Devices and methods are described for accessing the mediastinum without an intercostal incision and without deflating the lungs. In some embodiments, the devices and methods facilitate mediastinal access via a single percutaneous needle puncture. In some embodiments, a first puncture below the ribs or sternum, and a second puncture that is intercostal are used. Devices and methods to facilitate concurrent access to the pericardial and mediastinal spaces are also described. Multiple minimally invasive procedures are described that advantageously utilize the pericardial and mediastinal space access procedures.

Luminal grafts and methods of making and using the same. An exemplary luminal graft of the present disclosure is configured as a generally tubular element configured for nerve cells to grow therethrough and comprises at least one sheet of biological tissue having elastin fibers and collagen fibers, with the elastin fibers being a dominant component thereof; and a plurality of microchannels formed on a surface of the at least one sheet of biological tissue, each of the microchannels extending longitudinally between a first end and a second end of the at least one sheet of biological tissue and configured to provide intraluminal structural guidance to nerve cells proliferating therethrough.

A method for treating a patient may include establishing an anastomosis between a pulmonary artery and an aorta; and pumping blood from the pulmonary artery to the aorta when the pulmonary artery has a pressure lower than or equal to a pressure of the aorta.

The present technology is directed to adjustable shunting systems having a shunting element, a shape memory actuator, and a lumen extending therethrough for transporting fluid. The shape memory actuator can have a plurality of struts proximate the shunting element and a plurality of projections extending from the plurality of struts. In operation, the shape memory actuator can be used to adjust a geometry of the lumen. In some embodiments, the system is configured such that (a) any strain in the shape memory actuator is concentrated in the struts, and/or (b) the struts experience greater resistive heating than the projections when an electrical current is applied to the actuator.

A self-closing device for implantation within a patient's body includes base material including an inner surface area for securing the base material to a tissue structure, and a plurality of support elements surrounding or embedded in the base material. The support elements are separable laterally within a plane of the base material to accommodate creating an opening through the base material for receiving one or more instruments through the base material, and biased to return laterally towards a relaxed state for self-closing the opening after removing the one or more instruments. The device may be provided as a patch or integrally attached to a tubular graft or in various shapes.

A coupling system includes an applicator tool and an attachment ring mounted on the applicator tool. Clips are contained within the applicator tool and are deployed through the attachment ring in order to anchor the attachment ring to biological tissue. When deployed, tips of the clips follow a curved trajectory through an annular cuff of the attachment ring and through the underlying tissue. The tips loop back out of the tissue and to a location where they are later trapped or clamped by the attachment ring. While the tips are trapped or clamped, the applicator tool cinches the clips by pulling rear segments of the clips. Thereafter, the applicator tool disconnects from the attachment ring which remains anchored to the tissue and serves as a coupling for a cannula. The cannula can have movable lock members that secure it to the attachment ring.

A vascular anastomosis device includes a vascular jaw unit and a first vascular fastening component, wherein the vascular jaw unit is provided with a vascular anastomosis ring assembled on the first vascular fastening component. The first vascular fastening component includes a first tube provided with a first opening and a first guiding rail, a vascular positioning member connected with the first tube, a second tube arranged in the first tube, a vascular supporting unit assembled on the second tube and disposed near to the vascular positioning member, an advancing member arranged in the first tube, and a third tube arranged in the advancing member and provided with a cross rod and a guiding rod, wherein the vascular supporting unit includes a vascular supporting body and a vascular spreading member.

This document relates to the apparatus and methods used in the minimally invasive creation of arteriovenous fistula (AVF). In particular, the invention relates to the creation of an AVF using catheters and an alignment methodology that is based upon detection of asymmetric electric fields. The invention finds particular application in vascular access (VA) in the hemodialysis (HD) population.

Various systems, devices, and methods for endovascular implants and accurate placement thereof are disclosed. The implants include a proximal implant segment, a distal implant segment, connector struts connecting the proximal implant segment to the distal implant segment, and a side opening between the proximal implant segment and the distal implant segment. The implants can be used to create an arteriovenous fistula or connect one vessel of the body to another by placement of the proximal implant segment and the distal implant segment within the vessels to be connected. The implants can have an hourglass shape. The implants can include a continuous strut or ring at a distal edge of the proximal implant segment. Also disclosed are methods for accurate percutaneous placement of the implants disclosed, and a device for percutaneous delivery.

An apparatus includes a plurality of beads a linking assembly joining the beads together. The beads and the linking assembly are arranged in an annular arrangement and sized to form a loop around an anatomical structure in a patient. The loop may move between a contracted and expanded configuration. The loop is magnetically biased toward the contracted configuration by a magnetic bias of the beads. Each bead includes a housing having a first piece and a second piece that together define a magnetic chamber. A magnetic is within the magnetic chamber. A weld joins the first piece and the second piece while hermetically sealing the magnet chamber. The first piece of the housing includes a mounting feature integrated with a surface of the first piece. The mounting feature mates with a fixture to constrain the first piece of the housing as the weld is formed.