WO2021055963A1

WO2021055963A1 - Implantable cardiac assist devices and methods

Info

Publication number: WO2021055963A1
Application number: PCT/US2020/051839
Authority: WO
Inventors: Joshua D. Cross; Robert M. DEPUE; Paul D. Goodman; Brett J. Wham; Dustin C. Burkart; Zachary A. CRANNELL; Richard D. STRONES
Original assignee: W. L. Gore & Associates, Inc.
Priority date: 2019-09-20
Filing date: 2020-09-21
Publication date: 2021-03-25

Abstract

Various aspects of the present disclosure are directed toward implantable medical devices, systems, and methods for cardiac assistance.

Description

IMPLANTABLE CARDIAC ASSIST DEVICES AND METHODS

CROSS-REFERENCE TO RELATED APPLICATION [0001] This application claims the benefit of Provisional Application No. 62/903,419, filed September 20, 2019, Provisional Application No. 62/923,012, filed October 18, 2019, and Provisional Application No. 62/938,878, filed November 21, 2019 which are incorporated herein by reference in their entireties for all purposes.

FIELD

[0002] The present disclosure relates generally to medical devices and more specifically to implantable cardiac assist devices and supporting structures configured to operate within a patient’s vasculature and that can be minimally invasively delivered via a catheter.

BACKGROUND

[0003] Cardiac assist devices generally relate to systems that include a pump that assists heart function without replacing the heart in order to improve hemodynamics. Depending on the needs and demands of the patient, the pump may be placed outside the patient's body (extra- or para-corporeal devices), or within the patient’s abdomen such as in the pericardial cavity beneath or above the diaphragm (intracorporeal device). Attempts have also been made to place such pumps within the patient’s vasculature, including within the heart itself.

SUMMARY

[0004] According to one example (“Example 1”), a device for cardiac assistance includes a barrel portion including a lumen for fluid flow; a first flange at a first end of the barrel portion and configured to expand from a reduced diameter to engage a first tissue wall side; a second flange at a second end of the barrel portion and configured to expand from a reduced diameter to engage a second tissue wall side; and one or more anchor elements arranged within the barrel portion and configured to releasably engage a pump arranged within the barrel portion.

[0005] According to another example (“Example 2”), further to the device of Example 1 , the barrel portion, and the first flange, the second flange, and form a unitary structure that is a conduit. [0006] According to another example (“Example 3”), further to the device of Example 2, the one or more anchor elements are arranged within the barrel portion and extend within the lumen.

[0007] According to another example (“Example 4”), further to the device of Example 3, the first flange, the second flange, and the barrel portion are formed by struts having one or more of differing widths or differing depths within the barrel portion and at least one of the first flange and the second flange.

[0008] According to another example (“Example 5”), further to the device of Example 4, the struts include a curvature that extends portions of the flanges toward a center of the barrel portion.

[0009] According to another example (“Example 6”), further to the device of any one of Examples 4-5, a portion of the struts within at least one of the first flange and the second flange include a width less than a portion of the struts within the barrel portion.

[00010] According to another example (“Example 7”), further to the device of any one of Examples 4-5, a portion of the struts within the barrel portion include a depth less than a portion of the struts within at least one of the first flange and the second flange.

[00011] According to another example (“Example 8”), further to the device of any one of Examples 2-7, the one or more anchor elements are spaced about a circumference of the barrel portion.

[00012] According to another example (“Example 9”), further to the device of Example 8, the one or more anchor elements are configured to move inwardly into the lumen and move outwardly relative to the lumen to engage the pump.

[00013] According to another example (“Example 10”), a method of deploying the device of any one of Examples 1-9, includes deploying the first flange against a tissue wall of an aorta, deploying and the second flange against a tissue wall of a left atrium.

[00014] According to another example (“Example 11”), further to the method of Example 10, the method also includes deploying the pump concurrently with deploying the first flange and the second flange

[00015] According to another example (“Example 12”), further to the method of Example 10, the method includes deploying the pump after deploying the first flange and the second flange.

[00016] According to another example (“Example 13”), a system includes a pump configured to transfer fluid flow therethrough; a barrel portion including a lumen for the fluid flow; a first flange arranged at a first end of the barrel portion and configured to expand from a reduced diameter to engage a first side of a structure; a second flange arranged at a second end of the barrel portion and configured to expand from a reduced diameter to engage a second side of a structure, and one or more anchor elements arranged with the barrel portion and configured to releasably engage and the pump arranged within the barrel portion.

[00017] According to another example (“Example 14”), further to the system of Example 13, the system also includes a drive line coupled to the pump and a controller coupled to the pump and configured to configured to control the operation of the pump.

[00018] According to another example (“Example 15”), further to the system of Example 14, the first side of the structure is an implantable medical device and the second side of a structure is a tissue wall.

[00019] According to another example (“Example 16”), an apparatus include: a conduit having a conduit outer surface, a conduit first end and a conduit second end defining a conduit length, and a lumen extending therethrough; a first flange coupled to the conduit outer surface adjacent the conduit first end and configured to expand from a reduced diameter to a larger diameter operable to engage a first tissue surface; and a second flange coupled to the conduit outer surface adjacent the conduit second end and configured to expand from a reduced diameter to a larger diameter operable to engage a second tissue surface, and at least one of the first flange and the second flange is configured to be positioned to a location along the conduit length.

[00020] According to another example (“Example 17”), further to the apparatus of Example 17, the first flange movably coupled to the conduit outer surface and the second flange movably coupled to the conduit outer surface

[00021] According to another example (“Example 18”), further to the apparatus of any one of Examples 16-17, the apparatus also includes a pump arranged within the conduit and defining a fluid passage for the transfer of fluid from the conduit first end to the conduit second end.

[00022] According to another example (“Example 19”), further to the apparatus of any one of Examples 16-18, the conduit includes corrugations, and at least one of the first flange and the second flange are moveable along a length of the conduit.

[00023] According to another example (“Example 20”), further to the apparatus of Example 19, at least one of the first flange and the second flange include one or more tabs configured to interface with corrugations on the conduit.

[00024] According to one example (“Example 21”), an apparatus includes a conduit having a conduit outer surface, a conduit first end and a conduit second end defining a conduit length, and a lumen extending therethrough; a first flange coupled to the conduit outer surface adjacent the conduit first end and configured to expand from a reduced diameter to a larger diameter operable to engage a first tissue surface; and a second flange coupled to the conduit outer surface adjacent the conduit second end and configured to expand from a reduced diameter to a larger diameter operable to engage a second tissue surface, and the first flange and the second flange include gaps to allow fluid flow into the conduit for the pump to transfer fluid through the conduit.

[00025] According to one example (“Example 22”), an apparatus includes a conduit having a conduit outer surface, a conduit first end and a conduit second end defining a conduit length, and a lumen extending therethrough; one or more petals arranged at least one of a first end and a second end of the conduit; and one or more anchor elements arranged with the conduit and configured to releasably engage a medical device, optionally a pump, arranged within the conduit.

[00026] According to one example (“Example 23”), a method of treating heart disease includes arranging a conduit within between a patient’s heart and vasculature, the conduit having an outer surface, a conduit first end and a conduit second end defining a conduit length, and a lumen extending therethrough; arranging one or more petals arranged at least one of a first end and a second end of the conduit to contact a tissue wall of the heart or vasculature; and engaging a pump with the conduit by way of one or more anchor elements arranged with the conduit configured to releasably engage the pump

[00027] The foregoing Examples are just that, and should not be read to limit or otherwise narrow the scope of any of the inventive concepts otherwise provided by the instant disclosure. While multiple examples are disclosed, still other embodiments will become apparent to those skilled in the art from the following detailed description, which shows and describes illustrative examples. Accordingly, the drawings and detailed description are to be regarded as illustrative in nature rather than restrictive in nature.

BRIEF DESCRIPTION OF THE DRAWINGS

[00028] The accompanying drawings are included to provide a further understanding of the disclosure and are incorporated in and constitute a part of this specification, illustrate embodiments, and together with the description serve to explain the principles of the disclosure. [00029] FIG. 1 is an illustration of a system including a conduit and a pump, according to some embodiments;

[00030] FIG. 2A is an illustration of an implantable medical device for cardiac assistance and sheath in a first delivery configuration, according to some embodiments.

[00031] FIG. 2B is an illustration the implantable medical device for cardiac, shown in FIG. 2A, in a second delivery configuration, according to some embodiments.

[00032] FIG. 2C is a side view illustration the implantable medical device for cardiac assistance, shown in FIGS. 2A-B, in a deployed configuration, according to some embodiments.

[00033] FIG. 2D is an end view illustration a flange of the implantable medical device for cardiac assistance, shown in FIGS. 2A-C, in a deployed configuration, according to some embodiments.

[00034] FIG. 3A is a side view illustration of an example implantable medical device for cardiac assistance, according to some embodiments.

[00035] FIG. 3B is a perspective view illustration of the device shown in FIG. 3A, according to some embodiments.

[00036] FIG. 4A is an illustration of another implantable medical device for cardiac assistance in a first configuration, according to some embodiments.

[00037] FIG. 4B is an illustration of the implantable medical device for cardiac assistance, shown in FIG. 4A, in a second configuration, according to some embodiments.

[00038] FIG. 5A is a side view illustration of an example implantable medical device for cardiac assistance, according to some embodiments.

[00039] FIG. 5B is a perspective view illustration of the device shown in FIG.5A, according to some embodiments.

[00040] FIG. 6 is a perspective view illustration of an example implantable medical device for cardiac assistance in a delivery configuration, according to some embodiments.

[00041] FIG. 7 is a side view illustration of an example implantable medical device for cardiac assistance, according to some embodiments.

[00042] FIG. 8 is an illustration of an example conduit with flanges, according to some embodiments.

[00043] FIG. 9A is an end view another example conduit into which a pump may be arranged, according to some embodiments. [00044] FIG. 9B is a side view of the conduit, shown in FIG. 9B and a pump, according to some embodiments.

[00045] FIG. 10 is a side view another example conduit and a pump, according to some embodiments.

[00046] FIG. 11 A is an end view another example conduit into which a pump may be arranged, according to some embodiments.

[00047] FIG. 11 B is a side view of the conduit, shown in FIG. 11 B, according to some embodiments.

[00048] FIG. 12 is a perspective view another example conduit into which a pump may be arranged, according to some embodiments.

[00049] FIG. 13A is a perspective view another example conduit into which a pump may be arranged, according to some embodiments.

[00050] FIG. 13B is a side view of the conduit, shown in FIG. 13B, according to some embodiments.

[00051] FIG. 14 is a perspective view another example conduit into which a pump may be arranged, according to some embodiments.

[00052] Persons skilled in the art will readily appreciate that various aspects of the present disclosure can be realized by any number of methods and apparatus configured to perform the intended functions. It should also be noted that the accompanying drawing figures referred to herein are not necessarily drawn to scale, but may be exaggerated to illustrate various aspects of the present disclosure, and in that regard, the drawing figures should not be construed as limiting.

DETAILED DESCRIPTION

Definitions and Terminology

[00053] As the terms are used herein with respect to ranges of measurements “about” and “approximately” may be used, interchangeably, to refer to a measurement that includes the stated measurement and that also includes any measurements that are reasonably close to the stated measurement, but that may differ by a reasonably small amount such as will be understood, and readily ascertained, by individuals having ordinary skill in the relevant arts to be attributable to measurement error, differences in measurement and/or manufacturing equipment calibration, human error in reading and/or setting measurements, adjustments made to optimize performance and/or structural parameters in view of differences in measurements associated with other components, particular implementation scenarios, imprecise adjustment and/or manipulation of objects by a person or machine, and/or the like. In the event it is determined that individuals having ordinary skill in the relevant arts would not readily ascertain values for such reasonably small differences, the terms “about” and “approximately” can be understood to mean plus or minus 10% of the stated value.

Description of Various Embodiments

[00054] Various aspects of the present disclosure are directed to systems and methods for improving or assisting the cardiac function of the heart. The disclosed systems and methods generally include an endoprosthesis having a pump within the patient’s vasculature. The disclosed systems and methods also include a delivery system configured for transcatheter delivery of the pump and the conduit.

[00055] In the instant disclosure, the examples are primarily described in association with cardiac applications involving the aorta (also referred to herein as ventricular assist), although it should be readily appreciated that the various embodiments and examples discussed herein can be applied in association with any known uses of cardiac assist devices, including for use within other regions of the heart or vasculature, as well as percutaneous procedures ( e.g ., laparoscopic) and / or surgical procedures. Cardiac assist devices, including ventricular assist devices, may be beneficial for patients experiencing heart failure. The cardiac assist devices, consistent with various aspects of the present disclosure may include an implantable pump that forces blood from chambers of the heart {e.g., the right ventricle or left ventricle) to the rest of the body {e.g., via the aorta).

[00056] As shown in FIG. 1 , a system 1000 according to various embodiments includes a conduit 100 and a pump 200 disposed at least partially within the conduit 100, and a retention element 300 configured to help maintain a position of the pump 200 within the conduit 100. The conduit 100 may surround at least a portion of the pump 200 or form a portion of the pump 200. In certain instances, the conduit 100 may include a graft, a stent, or a combination of a stent and a graft.

[00057] The conduit 100 creates a fluidic connection between spaces or tissue structures such as the aorta and an atrium or ventricle or the conduit 100 may be arranged within the vasculature {e.g., pulmonary vein). For example, and in certain instances, the conduit 100 and pump 200 may act as a right ventricular assist device and increase blood flow into the pulmonary veins or arteries. In these instances, the conduit 100 may be placed in the pulmonary artery with blood being transferred or forced into the atrium or ventricle as discussed in detail herein. In addition, the conduit 100 and the pump 200 may increase flow of other non-blood bodily fluids when placed in other areas of the body ( e.g ., urinary, biliary)

[00058] In certain instances, the stent portion of a conduit 100 is defined by a plurality of interconnected strut elements. The stent portion of the conduit 100 may comprise, such as, but not limited to, elastically deformable metallic or polymeric biocompatible materials. The stent portion of the conduit 100 may comprise a shape- memory material, such as nitinol, a nickel-titanium alloy. Other materials suitable for the stent portion of the conduit 100 include, but are not limited to, other titanium alloys, stainless steel, cobalt-nickel alloy, polypropylene, acetyl homopolymer, acetyl copolymer, other alloys or polymers, or any other biocompatible {e.g., bio-absorbable) material having adequate physical and mechanical properties to function as the stent portion of the conduit 100, as described herein. The stent portion of the conduit 100 may be self-expanding and/or may be expandable using an expansion element, such as a balloon. That is, in various examples, the conduit 100 may be transitionable between a collapsed delivery configuration and an expanded deployed configuration.

[00059] In certain instances, the conduit 100 may be a stent that is partially covered with a graft material. The graft material of the conduit 100 may further include a graft material disposed thereabout {e.g., such as about an interior of or an exterior of the conduit 100). In various embodiments, graft materials can include, for example, expanded polytetrafluoroethylene (ePTFE), polyester, polyurethane, fluoropolymers, such as perfluoroelastomers and the like, polytetrafluoroethylene, silicones, urethanes, ultra high molecular weight polyethylene, aramid fibers, and combinations thereof.

Other embodiments for a graft member material can include high strength polymer fibers such as ultra-high molecular weight polyethylene fibers {e.g., Spectra®, Dyneema Purity®, etc.) or aramid fibers {e.g., Technora®, etc.). Some embodiments may comprise of a graft material only partially disposed about the conduit frame.

[00060] In certain instances, the system 1000 is configured such that the pump 200 can be removably coupled with the conduit 100. In some examples, the pump 200 is removably coupled with the conduit 100 after the conduit 100 has been delivered and deployed within the patient’s vasculature {e.g., a conduit of an implantable medical device). According to some implementations, the pump 200 is removable from the patient’s vasculature without also requiring removal of the conduit 100 {e.g., such that the pump 200 may be replaced and/or such that removal of the system 1000 may be done minimally invasively).

[00061] The pump 200 is generally configured to drive or otherwise cause blood to flow across the pump 200 from an inflow side 1004 of the system 1000 to an outflow side 1002 of the system, such as along a direction of arrow 1006. The pump mechanism (also referred to herein as a pump drive) of the pump 200 may be, for example, a centrifugal-action pump, an axial-action pump, or other similar device such as a worm-style drive mechanism, or impeller. The pump housing is configured to interface and engage with the conduit 100. The pump 200 is situated within the deployed conduit 100 such that the pump 200 is operable to pump or drive blood across the pump 200 and into the aorta and out into the vasculature of the body. The pump 200 can be operated to draw blood from the left ventricle (or other heart chamber), blood across the pump 200, and into the aorta and out through the vasculature of the body.

[00062] In certain instances, the system 1000 further includes a driveline 400.

The driveline 400 is a cable assembly that operates to electrically couple a controller 500 located external to the patient’s anatomy with the pump 200 or the drive line 400 can be a rotating driveshaft. The driveline 400 may be routed through the patient’s vasculature ( e.g exiting the heart through the apex of the left ventricle) and then out through the skin to where it is coupled with the controller 500 or to a subcutaneously implanted controller 500. The controller 500 is a module that is configured to control the operation of the pump 200. The controller 500 may include a battery to control operation of the pump 200.

[00063] In certain instances, the driveline 400 may be routed through one of the left or right subclavian arteries, veins, or the left common carotid artery to a subclavian or other associated access. Alternatively, the driveline 400 may be routed through the descending aorta to a femoral or other associated access. In certain instances, the driveline 400 is associated with the retention element 300, for example being routed through the retention element 300 or integral to the retention element 300. In some examples where the driveline 400 is integral with the retention element 300, the retention element 300 includes one or more connectors such that when the retention element 300 is coupled to the conduit 100, the driveline 400 is electrically coupled with the pump 200. [00064] In some embodiments, the system 1000 may be configured to operate without the need for the driveline 400, or the driveline 400 need not extend extracorporeally. That is, in some examples, an extracorporeal control system may be configured to both control the operation of the pump, and to power the pump wirelessly ( e.g through a transcutaneous energy transmission system). In some examples, transcutaneous energy transmission may be accomplished through known means of transcutaneous energy transmission, such as those described in U.S. Patent No. 6,400,991. Such a configuration eliminates the need to route the driveline 400 through the vasculature and out through a percutaneous access site, which can help minimize a risk for infection. In instances where the system 1000 is arranged trans-apically, the driveline 400 may not exit the patient through the thoracic cavity. In some examples, the driveline 400 may be configured to be unplugged or decoupled from the pump 200 at its junction with the pump 200. In some examples, decoupling the driveline 400 from the pump 200 includes decoupling or removing the retention element 300. In some examples, the system 1000 may include an “antenna” (or internal coil) that is configured for transcutaneous energy transfer (“TET”). In some examples, an extracorporeal TET component maybe worn around the torso similar to a standard heart rate monitor, and additionally coupled to a power source (wall unit or high capacity battery) such that the extracorporeal TET component is operable to transmit energy transcutaneously to the antenna.

[00065] FIG. 2A is an illustration of an implantable medical device for cardiac assistance and sheath 416 in a first delivery configuration, according to some embodiments. As shown in FIG. 2A, an access sheath 416 is arranged at a target location of delivery of an implantable medical device (not shown). The implantable medical device is arranged within a delivery sheath 314. In certain instances and as is shown, the access sheath 416 is arranged to deliver the implantable medical device between the aorta and the left atrium. In addition, the delivery sheath 314 may include a dilator 550 to facilitate delivery.

[00066] FIG. 2B is an illustration the implantable medical device for cardiac, shown in FIG. 2A, in a second delivery configuration, according to some embodiments. As shown in FIG. 2B, a pump 200 is arranged within the access sheath 416. In addition, flanges 520a, 520b may be directly coupled to the pump 200, or the flanges 520a, 520b may form a portion of a conduit 100, which is also arranged and collapsed within the access sheath 416 (and as is shown in further detail with reference to FIGS. 3A-B and in FIG. 6). In certain instances where the flanges 520a, 520b are separate from the pump 200 and form the conduit 100, the pump 200 may be removable from the flanges 520a, 520b. In other instances, the flanges 520a, 520b form a part of and extend from a circumference of the pump 200. A driveline 400 be coupled to the pump 200 to power the pump and communicate with a controller 500 as discussed in detail above.

[00067] FIG. 2C is a side view illustration the implantable medical device for cardiac assistance, shown in FIGS. 2A-B, in a deployed configuration, according to some embodiments. As shown in FIG. 2C, the flanges 520a, 520b have been deployed, and the pump 200 is arranged between the aorta and left atrium. In certain instances, the flanges 520a, 520b may be deployed within a vessel ( e.g ., pulmonary vein), or between the left or right ventricle and the aorta. In addition and as shown in comparing FIG. 2B and FIG. 2C, the pump 200 (and conduit 100) may have been expanded from the delivery configuration. In certain instances, the pump 200 (and conduit 100) may be configured to collapse within the sheath 416. Further, as shown in comparing FIG. 2B and FIG. 2C, the flanges 520a, 520b are configured to expand outwardly from a reduced diameter to engage tissue walls {e.g., of the aorta and left atrium). The flanges 520a, 520b may seal against the tissue walls and stabilize the pump 200 between the aorta and left atrium. As discussed in detail above, the flanges 520a, 520b and pump 200 may be arranged between and connect other areas of patients’ anatomy {e.g., vessel-vessel communication such as percutaneous fistula creation).

[00068] In certain instances, the flanges 520a, 520b may be a first flange 520a arranged at a first end of the conduit 100 and configured to expand from a reduced diameter to engage a first tissue wall {e.g., of the aorta, first vessel), and a second flange 520b is arranged at a second end of the conduit 100 and configured to expand from a reduced diameter to engage a second tissue wall {e.g., of the left atrium, right atrium, left ventricle, right ventricle, second vessel) the first and second flanges 520a, 520b are used to connect two areas within a patient with the conduit 100 being a fluid pathway between the two areas of the patient. When the pump 200 is engaged with the conduit 100, the pump 200 is configured to increase fluid between the areas of the patient. As noted above, the pump 200 may be for cardiac assistance and increase blood flow of the patient’s heart through the patient by supplementing blood flow into the aorta from the heart {e.g., left atrium or ventricle).

[00069] The driveline 400 may exit the left atrium (or other area of the heart). In addition, the pump 200 may be arranged within a conduit 100 as described in detail above. The conduit 100 and the pump 200 may be separately delivered. In addition the flanges 520a, 520b may be coupled to the conduit 100. Further, the pump 200 or the conduit 100 may have anchor features such that the pump 200 is removeable and/or replaceable. As the pump 200 may be removable from the flanges 520a, 520b (and conduit 100).

[00070] FIG. 2D is an end view illustration a flange 520a of the implantable medical device for cardiac assistance, shown in FIGS. 2A-C, in a deployed configuration, according to some embodiments. The flange 520a and flange 520b may be substantially similar structures. As shown, the flange 520a extends circumferentially outwardly relative to the pump 200. In addition, the pump 200 may dock within the flange 520a (and flange 520b). The flanges 520a, 520b (and conduit 100) and pump 200 may be deployed together, as shown in FIGS. 2A-C, or deployed separately (with the flanges 520a, 520b and conduit 100 being deployed and the pump 200 arranged and secured within the flanges 520a, 520b).

[00071] As shown, the flanges 520a, 520b may include a plurality of lobes 524 (with one highlighted for ease of illustration). The lobes 524 may be configured to rest against a tissue surface without puncturing or damaging the tissue. In certain instances, the lobes 524 may conform to the tissue surface. In addition, the lobes 524 stabilize against the tissue to lessen movement of the pump 200. In certain instances, the flanges 520a, 520b and/or the barrel portion 272 may be covered or partially covered with a graft component. In instances where the flanges 520a, 520b contact tissue, the graft portion arranged with the flanges may be configured to facilitate tissue in-growth. The graft portion, for example, can have a microporous structure that provides a tissue ingrowth scaffold for durable occlusion and supplemental anchoring strength. In addition, the graft portion can lessen leakage from about the flanges 520a, 520b.

[00072] FIG. 3A is a side view illustration of an example implantable medical device for cardiac assistance, according to some embodiments. A conduit 100 is shown in FIGS. 3A-B that includes flanges 520a, 520b that extend outwardly relative to a barrel portion 272. As noted above with reference to FIGS. 2A-C, the flanges 520a, 520b may be collapsed inwardly relative in a delivery configuration ( e.g as shown in FIG. 6) In addition, the barrel portion 272 may also be collapsed further to facilitate delivery to a target location.

[00073] As shown, the barrel portion 272 may include one or more anchor elements 570a, 570b configured to interface with a pump 200. One of the anchor elements 570a, 570b is highlighted for east of illustration. In certain instances, the pump 200 may include similar anchor elements 570a, 570b or in other instances, the anchor elements 560 may friction or interference couple to the pump 200 to secure the pump 200 within the conduit 100. The anchor elements 570a, 570b may be spaced about a circumference of the barrel portion 272. In instances where the pump 200 and the conduit 100 include anchor elements 570a, 570b, the anchor elements 570a, 570b of each may interface to secure the pump 200 to the conduit 100. In certain instances, a conduit 100, as described in detail above, may include similar anchor elements 570a, 570b to interface with a pump 200 having the anchor elements 570a, 570b.

[00074] The anchor elements 570a, 570b may be moveable relative to a lumen 46 of the conduit 100. The anchor elements 570a, 570b, for example and as is shown, may extend into the lumen 46, and may be moved outwardly relative to the lumen 46 during engagement and when engaged with the pump 200. In certain instances, the pump 200 may include receiving structures ( e.g ., similar to receiving structure 620) that receive the anchor elements 570a, 570b. In these instances, the anchor elements 570a, 570b may reside within the receiving structure on the pump 200 to secure the pump 200 to the conduit 100. The pump 200 may be arranged within the conduit 100 starting on either of the sides of the flanges 520a, 520b, and forced within the barrel portion 272. The anchor elements 570a, 570b may be forced outwardly by an outer surface of the pump 200 or by an outer surface of a delivery sheath that the pump is arranged {e.g., collapsed) within. The anchor elements 570a, 570b may then deploy or extend inwardly relative to the lumen 46 to engage the pump 200. In certain instances, the anchor elements 570a, 570b are arranged within the barrel portion 272 at a common location {e.g., relative to the x-axis shown on FIG. 3A) about a circumference the barrel portion 272.

[00075] In other instances, the anchor elements 570a, 570b may be staggered relative to the length of the barrel portion 272 such that multiple anchor elements 570a, 570b are arranged at differing locations within the barrel portion 272 relative to the length of the barrel portion 272. In certain instances, and as is shown in FIG. 3A and 3B, the barrel portion 272 includes the anchor elements 570a, 570b at multiple length locations and multiple anchor elements 570a, 570b arranged about the circumference of the barrel portion 272 at the multiple length locations. In these instances, the first row of anchor elements 570a may be configured to engage the pump 200 and the second row of anchor elements 570b are configured to engage the delivery sheath 314.

[00076] In certain instances, the barrel portion 272 and the flanges 520a, 520b are a unitary structure ( e.g formed from a cut-tube) formed by struts 555a, 555b or stent- elements. The flanges 520a, 520b and barrel portion 272 may be self-expanding and/or balloon expandable. In certain instances, the flanges 520a, 520b and barrel portion 272 are formed of Nitinol or stainless steel.

[00077] In certain instances, the barrel portion 272 may be substantially cylindrical and the flanges 520a, 520b may extend from the barrel portion 272 {e.g., as shown in FIG. 7). In other instances and is shown, the barrel portion 272 may increase in circumference or diameter between the flanges 520a, 520b. The barrel portion 272 increasing or tapering in diameter may facilitate arrangement of the pump 200 to engage the anchor elements 570a. The flanges 520a, 520b may extend circumferentially outward relative to the barrel portion 272 as is shown in particular in FIG. 3B. Struts 555b are arranged to extend the flanges 520a, 520 relative to the barrel portion 272. In certain instances, flanges 520a, 520b may be of different diameters, circumferences, shapes, and/or sizes.

[00078] In certain instances, the struts 555b may include a curvature as shown. The curvature of the struts 555b may extend portions of the flanges 520a, 520b downward (relative to a center) of the barrel portion 272. For example and as is shown, perimeters 520c, 520d of the flanges 520a, 520b are arranged lower or downward toward the barrel portion 272 (relative to an apex of the curvature of struts 555b). The curvature of the struts 555b may be a constant curve or a s-shaped curve with multiple stages. In certain instances, the curvature of the struts 555b may be different for each of the flanges 520a, 520b as shown in FIG. 3A. In addition, the perimeters 520c, 520d may be different. As shown, the perimeter 520c has a greater circumference than a circumference of perimeter 520d. The flanges 520a, 520b may be configured in this manner to lessen the pump 200 from shifting or otherwise damaging the tissue wall that the flanges 520a, 520b engage. For example, the pump 200 may be arranged to force blood through the conduit 100 from the flange 520b side to the flange 520a side. The force of the pump 200 may apply greater force on the flange 520b side. Thus, the flange 520b may be greater than the flange 520a to lessen movement of the pump 200. The greater perimeter 520c may increase a surface area of engagement of the flange 520b.

[00079] In certain instances, the struts 555a, 555b may include different widths within the barrel portion 272 and within the flanges 520a, 520b. For example, and as shown in FIG. 3A and FIG. 3B (and in further detail with reference to FIG. 7), a portion of the struts 555b include a less width ( e.g ., relative to the z-axis) than a portion of the struts 555a. The thinner width of the struts 555b may facilitate collapsing of the flanges 520a, 520b to a reduced diameter {e.g., toward the barrel portion 272, which may also reduce in diameter (as shown in FIG. 2A-C). In addition, the thinner width of the struts 555b may enhance flexibility of the flanges 520a, 520b and facilitate conformability of the flanges 520a, 520b to the tissue walls.

[00080] In certain instances, a depth {e.g., relative to the y-axis) of the struts 555a, 555b may differ. The depth of the struts 555a, 555b may be different in addition to or in alternative to the widths of the struts 555a, 555b being different. In certain instances, the depth of the struts 555a may be less than the depth of the struts 555b. In certain instances, the differences in width and depth may be cut into a cut-tube or cut-sheet pattern or laser removed.

[00081] As shown, the flanges 520a, 520b may include a plurality of lobes 524 (with one highlighted for ease of illustration). The lobes 524 may be configured to rest against a tissue surface without puncturing or damaging the tissue. In certain instances, the lobes 524 may conform to the tissue surface. In other instances, as described below with reference to FIG. 8, one of the flanges 520a, 520b may be configured to engage a tissue wall and another of the flanges 520a, 520b may be arranged within a main body portion that is implanted in a patient’s aorta.

[00082] In certain instances, the struts 555b have a width that is greater than the depth. The struts 555b having this arrangement may facilitate conformability and fatigue resistance. The width is aligned with the bend axis of the struts 555b, which may facilitate flexibility. In addition, the struts 555a may have a depth that it is greater than the width. The depth of the struts 555b is aligned where forces act on the barrel portion 272 when implanted. The depth of the struts 555b is configured to lessen potential radial contraction of the barrel portion 272.

[00083] FIG. 4A is an illustration of another implantable medical device for cardiac assistance in a first configuration, according to some embodiments. The device is a conduit 100 having flanges 520a, 520b. In certain instances, the flanges 520a, 520b are formed of a metallic material {e.g., Nitinol) and the conduit 100 is formed a graft material the conduit 100 may also include stent-components. In addition, reference may be made to FIG. 3A and FIG. 3B for further discussion of the arrangement and aspects of the flanges 520a, 520b. The flanges 520a, 520b, when arranged with the conduit 100, may include a barrel portion 754 that facilitates connection to the conduit 100. The conduit 100, as shown, includes a conduit outer surface, a conduit first end and a conduit second end defining a conduit length, and a lumen 46 extending therethrough.

[00084] In certain instances, one or both of the flanges 520a, 520b may be moveable along a length of the conduit 100. One or both of the flanges 520a, 520b may be positioned to a location along the conduit 100. As shown in comparing FIG. 4A and FIG. 4B, flange 520b is moved from the configuration shown in FIG. 4A to an opposite end of the conduit 100. In certain instances, the conduit 100 may be a pump 200, the conduit 100 may be similar to the conduit 100 and be configured to securely anchor a pump 200 therein. Thus, the conduit 100 may include one or more anchor or attachment features as described in detail above. In certain instances, the flange 520a is fixed to the conduit 100 and is not moveable along the length of the conduit 100. The conduit 100, as shown, may be corrugated such that the moveable flange 520b may stop at a number of locations along the conduit 100. One of both of the flanges 520a, 520b may include one or more tabs 752 that are configured to interface with corrugations on the conduit 100. The tabs 752 may be spaced about a circumference of the flanges 520a, 520b in instances where the flanges 520a, 520b include more than one tab 752. In certain instances, the conduit 100 includes one, two, three, four, or any additional corrugations.

[00085] During delivery, the flanges 520a, 520b and conduit 100 may be arranged within a sheath ( e.g as described above with reference to FIGS. 2A-C). The following describes the solution for use in a ventricular assistance procedure. The flanges 520a, 520b are attached to the conduit 100 (which may be the pump 200 as noted above) are constrained within the sheath. The sheath is placed across a pathway from the left atrium to the aorta, for example, and pulled back while holding a delivery catheter (not shown) stationary. The flange 520a deploys first to engage the tissue wall of, for example, the aorta. The delivery catheter is pulled proximally, abutting the underside of the flange 520a to the aortic wall. The sheath is further pulled back exposing the flange 520b, for example, to engage the tissue wall of the left atrium. The sheath may then advance distally to move the flange 520b along the conduit 100. The flange 520b may be moved closer to flange 520 until the flanges 520a, 520b abut, as shown in FIG. 4A, or until the tissue provides sufficient resistance against further movement. The conduit 100 includes a lumen 46 for fluid flow. The conduit 100 may connect any two areas of the body and may include a medical device other than a pump (e.g., occluder, filter, sensor or other).

[00086] FIG. 5A is a side view illustration of an example implantable medical device for cardiac assistance, according to some embodiments. The device is a conduit 100 and includes flanges 520a, 520b, and a barrel portion 272. In certain instances, the flanges 520a, 520b are formed of a metallic material {e.g., Nitinol) and the conduit 100 is formed a graft material the conduit 100 may also include stent-components. As noted above with reference to FIGS. 2A-C, the flanges 520a, 520b may be collapsed inwardly relative in a delivery configuration and the barrel portion 272 may also be collapsed further to facilitate delivery to a target location. Further, the barrel portion 272 may include one or more anchor elements 570a, 570b configured to interface with a pump 200 as shown and discussed with reference to FIGS. 3A-B.

[00087] As shown in FIG. 5A, the conduit 100 is in a first configuration and the flanges 520a, 520b are shown in a transition between delivery configuration (where the conduit 100 is a substantially cylindrical shape as shown in FIG. 2A) and in a deployed configuration shown in FIG. 5B. The flanges 520a, 520b are configured to expand in response to a contraction in length of the conduit. The flanges 520a, 520b are configured to expand or spring open relative to the barrel portion 272 when released from the delivery or collapsed configuration.

[00088] In certain instances, the flanges 520a, 520b may be a first flange 520a arranged at a first end of the conduit 100 and configured to expand from a reduced diameter to engage a first tissue wall {e.g., of the aorta, first vessel), and a second flange 520b is arranged at a second end of the conduit 100 and configured to expand from a reduced diameter to engage a second tissue wall {e.g., of the left atrium, right atrium, left ventricle, right ventricle, second vessel) the first and second flanges 520a, 520b are used to connect two areas within a patient with the conduit 100 being a fluid pathway between the two areas of the patient. When the pump 200 is engaged with the conduit 100, the pump 200 is configured to increase fluid between the areas of the patient. As noted above, the pump 200 may be for cardiac assistance and increase blood flow of the patient’s heart through the patient by supplementing blood flow into the aorta from the heart {e.g., left atrium or ventricle).

[00089] As shown, the flanges 520a, 520b may include a plurality of lobes 524 (with one highlighted for ease of illustration). The lobes 524 may be configured to rest against a tissue surface without puncturing or damaging the tissue. In certain instances, the lobes 524 may conform to the tissue surface. In addition, the lobes 524 stabilize against the tissue to lessen movement of the pump 200.

[00090] The flanges 520a, 520b may include gaps 530 (one highlighted for ease of illustration) to allow blood flow into the conduit 100 for the pump to force through the conduit. The gaps 530 may lessen collapsing of the flanges 520a, 520b against the tissue wall during operation of the pump.

[00091] FIG. 6 is a perspective view illustration of an example implantable medical device for cardiac assistance in a delivery configuration, according to some embodiments. As shown, the flanges 520a, 520b are collapsed inwardly relative in a delivery configuration. The flanges 520a, 520b and the barrel portion 272 are arranged in a substantially cylindrical configuration.

[00092] The flanges 520a, 520b and the barrel portion 272 may transition between the delivery configuration to in a deployed configuration shown in FIGS. 3A-B. The flanges 520a, 520b are configured to expand to engage tissue, and may spring open relative to the barrel portion 272 when released from the delivery or collapsed configuration.

[00093] FIG. 7 is a side view illustration of an example implantable medical device for cardiac assistance, according to some embodiments. As shown, a conduit 100 includes flanges 520a, 520b that extend outwardly relative to a barrel portion 272. In certain instances, the barrel portion 272 and the flanges 520a, 520b are a unitary structure ( e.g formed from a cut-tube) formed by struts 555a, 555b or stent-elements.

[00094] As shown, the barrel portion 272 may be substantially cylindrical and the flanges 520a, 520b may extend from the barrel portion 272. The flanges 520a, 520b may extend circumferentially outward relative to the barrel portion 272 as is shown. Struts 555b are arranged to extend the flanges 520a, 520 outwardly relative to the barrel portion 272. In certain instances, the struts 555b may include a curvature as shown. The curvature of the struts 555b may extend portions of the flanges 520a, 520b downward (relative to a center 590 or midline) of the barrel portion 272. For example and as is shown, perimeters 520c, 520d of the flanges 520a, 520b are arranged lower or downward toward the barrel portion 272 (relative to an apex of the curvature of struts 555b). The curvature of the struts 555b may be a constant curve or a s-shaped curve with multiple stages.

[00095] In certain instances, the struts 555a, 555b may include different widths within the barrel portion 272 and within the flanges 520a, 520b. For example, and as shown in FIG. 7 (and described in additional detail relative to FIG. 3A and FIG. 3B), a portion of the struts 555b include a less width ( e.g ., relative to the z-axis) than a portion of the struts 555a. The thinner width of the struts 555b may facilitate collapsing of the flanges 520a, 520b to a reduced diameter {e.g., as shown in FIG. 6). In certain instances, a depth {e.g., relative to the y-axis) of the struts 555a, 555b may differ. The depth of the struts 555a, 555b may be different in addition to or in alternative to the widths of the struts 555a, 555b being different. In certain instances, the depth of the struts 555a may be less than the depth of the struts 555b.

[00096] In certain instances, the struts 555b have a width that is greater than the depth. The struts 555b having this arrangement may facilitate conformability and fatigue resistance. The struts 555b are configured to bend and fold relative to the barrel portion 272. The width is aligned with the bend axis of the struts 555b, which may facilitate flexibility. In addition, the struts 555a may have a depth that it is greater than the width. The depth of the struts 555b is aligned where forces act on the barrel portion 272 when implanted. The depth of the struts 555b is configured to lessen potential radial contraction of the barrel portion 272.

[00097] As discussed in detail above, the barrel portion 272 may include anchor elements 570a, 570b. In other instances, the barrel portion 272 may be configured for friction or interference engagement with a pump 200. In certain instances, the anchor elements 570a, 570b are aligned with the center 690 of the barrel portion 272. In addition and as discussed above, the anchor elements 570a, 570b may be staggered and at multiple locations away from the center 690 {e.g., as shown in FIGS. 3A-B) to provide multiple docking locations for the pump 200.

[00098] FIG. 8 is an illustration of an example conduit 100 with flanges 520a,

520b, according to some embodiments. The conduit 100 creates a fluidic connection between spaces or tissue structures such as the aorta and an atrium or ventricle. As shown, the conduit 100 includes flanges 520a, 520b as discussed in detail above. The flanges 520a, 520b may be arranged to seal the conduit 100 within tissue structures or within a main body 208 of an implantable medical device. The main body 208 may be a stent, graft, or stent graft component that is configured to implant within a patient’s aorta. In instances where the conduit 100 includes two flanges 520a, 520b as shown, the main body 208 includes a fenestration (either created after implantable or prior to implantation). [00099] The conduit 100 includes a lumen 46 that extends longitudinally from a first end of the conduit 100 to a second end of the device 40. The lumen 46 acts as a connection ( e.g a shunt passageway) between the main body 208, implanted in the aorta, and the internal intestinal space of the heart {e.g., atrium or ventricle), such that the main body 208 is in fluid communication with the atrium or ventricle via the anastomosis conduit 100.

[000100] The flange 520b may be configured to engage a tissue wall 522 in a fluid tight fluid communication between the conduit 100 and atrium or ventricle into which the conduit 100 is arranged. The flange 520 prevents leakage between the puncture made in the atrium or ventricle and the conduit 100.

[000101] Figures 9-14 show various conduits 100 as may be used to engage a pump 200 as discussed in detail above. The conduits 100 shown in Figures 9-14 may include anchoring features such as the one or more anchor elements 570a, 570b described in detail above. In certain instances, the anchor elements 570a, 570b may be include a different shape or form than those shown. For example, the anchor elements 570a, 570b may be hooks, j-shape hooks, protrusions, or other elements that may interface with a corresponding recess or opening. For further discussion regarding other anchoring elements, reference may be made to U.S. Patent Application Ser. No. 16/577,565 (“ Bryson et al."), which is incorporated herein by reference.

[000102] In addition, the conduits 100 shown in Figures 9-14 include petals that may engage tissue walls. The petals may conform with the tissue and lessen the opportunity for tissue erosion.

[000103] FIG. 9A is an end view another example conduit 100 into which a pump may be arranged, according to some embodiments. FIG. 9B is a side view of the conduit 100, shown in FIG. 9B and a pump 200, according to some embodiments. The conduit 100 includes a wire frame 51 and a proximal 608 and distal eyelet 610, a plurality of wires 52 or a struts of a cut tube. The wires 52 form petals 55 that overlap one another in a deployed configuration as shown in FIG. 9. The wires 52 include a graft component 604 that may be attached to the frame. A portion of the graft component 604 of one petal 55 overlaps or overlays a portion of the graft component 604 of another petal 55. The pump 200 may friction fit within the eyelets 608, 610 or in other instances, the eyelets 608, 610 may include anchor features as discussed in detail herein. The petals 55 may be incorporated within any of the conduits 100 discussed above. The petals 55 may be formed as part of the flanges noted above. For further discussion regarding the conduit 100 shown in FIGS. 9A-B, reference may be made to U.S. Patent Application Ser. No. 13/838,166 (“Goble etai”), which is incorporated herein by reference.

[000104] FIG. 10 is a side view another example conduit 100 and a pump 200, according to some embodiments. The conduit 100 includes a distal end 308 and a proximal end 304. As shown, the distal end 308 is coupled to a delivery sheath 314 as discussed in detail above. The conduit 100 includes petals 356, 360 on each side of a waist 312. The petals 356, 360 and waist 312 may include struts formed by slits in a cut- tube. In certain instances, the waist 312 may include anchor features as discussed in detail herein. The petals 55 may be incorporated within any of the conduits 100 discussed above. The petals 356, 360 may be formed as part of the flanges noted above. For further discussion regarding the conduit 100 shown in FIG. 10, reference may be made to U.S. Patent No. 9,949,728 (“Cahill"), which is incorporated herein by reference.

[000105] FIG. 11 A is an end view another example conduit 100 into which a pump may be arranged, according to some embodiments. FIG. 11 B is a side view of the conduit 100, shown in FIG. 11 B, according to some embodiments. The conduit 100 includes one or more elongate members 410 that form a first apposition portion 420, a second apposition portion 430, and a central portion 440. The central portion 440 is disposed between the first apposition portion 420 and the second apposition portion 430. The central portion 440 is configured to traverse an opening or aperture in one or more layers of tissue. The apposition portions 420, 430 may be configured to be on opposite sides of the layer(s) of tissue. The one or more elongate members 410 may define petals 422 that form the first apposition portion 420, and petals 432 that form the second apposition portion 430. The central portion 440 may include anchor features as discussed in detail herein. The petals 422, 432 may be formed as part of the flanges noted above. For further discussion regarding the conduit 100 shown in FIGS. 11 A-B, reference may be made to U.S. Patent Publication No. 2015/0313599A1 (“Johnson et a!..").

[000106] FIG. 12 is a perspective view another example conduit 100 into which a pump may be arranged, according to some embodiments. The conduit 100 may include a framework of one or more elongate elements 501 that defines a first apposition portion 502, a second apposition portion 504, and a central portion 508. The central portion 506 is disposed between and interconnects the first apposition portion 502 and the second apposition portion 504. In certain instances, a graft component 512 is disposed on at least some portions of the conduit 100. In certain instances, the apposition portions 502 and 504 include one or more flange components 502a and 504a, respectively. Such flange components (e.g., flange components 502a and 504a) may also be referred to herein as "fins," "petals," or "fingers." The flange components 502a and 504a can be configured to exert a predictable and desired apposition force when in contact with tissue. The flange components 502a and 504a may be formed as part of the flanges noted above. The central portion 508 may include anchor features as discussed in detail herein. For further discussion regarding the conduit 100 shown in FIG. 12, reference may be made to U.S. Patent Publication No. 2015/0313595A1 (“ Houghton eta!.."), which is incorporated herein by reference.

[000107] FIG. 13A is a perspective view another example conduit 100 into which a pump may be arranged, according to some embodiments. FIG. 13B is a side view of the conduit 100, shown in FIG. 13B, according to some embodiments. The conduit 100 generally includes generally includes a first frame component 110 arranged on a first tissue wall, a second frame component 120 arranged on a second tissue wall, and a conduit portion 130. As shown, the conduit portion 130 is arranged between the first frame component and the second frame component. At least a portion of the conduit portion 130 is generally radially or circumferentially unsupported by the first and second frame components 110, 120 within the conduit portion 130. Each of the frame components 110, 120 may include petals 112, 122. The petals 112, 122 may conform to the tissue walls. FIG. 14 is a perspective view another example conduit 100 into which a pump may be arranged, according to some embodiments. The conduit 100 shown in FIG. 14 includes common features to that of the conduit 100 shown in FIGS. 13A-B.

The petals 112, 122 may be formed as part of the flanges noted above. The conduit portion 130 may include anchor features as discussed in detail herein.

[000108] A biocompatible material for the graft components, discussed herein, may be used. In certain instances, the graft may include a fluoropolymer, such as a polytetrafluoroethylene (PTFE) polymer or an expanded polytetrafluoroethylene (ePTFE) polymer. In some instances, the graft may be formed of a polyester, a silicone, a urethane, a polyethylene terephthalate, or another biocompatible polymer, or combinations thereof. In some instances, bioresorbable or bioabsorbable materials may be used, for example a bioresorbable or bioabsorbable polymer. In some instances, the graft can include Dacron, polyolefins, carboxy methylcellulose fabrics, polyurethanes, or other woven or film elastomers.

[000109] In addition, nitinol (NiTi) may be used as the material of the frame or stent (and any of the frames discussed herein), but other materials such as stainless steel, L605 steel, polymers, MP35N steel, polymeric materials, Pyhnox, Elgiloy, or any other appropriate biocompatible material, and combinations thereof, can be used as the material of the frame. The super-elastic properties and softness of NiTi may enhance the conformability of the stent. In addition, NiTi can be shape-set into a desired shape. That is, NiTi can be shape-set so that the frame tends to self-expand into a desired shape when the frame is unconstrained, such as when the frame is deployed out from a delivery system.

[000110] The invention of this application has been described above both generically and with regard to specific embodiments. It will be apparent to those skilled in the art that various modifications and variations can be made in the embodiments without departing from the scope of the disclosure. Thus, it is intended that the embodiments cover the modifications and variations of this invention provided they come within the scope of the appended claims and their equivalents.

Claims

WHAT IS CLAIMED IS:

1. A device for cardiac assistance, the implantable medical device comprising: a barrel portion including a lumen for fluid flow; a first flange at a first end of the barrel portion and configured to expand from a reduced diameter to engage a first tissue wall side; a second flange at a second end of the barrel portion and configured to expand from a reduced diameter to engage a second tissue wall side; and one or more anchor elements arranged within the barrel portion and configured to releasably engage a pump within the barrel portion.

2. The device of claim 1 , wherein the barrel portion, the first flange, and the second flange form a unitary structure that is a conduit.

3. The device of claim 2, wherein the one or more anchor elements are arranged within the barrel portion and extend within the lumen.

4. The device of claim 3, wherein the first flange, the second flange, and the barrel portion are formed by struts having one or more of differing widths or differing depths within the barrel portion and within at least one of the first flange and the second flange.

5. The device of claim 4, wherein the struts include a curvature that extends portions of the flanges toward a center of the barrel portion.

6. The device of any one of claims 4-5, wherein a portion of the struts within at least one of the first flange and the second flange include a width less than a portion of the struts within the barrel portion.

7. The device of any one of claims 4-5, wherein a portion of the struts within the barrel portion include a depth less than a portion of the struts within at least one of the first flange and the second flange.

8. The device of any one of claims 2-7, wherein the one or more anchor elements are spaced about a circumference of the barrel portion.

9. The device of claim 8, wherein the one or more anchor elements are configured to move inwardly into the lumen and move outwardly relative to the lumen to engage the pump.

10. An apparatus comprising: a conduit having a conduit outer surface, a conduit first end and a conduit second end defining a conduit length, and a lumen extending therethrough; a first flange coupled to the conduit outer surface adjacent the conduit first end and configured to expand from a reduced diameter to a larger diameter operable to engage a first tissue surface; and a second flange coupled to the conduit outer surface adjacent the conduit second end and configured to expand from a reduced diameter to a larger diameter operable to engage a second tissue surface, wherein the first flange and the second flange include gaps to allow fluid flow into the conduit for a pump to transfer fluid through the conduit.

11. An apparatus comprising: a conduit having a conduit outer surface, a conduit first end and a conduit second end defining a conduit length, and a lumen extending therethrough; one or more petals arranged at least one of a first end and a second end of the conduit; and one or more anchor elements arranged with the conduit and configured to releasably engage a medical device arranged within the conduit.

12. The apparatus of claim 11 , wherein the medical device is a pump.