Abstract: Methods, devices, and systems establish and facilitate retrograde or reverse flow blood circulation in the region of the carotid artery bifurcation in order to limit or prevent the release of emboli into the cerebral vasculature such as into the internal carotid artery. The methods are particularly useful for interventional procedures, such as stenting and angioplasty, atherectomy performed through a transcarotid approach or transfemoral into the common carotid artery, either using an open surgical technique or using a percutaneous technique, such as a modified Seldinger technique or a micropuncture technique.

Abstract: A method is provided for making an appendage of a soft surgical tool, including: receiving a set of mechanical constraints for a surgical procedure; calculating a set of articulation states based on the set of mechanical constraints; generating a plurality of print commands for printing an appendage configured to form the set of articulation states based on the calculation; and printing an appendage based on the plurality of print commands. Multiple printed appendages can be formed into an orienting assembly.

Abstract: A modular surgical apparatus is disclosed. Also disclosed is a modular incision apparatus. The modular incision apparatus may be used in a minimally invasive surgery. The modular incision apparatus includes a base having a pair of pivots, a pair of alignment tabs, a proximal opening, and at least one slide guide. The modular incision apparatus includes visual and cleaning access to the blade. The modular incision apparatus is suitable for safely, efficiently, and accurately making small incisions during surgical procedures. The modular incision apparatus provides a means of making small incisions of controlled depth, while reducing the chances of inadvertent exposure of surgical staff to sharp instrument.

Abstract: A collapsible medical device and associated methods of occluding an abnormal opening in, for example, a body organ, wherein the medical device is shaped from plural layers of a heat-treatable metal fabric. Each of the fabric layers is formed from a plurality of metal strands and the assembly is heat-treated within a mold in order to substantially set a desired shape of the device. By incorporating plural layers in the thus-formed medical device, the ability of the device to rapidly occlude an abnormal opening in a body organ is significantly improved.

Abstract: An instrument for treating tissue during a medical procedure includes a hand-held portion and a working portion. The hand-held portion is manually supported and moved by a user and the working portion is movably coupled to the hand-held portion. A tracking device is attached to the hand-held portion for tracking the instrument. The tracking device is in communication with a control system, which is used to keep the working portion within or outside of a boundary. A plurality of actuators are operatively coupled to the working portion. The control system instructs the actuators to move the working portion relative to the hand-held portion during the medical procedure in order to maintain a desired relationship between the working portion and the boundary.

Abstract: Tissue anchors comprise a woven filament braid body having an elongated tubular configuration and a foreshortened configuration where proximal and distal ends of the body expand radially into double-walled flange structures while leaving a cylindrical saddle region therebetween. The tissue anchors are deployed through penetrations between adjacent tissue layers, where the flanges engage the outer surfaces of the tissue layers and the saddle region resides within the tissue penetrations.

Abstract: Embodiments of the invention include a multi-lumen catheter for extracting or aspirating a blood clot or thrombus from arterial or veinous sites. Other embodiments are also included herein.

Abstract: Tissue anchors comprise a woven filament braid body having an elongated tubular configuration and a foreshortened configuration where proximal and distal ends of the body expand radially into double-walled flange structures while leaving a cylindrical saddle region therebetween. The tissue anchors are deployed through penetrations between adjacent tissue layers, where the flanges engage the outer surfaces of the tissue layers and the saddle region resides within the tissue penetrations.

Abstract: A trans-soft tissue anchor implantation system in one embodiment includes a positioning wire having a tissue penetrating distal tip, a cannula for passage through the soft tissue and a suture anchor. The cannula has an axial lumen therethrough sized to accommodate at least the positioning wire, a thin-walled distal portion and a tissue engaging feature, such as an arcuate groove, on at least a portion of an outer surface of the cannula proximal of and adjacent to the distal portion. Tissue, such as a tendon, expands into the groove allowing a surgeon to manipulate the tissue with the cannula.

Abstract: The present disclosure relates to a surgical device including a body portion and an end effector. The body portion defines a longitudinal axis. The end effector is disposed adjacent a distal end of the body portion and includes first and second jaw members. At least one jaw member is pivotable with respect to the other jaw member between open and approximated positions along a first plane. Each jaw member is independently movable with respect to the other jaw member between a first position where the jaw members are aligned with the longitudinal axis and a second position where at least one jaw member is disposed at an angle with respect to the longitudinal axis and with respect to the first plane.

Abstract: A method of delivering a prosthetic heart valve to a native aortic heart valve region of a patient can include introducing a prosthetic heart valve on a transvascular delivery apparatus into an artery of the patient, advancing the delivery apparatus through an aorta of the patient to the native aortic heart valve region, and releasing the prosthetic heart valve from the delivery apparatus. The delivery apparatus can have a shaft with a valve connection portion that is releasably coupled to posts of the prosthetic heart valve. The delivery apparatus can have a delivery sheath positioned around the prosthetic heart valve and the valve connection portion. The releasing the prosthetic valve can include moving the delivery sheath proximally relative to the shaft and the prosthetic heart valve such that the delivery sheath uncovers the prosthetic heart valve and the prosthetic heart valve can self-expand.

Abstract: A handle assembly for a transvascular prosthetic heart valve delivery apparatus including a handle housing, a main shaft extending distally from the handle housing, the main shaft configured to be coupled to a distal valve sheath that is configured to retain a prosthetic heart valve in a radially compressed state within the valve sheath, a screw shaft, a control knob that is rotatable relative to the handle housing and the screw shaft, a screw engagement latch that is adjustable between an engaged position and a disengaged position. In the engaged position, the latch can couple the control knob to the screw shaft such that rotation of the control knob relative to the handle housing causes the main shaft to move axially relative to the handle housing. In the disengaged position, the latch can decouple the control knob from the screw shaft such that the main shaft can move axially relative to the handle housing without rotation of the control knob.

Abstract: Systems, devices and methods for occluding the left atrial appendage (LAA). The device excludes the LAA from blood flow. The implantable device is delivered via transcatheter delivery into the LAA and secured within the LAA. The implant comprises an expandable and compliant frame and an expandable and conformable tubular foam body. A delivery and tether retraction system includes a handle for controlling a pusher and tether. The pusher may be moved a distance away from the implant without changing the orientation of the implant, while the tether is still attached to the implant. Severing the tether and proximally retracting a control on the hand piece by a distance causes the severed end to advance distally by at least about twice that distance. A loader includes a conical portion with guides and a reservoir for submerging the foam prior to loading and delivery.

Abstract: An assembly for replacing a native heart valve can have a prosthetic heart valve with an annular metal frame made from shape-memory material and a valve member disposed in an interior of the metal frame. The assembly can have a delivery apparatus with a handle, a shaft with a proximal end portion and a distal end portion. The proximal end portion can be coupled to the handle and the distal end portion can be releasably coupled to the prosthetic heart valve. The delivery apparatus can also have a delivery sheath and a hydraulic power source operatively connected to the delivery sheath. The prosthetic heart valve can be positioned within the delivery sheath in a radially compressed state. The hydraulic power source can be configured to move the delivery sheath longitudinally relative to the valve to allow the valve to self-expand from the radially compressed state to a radially expanded state.

Abstract: A needle system for providing fluidic and/or instrument access to an internal body structure. Exemplary embodiments may include non-linear needles having anatomically appropriate lengths and curvatures. Some exemplary embodiments may include a pivotable base, which may assist in stabilizing the needle system with respect to a body structure and/or may be reconfigurable into a safety guard position. Exemplary needle systems may include expandable conduits providing fluidic and/or instrument pathways into internal body structures.

Abstract: Disclosed herein is a fecalith treatment system for the removal of an impacted fecalith from a formed diverticula. The fecalith treatment system having an endoscopic device having a steerable line configured to be introduced into a patient via the endoscopic device; and an articulable fecalith treatment device coupled to a distal end of a treatment conduit that is configured to be received therein the steerable line to be delivered to an operative position within the patient. Subsequently, the fecalith treatment device is configured to allow for the removal of the impacted fecalith without damaging the underlying diverticula tissue.

Abstract: A catheter for positioning a guidewire across an occluded portion of a vessel includes an elongate catheter body, an integrated rotatable distal tip, a proximal handle region, and a catheter lumen extending through the elongate catheter body. The elongate body has a distal region configured to be bent to a set angle. The integrated rotatable distal tip includes one or more channeled flutes extending around the distal tip that are configured to be rotated in a first direction to dissect tissue and a second direction for bluntly contacting tissue. A proximal handle region includes a control for rotating the distal tip in either the first or second directions. The catheter lumen is configured to pass a guidewire.

Abstract: A lancet device includes a housing, a removable front cap mounted to the housing, a lancet holding member, a trigger and an arming system comprising a grippable cocking member structured and arranged to place the lancet device in a trigger-set or armed position. A depth adjustment system includes a member that is at least slidable and partially rotatably mounted and that has an axis of rotation arranged substantially parallel to a center axis of the lancet holding member. An ejection system includes an ejector having a portion extending outside a sidewall opening of the housing and being located closer to a front end of the housing than to a rear end of the housing. The sidewall opening of the housing is arranged on an area of the housing located between the trigger and a wall of the housing located opposite the trigger. The ejection system is structured and arranged to at least one of prevent axial movement of the lancet holding member or remove or eject a lancet from the lancet holding member.

Abstract: Provided is a medical fabric that is thin, and has both high tear strength and low water permeability. The medical fabric is characterized in that multifilament yarns having a total fineness of 7-80 dtex are disposed in the warp and weft, the single yarn fineness of at least one of the multifilament yarns among the warp and weft is 0.5 dtex or less, the twist factor A of the weft is 50-2,000, the thickness is 10-90 ?m, and the water permeability both before and after puncture by a needle is 300 cc/min/cm2 or less.

Abstract: A biodegradable device for maintaining the alignment of the edges of a trocar defect, consisting of two bases coupled and offset by a connector. The first base to be positioned below the defect and a second base above. The first base has a threaded hole from its upper surface but not through the lower surface. The connector attached to the bases such that there is a hole aligned with the threaded hole in the first base allowing a device to mate with the threads in the first base. The second base has a hole aligned with the hole in the connector and wide enough to allow a device to mate with the threads in the first base. The device is arranged so the distance between the lower surface of the second base and upper surface of the first base holds the fascia around the trocar defect.