WO2019149046A1 - 心脏瓣膜假体及其输送器 - Google Patents

心脏瓣膜假体及其输送器 Download PDF

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Publication number
WO2019149046A1
WO2019149046A1 PCT/CN2019/071292 CN2019071292W WO2019149046A1 WO 2019149046 A1 WO2019149046 A1 WO 2019149046A1 CN 2019071292 W CN2019071292 W CN 2019071292W WO 2019149046 A1 WO2019149046 A1 WO 2019149046A1
Authority
WO
WIPO (PCT)
Prior art keywords
valve
thorn
tube
stent
valve prosthesis
Prior art date
Application number
PCT/CN2019/071292
Other languages
English (en)
French (fr)
Inventor
侍行坤
阳明
陈国明
李�雨
Original Assignee
上海微创心通医疗科技有限公司
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by 上海微创心通医疗科技有限公司 filed Critical 上海微创心通医疗科技有限公司
Priority to US16/966,008 priority Critical patent/US20200352712A1/en
Priority to EP19747473.7A priority patent/EP3741328A4/en
Priority to JP2020564300A priority patent/JP7221304B2/ja
Publication of WO2019149046A1 publication Critical patent/WO2019149046A1/zh

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
    • A61F2/2412—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body with soft flexible valve members, e.g. tissue valves shaped like natural valves
    • A61F2/2418—Scaffolds therefor, e.g. support stents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
    • A61F2/2409—Support rings therefor, e.g. for connecting valves to tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
    • A61F2/2412—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body with soft flexible valve members, e.g. tissue valves shaped like natural valves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
    • A61F2/2427—Devices for manipulating or deploying heart valves during implantation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
    • A61F2/2427—Devices for manipulating or deploying heart valves during implantation
    • A61F2/2436—Deployment by retracting a sheath
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2210/00—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2210/0004—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof bioabsorbable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0008—Fixation appliances for connecting prostheses to the body
    • A61F2220/0016—Fixation appliances for connecting prostheses to the body with sharp anchoring protrusions, e.g. barbs, pins, spikes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0067—Three-dimensional shapes conical
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0086—Pyramidal, tetrahedral, or wedge-shaped

Definitions

  • the present invention relates to the field of medical device technology, and in particular, to a heart valve prosthesis and a conveyor thereof.
  • TMVR TMVR
  • TMVR TMVR
  • valve stent and the thorn structure are integrally manufactured, so that the bent thorn structure not only restricts the conveying tube
  • the size and length of the valve stent are also prone to anchor failure due to anchor fracture and can prevent the recovery of the valve when the release is not in place.
  • a heart valve prosthesis can include:
  • a thorn structure comprising an expandable thorn support and a plurality of thorns
  • the plurality of thorns are disposed on the thorn support for penetrating the plurality of fixation holes and piercing the tissue in the cardiac cavity when the heart valve prosthesis is implanted into the cardiac cavity To fix the valve support.
  • the heart valve prosthesis described above can be independently manufactured and processed by separately arranging the thorn structure and the valve support, and can be cooperatively operated by a non-connected manner, so as to be step-loaded and released, thereby being effective. Reducing the size of the delivery tube and the length of the valve support reduces the risk of breakage and also facilitates recovery when the heart valve prosthesis is not in place.
  • the size of the stab stent in the fully expanded state is greater than or equal to the size of the valve stent in the fully expanded state.
  • the thorn structure further includes:
  • a stabbing ear disposed at a proximal end of the lance holder and extending in a direction toward a central axis of the lance holder;
  • the plurality of thorns are disposed at a distal end of the lance holder and extend in a direction away from a central axis of the lance holder.
  • the tip of the lance is a conical tip, a pyramidal tip or a prismatic tip.
  • the tip of the thorn is provided with a plurality of barb structures.
  • the material of the thorn is a medical biodegradable material.
  • the medical biodegradable material comprises at least one of polycaprolactone, polylactic acid, and polyacetic acid glycolic acid copolymer.
  • the thorn bracket includes:
  • a plurality of connecting rods are connected end to end to form a closed chain structure
  • any two adjacent connecting rods form a structure.
  • the thorn and the lance are respectively disposed at a joint between any two of the connecting rods.
  • the thorn is integrally formed with the connecting rod.
  • the thorn bracket is a mesh structure composed of a plurality of diamond meshes.
  • the plurality of fixation holes include a circumferential direction of the valve stent ⁇ 0 2019/149046 ⁇ (:17 ⁇ 2019/071292 dense mesh, the size of the dense mesh is smaller than the size of other meshes on the valve support
  • the compact mesh is 1/3 to 1/6 the size of the other mesh on the valve support.
  • the position of the thorn on the lance holder matches the position of the fixation hole on the valve holder, and the thorn on the thorn holder The size is smaller than the size of the fixation aperture on the valve support.
  • the valve support includes an inflow channel portion for blood inflow and an outflow channel portion for blood outflow;
  • the fixing hole is disposed in the inflow channel portion or at an intersection of the inflow channel portion and the outflow channel portion;
  • a conveyor for loading the heart valve prosthesis of any of the above, the conveyor comprising
  • the delivery tube comprises a first tube assembly and a second tube assembly sleeved outside the first tube assembly, the first tube assembly for loading the thorn structure, the second tube a component for loading the valve support;
  • control handle is configured to control the first tube assembly to release the thorn structure during the process of controlling the second tube assembly to release the valve support, so that the thorn structure passes through the plurality The fixation holes pierce the tissue within the heart chamber to secure the valve support.
  • the above-mentioned conveyor can realize the step-loading and releasing operation of the thorn structure and the valve stent by arranging the delivery tube formed by the first tube assembly and the second tube assembly, thereby improving the fixation of the heart valve prosthesis. Strength and accuracy, as well as easy manipulation by the operator, and facilitates easy recovery when the heart valve prosthesis is not in place.
  • control handle includes a first control unit and a second control unit, where the ⁇ 0 2019/149046 ⁇ (:17 ⁇ 2019/071292 a control unit is connected to the first tube assembly for controlling the first tube assembly, the second control portion and the second tube assembly Connected to control the second tube assembly.
  • the first tube assembly comprises:
  • an external tube the proximal end of the external tube is connected to the first control portion
  • a lancet tube disposed inside the lancet outer tube, and the proximal end of the lancet tube is connected to the first control portion;
  • a first fixing head one end is connected to the internal stab tube, and the other end is connected to the conical head through the hose
  • the first control unit includes:
  • the first control structure is coupled to the external stab tube for controlling movement of the external stab tube relative to the internal cannula.
  • the second tube assembly comprises:
  • valve stent outer tube the proximal end of the valve stent outer tube is connected to the second control portion
  • valve stent inner tube disposed inside the outer tube of the valve stent and having a proximal end of the valve stent inner tube connected to the second control portion;
  • a second fixing head fixedly connected to the valve stent inner tube
  • the second control unit includes:
  • a second control structure coupled to the valve stent outer tube for controlling movement of the valve stent outer tube relative to the valve stent inner tube.
  • FIG. 1 is a schematic structural view of a heart valve prosthesis in an embodiment
  • FIG. 2 is a schematic view of the thorn structure shown in FIG. 1;
  • FIG. 3 is a partial enlarged schematic view of the thorn structure shown in FIG. 2; [0055] FIG. ⁇ 0 2019/149046 ⁇ (:17 ⁇ 2019/071292
  • FIGS. 4 & 4 ⁇ 4 are schematic views of the tip end of different shapes passing through the fixing hole
  • FIG. 5 is a schematic view of a lance tip provided with a barb structure passing through a fixing hole
  • FIG. 6 is a schematic structural view of a front end portion of a conveyor loaded into a thorn structure in one embodiment
  • FIG. 7 is a schematic structural view of the front end portion of the conveyor of FIG. 6 loaded into the lance structure and the valve support;
  • FIG. 8 is a schematic view showing the overall structure of the conveyor of FIG. 6 after being loaded into the lance structure and the valve support;
  • FIG. 9 is a schematic view of the conveyor of FIG. 6 when implanted.
  • FIG. 10 is a schematic structural view of a control handle of a conveyor in an embodiment
  • FIG. 11 is another schematic structural view of the front end portion of the conveyor of FIG. 6 loaded into the lance structure and the valve stent
  • a heart valve prosthesis includes an expandable prosthetic valve (i.e., a leaflet) 100, an expandable valve support 200, and a lancet structure 300, and a prosthetic valve 100 is disposed on the valve support 200.
  • the valve stent 200 is provided with a plurality of fixing holes 204.
  • the thorn structure 300 can penetrate the human body through the fixing hole 204 from the inside of the valve stent 200 when the heart valve prosthesis is implanted into the heart chamber of the human body.
  • the artificial valve 100 is replaced by a human tissue such as a mitral valve to achieve the purpose of treating mitral valve disease.
  • the valve stent 200 is substantially tubular and expandable to be compressed. ⁇ 0 2019/149046 ⁇ (:17 ⁇ 2019/071292 is easy to load into the conveyor, and when the valve stent 200 is released into the human body through the conveyor, the valve stent 200 can be expanded to a preset size to play
  • the valve support 200 can include an inflow tract portion 201 and an outflow tract portion 202 that can be used as a passage for blood to flow into the heart valve prosthesis, while the outflow tract portion 202 can be used as a heart valve prosthesis.
  • the middle blood outflow channel after implanting the heart valve prosthesis described above, the inflow channel portion 201 is located at the left atrial end, and the outflow channel portion 202 is located at the left ventricular end, and the thorn structure 300 can be inserted into the mitral annulus to The valve stent 200 is secured.
  • the prosthetic valve 100 can be made of a biological material such as a bovine pericardium, a horse pericardium or a pig pericardium, and the prosthetic valve 100 can be sutured (such as a three-lobed suture) on the valve stent 200 by using a suturing process, that is, in normal work.
  • a biological material such as a bovine pericardium, a horse pericardium or a pig pericardium
  • the prosthetic valve 100 can be sutured (such as a three-lobed suture) on the valve stent 200 by using a suturing process, that is, in normal work.
  • blood passes from the left atrium through the inflow tract portion 201 through the prosthetic valve 100 and through the outflow tract portion 202 into the left ventricle.
  • the plurality of fixing holes 204 may be disposed in the inflow channel portion 201 or the inflow channel portion 201 and the outflow channel. At the intersection of the portions 202, and in order to further improve the stability and the ease of operation, the plurality of fixing holes 204 described above may be evenly distributed in the circumferential direction.
  • the valve support 200 may further be a dumbbell-shaped structure, that is, the large intermediate portion of the opening at both ends is small, and the diameter of the intersection of the inflow passage portion 201 and the outflow passage portion 202 is smaller than the diameter of the port of the outflow passage portion 202 and the inflow passage portion 201.
  • Port diameter; Further, the port diameter of the inflow channel portion 201 may be larger than the port diameter of the outflow channel portion 202. The diameter of the port of the inflow channel portion 201 can be
  • the valve stent 200 may be a tubular diamond mesh structure prepared by knitting or cutting using a shape memory alloy such as a nickel-titanium alloy, so as to be compressed to a diameter when implanted.
  • a shape memory alloy such as a nickel-titanium alloy
  • 6 ⁇ 24 (such as 6, 8, 12, 16, 20 or 24) grids can be set along the circumferential direction of the valve stent 200, and 3 ⁇ 8 can be set in the axial direction ( For example, 3, 4, 5, 6, 7, or 8, etc.) Grid, and in order to make the valve stent 200 more stable, the size and shape of each grid in the same circumferential direction can be set the same.
  • the deployed valve stent 200 has a circumferentially evenly distributed annular grid, further enhancing the radial support force of the valve stent 200, that is, the valve stent 200 can be expanded when deployed ⁇ 0 2019/149046 ⁇ (: 17 ⁇ 2019/071292 opens the primary leaflets, and fixes the deployed valve stent 200 through the lance structure 300 such that the prosthetic valve 100 is at a predetermined position.
  • the fixation holes 204 may be a circle of compactness along the circumferential direction of the valve stent 200, and each of the dense meshes is smaller in size than the other meshes on the valve support 200, in order to ensure a better thorn structure 300.
  • the fixed effect allows the size of the dense mesh to be set to 1/3 to 1/6 of the size of other meshes on the valve support 200.
  • a plurality of valve stent mounting ears 203 for loading are also fixedly disposed at the open end of the inflow channel portion 201, and between different meshes of the valve stent 200 (eg, between the meshes of the valve stent 200, compactness)
  • the joints between the meshes and between the mesh of the valve support 200 and the dense mesh can be smoothly transitioned with rounded corners, and the radius of the rounded corners can be 0.2 5111111 or 0.3111111, etc.).
  • the lance structure 300 includes a thorn support 310 and a plurality of thorns 301, and the plurality of thorns 301 are fixedly disposed on the thorn support 310 for implantation of the heart valve prosthesis.
  • the plurality of lances 301 - 1 are correspondingly penetrated into the body tissue through the plurality of fixing holes 20 4 , and the valve holder 200 is fixed by the thorn support 310 .
  • the lance holder 31 0 includes a plurality of connecting rods 302.
  • the plurality of connecting rods 302 can be connected end to end to form a closed chain structure as shown in FIG. 2, wherein the adjacent two rods 302 form a structure.
  • the lance holder 310 may also be a mesh structure composed of a plurality of diamond-shaped meshes, which is not limited in this application.
  • the stab stent 310 is also an expandable structure, preferably made of a shape memory alloy material, such as a nickel titanium alloy, to be compressed and loaded into the conveyor, and released upon expansion of the heart valve prosthesis, from expansion
  • the inside of the valve stent 200 is such that the thorn 301 on the lance holder 310 is inserted into the heart chamber tissue through the above-mentioned fixing hole, thereby fixing the valve holder 200.
  • a thorn 301 may be disposed at an end connection of two adjacent connecting rods 302, and a tip end of the thorn 301 may protrude from the thorn bracket. 310, facing the outer region of the stab stent 310, so as to be inserted and fixed in the heart chamber tissue through the fixing hole 204.
  • the size of the lance holder 310 in the fully expanded state is greater than or equal to the size of the valve stent 200 in the fully expanded state, and the position of the thorn 301 on the lance holder 310 matches the position of the fixing hole 204 on the valve holder 200,
  • the size of the thorn 301 on the lance holder 310 is smaller than the size of the fixing hole 204 on the valve holder 200, so that the thorn 3 01 can smoothly pass through the fixing hole 204 on the valve holder 200 and penetrate into the body cavity of the human body.
  • FIG. 3 is a partially enlarged schematic view of the thorn structure shown in FIG. 2. As shown in FIG. 3, in an optional embodiment, a thorn 301 and a slinging ear 303 may be disposed on the connecting node of the connecting rod 302.
  • the thorn 301 is disposed at the distal end of the thorn bracket 310, and the slinging ear 303
  • the shank 303 and the thorn 301 are arranged at different connection points of the thorn support 310, and the thorn 301 extends in a direction away from the central axis of the lance holder 310, and
  • the lancet 303 extends in a direction toward the central axis of the lance holder 310 to facilitate loading and release of the lance structure 300. For example, as shown in FIGS.
  • a plurality of fixing holes 204 are evenly distributed in the circumferential direction of the deployed valve stent 200, and the deployed stab brackets 310 are distributed with a plurality of matching thorns 301 corresponding to the positions of the fixing holes 204.
  • 2 ⁇ 6 slinging ears 303 are evenly distributed on the unfolded thorn bracket 310.
  • FIG. 5 is a schematic view of the tip end of the different shape passing through the fixing hole
  • FIG. 5 is a schematic view of the tip end of the thorn provided with the barbed structure passing through the fixing hole.
  • the above-mentioned thorn 301 is the free end.
  • the other end is a non-free end
  • the free end of the thorn 301 is a tip end.
  • the tip end of the thorn 301 can be a conical tip 301> shown in Fig. 41, a pyramidal tip 3011 as shown in Fig. 41, and/or Fig. 4 (:
  • the prismatic tip 301 is shown (..., and in order to further improve the fixing performance of the lance 301, a barb structure 3011 as shown in Fig. 5 may be provided at the tip end of the lance 301.
  • the above-mentioned thorn 301 and the connecting rod 302 can be integrally manufactured to reduce manufacturing cost and process difficulty; for example, a shape memory metal such as nickel-titanium alloy can be used to cut through a process such as cutting.
  • producing the spines structure 300 such as stainless steel may be used conventional metal materials, polymer materials, degradable material for producing the above-described configuration 3 thousand and thorns.
  • the thorn structure 300 is mainly fixed in the early stage of the implantation of the prosthesis, after the posterior valve stent 200 is wrapped by the endothelium, the thorn 301 loses the original positioning effect, and the residual thorn structure 300 also causes an annulus structure.
  • the thorn 301 can be manufactured separately from the connecting rod 302, and the thorn structure 300 can be formed by a joint such as welding or mechanical fit to facilitate the implantation of the prosthesis.
  • the thorn 301 is removed later; for example, at least one or more degradable medical biomaterials such as polycaprolactone, polylactic acid or polyacetic acid glycolic acid copolymer may be used to prepare the thorn 301, such as nickel titanium alloy Metal or polymer material such as stainless steel is used to manufacture the connecting rod 302, so that the connecting rod 302 can maintain the existing supporting function, and the thorn 301 is used for fixing in the early stage of the prosthesis implantation, and is automatically degraded in the later stage, so as to effectively avoid the residual thorn.
  • degradable medical biomaterials such as polycaprolactone, polylactic acid or polyacetic acid glycolic acid copolymer
  • the connecting rod 302 can maintain the existing supporting function
  • the thorn 301 is used for fixing in the early stage of the prosthesis implantation, and is automatically degraded in the later stage, so as to effectively avoid the residual thorn.
  • the valve stent 200 when the valve prosthesis is implanted into the human body, the valve stent 200 can be released and implanted first, and then the thorn structure 300 is released inside the deployed valve stent 200 so that the thorn 301 can pass through the valve.
  • the fixation holes 204 in the stent 200 are inserted into the native annulus and/or leaflets of the patient, thereby facilitating fixation of the valve stent 200 at a predetermined location without loosening.
  • the artificial leaflet when the valve stent 200 is fixed at a predetermined position, the artificial leaflet may be located below the thorn 301; for example, the axial distance between the highest point of the leaflet and the thorn 301
  • valve prosthesis in the above embodiment because the lance structure 300 and the valve support 200 are separately manufactured, and the valve prosthesis is fixed based on step loading and release and mechanical cooperation, thereby avoiding the thorn structure manufactured by the whole body. Breaking and detachment occur, causing complications such as thrombosis and infarction; at the same time, the separately manufactured thorn structure and valve stent can freely select the direction of thorn 301 folding according to the actual situation, which is beneficial to the recovery of the valve, and the thorn of the degradable material. It can effectively avoid permanent damage to the tissue and facilitate the re-implantation of the same type of valve prosthesis.
  • FIG. 6 is a schematic view showing the structure of the front end portion of the conveyor loaded into the thorn structure in one embodiment
  • FIG. 8 is a schematic view showing the overall structure of the conveyor of FIG. 6 after being loaded into the lance structure and the valve holder.
  • the conveyor of the present embodiment can be used to load the valve prosthesis of any of the above embodiments, and the conveyor can be composed of a plurality of multi-layered tube nesting, and specifically includes a conical head 401.
  • the control handle 500 and the delivery tube 400 are connected, and the proximal end of the delivery tube 400 is connected to the control handle 500, and the distal end of the delivery tube 400 is connected to the conical head 401.
  • the delivery tube 400 may include a first tube assembly 41 and a second tube assembly 42 sleeved outside the first tube assembly 41, the first tube assembly 41 being usable for loading And the delivery lance structure 300, the second tube assembly 42 can be used to load and transport the valve support 200, and the control handle 500 is used to control the second tube assembly 42 to release the valve support 200 described above, and after the valve support 200 is deployed, the control unit A tube assembly 41 releases the lance structure 300 such that the thorn 301 in the thorn structure 300 penetrates into the body tissue through the fixation hole 204 in the valve stent 200 to fix the valve stent 200 at a predetermined position, such that the prosthetic valve 100 can replace the native leaflet work.
  • the first tube assembly 41 is disposed in the second tube assembly 42.
  • the control handle 500 includes a first control unit 511 and a second control unit 502.
  • the first control unit 501 is connected to the first tube assembly 41 for controlling the first tube assembly 41, the second control unit 502 and the The two tube assemblies 42 are connected for controlling the second tube assembly 42. ⁇ 0 2019/149046 ⁇ (:17 ⁇ 2019/071292
  • the diameter of the delivery tube 400 and the height of the valve support 200 can be reduced to facilitate the interatrial approach, that is, The catheter is implanted into the human body through the femoral vein, enters the right atrium through the vein, and punctures the fossa into the left atrium, thereby reducing the trauma to the human tissue.
  • the first tube assembly 41 may include a hose 402, a first fixing head 404, a stab tube 403, a lance tube 408, and an inner tube.
  • Core tube 410 one end of the first fixing head 404 is respectively connected to the inner tube 408 and the inner core tube 410, the inner core tube 410 is located inside the internal tube 408 and the other end thereof is connectable to the first control portion 501;
  • the other end of the 404 is connected to the conical head 401 via a hose 402, and the internal tube 408 is disposed in the external tube 403 so that the external tube 403 is sleeved on the internal tube 408, and the external tube 403 and
  • the proximal end of the internal cannula 408 is respectively connected to the first control unit 501.
  • the first control portion 501 further has a first control structure 501 & for connecting with the external stab tube 403, thereby controlling the outer tube 403 to move relative to the internal tube 408; the first control structure 501& can be a knob.
  • the worm gear structure is connected to the lancet tube 408.
  • those skilled in the art can also use other mechanical structures or electric structures to control the thorn outer tube 403, which is not limited in this application.
  • the second tube assembly 42 includes a second fixation head 406, a valve stent outer tube 405, and a valve stent inner tube 407.
  • the proximal end of the valve stent outer tube 405 and the valve stent inner tube 407 are respectively connected to the second control portion 502; the valve stent inner tube 407 is disposed inside the valve stent outer tube 405, that is, the valve stent outer tube 405 is sleeved on the valve
  • the stent tube 407 is affixed; the second fixation head 406 is fixedly coupled to the valve stent inner tube 407.
  • the second control portion 502 further has a second control structure 502 & for connecting with the valve stent outer tube 405, thereby controlling the valve stent outer tube 405 to move relative to the valve stent inner tube 407, and the second control structure 502 & can be a knob
  • the worm gear structure is connected to the valve stent inner tube 407.
  • those skilled in the art can also use other mechanical structures or electric structures to control the outer tube 405 of the valve stent, which is not limited in this application.
  • the external stab tube 403 and the internal lance tube 408 are connected to the first control portion 501 through the second control portion 502 and the external tube 403 and the internal lance tube 408 may be in the first control portion 501.
  • the distance between the second control portion 502 and the first control portion 501 is changed according to the relative movement of the two; in addition, the first control portion 501 has a hollow passage, The guide wire 409 is passed through. ⁇ 0 2019/149046 ⁇ (:17 ⁇ 2019/071292
  • valve prosthesis of the above embodiment by manufacturing and implanting the valve stent separately from the lancet structure, can reduce the diameter of the delivery tube and the size of the valve support, facilitating passage through the aortic arch or through the mitral valve vein
  • the curved path is clinically implanted, thereby greatly reducing the difficulty of transportation and the risk of vascular injury, thereby effectively avoiding the risk of complications;
  • the thorn structure of the valve stent can be effectively solved by mechanically fitting to fix the existing valve stent due to the bending angle.
  • the problem of the ideal bending angle cannot be achieved, and the risk of the fracture of the thorn in the manufacturing process and the fatigue fracture in the human body due to the large bending angle and the excessive deformation is effectively avoided, thereby greatly improving the production efficiency. , can also effectively reduce production costs.
  • valve prosthesis 9 is a schematic view of the conveyor of FIG. 6 when implanted. As shown in Figures 6-11, when the above-described valve prosthesis is loaded and released by the above-described conveyor, the valve prosthesis can be implanted by step loading and release, specifically:
  • Step 811 using the second control unit 502 of the control handle 500 to successively withdraw the second tube assembly 42 in the conveyor to expose the first tube assembly 41 for loading the thorn structure 300 (see FIG. 6). .
  • Step 312 the outer tube 403 of the first tube assembly 41 is retracted by the first control portion 501 in the control handle 500 to expose the first fixing head 404 for fixing the thorn structure 300.
  • Step 813 after loading and fixing the slinging lug 303 in the thorn structure 300 to the first fixing head 404, the outer tube 403 is advanced so that the front end of the thorn outer tube 403 and the thorn 301 in the thorn structure 300. Contact, at this time, the lance holder 302 in the thorn structure 300 is in a compressed state, thereby completing the loading operation of the thorn structure 300 (as shown in Fig. 6).
  • Step 814 continue to advance the second fixing head 406, so that the second fixing head 406 occludes (or sleeves) the valve holder after the position of the thorn 301 in the loaded thorn structure 300
  • the ear 203 is loaded and fixed on the second fixed head 406, and then the valve stent outer tube 405 is pushed forward until the full compression of the valve stent 200 is received into the valve stent outer tube 405, at which point the front end of the valve stent 200 is compressed ( Far away from the valve ⁇ 0 2019/149046 ⁇ (: 17 ⁇ 2019/071292 one end of the bracket hanger 203) abuts against the conical head 401, thereby completing the loading operation of the valve holder 200 (as shown in Fig. 7).
  • a structure as shown in FIG. 8 may be formed, due to the outer tube 403 and the inner tube 408 in the first tube assembly 41, and the second tube assembly 42.
  • the valve stent outer tube 405 and the valve stent inner tube 407 can be made of a polymer flexible material, so that the transport tube 400 formed by the tube 400 can be bent at will.
  • the rear end of the delivery tube 400 is connected to the control handle 500, and the front end is connected to the conical cone head 401 to facilitate the implantation of the valve prosthesis to avoid stabbing the blood vessel wall.
  • Step 315 based on the structure shown in FIGS. 7-8, as shown in FIG. 9, the guide wire 409 is implanted into the left ventricle 605 through the femoral vein, and then the delivery tube 400 is punctured through the inferior vena cava 601. 602 enters the left atrium 603 to reach the location of the mitral valve 604.
  • Step 816 after the delivery tube 400 is delivered to a suitable position, the valve stent outer tube 405 is withdrawn such that the valve stent 200 is slowly released from the valve stent outer tube 405, and the end of the outer tube of the valve stent to be released is approached.
  • the first control portion 501 is pushed forward by a distance 111 with respect to the second control portion 502.
  • the thorn 301 can just be inserted into the human tissue through the fixing hole 204.
  • the doctor can observe the specific position of the first control portion 501 by angiography, thereby ensuring that the thorn 301 is accurately released to the designated position (see FIG. 10). ⁇ 11 shows).
  • Step 317 the external tube 403 is retracted, so that the thorn 301 is slowly released from the internal cannula 41, and after the thorn 301 is completely released and penetrates the pericardial tissue through the fixing hole, the hanging ear of the thorn 301 The 303 is separated from the first fixed head 404, which in turn releases the lance structure 300 completely.
  • Step 818 retracting the valve stent outer tube 405, completely separating the valve stent mounting ear 203 from the second fixing head 406, so as to completely separate the valve stent 200, that is, the release of the heart valve prosthetic valve stent is completed.
  • the inserted prosthetic valve 100 begins to work in place of the native flap of the lesion.
  • Step 319 withdrawing the conveyor 400.
  • the lancet structure and the valve stent are loaded into the same delivery system step by step, and when the valve stent is released but the valve stent mounting ear is not completely detached from the conveyor, that is, the valve stent mounting ear
  • the thorn structure is released, and since the leaflets (ie, the prosthetic valve) fixed on the valve stent have begun to work instead of the native leaflets, there is sufficient time for the thorn ⁇ 0 2019/149046 ⁇ (:17 ⁇ 2019/071292 release; and wait until the thorn anchor is stable, then release the thorn structure completely, then continue to release the valve stent until the valve stent is separated from the conveyor, and is withdrawn And then complete the implantation of the heart valve prosthesis.
  • the heart valve prosthesis, the conveyor, and the method of loading the release heart valve prosthesis described in the embodiments of the present application, by the main body of the valve stent (ie, the valve stent 200) and the anchoring structure (ie, the thorn structure 300) is separately manufactured, implanted and released, which can effectively reduce the size of the valve support and the conveyor tube, enhance the stability of the fixation, and adopt the thorn made of degradable material, and can effectively avoid permanent invasion.
  • the complications caused by the fixation and the risk of rupture of the thorn structure are examples of the fixation and the risk of rupture of the thorn structure.

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  • Health & Medical Sciences (AREA)
  • Cardiology (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Transplantation (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)

Abstract

一种心脏瓣膜假体，可包括：可扩张的瓣膜支架（200），开设有多个固定孔（204）；人工瓣膜（100），设置于瓣膜支架（200）上；以及刺结构（300），包括可扩张的刺支架（310）和多个刺（301）；其中，多个刺（301）设置于刺支架（310）上，用于在心脏瓣膜假体植入心腔时穿过多个固定孔（204）并刺入心腔内的组织，以将瓣膜支架（200）予以固定。通过将刺结构（300）与瓣膜支架（200）相互独立设置，可实现各自独自制造及加工，并通过非连接方式进行配合工作，以便于进行分步装载及释放，进而能够有效减小输送管的尺寸及瓣膜支架（200）的长度，降低发生断裂的风险，同时还有利于在心脏瓣膜假体释放不到位时进行回收。

Description

、脏瓣膜假体及其输送器
技术领域
[0001] 本发明涉及医疗器械技术领域， 特别是涉及一种心脏瓣膜假体及其输送器。
背景技术
[0002] 当前， 对二尖瓣返流的经导管置换治疗 (Transcatheter Mitral Valve Replacement
， 简称 TMVR)成为国内外的研究热点， 但存在支架尺寸大， 左室流出道干涉， 锚固困难等核心问题。 为了解决大尺寸的二尖瓣支架瓣膜锚固问题， 国外一些 公司采取了不同的尝试， 如美敦力公司的 intrepid二尖瓣介入瓣膜， 其采用了支 架上的锚固刺进行瓣膜固定； 又如爱德华公司的 CardiAQe二尖瓣介入瓣膜， 采 用了勾挂原生二尖瓣瓣叶的方式进行假体锚固； 又如 Highlife公司的介入瓣膜， 使用额外的锚固环将假体束缚在原生瓣叶上。 综合来看， 利用刺锚固的方式操 作简单， 受解剖的差异的影响小， 但是仍然存在如下的问题： 瓣膜支架与刺结 构是一体制造， 就使得弯折突出的刺结构不仅会限制输送管的尺寸及瓣膜支架 的长度， 还易发生锚固刺断裂引起锚固失效， 同时在释放不到位时会阻碍瓣膜 的回收。
发明概述
技术问题
[0003] 基于此， 有必要针对上述技术问题提供一种心脏瓣膜假体、 输送器及装载释放 心脏瓣膜假体的方法， 通过将瓣膜支架与刺结构相互独立设置， 来减小输送管 的尺寸及瓣膜支架的长度， 降低发生断裂的风险， 便于在释放不到位时回收瓣 膜。
问题的解决方案
技术解决方案
[0004] 一种心脏瓣膜假体， 可包括：
[0005] 可扩张的瓣膜支架， 开设有多个固定孔；
[0006] 人工瓣膜， 设置于所述瓣膜支架上； 以及 \¥0 2019/149046 卩（：17 \2019/071292
[0007] 刺结构， 包括可扩张的刺支架和多个刺；
[0008] 其中， 所述多个刺设置于所述刺支架上， 用于在所述心脏瓣膜假体植入心腔时 穿过所述多个固定孔并刺入所述心腔内的组织， 以将所述瓣膜支架予以固定。
[0009] 上述的心脏瓣膜假体， 通过将刺结构与瓣膜支架相互独立设置， 可实现各自独 自制造及加工， 并通过非连接方式进行配合工作， 以便于进行分步装载及释放 ， 进而能够有效减小输送管的尺寸及瓣膜支架的长度， 降低发生断裂的风险， 同时还有利于在心脏瓣膜假体释放不到位时进行回收。
[0010] 在一个可选的实施例中， 所述刺支架在完全扩张状态下的尺寸大于或等于所述 瓣膜支架在完全扩张状态下的尺寸。
[0011] 在一个可选的实施例中， 所述刺结构还包括：
[0012] 刺挂耳， 设置于所述刺支架的近端并朝着靠近所述刺支架的中心轴线的方向延 伸；
[0013] 其中， 所述多个刺设置于所述刺支架的远端并朝着远离所述刺支架的中心轴线 的方向延伸。
[0014] 在一个可选的实施例中， 所述刺的尖端为圆锥形尖端、 棱锥形尖端或棱柱形尖 端。
[0015] 在一个可选的实施例中， 所述刺的尖端设置有多个倒刺结构。
[0016] 在一个可选的实施例中， 所述刺的材质为医用生物可降解材料。
[0017] 在一个可选的实施例中， 所述医用生物可降解材料包括聚己内酯、 聚乳酸、 聚 乙酸乙醇酸共聚物中的至少一种。
[0018] 在一个可选的实施例中， 所述刺支架包括：
[0019] 多根连接杆， 所述多根连接杆依次首尾连接形成一闭合链式结构；
[0020] 其中， 任意两根相邻的所述连接杆形成 型结构。
[0021] 在一个可选的实施例中， 所述刺和所述刺挂耳分别设置于任意两根所述连接杆 之间的连接处。
[0022] 在一个可选的实施例中， 所述刺与所述连接杆为一体制造的结构。
[0023] 在一个可选的实施例中， 所述刺支架为由多个菱形网格组成的网状结构。
[0024] 在一个可选的实施例中， 所述多个固定孔包括沿所述瓣膜支架周向方向设置的 \¥0 2019/149046 卩（：17 \2019/071292 致密性网格， 所述致密性网格的尺寸均小于所述瓣膜支架上的其他网格的尺寸
[0025] 在一个可选的实施例中， 所述致密性网格的尺寸为所述瓣膜支架上所述其他网 格的尺寸的 1/3~1/6。
[0026] 在一个可选的实施例中， 所述刺支架上的所述刺的位置与所述瓣膜支架上的所 述固定孔的位置相匹配， 且所述刺支架上的所述刺的尺寸小于所述瓣膜支架上 的所述固定孔的尺寸。
[0027] 在一个可选的实施例中， 所述瓣膜支架包括用于血液流入的流入道部分和用于 血液流出的流出道部分； 以及
[0028] 所述固定孔设置于所述流入道部分内， 或者设置于所述流入道部分与所述流出 道部分的交接处；
[0029] 其中， 所述多个固定孔沿周向分布于所述瓣膜支架上。
[0030] 一种输送器， 可用于装载上述任意一项所述的心脏瓣膜假体， 所述输送器包括
[0031] 锥形头；
[0032] 控制手柄；
[0033] 输送管， 两端分别与所述锥形头和所述控制手柄连接；
[0034] 其中， 所述输送管包括第一管组件和套设于所述第一管组件外部的第二管组件 ， 所述第一管组件用于装载所述刺结构， 所述第二管组件用于装载所述瓣膜支 架； 以及
[0035] 所述控制手柄用于在控制所述第二管组件释放所述瓣膜支架的过程中， 控制所 述第一管组件释放所述刺结构， 以使所述刺结构穿过所述多个固定孔刺入所述 心腔内的组织从而将所述瓣膜支架予以固定。
[0036] 上述的输送器， 通过套设第一管组件和第二管组件所形成的输送管， 能够实现 刺结构与瓣膜支架的分步装载及释放操作， 进而能够提升心脏瓣膜假体的固定 强度及精确性， 同时也便于操作人员进行操控， 还有利于在心脏瓣膜假体释放 不到位时方便回收。
[0037] 在一个可选的实施例中， 所述控制手柄包括第一控制部和第二控制部， 所述第 \¥0 2019/149046 卩（：17 \2019/071292 一控制部与所述第一管组件相连接， 用于控制所述第一管组件， 所述第二控制 部与所述第二管组件相连接， 用于控制所述第二管组件。
[0038] 在一个可选的实施例中， 所述第一管组件包括：
[0039] 软管；
[0040] 刺外管， 所述刺外管的近端与所述第一控制部连接；
[0041] 刺内管， 设置于所述刺外管的内部， 并且所述刺内管的近端与所述第一控制部 连接；
[0042] 第一固定头， 一端与所述刺内管连接， 另一端通过所述软管与所述锥形头连接
[0043] 其中， 所述第一固定头用于装载所述刺结构。
[0044] 在一个可选的实施例中， 所述第一控制部包括：
[0045] 第一控制结构， 与所述刺外管连接， 用于控制所述刺外管相对于所述刺内管移 动。
[0046] 在一个可选的实施例中， 所述第二管组件包括：
[0047] 瓣膜支架外管， 瓣膜支架外管的近端与所述第二控制部连接；
[0048] 瓣膜支架内管， 设置于所述瓣膜支架外管的内部并且瓣膜支架内管的近端与所 述第二控制部连接；
[0049] 第二固定头， 与所述瓣膜支架内管固定连接；
[0050] 其中， 所述第二固定头用于装载所述瓣膜支架。
[0051] 在一个可选的实施例中， 所述第二控制部包括：
[0052] 第二控制结构， 与所述瓣膜支架外管连接， 用于控制所述瓣膜支架外管相对于 所述瓣膜支架内管移动。
发明的有益效果
对附图的简要说明
附图说明
[0053] 图 1是一个实施例中心脏瓣膜假体的结构示意图；
[0054] 图 2是图 1中所示刺结构的示意图；
[0055] 图 3是图 2中所示刺结构的局部放大示意图； \¥0 2019/149046 卩（：17 \2019/071292
[0056] 图 4&~4<:是不同形状的刺尖端穿过固定孔的示意图；
[0057] 图 5是设置有倒刺结构的刺尖端穿过固定孔的示意图；
[0058] 图 6是一个实施例中输送器装载入刺结构后前端部的结构示意图；
[0059] 图 7是图 6中的输送器装载入刺结构和瓣膜支架后前端部的结构示意图；
[0060] 图 8是图 6中的输送器装载入刺结构和瓣膜支架后的整体结构示意图；
[0061] 图 9是图 6中的输送器植入时的示意图；
[0062] 图 10是一个实施例中输送器的控制手柄的结构示意图；
[0063] 图 11是图 6中的输送器装载入刺结构和瓣膜支架后前端部的另一个结构示意图
发明实施例
本发明的实施方式
[0064] 为了使本申请的目的、 技术方案及优点更加清楚明白， 以下结合附图及实施例 ， 对本申请进行进一步详细说明。 应当理解， 此处所描述的具体实施例仅仅用 以解释本申请， 并不用于限定本申请。
[0065] 本申请利用示意图进行了详细的表述， 但这些示意图仅为了便于详述本申请的 实例， 不应对此作为本申请的限定。 如在本说明书和所附权利要求中所使用的 ， 单数形式“一”、 “一个”以及“该”包括复数对象， 除非内容另外明确指出外。 如 在本说明书和所附权利要求中所使用的， 术语“或”通常是以包括“和/或”的含义 而进行使用的， 除非内容另外明确指出外。 术语“近端”通常是指靠近操作者的一 端， “远端”是指远离操作者的一端。
[0066] 图 1是一个实施例中心脏瓣膜假体的结构示意图。 如图 1所示， 一种心脏瓣膜假 体包括可扩张的人工瓣膜 （即瓣叶） 100、 可扩张的瓣膜支架 200和刺结构 300， 人工瓣膜 100设置在瓣膜支架 200上。 该瓣膜支架 200上开设有多个固定孔 204， 其中， 上述的刺结构 300可在心脏瓣膜假体植入人体心腔时， 从瓣膜支架 200的 内部穿过上述的固定孔 204刺入人体组织内， 以将上述的瓣膜支架 200固定在预 定的位置处， 从而使得人工瓣膜 100替代诸如二尖瓣瓣膜等人体组织进行工作， 从而达到治疗二尖瓣瓣膜疾病的目的。
[0067] 具体的， 如图 1所示， 瓣膜支架 200大致为管状可扩张的结构， 以在压缩的时候 \¥0 2019/149046 卩（：17 \2019/071292 便于装载入输送器中， 而通过输送器将瓣膜支架 200植入人体释放时， 该瓣膜支 架 200可扩张到预设的尺寸以起到支撑的作用。 该瓣膜支架 200可包括流入道部 分 201和流出道部分 202, 该流入道部分 201可用于作为血液流入心脏瓣膜假体的 通道， 而流出道部分 202则可用于作为心脏瓣膜假体中血液流出通道， 将上述的 心脏瓣膜假体植入后， 流入道部分 201位于左心房端， 而流出道部分 202位于左 心室端， 而刺结构 300则可扎入二尖瓣瓣环， 以将瓣膜支架 200予以固定。
[0068] 人工瓣膜 100可采用牛心包、 马心包或猪心包等生物材料制作， 并可采用缝合 工艺将该人工瓣膜 100缝合 （如三瓣叶缝合） 固定在瓣膜支架 200上， 即在正常 工作时， 血液从左心房经流入道部分 201通过人工瓣膜 100, 并经流出道部分 202 进入左心室。
[0069] 进一步地， 如图 1所示， 为了使得刺结构 300可更加稳固的固定瓣膜支架 200， 可将上述的多个固定孔 204设置于流入道部分 201内或者流入道部分 201与流出道 部分 202的交接处， 同时为了进一步的提升稳固性和操作便捷性， 还可将上述的 多个固定孔 204沿周向进行均匀分布。 其中， 瓣膜支架 200可进一步为哑铃状结 构， 即两端开口大中间部分小， 流入道部分 201与流出道部分 202交接处的直径 小于上述的流出道部分 202的端口直径和流入道部分 201的端口直径； 进一步地 ， 流入道部分 201的端口直径可大于流出道部分 202的端口直径。 流入道部分 201 的端口直径可为
Figure imgf000008_0001
Figure imgf000008_0002
[0070] 进一步地， 如图 1所示， 瓣膜支架 200可为采用诸如镍钛合金等形状记忆合金通 过编织或切割等方式所制备的管状菱形网格结构， 以便于植入时压缩至直径较 小的输送管内； 例如， 沿该瓣膜支架 200的周向方向可设置 6~24 （如 6、 8、 12、 16、 20或 24等） 个网格， 沿轴向方向可设置 3~8 （如 3、 4、 5、 6、 7或 8等） 排网 格， 而为了使得瓣膜支架 200具有更佳的稳固性， 还可将同一个周向上的每个网 格的尺寸及形状均设置相同， 以使得展开后的瓣膜支架 200具有周向均匀分布的 环形网格， 进一步提升瓣膜支架 200的径向支撑力， 即瓣膜支架 200展开时可撑 \¥0 2019/149046 卩（：17 \2019/071292 开原生瓣叶， 并通过刺结构 300将展开的瓣膜支架 200予以固定， 以使得人工瓣 膜 100处于预定的位置处。 其中， 上述的多个固定孔 204可为沿瓣膜支架 200周向 方向一圈致密性网格， 且每个致密性网格的尺寸均小于上述瓣膜支架 200上的其 他网格的尺寸， 为了确保刺结构 300具有更佳的固定效果， 可将致密性网格的尺 寸设置为瓣膜支架 200上其他网格的尺寸的 1/3~1/6。
[0071] 在位于流入道部分 201开口端还固定设置有多个用于装载的瓣膜支架挂耳 203 , 且瓣膜支架 200的不同网格之间 （如瓣膜支架 200的网格之间、 致密性网格之间 及瓣膜支架 200的网格与致密性网格之间） 的连接处均可采用圆角来光滑过渡， 而圆角的半径可为
Figure imgf000009_0001
0.2 5111111或 0.3111111等） 。
[0072] 图 2是图 1中所示刺结构的示意图。 如图 1~2所示， 基于上述实施例的基础上， 刺结构 300包括刺支架 310和多个刺 301， 多个刺 301固定设置在刺支架 310上， 以 在心脏瓣膜假体植入时， 上述的多个刺 301—一对应地穿过上述的多个固定孔 20 4刺入人体组织中， 并配合刺支架 310将瓣膜支架 200予以固定。 其中， 刺支架 31 0包括多根连接杆 302， 该多根连接杆 302可首尾依次连接， 形成如图 2中所示的 闭合链式结构， 其中相邻的两根杆 302形成 型结构。 当然， 在其他实施例中， 刺支架 310也可以是由多个菱形网格组成的网状结构， 本申请对此不做限制。
[0073] 刺支架 310也为可扩张结构， 优选由形状记忆合金材料制成， 例如镍钛合金， 以便于被压缩后装载至输送器中， 并在心脏瓣膜假体植入时释放， 从扩张的瓣 膜支架 200的内部使得设置刺支架 310上的刺 301穿过上述的固定孔刺入心腔组织 中， 进而将该瓣膜支架 200予以固定。
[0074] 具体的， 如图 2所示， 上述的刺结构 300中， 相邻的两根连接杆 302端部连接处 可设置有一个刺 301， 且该刺 301的尖端可突出于该刺支架 310, 朝向刺支架 310 的外部区域， 以便于通过固定孔 204刺入并固定在心腔组织内。 其中， 该刺支架 310在完全扩张状态下的尺寸大于或等于瓣膜支架 200在完全扩张状态下的尺寸 ， 刺支架 310上的刺 301的位置与瓣膜支架 200上的固定孔 204的位置相匹配， 且 刺支架 310上的刺 301的尺寸小于瓣膜支架 200上的固定孔 204的尺寸， 以使得刺 3 01可顺利通过瓣膜支架 200上的固定孔 204, 刺入人体心腔组织内固定。 \¥0 2019/149046 卩（：17 \2019/071292
[0075] 图 3是图 2中所示刺结构的局部放大示意图。 如图 3所示， 在一个可选的实施例 中， 在连接杆 302的连接节点上可设置有刺 301和刺挂耳 303 , 刺 301设置于刺支 架 310的远端， 而刺挂耳 303设置于刺支架 310的近端， 进一步地， 刺挂耳 303与 刺 301可以在刺支架 310不同的连接节点以间隔式排列， 且刺 301朝着远离刺支架 310的中心轴线的方向延伸， 而刺挂耳 303则朝着靠近刺支架 310的中心轴线的方 向延伸， 以便于刺结构 300的装载和释放。 例如， 如图 1~3所示， 在展开的瓣膜 支架 200周向均匀分布有多个固定孔 204, 而展开的刺支架 310对应上述的固定孔 204的位置分布有多个相匹配的刺 301， 且在展开的刺支架 310上还均匀分布有 2~ 6个刺挂耳 303。
[0076] 进一步地， 图 ~ 是不同形状的刺尖端穿过固定孔的示意图， 图 5是设置有倒 刺结构的刺尖端穿过固定孔的示意图。 如图 4&~4〇及图 5所示， 上述的刺 301—端 为自由端。 另一端则为非自由端， 且刺 301的自由端为尖端， 如该刺 301的尖端 可为图 所示的圆锥形尖端 301&、 图 41?所示的棱锥形尖端 3011?和/或图 4（：所示的 棱柱形尖端 301（：等， 而为了进一步提升刺 301的固定性能， 还可在刺 301的尖端设 置如图 5所示的倒刺结构 3011。
[0077] 如图 2~3所示， 上述的刺 301与连接杆 302之间可一体制造， 以降低制造成本及 工艺难度； 例如， 可采用诸如镍钛合金等形状记忆金属通过切割等工艺一体制 造上述的刺结构 300, 也可以采用不锈钢等传统的金属材料、 高分子材料、 可降 解材料等制造上述的刺结构 3〇〇。 优选地， 由于刺结构 300主要是在假体植入前 期进行固定， 后期瓣膜支架 200被内皮包裹后， 刺 301便会丧失原先的定位作用 ， 且残留的刺结构 300还会对瓣环组织造成永久性创伤等， 为了降低因残留的刺 301所导致的诸多并发症， 可将刺 301与连接杆 302分开制造， 并可通过诸如焊接 或机械配合连接形成刺结构 300， 以便于假体植入后期去除刺 301 ; 例如， 可采 用诸如聚己内酯、 聚乳酸或聚乙酸乙醇酸共聚物等中的至少一种或多种可降解 的医用生物材料来制备刺 301， 而采用诸如镍钛合金、 不锈钢等金属或高分子材 料来制造连接杆 302, 从而使得连接杆 302可保持既有的支撑作用， 而刺 301在假 体植入前期用于固定、 后期则自动降解， 以有效避免残留刺 301所带来的并发症 \¥0 2019/149046 卩（：17 \2019/071292
[0078] 在实际的应用中， 将瓣膜假体植入人体时， 可先释放并植入瓣膜支架 200, 然 后在展开的瓣膜支架 200的内部释放刺结构 300， 以使得刺 301能够穿过瓣膜支架 200上的固定孔 204刺入患者的原生瓣环和/或瓣叶中， 故可利于将瓣膜支架 200固 定在预定的位置处而不会出现松动。 其中， 在瓣膜支架 200固定在预定的位置时 ， 人工瓣叶可位于刺 301的下方； 例如， 瓣叶的最高点与刺 301的轴向距离范围
Figure imgf000011_0001
[0079] 上述实施例中的瓣膜假体， 由于刺结构 300与瓣膜支架 200是单独制造， 且基于 分步装载及释放并通过机械配合将瓣膜假体予以固定， 进而避免因一体制造的 刺结构发生断裂脱落， 引起诸如血栓、 梗塞等并发症； 同时， 单独制造的刺结 构和瓣膜支架还能够根据实际情况自由的选择刺 301翻折的方向， 利于瓣膜的回 收， 且可降解材质的刺还能有效避免对组织造成永久性损伤， 便于再次植入同 类型的瓣膜假体。
[0080] 图 6是一个实施例中输送器装载入刺结构后前端部的结构示意图， 图 8是图 6中 的输送器装载入刺结构和瓣膜支架后的整体结构示意图。 如图 6和图 8所示， 本 实施例中的输送器可用于装载上述任一实施例中的瓣膜假体， 该输送器可由多 层输送管嵌套组成， 具体的可包括锥形头 401、 控制手柄 500和输送管 400, 且该 输送管 400的近端与控制手柄 500相连接， 输送管 400的远端与锥形头 401相连接
[0081] 具体地， 如图 6和图 7所示， 输送管 400可包括第一管组件 41和套设于第一管组 件 41外部的第二管组件 42, 第一管组件 41可用于装载和输送刺结构 300, 第二管 组件 42可用于装载和输送瓣膜支架 200， 上述的控制手柄 500用于控制第二管组 件 42释放上述的瓣膜支架 200并在该瓣膜支架 200展开后， 控制第一管组件 41释 放刺结构 300， 以使得刺结构 300中的刺 301穿过瓣膜支架 200上的固定孔 204刺入 人体组织中， 以将该瓣膜支架 200固定在预定的位置处， 使得人工瓣膜 100可替 代原生瓣叶工作。
[0082] 第一管组件 41设置于第二管组件 42中。 对应地， 控制手柄 500包括第一控制部 5 01和第二控制部 502, 第一控制部 501与第一管组件 41相连接， 用于控制第一管 组件 41， 第二控制部 502与第二管组件 42相连接， 用于控制第二管组件 42。 \¥0 2019/149046 卩（：17 \2019/071292
[0083] 在上述的实施例中， 由于刺结构 300和瓣膜支架 200是分别制造和装载的， 进而 可减小输送管 400的直径及瓣膜支架 200的高度， 以利于房间隔入路， 即便于导 管通过股静脉植入人体， 通过静脉进入右心房， 穿刺卵窝进入左心房， 进而降 低对人体组织的创伤。
[0084] 如图 6~10所示， 在一个可选的实施例中， 上述的第一管组件 41可包括软管 402 、 第一固定头 404、 刺外管 403、 刺内管 408和内芯管 410。 其中， 第一固定头 404 的一端分别与刺内管 408和内芯管 410连接， 内芯管 410位于刺内管 408之内且其 另一端可连接至第一控制部 501 ; 第一固定头 404的另一端通过软管 402与锥形头 401连接， 刺内管 408设置于刺外管 403之中， 以使得刺外管 403套设在刺内管 408 上， 且该刺外管 403和刺内管 408的近端分别与第一控制部 501连接， 当第一控制 部 501移动时， 可带动刺外管 403和刺内管 408做同步移动。 具体地， 第一控制部 501还具有第一控制结构 501&， 用于与刺外管 403连接， 从而控制刺外管 403相对 于刺内管 408移动； 第一控制结构 501&可以是一旋钮， 通过蜗轮蜗杆结构与刺内 管 408连接， 当然本领域的技术人员也可以利用其他机械结构或电动结构实现对 刺外管 403的控制， 本申请对此不做限制。
[0085] 如图 6~8所示， 第二管组件 42包括第二固定头 406、 瓣膜支架外管 405和瓣膜支 架内管 407。 其中， 瓣膜支架外管 405和瓣膜支架内管 407的近端分别与第二控制 部 502连接； 瓣膜支架内管 407设置于瓣膜支架外管 405的内部， 即瓣膜支架外管 405套设于瓣膜支架内管 407上； 第二固定头 406则与瓣膜支架内管 407固定连接 。 第二控制部 502还具有第二控制结构 502&， 用于与瓣膜支架外管 405连接， 从而 控制瓣膜支架外管 405相对于瓣膜支架内管 407移动， 第二控制结构 502&可以是一 旋钮， 通过蜗轮蜗杆结构与瓣膜支架内管 407连接， 当然本领域的技术人员也可 以利用其他机械结构或电动结构实现对瓣膜支架外管 405的控制， 本申请对此不 做限制。
[0086] 如图 10所示， 刺外管 403和刺内管 408穿过第二控制部 502连接到第一控制部 501 并且刺外管 403和刺内管 408可以在第一控制部 501的带动下相对于第二控制部 50 2移动， 并且可以理解， 第二控制部 502与第一控制部 501的距离根据两者的相对 运动而发生改变； 另外， 第一控制部 501具有中空通道， 供导丝 409穿过。 \¥0 2019/149046 卩（：17 \2019/071292
[0087] 如图 6和图 7所示， 当刺结构 300装载入第一管组件 41时， 刺结构 300的刺挂耳 30 3抵靠于第一固定头 404上， 刺外管 403包覆于刺支架 310外侧， 露出刺 301 （在图 11中示出） 。 当瓣膜支架 200装载入第二管组件 42时， 瓣膜支架 200的瓣膜支架 挂耳 203抵靠于第二固定头 406上， 瓣膜支架外管 405包覆于瓣膜支架 200的瓣膜 支架外侧。
[0088] 上述实施例中的瓣膜假体， 通过将瓣膜支架与刺结构分开制造及植入， 可以降 低输送器的输送管直径以及瓣膜支架的尺寸， 便于通过主动脉弓或通过二尖瓣 股静脉路径弯曲路径进行临床植入， 从而大大降低输送难度及血管损伤风险， 从而有效避免引起并发症风险； 另外， 通过机械配合固定瓣膜支架的刺结构还 可以有效解决现有瓣膜支架因弯折角度固定而无法达到理想的弯折角度的难题 ， 以及有效避免由于弯折角度大、 形变过大而导致的刺在制造过程中的断裂以 及在人体内的疲劳断裂等风险， 从而在极大地提高生产效率同时， 还能有效降 低生产成本。
[0089] 图 9是图 6中的输送器植入时的示意图。 如图 6~11所示， 利用上述的输送器装载 和释放上述的瓣膜假体时， 可通过分步装载及释放来进行瓣膜假体的植入， 具 体的：
[0090] 步骤 811， 利用控制手柄 500中第二控制部 502先后撤输送器中第二管组件 42， 以将用于装载刺结构 300的第一管组件 41予以暴露 （参见图 6所示） 。
[0091] 步骤 312， 在利用控制手柄 500中的第一控制部 501后撤第一管组件 41的刺外管 4 03， 以将用于固定刺结构 300的第一固定头 404予以暴露。
[0092] 步骤 813 , 将刺结构 300中的刺挂耳 303装载固定到第一固定头 404上后， 前移刺 外管 403， 以使得刺外管 403的前端与刺结构 300中的刺 301接触， 此时刺结构 300 中的刺支架 302处于压缩状态， 进而完成刺结构 300的装载操作 （如图 6所示形态 '、 。
[0093] 步骤 814, 继续向前推进第二固定头 406， 以使得该第二固定头 406遮挡 （或套 设） 在装载的刺结构 300中刺 301所处的位置处后， 将瓣膜支架挂耳 203装载固定 在第二固定头 406上， 再向前推送瓣膜支架外管 405 , 直至将瓣膜支架 200的完全 压缩收进该瓣膜支架外管 405内， 此时压缩后瓣膜支架 200的前端 （即远离瓣膜 \¥0 2019/149046 卩（：17 \2019/071292 支架挂耳 203的一端） 与锥形头 401抵靠， 进而完成瓣膜支架 200的装载操作 （如 图 7所示形态） 。
[0094] 进一步地， 在进行上述的步骤 811414后， 可形成如图 8所示的结构， 由于上述 的第一管组件 41中的刺外管 403和刺内管 408， 以及第二管组件 42中的瓣膜支架 外管 405和瓣膜支架内管 407均可采用高分子柔性材料制作， 故其所构成的输送 管 400可任意弯曲。 其中， 输送管 400的后端连接控制手柄 500, 前端连接圆锥形 的锥形头 401， 以便于进行瓣膜假体的植入， 避免戳伤血管壁。
[0095] 步骤 315， 基于图 7~8所示的结构， 参见图 9所示， 将导丝 409经股静脉植入到左 心室 605 , 再将输送管 400经下腔静脉 601穿刺卵圆窝 602进入左心房 603， 以到达 二尖瓣 604的位置处。
[0096] 步骤 816 , 将输送管 400输送到合适的位置后， 回撤瓣膜支架外管 405， 以使得 瓣膜支架 200缓慢的从瓣膜支架外管 405中释放， 待释放瓣膜支架外管端部接近 瓣膜支架挂耳 203时， 相对于第二控制部 502, 推动第一控制部 501前移距离 111， 当距离 111与刺 301和固定孔 204之间的距离 112相等时 （即 111=112） ， 刺 301刚好能 够穿过固定孔 204扎进人体组织中， 在推动过程中， 医生可以通过造影术观察第 一控制部 501的具体位置， 即可确保刺 301准确地释放到指定位置 （参见图 10~11 所示） 。
[0097] 步骤 317， 回撤刺外管 403， 以使刺 301缓慢从刺内管 41中释放出来， 且刺 301完 全释放并穿过固定孔刺进心腔组织后， 将刺 301的挂耳 303与第一固定头 404分离 ， 进而将刺结构 300完全释放。
[0098] 步骤 818 , 回撤瓣膜支架外管 405 , 使瓣膜支架挂耳 203与第二固定头 406完全分 离， 以将瓣膜支架 200完全分离， 即此时心脏瓣膜假体瓣膜支架释放完成， 植入 的人工瓣膜 100代替病变的原生瓣开始工作。
[0099] 步骤 319， 撤出输送器 400。
[0100] 上述的实施例中， 通过将刺结构和瓣膜支架分步装载进同一个输送系统中， 并 在瓣膜支架释放完毕但瓣膜支架挂耳尚未完全和输送器脱离时， 即瓣膜支架挂 耳还和输送器上的固定头连接时， 释放刺结构， 由于此时固定在瓣膜支架上的 瓣叶 （即人工瓣膜） 已经开始代替原生瓣叶工作， 所以有充足的时间进行刺的 \¥0 2019/149046 卩（：17 \2019/071292 释放； 而等到刺锚固稳定后， 再把刺结构完全释放出来， 之后再继续释放瓣膜 支架， 直至瓣膜支架与输送器分离， 并撤出输送器， 进而完成心脏瓣膜假体的 植入操作。
[0101] 综上所述， 在本申请的实施例中所记载的心脏瓣膜假体、 输送器及装载释放心 脏瓣膜假体的方法， 通过将瓣膜支架的主体 （即瓣膜支架 200） 与锚固结构 （即 刺结构 300） 分开制造、 植入即释放， 能够有效减小瓣膜支架及传输器输送管的 尺寸， 增强固定的稳固性， 且采用可降解材料制造的刺， 还能有效避免因永久 侵入的固定方式所引起的并发症及刺结构断裂的风险。
[0102] 以上所述实施例的各技术特征可以进行任意的组合， 为使描述简洁， 未对上述 实施例中的各个技术特征所有可能的组合都进行描述， 然而， 只要这些技术特 征的组合不存在矛盾， 都应当认为是本说明书记载的范围。
[0103] 以上所述实施例仅表达了本申请的几种实施方式， 其描述较为具体和详细， 但 并不能因此而理解为对发明专利范围的限制。 应当指出的是， 对于本领域的普 通技术人员来说， 在不脱离本申请构思的前提下， 还可以做出若干变形和改进 ， 这些都属于本发明的保护范围。 因此， 本发明专利的保护范围应以所附权利 要求为准。

Claims

\¥0 2019/149046 卩（：17 \2019/071292 权利要求书
[权利要求 1] 一种心脏瓣膜假体， 其特征在于， 包括：
可扩张的瓣膜支架， 开设有多个固定孔；
人工瓣膜， 设置于所述瓣膜支架上； 以及
刺结构， 包括可扩张的刺支架和多个刺；
其中， 所述多个刺设置于所述刺支架上， 用于在所述心脏瓣膜假体植 入心腔时穿过所述多个固定孔并刺入所述心腔内的组织， 以将所述瓣 膜支架予以固定。
[权利要求 2] 根据权利要求 1所述的心脏瓣膜假体， 其特征在于， 所述刺支架在完 全扩张状态下的尺寸大于或等于所述瓣膜支架在完全扩张状态下的尺 寸。
[权利要求 3] 根据权利要求 1所述的心脏瓣膜假体， 其特征在于， 所述刺结构还包 括：
刺挂耳， 设置于所述刺支架的近端并朝着靠近所述刺支架的中心轴线 的方向延伸；
其中， 所述多个刺设置于所述刺支架的远端并朝着远离所述刺支架的 中心轴线的方向延伸。
[权利要求 4] 根据权利要求 1所述的心脏瓣膜假体， 其特征在于， 所述刺的尖端为 圆锥形尖端、 棱锥形尖端或棱柱形尖端。
[权利要求 5] 根据权利要求 1所述的心脏瓣膜假体， 其特征在于， 所述刺的尖端设 置有多个倒刺结构。
[权利要求 6] 根据权利要求 1所述的心脏瓣膜假体， 其特征在于， 所述刺的材质为 医用生物可降解材料。
[权利要求 7] 根据权利要求 6所述的心脏瓣膜假体， 其特征在于， 所述医用生物可 降解材料包括聚己内酯、 聚乳酸、 聚乙酸乙醇酸共聚物中的至少一种
[权利要求 8] 根据权利要求 3~7中任意一项所述的心脏瓣膜假体， 其特征在于， 所 述刺支架包括： \¥0 2019/149046 卩（：17 \2019/071292 多根连接杆， 所述多根连接杆依次首尾连接形成一闭合链式结构; 其中， 任意两根相邻的所述连接杆形成 型结构。
[权利要求 9] 根据权利要求 8所述的心脏瓣膜假体， 其特征在于， 所述刺和所述刺 挂耳分别设置于任意两根所述连接杆之间的连接处。
[权利要求 10] 根据权利要求 8所述的心脏瓣膜假体， 其特征在于， 所述刺与所述连 接杆为一体制造的结构。
[权利要求 11] 根据权利要求 3~7中任意一项所述的心脏瓣膜假体， 其特征在于， 所 述刺支架为由多个菱形网格组成的网状结构。
[权利要求 12] 根据权利要求 1所述的心脏瓣膜假体， 其特征在于， 所述多个固定孔 包括沿所述瓣膜支架周向方向设置的致密性网格， 所述致密性网格的 尺寸均小于所述瓣膜支架上的其他网格的尺寸。
[权利要求 13] 根据权利要求 12所述的心脏瓣膜假体， 其特征在于， 所述致密性网格 的尺寸为所述瓣膜支架上所述其他网格的尺寸的 1/3~1/6。
[权利要求 14] 根据权利要求 1所述的心脏瓣膜假体， 其特征在于， 所述刺支架上的 所述刺的位置与所述瓣膜支架上的所述固定孔的位置相匹配， 且所述 刺支架上的所述刺的尺寸小于所述瓣膜支架上的所述固定孔的尺寸。
[权利要求 15] 根据权利要求 1所述的心脏瓣膜假体， 其特征在于， 所述瓣膜支架包 括用于血液流入的流入道部分和用于血液流出的流出道部分； 以及 所述固定孔设置于所述流入道部分内， 或者设置于所述流入道部分与 所述流出道部分的交接处；
其中， 所述多个固定孔沿周向分布于所述瓣膜支架上。
[权利要求 16] 一种输送器， 其特征在于， 用于装载所述权利要求 1-15中任意一项所 述的心脏瓣膜假体， 所述输送器包括：
锥形头；
控制手柄；
输送管， 两端分别与所述锥形头和所述控制手柄连接；
其中， 所述输送管包括第一管组件和套设于所述第一管组件外部的第 二管组件， 所述第一管组件用于装载所述刺结构， 所述第二管组件用 \¥0 2019/149046 卩（：17 \2019/071292 于装载所述瓣膜支架； 以及
所述控制手柄用于在控制所述第二管组件释放所述瓣膜支架的过程中 ， 控制所述第一管组件释放所述刺结构， 以使所述刺结构穿过所述多 个固定孔刺入所述心腔内的组织从而将所述瓣膜支架予以固定。
[权利要求 17] 如权利要求 16所述的输送器， 其特征在于， 所述控制手柄包括第一控 制部和第二控制部， 所述第一控制部与所述第一管组件相连接， 用于 控制所述第一管组件， 所述第二控制部与所述第二管组件相连接， 用 于控制所述第二管组件。
[权利要求 18] 如权利要求 17所述的输送器， 其特征在于， 所述第一管组件包括： 软管；
刺外管， 所述刺外管的近端与所述第一控制部连接；
刺内管， 设置于所述刺外管的内部， 并且所述刺内管的近端与所述第 一控制部连接；
第一固定头， 一端与所述刺内管连接， 另一端通过所述软管与所述锥 形头连接；
其中， 所述第一固定头用于装载所述刺结构。
[权利要求 19] 如权利要求 18所述的输送器， 其特征在于， 所述第一控制部包括： 第一控制结构， 与所述刺外管连接， 用于控制所述刺外管相对于所述 刺内管移动。
[权利要求 20] 如权利要求 17所述的输送器， 其特征在于， 所述第二管组件包括： 瓣膜支架外管， 瓣膜支架外管的近端与所述第二控制部连接； 瓣膜支架内管， 设置于所述瓣膜支架外管的内部并且瓣膜支架内管的 近端与所述第二控制部连接；
第二固定头， 与所述瓣膜支架内管固定连接；
其中， 所述第二固定头用于装载所述瓣膜支架。
[权利要求 21] 如权利要求 20所述的输送器， 其特征在于， 所述第二控制部包括： 第二控制结构， 与所述瓣膜支架外管连接， 用于控制所述瓣膜支架外 管相对于所述瓣膜支架内管移动。

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