Articulation devices, systems, and methods for articulating elongate flexible structures can locally contract a flexible elongate frame or skeleton of an elongate flexible body such as a catheter. Balloons along one side of an axial segment of the elongate flexible body can be inflated so as to help define a resting shape of the elongate body. The skeleton may have pairs of corresponding axially oriented surface regions coupled to each other by a loop of a deformable helical coil structure. Balloons may be between the regions, and the pairs may be separated by an offset that increases when the axis of the skeleton is axially compressed. Inflation of the balloons can axially contract or shorten the skeleton adjacent the balloons so that the elongate body bends toward the balloons. Different sets of balloons may apply opposing local axial elongation and contraction forces so that selective inflation and deflation of subsets of the balloons can controllably bend and/or change an overall axial length of the elongate body throughout a workspace. Varying the inflation pressures of the opposed balloons can controllably and locally modulate the stiffness of the elongate body.

Various aspects of the present disclosure are directed toward apparatuses, systems, and methods that include an access sheath including an elongate body with an internal lumen to facilitate delivery of a device to a target location within a patient. The elongate body may include a distal portion having a distal opening and a plurality of curved segments configured to orient the distal opening relative to the target location.

In one representative embodiment, a steerable catheter device comprises a shaft comprising a proximal portion, a distal portion, and a pull-wire lumen that extends at least partially through the proximal and distal portions. A pull wire extends through the pull-wire lumen and has a proximal end portion and a distal end portion, wherein the distal end portion of pull wire is fixed to the distal end portion of the shaft. An adjustment mechanism is operatively connected to the proximal end portion of the pull wire and configured to increase and decrease tension in the pull wire to adjust the curvature of the distal portion of the shaft. An axially non-compressible pull-wire sleeve extends co-axially through the pull-wire lumen and over the pull wire.

A catheter has a distal section that includes a spring member having at least a slot, a rib and a spine for biasing the distal section for deflection within a single plane. Depending on the plurality and orientation of slot(s), rib(s) and spine(s)s, the distal section can allow for deflection in two opposing directions while allowing only limited deflection in perpendicular directions to maintain torquability, axial loading capabilities, and side force performance.

A steerable tube (100), comprising a hollow elongate tubular member (1) having a proximal end (2), distal end (3), a wall surface disposed between said proximal (2) and distal end (4), a bend-resistive zone (6) flanked by a proximal bendable zone (4) that forms a controller and a distal bendable zone (5) that forms an effector that moves responsive to movements of the controller, whereby the wall of the tubular member (1) in the bend-resistive zone (6) comprises a structure that is a plurality of longitudinal slits (7), forming a plurality of longitudinal strips (8, 8), the wall of the tubular member (1) in the proximal bendable zone (4) and the distal bendable zone (5) comprises a structure that is a plurality of longitudinal wires (9, 9, 10, 10), at least one strip (8) is in connection with a wire (9) in the proximal bendable zone (4) and a wire (10) in the distal bendable zone (5), such that translation by said wire (9) in the controller is transmitted via the strip (8) to said wire (10) in the effector, a proximal annular region (11) of the tubular member (1), proximal to the proximal bendable zone (4) to which the proximal wires (9) are anchored, a distal annular region (12) of the tubular member (1) distal to the distal bendable zone (5) to which the distal wires (10) are anchored.

A catheter device for lumen re-entry is provided. The catheter device includes a catheter shaft having a lumen extending from a proximal end to a distal end and an expandable member positioned at the distal end of the catheter shaft. The catheter shaft having interior walls defining a central lumen extending from a proximal end to a distal end along a longitudinal axis of the lumen. The expandable member configured to receive a fluid that selectively expands the expandable member from a first volume to a second volume, the second volume being larger than the first volume to provide a deflection surface that is oriented at an angle with respect to the longitudinal axis of the lumen. The deflection member provides a surface to angle a guidewire out of the distal opening at the tip of the catheter shaft (i.e., not a separate side-facing hole].

System for fixation of leaflets of a heart valve including a delivery catheter having an elongated shaft, a proximal end portion and a distal end portion configured to be positioned proximate native leaflets of a heart valve from a remote vascular access point, the delivery catheter further includes a rotatable actuator rod having a threaded fastener at a distal end thereof, and a fixation device releasably coupled by a threaded connection to the threaded fastener of the actuator rod. The fixation device includes a first arm moveable between a closed position and an open position, a second arm moveable between a closed position and an open position. The fixation device further includes a first gripping element movable relative to the first arm in the open position, the first gripping element biased toward the first arm to capture a first leaflet of the heart valve therebetween, and a second gripping element movable relative to the second arm in the open position, the second gripping element biased toward the second arm to capture a second leaflet of the heart valve therebetween. The first gripping element and the second gripping element each includes a plurality of barbs extending therefrom, the plurality of barbs of each of the first gripping element and the second gripping element being aligned transversely in at least one row. The fixation device further includes a covering disposed on each of the first gripping element and the second gripping element, wherein the plurality of barbs of the first gripping element and the second gripping element, respectively, protrude through the covering.

An instrument for facilitating transseptal delivery of a cardiac therapeutic device is positionable in a left ventricle. The instrument includes an elongate shaft having a tubular lumen, the shaft having a proximal portion and a distal portion actively steerable between a generally straight position and a curved position. An external pull wire and an internal pull wire are each actuatable to move the distal portion to the curved position. The external pull wire extends internally through the proximal portion of the shaft and longitudinally along the exterior of the distal portion of the shaft, while the internal pull wire extends internally through the proximal portion of the shaft adjacent to the external pull wire, and extends internally through the distal portion of the shaft.

A conduit for creating a passage from a right atrium to a left atrium, through a mitral valve into the left ventricle, and to provide a passage from the left ventricle into the aortic valve. The conduit includes an elongate tubular member having a shaft with a proximal section and a distal loop section at a distal end of the proximal section. The distal loop section includes a proximal curve, a distal curve, a generally straight segment extending between the curves, and a distal tip. The shaft in the distal loop section curves back on itself so that proximal curve is formed by a part of the shaft that is closer along the length of the shaft to the distal tip. The shapes of the proximal and distal curves are selected to direct the distal tip into the mitral valve after it has crossed the inter-atrial septum from the right atrium to the left atrium of the heart, and to orient the distal opening of the distal tip towards the aortic valve when the proximal curve is in the mitral valve and the distal tip is in the left ventricle.

A system and method used to deliver a percutaneous ventricular assist device (pVAD) or other cardiac therapeutic device to a site within the heart, such as a site at the aortic valve. A flexible device is percutaneously introduced into a vasculature of a patient and positioned to run from a femoral vein, through the heart via a transseptal puncture, and to a femoral artery. The venous-side end of the flexible device is withdrawn out the venous vasculature superior to the heart, and a pVAD is secured to the flexible device. The pVAD is pushed in a distal direction while the arterial-side end of the flexible device is pulled in the proximal direction to advance the pVAD to the target site. A left ventricle redirector aids in orienting the pVAD and preventing migration of the flexible member towards delicate structures of the heart during advancement of the pVAD.