Aspects of the disclosure relate to devices and methods for preparing an existing, implanted prosthetic aortic valve for subsequent prosthetic aortic valve implantation. To prepare the existing valve, a valve preparation device is delivered to the valve and valve leaflets are severed either via mechanical cutting or electrodes so that the leaflets cannot obstruct a blood flow path once a prosthetic valve is subsequently implanted within the valve. Similarly, in alternate embodiments, devices and methods of the disclosure can be used for preparing a native aortic valve for delivery and implantation of a prosthetic valve.

The present disclosure describes an excision catheter system including a cutting catheter and extraction catheter. The cutting catheter is configured to pierce and/or cut a leaflet and the extraction catheter is configured to hold and/or remove the excised leaflet portion.

A catheter system can include a tubular body, and at least one of a targeting system coupled to the tubular body, an expandable member, or a fluid injection port. A method of identifying a bifurcation can include inserting a catheter system into a first vessel, positioning the catheter system at a first location, expanding an expandable member to occlude the first vessel, delivering contrast material so the contrast material pooling proximate to the expandable member, and reviewing a shape of the contrast material in the first vessel under fluoroscopy.

The present technology is directed generally to devices, systems, and methods for capturing and cutting fibrous and trabeculated structures (such as synechiae) in vessel lumens. In one embodiment, the present technology includes an intraluminal tissue modifying system configured to capture the fibrous structures, put the fibrous structures in tension, and controllably cut through the fibrous structures without applying appreciable additional force to the vessel wall. The system may include an expandable capture device and a cutting device.

A device includes a first end portion, a second end portion, an intermediate portion, and a graft material. The first end portion has a first end diameter. The second end portion has a second end diameter smaller than the first end diameter. The first end portion comprises a first material. The second end portion comprises a second material different than the first material. The intermediate portion is between the first end portion and the second end portion. The intermediate portion tapers between the first end portion and the second end portion. The graft material is coupled to at least the intermediate portion.

A medical system includes a shaft, an inflatable balloon, a radial array of ultrasound transducers and a processor. The shaft is configured for insertion into a body of a patient. The inflatable balloon is coupled to a distal end of the shaft and configured to perform a treatment to surrounding anatomy. The ultrasound transducers are distributed circumferentially around the distal end of the shaft inside the balloon, and configured to transmit ultrasound waves at respective radial directions and receive respective ultrasound reflections. The processor is configured to estimate and output to a user, based on the ultrasound reflections received from the ultrasound transducers, an extent of mechanical contact between the balloon and the surrounding anatomy.

Described here are devices and methods for forming shock waves. The devices may comprise an axially extending elongate member. A first electrode pair may comprise a first electrode and a second electrode. The first electrode pair may be provided on the elongate member and positioned within a conductive fluid. A controller may be coupled to the first electrode pair. The controller may be configured to deliver a series of individual pulses to the first electrode pair, where each pulse creates a shock wave. The controller may cause current to flow through the electrode pair in a first direction for some of the pulses in the series and in a second direction opposite the first direction for the remaining pulses in the series.

A device (100) is presented for excision of a heart valve comprising a first (120) and second (140) clamping element in mutual sliding relation, each having an annular clamping surface (122, 142) which annular clamping surfaces (122, 142) mutually co-operate to form an annular clamping region (166) configured for clamping a heart valve annularly, and a slidable cutting element (160) slidable and rotatable with respect to the annular clamping region (166) configured to circularly excise the heart valve, wherein the slidable cutting element (160) is displaceable within an annulus of the annular clamping zone region (166).

Methods and systems for introducing a delivery device, having a prosthesis, in the heart at or near the apex of the heart are provided. The methods include the steps of piercing the apex of the heart with a tissue piercing end of the delivery device, advancing the prosthesis to the target site and disengaging the prosthesis from the delivery device at the target site for implantation. The valve replacement systems are configured to deliver a replacement heart valve to a target site in or near a heart. The valve replacement system includes a trocar or other suitable device to penetrate the heart at or near the apex of the heart, a delivery member that is movably disposed within the trocar, and a replacement cardiac valve disposed on the delivery member. The delivery member optionally includes mechanical or inflatable expanding members for implantating the prosthetic valve at the target site.

A surgical cutting instrument for transapical aortic valve resection includes a cutting unit arranged on the distal end of a tool shaft and at least one mechanical cutting element for making a circular incision. The at least one cutting element can be adapted, in particular continuously adapted to different aortic diameters by means of a radially movable actuating mechanism.