Advanced 3-Way Steering

Abstract

A medical device delivery system includes a steering catheter including a first steering ring having a plurality of apertures positioned in the wall of the first steering ring. The plurality of apertures are positioned at spaced distances around a circumference of the first steering ring. A first steering cable passes through a first one of the apertures, and a first return cable passes through a second one of the apertures. A second steering cable passes through a third one of the apertures, and a second return cable passes through a fourth one of the apertures. The first steering cable is positioned about 180 degrees from the second steering cable. A handle is operably coupled to a proximal end of the steering catheter. A first control member controls the first steering and first return cable, and a second control member controls the second steering and second return cable.

1 . A medical device delivery system comprising:
 a steering catheter including:
 a first steering ring having a proximal end, a distal end, an outer surface, an inner surface, a wall defined between the outer surface and inner surface, and a central lumen defined by the inner surface along a longitudinal direction; 
 a plurality of apertures positioned in the wall of the first steering ring, the plurality of apertures positioned at spaced distances around a circumference of the first steering ring; 
 a first steering cable passing through a first aperture of the plurality of apertures; 
 a second steering cable passing through a third aperture of the plurality of apertures, wherein the first steering cable is positioned about 180 degrees from the second steering cable; and 
   a handle operably coupled to a proximal end of the steering catheter, the handle including:
 a first control member, the first steering cable coupled to the first control member so that actuation of the first control member in a first direction pulls the first steering cable; 
 a second control member, the second steering cable coupled to the second control member so that actuation of the second control member in a third direction pulls the second steering cable. 
   
     
     
         2 . The system of  claim 1 , wherein the steering catheter includes a first return cable passing through a second aperture of the plurality of apertures and a second return cable passing through a fourth aperture of the plurality of apertures, the first return cable being coupled to the first control member so that actuation of the first control member in a second direction opposite the first direction pulls the first return cable, the second return cable being coupled to the second control member so that actuation of the second control member in a fourth direction opposite the third direction pulls the second control member. 
     
     
         3 . The system of  claim 2 , further comprising a third steering cable passing through a fifth aperture of the plurality of apertures of the first steering ring and a third return cable passing through a sixth aperture of the plurality of apertures. 
     
     
         4 . The system of  claim 3 , further comprising a third control member, the third steering cable and the third return cable coupled to the third control member so that actuation of the third control member in a fifth direction pulls the third steering cable, and actuation of the second control member in a sixth direction opposite the fifth direction pulls the third return cable. 
     
     
         5 . The system of  claim 4 , further comprising a second steering ring, the second steering ring spaced apart from the first steering ring in a longitudinal direction and including a proximal end, a distal end, an outer surface, an inner surface, a wall defined between the outer surface and inner surface, a central lumen defined by the inner surface along a longitudinal direction, and a plurality of apertures positioned in the wall at spaced distances around a circumference of the second steering ring. 
     
     
         6 . The system of  claim 5 , wherein the second steering cable extends through a first aperture of the second steering ring and the second return cable extends through a second aperture of the second steering ring. 
     
     
         7 . The system of  claim 6 , wherein the first steering cable extends through a third aperture of the second steering ring and the first return cable extends through a fourth aperture of the second steering ring. 
     
     
         8 . The system of  claim 7 , wherein the first aperture of the second steering ring and the third aperture of the second steering ring are diametrically opposed to each other and the second aperture of the second steering ring and the fourth aperture of the second steering ring are diametrically opposed to each other. 
     
     
         9 . The system of  claim 5 , further comprising a third steering ring, the third steering ring spaced apart from the first steering ring and the second steering ring in a longitudinal direction and including a proximal end, a distal end, an outer surface, an inner surface, a wall defined between the outer surface and inner surface, a central lumen defined by the inner surface along a longitudinal direction, and a plurality of apertures positioned in the wall at spaced distances around a circumference of the third steering ring. 
     
     
         10 . The system of  claim 9 , wherein the first steering cable extends through a first aperture of the third steering ring and the first return cable extends through a second aperture of the third steering ring. 
     
     
         11 . The system of  claim 10 , wherein actuation of the first control member in the first direction pulls the first steering ring, actuation of the second control member in the third direction pulls the second steering ring, and actuation of the third control member in the fifth direction pulls the third steering ring. 
     
     
         12 . The system of  claim 9 , wherein each of the first steering cable, the second steering cable, and the third steering cable is a pair of cables and each of the plurality of apertures of the first steering ring, second steering ring, and third steering ring is a corresponding pair of apertures. 
     
     
         13 . The system of  claim 12 , wherein each of the first steering ring, the second steering ring, and the third steering ring comprises a step between each aperture of the pairs of apertures. 
     
     
         14 . The system of  claim 9 , further comprising a hypotube having a proximal section, an intermediary section, and distal section. 
     
     
         15 . The system of  claim 14 , wherein the proximal section has slits to allow for bending of the hypotube corresponding to a pull direction of the first steering ring, the intermediary section has slits to allow for bending of the hypotube corresponding to a pull direction of the second steering ring, and the distal section has slits to allow for bending of the hypotube corresponding to a pull direction of the third steering ring. 
     
     
         16 . The system of  claim 4 , wherein each of the first control member, the second control member, and the third control member is a knob. 
     
     
         17 . The system of  claim 11 , wherein the first and second apertures of the third steering ring are offset from each other an angle equal to an angle between the third and fourth apertures in the second steering ring. 
     
     
         18 . The system of  claim 15 , wherein the bending of the hypotube corresponding to the pull direction of the second steering ring is coplanar with the bending direction of the hypotube corresponding to the pull direction of the third steering ring. 
     
     
         19 . A method of implanting a prosthetic atrioventricular valve into a patient, comprising:
 positioning a valve cover of a delivery device in or adjacent a native atrioventricular valve annulus of the patient while the prosthetic atrioventricular valve is in a collapsed condition within the valve cover;   withdrawing the valve cover to expose a ventricular anchor of the prosthetic atrioventricular valve, the ventricular anchor being restricted from self-expansion upon being exposed;   further withdrawing the valve cover to expose an atrial anchor of the prosthetic atrioventricular valve, the atrial anchor self-expanding and deploying upon being exposed;   advancing the prosthetic atrioventricular valve distally until the self-expanded and deployed atrial anchor contacts tissue on an atrial side of the native atrioventricular valve annulus; and   after the atrial anchor contacts tissue on the atrial side of the native atrioventricular valve annulus, releasing the restriction on the ventricular anchor to allow the ventricular anchor to self-expand and deploy into contact with a ventricular side of the native atrioventricular valve annulus.