Abstract: Apparatus and methods are described for use with a venous system of a subject that includes one or more tributary vessels that flow into a vein at junctions. A blood-pump-catheter (70) includes a material (36) configured to be placed at a downstream location that is downstream of the junctions and to at least partially occlude blood flow through the vein. The material defines a blood-outlet opening (31). A blood pump (24) pumps blood from a region of the vein that is adjacent to the junctions, and through the blood-outlet opening (31). A blood-flow pathway (60) directs upstream venous blood flow from an upstream location that is upstream of the junctions, to downstream of the material (36), without the upstream venous blood flow being pumped by the pump (24). Other applications are also described.

Abstract: Apparatus and methods are described including a ventricular assist device that includes a blood pump configured to be placed inside a left ventricle of a subject and to pump blood from the subject's left ventricle to an aorta of the subject. A blood pressure sensor measures aortic pressure of the subject. A computer processor varies a flow rate that is that is generated by the blood pump, and determines a relationship between arterial pulsatility of the subject and the flow rate that is generated by the blood pump, based upon aortic pressure that is measured by the blood pressure sensor as the flow rate that is generated by the blood pump is varied. The computer processor estimates native cardiac output of the subject at least partially based upon the relationship. Other applications are also described.

Abstract: Apparatus and methods are described including a ventricular assist device configured to assist ventricular functioning of a subject. The ventricular assist device includes an impeller and a frame disposed around the impeller. An axial shaft extends from a proximal end of the frame to a distal end of the frame, the impeller being coupled to the axial shaft. The axial shaft includes a proximal portion and a distal portion, which are coupled to each other via a joint. The proximal portion and the distal portion of the axial shaft are configured to flex with respect to each other via the joint. Other applications are also described.

Abstract: Apparatus and methods are described including a left-ventricular assist device that includes an impeller configured to be placed inside a subject's left ventricle and to pump blood from the left ventricle to the subject's aorta, by rotating. A frame is disposed around the impeller. A tube traverses the subject's aortic valve, such that a proximal portion of the tube is disposed within the aorta and a distal portion of the tube is disposed within the left ventricle. The distal portion of the tube extends to the distal end of the frame and defines more than 10 blood-inlet openings that are sized such as (a) to allow blood to flow from the subject's left ventricle into the tube and (b) to block structures from the subject's left ventricle from entering into the frame. Other applications are also described.

Abstract: An example anchor-manipulation tool includes (i) at a distal portion of the tool, an anchor-engaging element and an actuator, (ii) at an extracorporeal proximal portion of the tool, a controller, and (iii) a flexible longitudinal member extending between the proximal portion and the distal portion. The distal portion of the tool can be transluminally advanced to an anchor that is intracorporeally implanted in a subject. Subsequently, the anchor-engaging element can be engaged with an eyelet defined by a head of the anchor. Subsequently, the controller can be used to transition the tool into an articulatably-coupled state in which: (i) the eyelet at least in part inhibits movement of the anchor-engaging element away from the anchor, and (ii) the distal portion of the anchor-manipulation tool is deflectable with respect to the anchor. Subsequently, the anchor can be de-anchored by using the anchor-manipulation tool to apply a de-anchoring force to the eyelet.

Abstract: An implant comprises an anchor that comprises a helical tissue-coupling element. A tool is configured to advance the implant to a heart of a subject, and to position the anchor at tissue of the heart such that the implant extends from the anchor proximally away from the tissue. The tool comprises a tube having a distal end coupled to the implant, and a deployment manipulator. The deployment manipulator extends through the tube to the anchor disposed distally beyond the tube, and is configured to anchor the anchor to the tissue. Presence of the deployment manipulator through the distal end of the tube maintains the coupling between the distal end of the tube and the implant. Other embodiments are also described.

Abstract: Apparatus and methods are described including a ventricular assist device that includes an impeller configured to be placed inside a left ventricle of a subject. A driving magnet is coupled to a motor and is rotated by the motor. A driven magnet is magnetically coupled to the driving magnet and is rotated by the driving magnet. A drive cable extends from the driven magnet and imparts rotational motion from the driven magnet to the impeller. A set of sensors is configured to detect a magnetic phase difference between the driven magnet and the driving magnet. A computer processor receives the detected magnetic phase difference and determines a physiological parameter of the subject, at least partially in response thereto. Other applications are also described.

Abstract: Apparatus and methods are described including manufacturing an impeller by forming a structure having first and second bushings at proximal and distal ends of the structure, the first and second bushings being connected to one another by at least one elongate element. The elongate element is caused to radially expand and form at least one helical elongate element, at least partially by axially compressing the structure. The helical elongate element is coated with a coupling agent configured to enhance bonding between the helical elongate element and an elastomeric layer. The coated helical elongate element is coated with the elastomeric layer. Subsequently, an elastomeric film is coupled to the helical elongate element, such that the helical elongate element with the elastomeric film coupled thereto defines a blade of the impeller. Other applications are also described.

Abstract: Apparatus is provided, including: (A) a valve body (204) including a first frame (206) shaped to define a lumen therethrough, and a valve member (205) disposed within the lumen, (B) an upstream support (210), configured to be placed against an upstream surface of a native heart valve, and (C) a flexible sheet (214) that couples the upstream support to the valve body. The valve body has a compressed state in which the first frame has a first diameter, and an expanded state in which the first frame has a second diameter that is greater than the first diameter. The support includes a second frame (212) that has a compressed state, and an expanded state in which the second frame is annular, has an inner perimeter that defines an opening through the second frame, and has an outer perimeter. Other embodiments are also described.

Abstract: A method is described for use at a valve of a heart of a subject, the valve having an annulus, and the heart having an atrium upstream of the valve. A distal end of a manipulator is transluminally advanced into the atrium. A first part of an implant that includes an elongated contracting member is anchored to a first site on the annulus using the manipulator. The distal end of the manipulator is then pointed at a second site on the annulus such that a central longitudinal axis of the manipulator is disposed at an angle of 45-90 degrees with respect to a surface of the annulus. A second part of the implant is then anchored to the second site using the manipulator. Subsequently, the first site and the second site are drawn together by applying tension to the contracting member. Other embodiments are also described.

Abstract: Apparatus is provided for repairing a cardiac valve, the apparatus including a catheter sized for delivery through vasculature of a subject and an elongated and flexible annuloplasty structure having an annuloplasty structure axis. The annuloplasty structure is sized and configured for delivery to a heart of the subject through the catheter substantially along a catheter axis of the catheter while the annuloplasty structure axis is substantially parallel to the catheter axis. The apparatus also includes a plurality of anchors configured for delivery to a region of cardiac tissue from a proximal end of the catheter toward a distal end of the catheter and substantially along the annuloplasty structure axis and the catheter axis while at least a portion of the annuloplasty structure is within a delivery passage of the catheter. Other embodiments are also described.

Abstract: An anchor-handling device comprises a housing shaped to define a channel having an anchor-storage zone and a proximal opening. An anchor driver comprises an anchor-engaging head, the anchor-engaging head being dimensioned to be advanceable through the proximal opening toward the anchor-storage zone. A tissue anchor is stored in the anchor-storage zone, and comprises a coupling head configured to be locked to the anchor-engaging head. The tissue anchor is movable out of the anchor-storage zone toward the proximal opening in response to a proximally-directed force being applied to the tissue anchor by the anchor driver. The anchor-handling device comprises an element that serves as an indicator of movement of the tissue anchor out of the anchor-storage zone toward the proximal opening, by moving in response to the proximally-directed force such that at least part of the element protrudes out of the housing. Other embodiments are also described.

Abstract: Apparatus is provided, including: (A) a valve body (204) including a first frame (206) shaped to define a lumen therethrough, and a valve member (205) disposed within the lumen, (B) an upstream support (210), configured to be placed against an upstream surface of a native heart valve, and (C) a flexible sheet (214) that couples the upstream support to the valve body. The valve body has a compressed state in which the first frame has a first diameter, and an expanded state in which the first frame has a second diameter that is greater than the first diameter. The support includes a second frame (212) that has a compressed state, and an expanded state in which the second frame is annular, has an inner perimeter that defines an opening through the second frame, and has an outer perimeter. Other embodiments are also described.

Abstract: A method is described for use at a valve of a heart of a subject, the valve having an annulus, and the heart having an atrium upstream of the valve. A distal end of a manipulator is transluminally advanced into the atrium. A first part of an implant that includes an elongated contracting member is anchored to a first site on the annulus using the manipulator. The distal end of the manipulator is then pointed at a second site on the annulus such that a central longitudinal axis of the manipulator is disposed at an angle of 45-90 degrees with respect to a surface of the annulus. A second part of the implant is then anchored to the second site using the manipulator. Subsequently, the first site and the second site are drawn together by applying tension to the contracting member. Other embodiments are also described.

Abstract: Apparatus is provided for repairing a cardiac valve, the apparatus including a catheter sized for delivery through vasculature of a subject and an elongated and flexible annuloplasty structure having an elongated lumen and an annuloplasty structure axis extending along the lumen. The annuloplasty structure is sized and configured for delivery to a heart of the subject through the catheter substantially along a catheter axis of the catheter while the annuloplasty structure axis is substantially parallel to the catheter axis. The apparatus also includes a plurality of anchors configured for delivery to a region of cardiac tissue from a proximal end of the catheter toward a distal end of the catheter and substantially along the annuloplasty structure axis and the catheter axis while at least a portion of the annuloplasty structure is within a delivery passage of the catheter. Other embodiments are also described.

Abstract: An anchor-storage device comprises (i) a housing, shaped to define a channel having an anchor-storage zone and an opening configured to provide access for an anchor driver to the anchor-storage zone; and (ii) a retaining member. A tissue anchor is stored in the anchor-storage zone and is slidable through the channel. The retaining member (a) has a retaining state in which the retaining member is configured to retain the tissue anchor in the anchor-storage zone, and (b) is configured, by moving in response to a proximally-directed force applied to the tissue anchor, to allow the tissue anchor to leave the anchor-storage zone in response to the proximally-directed force. The proximally-directed force is greater than a pre-determined threshold force. Other embodiments are also described.

Abstract: An embolization microcatheter is configured to deliver embolization particles to a target area and minimize or prevent embolization of a non-target area. The microcatheter includes a section, located between the distal and proximal ends of the microcatheter, having a skeleton formed of braided wires and a polymeric layer intercalated into and/or overlaying the skeleton. This section includes a plurality of axial slits, each slit having a smallest cross-sectional dimension configured to prevent outflow of the embolization particles.

Abstract: Apparatus is provided for repairing a cardiac valve, the apparatus can include a flexible annuloplasty structure having a sleeve with an elongated tubular side wall and a distal tip. A first tissue anchor can passing through the distal tip of the sleeve, and a second tissue anchor can pass through a section of the tubular side wall. The first and second tissue anchors can extend in a substantially same direction. A longitudinal portion of the tubular side wall can be disposed between the first and second tissue anchors, and have a first lateral part opposite a second lateral part and closer to the first and second tissue anchors than the second lateral part is to the first and second tissue anchors. The second lateral part can have a degree of tension that is larger than a degree of tension of the first lateral part.

Abstract: An annuloplasty implant comprises a flexible member, helical anchors, and non-compressible portions. The helical anchors are configured to anchor the flexible member at least partway around the valve by being screwed into tissue of the heart of a subject. Each of the non-compressible portions comprises a helical coil having a plurality of turns, and at rest has a helix pitch that contacts each turn of the coil with an adjacent turn of the coil. The flexible member extends through the non-compressible portions. The implant is configured such that applying tension to the flexible member from one end thereof contracts the implant, thereby drawing the anchors closer to each other, the helical coil of each of the non-compressible portions inhibiting contraction of the implant at the non-compressible portion.

Abstract: An annuloplasty implant comprises an elongate member, a plurality of anchors, and a gripper. The elongate member has a proximal end, and a distal portion that includes a distal end. The plurality of anchors are distributed along the elongate member. The elongate member extends proximally from a proximal-most anchor and through the gripper. The gripper comprises a locking element that, in a locked state, inhibits sliding of the elongate member through the gripper. An unlocker, disposed within the gripper, obstructs the locking element from assuming the locked state, and is pullable proximally out of the gripper. The gripper automatically assumes the locked state upon the unlocker being pulled proximally out of the gripper. A tool tensions the distal portion of the elongate member by pulling the elongate member proximally through the gripper while the unlocker obstructs the locking element from assuming the locked state. Other embodiments are also described.