect can be implemented. Additional frame parts and / or different shapes or supports can be used to adapt the application to specific anatomies. In addition, the various methods described here can be implemented with different types of arteries, valves and tissues, as well as different types of living beings. Such modifications do not abandon the true spirit and scope of various aspects of the invention, including aspects established in the claims.

权利要求:
Claims (33)
[1]
1. Apparatus, CHARACTERIZED by the fact that it comprises:
an extension arm;
a frame connected to the extension arm; and a filter with opposite surface areas ending around a perimeter of the filter, the filter being connected to the frame at the perimeter and configured and arranged with the frame and the extension arm to expand with the frame in an implanted state and, in the state implanted, adapt one of the opposite surface areas to an inner side wall of a tubular organ, engaging the extension arm with the respective surfaces of an inner side wall of the tubular organ and, through the engagement, apply force to the frame that seals the frame and the perimeter of the filter to the inner side wall.
[2]
2. Apparatus, according to claim 1, further CHARACTERIZED by the fact that it comprises an axis connected to the extension arm and configured and arranged to slide inside a catheter, and to position the extension arm, frame and filter in relation to the inner side wall of the tubular organ to apply force to the frame.
[3]
3. Apparatus, according to claim 2, further characterized by the fact that it comprises the catheter, where the axis is configured and arranged with the frame to contract the frame and the filter to a contracted state, and to remove the frame and the filter for the catheter in the contracted state.
[4]
4. Apparatus, according to claim 3, CHARACTERIZED by the fact that the axis is configured and arranged with the frame to, through the contraction of the filter, capture particles trapped on the other of the opposite surfaces that is opposite to one of the suitable opposite surfaces to the inner side wall, and to remove particles captured in the catheter for removal from the tubular organ.
[5]
5. Apparatus, according to claim 1, CHARACTERIZED by the fact
Petition 870190096293, of 26/09/2019, p. 115/122
2/8 that the frame and the extension arm are configured and arranged to contract to a contracted state and, in the contracted state, to retract in a catheter for removal from the tubular organ.
[6]
6. Apparatus, according to claim 1, CHARACTERIZED by the fact that the frame includes an internal frame configured and arranged to seal the filter to the internal side wall, an external frame, and a plurality of supports that connect the internal frame to the frame external and that are configured and arranged to translate the force, applied through the extension arm to the external frame, the internal frame and thus flexibly adapt the internal frame to the internal side wall.
[7]
7. Apparatus, according to claim 6, CHARACTERIZED by the fact that the supports are configured and arranged to facilitate the flexing of the internal frame, in relation to the external frame, providing a spring force, and facilitate the adaptation of the external frame to the physical characteristics of the internal side wall.
[8]
8. Apparatus, according to claim 6, CHARACTERIZED by the fact that:
the filter extends within a perimeter of the inner frame and between the inner frame and the outer frame, and the brackets are configured and arranged to apply force between the outer frame and the inner frame and seal an opening in an inner wall of the vessel pressing the inner and outer frames against the inner wall of the vessel and around an opening in it.
[9]
9. Apparatus, according to claim 6, CHARACTERIZED by the fact that the supports are configured and arranged to maintain the internal and external perimeters at a displacement distance from each other that varies according to the applied force.
[10]
10. Apparatus, according to claim 1, CHARACTERIZED by the fact that the extension arm is configured and arranged to apply force to the frame,
Petition 870190096293, of 26/09/2019, p. 116/122
3/8 applying a spring force that translates an input force applied to the extension arm into an output force applied to the frame in a direction contrary to the force imparted to the frame by the curvature of the inner sidewall.
[11]
11. Apparatus, CHARACTERIZED by the fact that it comprises:
a catheter extending from a proximal end to a distal and configured end and arranged for insertion into a tubular organ;
an axis extending in the catheter from the proximal end to the distal end and being configured and arranged to move within the catheter;
a frame connected to the axis and configured and arranged with the axis to retract the catheter in a contracted state and extend out of the catheter in an implanted state; and a filter with opposite surface areas ending around a perimeter of the filter, the filter being connected to the frame at the perimeter and configured and arranged with the frame to:
expand with the framework in the implanted state and, in the implanted state, adapt one of the opposite surface areas to an internal side wall of the tubular organ, and contract with the framework in the contracted state; and where the shaft includes an extension arm configured and arranged with the frame and the filter to, in the implanted state, engage with the respective surfaces of the inner side wall of the tubular organ and, via engagement, seal the frame and the perimeter of the filter to the inner side wall, applying force to the frame.
[12]
12. Apparatus, according to claim 11, CHARACTERIZED by the fact that the frame and filter are configured and arranged with the axis and the extension arm for, in response to being implanted within a human aortic arch in the implanted state, seal the perimeter of the filter around an arterial opening in the internal side wall of the human aortic arch, applying force to the frame and adapting the filter to the
Petition 870190096293, of 26/09/2019, p. 117/122
4/8 internal side wall, and filter the blood that flows through the arterial opening.
[13]
13. Apparatus according to claim 11, CHARACTERIZED by the fact that the extension arm includes at least two folds along a part of the extension arm that connects the axis to the frame, the folds being configured and arranged to interact respectively with opposite parts of an internal side wall and direct the force applied to the frame to facilitate the sealing of the frame and the perimeter of the filter to the internal side wall.
[14]
14. Apparatus according to claim 11, CHARACTERIZED by the fact that the extension arm is configured and arranged to apply force to the frame, applying a spring force that translates an input force applied to the extension arm through the axis in an output force applied by the extension arm to the frame.
[15]
15. Apparatus according to claim 11, CHARACTERIZED by the fact that the frame and the extension arm are configured and arranged with the shaft and the catheter to collect the particles in a surface area of the filter contracting to a contracted state and , in the contracted state, retracting into the catheter for removal from the tubular organ.
[16]
16. Apparatus, according to claim 11, CHARACTERIZED by the fact that the table includes:
an internal frame configured and arranged to seal the filter to the internal side wall, an external frame; and a plurality of supports that connect the inner frame to the outer frame and that are configured and arranged with the outer frame to translate the force applied through the extension arm to the inner frame and flexibly adapt the inner frame to the inner sidewall.
Petition 870190096293, of 26/09/2019, p. 118/122
5/8
[17]
17. Apparatus, according to claim 16, CHARACTERIZED by the fact that the supports are configured and arranged to facilitate the flexing of the inner frame, in relation to the outer frame, providing a spring force contrary to the curvature of the inner sidewall and facilitates the adaptation of the external frame to the physical characteristics of the internal side wall.
[18]
18. Apparatus according to claim 16, CHARACTERIZED by the fact that the filter extends within a perimeter of the inner frame and between the inner frame and the outer frame, and the supports are configured and arranged to apply a force between the outer frame and inner frame and to flex in response to pressure exerted by the extension arm to seal the inner and outer frames against the inner side wall and around an opening in the inner side wall.
[19]
19. Apparatus, according to claim 16, CHARACTERIZED by the fact that the supports are configured and arranged to maintain the internal and external perimeters at a displacement distance from each other that varies according to the applied force.
[20]
20. Apparatus, according to claim 11, CHARACTERIZED by the fact that the catheter is configured and arranged for insertion in a human aortic arch, and the axis is configured and arranged with the frame to adapt the filter to an internal wall of the arch aortic arch and to cover an opening in the aortic arch that leads to at least one artery, with the frame pressed against an internal wall of the aortic arch and around at least one artery.
[21]
21. Apparatus according to claim 20, CHARACTERIZED by the fact that the axis and the frame are configured and arranged to adapt the filter to the internal wall and to cover at least one opening in it, with substantially all opposite surfaces in contact with the wall or extending over at least one opening.
[22]
22. Apparatus for use with a catheter, CHARACTERIZED by the fact that
Petition 870190096293, of 26/09/2019, p. 119/122
6/8 comprises:
a filter having a frame, the frame forming a perimeter of the filter and separating the opposite surfaces of the filter; and an articulated arm connected to the frame and configured and arranged to, when implanted inside a tubular organ, engage with opposite parts of the inner side wall of the tubular organ and use the parts of the inner side wall to seal the filter to the inner side wall applying force to the frame.
[23]
23. Apparatus, according to claim 22, CHARACTERIZED by the fact that the articulated arm is configured with the respective supports, each support forming one of the joints and being configured and arranged with a rigidity that, when engaged in the opposite parts of the side wall internal, provides a spring force that seals the frame and filter to the inner side wall.
[24]
24. Apparatus according to claim 22, CHARACTERIZED by the fact that each support is coupled by a U-shaped bend configured and arranged to provide the spring force in response to the supports coupled to it being engaged with the opposite parts of the internal side wall.
[25]
25. Method, CHARACTERIZED by the fact that it comprises:
provide an extension arm;
provide a frame connected to the extension arm;
providing a filter having opposite surface areas ending around a perimeter of the filter, with the filter being connected to the frame at the perimeter; and use the frame and the extension arm to expand the filter with the frame in an implanted state and, in the implanted state, to adapt one of the opposite surface areas to an inner side wall of a tubular organ, engaging the extension arm with the respective surfaces of the inner lateral wall of the tubular organ and, through the engagement, apply force to the frame that seals the frame and the perimeter of the filter to the inner side wall.
Petition 870190096293, of 26/09/2019, p. 120/122
7/8
[26]
26. Method, according to claim 25, CHARACTERIZED by the fact that sealing the frame and the perimeter of the filter to the inner side wall includes using the extension arm to engage with a different part of the inner side wall and to translate a force, applied to the extension arm via the different part of the inner side wall, the frame.
[27]
27. Method, according to claim 25, CHARACTERIZED by the fact that:
supplying the extension arm, frame and filter includes extending the extension arm, frame and filter out of a catheter by means of an axis connected to the extension arm, and applying force to the frame includes applying force to the extending axis through the catheter, and translate the axis force into the frame through the extension arm, using another part of the inner side wall to support and apply force to the extension arm.
[28]
28. Method according to claim 27, CHARACTERIZED by the fact that sealing the frame and the perimeter of the filter to the inner side wall includes sealing the perimeter of the filter around an opening in the side wall, additionally including:
use the filter to filter particles from a fluid flowing through the filter via the opening, contract the filter around the particles on one of the filter surfaces, then capture the particles in the filter, and retract the contracted filter with the captured particles in the catheter and remove the contracted filter and the catheter from the tubular organ.
[29]
29. Method, according to any one of claims 25 to 28, CHARACTERIZED by the fact that it comprises implanting the filter from inside a catheter, manipulating an axis extending from a proximal end of the catheter
Petition 870190096293, of 26/09/2019, p. 121/122
8/8 towards a distal end of the catheter with the extension arm attached to a distal end of the axis and the frame, and applying force by manipulating the axis.
[30]
30. Method, according to claim 29, CHARACTERIZED by the fact that implanting the filter includes inserting the catheter into a human aortic arch and implanting the filter over at least one opening of the artery in the aortic arch, and applying force includes sealing the filter a part of an internal wall of the aortic arch around at least one opening of the artery and thus capture blood particles that flow into at least one opening of the artery.
[31]
31. Method according to any one of claims 25 to 28, CHARACTERIZED by the fact that providing the frame includes providing a frame having an inner frame and an outer frame connected by brackets, and using the brackets to apply flexible force to the frame internal, using a force applied to the supports by the external frame.
[32]
32. Method according to any one of claims 25 to 28, CHARACTERIZED by the fact that applying the force includes using a spring characteristic of the extension arm to provide the force in response to a force applied to the extension arm at one end of it and a force applied to the extension arm by a part of the inner side wall of the tubular organ that opposes a part of the inner side wall to which the filter is sealed.
[33]
33. Method, according to claim 32, CHARACTERIZED by the fact that using the spring feature of the extension arm includes engaging the frame and filter with a curved part into the tubular member, and using a spring feature of the arm extension that applies a force contrary to the curvature of the extension arm and the frame along the curved part into the tubular organ.

类似技术:

---

公开号 | 公开日 | 专利标题

---

BR112019020142A2|2020-04-22|filter apparatus and methods

---

US10987118B2|2021-04-27|Catheter-based apparatuses and methods

---

AU2016320844B2|2020-11-12|Intra-aortic emboli protection filter device

---

US6989027B2|2006-01-24|Percutaneously delivered temporary valve assembly

---

US20200054434A1|2020-02-20|Intravascular Device With Multiple Leaflets

---

JP2022501113A|2022-01-06|Methods and techniques for forming connections and shunts between cavities and tubes of biological structure

---

WO2014185969A2|2014-11-20|Catheter-based apparatuses and methods

---

JP2021079270A|2021-05-27|Stent graft device comprising anchor member comprising adjustable geometry

---

WO2021055826A1|2021-03-25|Filter apparatuses and methods

---

JPH11318910A|1999-11-24|Atraumatic anchoring and disengagement mechanism for permanent implanting device

---

WO2021055810A1|2021-03-25|Apparatuses and methods with filter pouch

同族专利:

---

公开号 | 公开日

---

CN110691563B|2021-05-07|

---

EP3432825A1|2019-01-30|

---

CN110691563A|2020-01-14|

---

EP3432825A4|2019-05-22|

---

US11246698B2|2022-02-15|

---

US20200163685A1|2020-05-28|

---

CA3057985A1|2018-10-04|

---

WO2018183321A1|2018-10-04|

---

JP2020518314A|2020-06-25|

---

AU2018243878A1|2019-11-14|

引用文献:

---

公开号 | 申请日 | 公开日 | 申请人 | 专利标题

---

---

US6361545B1|1997-09-26|2002-03-26|Cardeon Corporation|Perfusion filter catheter|

---

DE60326000D1|2002-12-04|2009-03-12|Cook Inc|METHOD AND DEVICE FOR TREATMENT IN AORTASE ACTION|

---

US20080021497A1|2005-01-03|2008-01-24|Eric Johnson|Endoluminal filter|

---

US20100324589A1|2006-09-11|2010-12-23|Carpenter Judith T|Embolic deflection device|

---

DK2537488T3|2008-09-04|2016-06-27|Swat Medical Ab|Device for the temporary embolic protection|

---

CN202478392U|2010-10-20|2012-10-10|美敦力阿迪安卢森堡有限责任公司|Associated system of catheter device|

---

WO2013074521A1|2011-11-14|2013-05-23|Boston Scientific Scimed, Inc.|Embolic protection device and method|

---

WO2014185969A2|2013-05-14|2014-11-20|Transverse Medical, Inc.|Catheter-based apparatuses and methods|

---

JP2016517333A|2013-03-15|2016-06-16|ボルケーノ コーポレイション|Distal protection system and method with pressure and ultrasound capabilities|

---

EP2859864A1|2013-10-14|2015-04-15|Protembis GmbH|Medical device for embolic protection|

---

US20160324621A1|2014-01-10|2016-11-10|Keystone Heart Ltd.|Anatomy independent deflector|

---

WO2015177322A1|2014-05-21|2015-11-26|Swat Medical Ab|Improved embolic protection device and method|

---

CN111603266A|2015-09-07|2020-09-01|菲尔特莱克斯医药有限公司|Aorta internal embolus protection filter device|

---

BR112018007157A2|2015-10-09|2018-11-06|Transverse Medical Inc|catheter-based apparatus and methods|

---

US11246698B2|2017-03-27|2022-02-15|Transverse Medical, Inc.|Filter apparatuses and methods|US11246698B2|2017-03-27|2022-02-15|Transverse Medical, Inc.|Filter apparatuses and methods|

---

US10595994B1|2018-09-20|2020-03-24|Vdyne, Llc|Side-delivered transcatheter heart valve replacement|

---

CA3114705A1|2018-10-17|2020-04-23|W. L. Gore & Associates, Inc.|Embolic filter with flexible coupling|

---

US11071627B2|2018-10-18|2021-07-27|Vdyne, Inc.|Orthogonally delivered transcatheter heart valve frame for valve in valve prosthesis|

---

US11109969B2|2018-10-22|2021-09-07|Vdyne, Inc.|Guidewire delivery of transcatheter heart valve|

---

US11253359B2|2018-12-20|2022-02-22|Vdyne, Inc.|Proximal tab for side-delivered transcatheter heart valves and methods of delivery|

---

US11185409B2|2019-01-26|2021-11-30|Vdyne, Inc.|Collapsible inner flow control component for side-delivered transcatheter heart valve prosthesis|

---

US11173027B2|2019-03-14|2021-11-16|Vdyne, Inc.|Side-deliverable transcatheter prosthetic valves and methods for delivering and anchoring the same|

---

US11076956B2|2019-03-14|2021-08-03|Vdyne, Inc.|Proximal, distal, and anterior anchoring tabs for side-delivered transcatheter mitral valve prosthesis|

---

AU2020267390A1|2019-05-04|2021-11-11|Vdyne, Inc.|Cinch device and method for deployment of a side-delivered prosthetic heart valve in a native annulus|

---

WO2021035032A1|2019-08-20|2021-02-25|Vdyne, Inc.|Delivery and retrieval devices and methods for side-deliverable transcatheter prosthetic valves|

---

WO2021055810A1|2019-09-19|2021-03-25|Transverse Medical, Inc.|Apparatuses and methods with filter pouch|

---

WO2021055826A1|2019-09-19|2021-03-25|Transverse Medical, Inc.|Filter apparatuses and methods|

---

US11234813B2|2020-01-17|2022-02-01|Vdyne, Inc.|Ventricular stability elements for side-deliverable prosthetic heart valves and methods of delivery|

法律状态:
2021-10-19| B350| Update of information on the portal [chapter 15.35 patent gazette]|

优先权:

---

申请号 | 申请日 | 专利标题

---

US201762476977P| true| 2017-03-27|2017-03-27|

---

PCT/US2018/024560|WO2018183321A1|2017-03-27|2018-03-27|Filter apparatuses and methods|

---