Steerable tubes

A method comprising:

• advancing a delivery apparatus comprising a steerable tube, over a guidewire, to a host valvular structure, the steerable tube comprising:
• two longitudinal slots defining a first tube portion and a second tube portion, a steerable tube distal portion extending distally from the longitudinal slots, and a slotted section which comprises a plurality of pairs of circumferential slots disposed along the second tube portion and defining a backbone opposite to the first tube portion;
• bending the slotted section by axially moving the first tube portion and the second tube portion relative to each other;
• and
• forming, with a piercing tip of the delivery apparatus, a pilot puncture within a host leaflet of the host valvular structure.

A stabilized tissue modification system, comprising:

• an anchor device comprising:
• an anchor shaft defining an anchor shaft lumen;
• a helical anchor head coupled to the anchor shaft, the helical anchor head defining an anchor channel in fluid communication with the anchor shaft lumen, the helical anchor head comprising:
• an anchor proximal end;
• and
• at least one helical slot extending distally from the anchor proximal end, the at least one helical slot defining one or more helical turns, wherein a distal- most helical turn of the one or more helical turns defines a tip portion terminating at an anchor tip;
• a balloon catheter defining a balloon catheter lumen;
• and
• a hole-dilating balloon mounted on the balloon catheter and in fluid communication with the balloon catheter lumen, the hole-dilating balloon configured to transition between deflated and inflated states thereof;
• wherein the anchor shaft is a flexible torque shaft configured to rotate around a central axis thereof, such that when the anchor shaft is rotated, the helical anchor head is configured to rotate therewith, and wherein the tip portion further comprises a cutting edge opposite to an inner side of the tip portion.

A steerable delivery system comprising:

• a handle;
• and a steerable catheter assembly extending distally from the handle and comprising:
• a steerable assembly lumen defining a steerable assembly central longitudinal axis;
• an inner tube comprising:
• an inner tube slotted portion defining an inner tube outer surface oriented away from the steerable assembly central longitudinal axis;
• and an inner tube distal end portion distal to the inner tube slotted portion;
• an outer tube disposed around the inner tube, the outer tube comprising:
• an outer tube slotted portion defining an outer tube inner surface oriented towards the steerable assembly central longitudinal axis;
• and an outer tube distal end portion distal to the inner tube slotted portion;
• and a pull-member comprising:
• a pull-ring portion affixed to the inner tube distal end portion and to the outer tube distal end portion;
• and at least one elongated pull-arm extending proximally from the pull-ring portion, wherein the at least one elongated pull-arm is disposed between the inner tube outer surface and the outer tube inner surface, and is axially slidable relative to the inner tube slotted portion and the outer tube slotted portion;
• wherein the at least one elongated pull-arm defines a circumferential width between arm circumferential ends that is greater than a radial thickness of the at least one elongated pull-arm;
• and wherein the at least one elongated pull-arm is configured to bend the steerable catheter assembly when the at least one elongated pull-arm is proximally pulled.