An implantable LVAD system includes an implantable LVAD including an outflow cannula, which is couplable in fluid communication with a circulatory system of the patient at a first site; and an inflow cannula, which is couplable in fluid communication with the circulatory system at a second site upstream of the first site. The LVAD further includes a continuous-flow pump includes a first inlet in fluid communication with the inflow cannula, and a first outlet. The LVAD still further includes a pulsatile-flow pump includes a second inlet in fluid communication with the first outlet of the continuous-flow pump, and a second outlet in fluid communication with the outflow cannula. Control circuitry is configured to activate the continuous-flow pump to provide flow without synchronization with cardiac cycles of a heart of the patient, and activate the pulsatile-flow pump to provide pulsatile flow synchronized with the cardiac cycles. Other embodiments are also described.

Apparatus and methods are described including delivering a left-ventricular assist device to a subject's left ventricle. A tube is positioned such that a proximal portion of the tube traverses an aortic valve of the subject, and a distal portion of the tube is disposed within a left ventricle of the subject. A pump pumps blood through the tube from the subject's left ventricle to the subject's aorta such as to cause the proximal portion of the tube to be maintained in an open state, and to cause at least a portion of the tube to become curved. Other applications are also described.

Apparatus and methods are described including delivering a left-ventricular assist device to a subject's left ventricle. A tube is positioned such that a proximal portion of the tube traverses an aortic valve of the subject, and a distal portion of the tube is disposed within a left ventricle of the subject. A pump pumps blood through the tube from the subject's left ventricle to the subject's aorta such as to cause the proximal portion of the tube to be maintained in an open state, and to cause at least a portion of the tube to become curved. Other applications are also described.

Apparatus and methods are described including delivering a left-ventricular assist device to a subject's aorta. The device including a distal-tip element that defines a straight proximal portion, and a curved distal portion, the curved distal portion defining first and second curves with an elongated straight portion between the first and second curves. The distal-tip element is centered with respect to the aortic valve using the curved distal portion of the distal-tip element, to thereby guide the device through the subject's aortic valve atraumatically. A pump pumps blood through from the subject's left ventricle to the subject's aorta. Other applications are also described.

Apparatus and methods are described including delivering a left-ventricular assist device to a subject's aorta. The device including a distal-tip element that defines a straight proximal portion, and a curved distal portion, the curved distal portion defining first and second curves with an elongated straight portion between the first and second curves. The distal-tip element is centered with respect to the aortic valve using the curved distal portion of the distal-tip element, to thereby guide the device through the subject's aortic valve atraumatically. A pump pumps blood through from the subject's left ventricle to the subject's aorta. Other applications are also described.

A percutaneous circulatory support device includes a housing having an inlet and an outlet. A shaft is rotatably fixed relative to the housing. An impeller is disposed within the housing and is rotatably supported by the shaft. The impeller is configured to rotate relative to the shaft and the housing to cause blood to flow into the inlet, through the housing, and out of the outlet. A keeper is coupled to the shaft distally relative to the impeller, and the keeper inhibits axial motion of the impeller relative to the shaft.

A percutaneous circulatory support device includes a housing having an inlet and an outlet. A shaft is rotatably fixed relative to the housing. An impeller is disposed within the housing and is rotatably supported by the shaft. The impeller is configured to rotate relative to the shaft and the housing to cause blood to flow into the inlet, through the housing, and out of the outlet. A keeper is coupled to the shaft distally relative to the impeller, and the keeper inhibits axial motion of the impeller relative to the shaft.

A medical device (e.g., blood flow assist system) can comprise: a shroud configured to house an impeller (or other movable device, whether imparting rotary or translational/linear movement) along a longitudinal axis of a device (such as a pump); a distal bearing comprising a peripheral ring having a first locating feature on a distal portion of an outer surface; and a strut module comprising a proximal ring having an inner surface and a plurality of struts extending distally from the proximal ring, the strut module comprising a second locating feature. The outer surface of the distal bearing can be configured to be slidably received within the proximal ring to engage the second locating feature with the first locating feature.

A medical device (e.g., blood flow assist system) can comprise: a shroud configured to house an impeller (or other movable device, whether imparting rotary or translational/linear movement) along a longitudinal axis of a device (such as a pump); a distal bearing comprising a peripheral ring having a first locating feature on a distal portion of an outer surface; and a strut module comprising a proximal ring having an inner surface and a plurality of struts extending distally from the proximal ring, the strut module comprising a second locating feature. The outer surface of the distal bearing can be configured to be slidably received within the proximal ring to engage the second locating feature with the first locating feature.