US20150351906A1 - Ventricularly-anchored prosthetic valves - Google Patents
Ventricularly-anchored prosthetic valves Download PDFInfo
- Publication number
- US20150351906A1 US20150351906A1 US14/763,004 US201414763004A US2015351906A1 US 20150351906 A1 US20150351906 A1 US 20150351906A1 US 201414763004 A US201414763004 A US 201414763004A US 2015351906 A1 US2015351906 A1 US 2015351906A1
- Authority
- US
- United States
- Prior art keywords
- valve
- valve body
- upstream
- coupled
- tissue
- Prior art date
- Legal status (The legal status 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 status listed.)
- Abandoned
Links
Images
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
- A61F2/2427—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
- A61F2/2409—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
- 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
- A61F2/2427—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
- A61F2210/0076—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof multilayered, e.g. laminated structures
-
- 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
- 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
- A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
-
- 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
- A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2220/0075—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements sutured, ligatured or stitched, retained or tied with a rope, string, thread, wire or cable
-
- 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
- A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
- A61F2250/0096—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers
- A61F2250/0098—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers radio-opaque, e.g. radio-opaque markers
Definitions
- Some applications of the present invention relate in general to valve replacement. More specifically, some applications of the present invention relate to prosthetic cardiac valves and techniques for implantation thereof.
- Ischemic heart disease causes regurgitation of a heart valve by the combination of ischemic dysfunction of the papillary muscles, and the dilatation of the ventricle that is present in ischemic heart disease, with the subsequent displacement of the papillary muscles and the dilatation of the valve annulus.
- Dilation of the annulus of the valve prevents the valve leaflets from fully coapting when the valve is closed. Regurgitation of blood from the ventricle into the atrium results in increased total stroke volume and decreased cardiac output, and ultimate weakening of the ventricle secondary to a volume overload and a pressure overload of the atrium.
- tissue anchors coupled to tethers are transluminally anchored to ventricular tissue of a native valve.
- a prosthetic valve component such as a prosthetic valve assembly, a prosthetic valve body, or a support, is transluminally slid along a guide member coupled to the tethers, and is anchored to the tethers.
- a prosthetic valve assembly comprises (1) a valve body shaped to define a lumen therethrough, and a valve member disposed within the lumen, (2) an upstream support configured to be placed against an upstream surface of a native heart valve, and (2) a flexible sheet that couples the upstream support to the valve body.
- the prosthetic valve assembly comprises eyelets to facilitate sliding along the guide member.
- the prosthetic valve assembly has a compressed delivery state in which the valve body and the upstream support are articulatably coupled to each other by the sheet.
- a delivery tool houses the prosthetic valve assembly such that the valve body and upstream support are articulatable with respect to each other during transluminal delivery.
- the prosthetic valve assembly comprises tethers that, when tensioned, move the valve body closer to the support.
- the assembly typically comprises tissue-engaging elements that protrude from the valve body, and the tethers are tensioned to sandwich tissue of the native valve between the tissue-engaging elements and the support.
- one or more forces is measured during implantation, and distributed among various anchoring elements.
- an intracorporeal spring is used that is extracorporeally observable using imaging techniques.
- the spring facilitates force distribution.
- a prosthetic valve assembly comprises a flexible sheet forms a pocket between the sheet and a frame of the assembly, and facilitates sealing between the assembly and tissue of the native valve.
- tissue anchors coupled to longitudinal members that are reversibly couplable to wires are transluminally advanced to the ventricle downstream of a native heart valve, and are anchored there.
- a prosthetic valve support comprising an upstream support portion is slid, in a compressed delivery configuration, over the wires and part of each longitudinal member, and into an atrium upstream of the native valve where it is deployed (e.g., expanded) and placed against an upstream surface (e.g., an atrial surface) of the native valve.
- a locking member is also slid over the wires and part of each longitudinal member, and locks to the longitudinal member, thereby securing the prosthetic valve support against the upstream surface of the native valve.
- a prosthetic valve is subsequently transluminally advanced to the native valve, and is implanted by coupling the prosthetic valve to leaflets of the native valve and to the prosthetic valve support.
- a tubular member is slidable over the wire and the longitudinal member, and when disposed over the wire and the long member, inhibits decoupling of the wire from the longitudinal member.
- the prosthetic valve support and the locking member are typically slidable over the tubular member.
- a control rod reversibly coupled to the locking member, is slid over the tubular member so as to push the locking member and the prosthetic valve support over the tubular member.
- the control rod is used to lock the locking member to the longitudinal member.
- apparatus for use with a native valve of a heart of a subject including:
- the upstream support is coupled to the valve body only via the sheet.
- the valve body has an upstream end, a downstream end, and a longitudinal axis therebetween along which the lumen is defined, and
- the sheet provides fluid communication between the opening and the lumen.
- the sheet is not attached to the inner perimeter of the second frame.
- the sheet is not attached to an upstream end of the valve body.
- the sheet is generally annular when the valve body is in the expanded state thereof and the upstream support is in the expanded state thereof.
- the sheet is generally frustoconical when the valve body is in the expanded state thereof and the upstream support is in the expanded state thereof.
- the sheet is attached to the inner perimeter of the second frame.
- the sheet is circumferentially attached to the second frame at a radius that is greater than a radius of the inner perimeter.
- the sheet is circumferentially attached to the second frame at the outer perimeter of the second frame.
- the sheet is attached to an upstream end of the valve body.
- the first frame is generally cylindrical in both the compressed state thereof and the expanded state thereof.
- the second frame is generally cylindrical in the compressed state thereof.
- the valve body includes at least one downstream anchor, configured such that, in the expanded configuration of the valve body, the anchor protrudes radially outward from the first frame.
- the apparatus further includes at least one tensioning element, coupled to the valve body and to the upstream support, a length of the tensioning element between the valve body and the upstream portion being adjustable such that a distance between the first frame and the second frame is adjustable.
- the at least one tensioning element includes a tether.
- the at least one tensioning element is coupled to the first frame, and slidably coupled to the second frame.
- valve body, the upstream support and the sheet together define a prosthetic valve assembly, the prosthetic valve assembly:
- valve body having an expanded state in which the valve body is in the expanded state thereof and the second frame of the upstream support is in the expanded state thereof
- the apparatus further includes a delivery tool:
- first housing configured to house and maintain at least part of the upstream support in the compressed state thereof, and defining a first housing orifice through which the at least part of the upstream support is removable from the first housing
- a second housing configured to house and maintain at least part of the valve body in the compressed state thereof, and defining a second housing orifice through which the at least part of the valve body is removable from the second housing,
- the delivery tool having a contracted state in which the second housing is disposed at a first distance from the first housing, and in which the delivery tool is configured to transluminally advance the prosthetic valve assembly in the compressed state thereof, to the native valve, and
- the apparatus having an extended state in which the second housing is disposed at a second distance from the first housing, the second distance being greater than the first distance, and the apparatus is configured such that, when the at least part of the upstream support is housed by the first housing and the at least part of the valve body is housed by the second housing, transitioning of the delivery tool from the contracted state into the extended state exposes at least part of at least one component selected from the group consisting of: the valve body and the upstream support, from the housing that houses the selected component.
- the apparatus is configured to be used with at least two guide members,
- the prosthetic valve assembly includes at least two eyelets, each eyelet being slidable over a respective one of the guide members, and
- the apparatus is configured such that the eyelets of the prosthetic valve assembly protrude radially outward and radially beyond an outer surface of the second housing while: (1) the at least part of the valve body, in the compressed state thereof, is housed by the second housing, and (2) the at least part of the upstream support, in the compressed state thereof, is housed by the first housing.
- the eyelets are pivotably coupled to the valve body.
- the delivery tool further includes at least two reference-force tubes, each reference-force tube configured (1) to be slidable over a respective one of the guide members, and (2) to apply a distally-directed force to the prosthetic valve assembly.
- each reference-force tube extends distally (1) through a lumen defined by the second frame of the upstream support, (2) through the sheet, and (3) along an outside of at least part of the valve body.
- the apparatus further includes at least two locking members, each locking member:
- the apparatus further includes the at least two guide members:
- each guide member includes:
- the tubular member inhibits decoupling of the pull-wire from the tether while the distal portion of the pull-wire and the proximal portion of the tether are disposed within the lumen of the tubular member, and
- the tubular member of each guide member while the tubular member of each guide member is disposed within the respective locking member, the tubular member inhibits transitioning of the locking member into the locked state.
- the apparatus is configured such that, for each respective guide member and locking member, while (1) the tubular member is disposed within the locking member, (2) the distal portion of the pull-wire and the proximal portion of the tether are disposed within the lumen of the tubular member, and (3) the tissue anchor is coupled to the ventricular tissue:
- proximal sliding of the tubular member with respect to the tether facilitates automatic transitioning of the locking member into the locked state
- At least one housing selected from the group consisting of: the first housing and the second housing has a lateral wall that is shaped to define at least two slits, the eyelets being configured to protrude radially outward from the delivery tool via the slits.
- each slit of the at least one selected housing is continuous with the orifice of the at least one selected housing.
- the eyelets are coupled to and protrude radially outward from the valve body.
- the eyelets are pivotably coupled to the valve body.
- the articulation zone defined by the prosthetic valve assembly includes a first articulation zone
- the apparatus defines a second articulation zone at a longitudinal zone of the apparatus (a) between the second housing and the first housing, and (b) in which is disposed at least part of the first articulation zone.
- the delivery tool further includes a housing-control rod that extends through the first housing and is coupled to the second housing such that a first portion of the housing-control rod is disposed within the first housing, a second portion of the housing-control rod is disposed within the second housing, and a third portion of the housing-control rod (1) is disposed within the second articulation zone, and (2) is more flexible than at least one portion of the housing-control rod selected from the group consisting of: the first portion and the second portion.
- the delivery tool further includes (1) a control rod assembly including at least a first housing-control rod coupled to the first housing, and (2) a second housing-control rod, more flexible than the first housing-control rod, extending through the first housing-control rod, extending through the second articulation zone, and coupled to the second housing.
- a control rod assembly including at least a first housing-control rod coupled to the first housing, and (2) a second housing-control rod, more flexible than the first housing-control rod, extending through the first housing-control rod, extending through the second articulation zone, and coupled to the second housing.
- the second housing orifice faces the first housing orifice.
- the delivery tool further includes a flexible control rod assembly including (1) a first housing-control rod coupled to the first housing, (2) a second housing-control rod coupled to the second housing, and (3) a prosthesis-control rod reversibly couplable to the prosthetic valve assembly,
- valve body is removable from the second housing by moving the second housing-control rod with respect to the prosthesis-control rod.
- the prosthesis-control rod is reversibly couplable to the prosthetic valve assembly by being reversibly couplable to the valve body.
- At least part of the second housing-control rod is disposed within and slidable through the prosthesis-control rod, and at least part of the prosthesis-control rod is disposed within and slidable through the first housing-control rod.
- the outer perimeter of the second frame has a third diameter that is greater than the second diameter.
- the inner perimeter has a fourth diameter that is greater than the second diameter.
- a gap is defined between the first frame and the second frame, the sheet spanning the gap.
- no metallic structure is disposed within the gap.
- the sheet is configured to inhibit expansion of the second frame.
- the apparatus is configured such that when the second frame expands from the compressed state thereof toward the expanded state thereof, the sheet retains the second frame in a generally frustoconical shape by inhibiting expansion of at least the outer perimeter of the second frame.
- the sheet extends over at least part of the second frame to serve as a covering of the upstream support.
- the covering defines a tissue-contacting surface of the upstream support.
- the sheet extends over at least part of the first frame to serve as a covering of the valve body.
- the covering is disposed on an inner surface of the first frame.
- apparatus for use with a native valve of a heart of a subject including:
- a prosthetic valve configured to be percutaneously delivered to the native valve
- annular upstream support configured to be placed against an upstream surface of the native valve, and to support the prosthetic valve at the native valve
- tissue anchor including a tissue-engaging element configured to be anchored to ventricular muscle tissue of the heart;
- a tether coupled to the tissue anchor
- a spring couplable to the tether so as to elastically couple the tissue-engaging element to the prosthetic valve.
- the spring is shaped to define a repeating pattern.
- the spring is pre-loaded.
- the spring is a constant-force spring.
- the spring is configured to facilitate extracorporeal fluoroscopic observation of a state of the spring.
- the spring is coupled to a plurality of radiopaque markers such that a juxtaposition of the markers changes as the state of the spring changes, the juxtaposition of the markers being extracorporeally fluoroscopically observable.
- the spring is coupled to at least one radiopaque marker
- the apparatus further includes an intracorporeal reference, a juxtaposition between the radiopaque marker and the intracorporeal reference being extracorporeally fluoroscopically observable.
- the intracorporeal reference includes a scale including a plurality of radiopaque markers.
- the plurality of radiopaque markers includes a first plurality of radiopaque markers, and the at least one radiopaque marker includes a second plurality of radiopaque markers.
- the spring is configured to provide distinct indication that is observable using fluoroscopy, when the spring is experiencing a force that is within a margin force from a target force.
- the spring is configured to provide the distinct indication when the spring experiences a force that is above 300 g force.
- the spring is configured to provide the distinct indication when the spring experiences a force that is above 400 g force.
- the spring is configured to provide the distinct indication when the spring experiences a force that is about 500 g force.
- the spring is coupled to the prosthetic valve, and is intracorporeally lockable to the tether subsequently to anchoring of the tissue anchor to the ventricular muscle tissue.
- the spring is slidable along at least part of the tether, and is intracorporeally couplable to the tether by inhibiting the sliding.
- the prosthetic valve includes a generally cylindrical valve body having an upstream end, and the spring includes an elastically-deformable appendage that protrudes laterally from the valve body.
- the prosthetic valve includes a generally cylindrical valve body having an upstream end, a downstream end, and a longitudinal lumen therebetween, and
- the spring (1) includes a compression spring having a longitudinal axis, and (2) is disposed laterally from, the valve body such that the longitudinal axis of the spring is generally parallel with the longitudinal lumen.
- the prosthetic valve includes:
- valve body having an upstream end, a downstream end, and a longitudinal lumen therebetween;
- tissue-engaging legs protruding laterally outward from the valve body, and configured to be placed against a ventricular surface of the native valve.
- the prosthetic valve is couplable to the upstream support intracorporeally by being expanded within an opening defined by the upstream support while the upstream support is disposed against the upstream surface.
- the apparatus is configured such that the coupling of the prosthetic valve to the upstream support couples the tether to the prosthetic valve.
- the apparatus is configured to sandwich a portion of the native valve between the tissue-engaging legs and the upstream support by providing a space having a height between the tissue-engaging legs and the upstream support.
- the apparatus is configured to facilitate altering the height without altering a force on the spring.
- the apparatus is configured such that altering the height automatically alters a force on the spring.
- the apparatus is configured to facilitate altering the height by moving the valve body through the opening defined by the upstream support.
- apparatus for use with a native heart valve of a subject including:
- an upstream support having an inner perimeter couplable to the valve body at a first longitudinal position of the valve body, the upstream support being configured to extend radially outward from the valve body and the inner perimeter;
- a flexible sheet defining a first aperture, a second aperture and a lateral wall therebetween, a first portion of the sheet that defines the first aperture being circumferentially attached to the upstream support portion at a radius that is greater than a radius of the inner perimeter, and a second portion of the sheet that defines the second aperture being circumferentially attached to the valve body at a second longitudinal position of the valve body, such that a pocket region is defined between the sheet and at least the first longitudinal position.
- the second longitudinal position is closer to the downstream end of the valve body than is the first longitudinal position.
- the first aperture is larger than the second aperture.
- the sheet is attached to the upstream support at an outer perimeter of the upstream support.
- the sheet assumes a frustoconical shape.
- the sheet assumes a funnel shape.
- the apparatus is provided with the inner perimeter of the upstream support pre-coupled to the valve body at the first longitudinal position of the valve body.
- the apparatus is configured such that the inner perimeter of the upstream support is intracorporeally couplable to the valve body at the first longitudinal position of the valve body.
- apparatus for use with a native heart valve disposed between an atrium and a ventricle of a heart of a subject including:
- annular upstream support defining an opening therethrough, and configured to be placed against an upstream surface of the native heart valve
- valve body having an upstream end, a downstream end and a lumen therebetween, the lumen having a first diameter, and the valve body being separated from the upstream element by a gap between the upstream end of the valve body and the upstream element;
- tissue-engaging elements that protrude radially outward from the valve body so as to define a second diameter that is greater than the first diameter
- a flexible sheet shaped to define a conduit, a downstream portion of the sheet being coupled to the valve body, an upstream portion of the sheet being coupled to the upstream element, and the sheet spanning the gap.
- the apparatus further includes at least one tether, a first portion of the tether being coupled to the valve body and a second portion of the tether being coupled to the upstream support, such that tensioning of at least a portion of the tether reduces the gap.
- the apparatus is configured such that tensioning of at least the portion of the tether rumples the sheet.
- apparatus for use with a native heart valve disposed between an atrium and a ventricle of a heart of a subject including:
- annular upstream element defining an opening therethrough, and configured to be placed against an upstream surface of the native heart valve
- a flexible sheet shaped to define a conduit, and coupled to the upstream element such that the conduit is in fluid communication with the opening;
- valve body coupled to the flexible sheet such that the conduit provides fluid communication between the prosthetic valve and the upstream element.
- the valve body includes:
- valve member coupled to the frame and disposed within the lumen.
- the frame is separated from the upstream element by a gap, and the conduit spans the gap.
- apparatus for use with a guide member that extends into a subject, the apparatus including:
- a delivery tool including a housing, the housing:
- the implant is configured to be implanted by being intracorporeally locked to the guide member.
- the implant has a compressed state and an expanded state, is configured to be housed by the housing while in the compressed state, and is configured to automatically expand toward the expanded state when removed from the housing.
- a method for use with a native valve of a heart of a subject including:
- the prosthetic valve including (1) a valve body shaped to define a lumen therethrough, and (2) one or more tissue-engaging legs configured to protrude laterally outward from the valve body;
- the spring at least in part responsively to the observed shape of the spring, facilitating holding of the upstream support against an upstream surface of the native valve by locking a second portion of the tether to at least one component selected from the group consisting of: the prosthetic valve and the upstream support.
- measuring the force includes measuring the force using an extracorporeal force meter.
- measuring the force includes observing a shape of the tissue-engaging legs using imaging.
- applying the tension includes applying the tension while applying the force.
- locking the second portion to the selected component includes locking the second portion to the prosthetic valve.
- locking the second portion to the selected component includes locking the second portion to the upstream support.
- locking the second portion includes locking the second portion when the observed shape indicates that the spring is experiencing between 400 g force and 600 g force.
- locking the second portion includes locking the second portion subsequently to applying the tension
- applying the force includes applying the force subsequently to locking the second portion
- anchoring the tissue anchor coupled to the tether includes anchoring a first tissue anchor coupled to a first tether, and applying the tension includes applying a first tension that changes a shape of a first spring coupled to the first tether,
- the method further includes:
- facilitating holding of the prosthetic valve against the upstream surface includes, at least in part responsively to the observed shape of the second spring, facilitating holding of the prosthetic valve against the upstream surface by locking a second portion of the second tether to the selected at least one component.
- facilitating holding includes locking the second portion of the first tether and the second portion of the second tether to the selected at least one component, at least in part responsively to a ratio between tension in the first tether and tension in the second tether, the ratio being derived from the observed shape of the first spring and the observed shape of the second spring.
- locking includes locking the second portion to the at least one component at least in part responsively to the observed shape.
- locking includes locking the second portion to the at least one component at least in part responsively to the measured force.
- applying the force includes moving the valve body in an upstream direction through an opening defined by the upstream support, and the method further includes coupling the prosthetic valve to the upstream support by expanding the valve body within the opening.
- coupling the prosthetic valve to the upstream support includes coupling the prosthetic valve to the upstream support at least in part responsively to the measured force.
- a method, for use with a native valve of a heart of a subject including:
- a first tension to a tether that couples (a) a tissue anchor anchored to ventricular tissue of a subject, to (b) a prosthetic valve body, the tether having a length between the tissue anchor and the valve body;
- a method for use with a native valve of a heart of a subject including:
- tensioning the tether coupled to the upstream support includes tensioning a tether that is coupled to a valve body coupled to the upstream support.
- the upstream support is generally flat annular, and changing the shape includes making the support assume a frustoconical shape.
- the upstream support before the tensioning, is frustoconical, and changing the shape includes changing a slant of the frustoconical shape.
- apparatus for use with a valve of a heart of a subject including:
- a tether a first end thereof coupled to the tissue anchor
- a delivery tool including:
- the anchor manipulator is slidably coupled to the catheter such that a distal end of the anchor manipulator is slidable distally no more than a pre-determined distance from the longitudinal site.
- the apparatus further includes an implant, intracorporeally lockable to the tether.
- the apparatus further includes a guide member, reversibly couplable to the tether, and the implant is intracorporeally slidable along the guide member toward the tether and the implant.
- the tether has exactly one locking site at which the implant is lockable to the tether.
- the exactly one locking site is disposed at a pre-determined distance from the anchor that is pre-determined at least in part dependently on a distance between the longitudinal site and a distal end of the catheter.
- apparatus for implantation at a native valve of a heart of a subject, the native valve being disposed between an atrium and a ventricle of the heart, the apparatus including:
- valve member disposed in the lumen of the valve body, and configured to facilitate flow of blood of the subject from the upstream portion of the valve body to the downstream portion of the valve body, and to inhibit flow of the blood from the downstream portion of the valve body to the upstream portion of the valve body.
- the at least one valve member is coupled to the downstream portion of the valve body.
- the native valve includes a plurality of native leaflets, and the downstream portion of the valve body is configured to be coupled to the native leaflets.
- the apparatus further includes a plurality of clips, configured to facilitate the coupling of the downstream portion of the valve body to the native leaflets.
- each clip :
- the clips are coupled to the downstream portion of the valve body, and the downstream portion of the valve body is configured to be coupled to the native leaflets by the clips being coupled to the native leaflets.
- each clip of the plurality of clips is articulatably coupled to the downstream portion of the valve body.
- the native valve includes an annulus having an upstream surface
- the apparatus further includes a prosthetic valve support:
- an upstream support portion configured to be placed against the upstream surface of the annulus of the native valve, and (2) the plurality of clips, coupled to the upstream support portion,
- the clips are configured to facilitate the coupling of the downstream portion of the valve body to the native leaflets by coupling the prosthetic valve support to the native leaflets.
- apparatus for use with a native valve of a heart of a subject the native valve having a plurality of leaflets that meet at a plurality of commissures, the apparatus including:
- At least one tissue anchor configured to be anchored to a first site within a ventricle of the heart of the subject
- At least one longitudinal member coupled at a distal end thereof to a respective one of the at least one tissue anchors
- an upstream support including an upstream support portion configured to be slidable over the longitudinal member and placed against an upstream surface of the native valve;
- At least one locking member configured to be slidable over a respective one of the at least one longitudinal members, and to be lockable to the respective longitudinal member such that a portion of the respective longitudinal member that is disposed between the respective anchor and the upstream support portion is longer than 1 cm.
- the longitudinal member is flexible.
- the longitudinal member includes a suture.
- a method for use with a native valve of a heart of a subject including:
- first tissue anchor to a first site within a ventricle of the heart of the subject, the first tissue anchor being coupled to a distal end of a first longitudinal member
- anchoring, placing, and securing include anchoring, securing, and placing without the use of cardiopulmonary bypass.
- anchoring to the first site and anchoring to the second site include anchoring to myocardium.
- placing the upstream support portion against the upstream surface includes sliding the upstream support portion over at least part of the first longitudinal member.
- coupling the upstream support portion to the first longitudinal member and to the second longitudinal member includes coupling the upstream support portion to the first longitudinal member in the atrium of the heart of the subject, and coupling the upstream support portion to the second longitudinal member includes coupling the upstream support portion to the second longitudinal member in the atrium of the heart of the subject.
- the leaflets move in response to beating of the heart of the subject, and securing the upstream support portion includes securing the upstream support portion without eliminating the movement of the native leaflets.
- coupling the upstream support portion to the first longitudinal member includes coupling the upstream support portion to the first longitudinal member such that a length of the portion of the first longitudinal member is greater than 1 cm.
- the method further includes:
- sliding the at least first tubular member includes sliding at least part of the at least first tubular member through a channel defined by a locking member, and coupling the upstream support portion to the respective longitudinal member includes locking the locking member to the respective longitudinal member by narrowing at least a portion of the channel.
- advancing the at least first tissue anchor includes advancing the at least first tissue anchor while (1) the respective longitudinal member is reversibly coupled to a portion of a wire, and (2) the respective tubular member inhibits the portion of the wire from decoupling from the portion of the wire, and
- the method further includes facilitating decoupling of the wire from the respective longitudinal member by sliding the at least first tubular member off of the portion of the wire.
- advancing the at least first tissue anchor includes advancing the at least first tissue anchor while (1) the respective longitudinal member is shaped to define a loop, and is coupled to the portion of the wire by the portion of the wire being threaded through the loop, and (2) the respective tubular member inhibits the portion of the wire from unthreading from the loop, and
- facilitating decoupling of the wire from the respective longitudinal member includes facilitating unthreading of the wire from the loop by sliding the at least first tubular member off of the portion of the wire.
- sliding the at least first tubular member off of the portion of the wire includes sliding the at least first tubular member off of the portion of the wire by applying less than 500 g of pulling force to the at least first tubular member.
- applying less than 500 g of pulling force to the at least first tubular member includes applying less than 300 g of pulling force to the at least first tubular member.
- the method further includes, subsequently to securing the upstream support portion, coupling a prosthetic valve to the prosthetic valve support.
- the upstream support portion has an inner edge that defines an opening through the upstream support portion
- coupling the prosthetic valve to the prosthetic valve support includes placing at least a portion of the prosthetic valve within the opening, and expanding at least the portion of the prosthetic valve such that at least the portion of the prosthetic valve applies a radially-expansive force against the inner edge of the upstream support portion
- the prosthetic valve includes one or more tissue-engaging elements, each of the one or more tissue-engaging elements including at least two arms, and the method further includes, subsequent to securing the upstream support portion, coupling the prosthetic valve to at least one of the leaflets by sandwiching the at least one of the leaflets between the at least clip arms of the one or more tissue-engaging elements.
- coupling the prosthetic valve to the at least one of the leaflets includes coupling the prosthetic valve to the at least one of the leaflets before coupling the prosthetic valve to the prosthetic valve support.
- the prosthetic valve includes a valve body, having an outer surface
- the at least two arms include a first arm and a second arm, the first arm being longer than the second arm, and
- the method further includes:
- facilitating deflection of the first arm includes facilitating deflection of the first arm a first angle from the outer surface of the prosthetic valve
- the method further includes facilitating deflection of the first arm away from the outer surface of the prosthetic valve a second angle that is greater than the first angle, by applying a force to the first arm using the delivery tube:
- applying the force to the first arm using the delivery tube includes pushing on the first arm by sliding the delivery tube over at least part of the prosthetic valve.
- apparatus for use with a body of a subject including:
- first longitudinal member coupled at a distal end thereof to the first implantable member
- the portion of the second longitudinal member is configured, when (1) the portion of the second longitudinal member is coupled to the first longitudinal member, and (2) the portion of the second longitudinal member is disposed outside of the lumen of the tubular member, to be decouplable from the first longitudinal member by the second longitudinal member being pulled away from the first longitudinal member.
- At least one longitudinal member selected from the group consisting of: the first longitudinal member and the second longitudinal member, is flexible.
- the tubular member is more rigid than the first longitudinal member.
- the tubular member fits snugly over at least the portion of the second longitudinal member.
- the first implantable member includes a tissue anchor, configured to be anchored to a tissue of the subject.
- the apparatus further includes a second implantable member, slidable over the tubular member, and couplable to the first longitudinal member while the portion of the second longitudinal member is coupled to the first longitudinal member.
- the portion of the second longitudinal member is reversibly couplable to the first longitudinal member at a first site of the first longitudinal member, and the second implantable member is couplable to the first longitudinal member at a second site of the first longitudinal member that is distal to the first site of the longitudinal member.
- the apparatus further includes a locking member having an unlocked state and a locked state, and configured to be slid over the tubular member in the unlocked state and to be locked to the first longitudinal member by being transitioned to the locked state.
- the locking member is configured to facilitate coupling of the second implantable member to the first longitudinal member.
- the locking member is configured to be coupled to the first longitudinal member at least 1 cm away from the first implantable member.
- apparatus for use at a native valve of a heart of a subject including:
- tissue anchor configured to be transluminally, transcatheterally advanced to a ventricle of the heart of the subject, and to be coupled to tissue of the ventricle;
- tissue anchor a longitudinal member, coupled at a distal end thereof to the tissue anchor;
- a prosthetic valve support including an upstream support portion slidable over the tubular member, and to be placed against an upstream surface of an annulus of the native valve by sliding over the tubular member;
- a locking member slidable over the tubular element and lockable to the longitudinal member.
- the locking member is configured to be locked to the longitudinal member at a site of the longitudinal member that is distal to a site of the longitudinal member to which the portion of the wire is reversibly couplable.
- the tubular member is configured to be slid out of the locking member before the locking member is locked to the longitudinal member.
- the apparatus further includes a control rod, slidable over the tubular member, the locking member being reversibly coupled to a control rod, the control rod being configured to restrain the locking member in an unlocked configuration thereof, and to facilitate locking of the locking member by ceasing to restrain the locking member in the unlocked configuration.
- control rod is configured to decouple from the locking member when the control rod ceases to restrain the locking member in the unlocked configuration thereof.
- control rod is configured to cease to restrain the locking member in the unlocked configuration thereof by the control rod being rotated with respect to the locking member.
- the prosthetic valve support is shaped to define a hole through which the tubular member is slidable
- control rod is coupled to the locking member, the control rod is not slidable through the hole defined by the prosthetic valve support, and
- control rod is configured to facilitate the sliding of the prosthetic valve support over the tubular member by pushing the prosthetic valve support over the tubular member.
- FIGS. 1A-F are schematic illustrations of a system for implanting a prosthetic valve support and a prosthetic valve at a native valve of a heart of a subject, in accordance with some applications of the invention
- FIG. 2 is a schematic illustration of the prosthetic valve being retrieved into a delivery tube, in accordance with some applications of the invention
- FIGS. 3A-C are schematic illustrations of the introduction of guide members through the prosthetic valve support and a delivery tube, in accordance with some applications of the invention
- FIGS. 4A-C are schematic illustrations of a locking member, and control thereof, in accordance with some applications of the invention.
- FIG. 5 is a schematic illustration of steps in the delivery and anchoring of tissue anchors, in accordance with some applications of the invention.
- FIG. 6 is a schematic illustration of a system for use with a prosthetic valve support, in accordance with some applications of the invention.
- FIGS. 7A-C are schematic illustrations of a system for facilitating transluminal delivery of a prosthetic valve assembly, in accordance with some applications of the invention.
- FIGS. 8A-H are schematic illustrations of a technique for use with the system of FIGS. 7A-C , to transluminally implant a prosthetic valve assembly, in accordance with some applications of the invention
- FIGS. 9A-B , 10 A-B, 11 A-B, 12 A-B, 13 A-B, and 14 A-B are schematic illustrations of prosthetic valve assemblies, in accordance with some applications of the invention.
- FIGS. 15A-C are schematic illustrations of a tool for facilitating application of force between a prosthetic valve assembly and tethers, in accordance with some applications of the invention.
- FIG. 16 is a schematic illustration of a system comprising a prosthetic valve assembly and one or more springs, via which the prosthetic valve assembly is elastically coupled to one or more tissue anchors, in accordance with some applications of the invention
- FIG. 17 is a schematic illustration of a system comprising a prosthetic valve assembly and one or more springs, via which the prosthetic valve assembly is elastically coupled to one or more tissue anchors, in accordance with some applications of the invention
- FIGS. 18A-B are schematic illustrations of springs coupled to respective tethers so as to elastically couple a tissue anchor to a prosthetic valve assembly, in accordance with some applications of the invention
- FIGS. 19A-B are schematic illustrations of a system for facilitating delivery of a prosthetic valve body, in accordance with some applications of the invention.
- FIG. 20 is a schematic illustration showing examples in which force measurements described herein may be combined to facilitate implantation of a prosthetic valve, in accordance with some applications of the invention.
- FIGS. 21A-B are schematic illustrations of a prosthetic valve assembly, in accordance with some applications of the invention.
- FIGS. 22A-B are schematic illustrations of a prosthetic valve assembly comprising a prosthetic valve having a tubular valve body that comprises an upstream portion, a downstream portion, and an elastic portion disposed between the upstream portion and the downstream portion, in accordance with some applications of the invention.
- FIGS. 23-24 are schematic illustrations of systems for facilitating anchoring of a tissue anchor in the heart of a subject, in accordance with some applications of the invention.
- FIGS. 1A-F are schematic illustrations of a system 40 for implanting an upstream prosthetic valve support 42 and a prosthetic valve 44 at a native valve 10 of a heart 4 of a subject, in accordance with some applications of the invention.
- applications of the invention are for use with the mitral valve of the subject (that is, native valve 10 comprises the mitral valve of the subject), but it is to be noted that applications of the invention may be used at other heart valves of the subject, such as the tricuspid valve, the aortic valve, or the pulmonary valve, mutatis mutandis.
- a sheath 46 is advanced transluminally (e.g., transfemorally) to right atrium 12 of the heart, and is typically advanced through the fossa ovalis into left atrium 6 of the heart using standard transseptal techniques. For some applications, sheath 46 is steerable. For some such applications, sheath 46 is steerable in two axes.
- tissue anchors 48 are advanced through sheath 46 , between leaflets 14 of the native valve, and into left ventricle 8 of the heart, and are there anchored to tissue (e.g., ventricular muscle tissue) of the heart.
- FIG. 1A shows a first tissue anchor 48 a being anchored at a first ventricular site
- FIG. 1B shows a second tissue anchor 48 b being anchored at a second ventricular site
- anchors 48 are anchored to muscle of the heart, such as to the walls of ventricle 8 and/or to papillary muscles.
- anchors 48 comprise helical anchors that are anchored by being rotated.
- other types of anchors may be used, such as barbed or harpoon-like anchors, e.g., that are anchored by being pushed into the tissue.
- FIGS. 1A and 1B show a catheter 50 having been advanced through sheath 46 and into ventricle 8 , and an anchor-delivery tube 52 having been advanced through catheter 50 to the respective ventricular site.
- the distal end of delivery tube 52 is placed against the tissue at the ventricular site.
- at least a distal portion of catheter 50 is steerable (e.g., independently of sheath 46 ).
- Anchor 48 is reversibly coupled to an anchor manipulator 54 (e.g., an anchor driver), which is slidable through at least part of tube 52 , and which is configured to apply a force (e.g., a rotational force) to the anchor so as to anchor the anchor at the ventricular site.
- anchor manipulator 54 and anchor 48 are advanced from outside the subject to the ventricular site only once the distal end of tube 52 is disposed against the ventricular site.
- the manipulator and anchor are disposed within, and advanced with, tube 52 .
- anchor 48 is anchored by rotating anchor manipulator 54 and tube 52 together.
- a separate anchor manipulator 54 is used to deliver and anchor each anchor 48 (e.g., each anchor 48 may be provided pre-coupled to a respective anchor manipulator).
- one anchor manipulator 54 may be used to deliver and anchor all (e.g., both) anchors 48 (e.g., each anchor 48 may be configured to be sequentially coupled to the anchor manipulator outside the body of the subject by the operating physician). It is to be noted that typically anchor 48 is not exposed from tube 52 other than when being anchored. It is hypothesized that for some applications this reduces a likelihood of inadvertently engaging and/or damaging tissue of the heart (e.g., chordae tendineae).
- a testing pulling force of known magnitude is applied to the anchor (e.g., by applying the pulling force to anchor manipulator 54 ), and movement of the tissue anchor in response to the pulling force is observed using imaging (e.g., fluoroscopy).
- the observed movement may be used to confirm successful and/or stable anchoring (e.g., relatively little movement may indicate firm anchoring in firm tissue) or to determine sub-optimal anchoring (e.g., relatively large movement may indicate weak anchoring and/or anchoring in weak tissue).
- the operating physician may decouple manipulator 54 from anchor 48 , or may de-anchor the anchor from the tissue using the manipulator.
- FIGS. 1A and 1B show anchor manipulator 54 having been decoupled from anchor 48 , and the manipulator and tube 52 being withdrawn proximally into catheter 50 .
- Each anchor 48 is provided pre-coupled to a guide member 56 (e.g., a first guide member 56 a , and a second guide member 56 b ), described in more detail hereinbelow (e.g., with reference to FIGS. 1 D and 4 A-C).
- guide member 56 e.g., a first guide member 56 a , and a second guide member 56 b
- the same catheter 50 is used to deliver both anchors 48 .
- anchor-delivery tube 52 fits alongside first guide member 56 a within catheter 50 .
- a separate catheter is used for each anchor, in which case the second catheter fits alongside first guide member 56 a within sheath 46 .
- FIGS. 1A and 1B show catheter 50 having been withdrawn proximally, into atrium 6 .
- catheter 50 is withdrawn completely from the body of the subject.
- catheter 50 is used for delivery of components during later steps in the procedure.
- Guide members 56 extend from atrium 6 , between leaflets 14 , and to respective ventricular sites. Typically, guide members 56 do not eliminate functioning of leaflets 14 and/or valve 10 .
- guide members 56 are configured to automatically move toward respective commissures 16 (e.g., into the joining corners at the commissures of leaflets 14 ).
- prosthetic valve support 42 e.g., deployment thereof pushes guide members 56 toward the respective commissures.
- FIG. 1C shows prosthetic valve support being delivered to, and deployed at, native valve 10 .
- Prosthetic valve support 42 is advanced through sheath 46 and into atrium 6 .
- support 42 is delivered in a compressed configuration thereof, within a housing, such as a delivery tube 80 .
- catheter 50 is used to facilitate delivery of prosthetic valve support 42 and delivery tube 80 (e.g., the support and delivery tube are advanced through catheter 50 ).
- a different catheter is used to facilitate delivery of prosthetic valve support 42 and delivery tube 80 .
- prosthetic valve support 42 and delivery tube 80 are advanced directly through sheath 46 .
- Prosthetic valve support 42 comprises an annular upstream support portion 43 which, in the delivery configuration of the prosthetic valve support, is generally cylindrical, and which, once the prosthetic valve is deployed and expands to an uncompressed configuration thereof, is generally annular.
- upstream support portion 43 is generally frustoconical in the uncompressed configuration thereof.
- a distal end of upstream support portion 43 in the compressed, cylindrical configuration defines an inner perimeter of the upstream support portion in the uncompressed configuration, the inner perimeter defining an opening through the upstream support portion.
- FIG. 1C shows delivery tube 80 , containing support 42 , having been delivered to atrium 6 over guide members 56 , and support 42 starting to be subsequently exposed from the delivery tube, and automatically expanding.
- Upstream support portion 43 of prosthetic valve support 42 is shaped to define holes 82 through which guide members 56 are slidable, thereby facilitating sliding of the prosthetic valve support over guide members 56 .
- holes 82 are disposed opposite each other around the generally annular shape of upstream support portion 43 .
- holes 82 are defined and/or reinforced by an eyelet 84 or pledget (visible in states B and C of FIG. 1C ).
- Guide members 56 extend proximally from delivery tube 80 , e.g., via holes in a proximal end of the delivery tube, such that the delivery tube, and prosthetic valve support 42 , in the compressed state within the delivery tube, are slidable over the guide members, the guide members thereby facilitating delivery of the prosthetic valve support within the delivery tube. Introduction of guide members 56 through the prosthetic valve support and delivery tube are described hereinbelow with reference to FIGS. 3A-C .
- State B of FIG. 1C shows prosthetic valve support 42 (e.g., upstream support portion 43 thereof) having been completely deployed from delivery tube 80 , and having automatically expanded to the uncompressed configuration thereof.
- Guide members 56 are typically pushed toward commissures 16 by the expansion of support 42 .
- delivery tube 80 is subsequently removed from the body of the subject.
- a tubular control rod 86 is advanced over each guide member 56 toward prosthetic valve support 42 , and is used to push prosthetic valve support 42 (e.g., upstream support portion 43 thereof) toward the annulus of valve 10 .
- Control rods 86 have a cross-sectional diameter that is larger than that of holes 82 , and may thereby be used to push against upstream support portion 43 without passing through the holes.
- prosthetic valve support 42 (e.g., upstream support portion 43 thereof) is provided with one or more (e.g., two) control filaments 88 reversibly coupled thereto.
- filaments 88 are coupled to upstream support portion 43 at sites that are disposed opposite each other around the generally annular shape of the upstream support portion, and disposed evenly between holes 82 . That is, in the expanded configuration of upstream support portion 43 , a straight line between holes 82 is typically perpendicular to a straight line between the sites at which filaments 88 are coupled to the upstream support portion. It should be noted that other numbers and arrangements of control filaments may also be used.
- each control filament 88 (1) comprises two portions of a loop of filament that passes through upstream support portion 43 , loops around a downstream surface of the upstream support portion (i.e., the surface that is placed in contact with the annulus of the native valve), and passes back through the upstream support portion, and (2) is decouplable from the upstream support portion by releasing a first end of the filament and pulling a second end, thereby unthreading and/or unlooping the control filament from the upstream support portion.
- Control filaments 88 facilitate some manipulation of prosthetic valve support 42 following deployment from delivery tube 80 .
- control rods 86 further facilitate such manipulation.
- State C of FIG. 1C shows such manipulation of prosthetic valve support 42 .
- it may be desirable to rotate the prosthetic valve support e.g., to position and/or orient the upstream support portion correctly with respect to native valve 10 , to control the order in which different regions of upstream support portion 43 contact the native valve, and/or to uncoil control rods 86 and/or control filaments 88 from each other).
- Each guide member 56 typically comprises a tether (e.g., a longitudinal member 102 ), a pull-wire 104 reversibly coupled to the longitudinal member, and a tubular member 100 in which the longitudinal member and the pull-wire are disposed, the tubular member fitting snugly over the longitudinal member and the pull-wire so as to inhibit the pull-wire from becoming decoupled from the longitudinal member (e.g., to maintain a state of coupling therebetween).
- Pull-wire 104 may or may not be metallic and may have various cross-sectional shapes (e.g., circular or rectangular).
- longitudinal member 102 defines a loop (e.g., a closed loop) (2) a portion (e.g., a distal portion) of pull-wire 104 is threaded through the loop defined by member 102 (e.g., is looped through the loop), and (3) the snug fitting of tubular member 100 over member 102 and pull-wire 104 inhibits the portion of the pull-wire from unthreading from the loop.
- longitudinal member 102 is shown as defining a loop that extends most (e.g., all) of the length of the longitudinal member, the loop may alternatively be defined only at a proximal end of the longitudinal member.
- longitudinal member 102 and pull-wire 104 are coupled via complementary screw threads.
- longitudinal member 102 may comprise, or be coupled to, a screw at a proximal end thereof
- pull-wire 104 may comprise, or be coupled to, a socket at a distal end thereof.
- tubular member 100 is used to decouple (e.g., unscrew) pull-wire 104 from longitudinal member 102 .
- Tubular member 100 is typically more rigid than pull-wire 104 and/or longitudinal member 102 (although it is still sufficiently flexible to be transluminally delivered). This rigidity reduces a likelihood of twisting, kinking, snagging, and/or other undesirable phenomenon or interactions within the transluminal delivery system (e.g., within sheath 46 , catheter 50 , and/or anchor-delivery tube 52 ).
- tubular member 100 has a smoother surface than does pull-wire 104 or longitudinal member 102 .
- tubular member 100 which is necessarily wider than pull-wire 104 and/or longitudinal member 102 , is also more visible using imaging techniques such as fluoroscopy. This advantageously allows an operating physician to monitor the intracorporeal juxtaposition of the tubular members and, if necessary, to intervene, such as by revolving the tubular members (e.g., proximal ends thereof) around each other.
- control rods 86 are used to push prosthetic valve support 42 toward the annulus of valve 10 by sliding the control rod over a respective guide member 56 (i.e., over the tubular member 100 of the respective guide member).
- Each control rod 86 is reversibly coupled at a distal end thereof to a respective locking member 110 that, in an unlocked state thereof, is slidable over guide member 56 .
- the pushing of prosthetic valve support 42 is typically performed by pushing with both control rod 86 and locking member 110 .
- State A of FIG. 1D shows control rods 86 and respective locking members 110 having been slid over respective tubular members 100 of respective guide members 56 , such that prosthetic valve support 42 has been pushed against the annulus of valve 10 .
- a counter force e.g., a proximal pulling force
- guide member 56 e.g., to tubular member 100 , longitudinal member 102 , and pull-wire 104
- State B of FIG. 1D shows tubular member 110 having been pulled proximally such that the distal end of the tubular member is disposed proximal to locking member 110 , thereby exposing, from the tubular member, progressive portions of longitudinal member 102 , at least until the tubular member is not disposed between the longitudinal member and the locking member (e.g., such that the locking member can directly contact the longitudinal member).
- tubular member 100 is pulled proximally such that the distal end thereof is disposed distal to the point at which longitudinal member 102 and pull-wire 104 are coupled, thereby retaining the coupling therebetween.
- locking member 110 While in this state, locking member 110 is locked to longitudinal member 102 (e.g., to a portion of the longitudinal member that is disposed within a channel of the locking member). For some applications, locking member 110 locks automatically in response to withdrawal of tubular member 100 . For some applications, locking of locking member 110 is independent of the withdrawal of the tubular member.
- An embodiment of locking member 110 and control thereof is described in more detail hereinbelow with respect to FIGS. 4A-C . It is to be noted that the scope of the invention also comprises the use of other locking members such as crimp-based locking members, and also comprises other locking techniques such as tying.
- tubular member 100 is pulled further proximally, such that the distal end of the tubular member is disposed proximal to the point at which longitudinal member 102 and pull-wire 104 are coupled, such that the pull-wire is decouplable from the longitudinal member (e.g., unthreadable from the loop defined by the longitudinal member).
- anchors 48 and longitudinal members 102 are configured to withstand a pulling force of at least 500 g, so as to withstand forces within the beating heart.
- the apparatus is typically configured such that a pulling force required to pull tubular member 100 proximally, is less than 500 g, such as less than 300 g.
- a configuration is achieved at least in part by reducing friction between tubular member 100 and pull-wire 104 , such as by thermally treating the pull-wire 104 .
- control rod 86 , tubular member 100 , and pull-wire 104 are pulled proximally, as shown in state D of FIG. 1D , thereby separating the control rod from locking member 110 , and the pull-wire from longitudinal member 102 .
- the control rod is decoupled from locking member 110 prior to said pulling.
- the decoupling of control rod 86 from locking member 110 is synchronous with the locking of the locking member (e.g., the same action locks the locking member and decouples the control rod from the locking member, such as described hereinbelow with respect to FIGS. 4A-C ).
- the decoupling of the control rod from the locking member is independent of the locking of the locking member.
- prosthetic valve support 42 (e.g., upstream support portion 43 thereof) is secured to the upstream surface of the annulus of native valve 10 , only by anchors 48 that are anchored to tissue in ventricle 8 of the subject. It is also to be noted that prosthetic valve support 42 is coupled to longitudinal members 102 in atrium 6 of the subject. Typically, a distance L 1 between each anchor 48 and the point of upstream support portion 43 to which it is coupled (e.g., to a respective hole 82 and/or locking member 110 ) is greater than 0.5 cm, e.g., greater than 1 cm, such as greater than 2 cm.
- each longitudinal member 102 that is disposed between a respective anchor and upstream support portion 43 is typically greater than 0.5 cm, e.g., greater than 1 cm, such as greater than 2 cm.
- the length of each longitudinal member 102 that is disposed between the respective anchor and the upstream support portion is typically less than 10 cm (e.g., less than 7 cm, such as less than 5 cm).
- the ventricular sites at which anchors 48 are anchored are typically more than 0.5 cm (e.g., more than 1 cm, such as more than 2 cm) away from prosthetic valve support 42 .
- FIG. 1E-F show steps in the delivery and implantation of prosthetic valve 44 at native valve 10 , facilitated by prosthetic valve support 42 .
- Prosthetic valve 44 is advanced in a delivery configuration (e.g., in a compressed state), through sheath 44 , typically within a delivery tube 120 .
- Prosthetic valve 44 comprises a stent-like valve body 122 , typically comprising an expandable frame that typically contains a shape-memory material such as nitinol.
- Valve body 122 is shaped to define a lumen therethrough, and an inner surface of the valve body is typically lined with a covering, such as a fabric.
- One or more prosthetic valve members (not shown for clarity), such as prosthetic leaflets, are coupled to valve body 122 and disposed within the lumen thereof.
- Prosthetic valve 44 further comprises one or more tissue-engaging elements 124 .
- valve 44 comprises two tissue-engaging elements 124 coupled to valve body 122 at sites that are on opposite sides of the circumference of the valve body.
- Each tissue-engaging element 124 typically comprises two arms 126 (e.g., a first clip arm 126 a and a second clip arm 126 b ).
- each arm 126 defines an arc that is coupled to valve body 122 at the base of the arc.
- each arm 126 may comprise a single arc of the same shape-memory material as the frame of valve body 122 .
- one or both arms 126 of each tissue-engaging element 124 may be covered in a covering, such as a fabric.
- arms 126 When valve 44 is in the compressed state thereof within delivery tube 120 , arms 126 are held against valve body 122 with a tip 127 of each arm disposed proximally to a site at which that arm is coupled to the valve body.
- Each tissue-engaging element 124 is configured such that a tip 127 a of arm 126 a is disposed distal to a tip 127 b of arm 126 b .
- arm 126 a may be shorter than arm 126 b .
- arm 126 a may be coupled to valve body 122 at a site that is distal to a site at which arm 126 b is coupled to the valve body.
- Prosthetic valve 44 within delivery tube 120 , is advanced distally between leaflets 14 of native valve 10 , and the prosthetic valve is progressively advanced distally out of a distal end of the delivery tube, as shown in states A-B of FIG. 1E . It is to be noted that leaflets 14 typically continue to function following implantation of prosthetic valve support 42 , and may further continue to function while delivery tube 120 is disposed therebetween; the leaflets typically coapt around the delivery tube.
- first arm 126 a At a given degree of advancement of prosthetic valve 44 out of delivery tube 120 , first arm 126 a is deployed: tip 127 a of each first arm 126 a becomes exposed from the delivery tube and each arm 126 a responsively deflects radially outward from valve body 122 , toward a pre-set position (state B of FIG. 1E ). Tip 127 b of each arm 126 b remains within delivery tube 120 . Throughout the procedure, as distal portions of valve body 122 are progressively exposed from delivery tube 120 , they typically automatically expand toward an expanded state
- prosthetic valve 44 and delivery tube 120 are moved proximally (e.g., atrially) such that arm 126 a of each tissue-engaging element 124 engages (e.g., captures) a leaflet 14 of native valve 10 , e.g., such that a portion of each leaflet is disposed between (1) each arm 126 a and (2) a respective second arm 126 b and valve body 122 .
- the first arm is deflected further from valve body 122 than its pre-set position by applying a force to the first arm using the delivery tube. That is, an angle between the first arm and an outer surface of the valve body is increased by applying the force to the first arm using the delivery tube.
- the force is applied by moving delivery tube 120 distally with respect to the prosthetic valve (e.g., sliding the delivery tube over at least part of the prosthetic valve), so as to push the arm, as shown in state C of FIG. 1E .
- tissue-engaging element 124 facilitates engagement of leaflets 14 (e.g., engagement of a larger portion of leaflets 14 ).
- delivery tube 120 is returned proximally with respect to prosthetic valve 44 , such that arm 126 a returns toward its pre-set position (state D of FIG. 1E ).
- prosthetic valve 44 is retrievable into delivery tube 120 and removable from the body of the subject, e.g., as described hereinbelow with respect to FIG. 2 .
- delivery tube 120 is pulled further proximally with respect to prosthetic valve 44 , such that tip 127 b of second arm 126 b of each tissue-engaging element 124 becomes exposed from the delivery tube, and each arm 126 b responsively deflects radially outward from valve body 122 , toward a pres-set position (state A of FIG. 1F ), thereby coupling the tissue-engaging element to the leaflet by sandwiching a portion of a leaflet 14 between the first and second arms of each tissue-engaging element.
- Second arm 126 b is typically configured, when completely unrestricted (e.g., in the absence of leaflet 14 ) to have a pre-set position that is close to that of first arm 126 a , planar with that of first arm 126 a , and/or further from valve body 122 than is arm 126 a .
- the difference in size and/or position of the arc of second arm 126 b to that of first arm 126 a facilitates the second arm to move into plane with, and/or beyond the plane of, the first arm.
- prosthetic valve 44 is fully deployed by a proximal end of the prosthetic valve (e.g., valve body 122 thereof) being exposed from delivery tube 120 (e.g., by further withdrawing the delivery tube proximally with respect to the prosthetic valve)(state C of FIG. 1F ).
- the proximal end of prosthetic valve 44 responsively (e.g., automatically) expands toward the expanded state thereof.
- Expansion of the prosthetic valve e.g., of valve body 122 thereof
- applies a radially-expansive force against prosthetic valve support 42 e.g., against an inner perimeter of upstream support portion 43 thereof
- prosthetic valve support 42 e.g., the inner perimeter of upstream support portion 43
- restricts expansion of prosthetic valve 44 at least in part.
- the prosthetic valve is pulled proximally, e.g., so as to align a portion of valve body 122 with upstream support portion 43 and/or to drawn leaflets 14 toward the upstream support portion.
- each tissue-engaging element 124 comprises only one arm 126 .
- the one arm 126 comprises and/or functions like first arm 126 a described herein.
- the one arm 126 is configured to couple to the leaflet by sandwiching a portion of the leaflet between the one arm and valve body 122 .
- the one arm 126 is configured, when the prosthetic valve is pulled proximally as shown in state B of FIG. 1F , to sandwich a portion of the leaflet between the one arm and prosthetic valve support 42 (e.g., upstream support portion 43 thereof).
- State D of FIG. 1F shows the implanted (e.g., final) state of prosthetic valve support 42 and prosthetic valve 44 , following implantation thereof at native valve 10 .
- prosthetic valve support 42 and prosthetic valve 44 are inhibited from moving upstream (e.g., atrially) both by tissue anchors 48 and by tissue-engaging elements 124 . That is, for some applications, resistance to forces on support 42 and valve 44 from the functioning of the heart of the subject, is provided in part by anchors 48 and in part by elements 124 .
- prosthetic valve support 42 and prosthetic valve 44 are inhibited from moving upstream mostly (e.g., solely) by tissue-engaging elements 124 .
- prosthetic valve support 42 (e.g., upstream support portion 43 thereof) inhibits movement ventricularly of prosthetic valve 44 , and of the prosthetic valve support itself.
- FIGS. 1D-F For some applications, locking of locking members 110 to longitudinal members 102 and/or decoupling of pull-wires 104 from longitudinal members 102 ( FIG. 1D ) is not performed until after implantation of prosthetic valve 44 ( FIGS. 1E-F ). For such applications, it is thereby possible to adjust the length of the portion of longitudinal members 102 (e.g., tension on the longitudinal members) after implantation of prosthetic valve 44 . For some applications, a similar advantage is conferred by locking members being reversibly lockable, being locked before implantation of prosthetic valve 44 , and subsequently to implantation of the prosthetic valve, being unlocked to allow re-adjustment of longitudinal members 102 .
- anatomical dimensions of native valve 10 and/or surrounding tissues are determined (e.g., measured), and prosthetic valve support 42 and/or prosthetic valve 44 are selected accordingly (e.g., from a selection of prosthetic valve supports and/or prosthetic valves of different sizes).
- an optimal lumen size e.g., transverse cross-sectional area
- a prosthetic valve having a lumen of that particular size may be selected.
- a prosthetic valve support having an inner perimeter that defines an opening having a particular cross-sectional area may be selected, so as to restrict the expansion of a prosthetic valve to have a lumen of that particular size.
- a prosthetic valve support having an outer perimeter of a particular size may be selected according to determined dimensions of the annulus of the valve and/or walls of the atrium. It is to be noted that selecting a size according to determined anatomical dimensions may only in some cases comprise selecting a size that matches the anatomical dimensions. For example, an optimal size for the transverse cross-sectional area of a prosthetic valve is typically less than 90% of the area defined by the annulus of the native valve, so as to allow the leaflets of the native valve to coapt around the prosthetic valve and facilitate sealing.
- prosthetic valve support 42 is typically implantable without eliminating functioning of the native leaflets, for some applications, the prosthetic valve support is implantable without the use of cardiopulmonary bypass. For some applications, prosthetic valve 44 is also implantable without the use of cardiopulmonary bypass.
- FIG. 2 is a schematic illustration of prosthetic valve 44 being retrieved into delivery tube 120 , in accordance with some applications of the invention.
- prosthetic valve 44 is retrievable into delivery tube 120 and removable from the body of the subject.
- Delivery tube 120 is moved distally with respect to prosthetic valve 44 , in a manner similar to that used to push arms 127 a , described with reference to FIG. 1E (state C), but such that delivery tube 120 is slid over the site at which arms 127 a are coupled to valve body 122 , thereby pushing arms 127 a to deflect distally.
- Prosthetic valve 44 including at least part of arms 127 a , is drawn into delivery tube 120 (e.g., by sliding the prosthetic valve distally and/or the delivery tube proximally), and is typically subsequently removed from the body of the subject.
- FIGS. 3A-C are schematic illustrations of the introduction of guide members 56 through prosthetic valve support 42 and delivery tube 80 , in accordance with some applications of the invention.
- prosthetic valve support 42 is slidable toward native valve 10 , over guide members 56 , including while the prosthetic valve support is compressed within delivery tube 80 .
- guide members 56 extend from the anchors to outside of the body of the subject, and have respective free proximal ends 57 .
- guide members 56 are threaded through holes 82 in upstream support portion 43 of prosthetic valve 42 , and through delivery tube 80 , e.g., by the operating physician.
- prosthetic valve support 42 is provided in the compressed state thereof, within delivery tube 80 , e.g., as a unit 140 , coupled to a distal end of a controller 142 that is used to move the unit transluminally (e.g., within sheath 46 ).
- Unit 140 comprises (e.g., is provided having) one or more introducer tubes 144 , each introducer tube being shaped to define a lumen therethrough, and having an open distal end 143 and an open proximal end 145 .
- Distal end 143 of each tube is disposed outside a distal end of support 42 and/or tube 80
- proximal end 145 of each tube is disposed outside a proximal end of the support and/or tube 80 .
- Each introducer tube 144 passes (1) from the distal end thereof, (2) through a respective hole 82 in upstream support portion 43 from the downstream surface of the support portion (which defines an outer surface of the support portion in the compressed state thereof) to an upstream surface of the support portion (which defines an inner surface of the support portion in the compressed state thereof), and (3) to the proximal end thereof.
- FIG. 3A shows free proximal end 57 of each guide member 56 being advanced through a respective introducer tube 144 , thereby threading the guide member through upstream support portion 43 of prosthetic valve support 42 .
- introducer tubes 144 are subsequently removed, prior to introduction of unit 140 into the body of the subject. That is, introducer tubes 144 are typically temporary.
- FIG. 3C shows upstream support portion 43 of prosthetic valve support 42 having been partially exposed from delivery tube 80 , in order to illustrate the resulting threading of guide members 56 through upstream support portion 43 .
- FIGS. 4A-C are schematic illustrations of locking member 110 , and control thereof, in accordance with some applications of the invention.
- locking member 110 is slidable over guide member 56 (e.g., over tubular member 100 thereof).
- locking member 110 is configured to lock to longitudinal member 102 .
- FIG. 4A shows locking member 110 in the unlocked state thereof, in which the locking member typically defines a channel therethrough through which tubular member 100 and longitudinal member 102 , either within the tubular member or outside of the tubular member, are slidable.
- the channel of locking member 110 is defined by a generally tubular portion 160 of the locking member.
- Tubular portion 160 defines one or more, such as two, oblique slits 162 in the lateral walls thereof.
- Locking member 110 comprises locking element, such as a locking bar 164 , that is disposed generally orthogonally to the channel of the locking member, and passes through the slits (e.g., through both slits) of the tubular member.
- Locking member 110 further comprises a spring 166 that is configured to push locking bar 164 in a given direction (e.g., distally), thereby transitioning the locking member into the locked configuration thereof (i.e., locking the locking member)( FIG. 4B ).
- Locking member 110 is typically controllable using a holding member 112 that inhibits (e.g., prevents) the locking member from locking, such as by inhibiting movement of locking bar 164 .
- each control rod 86 used to push prosthetic valve support 42 toward the annulus of valve 10 , is reversibly coupled at a distal end thereof to a respective locking member 110 , such that the pushing is typically performed by pushing with control rod 86 and locking member 110 .
- holding member 112 comprises and/or is defined by control rod 86 .
- control rod 86 defines one or more slits 168 in a lateral wall thereof (e.g., two slits 168 on opposite sides of the lateral wall of the control rod).
- slits 168 are L-shaped, thereby providing (1) a holding region 170 that is generally orthogonal to the proximal-distal (e.g., longitudinal) axis of control rod 86 , and (2) a release region 172 that is generally parallel with the proximal-distal axis of the control rod, and that is open to the distal end of the control rod.
- Locking bar 164 is configured such that ends thereof extend at least into (e.g., through) slits 168 .
- tubular member 100 is typically withdrawn from locking member 110 before the locking member is locked, and the locking member is locked to longitudinal member 102 , e.g., by locking bar 164 sandwiching longitudinal member 102 against the inner surface of the channel of the locking member (e.g., effectively narrowing the channel at the site of the locking bar). Movement of the ends of locking bar 164 into and through release region 172 also decouples control rod 86 from the locking member, allowing the control rod to be removed from the body of the subject (typically along with tubular member 100 )( FIG. 4C ).
- longitudinal member 102 comprises suture.
- long member 102 comprises a polymer, such as polyester.
- longitudinal member 102 comprises a metal.
- the longitudinal member may comprise one or more wires, such as a plurality of wires twisted or braided into a cable. It is hypothesized that for some applications, a metallic composition reduces compressibility of longitudinal member 102 and/or facilitates locking of locking member 110 to the longitudinal member.
- locking member 110 thereby (1) when unlocked, facilitates sliding therethrough of a relatively wide element, tubular member 100 , and (2) when locked, locks to a relatively narrow element, longitudinal member 102 .
- locking bar 164 thereby moves a sufficient distance across the channel defined by locking member 110 . That is, locking bar 164 moves a larger distance than would be necessary to lock a similar locking member that does not facilitate, in the unlocked state thereof, sliding therethrough of a tubular member that is wider than the longitudinal element.
- locking member 110 is typically configured to lock to longitudinal member 102 independently of (e.g., in the absence of) a complementary element, such as teeth, on the longitudinal member.
- locking member 110 is configured to be coupled to any part of longitudinal member 102 .
- FIG. 5 is a schematic illustration of steps in the delivery of tissue anchors 48 to ventricle 8 , and anchoring of the anchors in the ventricle, in accordance with some applications of the invention.
- the steps shown in FIG. 5 can be used in place of the steps shown in FIG. 1B (and/or states A/D thereof), mutatis mutandis (e.g., after the steps shown in FIG. 1A and/or before the steps shown in FIG. 1C ).
- FIG. 1B shows one delivery catheter 50 being used to deliver both anchors 48 , and when delivering second tissue anchor 48 b , anchor-delivery tube 52 fitting alongside first guide member 56 a within catheter 50 .
- a separate catheter is used for each anchor.
- FIG. 5 shows one such application.
- first anchor 48 a is delivered and anchored as described hereinabove with reference to FIG. 1A , wherein catheter 50 in FIG. 1A comprises a first catheter 50 a . Subsequently, and as shown in FIG. 5 , a second catheter 50 b is advanced through sheath 46 , such that second catheter 50 b is disposed alongside first guide member 56 a within sheath 46 . It is to be noted that, in both FIG. 1B and FIG. 5 , two anchors 48 are anchored at respective ventricular sites, and two respective guide members 56 , extend from the anchors, through atrium 6 , and typically out of the body of the subject.
- FIG. 6 is a schematic illustration of a system 180 for use with prosthetic valve support 42 , in accordance with some applications of the invention.
- prosthetic valve support 42 is slidable toward native valve 10 over guide members 56 , including while the prosthetic valve support is compressed within delivery tube 80 .
- guide members 56 extend from the anchors to outside of the body of the subject, and have respective free proximal ends 57 .
- guide members 56 are threaded through holes 82 in upstream support portion 43 of prosthetic valve 42 , and through delivery tube 80 , e.g., by the operating physician.
- FIGS. 3A-C and the descriptions thereof describe prosthetic valve support 42 being provided as a unit 140 comprising introducer tubes 144 , which are removed subsequently to advancement of guide members 56 through upstream support portion 43 and prior to introduction of the unit into the body of the subject.
- FIG. 6 shows system 180 , in which prosthetic valve support is provided within delivery tube 80 , e.g., as a unit 182 , coupled to a distal end of controller 142 , described hereinabove.
- Unit 182 comprises (e.g., is provided having) one or more introducer tubes 184 , each introducer tube being shaped to define a lumen therethrough, and having an open distal end 183 . Distal end 183 of each tube is disposed outside a distal end of support 42 and/or tube 80 , and each introducer tube 184 extends out of a proximal end of the support and/or tube 80 .
- unit 140 described with reference to FIGS.
- each introducer tube 144 of system 180 passes from the distal end thereof, through a respective hole in upstream support portion 43 from the downstream surface of the support portion (which defines an outer surface of the support portion in the compressed state thereof) to an upstream surface of the support portion (which defines an inner surface of the support portion in the compressed state thereof).
- introducer tubes 184 extend from a proximal end of delivery tube 80 to a proximal end portion of the apparatus.
- tubes 184 remain in place as unit 182 is advanced transluminally over guide members 56 .
- Tubes 184 are typically flexible to facilitate transluminal advancement thereof.
- a locking member 190 is disposed over each introducer tube 184 , such that the introduction of guide member 56 through the introducer tube also introduces the guide member through the locking member.
- Locking member 190 is slidable over guide member 56 (e.g., over tubular member 100 thereof), and is configured to lock to longitudinal member 102 .
- locking member 190 is identical to locking member 110 , described hereinabove, except that locking member 190 is configured (e.g., dimensioned) to be slidable also over introducer tube 184 .
- Each locking member 190 is disposed at the distal end of a respective tubular control rod 192 , which is typically identical to control rod 86 , described hereinabove, except that control rod 192 is configured (e.g., dimensioned) to be slidable also over introducer tube 184 .
- system 180 including introducer tubes 184 , advantageously (1) removes the requirement for two separate introductions of proximal end 57 of guide member 56 (i.e., through an introducer tube and subsequently through a locking member and control rod); and (2) facilitates control rods 192 (and locking members 190 ) being present in the atrium of the subject during expansion of prosthetic valve support 42 , thereby reducing an interval between the expansion of the prosthetic valve support and pressing of the prosthetic valve support against the annulus of the native valve.
- FIGS. 7A-C are schematic illustrations of a system 200 for facilitating transluminal delivery of a prosthetic valve assembly 202 , in accordance with some applications of the invention.
- FIG. 7A shows prosthetic valve assembly 202 in an expanded state thereof.
- Prosthetic valve assembly comprises (1) a prosthetic valve body 204 , which comprises a first frame 206 (e.g., a wire frame), and is shaped to define a lumen 208 therethrough, (2) an annular upstream support 210 , which comprises a second frame 212 (e.g., a wire frame), is shaped to define an opening through the upstream support, and is configured to be placed against an upstream surface (e.g., an atrial surface) of native valve 10 (e.g., of an annulus thereof), and (3) a flexible sheet 214 that couples the first frame to the second frame.
- frame 206 of body 204 In the expanded state of assembly 202 (and thereby of body 204 ), frame 206 of body 204 is generally cylindrical, and has a diameter d 1 .
- frame 212 of support 210 is typically generally annular, and has an outer perimeter 213 that has a diameter d 2 , which is greater than diameter d 1 .
- Sheet 214 may be a fabric, a film, and/or another sheet-like structure, and may comprise a natural material, a polymer, a biomaterial, and/or any other suitable material. Typically, sheet 214 comprises polyester, PTFE, and/or pericardial tissue.
- sheet 214 is generally annular and flat, and an upstream end 218 of frame 206 is disposed generally on a plane defined by support 210 .
- an inner perimeter 211 of frame 212 defines an opening that has a diameter d 3 that is greater than diameter d 1 .
- sheet 214 is generally frustoconical or funnel-shaped, and upstream end 218 of frame 206 is disposed below the plane defined by support 210 . (For some such frustoconical or funnel-shaped arrangements, the sheet may also be considered to be annular.)
- sheet 214 is generally tubular, upstream end 218 of frame 206 is disposed below the plane defined by support 210 .
- diameter d 3 is typically generally equal to diameter d 1 .
- one or both of frames 206 and 212 is covered on at least one side by a covering 220 .
- sheet 214 comprises a portion of covering 220 , e.g., the sheet is defined by a portion of the covering that is disposed between frames 206 and 212 .
- covering 220 is disposed (1) on a tissue-facing side of frame 212 (e.g., defines a tissue-contacting surface of support 210 ), and (2) on an inner surface of frame 206 (i.e., lines the frame, and defines lumen 208 ).
- a valve member 205 (e.g., comprising one or more prosthetic leaflets; shown in FIGS. 8D-G ) is coupled to frame 206 , is disposed within lumen 208 , and provides valve (e.g., one-way) functionality to assembly 202 .
- Valve member 205 may alternatively or additionally comprise a different valve member, such as a mechanical valve member.
- At least two eyelets 222 are disposed on an outer surface of body 204 (i.e., protrude radially outward from body 204 ).
- eyelets 222 are pivotably coupled to body 204 , e.g., such that the eyelets can pivot (e.g., rotate) in both directions by at least 5 degrees (e.g., more than 5 degrees and/or less than 90 degrees, such as between 5 and 90 degrees, e.g., between 5 and 60 degrees, such as between 5 and 45 degrees).
- the eyelets can pivot in a plane parallel to a plane defined by a tangent of the valve body at the site to which the eyelet is coupled, as shown in the blowup box.
- the eyelets can pivot in a plane that is orthogonal to the plane defined by the tangent, e.g., such that the eyelets can point toward and/or away from the valve body.
- eyelets 222 are sutured to body 204 . Eyelets 222 are arranged in at least one pair; each eyelet of the pair being disposed on the opposite side of body 206 from the other eyelet of the pair.
- FIG. 7B shows system 200 in a delivery configuration thereof.
- System 200 comprises a delivery tool 230 , which comprises a first housing 232 (e.g., a proximal housing) and a second housing 234 (e.g., a distal housing), which are articulatably coupled to each other via a flexible control rod assembly 240 disposed through the housings.
- a delivery tool 230 which comprises a first housing 232 (e.g., a proximal housing) and a second housing 234 (e.g., a distal housing), which are articulatably coupled to each other via a flexible control rod assembly 240 disposed through the housings.
- assembly 202 is in a compressed state thereof, in which prosthetic valve body 204 (in a compressed state thereof) is generally cylindrical, and upstream support 210 (in a compressed state thereof) is also generally cylindrical.
- sheet 214 is also generally cylindrical.
- Assembly 202 in the compressed configuration thereof, (1) has a central longitudinal axis, at one zone (e.g., at one end) of which body 204 is disposed, and at another zone (e.g., the other end) of which support 210 is disposed, and (2) defines an articulation zone 236 in which (a) at least part of sheet 214 is disposed, and (b) neither frame 206 of body 204 nor frame 212 of support 210 is disposed, and about which body 204 and support 210 are articulatable with respect to each other.
- At least part of support 210 is disposed within housing 232 (which maintains the at least part of the support in the compressed state thereof), and at least part of body 204 is disposed within housing 234 (which maintains the at least part of the support in the compressed state thereof).
- Housing 232 defines an orifice 233 through which support 210 is introducible into the housing, and removable from the housing.
- Housing 234 defines an orifice 235 that faces orifice 233 , and through which body 204 is introducible into the housing, and removable from the housing.
- eyelets 222 protrude radially outward beyond the surface of delivery tool 230 (e.g., beyond a lateral wall of housing 234 ).
- housing 234 e.g., the lateral wall thereof
- housing 234 is shaped to define a respective slit 237 for each eyelet, through which the eyelet protrudes beyond the surface of the housing.
- Each slit 237 is continuous with (i.e., is in communication with) orifice 235 such that, as described hereinbelow, during deployment of valve body 204 , eyelet 222 can slide out of the slit at the orifice.
- tool 230 is in a contracted state, in which housing 232 is disposed at a distance d 4 from housing 234 (e.g., orifice 233 is disposed at distance d 4 from orifice 235 ).
- Distance d 4 is typically greater than 1.5 mm and/or less than 30 mm, such as between 1.5 mm and 30 mm (e.g., between 10 and 15 mm).
- this state at least part of sheet 214 is exposed between the housings.
- control rod assembly 240 is flexible, so as to facilitate articulation at articulation zone 238 .
- assembly 240 as a whole is typically sufficiently flexible so as to facilitate its transluminal delivery to the heart
- control rods 244 and 246 may be more flexible than control rod 240 (e.g., more flexible than required for transluminal delivery to the heart alone), so as to facilitate articulation at articulation zone 238 .
- respective portions of control rods 244 and 246 that are disposed within articulation zone 238 when tool 230 is in the contracted state are more flexible than adjacent portions of the control rods (e.g., portions disposed within housings 232 and 234 when tool 230 is in the contracted state).
- a portion 245 of control rod 244 may be narrower than adjacent portions of the control rod.
- Control rod assembly 240 comprises (1) a first housing-control rod 242 , coupled to first housing 232 , (2) a second housing-control rod 244 , coupled to second housing 234 , and (3) a prosthesis-control rod 246 , coupled to a mount 248 that is reversibly couplable to valve assembly 202 , e.g., via a plurality of recesses 250 in the mount which receive respective portions of assembly 202 .
- assembly 202 is couplable to mount 248 by valve body 204 being coupled to the mount, and further typically by a plurality of protrusions 252 of frame 206 being disposed within respective recesses 250 .
- Housing 234 retains this coupling by inhibiting body 204 from expanding radially away from mount 248 .
- second housing-control rod 244 is disposed within and slidable through prosthesis-control rod 246 , and at least part of the prosthesis-control rod is disposed within and slidable through first housing-control rod 242 (e.g., coaxially).
- System 200 (e.g., tool 230 thereof) further comprises at least two flexible reference-force tubes 260 , which extend, (a) from a proximal end of the system (e.g., from an extracorporeal portion of the system, such as from a handle of tool 230 ), (b) through a proximal end of housing 232 , (c) through a lumen 254 defined by support 210 in the compressed state thereof, (d) through sheet 214 , (e) along the outside of at least part of body 204 , and typically (f) until a distal portion of body 204 .
- a locking member 262 is disposed between each eyelet 222 and a respective tube 260 .
- locking members 262 are not directly coupled to body 204 , but are instead each held in position between eyelet 222 and tube 260 by a guide member 256 being disposed through the eyelet, the tube, and the locking member.
- locking member 262 is integral with eyelet 222 (e.g., eyelet 222 is configured to and/or shaped to define locking member 262 ).
- guide members 256 are identical to guide members 56 , described hereinabove. Guide members 256 are described in more detail hereinbelow.
- FIGS. 8A-H are schematic illustrations of a technique for use with system 200 , to transluminally implant prosthetic valve assembly 202 , in accordance with some applications of the invention.
- sheath 46 is advanced transluminally (e.g., transfemorally) to right atrium 12 of heart 4 , through the fossa ovalis, and into left atrium 6 using standard transseptal techniques, as described hereinabove with reference to FIGS. 1A-B .
- first tissue anchor 48 a and second tissue anchor 48 b are anchored at respective ventricular sites, e.g., as described with reference to FIGS. 1A-B and/or 5 , mutatis mutandis.
- a guide member 256 is coupled to each tissue anchor (e.g., the tissue anchors are provided pre-coupled to the guide members), such that after anchoring of the tissue anchors, each guide member extends from the anchor, out of the body of the subject, e.g., as described hereinabove with respect to guide member 56 , mutatis mutandis.
- a proximal end of each guide member 256 is introduced through a respective eyelet 222 , locking member 262 , and reference-force tube 260 , such that system 200 appears as shown in FIG. 7B .
- each guide member 256 typically holds each locking member 262 in place between its respective eyelet 222 and reference-force tube 260 .
- System 200 (e.g., assembly 202 within delivery tool 230 ) is subsequently advanced along guide members 256 and via sheath 46 to left atrium 6 ( FIG. 8A ). Once exposed outside of the distal end of sheath 46 , system 200 is guided by guide members 256 generally toward the ventricular sites at which anchors 48 are anchored. Articulation of system 200 (e.g., at articulation zone 238 , and/or at another articulation zone 239 proximal to housing 232 ) facilitates transluminal advancement of the system past curves in the vasculature.
- the articulation also facilitates movement of system 200 from the distal end of sheath 46 and between leaflets 14 of valve 10 , e.g., by facilitating steering of the system along a path defined by guide members 256 .
- This steering is typically further facilitated by (1) the position of eyelets 222 at a distal portion of system 200 (e.g., at a distal portion of housing 234 ), which turns the housing in response to encountering a turn in members 256 , and/or (2) the pivotable coupling of eyelets 222 to body 204 , described hereinabove; pivoting of eyelet 222 reduces a likelihood of the eyelet snagging on guide member 256 when encountering a turn in the guide member.
- eyelets 222 are internally coated with a material having a low coefficient of friction, such as polytetrafluoroethylene, to further facilitate sliding of the eyelet over guide member 256 .
- a distance d 5 between a proximal end of housing 232 and a distal end of housing 234 may be greater than for a similar system that does not articulate.
- distance d 5 may be greater than a distance d 6 along an atrioventricular axis between (a) a height on the atrioventricular axis of the upstream surface of native valve 10 , and (b) a height on the atrioventricular axis of the transseptal entry point into left atrium 6 (e.g., the fossa ovalis).
- distance d 5 may be greater than the overall height of left atrium 6 .
- Distance d 5 is typically greater than 25 mm and/or less than 100 mm, such as between 25 mm and 100 mm (e.g., 35-60 mm, such as 40-50 mm).
- System 200 is advanced such that distal housing 234 , containing valve body 204 in the compressed state thereof, passes between leaflets 14 of native valve 10 .
- Valve body 204 is withdrawn out of orifice 235 of housing 234 by moving control rod 244 with respect to control rod 246 .
- control rod 244 (and thereby housing 234 ) may be moved distally into ventricle 8 , while control rod 246 (and thereby mount 248 and valve body 204 ) remains stationary, thereby increasing the distance between housing 232 and housing 234 .
- FIGS. 8C-D show the distal portion of valve body 204 expanding before the proximal portion of the valve body. It is to be noted, however, that portions of the valve body typically expand as they become exposed from housing 234 , and therefore the proximal portion of the valve body typically expands while the distal portion of the valve body is still disposed within housing 234 .
- FIG. 8D shows valve body 204 having been completely removed from housing 234 , and support 210 having been removed from proximal housing 232 by control rod 242 (and thereby housing 232 ) being withdrawn proximally, thereby further increasing the distance between housing 232 and housing 234 .
- an opposing reference force is provided by reference-force tubes 260 , so as to hold assembly 202 in place at the native valve while housing 232 is withdrawn.
- eyelets 222 typically slide through slits 237 , and out of the slits at orifice 235 .
- support 210 is deployed from housing 232 before valve body 204 is deployed from housing 234 .
- each guide member 256 is slid proximally with respect to its respective reference-force tube 260 .
- the reference-force is provided to assembly 202 by a distal end of each reference-force tube 260 abutting a respective locking member; the reference force being transferred via the locking member (and typically further via eyelet 222 to valve body 204 ).
- this tensioning moves valve body 204 at least slightly distally into ventricle 8 , such that sheet 214 becomes at least slightly frustoconical (e.g., as shown in FIG. 8E ).
- this tensioning deforms support 210 and/or deflects the support with respect to body 204 , e.g., such that the support becomes less flat (e.g., less planar).
- support 210 may be flat annular (as shown in FIG. 8D ), and after tensioning the support may be frustoconical (as shown in FIG. 8E ).
- FIGS. 8E Alternatively, and as described in more detail with reference to FIGS.
- the prosthetic valve assembly may be configured such that the upstream support is frustoconical before tensioning, and the tensioning changes a slant of the frustoconical shape.
- the upstream support may be frustoconical with the larger base of the frustum closer to a ventricular end of an atrioventricular axis than is the smaller base of the frustum, and after tensioning the support may become flatter, or may even invert, such that it becomes frustoconical with the smaller base closer to the ventricular end of the atrioventricular axis (e.g., the conformation shown in FIG. 8E , mutatis mutandis).
- tensioning is performed before deployment of support 210 from housing 232 .
- Each guide member 256 typically comprises a tether 282 (e.g., a longitudinal member), a pull-wire 284 , and a tubular member 280 in which the pull-wire and the tether are disposed.
- a distal portion of pull-wire 284 is reversibly coupled to a proximal portion of tether 282
- tubular member 280 fits snugly over at least the distal portion of the pull-wire and the proximal portion of the tether so as to inhibit the pull-wire from becoming decoupled from the tether (e.g., to maintain a state of coupling therebetween).
- the reversible coupling is provided by pull-wire 284 and tether 282 defining respective mating surfaces.
- the reversible coupling is provided as described hereinabove for guide member 56 .
- each guide member 256 e.g., the tether 282 thereof
- the guide member is withdrawn proximally until at least part of tether 282 (within tubular member 280 ) is disposed within locking member 262 (e.g., at least until the proximal portion of the tether has passed through the locking member; FIG. 8E state B).
- FIG. 8F Once a desired tension is obtained, the tension is fixed.
- Tubular member 280 is withdrawn proximally with respect to tether 282 , pull-wire 284 and locking member 262 ( FIG. 8F ).
- State A of FIG. 8F shows tubular member 280 having been withdrawn until eyelet 222 .
- State B of FIG. 8F shows tubular member 280 having been withdrawn until a distal end of the tubular member is disposed proximal to locking member 262 , thereby exposing tether 282 to the locking member.
- locking member 262 is biased (e.g., shape-set) to assume a locked state, and while tubular member 280 is disposed within the locking member, the tubular member inhibits locking of the locking member to tether 282 (or to pull-wire 284 ), and the removal of the tubular member from within the locking member facilitates automatic locking of the locking member to the tether (i.e., transitioning of the locking member into a locked state).
- Tubular member 280 is slidable through locking member 262 despite such biasing of the locking member, e.g., due to (a) the tubular member having a smooth surface, and/or (b) the tubular member retaining locking elements 263 of the locking member at an angle alpha_ 1 with respect to the tubular member, which is shallower than an angle alpha_ 2 with respect to tether 282 that the locking elements assume when the tubular element is withdrawn (compare FIG. 8F state A to state B).
- tether 282 defines a plurality of nodules 286 , which facilitate locking of locking member 262 to the tether.
- locking elements 263 and nodules 286 function as a ratchet.
- one-way movement of tether 282 through the locking member is possible, thereby facilitating further increase, but not reduction, of tension.
- Tubular member 280 and pull-wire 284 are decoupled from tether 282 and prosthetic valve assembly 202 , and delivery tool 230 is withdrawn proximally (e.g., into sheath 46 , and out of the body of the subject).
- delivery tool 230 is withdrawn proximally (e.g., into sheath 46 , and out of the body of the subject).
- housing 234 and mount 248 are withdrawn via the lumen of valve body 204 (e.g., between the prosthetic leaflets disposed therein).
- housing 234 , rods 244 and 246 , and mount 248 are withdrawn prior to the tensioning step (e.g., prior to withdrawal of reference-force tubes 260 , such as between the step shown in FIG. 8D and the step shown in FIG. 8E , mutatis mutandis).
- tubular member 280 and pull-wire 284 are decoupled from tether 282 by withdrawing the tubular member further proximally, such that the distal portion of pull-wire 284 and the proximal portion of tether 282 are exposed from the tubular member (state A of FIG. 8G ).
- Reference force for this withdrawal is provided by the anchored tether 282 , and optionally also by reference-force tubes 260 .
- Tubular member 280 , pull-wire 284 , and reference-force tube 260 are then withdrawn (state B of FIG. 8H ).
- FIG. 8H is a schematic illustration of prosthetic valve assembly 202 following implantation at native valve 10 of heart 4 .
- Assembly 202 provides replacement one-way valve functionality in which blood flows from atrium 6 , through the opening defined by upstream support 210 , past sheet 214 , through lumen 208 of valve body 204 , and into atrium 8 .
- Sheet 214 thereby defines and/or serves as a conduit that provides fluid communication between the opening defined by upstream support 210 (e.g., by frame 212 thereof) and lumen 208 of valve body 204 . Further typically, this conduit is uninterrupted except for holes (not shown) that may remain where reference-force tubes 260 originally extended through the sheet.
- the holes may be slit-like (rather than punched holes), such that in the absence of reference-force tubes 260 the holes become generally closed. Additionally, coaptation of leaflets 14 and tissue growth over the holes may further facilitate sealing. Alternatively or additionally, the holes may be defined by tubular protrusions 215 that extend from sheet 214 (shown in the “optional” box, FIG. 7B ). Tubular protrusions 215 may comprise the same material as sheet 214 , or may comprise a different material. Tubular protrusions 215 may be flexible or rigid.
- tubular protrusions are configured to provide a channel through which tubes 260 may pass, but which, in the absence of tubes 260 , inhibit movement of fluid therethrough.
- tubes 215 may inhibit fluid flow due to the ratio between their length and lumen diameter, and/or may act as duckbill valves. Therefore, sheet 214 typically provides a generally sealed conduit between upstream support 210 and valve body 204 .
- prosthetic valve assembly 202 at the native valve typically results in leaflets 14 of the native valve coapting around valve body 204 , thereby providing sealing that inhibits (e.g., prevents) perivalvular leakage.
- prosthetic valve assembly typically also places sheet 214 in contact with the annulus and/or leaflets of the native valve.
- a prosthetic valve implanted at a native valve encounters forces due to beating of the heart and/or the resulting flow of blood. Small movements (e.g., oscillations) resulting from these forces may inhibit tissue growth (e.g., fibrosis) that would otherwise facilitate sealing between the prosthetic valve and the native valve. For some applications, such movements are reduced (e.g., dampened) at sites at which the contact between assembly 202 and the surrounding tissue is provided by sheet 214 , e.g., due to flexibility of the sheet.
- sheet 214 typically provides stabilized (e.g., more constant) contact with tissue than would a less flexible structure in the same position; this is hypothesized to improve tissue growth and thereby sealing.
- sheet 214 itself may be configured to promote tissue growth thereon, e.g., due to surface treatments and/or impregnation, and/or structure, such as weave and/or porosity, thereby further facilitating sealing.
- FIGS. 9A-14B are schematic illustrations of prosthetic valve assemblies, in accordance with some applications of the invention.
- Each prosthetic valve assembly shown in FIGS. 9A-14B comprises a valve body, an upstream support, and a sheet, which are typically identical, mutatis mutandis, to valve body 204 , upstream support 210 and sheet 214 described hereinabove, except for where noted.
- FIGS. 9A-B show, prosthetic valve assembly 202 described hereinabove, in a simplified (e.g., two-dimensional) schematic manner that illustrates the arrangement of valve body 204 , upstream support 210 and sheet 214 , in the compressed state ( FIG. 9A ) and the expanded (e.g., implanted) state ( FIG. 9B ).
- FIGS. 9A-B are included at least in part in order to facilitate interpretation of the simplified schematic illustrations of the prosthetic valve assemblies of FIGS. 10A-14B .
- FIG. 9A like FIGS.
- sheet 214 is attached at least to inner perimeter 211 of upstream support 210 , and to an upstream end 207 of frame 206 of valve body 204 .
- FIGS. 10A-B show a prosthetic valve assembly 302 , which comprises a valve body 304 comprising a first frame 306 , an upstream support 310 comprising a second frame 312 , and a flexible sheet 314 .
- frame 312 defines an outer perimeter 313 and an inner perimeter 311 that defines an opening through the support.
- support 310 is placed against the upstream surface of the native valve, and valve body 304 is subsequently intracorporeally coupled (e.g., directly coupled) to the support by being expanded within the opening of the support, e.g., as described hereinabove with reference to FIG. 1F , mutatis mutandis.
- Sheet 314 is not attached to inner perimeter 311 of frame 312 , but rather is circumferentially attached to frame 312 at a radius that is greater than that of the inner perimeter.
- sheet 314 may be attached to frame 312 at outer perimeter 313 .
- Sheet 314 is also not attached to an upstream end 307 of valve body 304 . Thereby a pocket region 316 is defined between sheet 314 and at least inner perimeter 311 , in which sheet 314 is not attached to frame 312 or frame 306 .
- sheet 314 is disposed alongside and outside at least part of frame 312 and at least part of frame 306 .
- Frame 312 is configured such that when the frame is in the compressed state, inner perimeter 311 defines a downstream end of the frame (e.g., of the cylindrical shape of the frame), and outer perimeter 313 defines an upstream end. Therefore, when frame 312 expands, the upstream end of the frame expands radially outward more than does the downstream end of the frame.
- FIGS. 11A-B show a prosthetic valve assembly 342 , which comprises a valve body 344 comprising a first frame 346 , an upstream support 350 comprising a second frame 352 , and a flexible sheet 354 .
- frame 352 defines an outer perimeter 353 and an inner perimeter 351 that defines an opening through the support.
- support 350 is placed against the upstream surface of the native valve, and valve body 344 is subsequently intracorporeally coupled (e.g., directly coupled) to the support by being expanded within the opening of the support, e.g., as described hereinabove with reference to FIG. 1F , mutatis mutandis.
- Sheet 354 is not attached to inner perimeter 351 of frame 352 , but rather is circumferentially attached to frame 352 at a radius that is greater than that of the inner perimeter.
- sheet 354 may be attached to frame 352 at outer perimeter 353 .
- Sheet 354 is also not attached to an upstream end 347 of valve body 344 .
- a pocket region 356 is defined between sheet 354 and at least inner perimeter 351 , in which sheet 354 is not attached to frame 352 or frame 346 .
- Frame 352 is configured such that when the frame is in the compressed state, the frame has a generally cylindrical shape that defines a lumen therethrough, inner perimeter 351 defines an upstream end of the frame (e.g., of the cylindrical shape of the frame), and outer perimeter 353 defines a downstream end. Therefore, when frame 352 expands, the downstream end of the frame expands radially outward more than does the upstream end of the frame.
- sheet 354 is disposed alongside and outside of at least part of frame 346 , and through at least part of the lumen defined by frame 352 .
- FIGS. 12A-B show a prosthetic valve assembly 382 , which comprises a valve body 384 comprising a first frame 386 , an upstream support 390 comprising a second frame 392 , and a flexible sheet 394 .
- frame 392 defines an outer perimeter 393 and an inner perimeter 391 that defines an opening through the support.
- Frame 392 is coupled to frame 386 prior to implantation (e.g., assembly 382 is provided with frame 392 coupled to frame 386 ).
- frames 392 and 386 are integral, e.g., are defined by respective regions of a single frame.
- valve body 384 is advanced between leaflets of the native valve, and support 390 is placed against the upstream surface of the native valve (e.g., as described with reference to FIGS. 8B-D , mutatis mutandis.
- Sheet 394 is not attached to inner perimeter 391 of frame 392 , but rather is circumferentially attached to frame 392 at a radius that is greater than that of the inner perimeter.
- sheet 394 may be attached to frame 392 at outer perimeter 393 .
- Sheet 394 is also not attached to an upstream end 387 of valve body 384 . Thereby a pocket region 396 is defined between sheet 394 and at least inner perimeter 391 , in which sheet 394 is not attached to frame 392 or frame 386 .
- Assembly 382 is configured such that, in the compressed state thereof ( FIG. 12A ), frames 386 and 392 are generally collinear, and form a generally continuous cylinder.
- Frame 392 is configured such that in the compressed state, outer perimeter 393 defines an upstream end of the frame (and thereby of assembly 382 ). Therefore, when frame 392 expands, the upstream end of the frame expands radially outward more than does the downstream end of the frame.
- sheet 394 is disposed alongside and outside of at least part of frame 386 , and at least part of frame 392 .
- FIGS. 13A-B show a prosthetic valve assembly 402 , which comprises a valve body 404 comprising a first frame 406 , an upstream support 410 comprising a second frame 412 , and a flexible sheet 414 .
- frame 412 defines an outer perimeter 413 and an inner perimeter 411 that defines an opening through the support.
- Frame 412 is coupled to frame 406 prior to implantation (e.g., assembly 402 is provided with frame 412 coupled to frame 406 ).
- frames 412 and 406 are integral, e.g., are defined by respective regions of a single frame.
- valve body 404 is advanced between leaflets of the native valve, and support 410 is placed against the upstream surface of the native valve (e.g., as described with reference to FIGS. 8B-D , mutatis mutandis.
- Sheet 414 is not attached to inner perimeter 411 of frame 412 , but rather is circumferentially attached to frame 412 at a radius that is greater than that of the inner perimeter.
- sheet 414 may be attached to frame 412 at outer perimeter 413 .
- Sheet 414 is also not attached to an upstream end 407 of valve body 404 . Thereby a pocket region 416 is defined between sheet 414 and at least inner perimeter 411 , in which sheet 414 is not attached to frame 412 or frame 406 .
- Assembly 402 is configured such that, in the compressed state thereof ( FIG. 13A ), frame 412 is disposed generally alongside at least a portion of frame 406 .
- Frame 412 is configured such that in the compressed state, outer perimeter 413 defines a downstream end of the frame. Therefore, when frame 412 expands, the downstream end of the frame expands radially outward more than does the upstream end of the frame.
- sheet 414 is disposed alongside and outside of at least part of frame 406 .
- FIGS. 14A-B show a prosthetic valve assembly 422 an expanded state thereof, implanted at native valve 10 , in accordance with some applications of the invention.
- Assembly 422 comprises a valve body 424 comprising a first frame 426 , an upstream support 430 comprising a second frame 432 , and a sheet 434 .
- Frame 426 of valve body 424 has an upstream end 427 and a downstream end 429 .
- an outer perimeter 433 of second frame 432 of upstream support 430 is disposed closer to downstream end 429 than is an inner perimeter 431 of the second frame.
- upstream support 430 may define a frustum, the larger base of which is disposed closer to downstream end 429 (and closer to a ventricular end of an atrioventricular axis) than is the smaller base of the frustum.
- the assembly is thus configured such that, when placed at the native valve, outer perimeter 433 of the upstream support contacts the upstream surface of the native valve (e.g., the valve annulus), and the inner perimeter of the upstream support does not ( FIG. 14A ).
- frame 432 may be flat annular in the absence of external forces, and in the expanded state, sheet 434 retains the second frame in the frustoconical shape by inhibiting expansion of the second frame (e.g., expansion of at least outer perimeter 433 thereof).
- frame 432 curves downward toward the tissue that outer perimeter 433 contacts (configuration not shown).
- Sheet 434 is not attached to inner perimeter 431 of frame 432 , but rather is circumferentially attached to frame 432 at a radius that is greater than that of the inner perimeter.
- sheet 434 may be attached to frame 432 at outer perimeter 433 .
- Sheet 434 is also not attached to upstream end 427 of valve body 424 .
- a pocket region 436 is defined between sheet 434 and at least inner perimeter 431 , in which sheet 434 is not attached to frame 432 or frame 426 .
- such a configuration provides a spring functionality that allows valve body 424 to move along an atrioventricular axis while outer perimeter 433 and/or portions of sheet 434 remain in contact with tissue ( FIG. 14B ).
- assembly 422 may be implanted using techniques described with reference to FIGS. 8A-H , mutatis mutandis, and the spring functionality may allow movement of valve body 424 ventricularly during tensioning of tethers 282 while maintaining contact between outer perimeter 433 and the atrial surface.
- such a configuration may allow oscillation of valve body 424 along the atrioventricular axis (e.g., caused by beating of the heart and the resulting blood flow), while maintaining constant contact between outer perimeter 433 and the tissue.
- a compressed state of assembly 422 is as described for one or more of the prosthetic valve assemblies described with reference to FIGS. 10A-13B , mutatis mutandis.
- frame 426 of body 424 is coupled to frame 432 of support 430 prior to implantation (e.g., assembly 422 is provided with frame 426 coupled to frame 432 ), such as described for assembly 382 and/or assembly 402 , mutatis mutandis.
- frame 426 is intracorporeally coupled to frame 432 , e.g., as described for assembly 302 and/or assembly 342 , and/or with reference to FIG. 1F , mutatis mutandis.
- assembly 422 is implanted as described for one or more of the prosthetic valve assemblies described with respect to FIGS. 10A-13B , mutatis mutandis.
- assembly 202 in its compressed state, defines an articulation zone in which (a) at least part of sheet 214 is disposed, and (b) neither frame 206 of body 204 nor frame 212 of support 210 is disposed, and about which body 204 and support 210 are articulatable with respect to each other. It is to be noted that in their compressed states, assemblies 302 and 342 also define respective articulation zones 336 , 376 .
- assemblies 302 , 342 , 382 , 402 and 422 each define a respective pocket region between the respective sheet and at least the inner perimeter of the frame of the upstream support.
- placement of the flexible sheet of the prosthetic valve assembly in contact with tissue provides stabilized contact with the tissue, and thereby improves tissue growth and sealing. Provision of a pocket region such as those described hereinabove is hypothesized to further improve sealing (e.g., by further facilitating tissue growth).
- such configurations (1) may provide a greater surface area of the flexible sheet and/or a greater tissue-contact area of the sheet (e.g., due to an angle of the sheet), and/or (2) may hold the flexible sheet under less tension (e.g., compared to assembly 202 ), such that the sheet is freer to move with movement of the valve assembly and/or tissue, thereby dampening movements that may otherwise inhibit tissue growth and/or sealing.
- FIGS. 14A-B show an example of the contact between flexible sheet 434 and tissue (e.g., leaflets 14 ).
- the sheet is elastic, so as to further facilitate maintenance of contact despite movement of the frames of the prosthetic valve assembly with respect to the native valve.
- each assembly 302 , 342 , 382 , 402 and 422 is defined by the manner in which the sheet of the assembly is coupled to the frames of the assembly.
- the sheet When the assembly is in the expanded state thereof, the sheet is typically frustoconical and/or funnel-shaped. This shape is defined by a lateral wall (i.e., the sheet itself), and first and second apertures (at either end of the shape), the first aperture being larger than the second aperture.
- a portion of the sheet that defines the first aperture is circumferentially attached to the frame of the upstream support at a radius that is greater than a radius of the inner perimeter of the support.
- a portion of the sheet that defines the second aperture is circumferentially attached to the frame of the valve body at a longitudinal site that is closer to a downstream end of the valve body than is the longitudinal site at which the upstream support is coupled to the valve body.
- the sheet extends radially past the radius at which it is coupled to the upstream support. As described hereinabove, for some applications the sheet is coupled to the upstream support at an outer perimeter of the upstream support. For some applications, the sheet extends radially past the outer perimeter of the upstream support.
- FIGS. 15A-C are schematic illustrations of a tool 460 for facilitating application of force between prosthetic valve assembly 202 and guide members 256 (e.g., tethers 282 thereof), in accordance with some applications of the invention.
- tool 460 serves as a tension-detector tool.
- tool 460 alternatively or additionally serves as a tension-applicator tool.
- FIGS. 15A-C show assembly 202 being implanted at native valve 10 , as described hereinabove.
- the box of FIG. 15A shows assembly 202 having been deployed (e.g., delivered and expanded) at the native valve, e.g., as described with reference to FIG. 8D .
- the box of FIG. 15B shows tethers 282 of guide members 256 having been tensioned with respect to assembly 202 , e.g., as described with reference to FIG. 8E .
- 15C shows tubular member 280 of each guide member 256 having been withdrawn proximally so as to (1) facilitate locking of the respective locking member 262 to its respective tether 282 , e.g., as described with reference to FIG. 8F , and (2) decouple pull-wire 284 from tether 282 , e.g., as described with reference to FIG. 8G .
- FIGS. 15A-C shows (1) a proximal end of system 200 (e.g., a proximal end of delivery tool 230 thereof, e.g., including a handle 231 thereof), including a proximal portion of pull-wire 284 , a proximal portion of tubular member 280 , and a proximal portion of reference-force tube 260 , and (2) tool 460 coupled to the proximal portion of pull-wire 284 and the proximal portion of reference-force tube 260 .
- a proximal end of system 200 e.g., a proximal end of delivery tool 230 thereof, e.g., including a handle 231 thereof
- tool 460 coupled to the proximal portion of pull-wire 284 and the proximal portion of reference-force tube 260 .
- 15A-C shows one tool 460 being used with one pull-wire 284 , tubular member 280 , tube 260 and tool 460 (and one handle 231 ).
- tool 460 is typically used with each guide member (e.g., each tether 282 ), either sequentially, or by providing more than one tool 460 for use at generally the same time.
- Tool 460 comprises a pull-wire-coupling element 462 , configured to be coupled to the proximal portion of pull-wire 284 (e.g., to a grip 464 of the pull-wire), and a reference-force-tube-coupling element 466 , configured to be coupled to the proximal portion of reference-force tube 260 (e.g., to a grip 468 of the tubular member).
- Coupling elements 462 and 466 are coupled to each other via an adjustment member 470 that facilitates adjustment of a distance between the coupling elements.
- Adjustment member 470 may comprise screw threads, a ratchet mechanism, or any other suitable adjustment mechanism.
- Pull-wire-coupling element 462 is coupled to the proximal portion of pull-wire 284 (e.g., to a grip 464 of the pull-wire), and reference-force-tube-coupling element 466 is coupled to the proximal portion of reference-force tube 260 (e.g., to a grip 468 of the tubular member), typically subsequently to delivery of prosthetic valve assembly 202 to the native valve ( FIG. 15A ).
- a distance d 7 exists between coupling elements 462 and 466 .
- adjustment member 470 is used (e.g., actuated) so as to change (e.g., increase) the distance between coupling elements 462 and 466 ( FIG. 15B ; distance d 8 ).
- a length indicator 471 (e.g., a rule) is provided on tool 460 that indicates the change in length that has been made.
- tool 460 comprises a force detector 472 that detects and displays a force differential (e.g., a linear force differential) between coupling elements 462 and 466 , and thereby provides an indication of the tensile state of tether 282 .
- a desired tensile state of tether 282 has been achieved (e.g., an absolute value and/or a value relative to other detected forces, such as the tensile state of the other tether 282 )
- the tension is fixed, and pull-wire 284 is decoupled from tether 282 ( FIG. 15C ).
- this is achieved by withdrawing tubular member 280 proximally with respect to tether 282 , pull-wire 284 and locking member 262 .
- FIG. 15C shows a proximal portion of tubular member 280 (e.g., a grip 474 thereof) being withdrawn proximally with respect to (1) pull-wire 284 (and therefore with respect to tether 282 to which the pull-wire is coupled), and (2) reference-force tube 260 (and therefore with respect to locking member 262 which the distal end of the reference-force tube abuts).
- This is illustrated by a distance d 10 between grips 468 and 474 in FIG. 15C , which is greater than a distance d 9 between grips 468 and 474 in FIG. 15B .
- This thereby facilitates (1) locking of locking member 262 to tether 282 , and (2) subsequently (i.e., after further proximal withdrawal of the tubular member), decoupling of pull-wire 284 from the tether.
- this is performed by one continuous movement of tubular member 280 .
- visual and/or tactile indicators allow the operating physician to lock locking member 262 to tether 282 without decoupling pull-wire 284 from the tether. This may advantageously allow the physician to further increase the tension on the tether (e.g., by using the ratchet functionality described with reference to FIG. 8F ) before decoupling the pull-wire from the tether.
- tool 460 is described hereinabove for facilitating implantation of assembly 202 , the tool may also be used, mutatis mutandis, in combination with other systems described herein, such as system 40 described hereinabove and/or assembly 552 described hereinbelow (e.g., for tensioning tethers 582 thereof).
- FIG. 16 is a schematic illustration of a system 480 comprising a prosthetic valve assembly 482 and one or more springs 484 via which the prosthetic valve assembly is elastically coupled to one or more tissue anchors 48 , in accordance with some applications of the invention.
- system 480 is shown as comprising system 200 (e.g., comprising prosthetic valve assembly 202 ), described hereinabove, with the addition of springs 484 .
- system 200 e.g., comprising prosthetic valve assembly 202
- springs 484 the techniques described with reference to FIG.
- springs 484 may be added to other prosthetic valves and/or prosthetic valve assemblies described herein).
- Each spring 484 is disposed outside of valve body 204 , typically laterally outside the valve body, and further typically between eyelet 222 and locking member 262 (e.g., coupling the eyelet to the locking member).
- spring 484 may have a longitudinal axis that is generally parallel with lumen 208 of the valve body.
- reference-force tube 260 provides the reference force to locking member 262 during tensioning of guide member 256 (e.g., tether 282 thereof)
- the reference force is transferred via spring 484 .
- spring 484 serves as a compression spring, such that increasing tension on guide member 256 (e.g., the tether 282 thereof) compresses the spring.
- spring 484 provides an indication of a state of the spring that is observable and recognizable using imaging techniques (e.g., fluoroscopy). That is, spring 484 is configured to change shape in response to a force applied to it, in a manner that is observable and recognizable using fluoroscopy.
- imaging techniques e.g., fluoroscopy
- This functionality therefore provides intracorporeal measurement of tension on tether 282 (in a manner that is itself observable extracorporeally). It is hypothesized that for some applications, this intracorporeal measurement advantageously detects the tension with reduced interference (e.g., noise) that may be present in extracorporeal measurement techniques.
- extracorporeal measurement of the tension by extracorporeally measuring tension on pull-wire 284 may be inhibited by interference by inherent elasticity of the pull-wire and other elements of the system, and by friction between elements of the system.
- spring 484 alone provides the tension indication.
- spring 484 may be coated with a radiopaque material such as tantalum.
- spring 484 has (e.g., comprises and/or is coupled to) one or more radiopaque markers 486 , and the juxtaposition of the markers facilitates extracorporeal detection of the shape of the spring. For example, when spring 484 serves as a compression spring, a reduction of a distance d 11 (compare d 11 to d 11 ′) between adjacent markers 486 indicates an increase in tension on tether 282 .
- an intracorporeal reference e.g., a scale
- identification of shape change of spring 484 e.g., to facilitate quantification of the shape change by (1) comparing the position of markers 486 to reference 488 , and/or (2) comparing the juxtaposition of markers 486 to the juxtaposition of elements of the scale.
- scale 488 may itself also comprise a plurality of radiopaque markers 490 disposed on valve body 204 (e.g., coupled to frame 206 ) at known (e.g., regular) intervals, and distance d 11 (observed using fluoroscopy) is compared to a distance d 12 between adjacent markers 490 (observed using fluoroscopy) in order to determine the actual change in distance d 11 . That is, an observed relative change between d 11 and d 12 is used to determine an actual absolute change in d 11 .
- spring 484 also alters the relationship between (a) changes in the length of tether 282 disposed between eyelet 222 and anchor 48 and (b) tension on the tether.
- tension on tether 282 may remain constant and low despite the reduction in the length of the tether, until the tether encounters resistance provided by tissue anchor 48 , at which point tension increases relatively quickly for every unit reduction in length.
- spring 484 is configured so as to provide a desired tension (e.g., a desired resistance) over a range of lengths of tether 282 (e.g., over a range of compression states of the spring). That is, the spring constant of the spring is sufficiently low that a change in resistance is minimized per unit length change.
- the spring constant may be less than 50 g/mm.
- the desired tension is above 300 g force and/or below 700 g force, e.g., above 400 g force, and/or below 600 g force, such as between 400 g force and 600 g force, e.g., about 500 g force.
- a desired target tether tension may be 500 g force
- spring 484 may be configured to provide, over a range of compression states of the spring, resistance that results in a tether tension that is within a margin tension (e.g., within 200 g force, such as within 100 g force) of the target force.
- spring 484 is configured to provide a distinct indication, observable using fluoroscopy, when the spring experiences a force that is within a margin force (i.e., a force that corresponds to being within the margin tension). For example, spring 484 may undergo (e.g., suddenly undergo) a more obvious shape change when such a force is experienced.
- spring 484 is configured to act as a constant-force spring or similar, so as to facilitate the behavior described above.
- spring 484 is pre-loaded (e.g., pre-tensioned or pre-compressed).
- FIG. 17 is a schematic illustration of a system 500 comprising a prosthetic valve assembly 502 and one or more springs 504 via which the prosthetic valve assembly is elastically coupled to one or more tissue anchors 48 , in accordance with some applications of the invention.
- system 500 is shown as comprising system 200 (e.g., comprising prosthetic valve assembly 202 ), described hereinabove, with the addition of springs 504 .
- system 200 e.g., comprising prosthetic valve assembly 202
- 17 may alternatively or additionally be used to facilitate implantation of other prosthetic valves and/or prosthetic valve assemblies described herein, mutatis mutandis (e.g., springs 504 may be added to other prosthetic valves and/or prosthetic valve assemblies described herein).
- Each spring 504 is disposed outside of valve body 204 , typically laterally outside the valve body, and further typically is disposed functionally between locking member 262 and anchor 48 (e.g., between locking member 262 and eyelet 222 , or between eyelet 222 and anchor 48 .
- spring 504 is a cantilever spring, and may be defined by a protrusion of frame 206 that extends away (e.g., laterally away) from valve body 204 . That is, spring 504 may comprise an elastically-deformable appendage.
- the protrusion is shaped to define a loop 506 that provides spring 504 with constant-force-spring functionality.
- spring 504 provides similar functionality to spring 484 , described hereinabove, mutatis mutandis.
- spring 504 provides an indication of a state of the spring that is observable and recognizable using fluoroscopy. That is, spring 504 is configured to change shape in response to a force applied to it, in a manner that is detectable and recognizable using fluoroscopy.
- spring 504 also alters the relationship between (a) the length of tether 282 disposed between eyelet 222 and anchor 48 and (b) tension on the tether, e.g., as described hereinabove with reference to spring 484 , mutatis mutandis.
- FIGS. 18A-B are schematic illustrations of springs coupled to tether 282 so as to elastically couple tissue anchor 48 (e.g., a tissue-engaging element 49 thereof) to prosthetic valve assembly 202 (e.g., to valve body 204 thereof), in accordance with some applications of the invention.
- FIG. 18A shows a spring 520 disposed partway along tether 282 .
- FIG. 18B shows a spring 530 , one end of which is coupled to anchor 48 (e.g., to an anchor head 47 thereof) and the other end of which is coupled to tether 282 .
- Springs 520 and 530 are typically tension springs.
- spring 530 is rigidly coupled to anchor head 47 .
- springs 520 and 530 are shown being used with system 200 (e.g., with prosthetic valve assembly 202 ), described hereinabove.
- system 200 e.g., with prosthetic valve assembly 202
- the techniques described with reference to FIGS. 18A-B may alternatively or additionally be used to facilitate implantation of other prosthetic valves and/or prosthetic valve assemblies described herein, mutatis mutandis.
- springs 520 and 530 provide similar functionality to springs 484 and 504 , described hereinabove, mutatis mutandis.
- springs 520 and 530 provide an indication of a state of the spring that is observable and recognizable using fluoroscopy. That is, the springs are configured to change shape in response to a force applied to them, in a manner that is detectable and recognizable using fluoroscopy.
- springs 520 and 530 also alter the relationship between (a) the length of tether 282 disposed between eyelet 222 and anchor 48 and (b) tension on the tether, e.g., as described hereinabove with reference to springs 484 and 504 , mutatis mutandis.
- Springs 484 , 520 and 530 are shown as helical springs. However it is to be noted that each of these springs may have a shapes other than a helix. For example, each of these springs may have a zigzag shape. For some applications, the use of a spring that defines a repeating (e.g., oscillating) pattern such as a helix or a zigzag facilitates fluoroscopic identification of the state of the spring. For example, whereas a linear elastically-stretchable member (e.g., a strip of elastic rubber) remains linear when stretched, the shape of a helical or zigzag spring changes as force increases.
- a linear elastically-stretchable member e.g., a strip of elastic rubber
- FIGS. 19A-B are schematic illustrations of a system 700 for facilitating delivery of a prosthetic valve body 702 , in accordance with some applications of the invention.
- System 700 comprises a delivery tool 704 that comprises a distal housing 706 , configured to house valve body 702 in a compressed state thereof, a proximal portion 708 , and a flexible longitudinal portion 710 (e.g., a catheter) therebetween.
- Proximal portion 708 typically comprises a handle 712 .
- Housing 706 is configured to be transluminally advanced to the heart of the subject (e.g., as described herein, mutatis mutandis, while proximal portion 708 remains outside the body of the subject.
- Proximal portion 708 (e.g., handle 712 thereof) comprises a force detector 716 that detects a force between (a) the proximal portion, and (b) housing 706 and/or valve body 702 coupled thereto.
- force detector 716 detects tension. That is, the force detector detects resistance of valve body 702 to a proximally-directed force applied by tool 704 (e.g., when tool 704 is moved proximally).
- Housing 706 is advanced through native valve 10 and into ventricle 8 , and valve body 702 is partly advanced out of the housing, and automatically expands toward an expanded state ( FIG. 19A ).
- Valve body 702 is coupled to a plurality of tissue-engaging elements (e.g., tissue-engaging legs) 714 that protrude radially out from the valve body when exposed from housing 706 .
- Tissue-engaging elements 714 are configured to engage leaflets 14 of the native valve, thereby facilitating anchoring of the valve body.
- system 700 is used for implantation of valve body 702 at a native valve at which a prosthetic valve support (e.g., an upstream support) has already been delivered, and to which the valve body is intracorporeally coupled (e.g., as described elsewhere herein).
- a prosthetic valve support e.g., an upstream support
- system 700 may be used to implant valve body at native valve 10 after implantation of support 42 at the native valve.
- support 42 is secured against the upstream surface of native valve 10 by being anchored, via tethers (e.g., longitudinal members 102 ), to ventricular muscle tissue. (The tethers are not visible in FIGS. 19A-B .)
- valve body 702 proximally (i.e., atrially) while tissue-engaging elements 714 are protruding pushes the tissue-engaging elements against leaflets 14 , reducing a height of a gap between the tissue-engaging elements and support 42 , and sandwiching the leaflets against the support ( FIG. 19B ).
- Resistance to proximal movement of valve body 702 e.g., due to support 42 and leaflets 14 ) is detected and displayed by force detector 716 .
- the operating physician is thereby able to couple valve body 702 to support 42 (e.g., by fully deploying the valve body within the opening defined by the support) while a desired degree of tension is observed.
- the coupling of the valve body to the support fixes the degree of tension, such that leaflets 14 remain sandwiched, and the valve body remains secured to the native valve.
- the force encountered by tissue-engaging elements 714 is observed using fluoroscopy (e.g., by observing a shape and/or position of the tissue-engaging elements).
- the tissue-engaging elements are typically configured to facilitate such observation, as described herein for various springs.
- elements 714 are configured (e.g., shaped) to define a loop, e.g., as described hereinabove for springs 504 , mutatis mutandis.
- valve body 702 is coupled via tethers to tissue anchors that are anchored to ventricular muscle tissue, as described elsewhere herein.
- a spring couples the valve body to each tissue anchor (e.g., as described with reference to FIGS. 16-18B , mutatis mutandis).
- reducing the height of the gap automatically (and typically immediately) alters a force on the spring (e.g., when the valve body is locked to the tether before reducing the height of the gap).
- reducing the height of the gap does not necessarily alter the force on the spring (e.g., when the valve body is slidably couplable to the tether until after the height is reduced, and is subsequently locked to the tether.
- tool 230 and/or tool 460 may be used, mutatis mutandis, to measure and control tension and length of the tether until the valve body is locked to the tether.
- the above technique may be used for prosthetic valve assemblies in which the valve body is pre-coupled to the upstream support, mutatis mutandis.
- the proximal pulling force is not a sandwiching force, but rather is a testing force, typically used in combination with another testing force, e.g., as described hereinbelow, e.g., with reference to FIG. 20 .
- FIG. 20 is a schematic illustration showing examples in which force measurements described herein may be combined to facilitate implantation of a prosthetic valve, in accordance with some applications of the invention.
- force e.g., tension
- FIG. 20 is a schematic illustration showing examples in which force measurements described herein may be combined to facilitate implantation of a prosthetic valve, in accordance with some applications of the invention.
- force e.g., tension
- FIG. 20 is a schematic illustration showing examples in which force measurements described herein may be combined to facilitate implantation of a prosthetic valve, in accordance with some applications of the invention.
- force e.g., tension
- the apparatus and techniques described in one context may be used to measure force in another context (e.g., to facilitate controlled implantation of a different prosthetic valve assembly, prosthetic valve body, and/or support), and may be combined with one or more of the other apparatus and/or techniques.
- FIG. 20 shows examples of combinations of apparatus and techniques described herein, which include:
- Extracorporeal detection of sandwiching force (box 720 ). That is, extracorporeal detection of the force of tissue-engaging elements coupled to the valve body against the native valve tissue and/or the upstream support. This is described, for example, (a) with reference to FIGS. 19A-B , and (b) with reference to force detector 472 of tool 460 ( FIGS. 15A-C ) being used to augment the apparatus and facilitate the techniques described with reference to FIGS. 21A-B .
- Intracorporeal detection observed using imaging of tension on tethers ( 724 ). This is described, for example, with reference to the springs described with reference to FIGS. 16 , 17 , and 18 A-B.
- Intracorporeal detection observed using imaging
- tissue-engaging elements against tissue (e.g., leaflets or annulus) of the native valve (box 744 ). This is described, for example, with reference to FIGS. 19A-B .
- Intracorporeal detection (observed using imaging) of ventricularly-directed force of the upstream support against the native annulus (box 728 ). For some applications, this is achieved by using imaging (e.g., fluoroscopy) to extracorporeally observe intracorporeal changes in the shape of the upstream support (e.g., changes described with reference to FIGS. 8D-E , 14 A-B, and/or 15 A-B), in a similar manner to that described for extracorporeally observing changes in the shape of springs (e.g., described with reference to FIGS. 16 , 17 , and 18 A-B), mutatis mutandis.
- imaging e.g., fluoroscopy
- combining two or more of the force-measurement techniques described herein may provide synergistic benefits when implanting an implant (e.g., a prosthetic valve assembly, prosthetic valve body, and/or prosthetic valve support), so as to facilitate controlled implantation (box 730 ).
- an implant e.g., a prosthetic valve assembly, prosthetic valve body, and/or prosthetic valve support
- the ability to control various forces that secure the implant allows, inter alia, the forces to be spread as desired by the operating physician. For example, it may be desirable:
- tension on a given tether is optimized. For example, it may be desirable that tension on the given tether to be maximized within a tension range that is known to be supported by (1) the tissue anchor to which the tether is coupled, and (2) the tissue to which the tissue anchor is anchored.
- the operating physician applies a testing pulling force to the tissue anchor.
- the testing pulling force is used to confirm that the anchored tissue anchor is capable of supporting an overload tension that is greater than an expected tension that it is expected that the anchor will encounter during operation.
- the expected tension may be determined at least in part based on possible ventricular blood pressure and the cross-sectional area of the lumen of the valve body.
- the testing pulling force is applied (e.g., via the tether or via the anchor manipulator), and movement of the tissue anchor is observed using imaging, e.g., as described with reference to FIGS. 1A-B ).
- the testing pulling force is applied while measuring tension using an extracorporeal force detector such as detector 472 ( FIGS. 15A-C ), mutatis mutandis.
- the testing pulling force is applied by applying tension to the tether, and the tension is measured using intracorporeal springs and fluoroscopy, as described hereinabove, mutatis mutandis. It is to be noted that, for such applications, the same technique is used (1) to confirm that the anchored tissue anchor is capable of supporting the overload tension, and (2) to facilitate the application of the tension (e.g., the anchoring tension) that will be fixed when the locking member is locked to the tether.
- the tension e.g., the anchoring tension
- Anchor at least one tissue anchor coupled to a respective at least one tether (e.g., within guide members).
- a valve body that comprises at least one tissue-engaging element (e.g., a tissue-engaging leg) over at least part of the tether (e.g., by advancing over a guide member), such that a length of the tether is disposed between the valve body and the tissue anchor.
- tissue-engaging elements are described with reference to FIGS. 19A-B and 21 A-B.
- the valve body may or may not be pre-coupled to an upstream support.
- intracorporeally and/or extracorporeally measure (a) force of tissue-engaging element against tissue, and (b) tension on the tether (e.g., the change in tension on the tether caused by the proximal pulling.
- step 5 At least in part based on measurements (a) and (b) of step 5, adjust the length of the tether disposed between the valve body and the tissue anchor, and/or lock the valve body to the tether (i.e., fix the length of the tether disposed between the valve body and the tissue anchor).
- the above technique provides a prediction of the force distribution between the various anchoring elements that will exist during operation of the prosthetic valve assembly (e.g., during the lifetime thereof). For example, the technique provides a prediction of force distribution between the ventricular anchors and the valve-mounted tissue-engaging elements if/when atrially-directed force increases (e.g., as will be encountered during ventricular systole and/or increases in systemic blood pressure). Based on this indication, the technique facilitates adjustment of this distribution, via adjustment of the length of tethers disposed between the valve body and the tissue anchors.
- FIGS. 21A-B are schematic illustrations of a prosthetic valve assembly 552 , in accordance with some applications of the invention.
- Prosthetic valve assembly 552 comprises (1) a prosthetic valve body 554 , which comprises a first frame 556 (e.g., a wire frame), and is shaped to define a lumen therethrough, (2) an annular upstream support 560 , which comprises a second frame 562 (e.g., a wire frame), is shaped to define an opening through the upstream support, and is configured to be placed against an upstream surface (e.g., an atrial surface) of native valve 10 (e.g., of an annulus thereof), and (3) a flexible sheet 564 that couples the first frame to the second frame.
- FIG. 21A shows assembly 552 in an expanded state thereof (e.g., in the absence of external forces, such as if the assembly were resting on a table surface).
- frame 556 of body 554 is generally cylindrical, and has a diameter d 13 .
- frame 562 of support 560 is typically generally annular, and has an outer perimeter 563 that has a diameter d 14 , which is greater than diameter d 13 .
- Assembly 552 comprises one or more tissue-engaging elements 580 (e.g., legs) that protrude radially outward from valve body 554 so as to define a diameter d 15 , which is greater than diameter d 13 .
- tissue-engaging elements 580 e.g., legs
- frame 556 of body 554 is shaped to define tissue-engaging elements 580 .
- Assembly 552 further comprises one or more tensioning elements (e.g., contraction wires) such as one or more tethers 582 , a first portion (e.g., a distal end) of each tether being coupled to valve body 554 , and a second portion of each tether being coupled (e.g., slidably coupled) to a portion of assembly 552 that is configured to be placed upstream of valve body 554 .
- the second portion of each tether 582 may be slidably coupled to an upstream region of sheet 564 .
- the second portion of each tether 582 may be slidably coupled to frame 562 of support 560 .
- frame 562 being shaped to define one or more respective protrusions that protrude radially inward from the annular shape of the frame, to the site at which each tether 582 is shown in FIG. 21A passing through the sheet.
- assembly 552 is identical to (e.g., comprises the same components as, and/or has identical functionality to) assembly 202 , described hereinabove.
- Identically-named components of system 202 and system 552 are typically identical in structure and/or function.
- assembly 202 comprises tissue-engaging elements 580 and/or tethers 582 .
- assembly 552 comprises eyelets 222 and/or locking members 262 for sliding over and locking to guide members.
- Both support 560 of assembly 552 and support 210 of assembly 202 may be flat annular (e.g., as shown for support 210 ) or frustoconical (as shown for support 560 ).
- FIG. 21B shows assembly 552 being implanted. Following transluminal delivery to native heart valve 10 , valve body 554 is typically deployed first (i.e., before support 560 ), as shown in state A of FIG. 21B . For some applications, valve body is deployed sufficiently far into the ventricle that tissue-engaging elements 580 can expand freely without interfering with leaflets 14 of the native valve, and valve assembly is subsequently moved atrially into the position shown in state A of FIG. 21B .
- upstream support 560 is deployed, e.g., by a delivery housing 584 thereof being retracted (state B of FIG. 21B ).
- Support 560 becomes placed against the upstream (e.g., atrial) surface of native valve 10 , such as against the annulus of the valve and/or against the upstream surface of native leaflets 14 .
- assembly 552 has a total height d 16 from a proximal end of support 560 to a distal end of body 554 (e.g., a height along an atrioventricular axis), and a distance d 17 (e.g., a gap) measured along the height exists between a distal end of frame 562 and a proximal-most part of frame 554 (e.g., tissue-engaging elements 580 defined by the frame).
- d 16 from a proximal end of support 560 to a distal end of body 554
- a distance d 17 e.g., a gap
- tethers 582 are tensioned so as to draw support 560 and body 554 closer to each other, thereby reducing the total height of assembly 552 to height d 18 , and reducing the distance between the distal end of frame 562 and the proximal-most part of frame 554 to a distance d 19 (state C of FIG. 21B ).
- This moves body 554 and tissue-engaging elements 580 closer to leaflets 14 , thereby sandwiching the leaflets between the tissue-engaging elements and support 560 , and thereby anchoring assembly 552 at the native valve.
- Sheet 564 maintains fluid communication (e.g., sealed fluid communication) through assembly 252 , while also allowing the described contraction of the assembly. Typically, this characteristic is due to sheet 564 having tensile strength, but not compressive strength, and therefore rumpling when tethers 582 are tensioned.
- Tensioning of tethers 582 may be accomplished by any suitable technique.
- the tensioning is performed using control rods 86 and locking members 110 , e.g., as described with reference to FIGS. 1C-D , mutatis mutandis.
- the tensioning is performed using reference-force tubes and locking members, e.g., as described with reference to FIGS. 7B-8H , mutatis mutandis.
- support 560 comprises a ratchet mechanism that facilitates the tensioning by allowing only one-way movement of tether 582 through the support.
- assembly 552 comprises a spool mechanism for each tether, and tensioning is performed by rotating the spool mechanism.
- assembly 552 has a compressed state (e.g., for transluminal delivery) in which the assembly defines an articulation zone between frames 556 and 562 , e.g., as described hereinabove for assembly 202 , mutatis mutandis.
- assembly 552 may comprise a tension spring midway along each tether 582 , and/or may comprise a compression spring at the coupling point of support 560 and the tether (e.g., between the support and a locking member 262 configured to lock a respective tether to the support).
- tool 460 may be used, mutatis mutandis, to extracorporeally detect the tension applied to tethers 582 .
- FIGS. 22A-B are schematic illustrations of a prosthetic valve assembly 602 , comprising a prosthetic valve 603 having a tubular valve body 604 that comprises an upstream portion 606 , a downstream portion 608 , and an elastic portion 610 disposed between the upstream portion and the downstream portion, in accordance with some applications of the invention.
- Prosthetic valve 603 e.g., valve body 604 thereof
- Prosthetic valve 603 is configured to be implanted at native valve 10 such that upstream portion 606 is disposed in atrium 6 of the heart of the subject, and such that downstream portion 608 is disposed in ventricle 8 of the heart of the subject.
- prosthetic valve 603 may be coupled to a prosthetic valve support 612 that has been previously placed against (e.g., coupled to) to the native valve, and that defines an opening.
- Support 612 may comprise (1) a support described elsewhere herein (e.g., support 42 described with reference to FIGS. 1A-F and 19 A-B, support 310 described with reference to FIGS. 10A-B , and/or support 350 , described with reference to FIGS. 11A-B , and/or (2) a support described in U.S. Provisional Patent application 61/756,034 to HaCohen et al., from which the present application claims priority, and which is incorporated herein by reference.
- prosthetic valve support 612 comprises one or more tissue-engaging elements 618 , an annular upstream support portion 620 , and a flexible stabilizing member 622 , such as a stabilizing band, coupled to the tissue-engaging elements, and configured to form a ring that is shaped to define an opening therethrough.
- Tissue-engaging elements 618 may comprise, as shown in FIGS. 22A-B , clips configured to be coupled to leaflets 14 of the native valve.
- Tubular valve body 604 typically comprises a frame 614 , such as a stent-like wire frame.
- prosthetic valve 603 typically further comprises a covering 616 , disposed over (e.g., covering) an inner surface of frame 614 , thereby providing a sealed lumen from an upstream end to a downstream end of the tubular valve body.
- a covering 616 disposed over (e.g., covering) an inner surface of frame 614 , thereby providing a sealed lumen from an upstream end to a downstream end of the tubular valve body.
- an excess of covering 616 is provided in the vicinity of elastic portion 610 , so as to facilitate elastic stretching of the elastic portion.
- prosthetic valve 603 comprises an expandable prosthetic valve, and is deployed such that it (1) expands within the opening defined by upstream support portion 620 and/or the opening defined by stabilizing member 622 , (2) applies a radially-expansive force against the upstream support portion and/or the stabilizing member, and (3) thereby becomes coupled thereto.
- downstream portion 608 is expanded and coupled to stabilizing member 622 before upstream portion 606 is expanded and coupled to upstream support portion 620 .
- elastic portion 610 may be stretched and compressed e.g., such as by moving upstream portion 606 further upstream and downstream.
- Such stretching and compressing changes a length of prosthetic valve 603 , and for some applications, facilitates the coupling of a pre-determined portion of the prosthetic valve (e.g., of upstream portion 606 ) to upstream support portion 620 , irrespective, to some degree, of (a) a distance between tissue-engaging elements 618 and upstream support portion 620 , and/or (b) a dimension of native valve 10 (e.g., a length of leaflets 14 ).
- a pre-determined portion of the prosthetic valve e.g., of upstream portion 606
- upstream support portion 620 irrespective, to some degree, of (a) a distance between tissue-engaging elements 618 and upstream support portion 620 , and/or (b) a dimension of native valve 10 (e.g., a length of leaflets 14 ).
- such stretching and compressing adjusts a degree of tension of elastic portion 610 , and may alternatively or additionally facilitate “tightening” of leaflets 14 against the implant
- prosthetic valve 603 may be used in combination with other apparatus and techniques described herein.
- valve body 604 may be substituted for another valve body described herein, mutatis mutandis, including valve bodies that are described herein as being intracorporeally coupled to an upstream support, and valve bodies that are described herein as being provided pre-coupled to an upstream support (either directly, or via a flexible sheet).
- FIGS. 23-24 are schematic illustrations of respective systems for facilitating anchoring of a tissue anchor in the heart of a subject, in accordance with some applications of the invention.
- Each system comprises a delivery tool that comprises (1) a steerable catheter configured to be transluminally advanced to the heart of the subject (e.g., via sheath 46 ), and (2) an obstructing element disposed at a longitudinal site of the catheter, and configured to extend laterally (e.g., radially) outward from the catheter so as to inhibit movement of at least the longitudinal site of the catheter through the heart valve by abutting tissue of the heart valve.
- FIG. 23 shows a system 640 , comprising a delivery tool 642 that comprises a catheter 644 and an obstructing element 646 .
- Obstructing element 646 is typically collapsible for transluminal delivery (e.g., via sheath 46 ), and expandable in atrium 6 of the heart. For some applications, element 646 is configured to expand automatically upon becoming exposed from the distal end of sheath 46 .
- Obstructing element 646 is disposed at a longitudinal site 648 of catheter 644 , and is dimensioned, when in the expanded state thereof, to not pass through native valve 10 (i.e., between leaflets 14 of the native valve).
- obstructing element 646 abuts the atrial surface of the native valve (e.g., one or more leaflets, or the annulus), and thereby inhibits movement of at least longitudinal site 648 of the catheter from passing through the valve. Therefore a known length d 20 of catheter 644 (i.e., the length between longitudinal site 648 and distal end 645 ) is disposed downstream of the atrial surface of valve 10 . Distal end 645 is thereby placeable against ventricular tissue at ventricular sites that are disposed at a distance from the atrial surface (e.g., from a portion of the atrial surface that element 646 abuts) that is generally equal to d 20 .
- a distal portion 652 of catheter 644 disposed distal to longitudinal site 648 , is typically steerable, so as to facilitate placement of distal end 645 against many (e.g., any) ventricular site that is disposed at that distance from the atrial surface.
- a tissue anchor 48 is advanced through catheter 644 using an anchor manipulator 650 , and anchored to tissue at the ventricular site at which distal end 645 is disposed. Typically, little or none of anchor 48 or manipulator 650 becomes exposed from distal end 645 during anchoring.
- FIG. 24 shows a system 660 , comprising a delivery tool 662 that comprises a catheter 664 and an obstructing element 666 .
- Obstructing element 666 is typically collapsible for transluminal delivery (e.g., via sheath 46 ), and expandable in atrium 6 of the heart, and may be identical to obstructing element 646 , described hereinabove. For some applications, element 666 is configured to expand automatically upon becoming exposed from the distal end of sheath 46 .
- Obstructing element 666 is disposed at a longitudinal site 668 of catheter 664 , and is dimensioned, when in the expanded state thereof, to not pass through native valve 10 (i.e., between leaflets 14 of the native valve).
- obstructing element 666 When a distal end 665 of the catheter is extended through native valve 10 , obstructing element 666 abuts the atrial surface of the native valve (e.g., one or more leaflets, or the annulus), and thereby inhibits movement of at least longitudinal site 668 of the catheter from passing through the valve. Therefore a known length d 21 of catheter 664 (i.e., the length between longitudinal site 668 and distal end 665 ) is disposed downstream of the atrial surface of valve 10 .
- Length d 21 of system 660 is typically shorter than length d 20 of system 640 , and in contrast to system 640 , for system 660 , catheter 664 is not configured for distal end 665 to be placed against ventricular tissue. Rather, an anchor manipulator 670 advances tissue anchor 48 through catheter 664 , out of the distal end 665 , and toward a ventricular site at which it anchors the tissue anchor. Typically, anchor manipulator 670 is slidably coupled to catheter 664 such that a distal end of the anchor manipulator is slidable distally no more than a pre-determined distance d 22 from longitudinal site 668 (and thereby no more than a pre-determined distance from distal end 665 of catheter 664 ).
- Anchor manipulator 670 is thereby used to anchor anchor 48 at a ventricular site that is disposed at a distance from the atrial surface (e.g., from a portion of the atrial surface that element 666 abuts) that is generally equal to d 22 .
- anchor manipulator 670 (or at least a distal portion 672 thereof that is exposable from distal end 665 of catheter 664 ) is steerable independently of catheter 664 .
- the distance from the atrial surface at which anchor 48 is anchored is generally equal, but not necessarily exactly equal, to d 20 or d 22 .
- anchor 48 may be anchored at a site that is closer to another portion of the atrial surface than to the portion of the atrial surface that the obstructing element abuts.
- curvature of the catheter and/or the anchor manipulator may result in a direct distance between the atrial surface and the tissue anchor being smaller than d 20 or d 22 .
- anchor 48 is coupled to a tether, guide member, and/or other longitudinal member (e.g., as described hereinabove with reference to other systems).
- the tether extends proximally from the anchor (e.g., out of the body of the subject) so that an implant, such as a prosthetic valve, prosthetic valve support, and/or a prosthetic valve assembly (e.g., those described hereinabove) may be advanced therealong and/or locked thereto, e.g., as described hereinabove for other systems, mutatis mutandis.
- the tether coupled to the tissue anchor may comprise fewer locking sites for locking to the implant, a relatively shorter locking site, and/or only one locking site. It is hypothesized that this may provide the possibility of using simpler, smaller and/or more effective mechanisms to lock the implant to the tether.
- implant-control rod 246 is coupled (via mount 248 ) to assembly 202 by being coupled to valve body 204 , such that when the valve body is pushed distally, the valve body pulls upstream support 210 via sheet 214 .
- each of the prosthetic valve assemblies is shown implanted in a generally symmetrical state, it is to be noted that for some applications this characteristic of the sheet facilitates asymmetrical implantation.
- the assembly may better conform to the native anatomy, and/or one tether of assembly 552 may be tensioned more than another so as to alter the anchoring, sealing, and/or flow characteristics of the assembly, e.g., in response to the native anatomy.
- valve body may be disposed at a particular rotational orientation within ventricle 8 , and for the upstream support to be disposed at a particular rotational orientation within atrium 6 .
- the upstream support may be geometrically asymmetric, and a particular rotational orientation with respect to atrial tissue may be advantageous.
- the upstream support may be asymmetric with respect to rigidity (i.e., some regions of the support may be more rigid than others).
- the sheet facilitates implantation of the upstream support in a different rotational position to its valve body, e.g., by twisting.
- the upstream support may be implanted at more than 5 degrees (e.g., more than 10 degrees, such as more than 20 degrees) rotational offset with respect to the valve body.
- the first frame of the valve body is coupled to the second frame of the upstream support by the sheet (e.g., generally only by the sheet) in the compressed state (e.g., assemblies 202 , 302 , 342 and 552 ) and/or in the expanded state (e.g., assemblies 202 and 552 ).
- the first and second frames being “coupled by the sheet”, and/or (b) the sheet “coupling the first frame to the second frame”, do not include applications in which the frames are primarily and/or independently coupled to each other by a different means, and the covering extends over both frames.
- first and second frames are not “coupled to each other by the sheet” (1) in assemblies 382 , 402 and 422 , in which the frames are provided pre-coupled directly to each other, or (2) in the expanded state of assemblies 302 and 342 , in which the frames are intracorporeally coupled directly to each other.
- a gap typically exists between the first frame and the second frame.
- no metallic structure is disposed within the gap.
- the flexible sheet comprises, in addition to the sheet-like structure, one or more flexible longitudinal members, such as metallic or polymer wires (e.g., embedded within or attached to a surface of the sheet-like structure).
- These flexible longitudinal members may provide a small amount of rigidity to the sheet without detracting from the general nature of the sheet.
- the flexible longitudinal members may facilitate opening of the sheet during deployment of the prosthetic valve assembly.
- the frame of the valve body and the frame of the upstream support are typically distinct from each other, and can be considered to be coupled to each other by the sheet (e.g., generally only by the sheet).
- a distance exists within which no rigid and/or metallic structure is disposed.
- assembly 552 typically no rigid and/or metallic structure is disposed within distance d 17 and/or distance d 19 .
- a similar distance exists for assembly 202 between frames 210 and 206 (e.g., when implanted; see FIGS. 8F-G ).
- assembly 552 only sheet 564 and tethers 582 are disposed within distances d 17 and d 19 .
- tissue-engaging elements 580 extend proximally toward frame 562 such that the distance in which no rigid and/or metallic structure is disposed is reduced and/or absent (e.g., when tethers 582 are tensioned).
- tissue anchor 48 and/or the guide member coupled thereto are included as components of the provided apparatus. That is, they are typically provided with the prosthetic valve assembly.
- the tissue anchor and/or the guide member coupled thereto are not included as components of the provided apparatus (e.g., they are obtained separately).
- a “central longitudinal axis” of a structure is the set of all centroids of transverse cross-sectional sections of the structure along the structure.
- the cross-sectional sections are locally perpendicular to the central longitudinal axis, which runs along the structure. (If the structure is circular in cross-section, the centroids correspond with the centers of the circular cross-sectional sections.)
Abstract
Description
- The present application claims priority from U.S. provisional patent application 61/756,049 to HaCohen et al., filed Jan. 24, 2013, and entitled “Ventricularly-anchored prosthetic valve support”; and U.S. provisional patent application 61/756,034 to HaCohen et al., filed Jan. 24, 2013, and entitled “Tissue-engaging elements”, and is related to:
- US patent application publication 2012/0022639 to Hacohen et al., filed Jul. 21, 2010;
- US patent application publication 2012/0022640 to Gross et al., filed Feb. 24, 2011;
- U.S. patent application Ser. No. 13/811,308 to Gross et al., filed Jan. 21, 2013, which published as US 2013/0172992;
- U.S. patent application Ser. No. 13/412,814 to Gross et al., filed Mar. 6, 2012, which published as US 2013/0035759;
- PCT patent application IL2012/000292 to Gross et al., filed Aug. 5, 2012, which published as WO/2013/021374;
- PCT patent application IL2012/000293 to Gross et al., filed Aug. 5, 2012, which published as WO/2013/021375; and a US patent application to HaCohen et al., entitled “Anchoring of prosthetic valve supports”, filed on even date herewith, all of which are incorporated herein by reference.
- Some applications of the present invention relate in general to valve replacement. More specifically, some applications of the present invention relate to prosthetic cardiac valves and techniques for implantation thereof.
- Ischemic heart disease causes regurgitation of a heart valve by the combination of ischemic dysfunction of the papillary muscles, and the dilatation of the ventricle that is present in ischemic heart disease, with the subsequent displacement of the papillary muscles and the dilatation of the valve annulus.
- Dilation of the annulus of the valve prevents the valve leaflets from fully coapting when the valve is closed. Regurgitation of blood from the ventricle into the atrium results in increased total stroke volume and decreased cardiac output, and ultimate weakening of the ventricle secondary to a volume overload and a pressure overload of the atrium.
- For some applications of the invention, tissue anchors coupled to tethers are transluminally anchored to ventricular tissue of a native valve. A prosthetic valve component, such as a prosthetic valve assembly, a prosthetic valve body, or a support, is transluminally slid along a guide member coupled to the tethers, and is anchored to the tethers.
- For some applications, a prosthetic valve assembly comprises (1) a valve body shaped to define a lumen therethrough, and a valve member disposed within the lumen, (2) an upstream support configured to be placed against an upstream surface of a native heart valve, and (2) a flexible sheet that couples the upstream support to the valve body.
- For some applications, the prosthetic valve assembly comprises eyelets to facilitate sliding along the guide member.
- For some applications, the prosthetic valve assembly has a compressed delivery state in which the valve body and the upstream support are articulatably coupled to each other by the sheet. For such applications, a delivery tool houses the prosthetic valve assembly such that the valve body and upstream support are articulatable with respect to each other during transluminal delivery.
- For some applications, the prosthetic valve assembly comprises tethers that, when tensioned, move the valve body closer to the support. For such applications, the assembly typically comprises tissue-engaging elements that protrude from the valve body, and the tethers are tensioned to sandwich tissue of the native valve between the tissue-engaging elements and the support.
- For some applications, one or more forces is measured during implantation, and distributed among various anchoring elements. For some such applications, an intracorporeal spring is used that is extracorporeally observable using imaging techniques. For some such applications, the spring facilitates force distribution.
- For some applications, a prosthetic valve assembly comprises a flexible sheet forms a pocket between the sheet and a frame of the assembly, and facilitates sealing between the assembly and tissue of the native valve.
- For some applications of the invention, tissue anchors coupled to longitudinal members that are reversibly couplable to wires are transluminally advanced to the ventricle downstream of a native heart valve, and are anchored there. A prosthetic valve support comprising an upstream support portion is slid, in a compressed delivery configuration, over the wires and part of each longitudinal member, and into an atrium upstream of the native valve where it is deployed (e.g., expanded) and placed against an upstream surface (e.g., an atrial surface) of the native valve. A locking member is also slid over the wires and part of each longitudinal member, and locks to the longitudinal member, thereby securing the prosthetic valve support against the upstream surface of the native valve. A prosthetic valve is subsequently transluminally advanced to the native valve, and is implanted by coupling the prosthetic valve to leaflets of the native valve and to the prosthetic valve support.
- For some applications of the invention, a tubular member is slidable over the wire and the longitudinal member, and when disposed over the wire and the long member, inhibits decoupling of the wire from the longitudinal member. For such applications, the prosthetic valve support and the locking member are typically slidable over the tubular member.
- For some applications of the invention, a control rod, reversibly coupled to the locking member, is slid over the tubular member so as to push the locking member and the prosthetic valve support over the tubular member. For some such applications, the control rod is used to lock the locking member to the longitudinal member.
- There is therefore provided, in accordance with an application of the present invention, apparatus for use with a native valve of a heart of a subject, the apparatus including:
- a valve body:
-
- including (1) a first frame shaped to define a lumen therethrough, and (2) a valve member disposed within the lumen,
- having a compressed state in which the first frame has a first diameter, and
- having an expanded state in which the first frame has a second diameter that is greater than the first diameter;
- an upstream support:
-
- configured to be placed against an upstream surface of the native valve,
- including a second frame,
- having a compressed state, and
- having an expanded state in which the second frame is annular, has
- an inner perimeter that defines an opening through the second frame, and
- has an outer perimeter; and
- a flexible sheet that couples the upstream support to the valve body.
- In an application, the upstream support is coupled to the valve body only via the sheet.
- In an application:
- the valve body has an upstream end, a downstream end, and a longitudinal axis therebetween along which the lumen is defined, and
- when the valve body is in the expanded state thereof and the upstream support is in the expanded state thereof:
-
- the first frame is attached to the second frame at the inner perimeter of the second frame, and
- the sheet is attached to the valve body and to the upstream support in a manner that defines a pocket region between the sheet and at least the inner perimeter of the second frame, the sheet not being attached to the first frame or the second frame in the pocket region.
- In an application, the sheet provides fluid communication between the opening and the lumen.
- In an application, the sheet is not attached to the inner perimeter of the second frame.
- In an application, the sheet is not attached to an upstream end of the valve body.
- In an application, the sheet is generally annular when the valve body is in the expanded state thereof and the upstream support is in the expanded state thereof.
- In an application, the sheet is generally frustoconical when the valve body is in the expanded state thereof and the upstream support is in the expanded state thereof.
- In an application, the sheet is attached to the inner perimeter of the second frame.
- In an application, the sheet is circumferentially attached to the second frame at a radius that is greater than a radius of the inner perimeter.
- In an application, the sheet is circumferentially attached to the second frame at the outer perimeter of the second frame.
- In an application, the sheet is attached to an upstream end of the valve body.
- In an application, the first frame is generally cylindrical in both the compressed state thereof and the expanded state thereof.
- In an application, the second frame is generally cylindrical in the compressed state thereof.
- In an application, the valve body includes at least one downstream anchor, configured such that, in the expanded configuration of the valve body, the anchor protrudes radially outward from the first frame.
- In an application, the apparatus further includes at least one tensioning element, coupled to the valve body and to the upstream support, a length of the tensioning element between the valve body and the upstream portion being adjustable such that a distance between the first frame and the second frame is adjustable.
- In an application, the at least one tensioning element includes a tether.
- In an application, the at least one tensioning element is coupled to the first frame, and slidably coupled to the second frame.
- In an application, the valve body, the upstream support and the sheet together define a prosthetic valve assembly, the prosthetic valve assembly:
- having an expanded state in which the valve body is in the expanded state thereof and the second frame of the upstream support is in the expanded state thereof,
- having a compressed state in which:
-
- the prosthetic valve assembly has a longitudinal axis,
- the valve body is in the compressed state thereof at a first zone of the longitudinal axis,
- the upstream support is in the compressed state thereof at a second zone of the longitudinal axis, and
- the prosthetic valve assembly defines an articulation zone, between the first zone and the second zone, in which at least part of the sheet is disposed, in which neither the first frame nor the second frame is disposed, and about which the valve body and the upstream support are articulatable with respect to each other.
- In an application, the apparatus further includes a delivery tool:
- including a first housing configured to house and maintain at least part of the upstream support in the compressed state thereof, and defining a first housing orifice through which the at least part of the upstream support is removable from the first housing,
- including a second housing configured to house and maintain at least part of the valve body in the compressed state thereof, and defining a second housing orifice through which the at least part of the valve body is removable from the second housing,
- having a contracted state in which the second housing is disposed at a first distance from the first housing, and in which the delivery tool is configured to transluminally advance the prosthetic valve assembly in the compressed state thereof, to the native valve, and
- having an extended state in which the second housing is disposed at a second distance from the first housing, the second distance being greater than the first distance, and the apparatus is configured such that, when the at least part of the upstream support is housed by the first housing and the at least part of the valve body is housed by the second housing, transitioning of the delivery tool from the contracted state into the extended state exposes at least part of at least one component selected from the group consisting of: the valve body and the upstream support, from the housing that houses the selected component.
- In an application:
- the apparatus is configured to be used with at least two guide members,
- the prosthetic valve assembly includes at least two eyelets, each eyelet being slidable over a respective one of the guide members, and
- the apparatus is configured such that the eyelets of the prosthetic valve assembly protrude radially outward and radially beyond an outer surface of the second housing while: (1) the at least part of the valve body, in the compressed state thereof, is housed by the second housing, and (2) the at least part of the upstream support, in the compressed state thereof, is housed by the first housing.
- In an application, the eyelets are pivotably coupled to the valve body.
- In an application, the delivery tool further includes at least two reference-force tubes, each reference-force tube configured (1) to be slidable over a respective one of the guide members, and (2) to apply a distally-directed force to the prosthetic valve assembly.
- In an application, in the compressed state of the prosthetic valve assembly, each reference-force tube extends distally (1) through a lumen defined by the second frame of the upstream support, (2) through the sheet, and (3) along an outside of at least part of the valve body.
- In an application, the apparatus further includes at least two locking members, each locking member:
- having an unlocked state in which the locking member is slidable along a respective one of the guide members,
- being transitionable into a locked state in which (1) the locking member is locked to the respective one of the guide members, and (2) the sliding of the eyelet over the guide member is inhibited.
- In an application, the apparatus further includes the at least two guide members:
- each guide member includes:
-
- a tubular member, shaped to define a lumen therethrough,
- a tether, coupled at a distal end thereof to a tissue anchor configured to be anchored to ventricular tissue of the heart, at least a proximal portion of the tether being disposed within the lumen of the tubular member, and
- a pull-wire, coupled at a distal portion thereof to the proximal portion of the tether, at least the distal portion of the pull-wire being disposed within the lumen of the tubular member,
- the tubular member inhibits decoupling of the pull-wire from the tether while the distal portion of the pull-wire and the proximal portion of the tether are disposed within the lumen of the tubular member, and
- while the tubular member of each guide member is disposed within the respective locking member, the tubular member inhibits transitioning of the locking member into the locked state.
- In an application, the apparatus is configured such that, for each respective guide member and locking member, while (1) the tubular member is disposed within the locking member, (2) the distal portion of the pull-wire and the proximal portion of the tether are disposed within the lumen of the tubular member, and (3) the tissue anchor is coupled to the ventricular tissue:
- proximal sliding of the tubular member with respect to the tether facilitates automatic transitioning of the locking member into the locked state, and
- further proximal sliding of the tubular member with respect to the tether facilitates decoupling of the pull-wire from the tether.
- In an application, at least one housing selected from the group consisting of: the first housing and the second housing has a lateral wall that is shaped to define at least two slits, the eyelets being configured to protrude radially outward from the delivery tool via the slits.
- In an application, each slit of the at least one selected housing is continuous with the orifice of the at least one selected housing.
- In an application, the eyelets are coupled to and protrude radially outward from the valve body.
- In an application, the eyelets are pivotably coupled to the valve body.
- In an application:
- the articulation zone defined by the prosthetic valve assembly includes a first articulation zone, and
- while (1) the at least part of the valve body, in the compressed state thereof, is housed by the second housing, (2) the at least part of the upstream support, in the compressed state thereof, is housed by the first housing, and (3) the delivery tool is in the contracted state thereof, the apparatus defines a second articulation zone at a longitudinal zone of the apparatus (a) between the second housing and the first housing, and (b) in which is disposed at least part of the first articulation zone.
- In an application, the delivery tool further includes a housing-control rod that extends through the first housing and is coupled to the second housing such that a first portion of the housing-control rod is disposed within the first housing, a second portion of the housing-control rod is disposed within the second housing, and a third portion of the housing-control rod (1) is disposed within the second articulation zone, and (2) is more flexible than at least one portion of the housing-control rod selected from the group consisting of: the first portion and the second portion.
- In an application:
- the delivery tool further includes (1) a control rod assembly including at least a first housing-control rod coupled to the first housing, and (2) a second housing-control rod, more flexible than the first housing-control rod, extending through the first housing-control rod, extending through the second articulation zone, and coupled to the second housing.
- In an application, the second housing orifice faces the first housing orifice.
- In an application:
- the delivery tool further includes a flexible control rod assembly including (1) a first housing-control rod coupled to the first housing, (2) a second housing-control rod coupled to the second housing, and (3) a prosthesis-control rod reversibly couplable to the prosthetic valve assembly,
- longitudinal movement of the second housing-control rod with respect to the first housing-control rod transitions the delivery tool between the contracted state and the extended state thereof, and
- the valve body is removable from the second housing by moving the second housing-control rod with respect to the prosthesis-control rod.
- In an application, the prosthesis-control rod is reversibly couplable to the prosthetic valve assembly by being reversibly couplable to the valve body.
- In an application, at least part of the second housing-control rod is disposed within and slidable through the prosthesis-control rod, and at least part of the prosthesis-control rod is disposed within and slidable through the first housing-control rod.
- In an application, the outer perimeter of the second frame has a third diameter that is greater than the second diameter.
- In an application, the inner perimeter has a fourth diameter that is greater than the second diameter.
- In an application, when the valve body is in the expanded state thereof and the upstream support is in the expanded state thereof, a gap is defined between the first frame and the second frame, the sheet spanning the gap.
- In an application, no metallic structure is disposed within the gap.
- In an application, the sheet is configured to inhibit expansion of the second frame.
- In an application, the apparatus is configured such that when the second frame expands from the compressed state thereof toward the expanded state thereof, the sheet retains the second frame in a generally frustoconical shape by inhibiting expansion of at least the outer perimeter of the second frame.
- In an application, the sheet extends over at least part of the second frame to serve as a covering of the upstream support.
- In an application, the covering defines a tissue-contacting surface of the upstream support.
- In an application, the sheet extends over at least part of the first frame to serve as a covering of the valve body.
- In an application, the covering is disposed on an inner surface of the first frame.
- There is further provided, in accordance with an application of the present invention, apparatus for use with a native valve of a heart of a subject, the apparatus including:
- a prosthetic valve, configured to be percutaneously delivered to the native valve;
- an annular upstream support, configured to be placed against an upstream surface of the native valve, and to support the prosthetic valve at the native valve;
- a tissue anchor, including a tissue-engaging element configured to be anchored to ventricular muscle tissue of the heart;
- a tether, coupled to the tissue anchor; and
- a spring, couplable to the tether so as to elastically couple the tissue-engaging element to the prosthetic valve.
- In an application, the spring is shaped to define a repeating pattern.
- In an application, the spring is pre-loaded.
- In an application, the spring is a constant-force spring.
- In an application, the spring is configured to facilitate extracorporeal fluoroscopic observation of a state of the spring.
- In an application, the spring is coupled to a plurality of radiopaque markers such that a juxtaposition of the markers changes as the state of the spring changes, the juxtaposition of the markers being extracorporeally fluoroscopically observable.
- In an application, the spring is coupled to at least one radiopaque marker, and the apparatus further includes an intracorporeal reference, a juxtaposition between the radiopaque marker and the intracorporeal reference being extracorporeally fluoroscopically observable.
- In an application, the intracorporeal reference includes a scale including a plurality of radiopaque markers.
- In an application, the plurality of radiopaque markers includes a first plurality of radiopaque markers, and the at least one radiopaque marker includes a second plurality of radiopaque markers.
- In an application, the spring is configured to provide distinct indication that is observable using fluoroscopy, when the spring is experiencing a force that is within a margin force from a target force.
- In an application, the spring is configured to provide the distinct indication when the spring experiences a force that is above 300 g force.
- In an application, the spring is configured to provide the distinct indication when the spring experiences a force that is above 400 g force.
- In an application, the spring is configured to provide the distinct indication when the spring experiences a force that is about 500 g force.
- In an application, the spring is coupled to the prosthetic valve, and is intracorporeally lockable to the tether subsequently to anchoring of the tissue anchor to the ventricular muscle tissue.
- In an application, the spring is slidable along at least part of the tether, and is intracorporeally couplable to the tether by inhibiting the sliding.
- In an application, the prosthetic valve includes a generally cylindrical valve body having an upstream end, and the spring includes an elastically-deformable appendage that protrudes laterally from the valve body.
- In an application:
- the prosthetic valve includes a generally cylindrical valve body having an upstream end, a downstream end, and a longitudinal lumen therebetween, and
- the spring (1) includes a compression spring having a longitudinal axis, and (2) is disposed laterally from, the valve body such that the longitudinal axis of the spring is generally parallel with the longitudinal lumen.
- In an application, the prosthetic valve includes:
- a generally cylindrical valve body having an upstream end, a downstream end, and a longitudinal lumen therebetween; and
- one or more tissue-engaging legs, protruding laterally outward from the valve body, and configured to be placed against a ventricular surface of the native valve.
- In an application, the prosthetic valve is couplable to the upstream support intracorporeally by being expanded within an opening defined by the upstream support while the upstream support is disposed against the upstream surface.
- In an application, the apparatus is configured such that the coupling of the prosthetic valve to the upstream support couples the tether to the prosthetic valve.
- In an application, the apparatus is configured to sandwich a portion of the native valve between the tissue-engaging legs and the upstream support by providing a space having a height between the tissue-engaging legs and the upstream support.
- In an application, the apparatus is configured to facilitate altering the height without altering a force on the spring.
- In an application, the apparatus is configured such that altering the height automatically alters a force on the spring.
- In an application, the apparatus is configured to facilitate altering the height by moving the valve body through the opening defined by the upstream support.
- There is further provided, in accordance with an application of the present invention, apparatus for use with a native heart valve of a subject, the apparatus including:
- a valve body:
-
- having an upstream end, a downstream end, and a longitudinal axis therebetween,
- including a lateral wall that circumscribes the longitudinal axis and defines a longitudinal lumen, and
- including a valve member disposed within the lumen;
- an upstream support having an inner perimeter couplable to the valve body at a first longitudinal position of the valve body, the upstream support being configured to extend radially outward from the valve body and the inner perimeter; and
- a flexible sheet defining a first aperture, a second aperture and a lateral wall therebetween, a first portion of the sheet that defines the first aperture being circumferentially attached to the upstream support portion at a radius that is greater than a radius of the inner perimeter, and a second portion of the sheet that defines the second aperture being circumferentially attached to the valve body at a second longitudinal position of the valve body, such that a pocket region is defined between the sheet and at least the first longitudinal position.
- In an application, the second longitudinal position is closer to the downstream end of the valve body than is the first longitudinal position.
- In an application, the first aperture is larger than the second aperture.
- In an application, the sheet is attached to the upstream support at an outer perimeter of the upstream support.
- In an application, the sheet assumes a frustoconical shape.
- In an application, the sheet assumes a funnel shape.
- In an application, the apparatus is provided with the inner perimeter of the upstream support pre-coupled to the valve body at the first longitudinal position of the valve body.
- In an application, the apparatus is configured such that the inner perimeter of the upstream support is intracorporeally couplable to the valve body at the first longitudinal position of the valve body.
- There is further provided, in accordance with an application of the present invention, apparatus for use with a native heart valve disposed between an atrium and a ventricle of a heart of a subject, the apparatus including:
- an annular upstream support defining an opening therethrough, and configured to be placed against an upstream surface of the native heart valve;
- a tubular valve body having an upstream end, a downstream end and a lumen therebetween, the lumen having a first diameter, and the valve body being separated from the upstream element by a gap between the upstream end of the valve body and the upstream element;
- one or more tissue-engaging elements that protrude radially outward from the valve body so as to define a second diameter that is greater than the first diameter; and
- a flexible sheet shaped to define a conduit, a downstream portion of the sheet being coupled to the valve body, an upstream portion of the sheet being coupled to the upstream element, and the sheet spanning the gap.
- In an application, the apparatus further includes at least one tether, a first portion of the tether being coupled to the valve body and a second portion of the tether being coupled to the upstream support, such that tensioning of at least a portion of the tether reduces the gap.
- In an application, the apparatus is configured such that tensioning of at least the portion of the tether rumples the sheet.
- There is further provided, in accordance with an application of the present invention, apparatus for use with a native heart valve disposed between an atrium and a ventricle of a heart of a subject, the apparatus including:
- an annular upstream element defining an opening therethrough, and configured to be placed against an upstream surface of the native heart valve;
- a flexible sheet, shaped to define a conduit, and coupled to the upstream element such that the conduit is in fluid communication with the opening; and
- a valve body, coupled to the flexible sheet such that the conduit provides fluid communication between the prosthetic valve and the upstream element.
- In an application, the valve body includes:
- a generally cylindrical frame shaped to define a lumen therethrough, and
- a valve member coupled to the frame and disposed within the lumen.
- In an application, the frame is separated from the upstream element by a gap, and the conduit spans the gap.
- There is further provided, in accordance with an application of the present invention, apparatus, for use with a guide member that extends into a subject, the apparatus including:
- a delivery tool, including a housing, the housing:
-
- being transluminally advanceable into the subject,
- shaped to define an orifice at an end of the housing, and
- having a lateral wall shaped to define a slit that is continuous with the orifice;
- an implant:
-
- configured to be housed by the housing, and
- including an eyelet that (1) is slidable over the guide member, and (2) when the implant is housed by the housing, extends through the slit and radially beyond the lateral wall such that the eyelet facilitates transluminal sliding of the implant and the housing along the guide member and into the subject,
the apparatus being configured such that, while (1) the implant remains within the subject, and (2) the guide member remains disposed through the eyelet, (1) the implant is removable from the housing via the orifice, and (2) the housing is removable from the subject.
- In an application, the implant is configured to be implanted by being intracorporeally locked to the guide member.
- In an application, the implant has a compressed state and an expanded state, is configured to be housed by the housing while in the compressed state, and is configured to automatically expand toward the expanded state when removed from the housing.
- There is further provided, in accordance with an application of the present invention, a method for use with a native valve of a heart of a subject, the method including:
- transluminally anchoring a tissue anchor to ventricular tissue of a subject using an anchor-manipulation tool, the tissue anchor being coupled to a first portion of a tether;
- transluminally delivering an annular upstream support and a prosthetic valve to the heart, the prosthetic valve including (1) a valve body shaped to define a lumen therethrough, and (2) one or more tissue-engaging legs configured to protrude laterally outward from the valve body;
- pressing the tissue-engaging legs in an upstream direction against a ventricular surface of the native valve by applying a force to the prosthetic valve while measuring the force;
- applying, to the tether, a tension that changes a shape of a spring coupled to the tether, while observing the shape of the spring using imaging; and
- at least in part responsively to the observed shape of the spring, facilitating holding of the upstream support against an upstream surface of the native valve by locking a second portion of the tether to at least one component selected from the group consisting of: the prosthetic valve and the upstream support.
- In an application, measuring the force includes measuring the force using an extracorporeal force meter.
- In an application, measuring the force includes observing a shape of the tissue-engaging legs using imaging.
- In an application, applying the tension includes applying the tension while applying the force.
- In an application, locking the second portion to the selected component includes locking the second portion to the prosthetic valve.
- In an application, locking the second portion to the selected component includes locking the second portion to the upstream support.
- In an application, locking the second portion includes locking the second portion when the observed shape indicates that the spring is experiencing between 400 g force and 600 g force.
- In an application, locking the second portion includes locking the second portion subsequently to applying the tension, and applying the force includes applying the force subsequently to locking the second portion.
- In an application:
- anchoring the tissue anchor coupled to the tether includes anchoring a first tissue anchor coupled to a first tether, and applying the tension includes applying a first tension that changes a shape of a first spring coupled to the first tether,
- the method further includes:
-
- anchoring a second tissue anchor to the ventricular tissue, the second tissue anchor being coupled to a first portion of a second tether; and
- applying, to the second tether, a second tension that changes a shape of a second spring coupled to the second tether, while observing the shape of the second spring using imaging, and
- facilitating holding of the prosthetic valve against the upstream surface includes, at least in part responsively to the observed shape of the second spring, facilitating holding of the prosthetic valve against the upstream surface by locking a second portion of the second tether to the selected at least one component.
- In an application, facilitating holding includes locking the second portion of the first tether and the second portion of the second tether to the selected at least one component, at least in part responsively to a ratio between tension in the first tether and tension in the second tether, the ratio being derived from the observed shape of the first spring and the observed shape of the second spring.
- In an application, locking includes locking the second portion to the at least one component at least in part responsively to the observed shape.
- In an application, locking includes locking the second portion to the at least one component at least in part responsively to the measured force.
- In an application, applying the force includes moving the valve body in an upstream direction through an opening defined by the upstream support, and the method further includes coupling the prosthetic valve to the upstream support by expanding the valve body within the opening.
- In an application, coupling the prosthetic valve to the upstream support includes coupling the prosthetic valve to the upstream support at least in part responsively to the measured force.
- There is further provided, in accordance with an application of the present invention, a method, including:
- transluminally advancing a plurality of tissue anchors, coupled to a respective plurality of springs, into a body of a subject;
- anchoring the plurality of tissue anchors to tissue of the subject;
- tensioning at least one of the springs;
- using imaging, while the tension is applied to the at least one spring, observing a state of the at least one spring; and
- at least in part responsively to the observed state of at least one spring, adjusting a tension on at least one of the springs.
- There is further provided, in accordance with an application of the present invention, a method, for use with a native valve of a heart of a subject, the method including:
- applying a first tension to a tether that couples (a) a tissue anchor anchored to ventricular tissue of a subject, to (b) a prosthetic valve body, the tether having a length between the tissue anchor and the valve body;
- by applying an atrially-directed force to the prosthetic valve body, pressing, against tissue of the native valve, a tissue-engaging element that protrudes radially from the valve body
- transluminally advancing a prosthetic valve body to a native valve of the subject;
- while applying the atrially-directed force, measuring:
-
- a pressing force of the tissue-engaging element against the tissue of the native valve, and
- a second tension on the tether, the second tension differing from the first tension at least in part due to the atrially-directed force; and
- at least in part responsively to the measured pressing force and the measured second tension, performing an action selected from the group consisting of: adjusting the length of the tether between the tissue anchor and the valve body, and locking the valve body to the tether.
- There is further provided, in accordance with an application of the present invention, a method for use with a native valve of a heart of a subject, the method including:
- transluminally delivering a tissue anchor to a ventricle of the heart, and anchoring the tissue anchor to ventricular muscle tissue of the subject;
- transluminally delivering an upstream support to an atrium of the heart, and placing the upstream support against an upstream surface of an annulus of the native valve; and
- changing a shape of the upstream support by tensioning a tether coupled to upstream support and to the tissue anchor; and
- extracorporeally fluoroscopically observing the shape change of the upstream support.
- In an application, tensioning the tether coupled to the upstream support includes tensioning a tether that is coupled to a valve body coupled to the upstream support.
- In an application, before the tensioning, the upstream support is generally flat annular, and changing the shape includes making the support assume a frustoconical shape.
- In an application, before the tensioning, the upstream support is frustoconical, and changing the shape includes changing a slant of the frustoconical shape.
- There is further provided, in accordance with an application of the present invention, apparatus for use with a valve of a heart of a subject, the apparatus including:
- a transluminally-deliverable tissue anchor;
- a tether, a first end thereof coupled to the tissue anchor; and
- a delivery tool, including:
-
- a steerable catheter having a longitudinal axis, and being transluminally deliverable to the valve, and
- an obstructing element:
- disposed at a longitudinal site of the catheter,
- configured to extend laterally outward from the catheter, and
- dimensioned, when extending laterally outward from the catheter, to inhibit movement of at least the longitudinal site through the valve by abutting tissue of the valve, and
- an anchor manipulator:
- reversibly couplable to the tissue anchor,
- slidable through the catheter, and
- configured to drive the anchor into ventricular tissue of the heart of the subject.
- In an application, the anchor manipulator is slidably coupled to the catheter such that a distal end of the anchor manipulator is slidable distally no more than a pre-determined distance from the longitudinal site.
- In an application, the apparatus further includes an implant, intracorporeally lockable to the tether.
- In an application, the apparatus further includes a guide member, reversibly couplable to the tether, and the implant is intracorporeally slidable along the guide member toward the tether and the implant.
- In an application, the tether has exactly one locking site at which the implant is lockable to the tether.
- In an application, the exactly one locking site is disposed at a pre-determined distance from the anchor that is pre-determined at least in part dependently on a distance between the longitudinal site and a distal end of the catheter.
- There is further provided, in accordance with an application of the present invention, a method, including:
- transluminally anchoring a tissue anchor to tissue of a subject using an anchor-manipulation tool;
- subsequently applying to the anchor a pulling force having a given magnitude;
- using imaging, observing a movement of the tissue anchor in response to the pulling force; and
- at least in part responsively to the observed movement, performing an action selected from the group consisting of: de-anchoring the tissue anchor from the tissue, and decoupling the anchor-manipulation tool from the tissue anchor.
- There is further provided, in accordance with an application of the present invention, apparatus, for implantation at a native valve of a heart of a subject, the native valve being disposed between an atrium and a ventricle of the heart, the apparatus including:
- a tubular valve body:
-
- having an upstream portion, configured to be disposed in the atrium of the heart of the subject,
- having a downstream portion, configured to be disposed in the ventricle of the subject,
- having an elastic portion, disposed between the upstream portion and the downstream portion, and elastically coupling the upstream portion to the downstream portion, and
- shaped to define a continuous lumen through the upstream portion, the elastic portion, and the downstream portion; and
- at least one valve member, disposed in the lumen of the valve body, and configured to facilitate flow of blood of the subject from the upstream portion of the valve body to the downstream portion of the valve body, and to inhibit flow of the blood from the downstream portion of the valve body to the upstream portion of the valve body.
- In an application, the at least one valve member is coupled to the downstream portion of the valve body.
- In an application, the native valve includes a plurality of native leaflets, and the downstream portion of the valve body is configured to be coupled to the native leaflets.
- In an application, the apparatus further includes a plurality of clips, configured to facilitate the coupling of the downstream portion of the valve body to the native leaflets.
- In an application, each clip:
- includes at least two clip arms, articulatably coupled to each other, and
- is reversibly closeable.
- In an application, the clips are coupled to the downstream portion of the valve body, and the downstream portion of the valve body is configured to be coupled to the native leaflets by the clips being coupled to the native leaflets.
- In an application, each clip of the plurality of clips is articulatably coupled to the downstream portion of the valve body.
- In an application, the native valve includes an annulus having an upstream surface, and the apparatus further includes a prosthetic valve support:
- including (1) an upstream support portion, configured to be placed against the upstream surface of the annulus of the native valve, and (2) the plurality of clips, coupled to the upstream support portion,
- shaped to define an opening therethrough that is configured to receive the prosthetic valve,
- and the clips are configured to facilitate the coupling of the downstream portion of the valve body to the native leaflets by coupling the prosthetic valve support to the native leaflets.
- There is further provided, in accordance with an application of the present invention, apparatus for use with a native valve of a heart of a subject, the native valve having a plurality of leaflets that meet at a plurality of commissures, the apparatus including:
- at least one tissue anchor, configured to be anchored to a first site within a ventricle of the heart of the subject;
- at least one longitudinal member, coupled at a distal end thereof to a respective one of the at least one tissue anchors;
- an upstream support, including an upstream support portion configured to be slidable over the longitudinal member and placed against an upstream surface of the native valve; and
- at least one locking member, configured to be slidable over a respective one of the at least one longitudinal members, and to be lockable to the respective longitudinal member such that a portion of the respective longitudinal member that is disposed between the respective anchor and the upstream support portion is longer than 1 cm.
- In an application, the longitudinal member is flexible.
- In an application, the longitudinal member includes a suture.
- There is further provided, in accordance with an application of the present invention, a method for use with a native valve of a heart of a subject, the native valve having a plurality of leaflets that meet at a first commissure and at a second commissure, the method including:
- anchoring a first tissue anchor to a first site within a ventricle of the heart of the subject, the first tissue anchor being coupled to a distal end of a first longitudinal member;
- anchoring a second tissue anchor to a second site within the ventricle of the heart of the subject, the second tissue anchor being coupled to a distal end of a second longitudinal member;
- subsequently, placing at least an upstream support portion of a prosthetic valve support against an upstream surface of the native valve, the valve being disposed between the ventricle and an atrium of the heart of the subject; and
- securing the upstream support portion against the upstream surface of the valve by:
-
- coupling the upstream support portion to the first longitudinal member such that at least part of a portion of the first longitudinal member that is disposed between the upstream support portion and the first tissue anchor, is disposed between the first and second leaflets at the first commissure, and
- coupling the upstream support portion to the second longitudinal member such that at least part of a portion of the second longitudinal member that is disposed between the upstream support portion and the first tissue anchor, is disposed between the first and second leaflets at the second commissure.
- In an application, anchoring, placing, and securing include anchoring, securing, and placing without the use of cardiopulmonary bypass.
- In an application, anchoring to the first site and anchoring to the second site include anchoring to myocardium.
- In an application, placing the upstream support portion against the upstream surface includes sliding the upstream support portion over at least part of the first longitudinal member.
- In an application, coupling the upstream support portion to the first longitudinal member and to the second longitudinal member includes coupling the upstream support portion to the first longitudinal member in the atrium of the heart of the subject, and coupling the upstream support portion to the second longitudinal member includes coupling the upstream support portion to the second longitudinal member in the atrium of the heart of the subject.
- In an application, the leaflets move in response to beating of the heart of the subject, and securing the upstream support portion includes securing the upstream support portion without eliminating the movement of the native leaflets.
- In an application, coupling the upstream support portion to the first longitudinal member includes coupling the upstream support portion to the first longitudinal member such that a length of the portion of the first longitudinal member is greater than 1 cm.
- In an application, the method further includes:
- transluminally advancing at least the first tissue anchor to the first site while the respective longitudinal member coupled thereto is disposed within a respective tubular member; and
- subsequently to anchoring the at least first tissue anchor, and before coupling the upstream support portion to the respective longitudinal member, sliding the at least first tubular member off of at least part of the respective longitudinal member.
- In an application, sliding the at least first tubular member includes sliding at least part of the at least first tubular member through a channel defined by a locking member, and coupling the upstream support portion to the respective longitudinal member includes locking the locking member to the respective longitudinal member by narrowing at least a portion of the channel.
- In an application:
- advancing the at least first tissue anchor includes advancing the at least first tissue anchor while (1) the respective longitudinal member is reversibly coupled to a portion of a wire, and (2) the respective tubular member inhibits the portion of the wire from decoupling from the portion of the wire, and
- the method further includes facilitating decoupling of the wire from the respective longitudinal member by sliding the at least first tubular member off of the portion of the wire.
- In an application:
- advancing the at least first tissue anchor includes advancing the at least first tissue anchor while (1) the respective longitudinal member is shaped to define a loop, and is coupled to the portion of the wire by the portion of the wire being threaded through the loop, and (2) the respective tubular member inhibits the portion of the wire from unthreading from the loop, and
- facilitating decoupling of the wire from the respective longitudinal member includes facilitating unthreading of the wire from the loop by sliding the at least first tubular member off of the portion of the wire.
- In an application, sliding the at least first tubular member off of the portion of the wire includes sliding the at least first tubular member off of the portion of the wire by applying less than 500 g of pulling force to the at least first tubular member.
- In an application, applying less than 500 g of pulling force to the at least first tubular member includes applying less than 300 g of pulling force to the at least first tubular member.
- In an application, the method further includes, subsequently to securing the upstream support portion, coupling a prosthetic valve to the prosthetic valve support.
- In an application, the upstream support portion has an inner edge that defines an opening through the upstream support portion, and coupling the prosthetic valve to the prosthetic valve support includes placing at least a portion of the prosthetic valve within the opening, and expanding at least the portion of the prosthetic valve such that at least the portion of the prosthetic valve applies a radially-expansive force against the inner edge of the upstream support portion.
- In an application, the prosthetic valve includes one or more tissue-engaging elements, each of the one or more tissue-engaging elements including at least two arms, and the method further includes, subsequent to securing the upstream support portion, coupling the prosthetic valve to at least one of the leaflets by sandwiching the at least one of the leaflets between the at least clip arms of the one or more tissue-engaging elements.
- In an application, coupling the prosthetic valve to the at least one of the leaflets includes coupling the prosthetic valve to the at least one of the leaflets before coupling the prosthetic valve to the prosthetic valve support.
- In an application:
- the prosthetic valve includes a valve body, having an outer surface,
- the at least two arms include a first arm and a second arm, the first arm being longer than the second arm, and
- the method further includes:
-
- delivering, within a delivery tube, the prosthetic valve in a delivery configuration thereof, in which the first arm and the second arm are constrained against the outer surface of the valve body;
- facilitating deflection of the first arm away from the outer surface of the prosthetic valve, by advancing a first portion of the prosthetic valve out of the delivery tube such that the first arm automatically deflects away from the outer surface of the prosthetic valve; and
- facilitating deflection of the second arm away from the outer surface of the prosthetic valve, by advancing a second portion of the prosthetic valve out of the delivery tube such that the second arm automatically deflects away from the outer surface of the prosthetic valve.
- In an application:
- facilitating deflection of the first arm includes facilitating deflection of the first arm a first angle from the outer surface of the prosthetic valve, and
- the method further includes facilitating deflection of the first arm away from the outer surface of the prosthetic valve a second angle that is greater than the first angle, by applying a force to the first arm using the delivery tube:
-
- subsequently to facilitating deflection of the first arm the first angle, and
- prior to facilitating deflection of the second arm.
- In an application, applying the force to the first arm using the delivery tube includes pushing on the first arm by sliding the delivery tube over at least part of the prosthetic valve.
- There is further provided, in accordance with an application of the present invention, apparatus for use with a body of a subject, the apparatus including:
- at least a first implantable member;
- a first longitudinal member, coupled at a distal end thereof to the first implantable member;
- a second longitudinal member, at least a portion of the second longitudinal member being reversibly couplable to the first longitudinal member; and
- a tubular member:
-
- slidable over the first and second longitudinal members,
- shaped to define a lumen therethrough, and
- configured, when the portion of the second longitudinal member is (1) coupled to the first longitudinal member, and (2) disposed within the lumen of the tubular member, to inhibit decoupling of the portion of the second longitudinal member from the first longitudinal member.
- In an application, the portion of the second longitudinal member is configured, when (1) the portion of the second longitudinal member is coupled to the first longitudinal member, and (2) the portion of the second longitudinal member is disposed outside of the lumen of the tubular member, to be decouplable from the first longitudinal member by the second longitudinal member being pulled away from the first longitudinal member.
- In an application, at least one longitudinal member selected from the group consisting of: the first longitudinal member and the second longitudinal member, is flexible.
- In an application, the tubular member is more rigid than the first longitudinal member.
- In an application, the tubular member fits snugly over at least the portion of the second longitudinal member.
- In an application, the first implantable member includes a tissue anchor, configured to be anchored to a tissue of the subject.
- In an application, the apparatus further includes a second implantable member, slidable over the tubular member, and couplable to the first longitudinal member while the portion of the second longitudinal member is coupled to the first longitudinal member.
- In an application, the portion of the second longitudinal member is reversibly couplable to the first longitudinal member at a first site of the first longitudinal member, and the second implantable member is couplable to the first longitudinal member at a second site of the first longitudinal member that is distal to the first site of the longitudinal member.
- In an application, the apparatus further includes a locking member having an unlocked state and a locked state, and configured to be slid over the tubular member in the unlocked state and to be locked to the first longitudinal member by being transitioned to the locked state.
- In an application, the locking member is configured to facilitate coupling of the second implantable member to the first longitudinal member.
- In an application, the locking member is configured to be coupled to the first longitudinal member at least 1 cm away from the first implantable member.
- There is further provided, in accordance with an application of the present invention, apparatus for use at a native valve of a heart of a subject, the apparatus including:
- a tissue anchor, configured to be transluminally, transcatheterally advanced to a ventricle of the heart of the subject, and to be coupled to tissue of the ventricle;
- a longitudinal member, coupled at a distal end thereof to the tissue anchor;
- a wire, a portion of the wire being reversibly couplable to the longitudinal member;
- a tubular member:
-
- slidable over the longitudinal member and the wire,
- shaped to define a lumen therethrough, and
- configured, when the portion of the wire is (1) coupled to the longitudinal member, and (2) disposed within the lumen of the tubular member, to inhibit decoupling of the portion of the wire from the longitudinal member;
- a prosthetic valve support including an upstream support portion slidable over the tubular member, and to be placed against an upstream surface of an annulus of the native valve by sliding over the tubular member; and
- a locking member, slidable over the tubular element and lockable to the longitudinal member.
- In an application, the locking member is configured to be locked to the longitudinal member at a site of the longitudinal member that is distal to a site of the longitudinal member to which the portion of the wire is reversibly couplable.
- In an application, the tubular member is configured to be slid out of the locking member before the locking member is locked to the longitudinal member.
- In an application, the apparatus further includes a control rod, slidable over the tubular member, the locking member being reversibly coupled to a control rod, the control rod being configured to restrain the locking member in an unlocked configuration thereof, and to facilitate locking of the locking member by ceasing to restrain the locking member in the unlocked configuration.
- In an application, the control rod is configured to decouple from the locking member when the control rod ceases to restrain the locking member in the unlocked configuration thereof.
- In an application, the control rod is configured to cease to restrain the locking member in the unlocked configuration thereof by the control rod being rotated with respect to the locking member.
- In an application:
- the prosthetic valve support is shaped to define a hole through which the tubular member is slidable,
- at least while the control rod is coupled to the locking member, the control rod is not slidable through the hole defined by the prosthetic valve support, and
- the control rod is configured to facilitate the sliding of the prosthetic valve support over the tubular member by pushing the prosthetic valve support over the tubular member.
- The present invention will be more fully understood from the following detailed description of applications thereof, taken together with the drawings, in which:
-
FIGS. 1A-F are schematic illustrations of a system for implanting a prosthetic valve support and a prosthetic valve at a native valve of a heart of a subject, in accordance with some applications of the invention; -
FIG. 2 is a schematic illustration of the prosthetic valve being retrieved into a delivery tube, in accordance with some applications of the invention; -
FIGS. 3A-C are schematic illustrations of the introduction of guide members through the prosthetic valve support and a delivery tube, in accordance with some applications of the invention; -
FIGS. 4A-C are schematic illustrations of a locking member, and control thereof, in accordance with some applications of the invention; -
FIG. 5 is a schematic illustration of steps in the delivery and anchoring of tissue anchors, in accordance with some applications of the invention; -
FIG. 6 is a schematic illustration of a system for use with a prosthetic valve support, in accordance with some applications of the invention; -
FIGS. 7A-C are schematic illustrations of a system for facilitating transluminal delivery of a prosthetic valve assembly, in accordance with some applications of the invention; -
FIGS. 8A-H are schematic illustrations of a technique for use with the system ofFIGS. 7A-C , to transluminally implant a prosthetic valve assembly, in accordance with some applications of the invention; -
FIGS. 9A-B , 10A-B, 11A-B, 12A-B, 13A-B, and 14A-B are schematic illustrations of prosthetic valve assemblies, in accordance with some applications of the invention; -
FIGS. 15A-C are schematic illustrations of a tool for facilitating application of force between a prosthetic valve assembly and tethers, in accordance with some applications of the invention; -
FIG. 16 is a schematic illustration of a system comprising a prosthetic valve assembly and one or more springs, via which the prosthetic valve assembly is elastically coupled to one or more tissue anchors, in accordance with some applications of the invention; -
FIG. 17 is a schematic illustration of a system comprising a prosthetic valve assembly and one or more springs, via which the prosthetic valve assembly is elastically coupled to one or more tissue anchors, in accordance with some applications of the invention; -
FIGS. 18A-B are schematic illustrations of springs coupled to respective tethers so as to elastically couple a tissue anchor to a prosthetic valve assembly, in accordance with some applications of the invention; -
FIGS. 19A-B are schematic illustrations of a system for facilitating delivery of a prosthetic valve body, in accordance with some applications of the invention; -
FIG. 20 is a schematic illustration showing examples in which force measurements described herein may be combined to facilitate implantation of a prosthetic valve, in accordance with some applications of the invention; -
FIGS. 21A-B are schematic illustrations of a prosthetic valve assembly, in accordance with some applications of the invention; -
FIGS. 22A-B are schematic illustrations of a prosthetic valve assembly comprising a prosthetic valve having a tubular valve body that comprises an upstream portion, a downstream portion, and an elastic portion disposed between the upstream portion and the downstream portion, in accordance with some applications of the invention; and -
FIGS. 23-24 are schematic illustrations of systems for facilitating anchoring of a tissue anchor in the heart of a subject, in accordance with some applications of the invention. - Reference is made to
FIGS. 1A-F , which are schematic illustrations of asystem 40 for implanting an upstreamprosthetic valve support 42 and aprosthetic valve 44 at anative valve 10 of aheart 4 of a subject, in accordance with some applications of the invention. Typically, applications of the invention are for use with the mitral valve of the subject (that is,native valve 10 comprises the mitral valve of the subject), but it is to be noted that applications of the invention may be used at other heart valves of the subject, such as the tricuspid valve, the aortic valve, or the pulmonary valve, mutatis mutandis. - Reference is now made to
FIGS. 1A-B . Asheath 46 is advanced transluminally (e.g., transfemorally) toright atrium 12 of the heart, and is typically advanced through the fossa ovalis intoleft atrium 6 of the heart using standard transseptal techniques. For some applications,sheath 46 is steerable. For some such applications,sheath 46 is steerable in two axes. One or more (typically two) tissue anchors 48 are advanced throughsheath 46, betweenleaflets 14 of the native valve, and intoleft ventricle 8 of the heart, and are there anchored to tissue (e.g., ventricular muscle tissue) of the heart.FIG. 1A shows afirst tissue anchor 48 a being anchored at a first ventricular site, andFIG. 1B shows asecond tissue anchor 48 b being anchored at a second ventricular site. Typically, anchors 48 are anchored to muscle of the heart, such as to the walls ofventricle 8 and/or to papillary muscles. Typically, and as shown, anchors 48 comprise helical anchors that are anchored by being rotated. However, other types of anchors may be used, such as barbed or harpoon-like anchors, e.g., that are anchored by being pushed into the tissue. - State A of
FIGS. 1A and 1B show acatheter 50 having been advanced throughsheath 46 and intoventricle 8, and an anchor-delivery tube 52 having been advanced throughcatheter 50 to the respective ventricular site. Typically, and as shown, the distal end ofdelivery tube 52 is placed against the tissue at the ventricular site. Typically, at least a distal portion ofcatheter 50 is steerable (e.g., independently of sheath 46). - State B of
FIGS. 1A and 1B each show arespective anchor 48 being anchored to a respective ventricular site. Typically,anchor 48 is reversibly coupled to an anchor manipulator 54 (e.g., an anchor driver), which is slidable through at least part oftube 52, and which is configured to apply a force (e.g., a rotational force) to the anchor so as to anchor the anchor at the ventricular site. For some applications,anchor manipulator 54 andanchor 48 are advanced from outside the subject to the ventricular site only once the distal end oftube 52 is disposed against the ventricular site. For some applications, the manipulator and anchor are disposed within, and advanced with,tube 52. For some applications,anchor 48 is anchored by rotatinganchor manipulator 54 andtube 52 together. For some applications, aseparate anchor manipulator 54 is used to deliver and anchor each anchor 48 (e.g., eachanchor 48 may be provided pre-coupled to a respective anchor manipulator). For some applications, oneanchor manipulator 54 may be used to deliver and anchor all (e.g., both) anchors 48 (e.g., eachanchor 48 may be configured to be sequentially coupled to the anchor manipulator outside the body of the subject by the operating physician). It is to be noted that typically anchor 48 is not exposed fromtube 52 other than when being anchored. It is hypothesized that for some applications this reduces a likelihood of inadvertently engaging and/or damaging tissue of the heart (e.g., chordae tendineae). - For some applications, subsequent to anchoring each
tissue anchor 48 to the tissue, a testing pulling force of known magnitude is applied to the anchor (e.g., by applying the pulling force to anchor manipulator 54), and movement of the tissue anchor in response to the pulling force is observed using imaging (e.g., fluoroscopy). The observed movement may be used to confirm successful and/or stable anchoring (e.g., relatively little movement may indicate firm anchoring in firm tissue) or to determine sub-optimal anchoring (e.g., relatively large movement may indicate weak anchoring and/or anchoring in weak tissue). Thus, at least in part responsively to the observed movement, the operating physician may decouplemanipulator 54 fromanchor 48, or may de-anchor the anchor from the tissue using the manipulator. - State C of
FIGS. 1A and 1B show anchor manipulator 54 having been decoupled fromanchor 48, and the manipulator andtube 52 being withdrawn proximally intocatheter 50. Eachanchor 48 is provided pre-coupled to a guide member 56 (e.g., a first guide member 56 a, and a second guide member 56 b), described in more detail hereinbelow (e.g., with reference to FIGS. 1D and 4A-C). Asmanipulator 54 andtube 52 are withdrawn,guide member 56 is exposed fromtube 52. - Typically, and as shown in
FIGS. 1A-B , thesame catheter 50 is used to deliver bothanchors 48. For such applications, and as shown in states B and C ofFIG. 1B , when deliveringsecond tissue anchor 48 b, anchor-delivery tube 52 fits alongside first guide member 56 a withincatheter 50. Alternatively, and as described hereinbelow with reference toFIG. 5 , a separate catheter is used for each anchor, in which case the second catheter fits alongside first guide member 56 a withinsheath 46. - State D of
FIGS. 1A and 1B showcatheter 50 having been withdrawn proximally, intoatrium 6. For some applications,catheter 50 is withdrawn completely from the body of the subject. For some applications,catheter 50 is used for delivery of components during later steps in the procedure.Guide members 56 extend fromatrium 6, betweenleaflets 14, and to respective ventricular sites. Typically,guide members 56 do not eliminate functioning ofleaflets 14 and/orvalve 10. For some applications, guidemembers 56 are configured to automatically move toward respective commissures 16 (e.g., into the joining corners at the commissures of leaflets 14). For some applications, and as shown inFIG. 1C , prosthetic valve support 42 (e.g., deployment thereof) pushesguide members 56 toward the respective commissures. - Reference is now made to
FIG. 1C , which shows prosthetic valve support being delivered to, and deployed at,native valve 10.Prosthetic valve support 42 is advanced throughsheath 46 and intoatrium 6. Typically,support 42 is delivered in a compressed configuration thereof, within a housing, such as adelivery tube 80. For some applications,catheter 50 is used to facilitate delivery ofprosthetic valve support 42 and delivery tube 80 (e.g., the support and delivery tube are advanced through catheter 50). For some applications, a different catheter is used to facilitate delivery ofprosthetic valve support 42 anddelivery tube 80. For some applications,prosthetic valve support 42 anddelivery tube 80 are advanced directly throughsheath 46. -
Prosthetic valve support 42 comprises an annular upstream support portion 43 which, in the delivery configuration of the prosthetic valve support, is generally cylindrical, and which, once the prosthetic valve is deployed and expands to an uncompressed configuration thereof, is generally annular. For some applications, upstream support portion 43 is generally frustoconical in the uncompressed configuration thereof. Typically, a distal end of upstream support portion 43 in the compressed, cylindrical configuration, defines an inner perimeter of the upstream support portion in the uncompressed configuration, the inner perimeter defining an opening through the upstream support portion. - State A of
FIG. 1C showsdelivery tube 80, containingsupport 42, having been delivered toatrium 6 overguide members 56, andsupport 42 starting to be subsequently exposed from the delivery tube, and automatically expanding. Upstream support portion 43 ofprosthetic valve support 42 is shaped to defineholes 82 through which guidemembers 56 are slidable, thereby facilitating sliding of the prosthetic valve support overguide members 56. Typically, holes 82 are disposed opposite each other around the generally annular shape of upstream support portion 43. For some applications, holes 82 are defined and/or reinforced by aneyelet 84 or pledget (visible in states B and C ofFIG. 1C ).Guide members 56 extend proximally fromdelivery tube 80, e.g., via holes in a proximal end of the delivery tube, such that the delivery tube, andprosthetic valve support 42, in the compressed state within the delivery tube, are slidable over the guide members, the guide members thereby facilitating delivery of the prosthetic valve support within the delivery tube. Introduction ofguide members 56 through the prosthetic valve support and delivery tube are described hereinbelow with reference toFIGS. 3A-C . - State B of
FIG. 1C shows prosthetic valve support 42 (e.g., upstream support portion 43 thereof) having been completely deployed fromdelivery tube 80, and having automatically expanded to the uncompressed configuration thereof.Guide members 56 are typically pushed towardcommissures 16 by the expansion ofsupport 42. For some applications,delivery tube 80 is subsequently removed from the body of the subject. Atubular control rod 86 is advanced over eachguide member 56 towardprosthetic valve support 42, and is used to push prosthetic valve support 42 (e.g., upstream support portion 43 thereof) toward the annulus ofvalve 10.Control rods 86 have a cross-sectional diameter that is larger than that ofholes 82, and may thereby be used to push against upstream support portion 43 without passing through the holes. - Typically, prosthetic valve support 42 (e.g., upstream support portion 43 thereof) is provided with one or more (e.g., two)
control filaments 88 reversibly coupled thereto. Typically,filaments 88 are coupled to upstream support portion 43 at sites that are disposed opposite each other around the generally annular shape of the upstream support portion, and disposed evenly between holes 82. That is, in the expanded configuration of upstream support portion 43, a straight line betweenholes 82 is typically perpendicular to a straight line between the sites at whichfilaments 88 are coupled to the upstream support portion. It should be noted that other numbers and arrangements of control filaments may also be used. Typically, each control filament 88 (1) comprises two portions of a loop of filament that passes through upstream support portion 43, loops around a downstream surface of the upstream support portion (i.e., the surface that is placed in contact with the annulus of the native valve), and passes back through the upstream support portion, and (2) is decouplable from the upstream support portion by releasing a first end of the filament and pulling a second end, thereby unthreading and/or unlooping the control filament from the upstream support portion. -
Control filaments 88 facilitate some manipulation ofprosthetic valve support 42 following deployment fromdelivery tube 80. Typically,control rods 86 further facilitate such manipulation. State C ofFIG. 1C shows such manipulation ofprosthetic valve support 42. For example, it may be desirable to rotate the prosthetic valve support (e.g., to position and/or orient the upstream support portion correctly with respect tonative valve 10, to control the order in which different regions of upstream support portion 43 contact the native valve, and/or to uncoilcontrol rods 86 and/orcontrol filaments 88 from each other). - Reference is now made to
FIG. 1D , which show steps in securingprosthetic valve support 42 against the upstream surface (e.g., the atrial surface) ofnative valve 10. Eachguide member 56 typically comprises a tether (e.g., a longitudinal member 102), a pull-wire 104 reversibly coupled to the longitudinal member, and atubular member 100 in which the longitudinal member and the pull-wire are disposed, the tubular member fitting snugly over the longitudinal member and the pull-wire so as to inhibit the pull-wire from becoming decoupled from the longitudinal member (e.g., to maintain a state of coupling therebetween). Pull-wire 104 may or may not be metallic and may have various cross-sectional shapes (e.g., circular or rectangular). Typically, (1)longitudinal member 102 defines a loop (e.g., a closed loop) (2) a portion (e.g., a distal portion) of pull-wire 104 is threaded through the loop defined by member 102 (e.g., is looped through the loop), and (3) the snug fitting oftubular member 100 overmember 102 and pull-wire 104 inhibits the portion of the pull-wire from unthreading from the loop. It is to be noted that, althoughlongitudinal member 102 is shown as defining a loop that extends most (e.g., all) of the length of the longitudinal member, the loop may alternatively be defined only at a proximal end of the longitudinal member. - For some applications,
longitudinal member 102 and pull-wire 104 are coupled via complementary screw threads. For example,longitudinal member 102 may comprise, or be coupled to, a screw at a proximal end thereof, and pull-wire 104 may comprise, or be coupled to, a socket at a distal end thereof. For some applications,tubular member 100 is used to decouple (e.g., unscrew) pull-wire 104 fromlongitudinal member 102. -
Tubular member 100 is typically more rigid than pull-wire 104 and/or longitudinal member 102 (although it is still sufficiently flexible to be transluminally delivered). This rigidity reduces a likelihood of twisting, kinking, snagging, and/or other undesirable phenomenon or interactions within the transluminal delivery system (e.g., withinsheath 46,catheter 50, and/or anchor-delivery tube 52). For some applicationstubular member 100 has a smoother surface than does pull-wire 104 orlongitudinal member 102. For some applications,tubular member 100, which is necessarily wider than pull-wire 104 and/orlongitudinal member 102, is also more visible using imaging techniques such as fluoroscopy. This advantageously allows an operating physician to monitor the intracorporeal juxtaposition of the tubular members and, if necessary, to intervene, such as by revolving the tubular members (e.g., proximal ends thereof) around each other. - As described hereinabove,
control rods 86 are used to pushprosthetic valve support 42 toward the annulus ofvalve 10 by sliding the control rod over a respective guide member 56 (i.e., over thetubular member 100 of the respective guide member). Eachcontrol rod 86 is reversibly coupled at a distal end thereof to arespective locking member 110 that, in an unlocked state thereof, is slidable overguide member 56. Thereby, the pushing ofprosthetic valve support 42 is typically performed by pushing with bothcontrol rod 86 and lockingmember 110. State A ofFIG. 1D showscontrol rods 86 andrespective locking members 110 having been slid over respectivetubular members 100 ofrespective guide members 56, such thatprosthetic valve support 42 has been pushed against the annulus ofvalve 10. Typically, a counter force (e.g., a proximal pulling force) is applied to guide member 56 (e.g., totubular member 100,longitudinal member 102, and pull-wire 104) so as to facilitate such sliding. - State B of
FIG. 1D showstubular member 110 having been pulled proximally such that the distal end of the tubular member is disposed proximal to lockingmember 110, thereby exposing, from the tubular member, progressive portions oflongitudinal member 102, at least until the tubular member is not disposed between the longitudinal member and the locking member (e.g., such that the locking member can directly contact the longitudinal member). Typically, and as shown in state B ofFIG. 1D ,tubular member 100 is pulled proximally such that the distal end thereof is disposed distal to the point at whichlongitudinal member 102 and pull-wire 104 are coupled, thereby retaining the coupling therebetween. While in this state, lockingmember 110 is locked to longitudinal member 102 (e.g., to a portion of the longitudinal member that is disposed within a channel of the locking member). For some applications, lockingmember 110 locks automatically in response to withdrawal oftubular member 100. For some applications, locking of lockingmember 110 is independent of the withdrawal of the tubular member. An embodiment of lockingmember 110 and control thereof is described in more detail hereinbelow with respect toFIGS. 4A-C . It is to be noted that the scope of the invention also comprises the use of other locking members such as crimp-based locking members, and also comprises other locking techniques such as tying. - Subsequently, and as shown in state C of
FIG. 1D ,tubular member 100 is pulled further proximally, such that the distal end of the tubular member is disposed proximal to the point at whichlongitudinal member 102 and pull-wire 104 are coupled, such that the pull-wire is decouplable from the longitudinal member (e.g., unthreadable from the loop defined by the longitudinal member). - Typically, anchors 48 and
longitudinal members 102 are configured to withstand a pulling force of at least 500 g, so as to withstand forces within the beating heart. The apparatus is typically configured such that a pulling force required to pulltubular member 100 proximally, is less than 500 g, such as less than 300 g. For some applications, such a configuration is achieved at least in part by reducing friction betweentubular member 100 and pull-wire 104, such as by thermally treating the pull-wire 104. - Subsequently,
control rod 86,tubular member 100, and pull-wire 104 are pulled proximally, as shown in state D ofFIG. 1D , thereby separating the control rod from lockingmember 110, and the pull-wire fromlongitudinal member 102. In order forcontrol rod 86 to be pulled proximally, the control rod is decoupled from lockingmember 110 prior to said pulling. For some applications, the decoupling ofcontrol rod 86 from lockingmember 110 is synchronous with the locking of the locking member (e.g., the same action locks the locking member and decouples the control rod from the locking member, such as described hereinbelow with respect toFIGS. 4A-C ). For some applications, the decoupling of the control rod from the locking member is independent of the locking of the locking member. - It is to be noted that, as shown in
FIG. 1D , for some applications, prosthetic valve support 42 (e.g., upstream support portion 43 thereof) is secured to the upstream surface of the annulus ofnative valve 10, only byanchors 48 that are anchored to tissue inventricle 8 of the subject. It is also to be noted thatprosthetic valve support 42 is coupled tolongitudinal members 102 inatrium 6 of the subject. Typically, a distance L1 between eachanchor 48 and the point of upstream support portion 43 to which it is coupled (e.g., to arespective hole 82 and/or locking member 110) is greater than 0.5 cm, e.g., greater than 1 cm, such as greater than 2 cm. That is, the length of eachlongitudinal member 102 that is disposed between a respective anchor and upstream support portion 43 is typically greater than 0.5 cm, e.g., greater than 1 cm, such as greater than 2 cm. The length of eachlongitudinal member 102 that is disposed between the respective anchor and the upstream support portion is typically less than 10 cm (e.g., less than 7 cm, such as less than 5 cm). Thereby, the ventricular sites at which anchors 48 are anchored are typically more than 0.5 cm (e.g., more than 1 cm, such as more than 2 cm) away fromprosthetic valve support 42. - Reference is now made to
FIG. 1E-F , which show steps in the delivery and implantation ofprosthetic valve 44 atnative valve 10, facilitated byprosthetic valve support 42.Prosthetic valve 44 is advanced in a delivery configuration (e.g., in a compressed state), throughsheath 44, typically within adelivery tube 120.Prosthetic valve 44 comprises a stent-like valve body 122, typically comprising an expandable frame that typically contains a shape-memory material such as nitinol.Valve body 122 is shaped to define a lumen therethrough, and an inner surface of the valve body is typically lined with a covering, such as a fabric. One or more prosthetic valve members (not shown for clarity), such as prosthetic leaflets, are coupled tovalve body 122 and disposed within the lumen thereof. -
Prosthetic valve 44 further comprises one or more tissue-engagingelements 124. Typically, and as shown,valve 44 comprises two tissue-engagingelements 124 coupled tovalve body 122 at sites that are on opposite sides of the circumference of the valve body. Each tissue-engagingelement 124 typically comprises two arms 126 (e.g., a first clip arm 126 a and a second clip arm 126 b). For some applications, and as shown, each arm 126 defines an arc that is coupled tovalve body 122 at the base of the arc. For example, and as shown, each arm 126 may comprise a single arc of the same shape-memory material as the frame ofvalve body 122. For some applications, one or both arms 126 of each tissue-engagingelement 124 may be covered in a covering, such as a fabric. - When
valve 44 is in the compressed state thereof withindelivery tube 120, arms 126 are held againstvalve body 122 with a tip 127 of each arm disposed proximally to a site at which that arm is coupled to the valve body. Each tissue-engagingelement 124 is configured such that atip 127 a of arm 126 a is disposed distal to atip 127 b of arm 126 b. For example, arm 126 a may be shorter than arm 126 b. Alternatively or additionally, arm 126 a may be coupled tovalve body 122 at a site that is distal to a site at which arm 126 b is coupled to the valve body. -
Prosthetic valve 44, withindelivery tube 120, is advanced distally betweenleaflets 14 ofnative valve 10, and the prosthetic valve is progressively advanced distally out of a distal end of the delivery tube, as shown in states A-B ofFIG. 1E . It is to be noted thatleaflets 14 typically continue to function following implantation ofprosthetic valve support 42, and may further continue to function whiledelivery tube 120 is disposed therebetween; the leaflets typically coapt around the delivery tube. At a given degree of advancement ofprosthetic valve 44 out ofdelivery tube 120, first arm 126 a is deployed: tip 127 a of each first arm 126 a becomes exposed from the delivery tube and each arm 126 a responsively deflects radially outward fromvalve body 122, toward a pre-set position (state B ofFIG. 1E ).Tip 127 b of each arm 126 b remains withindelivery tube 120. Throughout the procedure, as distal portions ofvalve body 122 are progressively exposed fromdelivery tube 120, they typically automatically expand toward an expanded state - Subsequently, and as shown in state D of
FIG. 1E ,prosthetic valve 44 anddelivery tube 120 are moved proximally (e.g., atrially) such that arm 126 a of each tissue-engagingelement 124 engages (e.g., captures) aleaflet 14 ofnative valve 10, e.g., such that a portion of each leaflet is disposed between (1) each arm 126 a and (2) a respective second arm 126 b andvalve body 122. Optionally, subsequently to deployment of first arm 126 a and prior to movingprosthetic valve 44 proximally, the first arm is deflected further fromvalve body 122 than its pre-set position by applying a force to the first arm using the delivery tube. That is, an angle between the first arm and an outer surface of the valve body is increased by applying the force to the first arm using the delivery tube. - Typically, the force is applied by moving
delivery tube 120 distally with respect to the prosthetic valve (e.g., sliding the delivery tube over at least part of the prosthetic valve), so as to push the arm, as shown in state C ofFIG. 1E . It is hypothesized that such “opening” of tissue-engagingelement 124 facilitates engagement of leaflets 14 (e.g., engagement of a larger portion of leaflets 14). Subsequently,delivery tube 120 is returned proximally with respect toprosthetic valve 44, such that arm 126 a returns toward its pre-set position (state D ofFIG. 1E ). For some applications, until at least the step shown in state D ofFIG. 1E ,prosthetic valve 44 is retrievable intodelivery tube 120 and removable from the body of the subject, e.g., as described hereinbelow with respect toFIG. 2 . - Subsequently,
delivery tube 120 is pulled further proximally with respect toprosthetic valve 44, such thattip 127 b of second arm 126 b of each tissue-engagingelement 124 becomes exposed from the delivery tube, and each arm 126 b responsively deflects radially outward fromvalve body 122, toward a pres-set position (state A ofFIG. 1F ), thereby coupling the tissue-engaging element to the leaflet by sandwiching a portion of aleaflet 14 between the first and second arms of each tissue-engaging element. Second arm 126 b is typically configured, when completely unrestricted (e.g., in the absence of leaflet 14) to have a pre-set position that is close to that of first arm 126 a, planar with that of first arm 126 a, and/or further fromvalve body 122 than is arm 126 a. For some applications, the difference in size and/or position of the arc of second arm 126 b to that of first arm 126 a facilitates the second arm to move into plane with, and/or beyond the plane of, the first arm. - Subsequently,
prosthetic valve 44 is fully deployed by a proximal end of the prosthetic valve (e.g.,valve body 122 thereof) being exposed from delivery tube 120 (e.g., by further withdrawing the delivery tube proximally with respect to the prosthetic valve)(state C ofFIG. 1F ). The proximal end ofprosthetic valve 44 responsively (e.g., automatically) expands toward the expanded state thereof. Expansion of the prosthetic valve (e.g., ofvalve body 122 thereof) applies a radially-expansive force against prosthetic valve support 42 (e.g., against an inner perimeter of upstream support portion 43 thereof), thereby coupling the prosthetic valve to the prosthetic valve support. Typically, prosthetic valve support 42 (e.g., the inner perimeter of upstream support portion 43) restricts expansion ofprosthetic valve 44, at least in part. - For some applications, and as shown in state B of
FIG. 1F , subsequently to the coupling of tissue-engagingelements 124 toleaflets 14, and prior to coupling ofprosthetic valve 44 toprosthetic valve support 42, the prosthetic valve is pulled proximally, e.g., so as to align a portion ofvalve body 122 with upstream support portion 43 and/or to drawnleaflets 14 toward the upstream support portion. - It is to be noted that, for some applications, each tissue-engaging
element 124 comprises only one arm 126. For some such applications, the one arm 126 comprises and/or functions like first arm 126 a described herein. For some such applications, the one arm 126 is configured to couple to the leaflet by sandwiching a portion of the leaflet between the one arm andvalve body 122. For some such applications, the one arm 126 is configured, when the prosthetic valve is pulled proximally as shown in state B ofFIG. 1F , to sandwich a portion of the leaflet between the one arm and prosthetic valve support 42 (e.g., upstream support portion 43 thereof). - State D of
FIG. 1F shows the implanted (e.g., final) state ofprosthetic valve support 42 andprosthetic valve 44, following implantation thereof atnative valve 10. For some applications, in this implanted state,prosthetic valve support 42 andprosthetic valve 44 are inhibited from moving upstream (e.g., atrially) both by tissue anchors 48 and by tissue-engagingelements 124. That is, for some applications, resistance to forces onsupport 42 andvalve 44 from the functioning of the heart of the subject, is provided in part byanchors 48 and in part byelements 124. For some applications, in this implanted state,prosthetic valve support 42 andprosthetic valve 44 are inhibited from moving upstream mostly (e.g., solely) by tissue-engagingelements 124. That is, for some applications, resistance to forces onsupport 42 andvalve 44 from the functioning of the heart of the subject, is provided mostly (e.g., solely) byelements 124. For some such applications, anchors 48 andlongitudinal members 102 are thereby only required untilprosthetic valve 44 has been implanted. It is to be noted that in both cases, prosthetic valve support 42 (e.g., upstream support portion 43 thereof) inhibits movement ventricularly ofprosthetic valve 44, and of the prosthetic valve support itself. - Reference is again made to
FIGS. 1D-F . For some applications, locking of lockingmembers 110 tolongitudinal members 102 and/or decoupling of pull-wires 104 from longitudinal members 102 (FIG. 1D ) is not performed until after implantation of prosthetic valve 44 (FIGS. 1E-F ). For such applications, it is thereby possible to adjust the length of the portion of longitudinal members 102 (e.g., tension on the longitudinal members) after implantation ofprosthetic valve 44. For some applications, a similar advantage is conferred by locking members being reversibly lockable, being locked before implantation ofprosthetic valve 44, and subsequently to implantation of the prosthetic valve, being unlocked to allow re-adjustment oflongitudinal members 102. - Reference is again made to
FIGS. 1A-F . For some applications, anatomical dimensions ofnative valve 10 and/or surrounding tissues are determined (e.g., measured), andprosthetic valve support 42 and/orprosthetic valve 44 are selected accordingly (e.g., from a selection of prosthetic valve supports and/or prosthetic valves of different sizes). For example, an optimal lumen size (e.g., transverse cross-sectional area) for a prosthetic valve may be determined according to an area of the lumen defined by the annulus of the native valve of the subject. Responsively, a prosthetic valve having a lumen of that particular size may be selected. Similarly, a prosthetic valve support having an inner perimeter that defines an opening having a particular cross-sectional area may be selected, so as to restrict the expansion of a prosthetic valve to have a lumen of that particular size. Alternatively or additionally, a prosthetic valve support having an outer perimeter of a particular size may be selected according to determined dimensions of the annulus of the valve and/or walls of the atrium. It is to be noted that selecting a size according to determined anatomical dimensions may only in some cases comprise selecting a size that matches the anatomical dimensions. For example, an optimal size for the transverse cross-sectional area of a prosthetic valve is typically less than 90% of the area defined by the annulus of the native valve, so as to allow the leaflets of the native valve to coapt around the prosthetic valve and facilitate sealing. - Because
prosthetic valve support 42 is typically implantable without eliminating functioning of the native leaflets, for some applications, the prosthetic valve support is implantable without the use of cardiopulmonary bypass. For some applications,prosthetic valve 44 is also implantable without the use of cardiopulmonary bypass. - Reference is made to
FIG. 2 , which is a schematic illustration ofprosthetic valve 44 being retrieved intodelivery tube 120, in accordance with some applications of the invention. As described hereinabove, for some applications, until at least the step shown in state D ofFIG. 1E ,prosthetic valve 44 is retrievable intodelivery tube 120 and removable from the body of the subject.Delivery tube 120 is moved distally with respect toprosthetic valve 44, in a manner similar to that used to pusharms 127 a, described with reference toFIG. 1E (state C), but such thatdelivery tube 120 is slid over the site at whicharms 127 a are coupled tovalve body 122, thereby pushingarms 127 a to deflect distally.Prosthetic valve 44, including at least part ofarms 127 a, is drawn into delivery tube 120 (e.g., by sliding the prosthetic valve distally and/or the delivery tube proximally), and is typically subsequently removed from the body of the subject. - Reference is made to
FIGS. 3A-C , which are schematic illustrations of the introduction ofguide members 56 throughprosthetic valve support 42 anddelivery tube 80, in accordance with some applications of the invention. As described hereinabove (e.g., with reference toFIG. 1C ),prosthetic valve support 42 is slidable towardnative valve 10, overguide members 56, including while the prosthetic valve support is compressed withindelivery tube 80. Following coupling ofanchors 48 to the ventricular sites, guidemembers 56 extend from the anchors to outside of the body of the subject, and have respective free proximal ends 57. Before introduction ofsupport 42 withintube 80 into the body of the subject (e.g., into sheath 46),guide members 56 are threaded throughholes 82 in upstream support portion 43 ofprosthetic valve 42, and throughdelivery tube 80, e.g., by the operating physician. - Typically,
prosthetic valve support 42 is provided in the compressed state thereof, withindelivery tube 80, e.g., as aunit 140, coupled to a distal end of acontroller 142 that is used to move the unit transluminally (e.g., within sheath 46).Unit 140 comprises (e.g., is provided having) one ormore introducer tubes 144, each introducer tube being shaped to define a lumen therethrough, and having an opendistal end 143 and an openproximal end 145.Distal end 143 of each tube is disposed outside a distal end ofsupport 42 and/ortube 80, andproximal end 145 of each tube is disposed outside a proximal end of the support and/ortube 80. Eachintroducer tube 144 passes (1) from the distal end thereof, (2) through arespective hole 82 in upstream support portion 43 from the downstream surface of the support portion (which defines an outer surface of the support portion in the compressed state thereof) to an upstream surface of the support portion (which defines an inner surface of the support portion in the compressed state thereof), and (3) to the proximal end thereof. - As shown in
FIG. 3A , freeproximal end 57 of eachguide member 56 is advanced through arespective introducer tube 144, thereby threading the guide member through upstream support portion 43 ofprosthetic valve support 42. Typically, and as shown inFIG. 3B ,introducer tubes 144 are subsequently removed, prior to introduction ofunit 140 into the body of the subject. That is,introducer tubes 144 are typically temporary.FIG. 3C shows upstream support portion 43 ofprosthetic valve support 42 having been partially exposed fromdelivery tube 80, in order to illustrate the resulting threading ofguide members 56 through upstream support portion 43. - Reference is made to
FIGS. 4A-C , which are schematic illustrations of lockingmember 110, and control thereof, in accordance with some applications of the invention. As described hereinabove, lockingmember 110 is slidable over guide member 56 (e.g., overtubular member 100 thereof). As also described hereinabove, lockingmember 110 is configured to lock tolongitudinal member 102. -
FIG. 4A shows lockingmember 110 in the unlocked state thereof, in which the locking member typically defines a channel therethrough through whichtubular member 100 andlongitudinal member 102, either within the tubular member or outside of the tubular member, are slidable. The channel of lockingmember 110 is defined by a generallytubular portion 160 of the locking member.Tubular portion 160 defines one or more, such as two, oblique slits 162 in the lateral walls thereof. Lockingmember 110 comprises locking element, such as a lockingbar 164, that is disposed generally orthogonally to the channel of the locking member, and passes through the slits (e.g., through both slits) of the tubular member. When lockingbar 164 is slid distally and/or proximally, the locking bar thereby moves across at least part of the channel defined bytubular portion 160. Lockingmember 110 further comprises aspring 166 that is configured to push lockingbar 164 in a given direction (e.g., distally), thereby transitioning the locking member into the locked configuration thereof (i.e., locking the locking member)(FIG. 4B ). - Locking
member 110 is typically controllable using a holdingmember 112 that inhibits (e.g., prevents) the locking member from locking, such as by inhibiting movement of lockingbar 164. As described hereinabove, eachcontrol rod 86, used to pushprosthetic valve support 42 toward the annulus ofvalve 10, is reversibly coupled at a distal end thereof to arespective locking member 110, such that the pushing is typically performed by pushing withcontrol rod 86 and lockingmember 110. For some applications, and as shown inFIGS. 4A-C , holdingmember 112 comprises and/or is defined bycontrol rod 86. For such applications,control rod 86 defines one ormore slits 168 in a lateral wall thereof (e.g., twoslits 168 on opposite sides of the lateral wall of the control rod). Typically, slits 168 are L-shaped, thereby providing (1) a holding region 170 that is generally orthogonal to the proximal-distal (e.g., longitudinal) axis ofcontrol rod 86, and (2) arelease region 172 that is generally parallel with the proximal-distal axis of the control rod, and that is open to the distal end of the control rod. Lockingbar 164 is configured such that ends thereof extend at least into (e.g., through) slits 168. - In the unlocked state in which locking
member 110 is advanced overguide member 56 toward upstream support portion 43 and the annulus of the native valve, the ends of lockingbar 164 are disposed in holding region 170 of eachslit 168, and the locking bar is thereby inhibited from moving distally and locking the locking member (FIG. 4A ). In order to lock the locking member,control rod 86 is rotated with respect to lockingmember 110, such that the ends of lockingbar 164 move intorelease region 172 of eachslit 168. In this position,spring 166 is thereby able to move locking bar toward the distal end ofrelease region 172, thereby locking the locking member (FIG. 4B ). - As described hereinabove,
tubular member 100 is typically withdrawn from lockingmember 110 before the locking member is locked, and the locking member is locked tolongitudinal member 102, e.g., by lockingbar 164 sandwichinglongitudinal member 102 against the inner surface of the channel of the locking member (e.g., effectively narrowing the channel at the site of the locking bar). Movement of the ends of lockingbar 164 into and throughrelease region 172 also decouplescontrol rod 86 from the locking member, allowing the control rod to be removed from the body of the subject (typically along with tubular member 100)(FIG. 4C ). For some applications,longitudinal member 102 comprises suture. For some applications,long member 102 comprises a polymer, such as polyester. For some applications,longitudinal member 102 comprises a metal. For example, the longitudinal member may comprise one or more wires, such as a plurality of wires twisted or braided into a cable. It is hypothesized that for some applications, a metallic composition reduces compressibility oflongitudinal member 102 and/or facilitates locking of lockingmember 110 to the longitudinal member. - It is to be noted that locking
member 110 thereby (1) when unlocked, facilitates sliding therethrough of a relatively wide element,tubular member 100, and (2) when locked, locks to a relatively narrow element,longitudinal member 102. To facilitate this, between the locked and unlocked states, lockingbar 164 thereby moves a sufficient distance across the channel defined by lockingmember 110. That is, lockingbar 164 moves a larger distance than would be necessary to lock a similar locking member that does not facilitate, in the unlocked state thereof, sliding therethrough of a tubular member that is wider than the longitudinal element. - Reference is again made to FIGS. 1D and 4A-C. It is to be noted that locking
member 110 is typically configured to lock tolongitudinal member 102 independently of (e.g., in the absence of) a complementary element, such as teeth, on the longitudinal member. For some applications, lockingmember 110 is configured to be coupled to any part oflongitudinal member 102. - Reference is made to
FIG. 5 , which is a schematic illustration of steps in the delivery of tissue anchors 48 toventricle 8, and anchoring of the anchors in the ventricle, in accordance with some applications of the invention. For some applications, the steps shown inFIG. 5 (and/or states A-D thereof) can be used in place of the steps shown inFIG. 1B (and/or states A/D thereof), mutatis mutandis (e.g., after the steps shown inFIG. 1A and/or before the steps shown inFIG. 1C ).FIG. 1B shows onedelivery catheter 50 being used to deliver bothanchors 48, and when deliveringsecond tissue anchor 48 b, anchor-delivery tube 52 fitting alongside first guide member 56 a withincatheter 50. As stated hereinabove, for some applications, a separate catheter is used for each anchor.FIG. 5 shows one such application. - Typically,
first anchor 48 a is delivered and anchored as described hereinabove with reference toFIG. 1A , whereincatheter 50 inFIG. 1A comprises a first catheter 50 a. Subsequently, and as shown inFIG. 5 , a second catheter 50 b is advanced throughsheath 46, such that second catheter 50 b is disposed alongside first guide member 56 a withinsheath 46. It is to be noted that, in bothFIG. 1B andFIG. 5 , twoanchors 48 are anchored at respective ventricular sites, and tworespective guide members 56, extend from the anchors, throughatrium 6, and typically out of the body of the subject. - Reference is made to
FIG. 6 , which is a schematic illustration of asystem 180 for use withprosthetic valve support 42, in accordance with some applications of the invention. For such applications of the invention,prosthetic valve support 42 is slidable towardnative valve 10 overguide members 56, including while the prosthetic valve support is compressed withindelivery tube 80. Following coupling ofanchors 48 to the ventricular sites, guidemembers 56 extend from the anchors to outside of the body of the subject, and have respective free proximal ends 57. Before introduction ofsupport 42 withintube 80 into the body of the subject (e.g., into sheath 46),guide members 56 are threaded throughholes 82 in upstream support portion 43 ofprosthetic valve 42, and throughdelivery tube 80, e.g., by the operating physician. -
FIGS. 3A-C and the descriptions thereof describeprosthetic valve support 42 being provided as aunit 140 comprisingintroducer tubes 144, which are removed subsequently to advancement ofguide members 56 through upstream support portion 43 and prior to introduction of the unit into the body of the subject.FIG. 6 showssystem 180, in which prosthetic valve support is provided withindelivery tube 80, e.g., as aunit 182, coupled to a distal end ofcontroller 142, described hereinabove. -
Unit 182 comprises (e.g., is provided having) one ormore introducer tubes 184, each introducer tube being shaped to define a lumen therethrough, and having an opendistal end 183.Distal end 183 of each tube is disposed outside a distal end ofsupport 42 and/ortube 80, and eachintroducer tube 184 extends out of a proximal end of the support and/ortube 80. Similarly tounit 140 described with reference toFIGS. 3A-C , eachintroducer tube 144 ofsystem 180 passes from the distal end thereof, through a respective hole in upstream support portion 43 from the downstream surface of the support portion (which defines an outer surface of the support portion in the compressed state thereof) to an upstream surface of the support portion (which defines an inner surface of the support portion in the compressed state thereof). In contrast tounit 140,introducer tubes 184 extend from a proximal end ofdelivery tube 80 to a proximal end portion of the apparatus. In further contrast tounit 140,tubes 184 remain in place asunit 182 is advanced transluminally overguide members 56.Tubes 184 are typically flexible to facilitate transluminal advancement thereof. - A locking
member 190 is disposed over eachintroducer tube 184, such that the introduction ofguide member 56 through the introducer tube also introduces the guide member through the locking member. Lockingmember 190 is slidable over guide member 56 (e.g., overtubular member 100 thereof), and is configured to lock tolongitudinal member 102. Typically, lockingmember 190 is identical to lockingmember 110, described hereinabove, except that lockingmember 190 is configured (e.g., dimensioned) to be slidable also overintroducer tube 184. Each lockingmember 190 is disposed at the distal end of a respectivetubular control rod 192, which is typically identical tocontrol rod 86, described hereinabove, except thatcontrol rod 192 is configured (e.g., dimensioned) to be slidable also overintroducer tube 184. - The use of
system 180, includingintroducer tubes 184, advantageously (1) removes the requirement for two separate introductions ofproximal end 57 of guide member 56 (i.e., through an introducer tube and subsequently through a locking member and control rod); and (2) facilitates control rods 192 (and locking members 190) being present in the atrium of the subject during expansion ofprosthetic valve support 42, thereby reducing an interval between the expansion of the prosthetic valve support and pressing of the prosthetic valve support against the annulus of the native valve. - Reference is made to
FIGS. 7A-C , which are schematic illustrations of asystem 200 for facilitating transluminal delivery of aprosthetic valve assembly 202, in accordance with some applications of the invention.FIG. 7A showsprosthetic valve assembly 202 in an expanded state thereof. Prosthetic valve assembly comprises (1) aprosthetic valve body 204, which comprises a first frame 206 (e.g., a wire frame), and is shaped to define alumen 208 therethrough, (2) an annularupstream support 210, which comprises a second frame 212 (e.g., a wire frame), is shaped to define an opening through the upstream support, and is configured to be placed against an upstream surface (e.g., an atrial surface) of native valve 10 (e.g., of an annulus thereof), and (3) aflexible sheet 214 that couples the first frame to the second frame. In the expanded state of assembly 202 (and thereby of body 204),frame 206 ofbody 204 is generally cylindrical, and has a diameter d1. In the expanded state of assembly 202 (and thereby of upstream support 210),frame 212 ofsupport 210 is typically generally annular, and has anouter perimeter 213 that has a diameter d2, which is greater than diameter d1. -
Sheet 214 may be a fabric, a film, and/or another sheet-like structure, and may comprise a natural material, a polymer, a biomaterial, and/or any other suitable material. Typically,sheet 214 comprises polyester, PTFE, and/or pericardial tissue. - For some applications, and as shown in
FIG. 7A , in the expanded state ofassembly 202, and in the absence of external forces (e.g., if the assembly were resting on a table surface),sheet 214 is generally annular and flat, and anupstream end 218 offrame 206 is disposed generally on a plane defined bysupport 210. For such applications, aninner perimeter 211 offrame 212 defines an opening that has a diameter d3 that is greater than diameter d1. - For some applications, in such an expanded and unconstrained state,
sheet 214 is generally frustoconical or funnel-shaped, andupstream end 218 offrame 206 is disposed below the plane defined bysupport 210. (For some such frustoconical or funnel-shaped arrangements, the sheet may also be considered to be annular.) - For some applications, in such an expanded and unconstrained state,
sheet 214 is generally tubular,upstream end 218 offrame 206 is disposed below the plane defined bysupport 210. For such applications, diameter d3 is typically generally equal to diameter d1. - Typically, one or both of
frames covering 220. For some applications,sheet 214 comprises a portion of covering 220, e.g., the sheet is defined by a portion of the covering that is disposed betweenframes FIG. 7A , covering 220 is disposed (1) on a tissue-facing side of frame 212 (e.g., defines a tissue-contacting surface of support 210), and (2) on an inner surface of frame 206 (i.e., lines the frame, and defines lumen 208). - A valve member 205 (e.g., comprising one or more prosthetic leaflets; shown in
FIGS. 8D-G ) is coupled toframe 206, is disposed withinlumen 208, and provides valve (e.g., one-way) functionality toassembly 202.Valve member 205 may alternatively or additionally comprise a different valve member, such as a mechanical valve member. - At least two
eyelets 222 are disposed on an outer surface of body 204 (i.e., protrude radially outward from body 204). Typically, eyelets 222 are pivotably coupled tobody 204, e.g., such that the eyelets can pivot (e.g., rotate) in both directions by at least 5 degrees (e.g., more than 5 degrees and/or less than 90 degrees, such as between 5 and 90 degrees, e.g., between 5 and 60 degrees, such as between 5 and 45 degrees). For some applications, the eyelets can pivot in a plane parallel to a plane defined by a tangent of the valve body at the site to which the eyelet is coupled, as shown in the blowup box. Alternatively or additionally, the eyelets can pivot in a plane that is orthogonal to the plane defined by the tangent, e.g., such that the eyelets can point toward and/or away from the valve body. For some applications, eyelets 222 are sutured tobody 204.Eyelets 222 are arranged in at least one pair; each eyelet of the pair being disposed on the opposite side ofbody 206 from the other eyelet of the pair. -
FIG. 7B showssystem 200 in a delivery configuration thereof.System 200 comprises adelivery tool 230, which comprises a first housing 232 (e.g., a proximal housing) and a second housing 234 (e.g., a distal housing), which are articulatably coupled to each other via a flexiblecontrol rod assembly 240 disposed through the housings. - In the delivery configuration of
system 200,assembly 202 is in a compressed state thereof, in which prosthetic valve body 204 (in a compressed state thereof) is generally cylindrical, and upstream support 210 (in a compressed state thereof) is also generally cylindrical. Typically, in the delivery configuration ofsystem 200,sheet 214 is also generally cylindrical.Assembly 202, in the compressed configuration thereof, (1) has a central longitudinal axis, at one zone (e.g., at one end) of whichbody 204 is disposed, and at another zone (e.g., the other end) of which support 210 is disposed, and (2) defines anarticulation zone 236 in which (a) at least part ofsheet 214 is disposed, and (b) neitherframe 206 ofbody 204 norframe 212 ofsupport 210 is disposed, and about whichbody 204 andsupport 210 are articulatable with respect to each other. - In the delivery configuration of
system 200, at least part ofsupport 210 is disposed within housing 232 (which maintains the at least part of the support in the compressed state thereof), and at least part ofbody 204 is disposed within housing 234 (which maintains the at least part of the support in the compressed state thereof).Housing 232 defines anorifice 233 through which support 210 is introducible into the housing, and removable from the housing.Housing 234 defines anorifice 235 that facesorifice 233, and through whichbody 204 is introducible into the housing, and removable from the housing. In the delivery configuration, eyelets 222 protrude radially outward beyond the surface of delivery tool 230 (e.g., beyond a lateral wall of housing 234). Typically, housing 234 (e.g., the lateral wall thereof) is shaped to define arespective slit 237 for each eyelet, through which the eyelet protrudes beyond the surface of the housing. Eachslit 237 is continuous with (i.e., is in communication with)orifice 235 such that, as described hereinbelow, during deployment ofvalve body 204,eyelet 222 can slide out of the slit at the orifice. - In the delivery configuration of
system 200,tool 230 is in a contracted state, in whichhousing 232 is disposed at a distance d4 from housing 234 (e.g.,orifice 233 is disposed at distance d4 from orifice 235). Distance d4 is typically greater than 1.5 mm and/or less than 30 mm, such as between 1.5 mm and 30 mm (e.g., between 10 and 15 mm). In this state, at least part ofsheet 214 is exposed between the housings. The at least part of sheet 214 (and thereby of articulation zone 236) that is exposed betweenhousings housing 234 containingbody 204 with respect tohousing 232 containingsupport 210, and thereby defines an articulation zone 238 ofsystem 200 in the delivery configuration thereof. Typically at least part ofcontrol rod assembly 240 is flexible, so as to facilitate articulation at articulation zone 238. For example, althoughassembly 240 as a whole is typically sufficiently flexible so as to facilitate its transluminal delivery to the heart,control rods control rods tool 230 is in the contracted state (FIG. 7C ) are more flexible than adjacent portions of the control rods (e.g., portions disposed withinhousings tool 230 is in the contracted state). For example, and as shown, aportion 245 ofcontrol rod 244 may be narrower than adjacent portions of the control rod. -
Control rod assembly 240 comprises (1) a first housing-control rod 242, coupled tofirst housing 232, (2) a second housing-control rod 244, coupled tosecond housing 234, and (3) a prosthesis-control rod 246, coupled to amount 248 that is reversibly couplable tovalve assembly 202, e.g., via a plurality ofrecesses 250 in the mount which receive respective portions ofassembly 202. Typically,assembly 202 is couplable to mount 248 byvalve body 204 being coupled to the mount, and further typically by a plurality ofprotrusions 252 offrame 206 being disposed withinrespective recesses 250.Housing 234 retains this coupling by inhibitingbody 204 from expanding radially away frommount 248. - Typically, at least part of second housing-
control rod 244 is disposed within and slidable through prosthesis-control rod 246, and at least part of the prosthesis-control rod is disposed within and slidable through first housing-control rod 242 (e.g., coaxially). - System 200 (e.g.,
tool 230 thereof) further comprises at least two flexible reference-force tubes 260, which extend, (a) from a proximal end of the system (e.g., from an extracorporeal portion of the system, such as from a handle of tool 230), (b) through a proximal end ofhousing 232, (c) through alumen 254 defined bysupport 210 in the compressed state thereof, (d) throughsheet 214, (e) along the outside of at least part ofbody 204, and typically (f) until a distal portion ofbody 204. A lockingmember 262 is disposed between eacheyelet 222 and arespective tube 260. Typically, lockingmembers 262 are not directly coupled tobody 204, but are instead each held in position betweeneyelet 222 andtube 260 by aguide member 256 being disposed through the eyelet, the tube, and the locking member. For some applications, lockingmember 262 is integral with eyelet 222 (e.g.,eyelet 222 is configured to and/or shaped to define locking member 262). - For some applications, guide
members 256 are identical to guidemembers 56, described hereinabove.Guide members 256 are described in more detail hereinbelow. - Reference is now made to
FIGS. 8A-H , which are schematic illustrations of a technique for use withsystem 200, to transluminally implantprosthetic valve assembly 202, in accordance with some applications of the invention. Typically,sheath 46 is advanced transluminally (e.g., transfemorally) toright atrium 12 ofheart 4, through the fossa ovalis, and intoleft atrium 6 using standard transseptal techniques, as described hereinabove with reference toFIGS. 1A-B . Subsequently,first tissue anchor 48 a andsecond tissue anchor 48 b are anchored at respective ventricular sites, e.g., as described with reference toFIGS. 1A-B and/or 5, mutatis mutandis. - A
guide member 256 is coupled to each tissue anchor (e.g., the tissue anchors are provided pre-coupled to the guide members), such that after anchoring of the tissue anchors, each guide member extends from the anchor, out of the body of the subject, e.g., as described hereinabove with respect to guidemember 56, mutatis mutandis. A proximal end of eachguide member 256 is introduced through arespective eyelet 222, lockingmember 262, and reference-force tube 260, such thatsystem 200 appears as shown inFIG. 7B . As described hereinabove, eachguide member 256 typically holds each lockingmember 262 in place between itsrespective eyelet 222 and reference-force tube 260. - System 200 (e.g.,
assembly 202 within delivery tool 230) is subsequently advanced alongguide members 256 and viasheath 46 to left atrium 6 (FIG. 8A ). Once exposed outside of the distal end ofsheath 46,system 200 is guided byguide members 256 generally toward the ventricular sites at which anchors 48 are anchored. Articulation of system 200 (e.g., at articulation zone 238, and/or at anotherarticulation zone 239 proximal to housing 232) facilitates transluminal advancement of the system past curves in the vasculature. The articulation also facilitates movement ofsystem 200 from the distal end ofsheath 46 and betweenleaflets 14 ofvalve 10, e.g., by facilitating steering of the system along a path defined byguide members 256. This steering is typically further facilitated by (1) the position ofeyelets 222 at a distal portion of system 200 (e.g., at a distal portion of housing 234), which turns the housing in response to encountering a turn inmembers 256, and/or (2) the pivotable coupling ofeyelets 222 tobody 204, described hereinabove; pivoting ofeyelet 222 reduces a likelihood of the eyelet snagging onguide member 256 when encountering a turn in the guide member. For some applications, eyelets 222 are internally coated with a material having a low coefficient of friction, such as polytetrafluoroethylene, to further facilitate sliding of the eyelet overguide member 256. - It is to be noted that, due to the described articulation, a distance d5 between a proximal end of
housing 232 and a distal end ofhousing 234 may be greater than for a similar system that does not articulate. For example, distance d5 may be greater than a distance d6 along an atrioventricular axis between (a) a height on the atrioventricular axis of the upstream surface ofnative valve 10, and (b) a height on the atrioventricular axis of the transseptal entry point into left atrium 6 (e.g., the fossa ovalis). For some applications, distance d5 may be greater than the overall height ofleft atrium 6. Distance d5 is typically greater than 25 mm and/or less than 100 mm, such as between 25 mm and 100 mm (e.g., 35-60 mm, such as 40-50 mm). - Reference is made to
FIG. 8B .System 200 is advanced such thatdistal housing 234, containingvalve body 204 in the compressed state thereof, passes betweenleaflets 14 ofnative valve 10.Valve body 204 is withdrawn out oforifice 235 ofhousing 234 by movingcontrol rod 244 with respect tocontrol rod 246. For example, and as shown inFIGS. 8B-C , control rod 244 (and thereby housing 234) may be moved distally intoventricle 8, while control rod 246 (and thereby mount 248 and valve body 204) remains stationary, thereby increasing the distance betweenhousing 232 andhousing 234. - When
protrusions 252 offrame 206 become withdrawn fromhousing 234, the portion ofvalve body 204 coupled to the mount expands (e.g., automatically), thereby disengaging the protrusions fromrecesses 250 ofmount 248, and decoupling the valve body from the mount (FIG. 8C ). For clarity,FIGS. 8C-D show the distal portion ofvalve body 204 expanding before the proximal portion of the valve body. It is to be noted, however, that portions of the valve body typically expand as they become exposed fromhousing 234, and therefore the proximal portion of the valve body typically expands while the distal portion of the valve body is still disposed withinhousing 234. -
FIG. 8D showsvalve body 204 having been completely removed fromhousing 234, andsupport 210 having been removed fromproximal housing 232 by control rod 242 (and thereby housing 232) being withdrawn proximally, thereby further increasing the distance betweenhousing 232 andhousing 234. Typically, an opposing reference force is provided by reference-force tubes 260, so as to holdassembly 202 in place at the native valve whilehousing 232 is withdrawn. - During the withdrawal of
valve body 204 fromhousing 234,eyelets 222 typically slide throughslits 237, and out of the slits atorifice 235. - For some applications,
support 210 is deployed fromhousing 232 beforevalve body 204 is deployed fromhousing 234. - Subsequently, tension is applied to guide
members 256 while an opposing reference force is provided toassembly 202 bytubes 260, thereby reducing a length of eachguide member 256 that is disposed betweeneyelet 222 and its respective tissue anchor 48 (FIG. 8E ). That is, eachguide member 256 is slid proximally with respect to its respective reference-force tube 260. Typically, the reference-force is provided toassembly 202 by a distal end of each reference-force tube 260 abutting a respective locking member; the reference force being transferred via the locking member (and typically further viaeyelet 222 to valve body 204). - For some applications this tensioning moves
valve body 204 at least slightly distally intoventricle 8, such thatsheet 214 becomes at least slightly frustoconical (e.g., as shown inFIG. 8E ). For some applications this tensioning deformssupport 210 and/or deflects the support with respect tobody 204, e.g., such that the support becomes less flat (e.g., less planar). For example, before tensioning,support 210 may be flat annular (as shown inFIG. 8D ), and after tensioning the support may be frustoconical (as shown inFIG. 8E ). Alternatively, and as described in more detail with reference toFIGS. 14A-B , mutatis mutandis, the prosthetic valve assembly may be configured such that the upstream support is frustoconical before tensioning, and the tensioning changes a slant of the frustoconical shape. For example, before tensioning, the upstream support may be frustoconical with the larger base of the frustum closer to a ventricular end of an atrioventricular axis than is the smaller base of the frustum, and after tensioning the support may become flatter, or may even invert, such that it becomes frustoconical with the smaller base closer to the ventricular end of the atrioventricular axis (e.g., the conformation shown inFIG. 8E , mutatis mutandis). - For some applications, tensioning is performed before deployment of
support 210 fromhousing 232. - Each
guide member 256 typically comprises a tether 282 (e.g., a longitudinal member), a pull-wire 284, and atubular member 280 in which the pull-wire and the tether are disposed. A distal portion of pull-wire 284 is reversibly coupled to a proximal portion oftether 282, andtubular member 280 fits snugly over at least the distal portion of the pull-wire and the proximal portion of the tether so as to inhibit the pull-wire from becoming decoupled from the tether (e.g., to maintain a state of coupling therebetween). For some applications, and as shown, the reversible coupling is provided by pull-wire 284 andtether 282 defining respective mating surfaces. For some applications, the reversible coupling is provided as described hereinabove forguide member 56. - When each guide member 256 (e.g., the
tether 282 thereof) is tensioned, the guide member is withdrawn proximally until at least part of tether 282 (within tubular member 280) is disposed within locking member 262 (e.g., at least until the proximal portion of the tether has passed through the locking member;FIG. 8E state B). - Reference is now made to
FIG. 8F . Once a desired tension is obtained, the tension is fixed.Tubular member 280 is withdrawn proximally with respect totether 282, pull-wire 284 and locking member 262 (FIG. 8F ). State A ofFIG. 8F showstubular member 280 having been withdrawn untileyelet 222. State B ofFIG. 8F showstubular member 280 having been withdrawn until a distal end of the tubular member is disposed proximal to lockingmember 262, thereby exposingtether 282 to the locking member. - Typically, locking
member 262 is biased (e.g., shape-set) to assume a locked state, and whiletubular member 280 is disposed within the locking member, the tubular member inhibits locking of the locking member to tether 282 (or to pull-wire 284), and the removal of the tubular member from within the locking member facilitates automatic locking of the locking member to the tether (i.e., transitioning of the locking member into a locked state).Tubular member 280 is slidable through lockingmember 262 despite such biasing of the locking member, e.g., due to (a) the tubular member having a smooth surface, and/or (b) the tubular member retaininglocking elements 263 of the locking member at an angle alpha_1 with respect to the tubular member, which is shallower than an angle alpha_2 with respect to tether 282 that the locking elements assume when the tubular element is withdrawn (compareFIG. 8F state A to state B). - Typically,
tether 282 defines a plurality ofnodules 286, which facilitate locking of lockingmember 262 to the tether. For some applications, lockingelements 263 andnodules 286 function as a ratchet. For some such applications, subsequently to transitioning of lockingmember 262 into the locked state thereof, one-way movement oftether 282 through the locking member is possible, thereby facilitating further increase, but not reduction, of tension. - Reference is now made to
FIG. 8G .Tubular member 280 and pull-wire 284 are decoupled fromtether 282 andprosthetic valve assembly 202, anddelivery tool 230 is withdrawn proximally (e.g., intosheath 46, and out of the body of the subject). Typically,housing 234 and mount 248 are withdrawn via the lumen of valve body 204 (e.g., between the prosthetic leaflets disposed therein). For some applications,housing 234,rods force tubes 260, such as between the step shown inFIG. 8D and the step shown inFIG. 8E , mutatis mutandis). - Typically,
tubular member 280 and pull-wire 284 are decoupled fromtether 282 by withdrawing the tubular member further proximally, such that the distal portion of pull-wire 284 and the proximal portion oftether 282 are exposed from the tubular member (state A ofFIG. 8G ). Reference force for this withdrawal is provided by the anchoredtether 282, and optionally also by reference-force tubes 260.Tubular member 280, pull-wire 284, and reference-force tube 260 are then withdrawn (state B ofFIG. 8H ). -
FIG. 8H is a schematic illustration ofprosthetic valve assembly 202 following implantation atnative valve 10 ofheart 4.Assembly 202 provides replacement one-way valve functionality in which blood flows fromatrium 6, through the opening defined byupstream support 210,past sheet 214, throughlumen 208 ofvalve body 204, and intoatrium 8.Sheet 214 thereby defines and/or serves as a conduit that provides fluid communication between the opening defined by upstream support 210 (e.g., byframe 212 thereof) andlumen 208 ofvalve body 204. Further typically, this conduit is uninterrupted except for holes (not shown) that may remain where reference-force tubes 260 originally extended through the sheet. - Regurgitation through these holes is typically minimal or absent due to their small size. The holes may be slit-like (rather than punched holes), such that in the absence of reference-
force tubes 260 the holes become generally closed. Additionally, coaptation ofleaflets 14 and tissue growth over the holes may further facilitate sealing. Alternatively or additionally, the holes may be defined bytubular protrusions 215 that extend from sheet 214 (shown in the “optional” box,FIG. 7B ).Tubular protrusions 215 may comprise the same material assheet 214, or may comprise a different material.Tubular protrusions 215 may be flexible or rigid. The tubular protrusions are configured to provide a channel through whichtubes 260 may pass, but which, in the absence oftubes 260, inhibit movement of fluid therethrough. For example,tubes 215 may inhibit fluid flow due to the ratio between their length and lumen diameter, and/or may act as duckbill valves. Therefore,sheet 214 typically provides a generally sealed conduit betweenupstream support 210 andvalve body 204. - The positioning of
prosthetic valve assembly 202 at the native valve typically results inleaflets 14 of the native valve coapting aroundvalve body 204, thereby providing sealing that inhibits (e.g., prevents) perivalvular leakage. - The positioning of prosthetic valve assembly typically also places
sheet 214 in contact with the annulus and/or leaflets of the native valve. In general, a prosthetic valve implanted at a native valve encounters forces due to beating of the heart and/or the resulting flow of blood. Small movements (e.g., oscillations) resulting from these forces may inhibit tissue growth (e.g., fibrosis) that would otherwise facilitate sealing between the prosthetic valve and the native valve. For some applications, such movements are reduced (e.g., dampened) at sites at which the contact betweenassembly 202 and the surrounding tissue is provided bysheet 214, e.g., due to flexibility of the sheet. Therebysheet 214 typically provides stabilized (e.g., more constant) contact with tissue than would a less flexible structure in the same position; this is hypothesized to improve tissue growth and thereby sealing. Furthermore,sheet 214 itself may be configured to promote tissue growth thereon, e.g., due to surface treatments and/or impregnation, and/or structure, such as weave and/or porosity, thereby further facilitating sealing. - Reference is made to
FIGS. 9A-14B , which are schematic illustrations of prosthetic valve assemblies, in accordance with some applications of the invention. Each prosthetic valve assembly shown inFIGS. 9A-14B comprises a valve body, an upstream support, and a sheet, which are typically identical, mutatis mutandis, tovalve body 204,upstream support 210 andsheet 214 described hereinabove, except for where noted. -
FIGS. 9A-B show,prosthetic valve assembly 202 described hereinabove, in a simplified (e.g., two-dimensional) schematic manner that illustrates the arrangement ofvalve body 204,upstream support 210 andsheet 214, in the compressed state (FIG. 9A ) and the expanded (e.g., implanted) state (FIG. 9B ).FIGS. 9A-B are included at least in part in order to facilitate interpretation of the simplified schematic illustrations of the prosthetic valve assemblies ofFIGS. 10A-14B .FIG. 9A , likeFIGS. 10A , 11A, 12A and 13A, shows the prosthetic valve assembly in the compressed state as if it were contained in the delivery tool thereof (e.g., tool 230), but for clarity does not show the delivery tool. Typically,sheet 214 is attached at least toinner perimeter 211 ofupstream support 210, and to anupstream end 207 offrame 206 ofvalve body 204. -
FIGS. 10A-B show aprosthetic valve assembly 302, which comprises a valve body 304 comprising a first frame 306, an upstream support 310 comprising a second frame 312, and aflexible sheet 314. In the expanded state of support 310 (FIG. 10B ), frame 312 defines anouter perimeter 313 and aninner perimeter 311 that defines an opening through the support. During implantation, support 310 is placed against the upstream surface of the native valve, and valve body 304 is subsequently intracorporeally coupled (e.g., directly coupled) to the support by being expanded within the opening of the support, e.g., as described hereinabove with reference toFIG. 1F , mutatis mutandis. -
Sheet 314 is not attached toinner perimeter 311 of frame 312, but rather is circumferentially attached to frame 312 at a radius that is greater than that of the inner perimeter. For example,sheet 314 may be attached to frame 312 atouter perimeter 313.Sheet 314 is also not attached to anupstream end 307 of valve body 304. Thereby apocket region 316 is defined betweensheet 314 and at leastinner perimeter 311, in whichsheet 314 is not attached to frame 312 or frame 306. - In the compressed state (
FIG. 10A ),sheet 314 is disposed alongside and outside at least part of frame 312 and at least part of frame 306. Frame 312 is configured such that when the frame is in the compressed state,inner perimeter 311 defines a downstream end of the frame (e.g., of the cylindrical shape of the frame), andouter perimeter 313 defines an upstream end. Therefore, when frame 312 expands, the upstream end of the frame expands radially outward more than does the downstream end of the frame. -
FIGS. 11A-B show aprosthetic valve assembly 342, which comprises a valve body 344 comprising a first frame 346, an upstream support 350 comprising a second frame 352, and aflexible sheet 354. In the expanded state of support 350 (FIG. 11B ), frame 352 defines anouter perimeter 353 and aninner perimeter 351 that defines an opening through the support. During implantation, support 350 is placed against the upstream surface of the native valve, and valve body 344 is subsequently intracorporeally coupled (e.g., directly coupled) to the support by being expanded within the opening of the support, e.g., as described hereinabove with reference toFIG. 1F , mutatis mutandis. -
Sheet 354 is not attached toinner perimeter 351 of frame 352, but rather is circumferentially attached to frame 352 at a radius that is greater than that of the inner perimeter. For example,sheet 354 may be attached to frame 352 atouter perimeter 353.Sheet 354 is also not attached to anupstream end 347 of valve body 344. Thereby apocket region 356 is defined betweensheet 354 and at leastinner perimeter 351, in whichsheet 354 is not attached to frame 352 or frame 346. - Frame 352 is configured such that when the frame is in the compressed state, the frame has a generally cylindrical shape that defines a lumen therethrough,
inner perimeter 351 defines an upstream end of the frame (e.g., of the cylindrical shape of the frame), andouter perimeter 353 defines a downstream end. Therefore, when frame 352 expands, the downstream end of the frame expands radially outward more than does the upstream end of the frame. In the compressed state (FIG. 11A ),sheet 354 is disposed alongside and outside of at least part of frame 346, and through at least part of the lumen defined by frame 352. -
FIGS. 12A-B show aprosthetic valve assembly 382, which comprises a valve body 384 comprising a first frame 386, an upstream support 390 comprising a second frame 392, and aflexible sheet 394. In the expanded state of support 390 (FIG. 12B ), frame 392 defines anouter perimeter 393 and aninner perimeter 391 that defines an opening through the support. Frame 392 is coupled to frame 386 prior to implantation (e.g.,assembly 382 is provided with frame 392 coupled to frame 386). For some applications, frames 392 and 386 are integral, e.g., are defined by respective regions of a single frame. During implantation, valve body 384 is advanced between leaflets of the native valve, and support 390 is placed against the upstream surface of the native valve (e.g., as described with reference toFIGS. 8B-D , mutatis mutandis. -
Sheet 394 is not attached toinner perimeter 391 of frame 392, but rather is circumferentially attached to frame 392 at a radius that is greater than that of the inner perimeter. For example,sheet 394 may be attached to frame 392 atouter perimeter 393.Sheet 394 is also not attached to anupstream end 387 of valve body 384. Thereby apocket region 396 is defined betweensheet 394 and at leastinner perimeter 391, in whichsheet 394 is not attached to frame 392 or frame 386. -
Assembly 382 is configured such that, in the compressed state thereof (FIG. 12A ), frames 386 and 392 are generally collinear, and form a generally continuous cylinder. Frame 392 is configured such that in the compressed state,outer perimeter 393 defines an upstream end of the frame (and thereby of assembly 382). Therefore, when frame 392 expands, the upstream end of the frame expands radially outward more than does the downstream end of the frame. In the compressed state,sheet 394 is disposed alongside and outside of at least part of frame 386, and at least part of frame 392. -
FIGS. 13A-B show aprosthetic valve assembly 402, which comprises a valve body 404 comprising a first frame 406, an upstream support 410 comprising a second frame 412, and aflexible sheet 414. In the expanded state of support 410 (FIG. 13B ), frame 412 defines anouter perimeter 413 and aninner perimeter 411 that defines an opening through the support. Frame 412 is coupled to frame 406 prior to implantation (e.g.,assembly 402 is provided with frame 412 coupled to frame 406). For some applications, frames 412 and 406 are integral, e.g., are defined by respective regions of a single frame. During implantation, valve body 404 is advanced between leaflets of the native valve, and support 410 is placed against the upstream surface of the native valve (e.g., as described with reference toFIGS. 8B-D , mutatis mutandis. -
Sheet 414 is not attached toinner perimeter 411 of frame 412, but rather is circumferentially attached to frame 412 at a radius that is greater than that of the inner perimeter. For example,sheet 414 may be attached to frame 412 atouter perimeter 413. -
Sheet 414 is also not attached to anupstream end 407 of valve body 404. Thereby apocket region 416 is defined betweensheet 414 and at leastinner perimeter 411, in whichsheet 414 is not attached to frame 412 or frame 406. -
Assembly 402 is configured such that, in the compressed state thereof (FIG. 13A ), frame 412 is disposed generally alongside at least a portion of frame 406. Frame 412 is configured such that in the compressed state,outer perimeter 413 defines a downstream end of the frame. Therefore, when frame 412 expands, the downstream end of the frame expands radially outward more than does the upstream end of the frame. In the compressed state,sheet 414 is disposed alongside and outside of at least part of frame 406. -
FIGS. 14A-B show aprosthetic valve assembly 422 an expanded state thereof, implanted atnative valve 10, in accordance with some applications of the invention.Assembly 422 comprises a valve body 424 comprising a first frame 426, an upstream support 430 comprising a second frame 432, and asheet 434. - Frame 426 of valve body 424 has an
upstream end 427 and adownstream end 429. In the expanded state, in the absence of external forces, anouter perimeter 433 of second frame 432 of upstream support 430 is disposed closer todownstream end 429 than is aninner perimeter 431 of the second frame. For example, upstream support 430 may define a frustum, the larger base of which is disposed closer to downstream end 429 (and closer to a ventricular end of an atrioventricular axis) than is the smaller base of the frustum. For some applications, the assembly is thus configured such that, when placed at the native valve,outer perimeter 433 of the upstream support contacts the upstream surface of the native valve (e.g., the valve annulus), and the inner perimeter of the upstream support does not (FIG. 14A ). For some such applications, frame 432 may be flat annular in the absence of external forces, and in the expanded state,sheet 434 retains the second frame in the frustoconical shape by inhibiting expansion of the second frame (e.g., expansion of at leastouter perimeter 433 thereof). For some applications, frame 432 curves downward toward the tissue thatouter perimeter 433 contacts (configuration not shown). -
Sheet 434 is not attached toinner perimeter 431 of frame 432, but rather is circumferentially attached to frame 432 at a radius that is greater than that of the inner perimeter. For example,sheet 434 may be attached to frame 432 atouter perimeter 433.Sheet 434 is also not attached toupstream end 427 of valve body 424. Thereby apocket region 436 is defined betweensheet 434 and at leastinner perimeter 431, in whichsheet 434 is not attached to frame 432 or frame 426. - For some such applications, such a configuration provides a spring functionality that allows valve body 424 to move along an atrioventricular axis while
outer perimeter 433 and/or portions ofsheet 434 remain in contact with tissue (FIG. 14B ). For example,assembly 422 may be implanted using techniques described with reference toFIGS. 8A-H , mutatis mutandis, and the spring functionality may allow movement of valve body 424 ventricularly during tensioning oftethers 282 while maintaining contact betweenouter perimeter 433 and the atrial surface. Similarly, such a configuration may allow oscillation of valve body 424 along the atrioventricular axis (e.g., caused by beating of the heart and the resulting blood flow), while maintaining constant contact betweenouter perimeter 433 and the tissue. - For some applications, a compressed state of
assembly 422 is as described for one or more of the prosthetic valve assemblies described with reference toFIGS. 10A-13B , mutatis mutandis. For example, for some applications frame 426 of body 424 is coupled to frame 432 of support 430 prior to implantation (e.g.,assembly 422 is provided with frame 426 coupled to frame 432), such as described forassembly 382 and/orassembly 402, mutatis mutandis. Alternatively, frame 426 is intracorporeally coupled to frame 432, e.g., as described forassembly 302 and/orassembly 342, and/or with reference toFIG. 1F , mutatis mutandis. - For some applications,
assembly 422 is implanted as described for one or more of the prosthetic valve assemblies described with respect toFIGS. 10A-13B , mutatis mutandis. - Reference is again made to
FIGS. 9A-B , 10A-B, and 11A-B. As described hereinabove, in its compressed state,assembly 202 defines an articulation zone in which (a) at least part ofsheet 214 is disposed, and (b) neitherframe 206 ofbody 204 norframe 212 ofsupport 210 is disposed, and about whichbody 204 andsupport 210 are articulatable with respect to each other. It is to be noted that in their compressed states,assemblies respective articulation zones - Reference is again made to
FIGS. 10A-B , 11A-B, 12A-B, 13A-B, and 14A-B. As described hereinabove,assemblies FIGS. 14A-B , which show an example of the contact betweenflexible sheet 434 and tissue (e.g., leaflets 14). For some applications, the sheet is elastic, so as to further facilitate maintenance of contact despite movement of the frames of the prosthetic valve assembly with respect to the native valve. - As described hereinabove, the respective pocket region of each
assembly - For some applications, the sheet extends radially past the radius at which it is coupled to the upstream support. As described hereinabove, for some applications the sheet is coupled to the upstream support at an outer perimeter of the upstream support. For some applications, the sheet extends radially past the outer perimeter of the upstream support.
- Reference is made to
FIGS. 15A-C , which are schematic illustrations of atool 460 for facilitating application of force betweenprosthetic valve assembly 202 and guide members 256 (e.g., tethers 282 thereof), in accordance with some applications of the invention. For some applications,tool 460 serves as a tension-detector tool. For some applications,tool 460 alternatively or additionally serves as a tension-applicator tool. - The boxes on the right-hand side of
FIGS. 15A-C shows assembly 202 being implanted atnative valve 10, as described hereinabove. The box ofFIG. 15A shows assembly 202 having been deployed (e.g., delivered and expanded) at the native valve, e.g., as described with reference toFIG. 8D . The box ofFIG. 15B showstethers 282 ofguide members 256 having been tensioned with respect toassembly 202, e.g., as described with reference toFIG. 8E . The box ofFIG. 15C showstubular member 280 of eachguide member 256 having been withdrawn proximally so as to (1) facilitate locking of therespective locking member 262 to itsrespective tether 282, e.g., as described with reference toFIG. 8F , and (2) decouple pull-wire 284 fromtether 282, e.g., as described with reference toFIG. 8G . - The left-hand side of
FIGS. 15A-C shows (1) a proximal end of system 200 (e.g., a proximal end ofdelivery tool 230 thereof, e.g., including ahandle 231 thereof), including a proximal portion of pull-wire 284, a proximal portion oftubular member 280, and a proximal portion of reference-force tube 260, and (2)tool 460 coupled to the proximal portion of pull-wire 284 and the proximal portion of reference-force tube 260. The left-hand side ofFIGS. 15A-C shows onetool 460 being used with one pull-wire 284,tubular member 280,tube 260 and tool 460 (and one handle 231). However it is to be noted thattool 460 is typically used with each guide member (e.g., each tether 282), either sequentially, or by providing more than onetool 460 for use at generally the same time. -
Tool 460 comprises a pull-wire-coupling element 462, configured to be coupled to the proximal portion of pull-wire 284 (e.g., to agrip 464 of the pull-wire), and a reference-force-tube-coupling element 466, configured to be coupled to the proximal portion of reference-force tube 260 (e.g., to agrip 468 of the tubular member). Couplingelements adjustment member 470 that facilitates adjustment of a distance between the coupling elements.Adjustment member 470 may comprise screw threads, a ratchet mechanism, or any other suitable adjustment mechanism. - Pull-wire-
coupling element 462 is coupled to the proximal portion of pull-wire 284 (e.g., to agrip 464 of the pull-wire), and reference-force-tube-coupling element 466 is coupled to the proximal portion of reference-force tube 260 (e.g., to agrip 468 of the tubular member), typically subsequently to delivery ofprosthetic valve assembly 202 to the native valve (FIG. 15A ). A distance d7 exists betweencoupling elements - Subsequently,
adjustment member 470 is used (e.g., actuated) so as to change (e.g., increase) the distance betweencoupling elements 462 and 466 (FIG. 15B ; distance d8). - This reduces the length of
tether 282 that is disposed distal to the distal end of reference-force tube 282, (and thereby the length of the tether that is disposed betweeneyelet 222 and anchor 48), thereby applying tension to the tether). Typically, a length indicator 471 (e.g., a rule) is provided ontool 460 that indicates the change in length that has been made. Further typically,tool 460 comprises aforce detector 472 that detects and displays a force differential (e.g., a linear force differential) betweencoupling elements tether 282. - When a desired tensile state of
tether 282 has been achieved (e.g., an absolute value and/or a value relative to other detected forces, such as the tensile state of the other tether 282), the tension is fixed, and pull-wire 284 is decoupled from tether 282 (FIG. 15C ). As described with reference toFIG. 8F , this is achieved by withdrawingtubular member 280 proximally with respect totether 282, pull-wire 284 and lockingmember 262.FIG. 15C shows a proximal portion of tubular member 280 (e.g., agrip 474 thereof) being withdrawn proximally with respect to (1) pull-wire 284 (and therefore with respect to tether 282 to which the pull-wire is coupled), and (2) reference-force tube 260 (and therefore with respect to lockingmember 262 which the distal end of the reference-force tube abuts). This is illustrated by a distance d10 betweengrips FIG. 15C , which is greater than a distance d9 betweengrips FIG. 15B . This thereby facilitates (1) locking of lockingmember 262 to tether 282, and (2) subsequently (i.e., after further proximal withdrawal of the tubular member), decoupling of pull-wire 284 from the tether. - For some applications, this is performed by one continuous movement of
tubular member 280. For some applications, visual and/or tactile indicators allow the operating physician to lock lockingmember 262 to tether 282 without decoupling pull-wire 284 from the tether. This may advantageously allow the physician to further increase the tension on the tether (e.g., by using the ratchet functionality described with reference toFIG. 8F ) before decoupling the pull-wire from the tether. - Although
tool 460 is described hereinabove for facilitating implantation ofassembly 202, the tool may also be used, mutatis mutandis, in combination with other systems described herein, such assystem 40 described hereinabove and/orassembly 552 described hereinbelow (e.g., for tensioningtethers 582 thereof). - Reference is now made to
FIG. 16 , which is a schematic illustration of a system 480 comprising a prosthetic valve assembly 482 and one ormore springs 484 via which the prosthetic valve assembly is elastically coupled to one or more tissue anchors 48, in accordance with some applications of the invention. For illustrative purposes, system 480 is shown as comprising system 200 (e.g., comprising prosthetic valve assembly 202), described hereinabove, with the addition ofsprings 484. However it is to be noted that the techniques described with reference toFIG. 16 may alternatively or additionally be used to facilitate implantation of other prosthetic valves and/or prosthetic valve assemblies described herein, mutatis mutandis (e.g., springs 484 may be added to other prosthetic valves and/or prosthetic valve assemblies described herein). - Each
spring 484 is disposed outside ofvalve body 204, typically laterally outside the valve body, and further typically betweeneyelet 222 and locking member 262 (e.g., coupling the eyelet to the locking member). For example, and as shown,spring 484 may have a longitudinal axis that is generally parallel withlumen 208 of the valve body. When reference-force tube 260 provides the reference force to lockingmember 262 during tensioning of guide member 256 (e.g.,tether 282 thereof), the reference force is transferred viaspring 484. Typicallyspring 484 serves as a compression spring, such that increasing tension on guide member 256 (e.g., thetether 282 thereof) compresses the spring. - For some applications,
spring 484 provides an indication of a state of the spring that is observable and recognizable using imaging techniques (e.g., fluoroscopy). That is,spring 484 is configured to change shape in response to a force applied to it, in a manner that is observable and recognizable using fluoroscopy. This functionality therefore provides intracorporeal measurement of tension on tether 282 (in a manner that is itself observable extracorporeally). It is hypothesized that for some applications, this intracorporeal measurement advantageously detects the tension with reduced interference (e.g., noise) that may be present in extracorporeal measurement techniques. For example, for some applications, extracorporeal measurement of the tension by extracorporeally measuring tension on pull-wire 284 (e.g., tension with respect to reference-force tube 280) may be inhibited by interference by inherent elasticity of the pull-wire and other elements of the system, and by friction between elements of the system. - For some applications, the shape of
spring 484 alone provides the tension indication. For such applications,spring 484 may be coated with a radiopaque material such as tantalum. For some applications,spring 484 has (e.g., comprises and/or is coupled to) one or moreradiopaque markers 486, and the juxtaposition of the markers facilitates extracorporeal detection of the shape of the spring. For example, whenspring 484 serves as a compression spring, a reduction of a distance d11 (compare d11 to d11′) betweenadjacent markers 486 indicates an increase in tension ontether 282. - For some applications, an intracorporeal reference (e.g., a scale) 488 is provided, to facilitate identification of shape change of spring 484 (e.g., to facilitate quantification of the shape change by (1) comparing the position of
markers 486 toreference 488, and/or (2) comparing the juxtaposition ofmarkers 486 to the juxtaposition of elements of the scale. For example, and as shown inFIG. 16 ,scale 488 may itself also comprise a plurality ofradiopaque markers 490 disposed on valve body 204 (e.g., coupled to frame 206) at known (e.g., regular) intervals, and distance d11 (observed using fluoroscopy) is compared to a distance d12 between adjacent markers 490 (observed using fluoroscopy) in order to determine the actual change in distance d11. That is, an observed relative change between d11 and d12 is used to determine an actual absolute change in d11. - For some applications,
spring 484 also alters the relationship between (a) changes in the length oftether 282 disposed betweeneyelet 222 andanchor 48 and (b) tension on the tether. For example, forsystem 200 described hereinabove (i.e., in the absence of spring 484), starting with slack ontether 282 between the eyelet and the anchor, as the length of the tether between the eyelet and the anchor is reduced, tension ontether 282 may remain constant and low despite the reduction in the length of the tether, until the tether encounters resistance provided bytissue anchor 48, at which point tension increases relatively quickly for every unit reduction in length. For system 480 (i.e., using spring 484), the relationship between (a) the length oftether 282 disposed between the eyelet and the anchor, and (b) the tension on the tether, is smoother (e.g., the transition between before and after resistance from the anchor is encountered is smoother). That is,spring 484 absorbs some of the applied tensile force and in exchange provides additional length to the tether. This is hypothesized to advantageously provide more flexibility to the operating physician to adjust the length oftether 282 disposed between the eyelet and the anchor, with reduced changes to tension on the tether. - For some applications,
spring 484 is configured so as to provide a desired tension (e.g., a desired resistance) over a range of lengths of tether 282 (e.g., over a range of compression states of the spring). That is, the spring constant of the spring is sufficiently low that a change in resistance is minimized per unit length change. For example, the spring constant may be less than 50 g/mm. - For some applications, the desired tension is above 300 g force and/or below 700 g force, e.g., above 400 g force, and/or below 600 g force, such as between 400 g force and 600 g force, e.g., about 500 g force. For example, a desired target tether tension may be 500 g force, and
spring 484 may be configured to provide, over a range of compression states of the spring, resistance that results in a tether tension that is within a margin tension (e.g., within 200 g force, such as within 100 g force) of the target force. - For some applications,
spring 484 is configured to provide a distinct indication, observable using fluoroscopy, when the spring experiences a force that is within a margin force (i.e., a force that corresponds to being within the margin tension). For example,spring 484 may undergo (e.g., suddenly undergo) a more obvious shape change when such a force is experienced. - For some applications,
spring 484 is configured to act as a constant-force spring or similar, so as to facilitate the behavior described above. For some applications,spring 484 is pre-loaded (e.g., pre-tensioned or pre-compressed). - Reference is made to
FIG. 17 , which is a schematic illustration of a system 500 comprising a prosthetic valve assembly 502 and one ormore springs 504 via which the prosthetic valve assembly is elastically coupled to one or more tissue anchors 48, in accordance with some applications of the invention. For illustrative purposes, system 500 is shown as comprising system 200 (e.g., comprising prosthetic valve assembly 202), described hereinabove, with the addition ofsprings 504. However it is to be noted that the techniques described with reference toFIG. 17 may alternatively or additionally be used to facilitate implantation of other prosthetic valves and/or prosthetic valve assemblies described herein, mutatis mutandis (e.g., springs 504 may be added to other prosthetic valves and/or prosthetic valve assemblies described herein). - Each
spring 504 is disposed outside ofvalve body 204, typically laterally outside the valve body, and further typically is disposed functionally between lockingmember 262 and anchor 48 (e.g., between lockingmember 262 andeyelet 222, or betweeneyelet 222 andanchor 48. For some applications, and as shown,spring 504 is a cantilever spring, and may be defined by a protrusion offrame 206 that extends away (e.g., laterally away) fromvalve body 204. That is,spring 504 may comprise an elastically-deformable appendage. For some applications, the protrusion is shaped to define aloop 506 that providesspring 504 with constant-force-spring functionality. - Typically,
spring 504 provides similar functionality tospring 484, described hereinabove, mutatis mutandis. For example, for some applications,spring 504 provides an indication of a state of the spring that is observable and recognizable using fluoroscopy. That is,spring 504 is configured to change shape in response to a force applied to it, in a manner that is detectable and recognizable using fluoroscopy. For some applications,spring 504 also alters the relationship between (a) the length oftether 282 disposed betweeneyelet 222 andanchor 48 and (b) tension on the tether, e.g., as described hereinabove with reference tospring 484, mutatis mutandis. - Reference is made to
FIGS. 18A-B , which are schematic illustrations of springs coupled to tether 282 so as to elastically couple tissue anchor 48 (e.g., a tissue-engagingelement 49 thereof) to prosthetic valve assembly 202 (e.g., tovalve body 204 thereof), in accordance with some applications of the invention.FIG. 18A shows aspring 520 disposed partway alongtether 282.FIG. 18B shows aspring 530, one end of which is coupled to anchor 48 (e.g., to ananchor head 47 thereof) and the other end of which is coupled totether 282.Springs spring 530 is rigidly coupled to anchorhead 47. - For illustrative purposes, springs 520 and 530 are shown being used with system 200 (e.g., with prosthetic valve assembly 202), described hereinabove. However it is to be noted that the techniques described with reference to
FIGS. 18A-B may alternatively or additionally be used to facilitate implantation of other prosthetic valves and/or prosthetic valve assemblies described herein, mutatis mutandis. - Typically, springs 520 and 530 provide similar functionality to
springs tether 282 disposed betweeneyelet 222 andanchor 48 and (b) tension on the tether, e.g., as described hereinabove with reference tosprings - Reference is again made to
FIGS. 16 , and 18A-B. Springs - Reference is made to
FIGS. 19A-B , which are schematic illustrations of asystem 700 for facilitating delivery of aprosthetic valve body 702, in accordance with some applications of the invention.System 700 comprises adelivery tool 704 that comprises adistal housing 706, configured to housevalve body 702 in a compressed state thereof, aproximal portion 708, and a flexible longitudinal portion 710 (e.g., a catheter) therebetween.Proximal portion 708 typically comprises ahandle 712.Housing 706 is configured to be transluminally advanced to the heart of the subject (e.g., as described herein, mutatis mutandis, whileproximal portion 708 remains outside the body of the subject. Proximal portion 708 (e.g., handle 712 thereof) comprises aforce detector 716 that detects a force between (a) the proximal portion, and (b)housing 706 and/orvalve body 702 coupled thereto. Typically,force detector 716 detects tension. That is, the force detector detects resistance ofvalve body 702 to a proximally-directed force applied by tool 704 (e.g., whentool 704 is moved proximally). -
Housing 706 is advanced throughnative valve 10 and intoventricle 8, andvalve body 702 is partly advanced out of the housing, and automatically expands toward an expanded state (FIG. 19A ).Valve body 702 is coupled to a plurality of tissue-engaging elements (e.g., tissue-engaging legs) 714 that protrude radially out from the valve body when exposed fromhousing 706. Tissue-engagingelements 714 are configured to engageleaflets 14 of the native valve, thereby facilitating anchoring of the valve body. - Typically
system 700 is used for implantation ofvalve body 702 at a native valve at which a prosthetic valve support (e.g., an upstream support) has already been delivered, and to which the valve body is intracorporeally coupled (e.g., as described elsewhere herein). For example, and as shown inFIGS. 19A-B ,system 700 may be used to implant valve body atnative valve 10 after implantation ofsupport 42 at the native valve. As described with reference toFIGS. 1A-D ,support 42 is secured against the upstream surface ofnative valve 10 by being anchored, via tethers (e.g., longitudinal members 102), to ventricular muscle tissue. (The tethers are not visible inFIGS. 19A-B .) - Pulling
housing 706 andvalve body 702 proximally (i.e., atrially) while tissue-engagingelements 714 are protruding pushes the tissue-engaging elements againstleaflets 14, reducing a height of a gap between the tissue-engaging elements andsupport 42, and sandwiching the leaflets against the support (FIG. 19B ). Resistance to proximal movement of valve body 702 (e.g., due tosupport 42 and leaflets 14) is detected and displayed byforce detector 716. The operating physician is thereby able to couplevalve body 702 to support 42 (e.g., by fully deploying the valve body within the opening defined by the support) while a desired degree of tension is observed. The coupling of the valve body to the support fixes the degree of tension, such thatleaflets 14 remain sandwiched, and the valve body remains secured to the native valve. - For some applications, alternatively or additionally to using
extracorporeal force detector 716, the force encountered by tissue-engagingelements 714 is observed using fluoroscopy (e.g., by observing a shape and/or position of the tissue-engaging elements). For such applications, the tissue-engaging elements are typically configured to facilitate such observation, as described herein for various springs. For some applications,elements 714 are configured (e.g., shaped) to define a loop, e.g., as described hereinabove forsprings 504, mutatis mutandis. - For some applications,
valve body 702 is coupled via tethers to tissue anchors that are anchored to ventricular muscle tissue, as described elsewhere herein. For some such applications, a spring couples the valve body to each tissue anchor (e.g., as described with reference toFIGS. 16-18B , mutatis mutandis). For some applications in which a spring couples the valve body to each tissue anchor, reducing the height of the gap automatically (and typically immediately) alters a force on the spring (e.g., when the valve body is locked to the tether before reducing the height of the gap). For some applications in which a spring couples the valve body to each tissue anchor, reducing the height of the gap does not necessarily alter the force on the spring (e.g., when the valve body is slidably couplable to the tether until after the height is reduced, and is subsequently locked to the tether. For example,tool 230 and/ortool 460 may be used, mutatis mutandis, to measure and control tension and length of the tether until the valve body is locked to the tether. - It is to be noted that the above technique may be used for prosthetic valve assemblies in which the valve body is pre-coupled to the upstream support, mutatis mutandis. For such applications, the proximal pulling force is not a sandwiching force, but rather is a testing force, typically used in combination with another testing force, e.g., as described hereinbelow, e.g., with reference to
FIG. 20 . - Reference is made to
FIG. 20 , which is a schematic illustration showing examples in which force measurements described herein may be combined to facilitate implantation of a prosthetic valve, in accordance with some applications of the invention. Each apparatus and technique described herein for measuring force (e.g., tension) is described in a particular context (e.g., with reference to a particular prosthetic valve assembly, prosthetic valve body, and/or support) for the purpose of clarity. It is to be understood that the apparatus and techniques described in one context may be used to measure force in another context (e.g., to facilitate controlled implantation of a different prosthetic valve assembly, prosthetic valve body, and/or support), and may be combined with one or more of the other apparatus and/or techniques. -
FIG. 20 shows examples of combinations of apparatus and techniques described herein, which include: - (1) Extracorporeal detection of tension on tethers (box 722). This is described, for example, with reference to force
detector 472 oftool 460 ofFIGS. 15A-C . - (2) Extracorporeal detection of atrially-directed force of valve-mounted tissue-engaging elements against tissue (e.g., leaflets or annulus) of the native valve (box 742). This is described, for example, with reference to
FIGS. 19A-B . - (3) Extracorporeal detection of sandwiching force (box 720). That is, extracorporeal detection of the force of tissue-engaging elements coupled to the valve body against the native valve tissue and/or the upstream support. This is described, for example, (a) with reference to
FIGS. 19A-B , and (b) with reference to forcedetector 472 of tool 460 (FIGS. 15A-C ) being used to augment the apparatus and facilitate the techniques described with reference toFIGS. 21A-B . - (4) Intracorporeal detection (observed using imaging) of tension on tethers (724). This is described, for example, with reference to the springs described with reference to
FIGS. 16 , 17, and 18A-B. - (5) Intracorporeal detection (observed using imaging) of atrially-directed force of valve-mounted tissue-engaging elements against tissue (e.g., leaflets or annulus) of the native valve (box 744). This is described, for example, with reference to
FIGS. 19A-B . - (6) Intracorporeal detection (observed using imaging) of sandwiching force (box 726). This is described, for example, with reference to one or more of the springs described with reference to
FIGS. 16 , 17, and 18A-B being used to augment the apparatus and facilitate the techniques described with reference toFIGS. 21A-B . - (7) Intracorporeal detection (observed using imaging) of ventricularly-directed force of the upstream support against the native annulus (box 728). For some applications, this is achieved by using imaging (e.g., fluoroscopy) to extracorporeally observe intracorporeal changes in the shape of the upstream support (e.g., changes described with reference to
FIGS. 8D-E , 14A-B, and/or 15A-B), in a similar manner to that described for extracorporeally observing changes in the shape of springs (e.g., described with reference toFIGS. 16 , 17, and 18A-B), mutatis mutandis. - It is hypothesized that combining two or more of the force-measurement techniques described herein may provide synergistic benefits when implanting an implant (e.g., a prosthetic valve assembly, prosthetic valve body, and/or prosthetic valve support), so as to facilitate controlled implantation (box 730). The ability to control various forces that secure the implant allows, inter alia, the forces to be spread as desired by the operating physician. For example, it may be desirable:
-
- that tension is equally (or otherwise) distributed between the tethers,
- that tension on a given tether is optimized (discussed hereinbelow),
- that, during operation of the valve, resistance to a force that pushes the valve body in an atrial direction (e.g., during ventricular systole) is optimally balanced between the various anchoring elements, such as between (a) tissue anchors 48 and tethers coupled thereto and (b) other tissue-engaging elements (e.g., tissue-engaging elements 714 (
FIGS. 19A-B ) or tissue-engaging elements 580 (FIGS. 21A-B ), thereby balancing the anchoring forces between different tissue sites, and/or - that sandwiching forces are greater than, equal to, or less than the tensile force provided by the tethers.
- It is to be noted that the example combinations provided hereinabove are intended to be illustrative, and not limiting.
- As described hereinabove, it may be desirable to that tension on a given tether is optimized. For example, it may be desirable that tension on the given tether to be maximized within a tension range that is known to be supported by (1) the tissue anchor to which the tether is coupled, and (2) the tissue to which the tissue anchor is anchored. For some applications, subsequently to anchoring the tissue anchor, the operating physician applies a testing pulling force to the tissue anchor. The testing pulling force is used to confirm that the anchored tissue anchor is capable of supporting an overload tension that is greater than an expected tension that it is expected that the anchor will encounter during operation. The expected tension may be determined at least in part based on possible ventricular blood pressure and the cross-sectional area of the lumen of the valve body.
- For some applications, the testing pulling force is applied (e.g., via the tether or via the anchor manipulator), and movement of the tissue anchor is observed using imaging, e.g., as described with reference to
FIGS. 1A-B ). For some applications, the testing pulling force is applied while measuring tension using an extracorporeal force detector such as detector 472 (FIGS. 15A-C ), mutatis mutandis. - For some applications, the testing pulling force is applied by applying tension to the tether, and the tension is measured using intracorporeal springs and fluoroscopy, as described hereinabove, mutatis mutandis. It is to be noted that, for such applications, the same technique is used (1) to confirm that the anchored tissue anchor is capable of supporting the overload tension, and (2) to facilitate the application of the tension (e.g., the anchoring tension) that will be fixed when the locking member is locked to the tether.
- As described hereinabove, it may be desirable that, during operation of the valve, resistance to a force that pushes the valve body in an atrial direction (e.g., during ventricular systole) is optimally balanced between the various anchoring elements. For some applications, the following technique is used:
- (1) Anchor at least one tissue anchor coupled to a respective at least one tether (e.g., within guide members).
- (2) Advance a valve body that comprises at least one tissue-engaging element (e.g., a tissue-engaging leg) over at least part of the tether (e.g., by advancing over a guide member), such that a length of the tether is disposed between the valve body and the tissue anchor. Examples of such tissue-engaging elements are described with reference to
FIGS. 19A-B and 21A-B. The valve body may or may not be pre-coupled to an upstream support. - (3) Apply a first tension to the tether (measured intracorporeally or extracorporeally).
- (4) Apply proximal pulling force to the valve body such that the tissue-engaging element applies force against tissue of the native valve, such as leaflets and/or annulus. This pulling typically automatically increases the tension on the tether.
- (5) While applying the proximal pulling force, intracorporeally and/or extracorporeally measure (a) force of tissue-engaging element against tissue, and (b) tension on the tether (e.g., the change in tension on the tether caused by the proximal pulling.
- (6) At least in part based on measurements (a) and (b) of step 5, adjust the length of the tether disposed between the valve body and the tissue anchor, and/or lock the valve body to the tether (i.e., fix the length of the tether disposed between the valve body and the tissue anchor).
- It is hypothesized that the above technique provides a prediction of the force distribution between the various anchoring elements that will exist during operation of the prosthetic valve assembly (e.g., during the lifetime thereof). For example, the technique provides a prediction of force distribution between the ventricular anchors and the valve-mounted tissue-engaging elements if/when atrially-directed force increases (e.g., as will be encountered during ventricular systole and/or increases in systemic blood pressure). Based on this indication, the technique facilitates adjustment of this distribution, via adjustment of the length of tethers disposed between the valve body and the tissue anchors.
- Reference is made to
FIGS. 21A-B , which are schematic illustrations of aprosthetic valve assembly 552, in accordance with some applications of the invention.Prosthetic valve assembly 552 comprises (1) aprosthetic valve body 554, which comprises a first frame 556 (e.g., a wire frame), and is shaped to define a lumen therethrough, (2) an annularupstream support 560, which comprises a second frame 562 (e.g., a wire frame), is shaped to define an opening through the upstream support, and is configured to be placed against an upstream surface (e.g., an atrial surface) of native valve 10 (e.g., of an annulus thereof), and (3) aflexible sheet 564 that couples the first frame to the second frame.FIG. 21A shows assembly 552 in an expanded state thereof (e.g., in the absence of external forces, such as if the assembly were resting on a table surface). In the expanded state of assembly 552 (and thereby of body 554),frame 556 ofbody 554 is generally cylindrical, and has a diameter d13. In the expanded state of assembly 552 (and thereby of upstream support 560),frame 562 ofsupport 560 is typically generally annular, and has anouter perimeter 563 that has a diameter d14, which is greater than diameter d13. -
Assembly 552 comprises one or more tissue-engaging elements 580 (e.g., legs) that protrude radially outward fromvalve body 554 so as to define a diameter d15, which is greater than diameter d13. Typically, and as shown inFIGS. 21A-B ,frame 556 ofbody 554 is shaped to define tissue-engagingelements 580.Assembly 552 further comprises one or more tensioning elements (e.g., contraction wires) such as one ormore tethers 582, a first portion (e.g., a distal end) of each tether being coupled tovalve body 554, and a second portion of each tether being coupled (e.g., slidably coupled) to a portion ofassembly 552 that is configured to be placed upstream ofvalve body 554. For example, and as shown, the second portion of eachtether 582 may be slidably coupled to an upstream region ofsheet 564. Alternatively or additionally, the second portion of eachtether 582 may be slidably coupled to frame 562 ofsupport 560. For some applications, this is facilitated byframe 562 being shaped to define one or more respective protrusions that protrude radially inward from the annular shape of the frame, to the site at which eachtether 582 is shown inFIG. 21A passing through the sheet. - For some applications, except for (1) the presence of tissue-engaging
elements 580 andtethers 582, and (2) the absence ofeyelets 222,assembly 552 is identical to (e.g., comprises the same components as, and/or has identical functionality to)assembly 202, described hereinabove. Identically-named components ofsystem 202 andsystem 552 are typically identical in structure and/or function. - For some applications,
assembly 202 comprises tissue-engagingelements 580 and/or tethers 582. For some applications,assembly 552 compriseseyelets 222 and/or lockingmembers 262 for sliding over and locking to guide members. - Both
support 560 ofassembly 552 andsupport 210 ofassembly 202 may be flat annular (e.g., as shown for support 210) or frustoconical (as shown for support 560). -
FIG. 21B shows assembly 552 being implanted. Following transluminal delivery tonative heart valve 10,valve body 554 is typically deployed first (i.e., before support 560), as shown in state A ofFIG. 21B . For some applications, valve body is deployed sufficiently far into the ventricle that tissue-engagingelements 580 can expand freely without interfering withleaflets 14 of the native valve, and valve assembly is subsequently moved atrially into the position shown in state A ofFIG. 21B . - Subsequently,
upstream support 560 is deployed, e.g., by adelivery housing 584 thereof being retracted (state B ofFIG. 21B ).Support 560 becomes placed against the upstream (e.g., atrial) surface ofnative valve 10, such as against the annulus of the valve and/or against the upstream surface ofnative leaflets 14. Typically, immediately subsequently to deployment ofbody 554 andsupport 560,assembly 552 has a total height d16 from a proximal end ofsupport 560 to a distal end of body 554 (e.g., a height along an atrioventricular axis), and a distance d17 (e.g., a gap) measured along the height exists between a distal end offrame 562 and a proximal-most part of frame 554 (e.g., tissue-engagingelements 580 defined by the frame). - Subsequently, tethers 582 are tensioned so as to draw
support 560 andbody 554 closer to each other, thereby reducing the total height ofassembly 552 to height d18, and reducing the distance between the distal end offrame 562 and the proximal-most part offrame 554 to a distance d19 (state C ofFIG. 21B ). This movesbody 554 and tissue-engagingelements 580 closer toleaflets 14, thereby sandwiching the leaflets between the tissue-engaging elements andsupport 560, and thereby anchoringassembly 552 at the native valve.Sheet 564 maintains fluid communication (e.g., sealed fluid communication) throughassembly 252, while also allowing the described contraction of the assembly. Typically, this characteristic is due tosheet 564 having tensile strength, but not compressive strength, and therefore rumpling when tethers 582 are tensioned. - Tensioning of
tethers 582 may be accomplished by any suitable technique. For some applications, the tensioning is performed usingcontrol rods 86 and lockingmembers 110, e.g., as described with reference toFIGS. 1C-D , mutatis mutandis. For some applications, the tensioning is performed using reference-force tubes and locking members, e.g., as described with reference toFIGS. 7B-8H , mutatis mutandis. For some applications,support 560 comprises a ratchet mechanism that facilitates the tensioning by allowing only one-way movement oftether 582 through the support. For some applications,assembly 552 comprises a spool mechanism for each tether, and tensioning is performed by rotating the spool mechanism. - For some applications,
assembly 552 has a compressed state (e.g., for transluminal delivery) in which the assembly defines an articulation zone betweenframes assembly 202, mutatis mutandis. - For some application, one or more of the techniques described hereinabove may be used to (1) control applied to
tethers 582, and/or (2) facilitate intracorporeal measurement of tension on the tethers (and optionally fluoroscopic detection of that measurement). For example,assembly 552 may comprise a tension spring midway along eachtether 582, and/or may comprise a compression spring at the coupling point ofsupport 560 and the tether (e.g., between the support and a lockingmember 262 configured to lock a respective tether to the support). Alternatively or additionally, for applications in which the tensioning is performed using reference-force tubes and locking members (e.g., as described with reference toFIGS. 7B-8H ),tool 460 may be used, mutatis mutandis, to extracorporeally detect the tension applied totethers 582. - Reference is made to
FIGS. 22A-B , which are schematic illustrations of aprosthetic valve assembly 602, comprising aprosthetic valve 603 having atubular valve body 604 that comprises anupstream portion 606, adownstream portion 608, and anelastic portion 610 disposed between the upstream portion and the downstream portion, in accordance with some applications of the invention. Prosthetic valve 603 (e.g.,valve body 604 thereof) is shaped to define a continuous lumen throughportions Prosthetic valve 603 is configured to be implanted atnative valve 10 such thatupstream portion 606 is disposed inatrium 6 of the heart of the subject, and such thatdownstream portion 608 is disposed inventricle 8 of the heart of the subject. For example,prosthetic valve 603 may be coupled to aprosthetic valve support 612 that has been previously placed against (e.g., coupled to) to the native valve, and that defines an opening.Support 612 may comprise (1) a support described elsewhere herein (e.g.,support 42 described with reference toFIGS. 1A-F and 19A-B, support 310 described with reference toFIGS. 10A-B , and/or support 350, described with reference toFIGS. 11A-B , and/or (2) a support described in U.S. Provisional Patent application 61/756,034 to HaCohen et al., from which the present application claims priority, and which is incorporated herein by reference. - For some applications, and as shown in
FIG. 22B ,prosthetic valve support 612 comprises one or more tissue-engagingelements 618, an annularupstream support portion 620, and a flexible stabilizingmember 622, such as a stabilizing band, coupled to the tissue-engaging elements, and configured to form a ring that is shaped to define an opening therethrough. Tissue-engagingelements 618 may comprise, as shown inFIGS. 22A-B , clips configured to be coupled toleaflets 14 of the native valve. -
Tubular valve body 604 typically comprises aframe 614, such as a stent-like wire frame. As shown inFIG. 22A ,prosthetic valve 603 typically further comprises a covering 616, disposed over (e.g., covering) an inner surface offrame 614, thereby providing a sealed lumen from an upstream end to a downstream end of the tubular valve body. Typically, an excess of covering 616 is provided in the vicinity ofelastic portion 610, so as to facilitate elastic stretching of the elastic portion. - Typically,
prosthetic valve 603 comprises an expandable prosthetic valve, and is deployed such that it (1) expands within the opening defined byupstream support portion 620 and/or the opening defined by stabilizingmember 622, (2) applies a radially-expansive force against the upstream support portion and/or the stabilizing member, and (3) thereby becomes coupled thereto. Typically, and as shown inFIG. 22B ,downstream portion 608 is expanded and coupled to stabilizingmember 622 beforeupstream portion 606 is expanded and coupled toupstream support portion 620. Whiledownstream portion 608 is coupled tomember 622, and beforeupstream portion 606 is coupled toportion 620,elastic portion 610 may be stretched and compressed e.g., such as by movingupstream portion 606 further upstream and downstream. Such stretching and compressing changes a length ofprosthetic valve 603, and for some applications, facilitates the coupling of a pre-determined portion of the prosthetic valve (e.g., of upstream portion 606) toupstream support portion 620, irrespective, to some degree, of (a) a distance between tissue-engagingelements 618 andupstream support portion 620, and/or (b) a dimension of native valve 10 (e.g., a length of leaflets 14). For some applications, such stretching and compressing adjusts a degree of tension ofelastic portion 610, and may alternatively or additionally facilitate “tightening” ofleaflets 14 against the implanted apparatus, such as drawing of the leaflets towardupstream support portion 620. - For some applications,
prosthetic valve 603 may be used in combination with other apparatus and techniques described herein. For example,valve body 604 may be substituted for another valve body described herein, mutatis mutandis, including valve bodies that are described herein as being intracorporeally coupled to an upstream support, and valve bodies that are described herein as being provided pre-coupled to an upstream support (either directly, or via a flexible sheet). - Reference is made to
FIGS. 23-24 , which are schematic illustrations of respective systems for facilitating anchoring of a tissue anchor in the heart of a subject, in accordance with some applications of the invention. Each system comprises a delivery tool that comprises (1) a steerable catheter configured to be transluminally advanced to the heart of the subject (e.g., via sheath 46), and (2) an obstructing element disposed at a longitudinal site of the catheter, and configured to extend laterally (e.g., radially) outward from the catheter so as to inhibit movement of at least the longitudinal site of the catheter through the heart valve by abutting tissue of the heart valve. -
FIG. 23 shows asystem 640, comprising a delivery tool 642 that comprises acatheter 644 and an obstructingelement 646. Obstructingelement 646 is typically collapsible for transluminal delivery (e.g., via sheath 46), and expandable inatrium 6 of the heart. For some applications,element 646 is configured to expand automatically upon becoming exposed from the distal end ofsheath 46. Obstructingelement 646 is disposed at alongitudinal site 648 ofcatheter 644, and is dimensioned, when in the expanded state thereof, to not pass through native valve 10 (i.e., betweenleaflets 14 of the native valve). When adistal end 645 of the catheter is extended throughnative valve 10, obstructingelement 646 abuts the atrial surface of the native valve (e.g., one or more leaflets, or the annulus), and thereby inhibits movement of at leastlongitudinal site 648 of the catheter from passing through the valve. Therefore a known length d20 of catheter 644 (i.e., the length betweenlongitudinal site 648 and distal end 645) is disposed downstream of the atrial surface ofvalve 10.Distal end 645 is thereby placeable against ventricular tissue at ventricular sites that are disposed at a distance from the atrial surface (e.g., from a portion of the atrial surface thatelement 646 abuts) that is generally equal to d20. Adistal portion 652 ofcatheter 644, disposed distal tolongitudinal site 648, is typically steerable, so as to facilitate placement ofdistal end 645 against many (e.g., any) ventricular site that is disposed at that distance from the atrial surface. - A
tissue anchor 48 is advanced throughcatheter 644 using ananchor manipulator 650, and anchored to tissue at the ventricular site at whichdistal end 645 is disposed. Typically, little or none ofanchor 48 ormanipulator 650 becomes exposed fromdistal end 645 during anchoring. -
FIG. 24 shows asystem 660, comprising adelivery tool 662 that comprises acatheter 664 and an obstructingelement 666. Obstructingelement 666 is typically collapsible for transluminal delivery (e.g., via sheath 46), and expandable inatrium 6 of the heart, and may be identical to obstructingelement 646, described hereinabove. For some applications,element 666 is configured to expand automatically upon becoming exposed from the distal end ofsheath 46. Obstructingelement 666 is disposed at alongitudinal site 668 ofcatheter 664, and is dimensioned, when in the expanded state thereof, to not pass through native valve 10 (i.e., betweenleaflets 14 of the native valve). When adistal end 665 of the catheter is extended throughnative valve 10, obstructingelement 666 abuts the atrial surface of the native valve (e.g., one or more leaflets, or the annulus), and thereby inhibits movement of at leastlongitudinal site 668 of the catheter from passing through the valve. Therefore a known length d21 of catheter 664 (i.e., the length betweenlongitudinal site 668 and distal end 665) is disposed downstream of the atrial surface ofvalve 10. - Length d21 of
system 660 is typically shorter than length d20 ofsystem 640, and in contrast tosystem 640, forsystem 660,catheter 664 is not configured fordistal end 665 to be placed against ventricular tissue. Rather, ananchor manipulator 670 advancestissue anchor 48 throughcatheter 664, out of thedistal end 665, and toward a ventricular site at which it anchors the tissue anchor. Typically,anchor manipulator 670 is slidably coupled tocatheter 664 such that a distal end of the anchor manipulator is slidable distally no more than a pre-determined distance d22 from longitudinal site 668 (and thereby no more than a pre-determined distance fromdistal end 665 of catheter 664).Anchor manipulator 670 is thereby used to anchoranchor 48 at a ventricular site that is disposed at a distance from the atrial surface (e.g., from a portion of the atrial surface thatelement 666 abuts) that is generally equal to d22. Typically, anchor manipulator 670 (or at least adistal portion 672 thereof that is exposable fromdistal end 665 of catheter 664) is steerable independently ofcatheter 664. - It is to be noted that, for
systems anchor 48 may be anchored at a site that is closer to another portion of the atrial surface than to the portion of the atrial surface that the obstructing element abuts. Alternatively or additionally, curvature of the catheter and/or the anchor manipulator may result in a direct distance between the atrial surface and the tissue anchor being smaller than d20 or d22. - Typically,
anchor 48 is coupled to a tether, guide member, and/or other longitudinal member (e.g., as described hereinabove with reference to other systems). When the anchor driver is decoupled from the anchor and withdrawn proximally, the tether extends proximally from the anchor (e.g., out of the body of the subject) so that an implant, such as a prosthetic valve, prosthetic valve support, and/or a prosthetic valve assembly (e.g., those described hereinabove) may be advanced therealong and/or locked thereto, e.g., as described hereinabove for other systems, mutatis mutandis. Because the distance between the tissue anchor and the atrial surface is known, for some applications the tether coupled to the tissue anchor may comprise fewer locking sites for locking to the implant, a relatively shorter locking site, and/or only one locking site. It is hypothesized that this may provide the possibility of using simpler, smaller and/or more effective mechanisms to lock the implant to the tether. - Reference is again made to
FIGS. 7A-C , 8A-H, 9A-B, 15A-C, 16, 17, 18A-B, and 21A-B. The flexible sheets described hereinabove typically have tensile strength but very low compressive strength along the longitudinal axis ofassembly 202. Due to this characteristic, inter alia, implant-control rod 246 is coupled (via mount 248) toassembly 202 by being coupled tovalve body 204, such that when the valve body is pushed distally, the valve body pullsupstream support 210 viasheet 214. (It is hypothesized that it would be less effective for the implant-control rod to be coupled to the support, because in such acase sheet 214 may rumple and the support may move toward the valve body, possibly reducing articulation at the articulation zone. Nevertheless, for applications in which such reduced articulation is in any case sufficient, the implant-control rod may be coupled to the support) This characteristic of the flexible sheet also facilitates the height-adjustment ofassembly 552 and its sandwiching of the native leaflets by tensioningtethers 582. - Although each of the prosthetic valve assemblies is shown implanted in a generally symmetrical state, it is to be noted that for some applications this characteristic of the sheet facilitates asymmetrical implantation. For example, the assembly may better conform to the native anatomy, and/or one tether of
assembly 552 may be tensioned more than another so as to alter the anchoring, sealing, and/or flow characteristics of the assembly, e.g., in response to the native anatomy. - For some applications it may be advantageous for the valve body to be disposed at a particular rotational orientation within
ventricle 8, and for the upstream support to be disposed at a particular rotational orientation withinatrium 6. For example, for prosthetic valve assemblies such asassembly 202 that are tethered to ventricular anchors, it may be advantageous for each eyelet to be aligned with a respective anchor, and for the point at which each guide members passes through the upstream support to be aligned with a respective commissure. Alternatively or additionally, the upstream support may be geometrically asymmetric, and a particular rotational orientation with respect to atrial tissue may be advantageous. (Examples of such upstream supports are described in PCT patent application publication WO/2013/021374 to Gross et. al, which is incorporated herein by reference.) Alternatively or additionally, the upstream support may be asymmetric with respect to rigidity (i.e., some regions of the support may be more rigid than others). Alternatively or additionally, it may be advantageous to place the holes insheet 214 through whichtubes 260 pass in a particular rotational orientation with respect to the native valve. - For some applications, the sheet facilitates implantation of the upstream support in a different rotational position to its valve body, e.g., by twisting. For example, the upstream support may be implanted at more than 5 degrees (e.g., more than 10 degrees, such as more than 20 degrees) rotational offset with respect to the valve body.
- Reference is again made to
FIGS. 7A-14B , 16-18B, and 21A-B. For some applications the first frame of the valve body is coupled to the second frame of the upstream support by the sheet (e.g., generally only by the sheet) in the compressed state (e.g.,assemblies assemblies 202 and 552). As used in the present application, including in the claims, (a) the first and second frames being “coupled by the sheet”, and/or (b) the sheet “coupling the first frame to the second frame”, do not include applications in which the frames are primarily and/or independently coupled to each other by a different means, and the covering extends over both frames. For example, the first and second frames are not “coupled to each other by the sheet” (1) inassemblies assemblies - For applications in which the first frame of the valve body is coupled to the second frame of the upstream support by the sheet, a gap typically exists between the first frame and the second frame. For some such applications, no metallic structure is disposed within the gap.
- For some applications (including some applications in which the first and second frames are coupled independently of the sheet), the flexible sheet comprises, in addition to the sheet-like structure, one or more flexible longitudinal members, such as metallic or polymer wires (e.g., embedded within or attached to a surface of the sheet-like structure). These flexible longitudinal members may provide a small amount of rigidity to the sheet without detracting from the general nature of the sheet. For example, the flexible longitudinal members may facilitate opening of the sheet during deployment of the prosthetic valve assembly.
- It is to be noted that for applications in which the first and second frames are coupled by the sheet, even when the sheet comprises flexible longitudinal members that are metallic wires, the frame of the valve body and the frame of the upstream support are typically distinct from each other, and can be considered to be coupled to each other by the sheet (e.g., generally only by the sheet).
- For some applications, within the total height of the prosthetic valve assembly, a distance exists within which no rigid and/or metallic structure is disposed. For example, for
assembly 552, typically no rigid and/or metallic structure is disposed within distance d17 and/or distance d19. It is to be noted that a similar distance exists forassembly 202 betweenframes 210 and 206 (e.g., when implanted; seeFIGS. 8F-G ). For some applications, forassembly 552,only sheet 564 andtethers 582 are disposed within distances d17 and d19. However, for some applications, tissue-engagingelements 580 extend proximally towardframe 562 such that the distance in which no rigid and/or metallic structure is disposed is reduced and/or absent (e.g., when tethers 582 are tensioned). - Reference is again made to
FIGS. 1A-F , 3A-C, 6 and 7A-8H. For some applications of the invention,tissue anchor 48 and/or the guide member coupled thereto (e.g.,guide member 56,guide member 256, and/or the components thereof) are included as components of the provided apparatus. That is, they are typically provided with the prosthetic valve assembly. For some applications of the invention, the tissue anchor and/or the guide member coupled thereto are not included as components of the provided apparatus (e.g., they are obtained separately). - It will be understood that, although the terms “first, “second,” etc. may be used in the present application (including the specification and the claims) to describe various elements and/or directions, these terms should not be limiting. These terms are only used to distinguish one element and/or direction from another. Thus, a “first” element described herein could also be termed a “second” element without departing from the teachings of the present disclosure.
- As used in the present application, including in the claims, a “central longitudinal axis” of a structure (e.g., an elongate structure) is the set of all centroids of transverse cross-sectional sections of the structure along the structure. Thus the cross-sectional sections are locally perpendicular to the central longitudinal axis, which runs along the structure. (If the structure is circular in cross-section, the centroids correspond with the centers of the circular cross-sectional sections.)
- It will be appreciated by persons skilled in the art that the present invention is not limited to what has been particularly shown and described hereinabove. Rather, the scope of the present invention includes both combinations and subcombinations of the various features described hereinabove, as well as variations and modifications thereof that are not in the prior art, which would occur to persons skilled in the art upon reading the foregoing description.
Claims (165)
Priority Applications (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US14/763,004 US20150351906A1 (en) | 2013-01-24 | 2014-01-23 | Ventricularly-anchored prosthetic valves |
US15/872,501 US10631982B2 (en) | 2013-01-24 | 2018-01-16 | Prosthetic valve and upstream support therefor |
Applications Claiming Priority (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US201361756034P | 2013-01-24 | 2013-01-24 | |
US201361756049P | 2013-01-24 | 2013-01-24 | |
US14/763,004 US20150351906A1 (en) | 2013-01-24 | 2014-01-23 | Ventricularly-anchored prosthetic valves |
PCT/IL2014/050087 WO2014115149A2 (en) | 2013-01-24 | 2014-01-23 | Ventricularly-anchored prosthetic valves |
Related Parent Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/IL2014/050087 A-371-Of-International WO2014115149A2 (en) | 2013-01-24 | 2014-01-23 | Ventricularly-anchored prosthetic valves |
Related Child Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US15/872,501 Continuation US10631982B2 (en) | 2013-01-24 | 2018-01-16 | Prosthetic valve and upstream support therefor |
Publications (1)
Publication Number | Publication Date |
---|---|
US20150351906A1 true US20150351906A1 (en) | 2015-12-10 |
Family
ID=50277269
Family Applications (8)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US14/161,921 Active 2034-11-22 US9681952B2 (en) | 2013-01-24 | 2014-01-23 | Anchoring of prosthetic valve supports |
US14/763,004 Abandoned US20150351906A1 (en) | 2013-01-24 | 2014-01-23 | Ventricularly-anchored prosthetic valves |
US15/600,190 Active 2035-03-30 US10835377B2 (en) | 2013-01-24 | 2017-05-19 | Rolled prosthetic valve support |
US15/872,501 Active US10631982B2 (en) | 2013-01-24 | 2018-01-16 | Prosthetic valve and upstream support therefor |
US16/144,054 Pending US20190021857A1 (en) | 2013-01-24 | 2018-09-27 | Prosthetic valve with downstream covering |
US16/802,353 Active 2034-02-08 US11135059B2 (en) | 2013-01-24 | 2020-02-26 | Prosthetic valve and upstream support therefor |
US17/466,785 Active 2034-05-14 US11844691B2 (en) | 2013-01-24 | 2021-09-03 | Partially-covered prosthetic valves |
US18/385,643 Pending US20240058123A1 (en) | 2013-01-24 | 2023-10-31 | Prosthetic valve |
Family Applications Before (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US14/161,921 Active 2034-11-22 US9681952B2 (en) | 2013-01-24 | 2014-01-23 | Anchoring of prosthetic valve supports |
Family Applications After (6)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US15/600,190 Active 2035-03-30 US10835377B2 (en) | 2013-01-24 | 2017-05-19 | Rolled prosthetic valve support |
US15/872,501 Active US10631982B2 (en) | 2013-01-24 | 2018-01-16 | Prosthetic valve and upstream support therefor |
US16/144,054 Pending US20190021857A1 (en) | 2013-01-24 | 2018-09-27 | Prosthetic valve with downstream covering |
US16/802,353 Active 2034-02-08 US11135059B2 (en) | 2013-01-24 | 2020-02-26 | Prosthetic valve and upstream support therefor |
US17/466,785 Active 2034-05-14 US11844691B2 (en) | 2013-01-24 | 2021-09-03 | Partially-covered prosthetic valves |
US18/385,643 Pending US20240058123A1 (en) | 2013-01-24 | 2023-10-31 | Prosthetic valve |
Country Status (4)
Country | Link |
---|---|
US (8) | US9681952B2 (en) |
EP (2) | EP4166111A1 (en) |
ES (1) | ES2934670T3 (en) |
WO (1) | WO2014115149A2 (en) |
Cited By (150)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20140018906A1 (en) * | 2010-09-23 | 2014-01-16 | Nasser Rafiee | Methods and systems for delivering prostheses using rail techniques |
US20150182336A1 (en) * | 2013-12-26 | 2015-07-02 | Valtech Cardio, Ltd. | Implantation of flexible implant |
US9421094B2 (en) | 2013-10-23 | 2016-08-23 | Caisson Interventional, LLC | Methods and systems for heart valve therapy |
US9427315B2 (en) | 2012-04-19 | 2016-08-30 | Caisson Interventional, LLC | Valve replacement systems and methods |
US9526613B2 (en) | 2005-03-17 | 2016-12-27 | Valtech Cardio Ltd. | Mitral valve treatment techniques |
US9561104B2 (en) | 2009-02-17 | 2017-02-07 | Valtech Cardio, Ltd. | Actively-engageable movement-restriction mechanism for use with an annuloplasty structure |
US9566152B2 (en) | 2012-04-19 | 2017-02-14 | Caisson Interventional, LLC | Heart valve assembly and methods |
US9592122B2 (en) | 2009-05-07 | 2017-03-14 | Valtech Cardio, Ltd | Annuloplasty ring with intra-ring anchoring |
US9622861B2 (en) | 2009-12-02 | 2017-04-18 | Valtech Cardio, Ltd. | Tool for actuating an adjusting mechanism |
US9636224B2 (en) | 2008-12-22 | 2017-05-02 | Valtech Cardio, Ltd. | Deployment techniques for annuloplasty ring and over-wire rotation tool |
US9662209B2 (en) | 2008-12-22 | 2017-05-30 | Valtech Cardio, Ltd. | Contractible annuloplasty structures |
US9713530B2 (en) | 2008-12-22 | 2017-07-25 | Valtech Cardio, Ltd. | Adjustable annuloplasty devices and adjustment mechanisms therefor |
US20170209253A1 (en) * | 2014-07-17 | 2017-07-27 | Millipede, Inc. | Adjustable endolumenal implant for reshaping the mitral valve annulus |
US9724192B2 (en) | 2011-11-08 | 2017-08-08 | Valtech Cardio, Ltd. | Controlled steering functionality for implant-delivery tool |
US9730793B2 (en) | 2012-12-06 | 2017-08-15 | Valtech Cardio, Ltd. | Techniques for guide-wire based advancement of a tool |
US9730792B2 (en) | 2007-09-13 | 2017-08-15 | Georg Lutter | Truncated cone heart valve stent |
US9750607B2 (en) | 2014-10-23 | 2017-09-05 | Caisson Interventional, LLC | Systems and methods for heart valve therapy |
US9750606B2 (en) | 2014-10-23 | 2017-09-05 | Caisson Interventional, LLC | Systems and methods for heart valve therapy |
US9775709B2 (en) | 2011-11-04 | 2017-10-03 | Valtech Cardio, Ltd. | Implant having multiple adjustable mechanisms |
US20170312078A1 (en) * | 2016-04-29 | 2017-11-02 | Medtronic Vascular, Inc. | Prosthetic heart valve devices with tethered anchors and associated systems and methods |
US9827092B2 (en) | 2011-12-16 | 2017-11-28 | Tendyne Holdings, Inc. | Tethers for prosthetic mitral valve |
US9833315B2 (en) | 2011-08-11 | 2017-12-05 | Tendyne Holdings, Inc. | Prosthetic valves and related inventions |
US9872769B2 (en) | 2006-12-05 | 2018-01-23 | Valtech Cardio, Ltd. | Implantation of repair devices in the heart |
US9883943B2 (en) | 2006-12-05 | 2018-02-06 | Valtech Cardio, Ltd. | Implantation of repair devices in the heart |
US9895221B2 (en) | 2012-07-28 | 2018-02-20 | Tendyne Holdings, Inc. | Multi-component designs for heart valve retrieval device, sealing structures and stent assembly |
USD815744S1 (en) | 2016-04-28 | 2018-04-17 | Edwards Lifesciences Cardiaq Llc | Valve frame for a delivery system |
US9949828B2 (en) | 2012-10-23 | 2018-04-24 | Valtech Cardio, Ltd. | Controlled steering functionality for implant-delivery tool |
US9968452B2 (en) | 2009-05-04 | 2018-05-15 | Valtech Cardio, Ltd. | Annuloplasty ring delivery cathethers |
US9968454B2 (en) | 2009-10-29 | 2018-05-15 | Valtech Cardio, Ltd. | Techniques for guide-wire based advancement of artificial chordae |
US9974651B2 (en) | 2015-02-05 | 2018-05-22 | Mitral Tech Ltd. | Prosthetic valve with axially-sliding frames |
US9974647B2 (en) | 2014-06-12 | 2018-05-22 | Caisson Interventional, LLC | Two stage anchor and mitral valve assembly |
US9986993B2 (en) | 2014-02-11 | 2018-06-05 | Tendyne Holdings, Inc. | Adjustable tether and epicardial pad system for prosthetic heart valve |
US10004599B2 (en) | 2014-02-21 | 2018-06-26 | Edwards Lifesciences Cardiaq Llc | Prosthesis, delivery device and methods of use |
US10010414B2 (en) | 2014-06-06 | 2018-07-03 | Edwards Lifesciences Corporation | Prosthetic valve for replacing a mitral valve |
US10092400B2 (en) | 2015-06-23 | 2018-10-09 | Edwards Lifesciences Cardiaq Llc | Systems and methods for anchoring and sealing a prosthetic heart valve |
US10098737B2 (en) | 2009-10-29 | 2018-10-16 | Valtech Cardio, Ltd. | Tissue anchor for annuloplasty device |
US10111747B2 (en) | 2013-05-20 | 2018-10-30 | Twelve, Inc. | Implantable heart valve devices, mitral valve repair devices and associated systems and methods |
US10117744B2 (en) | 2015-08-26 | 2018-11-06 | Edwards Lifesciences Cardiaq Llc | Replacement heart valves and methods of delivery |
US10149756B2 (en) | 2008-09-29 | 2018-12-11 | Edwards Lifesciences Cardiaq Llc | Heart valve |
US10179044B2 (en) | 2014-05-19 | 2019-01-15 | Edwards Lifesciences Cardiaq Llc | Replacement mitral valve |
US20190029819A1 (en) * | 2004-10-02 | 2019-01-31 | Edwards Lifesciences Cardiaq Llc | Method for replacement of heart valve |
US10201419B2 (en) | 2014-02-05 | 2019-02-12 | Tendyne Holdings, Inc. | Apparatus and methods for transfemoral delivery of prosthetic mitral valve |
USD841812S1 (en) | 2017-08-03 | 2019-02-26 | Cardiovalve Ltd. | Prosthetic heart valve element |
US10219900B2 (en) | 2012-07-30 | 2019-03-05 | Tendyne Holdings, Inc. | Delivery systems and methods for transcatheter prosthetic valves |
US10226335B2 (en) | 2015-06-22 | 2019-03-12 | Edwards Lifesciences Cardiaq Llc | Actively controllable heart valve implant and method of controlling same |
US10231831B2 (en) | 2009-12-08 | 2019-03-19 | Cardiovalve Ltd. | Folding ring implant for heart valve |
US10238490B2 (en) | 2015-08-21 | 2019-03-26 | Twelve, Inc. | Implant heart valve devices, mitral valve repair devices and associated systems and methods |
US10258468B2 (en) | 2012-03-01 | 2019-04-16 | Twelve, Inc. | Hydraulic delivery systems for prosthetic heart valve devices and associated methods |
US10265166B2 (en) | 2015-12-30 | 2019-04-23 | Caisson Interventional, LLC | Systems and methods for heart valve therapy |
US10299793B2 (en) | 2013-10-23 | 2019-05-28 | Valtech Cardio, Ltd. | Anchor magazine |
US10299927B2 (en) | 2011-10-19 | 2019-05-28 | Twelve, Inc. | Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods |
US10299917B2 (en) | 2011-10-19 | 2019-05-28 | Twelve, Inc. | Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods |
US10327894B2 (en) | 2015-09-18 | 2019-06-25 | Tendyne Holdings, Inc. | Methods for delivery of prosthetic mitral valves |
US10350066B2 (en) | 2015-08-28 | 2019-07-16 | Edwards Lifesciences Cardiaq Llc | Steerable delivery system for replacement mitral valve and methods of use |
US10363135B2 (en) | 2013-10-29 | 2019-07-30 | Tendyne Holdings, Inc. | Apparatus and methods for delivery of transcatheter prosthetic valves |
US10376266B2 (en) | 2012-10-23 | 2019-08-13 | Valtech Cardio, Ltd. | Percutaneous tissue anchor techniques |
US10376363B2 (en) | 2015-04-30 | 2019-08-13 | Edwards Lifesciences Cardiaq Llc | Replacement mitral valve, delivery system for replacement mitral valve and methods of use |
US10376361B2 (en) | 2011-08-05 | 2019-08-13 | Cardiovalve Ltd. | Techniques for percutaneous mitral valve replacement and sealing |
US10390952B2 (en) | 2015-02-05 | 2019-08-27 | Cardiovalve Ltd. | Prosthetic valve with flexible tissue anchor portions |
US10405976B2 (en) | 2013-05-30 | 2019-09-10 | Tendyne Holdings, Inc. | Structural members for prosthetic mitral valves |
US10433961B2 (en) | 2017-04-18 | 2019-10-08 | Twelve, Inc. | Delivery systems with tethers for prosthetic heart valve devices and associated methods |
US10441416B2 (en) | 2015-04-21 | 2019-10-15 | Edwards Lifesciences Corporation | Percutaneous mitral valve replacement device |
US10441412B2 (en) | 2009-04-15 | 2019-10-15 | Edwards Lifesciences Cardiaq Llc | Vascular implant and delivery system |
US10449039B2 (en) | 2015-03-19 | 2019-10-22 | Caisson Interventional, LLC | Systems and methods for heart valve therapy |
US10449333B2 (en) | 2013-03-14 | 2019-10-22 | Valtech Cardio, Ltd. | Guidewire feeder |
US10463489B2 (en) | 2013-04-02 | 2019-11-05 | Tendyne Holdings, Inc. | Prosthetic heart valve and systems and methods for delivering the same |
US10463494B2 (en) | 2013-04-02 | 2019-11-05 | Tendyne Holdings, Inc. | Prosthetic heart valve and systems and methods for delivering the same |
US10470877B2 (en) | 2016-05-03 | 2019-11-12 | Tendyne Holdings, Inc. | Apparatus and methods for anterior valve leaflet management |
US10470882B2 (en) | 2008-12-22 | 2019-11-12 | Valtech Cardio, Ltd. | Closure element for use with annuloplasty structure |
US10478293B2 (en) | 2013-04-04 | 2019-11-19 | Tendyne Holdings, Inc. | Retrieval and repositioning system for prosthetic heart valve |
US10485660B2 (en) | 2010-06-21 | 2019-11-26 | Edwards Lifesciences Cardiaq Llc | Replacement heart valve |
US10492908B2 (en) | 2014-07-30 | 2019-12-03 | Cardiovalve Ltd. | Anchoring of a prosthetic valve |
US10517719B2 (en) | 2008-12-22 | 2019-12-31 | Valtech Cardio, Ltd. | Implantation of repair devices in the heart |
US10517725B2 (en) | 2010-12-23 | 2019-12-31 | Twelve, Inc. | System for mitral valve repair and replacement |
US10517728B2 (en) | 2014-03-10 | 2019-12-31 | Tendyne Holdings, Inc. | Devices and methods for positioning and monitoring tether load for prosthetic mitral valve |
US10531866B2 (en) | 2016-02-16 | 2020-01-14 | Cardiovalve Ltd. | Techniques for providing a replacement valve and transseptal communication |
US10555718B2 (en) | 2013-10-17 | 2020-02-11 | Tendyne Holdings, Inc. | Apparatus and methods for alignment and deployment of intracardiac devices |
US10575948B2 (en) | 2017-08-03 | 2020-03-03 | Cardiovalve Ltd. | Prosthetic heart valve |
US10575951B2 (en) | 2015-08-26 | 2020-03-03 | Edwards Lifesciences Cardiaq Llc | Delivery device and methods of use for transapical delivery of replacement mitral valve |
US10575950B2 (en) | 2017-04-18 | 2020-03-03 | Twelve, Inc. | Hydraulic systems for delivering prosthetic heart valve devices and associated methods |
US10583000B2 (en) | 2013-03-14 | 2020-03-10 | Edwards Lifesciences Cardiaq Llc | Prosthesis for atraumatically grasping intralumenal tissue and methods of delivery |
US10595996B2 (en) | 2013-06-25 | 2020-03-24 | Tendyne Holdings, Inc. | Thrombus management and structural compliance features for prosthetic heart valves |
US10610358B2 (en) | 2015-12-28 | 2020-04-07 | Tendyne Holdings, Inc. | Atrial pocket closures for prosthetic heart valves |
US10610356B2 (en) | 2015-02-05 | 2020-04-07 | Tendyne Holdings, Inc. | Expandable epicardial pads and devices and methods for delivery of same |
US10610354B2 (en) | 2013-08-01 | 2020-04-07 | Tendyne Holdings, Inc. | Epicardial anchor devices and methods |
US10631982B2 (en) | 2013-01-24 | 2020-04-28 | Cardiovale Ltd. | Prosthetic valve and upstream support therefor |
US10639143B2 (en) | 2016-08-26 | 2020-05-05 | Edwards Lifesciences Corporation | Multi-portion replacement heart valve prosthesis |
US10646338B2 (en) | 2017-06-02 | 2020-05-12 | Twelve, Inc. | Delivery systems with telescoping capsules for deploying prosthetic heart valve devices and associated methods |
US10646340B2 (en) | 2016-08-19 | 2020-05-12 | Edwards Lifesciences Corporation | Steerable delivery system for replacement mitral valve |
US10667905B2 (en) | 2015-04-16 | 2020-06-02 | Tendyne Holdings, Inc. | Apparatus and methods for delivery, repositioning, and retrieval of transcatheter prosthetic valves |
WO2020061331A3 (en) * | 2018-09-20 | 2020-06-11 | Vdyne, Llc | Transcatheter deliverable prosthetic heart valves and methods of delivery |
US10702378B2 (en) | 2017-04-18 | 2020-07-07 | Twelve, Inc. | Prosthetic heart valve device and associated systems and methods |
US10702380B2 (en) | 2011-10-19 | 2020-07-07 | Twelve, Inc. | Devices, systems and methods for heart valve replacement |
US10702385B2 (en) | 2011-08-05 | 2020-07-07 | Cardiovalve Ltd. | Implant for heart valve |
US10709591B2 (en) | 2017-06-06 | 2020-07-14 | Twelve, Inc. | Crimping device and method for loading stents and prosthetic heart valves |
US10716664B2 (en) | 2013-03-14 | 2020-07-21 | Edwards Lifesciences Cardiaq Llc | Prosthesis for atraumatically grasping intralumenal tissue and methods of delivery |
US10729541B2 (en) | 2017-07-06 | 2020-08-04 | Twelve, Inc. | Prosthetic heart valve devices and associated systems and methods |
US10751173B2 (en) | 2011-06-21 | 2020-08-25 | Twelve, Inc. | Prosthetic heart valve devices and associated systems and methods |
US10758348B2 (en) | 2016-11-02 | 2020-09-01 | Edwards Lifesciences Corporation | Supra and sub-annular mitral valve delivery system |
US10786352B2 (en) | 2017-07-06 | 2020-09-29 | Twelve, Inc. | Prosthetic heart valve devices and associated systems and methods |
US10786351B2 (en) | 2015-01-07 | 2020-09-29 | Tendyne Holdings, Inc. | Prosthetic mitral valves and apparatus and methods for delivery of same |
US10792151B2 (en) | 2017-05-11 | 2020-10-06 | Twelve, Inc. | Delivery systems for delivering prosthetic heart valve devices and associated methods |
US10792152B2 (en) | 2011-06-23 | 2020-10-06 | Valtech Cardio, Ltd. | Closed band for percutaneous annuloplasty |
US10799345B2 (en) | 2017-09-19 | 2020-10-13 | Cardiovalve Ltd. | Prosthetic valve with protective fabric covering around tissue anchor bases |
US10813757B2 (en) | 2017-07-06 | 2020-10-27 | Edwards Lifesciences Corporation | Steerable rail delivery system |
US10856975B2 (en) | 2016-08-10 | 2020-12-08 | Cardiovalve Ltd. | Prosthetic valve with concentric frames |
US20210000593A1 (en) * | 2018-02-15 | 2021-01-07 | Tricares SAS | Stent and replacement heart valve prosthesis with improved fixation features |
US10888421B2 (en) | 2017-09-19 | 2021-01-12 | Cardiovalve Ltd. | Prosthetic heart valve with pouch |
US20210030538A1 (en) * | 2017-04-05 | 2021-02-04 | Opus Medical Therapies, LLC | Methods of implantation of transcatheter atrial sealing skirt, anchor, and tether |
US10945835B2 (en) | 2011-10-19 | 2021-03-16 | Twelve, Inc. | Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods |
US11039921B2 (en) | 2016-06-13 | 2021-06-22 | Tendyne Holdings, Inc. | Sequential delivery of two-part prosthetic mitral valve |
US11051934B2 (en) * | 2018-02-28 | 2021-07-06 | Edwards Lifesciences Corporation | Prosthetic mitral valve with improved anchors and seal |
US11065116B2 (en) | 2016-07-12 | 2021-07-20 | Tendyne Holdings, Inc. | Apparatus and methods for trans-septal retrieval of prosthetic heart valves |
US11071627B2 (en) | 2018-10-18 | 2021-07-27 | Vdyne, Inc. | Orthogonally delivered transcatheter heart valve frame for valve in valve prosthesis |
US11076956B2 (en) | 2019-03-14 | 2021-08-03 | Vdyne, Inc. | Proximal, distal, and anterior anchoring tabs for side-delivered transcatheter mitral valve prosthesis |
WO2021156866A1 (en) | 2020-02-04 | 2021-08-12 | Cardiovalve Ltd. | Support-guided steering of a catheter |
US11090157B2 (en) | 2016-06-30 | 2021-08-17 | Tendyne Holdings, Inc. | Prosthetic heart valves and apparatus and methods for delivery of same |
US11096782B2 (en) | 2015-12-03 | 2021-08-24 | Tendyne Holdings, Inc. | Frame features for prosthetic mitral valves |
US11109969B2 (en) | 2018-10-22 | 2021-09-07 | Vdyne, Inc. | Guidewire delivery of transcatheter heart valve |
US11154399B2 (en) | 2017-07-13 | 2021-10-26 | Tendyne Holdings, Inc. | Prosthetic heart valves and apparatus and methods for delivery of same |
US11160653B2 (en) | 2017-03-27 | 2021-11-02 | Truleaf Medicai Ltd. | Docking elements |
US11166814B2 (en) | 2019-08-20 | 2021-11-09 | Vdyne, Inc. | Delivery and retrieval devices and methods for side-deliverable transcatheter prosthetic valves |
US11173027B2 (en) | 2019-03-14 | 2021-11-16 | Vdyne, Inc. | Side-deliverable transcatheter prosthetic valves and methods for delivering and anchoring the same |
US11179236B2 (en) | 2009-12-08 | 2021-11-23 | Colorado State University Research Foundation | Device and system for transcatheter mitral valve replacement |
US11185409B2 (en) | 2019-01-26 | 2021-11-30 | Vdyne, Inc. | Collapsible inner flow control component for side-delivered transcatheter heart valve prosthesis |
US11191639B2 (en) | 2017-08-28 | 2021-12-07 | Tendyne Holdings, Inc. | Prosthetic heart valves with tether coupling features |
US11202706B2 (en) | 2019-05-04 | 2021-12-21 | Vdyne, Inc. | Cinch device and method for deployment of a side-delivered prosthetic heart valve in a native annulus |
US11202704B2 (en) | 2011-10-19 | 2021-12-21 | Twelve, Inc. | Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods |
US11224510B2 (en) | 2013-04-02 | 2022-01-18 | Tendyne Holdings, Inc. | Prosthetic heart valve and systems and methods for delivering the same |
US11234813B2 (en) | 2020-01-17 | 2022-02-01 | Vdyne, Inc. | Ventricular stability elements for side-deliverable prosthetic heart valves and methods of delivery |
US11246704B2 (en) | 2017-08-03 | 2022-02-15 | Cardiovalve Ltd. | Prosthetic heart valve |
US11253359B2 (en) | 2018-12-20 | 2022-02-22 | Vdyne, Inc. | Proximal tab for side-delivered transcatheter heart valves and methods of delivery |
US11273032B2 (en) | 2019-01-26 | 2022-03-15 | Vdyne, Inc. | Collapsible inner flow control component for side-deliverable transcatheter heart valve prosthesis |
US11273033B2 (en) | 2018-09-20 | 2022-03-15 | Vdyne, Inc. | Side-delivered transcatheter heart valve replacement |
US11278437B2 (en) | 2018-12-08 | 2022-03-22 | Vdyne, Inc. | Compression capable annular frames for side delivery of transcatheter heart valve replacement |
US11291546B2 (en) | 2011-08-05 | 2022-04-05 | Cardiovalve Ltd. | Leaflet clip with collars |
US11298227B2 (en) * | 2019-03-05 | 2022-04-12 | Vdyne, Inc. | Tricuspid regurgitation control devices for orthogonal transcatheter heart valve prosthesis |
US11331186B2 (en) | 2019-08-26 | 2022-05-17 | Vdyne, Inc. | Side-deliverable transcatheter prosthetic valves and methods for delivering and anchoring the same |
US11344413B2 (en) | 2018-09-20 | 2022-05-31 | Vdyne, Inc. | Transcatheter deliverable prosthetic heart valves and methods of delivery |
US11382746B2 (en) | 2017-12-13 | 2022-07-12 | Cardiovalve Ltd. | Prosthetic valve and delivery tool therefor |
US11395738B2 (en) | 2018-09-25 | 2022-07-26 | Truleaf Medical Ltd. | Docking elements |
US11633277B2 (en) | 2018-01-10 | 2023-04-25 | Cardiovalve Ltd. | Temperature-control during crimping of an implant |
US11648110B2 (en) | 2019-12-05 | 2023-05-16 | Tendyne Holdings, Inc. | Braided anchor for mitral valve |
US11648114B2 (en) | 2019-12-20 | 2023-05-16 | Tendyne Holdings, Inc. | Distally loaded sheath and loading funnel |
US11653910B2 (en) | 2010-07-21 | 2023-05-23 | Cardiovalve Ltd. | Helical anchor implantation |
US11678980B2 (en) | 2020-08-19 | 2023-06-20 | Tendyne Holdings, Inc. | Fully-transseptal apical pad with pulley for tensioning |
US11684474B2 (en) | 2018-01-25 | 2023-06-27 | Edwards Lifesciences Corporation | Delivery system for aided replacement valve recapture and repositioning post-deployment |
US11786366B2 (en) | 2018-04-04 | 2023-10-17 | Vdyne, Inc. | Devices and methods for anchoring transcatheter heart valve |
US11793633B2 (en) | 2017-08-03 | 2023-10-24 | Cardiovalve Ltd. | Prosthetic heart valve |
US11931258B2 (en) | 2020-04-30 | 2024-03-19 | Edwards Lifesciences Corporation | Steerable delivery system for replacement mitral valve and methods of use |
Families Citing this family (103)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US8951285B2 (en) | 2005-07-05 | 2015-02-10 | Mitralign, Inc. | Tissue anchor, anchoring system and methods of using the same |
CA2629534C (en) | 2005-11-10 | 2015-02-24 | Arshad Quadri | Balloon-expandable, self-expanding, vascular prosthesis connecting stent |
US11259924B2 (en) | 2006-12-05 | 2022-03-01 | Valtech Cardio Ltd. | Implantation of repair devices in the heart |
US11660190B2 (en) | 2007-03-13 | 2023-05-30 | Edwards Lifesciences Corporation | Tissue anchors, systems and methods, and devices |
US8382829B1 (en) | 2008-03-10 | 2013-02-26 | Mitralign, Inc. | Method to reduce mitral regurgitation by cinching the commissure of the mitral valve |
US8652202B2 (en) | 2008-08-22 | 2014-02-18 | Edwards Lifesciences Corporation | Prosthetic heart valve and delivery apparatus |
US8449599B2 (en) | 2009-12-04 | 2013-05-28 | Edwards Lifesciences Corporation | Prosthetic valve for replacing mitral valve |
US8475525B2 (en) | 2010-01-22 | 2013-07-02 | 4Tech Inc. | Tricuspid valve repair using tension |
US9307980B2 (en) | 2010-01-22 | 2016-04-12 | 4Tech Inc. | Tricuspid valve repair using tension |
US10058323B2 (en) | 2010-01-22 | 2018-08-28 | 4 Tech Inc. | Tricuspid valve repair using tension |
US20110224785A1 (en) | 2010-03-10 | 2011-09-15 | Hacohen Gil | Prosthetic mitral valve with tissue anchors |
US9763657B2 (en) | 2010-07-21 | 2017-09-19 | Mitraltech Ltd. | Techniques for percutaneous mitral valve replacement and sealing |
US20140324164A1 (en) | 2011-08-05 | 2014-10-30 | Mitraltech Ltd. | Techniques for percutaneous mitral valve replacement and sealing |
US8961594B2 (en) | 2012-05-31 | 2015-02-24 | 4Tech Inc. | Heart valve repair system |
CA2885354A1 (en) | 2012-09-29 | 2014-04-03 | Mitralign, Inc. | Plication lock delivery system and method of use thereof |
US8628571B1 (en) | 2012-11-13 | 2014-01-14 | Mitraltech Ltd. | Percutaneously-deliverable mechanical valve |
US9788948B2 (en) | 2013-01-09 | 2017-10-17 | 4 Tech Inc. | Soft tissue anchors and implantation techniques |
WO2014134183A1 (en) | 2013-02-26 | 2014-09-04 | Mitralign, Inc. | Devices and methods for percutaneous tricuspid valve repair |
CN105208978B (en) | 2013-03-14 | 2016-12-07 | 4科技有限公司 | There is the support of tether interface |
EP2968847B1 (en) | 2013-03-15 | 2023-03-08 | Edwards Lifesciences Corporation | Translation catheter systems |
US10070857B2 (en) | 2013-08-31 | 2018-09-11 | Mitralign, Inc. | Devices and methods for locating and implanting tissue anchors at mitral valve commissure |
WO2015063580A2 (en) | 2013-10-30 | 2015-05-07 | 4Tech Inc. | Multiple anchoring-point tension system |
US10052095B2 (en) | 2013-10-30 | 2018-08-21 | 4Tech Inc. | Multiple anchoring-point tension system |
US9949825B2 (en) * | 2014-02-18 | 2018-04-24 | St. Jude Medical, Cardiology Division, Inc. | Bowed runners and corresponding valve assemblies for paravalvular leak protection |
US9801720B2 (en) | 2014-06-19 | 2017-10-31 | 4Tech Inc. | Cardiac tissue cinching |
WO2016059639A1 (en) | 2014-10-14 | 2016-04-21 | Valtech Cardio Ltd. | Leaflet-restraining techniques |
JP6717820B2 (en) | 2014-12-02 | 2020-07-08 | 4テック インコーポレイテッド | Eccentric tissue anchor |
US10524792B2 (en) | 2014-12-04 | 2020-01-07 | Edwards Lifesciences Corporation | Percutaneous clip for repairing a heart valve |
US20160256269A1 (en) | 2015-03-05 | 2016-09-08 | Mitralign, Inc. | Devices for treating paravalvular leakage and methods use thereof |
US10064718B2 (en) | 2015-04-16 | 2018-09-04 | Edwards Lifesciences Corporation | Low-profile prosthetic heart valve for replacing a mitral valve |
CN111265335B (en) | 2015-04-30 | 2022-03-15 | 瓦尔泰克卡迪欧有限公司 | Valvuloplasty techniques |
US10517726B2 (en) | 2015-05-14 | 2019-12-31 | Edwards Lifesciences Corporation | Heart valve sealing devices and delivery devices therefor |
US9974650B2 (en) * | 2015-07-14 | 2018-05-22 | Edwards Lifesciences Corporation | Prosthetic heart valve |
US10034747B2 (en) | 2015-08-27 | 2018-07-31 | Medtronic Vascular, Inc. | Prosthetic valve system having a docking component and a prosthetic valve component |
US10456243B2 (en) | 2015-10-09 | 2019-10-29 | Medtronic Vascular, Inc. | Heart valves prostheses and methods for percutaneous heart valve replacement |
US10751182B2 (en) | 2015-12-30 | 2020-08-25 | Edwards Lifesciences Corporation | System and method for reshaping right heart |
US10828160B2 (en) | 2015-12-30 | 2020-11-10 | Edwards Lifesciences Corporation | System and method for reducing tricuspid regurgitation |
US11833034B2 (en) | 2016-01-13 | 2023-12-05 | Shifamed Holdings, Llc | Prosthetic cardiac valve devices, systems, and methods |
US10321992B2 (en) | 2016-02-01 | 2019-06-18 | Medtronic, Inc. | Heart valve prostheses having multiple support arms and methods for percutaneous heart valve replacement |
US10799675B2 (en) | 2016-03-21 | 2020-10-13 | Edwards Lifesciences Corporation | Cam controlled multi-direction steerable handles |
US10835714B2 (en) | 2016-03-21 | 2020-11-17 | Edwards Lifesciences Corporation | Multi-direction steerable handles for steering catheters |
US11219746B2 (en) | 2016-03-21 | 2022-01-11 | Edwards Lifesciences Corporation | Multi-direction steerable handles for steering catheters |
US10702274B2 (en) | 2016-05-26 | 2020-07-07 | Edwards Lifesciences Corporation | Method and system for closing left atrial appendage |
US10588745B2 (en) | 2016-06-20 | 2020-03-17 | Medtronic Vascular, Inc. | Modular valve prosthesis, delivery system, and method of delivering and deploying a modular valve prosthesis |
US10973638B2 (en) | 2016-07-07 | 2021-04-13 | Edwards Lifesciences Corporation | Device and method for treating vascular insufficiency |
GB201611910D0 (en) | 2016-07-08 | 2016-08-24 | Valtech Cardio Ltd | Adjustable annuloplasty device with alternating peaks and troughs |
US10350062B2 (en) | 2016-07-21 | 2019-07-16 | Edwards Lifesciences Corporation | Replacement heart valve prosthesis |
US20190231525A1 (en) | 2016-08-01 | 2019-08-01 | Mitraltech Ltd. | Minimally-invasive delivery systems |
USD800908S1 (en) | 2016-08-10 | 2017-10-24 | Mitraltech Ltd. | Prosthetic valve element |
US10575946B2 (en) * | 2016-09-01 | 2020-03-03 | Medtronic Vascular, Inc. | Heart valve prosthesis and separate support flange for attachment thereto |
US10653862B2 (en) | 2016-11-07 | 2020-05-19 | Edwards Lifesciences Corporation | Apparatus for the introduction and manipulation of multiple telescoping catheters |
US10905554B2 (en) | 2017-01-05 | 2021-02-02 | Edwards Lifesciences Corporation | Heart valve coaptation device |
LT3558169T (en) | 2017-04-18 | 2022-02-10 | Edwards Lifesciences Corporation | Heart valve sealing devices and delivery devices therefor |
US11224511B2 (en) | 2017-04-18 | 2022-01-18 | Edwards Lifesciences Corporation | Heart valve sealing devices and delivery devices therefor |
US11045627B2 (en) | 2017-04-18 | 2021-06-29 | Edwards Lifesciences Corporation | Catheter system with linear actuation control mechanism |
US10799312B2 (en) | 2017-04-28 | 2020-10-13 | Edwards Lifesciences Corporation | Medical device stabilizing apparatus and method of use |
US10959846B2 (en) | 2017-05-10 | 2021-03-30 | Edwards Lifesciences Corporation | Mitral valve spacer device |
WO2019036810A1 (en) | 2017-08-25 | 2019-02-28 | Neovasc Tiara Inc. | Sequentially deployed transcatheter mitral valve prosthesis |
US11051940B2 (en) | 2017-09-07 | 2021-07-06 | Edwards Lifesciences Corporation | Prosthetic spacer device for heart valve |
US11065117B2 (en) | 2017-09-08 | 2021-07-20 | Edwards Lifesciences Corporation | Axisymmetric adjustable device for treating mitral regurgitation |
US11110251B2 (en) | 2017-09-19 | 2021-09-07 | Edwards Lifesciences Corporation | Multi-direction steerable handles for steering catheters |
US9895226B1 (en) | 2017-10-19 | 2018-02-20 | Mitral Tech Ltd. | Techniques for use with prosthetic valve leaflets |
CN112040907A (en) | 2017-10-19 | 2020-12-04 | 安特瑞斯技术公司 | Replacement heart valve with reduced suturing |
US10835221B2 (en) | 2017-11-02 | 2020-11-17 | Valtech Cardio, Ltd. | Implant-cinching devices and systems |
US11135062B2 (en) | 2017-11-20 | 2021-10-05 | Valtech Cardio Ltd. | Cinching of dilated heart muscle |
US10912664B2 (en) * | 2017-11-21 | 2021-02-09 | Cook Medical Technologies, LLC | Stent with induction responsive muscles that facilitate implantation adjustments |
US10238493B1 (en) | 2018-01-09 | 2019-03-26 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
US10105222B1 (en) | 2018-01-09 | 2018-10-23 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
WO2019139904A1 (en) | 2018-01-09 | 2019-07-18 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
US10076415B1 (en) | 2018-01-09 | 2018-09-18 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
US10231837B1 (en) | 2018-01-09 | 2019-03-19 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
US10136993B1 (en) | 2018-01-09 | 2018-11-27 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
US10123873B1 (en) | 2018-01-09 | 2018-11-13 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
US10111751B1 (en) | 2018-01-09 | 2018-10-30 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
US10973639B2 (en) | 2018-01-09 | 2021-04-13 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
US10159570B1 (en) | 2018-01-09 | 2018-12-25 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
US10245144B1 (en) | 2018-01-09 | 2019-04-02 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
CN111655200B (en) | 2018-01-24 | 2023-07-14 | 爱德华兹生命科学创新(以色列)有限公司 | Contraction of annuloplasty structures |
EP4248904A3 (en) | 2018-01-26 | 2023-11-29 | Edwards Lifesciences Innovation (Israel) Ltd. | Techniques for facilitating heart valve tethering and chord replacement |
US11389297B2 (en) | 2018-04-12 | 2022-07-19 | Edwards Lifesciences Corporation | Mitral valve spacer device |
US11207181B2 (en) | 2018-04-18 | 2021-12-28 | Edwards Lifesciences Corporation | Heart valve sealing devices and delivery devices therefor |
US11678982B2 (en) * | 2018-05-18 | 2023-06-20 | Anteris Technologies Corporation | Replacement heart valve assembly with a valve loaded distally from a stent |
US11666439B2 (en) | 2018-05-18 | 2023-06-06 | Anteris Technologies Corporation | Inverted heart valve for transcatheter valve replacement |
CN112203617A (en) | 2018-05-18 | 2021-01-08 | 安特瑞斯技术公司 | Heart valve with furled sealing area |
WO2020012481A2 (en) | 2018-07-12 | 2020-01-16 | Valtech Cardio, Ltd. | Annuloplasty systems and locking tools therefor |
US10779946B2 (en) | 2018-09-17 | 2020-09-22 | Cardiovalve Ltd. | Leaflet-testing apparatus |
EP3860519A4 (en) | 2018-10-05 | 2022-07-06 | Shifamed Holdings, LLC | Prosthetic cardiac valve devices, systems, and methods |
US10945844B2 (en) | 2018-10-10 | 2021-03-16 | Edwards Lifesciences Corporation | Heart valve sealing devices and delivery devices therefor |
US11737872B2 (en) | 2018-11-08 | 2023-08-29 | Neovasc Tiara Inc. | Ventricular deployment of a transcatheter mitral valve prosthesis |
WO2020168081A1 (en) | 2019-02-14 | 2020-08-20 | Edwards Lifesciences Corporation | Heart valve sealing devices and delivery devices therefor |
US11471282B2 (en) | 2019-03-19 | 2022-10-18 | Shifamed Holdings, Llc | Prosthetic cardiac valve devices, systems, and methods |
WO2020236931A1 (en) | 2019-05-20 | 2020-11-26 | Neovasc Tiara Inc. | Introducer with hemostasis mechanism |
EP4193934A1 (en) | 2019-10-29 | 2023-06-14 | Edwards Lifesciences Innovation (Israel) Ltd. | Annuloplasty and tissue anchor technologies |
WO2021158509A1 (en) | 2020-02-06 | 2021-08-12 | Laplace Interventional Inc. | Transcatheter heart valve prosthesis assembled inside heart chambers or blood vessels |
US11707355B2 (en) | 2020-05-28 | 2023-07-25 | Medtronic, Inc. | Modular heart valve prosthesis |
US20230248513A1 (en) | 2020-07-07 | 2023-08-10 | Anteris Technologies Corporation | Expandable frame for improved hemodynamic performance of transcatheter replacement heart valve |
WO2022053059A1 (en) * | 2020-09-14 | 2022-03-17 | Bluesail New Valve Technology Asia Ltd. | Annuloplasty implant system and associated methods |
US11744615B2 (en) * | 2020-09-24 | 2023-09-05 | Bioventrix, Inc. | Pericardial inflation catheter and systems and methods employing same |
EP4255350A1 (en) * | 2020-12-03 | 2023-10-11 | Shifamed Holdings, LLC | Mitral valve implants |
WO2023053147A1 (en) * | 2021-10-02 | 2023-04-06 | Institute Of Advanced Medical Research & Innovations Forum | Double disc based access and anchor device with shape memory properties |
US11510777B1 (en) | 2022-02-10 | 2022-11-29 | Laplace Interventional Inc. | Prosthetic heart valves |
US11712336B1 (en) | 2022-07-20 | 2023-08-01 | Laplace Interventional Inc. | Prosthetic heart valves |
US11622853B1 (en) | 2022-09-30 | 2023-04-11 | Anteris Technologies Corporation | Prosthetic heart valves |
Citations (11)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6010530A (en) * | 1995-06-07 | 2000-01-04 | Boston Scientific Technology, Inc. | Self-expanding endoluminal prosthesis |
US6458153B1 (en) * | 1999-12-31 | 2002-10-01 | Abps Venture One, Ltd. | Endoluminal cardiac and venous valve prostheses and methods of manufacture and delivery thereof |
US6669724B2 (en) * | 2001-06-05 | 2003-12-30 | M.I. Tech Co. Ltd. | Medical stent |
US20040210304A1 (en) * | 1999-11-17 | 2004-10-21 | Corevalve, S.A. | Prosthetic valve for transluminal delivery |
US20040260389A1 (en) * | 2003-04-24 | 2004-12-23 | Cook Incorporated | Artificial valve prosthesis with improved flow dynamics |
US20070213810A1 (en) * | 2005-03-14 | 2007-09-13 | Richard Newhauser | Segmented endoprosthesis |
US7442204B2 (en) * | 2003-07-08 | 2008-10-28 | Ventor Technologies, Ltd. | Fluid flow prosthetic device |
US20090088836A1 (en) * | 2007-08-23 | 2009-04-02 | Direct Flow Medical, Inc. | Translumenally implantable heart valve with formed in place support |
US20090240320A1 (en) * | 2008-03-18 | 2009-09-24 | Yosi Tuval | Valve suturing and implantation procedures |
US20110245911A1 (en) * | 2010-04-01 | 2011-10-06 | Medtronic, Inc. | Transcatheter Valve with Torsion Spring Fixation and Related Systems and Methods |
US20130304200A1 (en) * | 2011-10-19 | 2013-11-14 | Foundry Newco Xii, Inc. | Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods |
Family Cites Families (1359)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
NL143127B (en) | 1969-02-04 | 1974-09-16 | Rhone Poulenc Sa | REINFORCEMENT DEVICE FOR A DEFECTIVE HEART VALVE. |
US3604488A (en) | 1969-11-19 | 1971-09-14 | Vermont American Corp | Screwdriver attachment |
US3840018A (en) | 1973-01-31 | 1974-10-08 | M Heifetz | Clamp for occluding tubular conduits in the human body |
US3874388A (en) | 1973-02-12 | 1975-04-01 | Ochsner Med Found Alton | Shunt defect closure system |
US3898701A (en) | 1974-01-17 | 1975-08-12 | Russa Joseph | Implantable heart valve |
US4340091A (en) | 1975-05-07 | 1982-07-20 | Albany International Corp. | Elastomeric sheet materials for heart valve and other prosthetic implants |
US4042979A (en) | 1976-07-12 | 1977-08-23 | Angell William W | Valvuloplasty ring and prosthetic method |
US4118805A (en) | 1977-02-28 | 1978-10-10 | Codman & Shurtleff, Inc. | Artificial sphincter |
JPS53152790U (en) | 1977-04-30 | 1978-12-01 | ||
ES474582A1 (en) | 1978-10-26 | 1979-11-01 | Aranguren Duo Iker | Process for installing mitral valves in their anatomical space by attaching cords to an artificial stent |
US4214349A (en) | 1978-11-30 | 1980-07-29 | Midland-Ross Corporation | Tie wrap |
US4222126A (en) | 1978-12-14 | 1980-09-16 | The United States Of America As Represented By The Secretary Of The Department Of Health, Education & Welfare | Unitized three leaflet heart valve |
US4275469A (en) | 1979-12-13 | 1981-06-30 | Shelhigh Inc. | Prosthetic heart valve |
GB2084468B (en) | 1980-09-25 | 1984-06-06 | South African Inventions | Surgical implant |
US4473928A (en) | 1980-11-20 | 1984-10-02 | Tridon Limited | Hose clamps |
IT1144379B (en) | 1981-07-14 | 1986-10-29 | Sorin Biomedica Spa | CARDIAC VALVE PROSTHESIS |
DE3230858C2 (en) | 1982-08-19 | 1985-01-24 | Ahmadi, Ali, Dr. med., 7809 Denzlingen | Ring prosthesis |
US4892541A (en) | 1982-11-29 | 1990-01-09 | Tascon Medical Technology Corporation | Heart valve prosthesis |
US4434828A (en) | 1982-12-20 | 1984-03-06 | Richard Trincia | Screwdriver with handle for storing bits |
JPS6137235A (en) | 1984-07-31 | 1986-02-22 | テルモ株式会社 | Artificial valve |
US4625727A (en) | 1985-01-24 | 1986-12-02 | Leiboff Arnold R | Anastomosis device with excisable frame |
US4712549A (en) | 1985-07-01 | 1987-12-15 | Edward Weck & Co. | Automatic hemostatic clip applier |
US4853986A (en) | 1986-01-02 | 1989-08-08 | The Awareness Marketing Corporation | Water level control |
CA1303298C (en) | 1986-08-06 | 1992-06-16 | Alain Carpentier | Flexible cardiac valvular support prosthesis |
US4961738A (en) | 1987-01-28 | 1990-10-09 | Mackin Robert A | Angioplasty catheter with illumination and visualization within angioplasty balloon |
US4972494A (en) | 1988-02-26 | 1990-11-20 | R. J. Reynolds Tobacco Company | Package inspection system |
US4917698A (en) | 1988-12-22 | 1990-04-17 | Baxter International Inc. | Multi-segmented annuloplasty ring prosthesis |
CH678393A5 (en) | 1989-01-26 | 1991-09-13 | Ulrich Prof Dr Med Sigwart | |
EP0595791B1 (en) | 1989-02-13 | 1999-06-30 | Baxter International Inc. | Anuloplasty ring prosthesis |
US4994077A (en) | 1989-04-21 | 1991-02-19 | Dobben Richard L | Artificial heart valve for implantation in a blood vessel |
US5314473A (en) | 1989-07-20 | 1994-05-24 | Godin Norman J | Prosthesis for preventing gastric reflux into the esophagus |
US5290300A (en) | 1989-07-31 | 1994-03-01 | Baxter International Inc. | Flexible suture guide and holder |
US5632746A (en) | 1989-08-16 | 1997-05-27 | Medtronic, Inc. | Device or apparatus for manipulating matter |
US5078739A (en) | 1990-07-20 | 1992-01-07 | Janus Biomedical, Inc. | Bileaflet heart valve with external leaflets |
SE467459B (en) | 1990-09-25 | 1992-07-20 | Allset Marine Lashing Ab | WIRELESS BEFORE HEARING CHARGES TO CONTAINERS |
US5626609A (en) | 1990-10-05 | 1997-05-06 | United States Surgical Corporation | Endoscopic surgical instrument |
US5108420A (en) | 1991-02-01 | 1992-04-28 | Temple University | Aperture occlusion device |
US5329923A (en) | 1991-02-15 | 1994-07-19 | Lundquist Ingemar H | Torquable catheter |
US5397351A (en) | 1991-05-13 | 1995-03-14 | Pavcnik; Dusan | Prosthetic valve for percutaneous insertion |
AU678142B2 (en) | 1991-11-29 | 1997-05-22 | William Cook Europe A/S | Closure prosthesis for transcatheter placement |
US5201880A (en) | 1992-01-27 | 1993-04-13 | Pioneering Technologies, Inc. | Mitral and tricuspid annuloplasty rings |
DE69331315T2 (en) | 1992-01-27 | 2002-08-22 | Medtronic Inc | ANULOPLASTIC AND SEAM RINGS |
US5306296A (en) | 1992-08-21 | 1994-04-26 | Medtronic, Inc. | Annuloplasty and suture rings |
FR2688401B1 (en) | 1992-03-12 | 1998-02-27 | Thierry Richard | EXPANDABLE STENT FOR HUMAN OR ANIMAL TUBULAR MEMBER, AND IMPLEMENTATION TOOL. |
US5201757A (en) | 1992-04-03 | 1993-04-13 | Schneider (Usa) Inc. | Medial region deployment of radially self-expanding stents |
US5332402A (en) | 1992-05-12 | 1994-07-26 | Teitelbaum George P | Percutaneously-inserted cardiac valve |
US5405378A (en) | 1992-05-20 | 1995-04-11 | Strecker; Ernst P. | Device with a prosthesis implantable in the body of a patient |
US5325845A (en) | 1992-06-08 | 1994-07-05 | Adair Edwin Lloyd | Steerable sheath for use with selected removable optical catheter |
US5258008A (en) | 1992-07-29 | 1993-11-02 | Wilk Peter J | Surgical stapling device and associated method |
US5300034A (en) | 1992-07-29 | 1994-04-05 | Minnesota Mining And Manufacturing Company | Iv injection site for the reception of a blunt cannula |
US6074417A (en) | 1992-11-16 | 2000-06-13 | St. Jude Medical, Inc. | Total mitral heterologous bioprosthesis to be used in mitral or tricuspid heart replacement |
US6283127B1 (en) | 1992-12-03 | 2001-09-04 | Wesley D. Sterman | Devices and methods for intracardiac procedures |
US6125852A (en) | 1993-02-22 | 2000-10-03 | Heartport, Inc. | Minimally-invasive devices and methods for treatment of congestive heart failure |
US6346074B1 (en) | 1993-02-22 | 2002-02-12 | Heartport, Inc. | Devices for less invasive intracardiac interventions |
US6010531A (en) | 1993-02-22 | 2000-01-04 | Heartport, Inc. | Less-invasive devices and methods for cardiac valve surgery |
US5797960A (en) | 1993-02-22 | 1998-08-25 | Stevens; John H. | Method and apparatus for thoracoscopic intracardiac procedures |
US5972030A (en) | 1993-02-22 | 1999-10-26 | Heartport, Inc. | Less-invasive devices and methods for treatment of cardiac valves |
US5374286A (en) | 1993-03-31 | 1994-12-20 | Medtronic, Inc. | Torque indicator for fixed screw leads |
US5715817A (en) | 1993-06-29 | 1998-02-10 | C.R. Bard, Inc. | Bidirectional steering catheter |
US5450860A (en) | 1993-08-31 | 1995-09-19 | W. L. Gore & Associates, Inc. | Device for tissue repair and method for employing same |
US5651785A (en) | 1993-09-20 | 1997-07-29 | Abela Laser Systems, Inc. | Optical fiber catheter and method |
US5713950A (en) | 1993-11-01 | 1998-02-03 | Cox; James L. | Method of replacing heart valves using flexible tubes |
US5607444A (en) | 1993-12-02 | 1997-03-04 | Advanced Cardiovascular Systems, Inc. | Ostial stent for bifurcations |
AU1011595A (en) | 1994-01-13 | 1995-07-20 | Ethicon Inc. | Spiral surgical tack |
US5843120A (en) | 1994-03-17 | 1998-12-01 | Medinol Ltd. | Flexible-expandable stent |
US6165210A (en) | 1994-04-01 | 2000-12-26 | Gore Enterprise Holdings, Inc. | Self-expandable helical intravascular stent and stent-graft |
US5824041A (en) | 1994-06-08 | 1998-10-20 | Medtronic, Inc. | Apparatus and methods for placement and repositioning of intraluminal prostheses |
US6217610B1 (en) | 1994-07-29 | 2001-04-17 | Edwards Lifesciences Corporation | Expandable annuloplasty ring |
US5582616A (en) | 1994-08-05 | 1996-12-10 | Origin Medsystems, Inc. | Surgical helical fastener with applicator |
US5593424A (en) | 1994-08-10 | 1997-01-14 | Segmed, Inc. | Apparatus and method for reducing and stabilizing the circumference of a vascular structure |
US6015429A (en) | 1994-09-08 | 2000-01-18 | Gore Enterprise Holdings, Inc. | Procedures for introducing stents and stent-grafts |
US5765682A (en) | 1994-10-13 | 1998-06-16 | Menlo Care, Inc. | Restrictive package for expandable or shape memory medical devices and method of preventing premature change of same |
US5647857A (en) | 1995-03-16 | 1997-07-15 | Endotex Interventional Systems, Inc. | Protective intraluminal sheath |
US5607470A (en) | 1995-05-01 | 1997-03-04 | Milo; Simcha | Suture rings for prosthetic heart valves |
US5814098A (en) | 1995-06-07 | 1998-09-29 | St. Jude Medical, Inc. | Adjustable sizing apparatus |
US5716417A (en) | 1995-06-07 | 1998-02-10 | St. Jude Medical, Inc. | Integral supporting structure for bioprosthetic heart valve |
US5676653A (en) | 1995-06-27 | 1997-10-14 | Arrow International Investment Corp. | Kink-resistant steerable catheter assembly |
US5713948A (en) | 1995-07-19 | 1998-02-03 | Uflacker; Renan | Adjustable and retrievable graft and graft delivery system for stent-graft system |
US5662683A (en) | 1995-08-22 | 1997-09-02 | Ortho Helix Limited | Open helical organic tissue anchor and method of facilitating healing |
US6193745B1 (en) | 1995-10-03 | 2001-02-27 | Medtronic, Inc. | Modular intraluminal prosteheses construction and methods |
US5749371A (en) | 1995-10-06 | 1998-05-12 | Zadini; Filiberto P. | Automatic guidewire placement device for medical catheters |
AU720907B2 (en) | 1995-12-01 | 2000-06-15 | Medtronic, Inc. | Annuloplasty prosthesis |
US5730150A (en) | 1996-01-16 | 1998-03-24 | B. Braun Medical Inc. | Guidewire dispenser |
WO1997027898A1 (en) | 1996-02-02 | 1997-08-07 | Transvascular, Inc. | Methods and apparatus for connecting openings formed in adjacent blood vessels or other anatomical structures |
US5957953A (en) | 1996-02-16 | 1999-09-28 | Smith & Nephew, Inc. | Expandable suture anchor |
US5702397A (en) | 1996-02-20 | 1997-12-30 | Medicinelodge, Inc. | Ligament bone anchor and method for its use |
US6402780B2 (en) | 1996-02-23 | 2002-06-11 | Cardiovascular Technologies, L.L.C. | Means and method of replacing a heart valve in a minimally invasive manner |
US5716370A (en) | 1996-02-23 | 1998-02-10 | Williamson, Iv; Warren | Means for replacing a heart valve in a minimally invasive manner |
US6132390A (en) | 1996-02-28 | 2000-10-17 | Eupalamus Llc | Handle for manipulation of a stylet used for deflecting a tip of a lead or catheter |
US6702846B2 (en) | 1996-04-09 | 2004-03-09 | Endocare, Inc. | Urological stent therapy system and method |
US5885228A (en) | 1996-05-08 | 1999-03-23 | Heartport, Inc. | Valve sizer and method of use |
US6007544A (en) | 1996-06-14 | 1999-12-28 | Beth Israel Deaconess Medical Center | Catheter apparatus having an improved shape-memory alloy cuff and inflatable on-demand balloon for creating a bypass graft in-vivo |
US5776140A (en) | 1996-07-16 | 1998-07-07 | Cordis Corporation | Stent delivery system |
US6569188B2 (en) | 1996-08-05 | 2003-05-27 | Arthrex, Inc. | Hex drive bioabsorbable tissue anchor |
US5669919A (en) | 1996-08-16 | 1997-09-23 | Medtronic, Inc. | Annuloplasty system |
US5741297A (en) | 1996-08-28 | 1998-04-21 | Simon; Morris | Daisy occluder and method for septal defect repair |
US5830221A (en) | 1996-09-20 | 1998-11-03 | United States Surgical Corporation | Coil fastener applier |
US6599316B2 (en) | 1996-11-04 | 2003-07-29 | Advanced Stent Technologies, Inc. | Extendible stent apparatus |
US5716397A (en) | 1996-12-06 | 1998-02-10 | Medtronic, Inc. | Annuloplasty device with removable stiffening element |
WO1998025549A1 (en) | 1996-12-10 | 1998-06-18 | Purdue Research Foundation | Artificial vascular valves |
US6364901B1 (en) | 1996-12-20 | 2002-04-02 | Kanji Inoue | Appliance collapsible for insertion into a human organ and capable of resilient restoration |
US5935098A (en) | 1996-12-23 | 1999-08-10 | Conceptus, Inc. | Apparatus and method for accessing and manipulating the uterus |
US6352561B1 (en) | 1996-12-23 | 2002-03-05 | W. L. Gore & Associates | Implant deployment apparatus |
US6551350B1 (en) | 1996-12-23 | 2003-04-22 | Gore Enterprise Holdings, Inc. | Kink resistant bifurcated prosthesis |
EP0850607A1 (en) | 1996-12-31 | 1998-07-01 | Cordis Corporation | Valve prosthesis for implantation in body channels |
US6406420B1 (en) | 1997-01-02 | 2002-06-18 | Myocor, Inc. | Methods and devices for improving cardiac function in hearts |
US6045497A (en) | 1997-01-02 | 2000-04-04 | Myocor, Inc. | Heart wall tension reduction apparatus and method |
US6050936A (en) | 1997-01-02 | 2000-04-18 | Myocor, Inc. | Heart wall tension reduction apparatus |
US6183411B1 (en) | 1998-09-21 | 2001-02-06 | Myocor, Inc. | External stress reduction device and method |
US5961440A (en) | 1997-01-02 | 1999-10-05 | Myocor, Inc. | Heart wall tension reduction apparatus and method |
US6074401A (en) | 1997-01-09 | 2000-06-13 | Coalescent Surgical, Inc. | Pinned retainer surgical fasteners, instruments and methods for minimally invasive vascular and endoscopic surgery |
US5961539A (en) | 1997-01-17 | 1999-10-05 | Segmed, Inc. | Method and apparatus for sizing, stabilizing and/or reducing the circumference of an anatomical structure |
CN1626048B (en) | 1997-01-24 | 2012-09-12 | 帕拉贡知识产权有限责任公司 | Expandable device having bistable spring construction |
US5702398A (en) | 1997-02-21 | 1997-12-30 | Tarabishy; Sam | Tension screw |
US5961549A (en) | 1997-04-03 | 1999-10-05 | Baxter International Inc. | Multi-leaflet bioprosthetic heart valve |
US5876373A (en) | 1997-04-04 | 1999-03-02 | Eclipse Surgical Technologies, Inc. | Steerable catheter |
CA2286656A1 (en) | 1997-04-11 | 1998-10-22 | Leslie Organ | Steerable catheter with rotatable tip electrode and method of use |
US5957949A (en) * | 1997-05-01 | 1999-09-28 | World Medical Manufacturing Corp. | Percutaneous placement valve stent |
US6409755B1 (en) | 1997-05-29 | 2002-06-25 | Scimed Life Systems, Inc. | Balloon expandable stent with a self-expanding portion |
WO1999000059A1 (en) | 1997-06-27 | 1999-01-07 | The Trustees Of Columbia University In The City Of New York | Method and apparatus for circulatory valve repair |
US20030105519A1 (en) | 1997-09-04 | 2003-06-05 | Roland Fasol | Artificial chordae replacement |
FR2768324B1 (en) | 1997-09-12 | 1999-12-10 | Jacques Seguin | SURGICAL INSTRUMENT FOR PERCUTANEOUSLY FIXING TWO AREAS OF SOFT TISSUE, NORMALLY MUTUALLY REMOTE, TO ONE ANOTHER |
US5954766A (en) | 1997-09-16 | 1999-09-21 | Zadno-Azizi; Gholam-Reza | Body fluid flow control device |
US5984959A (en) | 1997-09-19 | 1999-11-16 | United States Surgical | Heart valve replacement tools and procedures |
US6206888B1 (en) | 1997-10-01 | 2001-03-27 | Scimed Life Systems, Inc. | Stent delivery system using shape memory retraction |
US5980565A (en) | 1997-10-20 | 1999-11-09 | Iowa-India Investments Company Limited | Sandwich stent |
US6120534A (en) | 1997-10-29 | 2000-09-19 | Ruiz; Carlos E. | Endoluminal prosthesis having adjustable constriction |
US6174332B1 (en) | 1997-12-05 | 2001-01-16 | St. Jude Medical, Inc. | Annuloplasty ring with cut zone |
US6332893B1 (en) | 1997-12-17 | 2001-12-25 | Myocor, Inc. | Valve to myocardium tension members device and method |
US6530952B2 (en) | 1997-12-29 | 2003-03-11 | The Cleveland Clinic Foundation | Bioprosthetic cardiovascular valve system |
EP1049425B1 (en) | 1997-12-29 | 2009-11-25 | Cleveland Clinic Foundation The | System for minimally invasive insertion of a bioprosthetic heart valve |
US6251092B1 (en) | 1997-12-30 | 2001-06-26 | Medtronic, Inc. | Deflectable guiding catheter |
ATE320229T1 (en) | 1998-01-30 | 2006-04-15 | St Jude Medical Atg Inc | MEDICAL TRANSPLANT CONNECTOR OR PLUG AND METHOD FOR PRODUCING THE SAME |
US6533807B2 (en) | 1998-02-05 | 2003-03-18 | Medtronic, Inc. | Radially-expandable stent and delivery system |
US20020087048A1 (en) | 1998-02-24 | 2002-07-04 | Brock David L. | Flexible instrument |
FR2777446B1 (en) | 1998-04-17 | 2000-12-01 | Perouse Implant Lab | LINK FOR ANASTOMOSIS, FASTENING DEVICE AND IMPLANT COMPRISING SAME |
US6074418A (en) | 1998-04-20 | 2000-06-13 | St. Jude Medical, Inc. | Driver tool for heart valve prosthesis fasteners |
US6059827A (en) | 1998-05-04 | 2000-05-09 | Axya Medical, Inc. | Sutureless cardiac valve prosthesis, and devices and methods for implanting them |
US6143024A (en) | 1998-06-04 | 2000-11-07 | Sulzer Carbomedics Inc. | Annuloplasty ring having flexible anterior portion |
US6250308B1 (en) | 1998-06-16 | 2001-06-26 | Cardiac Concepts, Inc. | Mitral valve annuloplasty ring and method of implanting |
US6106550A (en) | 1998-07-10 | 2000-08-22 | Sulzer Carbomedics Inc. | Implantable attaching ring |
US6165183A (en) | 1998-07-15 | 2000-12-26 | St. Jude Medical, Inc. | Mitral and tricuspid valve repair |
US7569062B1 (en) | 1998-07-15 | 2009-08-04 | St. Jude Medical, Inc. | Mitral and tricuspid valve repair |
US6260552B1 (en) | 1998-07-29 | 2001-07-17 | Myocor, Inc. | Transventricular implant tools and devices |
US6264700B1 (en) | 1998-08-27 | 2001-07-24 | Endonetics, Inc. | Prosthetic gastroesophageal valve |
US6159240A (en) | 1998-08-31 | 2000-12-12 | Medtronic, Inc. | Rigid annuloplasty device that becomes compliant after implantation |
FR2783153B1 (en) | 1998-09-14 | 2000-12-01 | Jerome Dargent | GASTRIC CONSTRICTION DEVICE |
US6334873B1 (en) | 1998-09-28 | 2002-01-01 | Autogenics | Heart valve having tissue retention with anchors and an outer sheath |
US6102945A (en) | 1998-10-16 | 2000-08-15 | Sulzer Carbomedics, Inc. | Separable annuloplasty ring |
US6113612A (en) | 1998-11-06 | 2000-09-05 | St. Jude Medical Cardiovascular Group, Inc. | Medical anastomosis apparatus |
US6152937A (en) | 1998-11-06 | 2000-11-28 | St. Jude Medical Cardiovascular Group, Inc. | Medical graft connector and methods of making and installing same |
US20040267349A1 (en) | 2003-06-27 | 2004-12-30 | Kobi Richter | Amorphous metal alloy medical devices |
US6254609B1 (en) | 1999-01-11 | 2001-07-03 | Scimed Life Systems, Inc. | Self-expanding stent delivery system with two sheaths |
US6558418B2 (en) | 1999-01-26 | 2003-05-06 | Edwards Lifesciences Corporation | Flexible heart valve |
WO2000042951A1 (en) | 1999-01-26 | 2000-07-27 | Edwards Lifesciences Corporation | Anatomical orifice sizers and methods of orifice sizing |
US6736845B2 (en) | 1999-01-26 | 2004-05-18 | Edwards Lifesciences Corporation | Holder for flexible heart valve |
US6315784B1 (en) | 1999-02-03 | 2001-11-13 | Zarija Djurovic | Surgical suturing unit |
US6425916B1 (en) | 1999-02-10 | 2002-07-30 | Michi E. Garrison | Methods and devices for implanting cardiac valves |
DE19910233A1 (en) | 1999-03-09 | 2000-09-21 | Jostra Medizintechnik Ag | Anuloplasty prosthesis |
EP1161185A2 (en) | 1999-03-09 | 2001-12-12 | St. Jude Medical Cardiovascular Group, Inc. | Medical grafting methods and apparatus |
US6319281B1 (en) | 1999-03-22 | 2001-11-20 | Kumar R. Patel | Artificial venous valve and sizing catheter |
WO2006116558A2 (en) | 1999-04-09 | 2006-11-02 | Evalve, Inc. | Device and methods for endoscopic annuloplasty |
US10327743B2 (en) | 1999-04-09 | 2019-06-25 | Evalve, Inc. | Device and methods for endoscopic annuloplasty |
US20040044350A1 (en) | 1999-04-09 | 2004-03-04 | Evalve, Inc. | Steerable access sheath and methods of use |
US6752813B2 (en) | 1999-04-09 | 2004-06-22 | Evalve, Inc. | Methods and devices for capturing and fixing leaflets in valve repair |
US7811296B2 (en) | 1999-04-09 | 2010-10-12 | Evalve, Inc. | Fixation devices for variation in engagement of tissue |
US7563267B2 (en) | 1999-04-09 | 2009-07-21 | Evalve, Inc. | Fixation device and methods for engaging tissue |
US8216256B2 (en) | 1999-04-09 | 2012-07-10 | Evalve, Inc. | Detachment mechanism for implantable fixation devices |
AU770243B2 (en) | 1999-04-09 | 2004-02-19 | Evalve, Inc. | Methods and apparatus for cardiac valve repair |
US6231602B1 (en) | 1999-04-16 | 2001-05-15 | Edwards Lifesciences Corporation | Aortic annuloplasty ring |
US6183512B1 (en) | 1999-04-16 | 2001-02-06 | Edwards Lifesciences Corporation | Flexible annuloplasty system |
US20050222665A1 (en) | 1999-04-23 | 2005-10-06 | Ernest Aranyi | Endovascular fastener applicator |
AU4810800A (en) * | 1999-04-26 | 2000-11-10 | Li Medical Technologies, Inc. | Prosthetic apparatus and method |
US6674993B1 (en) | 1999-04-30 | 2004-01-06 | Microvision, Inc. | Method and system for identifying data locations associated with real world observations |
US6187040B1 (en) | 1999-05-03 | 2001-02-13 | John T. M. Wright | Mitral and tricuspid annuloplasty rings |
WO2000067674A1 (en) | 1999-05-06 | 2000-11-16 | Kanji Inoue | Apparatus for folding instrument and use of the same apparatus |
US6964686B2 (en) | 1999-05-17 | 2005-11-15 | Vanderbilt University | Intervertebral disc replacement prosthesis |
US6428550B1 (en) | 1999-05-18 | 2002-08-06 | Cardica, Inc. | Sutureless closure and deployment system for connecting blood vessels |
US6790229B1 (en) | 1999-05-25 | 2004-09-14 | Eric Berreklouw | Fixing device, in particular for fixing to vascular wall tissue |
US6287339B1 (en) | 1999-05-27 | 2001-09-11 | Sulzer Carbomedics Inc. | Sutureless heart valve prosthesis |
US7628803B2 (en) | 2001-02-05 | 2009-12-08 | Cook Incorporated | Implantable vascular device |
US6699256B1 (en) | 1999-06-04 | 2004-03-02 | St. Jude Medical Atg, Inc. | Medical grafting apparatus and methods |
US6602289B1 (en) | 1999-06-08 | 2003-08-05 | S&A Rings, Llc | Annuloplasty rings of particular use in surgery for the mitral valve |
US6626899B2 (en) | 1999-06-25 | 2003-09-30 | Nidus Medical, Llc | Apparatus and methods for treating tissue |
SE514718C2 (en) | 1999-06-29 | 2001-04-09 | Jan Otto Solem | Apparatus for treating defective closure of the mitral valve apparatus |
US6193686B1 (en) | 1999-06-30 | 2001-02-27 | Advanced Cardiovascular Systems, Inc. | Catheter with enhanced flexibility |
US6997951B2 (en) | 1999-06-30 | 2006-02-14 | Edwards Lifesciences Ag | Method and device for treatment of mitral insufficiency |
US6312465B1 (en) | 1999-07-23 | 2001-11-06 | Sulzer Carbomedics Inc. | Heart valve prosthesis with a resiliently deformable retaining member |
US7462162B2 (en) | 2001-09-04 | 2008-12-09 | Broncus Technologies, Inc. | Antiproliferative devices for maintaining patency of surgically created channels in a body organ |
US6592609B1 (en) | 1999-08-09 | 2003-07-15 | Bonutti 2003 Trust-A | Method and apparatus for securing tissue |
US6231561B1 (en) | 1999-09-20 | 2001-05-15 | Appriva Medical, Inc. | Method and apparatus for closing a body lumen |
JP3553432B2 (en) | 1999-09-24 | 2004-08-11 | 本田技研工業株式会社 | Riding simulation device |
US6533806B1 (en) | 1999-10-01 | 2003-03-18 | Scimed Life Systems, Inc. | Balloon yielded delivery system and endovascular graft design for easy deployment |
FR2799364B1 (en) | 1999-10-12 | 2001-11-23 | Jacques Seguin | MINIMALLY INVASIVE CANCELING DEVICE |
US6626930B1 (en) | 1999-10-21 | 2003-09-30 | Edwards Lifesciences Corporation | Minimally invasive mitral valve repair method and apparatus |
US6440164B1 (en) | 1999-10-21 | 2002-08-27 | Scimed Life Systems, Inc. | Implantable prosthetic valve |
AUPQ366099A0 (en) | 1999-10-26 | 1999-11-18 | Queensland University Of Technology | Ortho paedic screw |
US6626917B1 (en) | 1999-10-26 | 2003-09-30 | H. Randall Craig | Helical suture instrument |
US6689150B1 (en) | 1999-10-27 | 2004-02-10 | Atritech, Inc. | Filter apparatus for ostium of left atrial appendage |
US6926730B1 (en) | 2000-10-10 | 2005-08-09 | Medtronic, Inc. | Minimally invasive valve repair procedure and apparatus |
KR20010046894A (en) | 1999-11-16 | 2001-06-15 | 오태준 | Electric razor |
US8016877B2 (en) | 1999-11-17 | 2011-09-13 | Medtronic Corevalve Llc | Prosthetic valve for transluminal delivery |
US7018406B2 (en) | 1999-11-17 | 2006-03-28 | Corevalve Sa | Prosthetic valve for transluminal delivery |
US20070043435A1 (en) | 1999-11-17 | 2007-02-22 | Jacques Seguin | Non-cylindrical prosthetic valve system for transluminal delivery |
US6911032B2 (en) | 1999-11-18 | 2005-06-28 | Scimed Life Systems, Inc. | Apparatus and method for compressing body tissue |
US6711444B2 (en) | 1999-11-22 | 2004-03-23 | Scimed Life Systems, Inc. | Methods of deploying helical diagnostic and therapeutic element supporting structures within the body |
US6602263B1 (en) | 1999-11-30 | 2003-08-05 | St. Jude Medical Atg, Inc. | Medical grafting methods and apparatus |
JP2001168306A (en) | 1999-12-09 | 2001-06-22 | Toshiba Corp | Non-volatile semiconductor memory device and its manufacturing method |
EP1108400A1 (en) | 1999-12-13 | 2001-06-20 | Biomedix S.A. | Removable fixation apparatus for a prosthesis in a body vessel |
US7169187B2 (en) | 1999-12-22 | 2007-01-30 | Ethicon, Inc. | Biodegradable stent |
US6494908B1 (en) | 1999-12-22 | 2002-12-17 | Ethicon, Inc. | Removable stent for body lumens |
US6942694B2 (en) | 2000-01-14 | 2005-09-13 | Viacor, Inc. | Tissue annuloplasty band and apparatus and method for fashioning, sizing and implanting the same |
NL1014095C2 (en) | 2000-01-17 | 2001-07-18 | Cornelis Hendrikus Anna Witten | Implant valve for implantation into a blood vessel. |
US6769434B2 (en) | 2000-06-30 | 2004-08-03 | Viacor, Inc. | Method and apparatus for performing a procedure on a cardiac valve |
US7296577B2 (en) | 2000-01-31 | 2007-11-20 | Edwards Lifescience Ag | Transluminal mitral annuloplasty with active anchoring |
US6989028B2 (en) | 2000-01-31 | 2006-01-24 | Edwards Lifesciences Ag | Medical system and method for remodeling an extravascular tissue structure |
US6402781B1 (en) | 2000-01-31 | 2002-06-11 | Mitralife | Percutaneous mitral annuloplasty and cardiac reinforcement |
DK1255510T5 (en) | 2000-01-31 | 2009-12-21 | Cook Biotech Inc | Stent Valve Klapper |
US6458076B1 (en) | 2000-02-01 | 2002-10-01 | 5 Star Medical | Multi-lumen medical device |
US6797002B2 (en) | 2000-02-02 | 2004-09-28 | Paul A. Spence | Heart valve repair apparatus and methods |
WO2001056512A1 (en) | 2000-02-02 | 2001-08-09 | Snyders Robert V | Artificial heart valve |
US20050070999A1 (en) | 2000-02-02 | 2005-03-31 | Spence Paul A. | Heart valve repair apparatus and methods |
US6821297B2 (en) | 2000-02-02 | 2004-11-23 | Robert V. Snyders | Artificial heart valve, implantation instrument and method therefor |
US6470892B1 (en) | 2000-02-10 | 2002-10-29 | Obtech Medical Ag | Mechanical heartburn and reflux treatment |
DE10010074B4 (en) | 2000-02-28 | 2005-04-14 | Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. | Device for fastening and anchoring heart valve prostheses |
US7993368B2 (en) | 2003-03-13 | 2011-08-09 | C.R. Bard, Inc. | Suture clips, delivery devices and methods |
US8474460B2 (en) | 2000-03-04 | 2013-07-02 | Pulmonx Corporation | Implanted bronchial isolation devices and methods |
IL153753A0 (en) | 2002-12-30 | 2003-07-06 | Neovasc Medical Ltd | Varying-diameter vascular implant and balloon |
US6953476B1 (en) | 2000-03-27 | 2005-10-11 | Neovasc Medical Ltd. | Device and method for treating ischemic heart disease |
US6569198B1 (en) | 2000-03-31 | 2003-05-27 | Richard A. Wilson | Mitral or tricuspid valve annuloplasty prosthetic device |
US6689125B1 (en) | 2000-04-04 | 2004-02-10 | Spinalabs, Llc | Devices and methods for the treatment of spinal disorders |
US6454799B1 (en) | 2000-04-06 | 2002-09-24 | Edwards Lifesciences Corporation | Minimally-invasive heart valves and methods of use |
US6533772B1 (en) | 2000-04-07 | 2003-03-18 | Innex Corporation | Guide wire torque device |
US20020049490A1 (en) | 2000-04-11 | 2002-04-25 | Pollock David T. | Single-piece endoprosthesis with high expansion ratios |
US6497713B1 (en) | 2000-04-28 | 2002-12-24 | Autogenics | Rotary tissue cutting die |
US7083628B2 (en) | 2002-09-03 | 2006-08-01 | Edwards Lifesciences Corporation | Single catheter mitral valve repair device and method for use |
US6610088B1 (en) * | 2000-05-03 | 2003-08-26 | Shlomo Gabbay | Biologically covered heart valve prosthesis |
WO2001087190A2 (en) | 2000-05-17 | 2001-11-22 | St. Jude Medical, Inc. | Two piece bioprosthetic heart valve |
ES2435094T3 (en) | 2000-05-19 | 2013-12-18 | C.R. Bard, Inc. | Device and method of tissue capture and suturing |
NZ522752A (en) | 2000-05-25 | 2004-08-27 | Bioring S | Device for shrinking or reinforcing the heart valvular orifices |
US8366769B2 (en) | 2000-06-01 | 2013-02-05 | Edwards Lifesciences Corporation | Low-profile, pivotable heart valve sewing ring |
US6406493B1 (en) | 2000-06-02 | 2002-06-18 | Hosheng Tu | Expandable annuloplasty ring and methods of use |
US6805711B2 (en) | 2000-06-02 | 2004-10-19 | 3F Therapeutics, Inc. | Expandable medical implant and percutaneous delivery |
US7632303B1 (en) | 2000-06-07 | 2009-12-15 | Advanced Cardiovascular Systems, Inc. | Variable stiffness medical devices |
US6478807B1 (en) | 2000-06-08 | 2002-11-12 | Advanced Cardiovascular Systems, Inc. | Pre-formed expandable member having grooves |
SE522805C2 (en) | 2000-06-22 | 2004-03-09 | Jan Otto Solem | Stent Application System |
US6702826B2 (en) | 2000-06-23 | 2004-03-09 | Viacor, Inc. | Automated annular plication for mitral valve repair |
US6676698B2 (en) * | 2000-06-26 | 2004-01-13 | Rex Medicol, L.P. | Vascular device with valve for approximating vessel wall |
US7144414B2 (en) | 2000-06-27 | 2006-12-05 | Smith & Nephew, Inc. | Surgical procedures and instruments |
US7077861B2 (en) | 2000-07-06 | 2006-07-18 | Medtentia Ab | Annuloplasty instrument |
US6419696B1 (en) | 2000-07-06 | 2002-07-16 | Paul A. Spence | Annuloplasty devices and related heart valve repair methods |
US6613078B1 (en) | 2000-08-02 | 2003-09-02 | Hector Daniel Barone | Multi-component endoluminal graft assembly, use thereof and method of implanting |
SE0002878D0 (en) | 2000-08-11 | 2000-08-11 | Kimblad Ola | Device and method of treatment of atrioventricular regurgitation |
US6524338B1 (en) | 2000-08-25 | 2003-02-25 | Steven R. Gundry | Method and apparatus for stapling an annuloplasty band in-situ |
US6846325B2 (en) | 2000-09-07 | 2005-01-25 | Viacor, Inc. | Fixation band for affixing a prosthetic heart valve to tissue |
US7510572B2 (en) | 2000-09-12 | 2009-03-31 | Shlomo Gabbay | Implantation system for delivery of a heart valve prosthesis |
US6554845B1 (en) | 2000-09-15 | 2003-04-29 | PARÉ Surgical, Inc. | Suturing apparatus and method |
US6893459B1 (en) | 2000-09-20 | 2005-05-17 | Ample Medical, Inc. | Heart valve annulus device and method of using same |
US20090287179A1 (en) | 2003-10-01 | 2009-11-19 | Ample Medical, Inc. | Devices, systems, and methods for reshaping a heart valve annulus, including the use of magnetic tools |
US20080091264A1 (en) | 2002-11-26 | 2008-04-17 | Ample Medical, Inc. | Devices, systems, and methods for reshaping a heart valve annulus, including the use of magnetic tools |
US20060106278A1 (en) | 2004-05-14 | 2006-05-18 | Ample Medical, Inc. | Devices, systems, and methods for reshaping a heart valve annulus, including the use of an adjustable bridge implant system |
WO2004030570A2 (en) | 2002-10-01 | 2004-04-15 | Ample Medical, Inc. | Devices for retaining native heart valve leaflet |
WO2004030568A2 (en) | 2002-10-01 | 2004-04-15 | Ample Medical, Inc. | Device and method for repairing a native heart valve leaflet |
US8784482B2 (en) | 2000-09-20 | 2014-07-22 | Mvrx, Inc. | Method of reshaping a heart valve annulus using an intravascular device |
US6602288B1 (en) | 2000-10-05 | 2003-08-05 | Edwards Lifesciences Corporation | Minimally-invasive annuloplasty repair segment delivery template, system and method of use |
US6723038B1 (en) | 2000-10-06 | 2004-04-20 | Myocor, Inc. | Methods and devices for improving mitral valve function |
US6918917B1 (en) | 2000-10-10 | 2005-07-19 | Medtronic, Inc. | Minimally invasive annuloplasty procedure and apparatus |
US20020082525A1 (en) | 2000-10-18 | 2002-06-27 | Oslund John C. | Rapid exchange delivery catheter |
US6913608B2 (en) | 2000-10-23 | 2005-07-05 | Viacor, Inc. | Automated annular plication for mitral valve repair |
US6482228B1 (en) | 2000-11-14 | 2002-11-19 | Troy R. Norred | Percutaneous aortic valve replacement |
US6491711B1 (en) | 2000-11-14 | 2002-12-10 | Advanced Cardiovascular Systems, Inc. | Balloon catheter with non-circular balloon taper and method of use |
US6974476B2 (en) | 2003-05-05 | 2005-12-13 | Rex Medical, L.P. | Percutaneous aortic valve |
US6884257B1 (en) | 2000-11-28 | 2005-04-26 | Advanced Cardiovascular Systems, Inc. | Stent delivery system with adjustable length balloon |
US6695867B2 (en) | 2002-02-21 | 2004-02-24 | Integrated Vascular Systems, Inc. | Plunger apparatus and methods for delivering a closure device |
US7211101B2 (en) | 2000-12-07 | 2007-05-01 | Abbott Vascular Devices | Methods for manufacturing a clip and clip |
US6623510B2 (en) | 2000-12-07 | 2003-09-23 | Integrated Vascular Systems, Inc. | Closure device and methods for making and using them |
US6716244B2 (en) | 2000-12-20 | 2004-04-06 | Carbomedics, Inc. | Sewing cuff assembly for heart valves |
US7591826B2 (en) | 2000-12-28 | 2009-09-22 | Cardiac Dimensions, Inc. | Device implantable in the coronary sinus to provide mitral valve therapy |
US7510576B2 (en) | 2001-01-30 | 2009-03-31 | Edwards Lifesciences Ag | Transluminal mitral annuloplasty |
US6810882B2 (en) | 2001-01-30 | 2004-11-02 | Ev3 Santa Rosa, Inc. | Transluminal mitral annuloplasty |
US8038708B2 (en) | 2001-02-05 | 2011-10-18 | Cook Medical Technologies Llc | Implantable device with remodelable material and covering material |
CA2437824C (en) | 2001-02-05 | 2008-09-23 | Viacor, Inc. | Apparatus and method for reducing mitral regurgitation |
JP4097924B2 (en) | 2001-02-05 | 2008-06-11 | オリンパス株式会社 | Biological tissue clip device |
US20050182483A1 (en) | 2004-02-11 | 2005-08-18 | Cook Incorporated | Percutaneously placed prosthesis with thromboresistant valve portion |
US6786924B2 (en) | 2001-03-15 | 2004-09-07 | Medtronic, Inc. | Annuloplasty band and method |
US7556646B2 (en) | 2001-09-13 | 2009-07-07 | Edwards Lifesciences Corporation | Methods and apparatuses for deploying minimally-invasive heart valves |
AUPR389201A0 (en) | 2001-03-23 | 2001-04-12 | Lane, Rodney James | Improvements in design of external vendus valve stents for the correction fo incompetent vendods valves |
US6733525B2 (en) | 2001-03-23 | 2004-05-11 | Edwards Lifesciences Corporation | Rolled minimally-invasive heart valves and methods of use |
US7374571B2 (en) | 2001-03-23 | 2008-05-20 | Edwards Lifesciences Corporation | Rolled minimally-invasive heart valves and methods of manufacture |
US7186264B2 (en) | 2001-03-29 | 2007-03-06 | Viacor, Inc. | Method and apparatus for improving mitral valve function |
AU2002321685A1 (en) | 2001-04-02 | 2002-11-11 | The Hook Research Foundation | Conformable balloonless catheter |
US6958076B2 (en) | 2001-04-16 | 2005-10-25 | Biomedical Research Associates Inc. | Implantable venous valve |
DE10119096A1 (en) | 2001-04-19 | 2002-10-24 | Keramed Medizintechnik Gmbh | New biologically functionalized coatings, useful for e.g. accelerating osteo-integration of implants, e.g. dental or joint implants, comprise resorbable calcium-phosphorus phase containing adhesion and/or signal proteins |
US20050148925A1 (en) | 2001-04-20 | 2005-07-07 | Dan Rottenberg | Device and method for controlling in-vivo pressure |
US20060069429A1 (en) | 2001-04-24 | 2006-03-30 | Spence Paul A | Tissue fastening systems and methods utilizing magnetic guidance |
US20050125011A1 (en) | 2001-04-24 | 2005-06-09 | Spence Paul A. | Tissue fastening systems and methods utilizing magnetic guidance |
CA2453277A1 (en) | 2001-04-24 | 2003-10-31 | Dhc Systems, Inc. | Method and apparatus for catheter-based annuloplasty using local plications |
US7037334B1 (en) | 2001-04-24 | 2006-05-02 | Mitralign, Inc. | Method and apparatus for catheter-based annuloplasty using local plications |
US6619291B2 (en) | 2001-04-24 | 2003-09-16 | Edwin J. Hlavka | Method and apparatus for catheter-based annuloplasty |
US8202315B2 (en) | 2001-04-24 | 2012-06-19 | Mitralign, Inc. | Catheter-based annuloplasty using ventricularly positioned catheter |
GB0110551D0 (en) | 2001-04-30 | 2001-06-20 | Angiomed Ag | Self-expanding stent delivery service |
US6682558B2 (en) | 2001-05-10 | 2004-01-27 | 3F Therapeutics, Inc. | Delivery system for a stentless valve bioprosthesis |
US6858039B2 (en) | 2002-07-08 | 2005-02-22 | Edwards Lifesciences Corporation | Mitral valve annuloplasty ring having a posterior bow |
FI114150B (en) | 2001-05-17 | 2004-08-31 | Inion Ltd | Magazine for surgical fixation instruments and arrangement for a magazine for surgical fixation instruments |
US7935145B2 (en) | 2001-05-17 | 2011-05-03 | Edwards Lifesciences Corporation | Annuloplasty ring for ischemic mitral valve insuffuciency |
ITMI20011012A1 (en) | 2001-05-17 | 2002-11-17 | Ottavio Alfieri | ANNULAR PROSTHESIS FOR MITRAL VALVE |
US20030069635A1 (en) | 2001-05-29 | 2003-04-10 | Cartledge Richard G. | Prosthetic heart valve |
DE60106216T2 (en) | 2001-06-11 | 2005-11-17 | Sorin Biomedica Cardio S.P.A., Saluggia | Annuloplasty prosthesis and manufacturing method therefor |
WO2002102237A2 (en) | 2001-06-15 | 2002-12-27 | The Cleveland Clinic Foundation | Tissue engineered mitral valve chrodae and methods of making and using same |
JP4159805B2 (en) * | 2001-06-15 | 2008-10-01 | ラディ・メディカル・システムズ・アクチェボラーグ | Pushing mechanism for closing method |
US6958079B1 (en) | 2001-07-03 | 2005-10-25 | Reflux Corporation | Perorally insertable/removable anti-reflux valve |
FR2826863B1 (en) | 2001-07-04 | 2003-09-26 | Jacques Seguin | ASSEMBLY FOR PLACING A PROSTHETIC VALVE IN A BODY CONDUIT |
US7150737B2 (en) | 2001-07-13 | 2006-12-19 | Sci/Med Life Systems, Inc. | Methods and apparatuses for navigating the subarachnoid space |
US7547322B2 (en) | 2001-07-19 | 2009-06-16 | The Cleveland Clinic Foundation | Prosthetic valve and method for making same |
FR2828263B1 (en) | 2001-08-03 | 2007-05-11 | Philipp Bonhoeffer | DEVICE FOR IMPLANTATION OF AN IMPLANT AND METHOD FOR IMPLANTATION OF THE DEVICE |
US7179265B2 (en) | 2001-08-21 | 2007-02-20 | Microline Pentax, Inc. | Reduced diameter clip applying arrangement |
US6726716B2 (en) | 2001-08-24 | 2004-04-27 | Edwards Lifesciences Corporation | Self-molding annuloplasty ring |
US6908482B2 (en) | 2001-08-28 | 2005-06-21 | Edwards Lifesciences Corporation | Three-dimensional annuloplasty ring and template |
US6749630B2 (en) | 2001-08-28 | 2004-06-15 | Edwards Lifesciences Corporation | Tricuspid ring and template |
ATE387160T1 (en) | 2001-08-31 | 2008-03-15 | Mitral Interventions | DEVICE FOR HEART VALVE REPAIR |
US7097659B2 (en) | 2001-09-07 | 2006-08-29 | Medtronic, Inc. | Fixation band for affixing a prosthetic heart valve to tissue |
US20030050693A1 (en) | 2001-09-10 | 2003-03-13 | Quijano Rodolfo C. | Minimally invasive delivery system for annuloplasty rings |
DE10148185B4 (en) | 2001-09-28 | 2005-08-11 | Alveolus, Inc. | Instrument for implanting vascular prostheses |
JP4458845B2 (en) | 2001-10-01 | 2010-04-28 | アンプル メディカル,インコーポレイテッド | Medical device |
CA2981561C (en) | 2001-10-04 | 2020-08-25 | Neovasc Medical Ltd. | Flow reducing implant |
US6893460B2 (en) | 2001-10-11 | 2005-05-17 | Percutaneous Valve Technologies Inc. | Implantable prosthetic valve |
US7144363B2 (en) | 2001-10-16 | 2006-12-05 | Extensia Medical, Inc. | Systems for heart treatment |
US20060020336A1 (en) | 2001-10-23 | 2006-01-26 | Liddicoat John R | Automated annular plication for mitral valve repair |
US7052487B2 (en) | 2001-10-26 | 2006-05-30 | Cohn William E | Method and apparatus for reducing mitral regurgitation |
GB0125925D0 (en) | 2001-10-29 | 2001-12-19 | Univ Glasgow | Mitral valve prosthesis |
US7311729B2 (en) | 2002-01-30 | 2007-12-25 | Cardiac Dimensions, Inc. | Device and method for modifying the shape of a body organ |
US6805710B2 (en) | 2001-11-13 | 2004-10-19 | Edwards Lifesciences Corporation | Mitral valve annuloplasty ring for molding left ventricle geometry |
US6575971B2 (en) | 2001-11-15 | 2003-06-10 | Quantum Cor, Inc. | Cardiac valve leaflet stapler device and methods thereof |
EP1448117B1 (en) | 2001-11-28 | 2013-05-22 | Aptus Endosystems, Inc. | Endovascular aneurysm repair system |
US8231639B2 (en) | 2001-11-28 | 2012-07-31 | Aptus Endosystems, Inc. | Systems and methods for attaching a prosthesis within a body lumen or hollow organ |
US20090099650A1 (en) | 2001-11-28 | 2009-04-16 | Lee Bolduc | Devices, systems, and methods for endovascular staple and/or prosthesis delivery and implantation |
US20050177180A1 (en) | 2001-11-28 | 2005-08-11 | Aptus Endosystems, Inc. | Devices, systems, and methods for supporting tissue and/or structures within a hollow body organ |
US7137993B2 (en) | 2001-12-03 | 2006-11-21 | Xtent, Inc. | Apparatus and methods for delivery of multiple distributed stents |
US20030176914A1 (en) | 2003-01-21 | 2003-09-18 | Rabkin Dmitry J. | Multi-segment modular stent and methods for manufacturing stents |
AU2002228753A1 (en) | 2001-12-04 | 2003-06-17 | Edwards Lifesciences Corporation | Minimally-invasive annuloplasty repair segment delivery template system |
US7179282B2 (en) | 2001-12-05 | 2007-02-20 | Cardiac Dimensions, Inc. | Device and method for modifying the shape of a body organ |
US6976995B2 (en) | 2002-01-30 | 2005-12-20 | Cardiac Dimensions, Inc. | Fixed length anchor and pull mitral valve device and method |
US6908478B2 (en) | 2001-12-05 | 2005-06-21 | Cardiac Dimensions, Inc. | Anchor and pull mitral valve device and method |
US6978176B2 (en) | 2001-12-08 | 2005-12-20 | Lattouf Omar M | Treatment for patient with congestive heart failure |
DE10161543B4 (en) | 2001-12-11 | 2004-02-19 | REITAN, Öyvind | Implant for the treatment of heart valve insufficiency |
US6740107B2 (en) | 2001-12-19 | 2004-05-25 | Trimedyne, Inc. | Device for treatment of atrioventricular valve regurgitation |
US8123801B2 (en) | 2001-12-21 | 2012-02-28 | QuickRing Medical Technologies, Ltd. | Implantation system for annuloplasty rings |
JP4230915B2 (en) | 2001-12-21 | 2009-02-25 | シムチャ ミロ | Annuloplasty ring transplantation system |
US20030120340A1 (en) | 2001-12-26 | 2003-06-26 | Jan Liska | Mitral and tricuspid valve repair |
US7201771B2 (en) | 2001-12-27 | 2007-04-10 | Arbor Surgical Technologies, Inc. | Bioprosthetic heart valve |
AU2002360066B2 (en) | 2001-12-28 | 2008-11-06 | Edwards Lifesciences Ag | Delayed memory device |
SE524709C2 (en) | 2002-01-11 | 2004-09-21 | Edwards Lifesciences Ag | Device for delayed reshaping of a heart vessel and a heart valve |
US7033390B2 (en) | 2002-01-02 | 2006-04-25 | Medtronic, Inc. | Prosthetic heart valve system |
US8308797B2 (en) | 2002-01-04 | 2012-11-13 | Colibri Heart Valve, LLC | Percutaneously implantable replacement heart valve device and method of making same |
US6764510B2 (en) | 2002-01-09 | 2004-07-20 | Myocor, Inc. | Devices and methods for heart valve treatment |
US20030139819A1 (en) | 2002-01-18 | 2003-07-24 | Beer Nicholas De | Method and apparatus for closing septal defects |
US7029482B1 (en) | 2002-01-22 | 2006-04-18 | Cardica, Inc. | Integrated anastomosis system |
US6989024B2 (en) | 2002-02-28 | 2006-01-24 | Counter Clockwise, Inc. | Guidewire loaded stent for delivery through a catheter |
US8430934B2 (en) | 2002-03-01 | 2013-04-30 | Regents Of The University Of Minnesota | Vascular occlusion device |
US7048754B2 (en) | 2002-03-01 | 2006-05-23 | Evalve, Inc. | Suture fasteners and methods of use |
US6797001B2 (en) | 2002-03-11 | 2004-09-28 | Cardiac Dimensions, Inc. | Device, assembly and method for mitral valve repair |
US6719786B2 (en) | 2002-03-18 | 2004-04-13 | Medtronic, Inc. | Flexible annuloplasty prosthesis and holder |
US7118595B2 (en) | 2002-03-18 | 2006-10-10 | Medtronic, Inc. | Flexible annuloplasty prosthesis and holder |
US7094244B2 (en) | 2002-03-26 | 2006-08-22 | Edwards Lifesciences Corporation | Sequential heart valve leaflet repair device and method of use |
US7288111B1 (en) | 2002-03-26 | 2007-10-30 | Thoratec Corporation | Flexible stent and method of making the same |
ES2370585T3 (en) | 2002-03-27 | 2011-12-20 | Sorin Biomedica Cardio S.R.L. | PROSTHESIS FOR ANULOPLASTY THAT INCLUDES A PERFORATED ELEMENT. |
US20030199974A1 (en) | 2002-04-18 | 2003-10-23 | Coalescent Surgical, Inc. | Annuloplasty apparatus and methods |
AU2003231752A1 (en) | 2002-04-22 | 2003-11-03 | Tyco Healthcare Group, Lp | Tack and tack applier |
US7105016B2 (en) | 2002-04-23 | 2006-09-12 | Medtronic Vascular, Inc. | Integrated mechanical handle with quick slide mechanism |
US6951565B2 (en) | 2002-04-24 | 2005-10-04 | Linvatec Biomaterials Ltd. | Device for inserting surgical implants |
US7077850B2 (en) | 2002-05-01 | 2006-07-18 | Scimed Life Systems, Inc. | Tissue fastening devices and related insertion tools and methods |
CA2485249A1 (en) | 2002-05-09 | 2003-11-20 | Thomas D. Egan | Gastric bypass prosthesis |
EP1507492A1 (en) | 2002-05-10 | 2005-02-23 | Cordis Corporation | Method of making a medical device having a thin wall tubular membrane over a structural frame |
US7351256B2 (en) | 2002-05-10 | 2008-04-01 | Cordis Corporation | Frame based unidirectional flow prosthetic implant |
DE10221076A1 (en) | 2002-05-11 | 2003-11-27 | Ruesch Willy Gmbh | stent |
US6830638B2 (en) | 2002-05-24 | 2004-12-14 | Advanced Cardiovascular Systems, Inc. | Medical devices configured from deep drawn nickel-titanium alloys and nickel-titanium clad alloys and method of making the same |
JP4508866B2 (en) | 2002-06-04 | 2010-07-21 | アボット ヴァスキュラー デヴァイシス | Vascular closure clip and delivery device |
AU2003247526A1 (en) | 2002-06-12 | 2003-12-31 | Mitral Interventions, Inc. | Method and apparatus for tissue connection |
US20060241656A1 (en) | 2002-06-13 | 2006-10-26 | Starksen Niel F | Delivery devices and methods for heart valve repair |
US8641727B2 (en) | 2002-06-13 | 2014-02-04 | Guided Delivery Systems, Inc. | Devices and methods for heart valve repair |
US7753924B2 (en) | 2003-09-04 | 2010-07-13 | Guided Delivery Systems, Inc. | Delivery devices and methods for heart valve repair |
US7588582B2 (en) | 2002-06-13 | 2009-09-15 | Guided Delivery Systems Inc. | Methods for remodeling cardiac tissue |
AU2003245507A1 (en) | 2002-06-13 | 2003-12-31 | Guided Delivery Systems, Inc. | Devices and methods for heart valve repair |
US7753922B2 (en) | 2003-09-04 | 2010-07-13 | Guided Delivery Systems, Inc. | Devices and methods for cardiac annulus stabilization and treatment |
US6679836B2 (en) | 2002-06-21 | 2004-01-20 | Scimed Life Systems, Inc. | Universal programmable guide catheter |
US6939370B2 (en) | 2002-06-28 | 2005-09-06 | Cook Incorporated | Thoracic aortic stent graft deployment device |
US7608103B2 (en) | 2002-07-08 | 2009-10-27 | Edwards Lifesciences Corporation | Mitral valve annuloplasty ring having a posterior bow |
US7172625B2 (en) | 2002-07-16 | 2007-02-06 | Medtronic, Inc. | Suturing rings for implantable heart valve prostheses |
IL150855A (en) | 2002-07-22 | 2007-06-03 | Leonid Monassevitch | Intratubular anastomosis apparatus |
EP1534146B1 (en) | 2002-08-13 | 2008-01-23 | The General Hospital Corporation | Cardiac devices for percutaneous repair of atrioventricular valves |
US7041132B2 (en) | 2002-08-16 | 2006-05-09 | 3F Therapeutics, Inc, | Percutaneously delivered heart valve and delivery means thereof |
US7211114B2 (en) | 2002-08-26 | 2007-05-01 | The Trustees Of Columbia University In The City Of New York | Endoscopic gastric bypass |
EP1592367B1 (en) | 2002-08-28 | 2016-04-13 | HLT, Inc. | Method and device for treating diseased valve |
WO2007136783A2 (en) | 2002-08-29 | 2007-11-29 | Mitralsolutions, Inc. | Implantable devices for controlling the size and shape of an anatomical structure or lumen |
US8758372B2 (en) | 2002-08-29 | 2014-06-24 | St. Jude Medical, Cardiology Division, Inc. | Implantable devices for controlling the size and shape of an anatomical structure or lumen |
KR101050626B1 (en) | 2002-08-29 | 2011-07-19 | 미트랄 솔루션스, 인크. | Implantation device for controlling the inner circumference of the anatomical orifice or lumen |
ES2291405T3 (en) | 2002-09-04 | 2008-03-01 | Endoart S.A. | SURGICAL RING PROVIDED WITH A REMOTE CONTROL SYSTEM AND REVERSIBLE IN THE VARIATION OF YOUR DIAMETER. |
WO2004021894A1 (en) | 2002-09-09 | 2004-03-18 | Brian Kelleher | Device and method for endoluminal therapy |
US20040059413A1 (en) | 2002-09-20 | 2004-03-25 | Claudio Argento | Suture template for facilitating implantation of a prosthetic heart valve |
US7137184B2 (en) | 2002-09-20 | 2006-11-21 | Edwards Lifesciences Corporation | Continuous heart valve support frame and method of manufacture |
CO5500017A1 (en) | 2002-09-23 | 2005-03-31 | 3F Therapeutics Inc | MITRAL PROTESTIC VALVE |
US7149587B2 (en) | 2002-09-26 | 2006-12-12 | Pacesetter, Inc. | Cardiovascular anchoring device and method of deploying same |
EP1562522B1 (en) | 2002-10-01 | 2008-12-31 | Ample Medical, Inc. | Devices and systems for reshaping a heart valve annulus |
US7087064B1 (en) | 2002-10-15 | 2006-08-08 | Advanced Cardiovascular Systems, Inc. | Apparatuses and methods for heart valve repair |
US8979923B2 (en) | 2002-10-21 | 2015-03-17 | Mitralign, Inc. | Tissue fastening systems and methods utilizing magnetic guidance |
BR0315392A (en) | 2002-10-21 | 2005-08-23 | Mitralign Inc | Incrementing catheters and methods of performing annuloplasty |
US6733536B1 (en) | 2002-10-22 | 2004-05-11 | Scimed Life Systems | Male urethral stent device |
US6715781B1 (en) | 2002-10-31 | 2004-04-06 | Jerry R. Smith | Interchangeable ball hitch assembly |
CN1711467A (en) | 2002-11-06 | 2005-12-21 | 皇家飞利浦电子股份有限公司 | Method of adhesion measurement at the interface between layers |
US7247134B2 (en) | 2002-11-12 | 2007-07-24 | Myocor, Inc. | Devices and methods for heart valve treatment |
US7112219B2 (en) | 2002-11-12 | 2006-09-26 | Myocor, Inc. | Devices and methods for heart valve treatment |
US8187324B2 (en) | 2002-11-15 | 2012-05-29 | Advanced Cardiovascular Systems, Inc. | Telescoping apparatus for delivering and adjusting a medical device in a vessel |
US7404824B1 (en) | 2002-11-15 | 2008-07-29 | Advanced Cardiovascular Systems, Inc. | Valve aptation assist device |
US7485143B2 (en) | 2002-11-15 | 2009-02-03 | Abbott Cardiovascular Systems Inc. | Apparatuses and methods for heart valve repair |
AU2003290979A1 (en) | 2002-11-15 | 2004-06-15 | The Government Of The United States Of America As Represented By The Secretary Of Health And Human Services | Method and device for catheter-based repair of cardiac valves |
US7335213B1 (en) | 2002-11-15 | 2008-02-26 | Abbott Cardiovascular Systems Inc. | Apparatus and methods for heart valve repair |
US7608114B2 (en) | 2002-12-02 | 2009-10-27 | Gi Dynamics, Inc. | Bariatric sleeve |
US6984242B2 (en) | 2002-12-20 | 2006-01-10 | Gore Enterprise Holdings, Inc. | Implantable medical device assembly |
US8551162B2 (en) | 2002-12-20 | 2013-10-08 | Medtronic, Inc. | Biologically implantable prosthesis |
US7316710B1 (en) | 2002-12-30 | 2008-01-08 | Advanced Cardiovascular Systems, Inc. | Flexible stent |
US6849084B2 (en) | 2002-12-31 | 2005-02-01 | Intek Technology L.L.C. | Stent delivery system |
US6931338B2 (en) | 2003-01-07 | 2005-08-16 | Guide Technology, Inc. | System for providing a calibrated path for multi-signal cables in testing of integrated circuits |
US6830585B1 (en) | 2003-01-14 | 2004-12-14 | 3F Therapeutics, Inc. | Percutaneously deliverable heart valve and methods of implantation |
US7753945B2 (en) | 2003-01-17 | 2010-07-13 | Gore Enterprise Holdings, Inc. | Deployment system for an endoluminal device |
US7314485B2 (en) | 2003-02-03 | 2008-01-01 | Cardiac Dimensions, Inc. | Mitral valve device using conditioned shape memory alloy |
US20040176788A1 (en) | 2003-03-07 | 2004-09-09 | Nmt Medical, Inc. | Vacuum attachment system |
EP1608297A2 (en) | 2003-03-18 | 2005-12-28 | St. Jude Medical, Inc. | Body tissue remodeling apparatus |
US20050107871A1 (en) | 2003-03-30 | 2005-05-19 | Fidel Realyvasquez | Apparatus and methods for valve repair |
CA2507649C (en) | 2003-04-02 | 2011-10-11 | Mehran Bashiri | Detachable and retrievable stent assembly |
US7530995B2 (en) | 2003-04-17 | 2009-05-12 | 3F Therapeutics, Inc. | Device for reduction of pressure effects of cardiac tricuspid valve regurgitation |
US7159593B2 (en) | 2003-04-17 | 2007-01-09 | 3F Therapeutics, Inc. | Methods for reduction of pressure effects of cardiac tricuspid valve regurgitation |
US7175656B2 (en) | 2003-04-18 | 2007-02-13 | Alexander Khairkhahan | Percutaneous transcatheter heart valve replacement |
US7717952B2 (en) | 2003-04-24 | 2010-05-18 | Cook Incorporated | Artificial prostheses with preferred geometries |
DE602004023350D1 (en) | 2003-04-30 | 2009-11-12 | Medtronic Vascular Inc | Percutaneous inserted provisional valve |
US20040220593A1 (en) | 2003-05-01 | 2004-11-04 | Secant Medical, Llc | Restraining clip for mitral valve repair |
US20040230208A1 (en) | 2003-05-13 | 2004-11-18 | Vafa Shayani | Article for positioning mesh over tissue |
US10667823B2 (en) | 2003-05-19 | 2020-06-02 | Evalve, Inc. | Fixation devices, systems and methods for engaging tissue |
US8512403B2 (en) | 2003-05-20 | 2013-08-20 | The Cleveland Clinic Foundation | Annuloplasty ring with wing members for repair of a cardiac valve |
US7341584B1 (en) | 2003-05-30 | 2008-03-11 | Thomas David Starkey | Device and method to limit filling of the heart |
US7670362B2 (en) | 2003-06-13 | 2010-03-02 | Tyco Healthcare Group Lp | Multiple member interconnect for surgical instrument and absorbable screw fastener |
US7967850B2 (en) | 2003-06-18 | 2011-06-28 | Jackson Roger P | Polyaxial bone anchor with helical capture connection, insert and dual locking assembly |
EP1648346A4 (en) | 2003-06-20 | 2006-10-18 | Medtronic Vascular Inc | Valve annulus reduction system |
US20040260394A1 (en) | 2003-06-20 | 2004-12-23 | Medtronic Vascular, Inc. | Cardiac valve annulus compressor system |
US7316706B2 (en) | 2003-06-20 | 2008-01-08 | Medtronic Vascular, Inc. | Tensioning device, system, and method for treating mitral valve regurgitation |
EP1648341A4 (en) | 2003-06-25 | 2009-01-14 | Georgia Tech Res Inst | Annuloplasty chain |
US8052751B2 (en) | 2003-07-02 | 2011-11-08 | Flexcor, Inc. | Annuloplasty rings for repairing cardiac valves |
BRPI0412362A (en) | 2003-07-08 | 2006-09-05 | Ventor Technologies Ltd | prosthetic implant devices particularly for transarterial transport in the treatment of aortic stenoses and implantation methods for such devices |
NZ527025A (en) | 2003-07-16 | 2007-01-26 | David Peter Shaw | Prosthetic valves for medical application |
EP1646332B1 (en) | 2003-07-18 | 2015-06-17 | Edwards Lifesciences AG | Remotely activated mitral annuloplasty system |
AU2004258942B2 (en) | 2003-07-21 | 2009-12-03 | The Trustees Of The University Of Pennsylvania | Percutaneous heart valve |
US20050016560A1 (en) | 2003-07-21 | 2005-01-27 | Dee Voughlohn | Unique hair-styling system and method |
DE10335648A1 (en) | 2003-07-30 | 2005-03-03 | Eberhard-Karls-Universität Tübingen | Closing plug for an opening in a wall of a vessel or hollow organ |
US7153324B2 (en) | 2003-07-31 | 2006-12-26 | Cook Incorporated | Prosthetic valve devices and methods of making such devices |
WO2005011535A2 (en) | 2003-07-31 | 2005-02-10 | Cook Incorporated | Prosthetic valve for implantation in a body vessel |
US8784472B2 (en) | 2003-08-15 | 2014-07-22 | Boston Scientific Scimed, Inc. | Clutch driven stent delivery system |
US7963952B2 (en) | 2003-08-19 | 2011-06-21 | Wright Jr John A | Expandable sheath tubing |
US8298280B2 (en) | 2003-08-21 | 2012-10-30 | Boston Scientific Scimed, Inc. | Stent with protruding branch portion for bifurcated vessels |
US8021421B2 (en) | 2003-08-22 | 2011-09-20 | Medtronic, Inc. | Prosthesis heart valve fixturing device |
EP1663065A1 (en) | 2003-09-02 | 2006-06-07 | Biomedix SA | Gastrointestinal anti-reflux prosthesis apparatus and method |
US20050049692A1 (en) | 2003-09-02 | 2005-03-03 | Numamoto Michael J. | Medical device for reduction of pressure effects of cardiac tricuspid valve regurgitation |
US20050075725A1 (en) | 2003-10-02 | 2005-04-07 | Rowe Stanton J. | Implantable prosthetic valve with non-laminar flow |
US10219899B2 (en) | 2004-04-23 | 2019-03-05 | Medtronic 3F Therapeutics, Inc. | Cardiac valve replacement systems |
US20050075712A1 (en) * | 2003-10-06 | 2005-04-07 | Brian Biancucci | Minimally invasive valve replacement system |
US20060259137A1 (en) | 2003-10-06 | 2006-11-16 | Jason Artof | Minimally invasive valve replacement system |
US7553324B2 (en) | 2003-10-14 | 2009-06-30 | Xtent, Inc. | Fixed stent delivery devices and methods |
US7226647B2 (en) | 2003-10-16 | 2007-06-05 | Hewlett-Packard Development Company, L.P. | Permanent fixation of dyes to surface-modified inorganic particulate-coated media |
US7004176B2 (en) | 2003-10-17 | 2006-02-28 | Edwards Lifesciences Ag | Heart valve leaflet locator |
US20060184242A1 (en) | 2003-10-20 | 2006-08-17 | Samuel Lichtenstein | Method and apparatus for percutaneous reduction of anterior-posterior diameter of mitral valve |
ITBO20030631A1 (en) | 2003-10-23 | 2005-04-24 | Roberto Erminio Parravicini | VALVULAR PROSTHETIC EQUIPMENT, IN PARTICULAR FOR HEART APPLICATIONS. |
US20050090827A1 (en) | 2003-10-28 | 2005-04-28 | Tewodros Gedebou | Comprehensive tissue attachment system |
CA2543680C (en) | 2003-10-31 | 2012-05-22 | Trudell Medical International | System and method for manipulating a catheter for delivering a substance to a body cavity |
US7655040B2 (en) | 2003-11-12 | 2010-02-02 | Medtronic Vascular, Inc. | Cardiac valve annulus reduction system |
WO2005046530A1 (en) | 2003-11-12 | 2005-05-26 | Medtronic Vascular, Inc. | Coronary sinus approach for repair of mitral valve reguritation |
US7955384B2 (en) | 2003-11-12 | 2011-06-07 | Medtronic Vascular, Inc. | Coronary sinus approach for repair of mitral valve regurgitation |
IL158960A0 (en) | 2003-11-19 | 2004-05-12 | Neovasc Medical Ltd | Vascular implant |
US7101336B2 (en) | 2003-11-25 | 2006-09-05 | General Electric Company | Methods and systems for motion adaptive spatial compounding |
AU2004296816A1 (en) | 2003-12-04 | 2005-06-23 | The Brigham And Women's Hospital, Inc. | Aortic valve annuloplasty rings |
US7186265B2 (en) | 2003-12-10 | 2007-03-06 | Medtronic, Inc. | Prosthetic cardiac valves and systems and methods for implanting thereof |
US20050177228A1 (en) | 2003-12-16 | 2005-08-11 | Solem Jan O. | Device for changing the shape of the mitral annulus |
US20050273138A1 (en) | 2003-12-19 | 2005-12-08 | Guided Delivery Systems, Inc. | Devices and methods for anchoring tissue |
US7329279B2 (en) | 2003-12-23 | 2008-02-12 | Sadra Medical, Inc. | Methods and apparatus for endovascularly replacing a patient's heart valve |
US8864822B2 (en) | 2003-12-23 | 2014-10-21 | Mitralign, Inc. | Devices and methods for introducing elements into tissue |
US8182528B2 (en) | 2003-12-23 | 2012-05-22 | Sadra Medical, Inc. | Locking heart valve anchor |
US20050137691A1 (en) | 2003-12-23 | 2005-06-23 | Sadra Medical | Two piece heart valve and anchor |
EP1702247B8 (en) | 2003-12-23 | 2015-09-09 | Boston Scientific Scimed, Inc. | Repositionable heart valve |
US7780725B2 (en) | 2004-06-16 | 2010-08-24 | Sadra Medical, Inc. | Everting heart valve |
US7431726B2 (en) | 2003-12-23 | 2008-10-07 | Mitralign, Inc. | Tissue fastening systems and methods utilizing magnetic guidance |
US8840663B2 (en) | 2003-12-23 | 2014-09-23 | Sadra Medical, Inc. | Repositionable heart valve method |
US7326236B2 (en) | 2003-12-23 | 2008-02-05 | Xtent, Inc. | Devices and methods for controlling and indicating the length of an interventional element |
WO2005070343A1 (en) | 2003-12-23 | 2005-08-04 | Laboratoires Perouse | Kit which is intended to be implanted in a conduit |
US7381219B2 (en) | 2003-12-23 | 2008-06-03 | Sadra Medical, Inc. | Low profile heart valve and delivery system |
US20050137686A1 (en) | 2003-12-23 | 2005-06-23 | Sadra Medical, A Delaware Corporation | Externally expandable heart valve anchor and method |
US7748389B2 (en) | 2003-12-23 | 2010-07-06 | Sadra Medical, Inc. | Leaflet engagement elements and methods for use thereof |
US7445631B2 (en) | 2003-12-23 | 2008-11-04 | Sadra Medical, Inc. | Methods and apparatus for endovascularly replacing a patient's heart valve |
US8052749B2 (en) | 2003-12-23 | 2011-11-08 | Sadra Medical, Inc. | Methods and apparatus for endovascular heart valve replacement comprising tissue grasping elements |
US8287584B2 (en) | 2005-11-14 | 2012-10-16 | Sadra Medical, Inc. | Medical implant deployment tool |
US7959666B2 (en) | 2003-12-23 | 2011-06-14 | Sadra Medical, Inc. | Methods and apparatus for endovascularly replacing a heart valve |
US7824442B2 (en) | 2003-12-23 | 2010-11-02 | Sadra Medical, Inc. | Methods and apparatus for endovascularly replacing a heart valve |
US9005273B2 (en) | 2003-12-23 | 2015-04-14 | Sadra Medical, Inc. | Assessing the location and performance of replacement heart valves |
US8603160B2 (en) | 2003-12-23 | 2013-12-10 | Sadra Medical, Inc. | Method of using a retrievable heart valve anchor with a sheath |
US7887574B2 (en) | 2003-12-23 | 2011-02-15 | Scimed Life Systems, Inc. | Stent delivery catheter |
US8343213B2 (en) | 2003-12-23 | 2013-01-01 | Sadra Medical, Inc. | Leaflet engagement elements and methods for use thereof |
US9526609B2 (en) | 2003-12-23 | 2016-12-27 | Boston Scientific Scimed, Inc. | Methods and apparatus for endovascularly replacing a patient's heart valve |
US7288115B2 (en) | 2004-01-02 | 2007-10-30 | Zimmer Technology, Inc. | Multipart component for an orthopaedic implant |
US9254213B2 (en) | 2004-01-09 | 2016-02-09 | Rubicon Medical, Inc. | Stent delivery device |
US20050159728A1 (en) | 2004-01-15 | 2005-07-21 | Thomas Medical Products, Inc. | Steerable sheath |
US7871435B2 (en) | 2004-01-23 | 2011-01-18 | Edwards Lifesciences Corporation | Anatomically approximate prosthetic mitral heart valve |
US7597711B2 (en) | 2004-01-26 | 2009-10-06 | Arbor Surgical Technologies, Inc. | Heart valve assembly with slidable coupling connections |
US7311730B2 (en) | 2004-02-13 | 2007-12-25 | Shlomo Gabbay | Support apparatus and heart valve prosthesis for sutureless implantation |
US7955375B2 (en) | 2004-02-20 | 2011-06-07 | Cook Medical Technologies Llc | Prosthetic valve with spacing member |
US20050187568A1 (en) | 2004-02-20 | 2005-08-25 | Klenk Alan R. | Devices and methods for closing a patent foramen ovale with a coil-shaped closure device |
US8206439B2 (en) | 2004-02-23 | 2012-06-26 | International Heart Institute Of Montana Foundation | Internal prosthesis for reconstruction of cardiac geometry |
CN101683291A (en) | 2004-02-27 | 2010-03-31 | 奥尔特克斯公司 | Prosthetic heart valve delivery systems and methods |
ITTO20040135A1 (en) | 2004-03-03 | 2004-06-03 | Sorin Biomedica Cardio Spa | CARDIAC VALVE PROSTHESIS |
US20050203549A1 (en) | 2004-03-09 | 2005-09-15 | Fidel Realyvasquez | Methods and apparatus for off pump aortic valve replacement with a valve prosthesis |
US20050203606A1 (en) | 2004-03-09 | 2005-09-15 | Vancamp Daniel H. | Stent system for preventing restenosis |
WO2005087140A1 (en) | 2004-03-11 | 2005-09-22 | Percutaneous Cardiovascular Solutions Pty Limited | Percutaneous heart valve prosthesis |
WO2005087139A1 (en) | 2004-03-15 | 2005-09-22 | Baker Medical Research Institute | Treating valve failure |
NL1025830C2 (en) | 2004-03-26 | 2005-02-22 | Eric Berreklouw | Prosthesis e.g. heart valve secured in place by ring with shape memory material anchor, includes anchor temperature control system |
US8048140B2 (en) | 2004-03-31 | 2011-11-01 | Cook Medical Technologies Llc | Fenestrated intraluminal stent system |
US7993397B2 (en) | 2004-04-05 | 2011-08-09 | Edwards Lifesciences Ag | Remotely adjustable coronary sinus implant |
GB0407908D0 (en) | 2004-04-07 | 2004-05-12 | Univ York | Ionic liquids |
EA009163B1 (en) | 2004-04-08 | 2007-10-26 | Ага Медикал Корпорейшн | Flange occlusion devices and methods |
US7294148B2 (en) | 2004-04-29 | 2007-11-13 | Edwards Lifesciences Corporation | Annuloplasty ring for mitral valve prolapse |
US7374573B2 (en) | 2004-05-03 | 2008-05-20 | Shlomo Gabbay | System and method for improving ventricular function |
US20050256566A1 (en) | 2004-05-03 | 2005-11-17 | Shlomo Gabbay | Apparatus and method for improving ventricular function |
EP2422751A3 (en) | 2004-05-05 | 2013-01-02 | Direct Flow Medical, Inc. | Unstented heart valve with formed in place support structure |
US7390329B2 (en) | 2004-05-07 | 2008-06-24 | Usgi Medical, Inc. | Methods for grasping and cinching tissue anchors |
US20060122692A1 (en) | 2004-05-10 | 2006-06-08 | Ran Gilad | Stent valve and method of using same |
US20050256532A1 (en) | 2004-05-12 | 2005-11-17 | Asha Nayak | Cardiovascular defect patch device and method |
US7452376B2 (en) | 2004-05-14 | 2008-11-18 | St. Jude Medical, Inc. | Flexible, non-planar annuloplasty rings |
EP1750592B1 (en) | 2004-05-14 | 2016-12-28 | Evalve, Inc. | Locking mechanisms for fixation devices |
WO2006007389A1 (en) | 2004-06-16 | 2006-01-19 | Cook Incorprated | Thoracic deployment device and stent graft |
EP1768630B1 (en) | 2004-06-16 | 2015-01-07 | Machine Solutions, Inc. | Stent crimping device |
US8317859B2 (en) | 2004-06-28 | 2012-11-27 | J.W. Medical Systems Ltd. | Devices and methods for controlling expandable prostheses during deployment |
US20050288778A1 (en) | 2004-06-29 | 2005-12-29 | Emanuel Shaoulian | Selectively adjustable cardiac valve implants |
US7462191B2 (en) | 2004-06-30 | 2008-12-09 | Edwards Lifesciences Pvt, Inc. | Device and method for assisting in the implantation of a prosthetic valve |
US7276078B2 (en) | 2004-06-30 | 2007-10-02 | Edwards Lifesciences Pvt | Paravalvular leak detection, sealing, and prevention |
US7556632B2 (en) | 2004-07-09 | 2009-07-07 | Reza Zadno | Device and method for repairing tissue |
US8308789B2 (en) | 2004-07-16 | 2012-11-13 | W. L. Gore & Associates, Inc. | Deployment system for intraluminal devices |
US8012202B2 (en) | 2004-07-27 | 2011-09-06 | Alameddine Abdallah K | Mitral valve ring for treatment of mitral valve regurgitation |
US20060041189A1 (en) | 2004-08-17 | 2006-02-23 | Vancaillie Thierry G | Grummet |
US7126289B2 (en) | 2004-08-20 | 2006-10-24 | O2 Micro Inc | Protection for external electrode fluorescent lamp system |
EP1786367B1 (en) | 2004-08-27 | 2013-04-03 | Cook Medical Technologies LLC | Placement of multiple intraluminal medical devices within a body vessel |
US20060052867A1 (en) | 2004-09-07 | 2006-03-09 | Medtronic, Inc | Replacement prosthetic heart valve, system and method of implant |
FR2874813B1 (en) | 2004-09-07 | 2007-06-22 | Perouse Soc Par Actions Simpli | VALVULAR PROSTHESIS |
CN101056596B (en) | 2004-09-14 | 2011-08-03 | 爱德华兹生命科学股份公司 | Device and method for treatment of heart valve regurgitation |
US8052592B2 (en) | 2005-09-27 | 2011-11-08 | Evalve, Inc. | Methods and devices for tissue grasping and assessment |
US7635329B2 (en) | 2004-09-27 | 2009-12-22 | Evalve, Inc. | Methods and devices for tissue grasping and assessment |
JP5393980B2 (en) | 2004-09-28 | 2014-01-22 | サージカル ソリューションズ リミテッド ライアビリティ カンパニー | Suture anchor |
US20060085012A1 (en) | 2004-09-28 | 2006-04-20 | Medtronic Vascular, Inc. | Torquing device delivered over a guidewire to rotate a medical fastener |
US20070083168A1 (en) | 2004-09-30 | 2007-04-12 | Whiting James S | Transmembrane access systems and methods |
US6951571B1 (en) | 2004-09-30 | 2005-10-04 | Rohit Srivastava | Valve implanting device |
US20090043381A1 (en) | 2004-10-05 | 2009-02-12 | Macoviak John A | Atrioventricular valve annulus repair systems and methods including retro-chordal anchors |
US7347868B2 (en) | 2004-10-26 | 2008-03-25 | Baronova, Inc. | Medical device delivery catheter |
US7458987B2 (en) | 2004-10-29 | 2008-12-02 | Cook Incorporated | Vascular valves having implanted and target configurations and methods of preparing the same |
US7470256B2 (en) | 2004-10-29 | 2008-12-30 | Merit Medical Systems, Inc., | Self-suturing anchor device for a catheter |
PL2338440T3 (en) | 2004-11-02 | 2013-06-28 | Machine Solutions Inc | Stent sheathing technology |
US7455688B2 (en) | 2004-11-12 | 2008-11-25 | Con Interventional Systems, Inc. | Ostial stent |
US8562672B2 (en) | 2004-11-19 | 2013-10-22 | Medtronic, Inc. | Apparatus for treatment of cardiac valves and method of its manufacture |
US7744642B2 (en) | 2004-11-19 | 2010-06-29 | Biomedical Research Associates, Inc. | Prosthetic venous valves |
WO2006049629A1 (en) | 2004-11-24 | 2006-05-11 | Sunnyside Technologies Inc. | Devices and methods for beating heart cardiac surgeries |
EP1818020B1 (en) | 2004-12-07 | 2017-05-10 | Olympus Corporation | Endo-therapy product system and cartridge including a treatment device |
EP1841383A1 (en) | 2004-12-15 | 2007-10-10 | Mednua Limited | A medical device suitable for use in treatment of a valve |
SE0403046D0 (en) | 2004-12-15 | 2004-12-15 | Medtentia Ab | A device and method for improving the function of a heart valve |
AU2005316431A1 (en) | 2004-12-15 | 2006-06-22 | Cook Ireland Limited | Radiopaque manipulation devices |
US7355461B2 (en) | 2004-12-15 | 2008-04-08 | Asahi Kasei Microsystems Co., Ltd. | Waveform generating circuit and spread spectrum clock generator |
US7758640B2 (en) | 2004-12-16 | 2010-07-20 | Valvexchange Inc. | Cardiovascular valve assembly |
US7578838B2 (en) | 2005-01-12 | 2009-08-25 | Cook Incorporated | Delivery system with helical shaft |
DE102005003632A1 (en) | 2005-01-20 | 2006-08-17 | Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. | Catheter for the transvascular implantation of heart valve prostheses |
CA2822801A1 (en) | 2005-02-07 | 2006-08-17 | Evalve, Inc. | Methods, systems and devices for cardiac valve repair |
EP3967269A3 (en) | 2005-02-07 | 2022-07-13 | Evalve, Inc. | Systems and devices for cardiac valve repair |
US8470028B2 (en) | 2005-02-07 | 2013-06-25 | Evalve, Inc. | Methods, systems and devices for cardiac valve repair |
US7992567B2 (en) | 2005-02-08 | 2011-08-09 | Koninklijke Philips Electronics N.V. | System and method for percutaneous glossoplasty |
US8220466B2 (en) | 2005-02-08 | 2012-07-17 | Koninklijke Philips Electronics N.V. | System and method for percutaneous palate remodeling |
ITTO20050074A1 (en) | 2005-02-10 | 2006-08-11 | Sorin Biomedica Cardio Srl | CARDIAC VALVE PROSTHESIS |
ES2558534T3 (en) | 2005-02-18 | 2016-02-05 | The Cleveland Clinic Foundation | Device to replace a heart valve |
CN102247225B (en) | 2005-02-28 | 2015-07-22 | 梅德坦提亚国际有限公司 | Device for improving the function of heart valve and kit |
US7955385B2 (en) | 2005-02-28 | 2011-06-07 | Medtronic Vascular, Inc. | Device, system, and method for aiding valve annuloplasty |
US8083793B2 (en) | 2005-02-28 | 2011-12-27 | Medtronic, Inc. | Two piece heart valves including multiple lobe valves and methods for implanting them |
US20060195186A1 (en) | 2005-02-28 | 2006-08-31 | Drews Michael J | Connectors for two piece heart valves and methods for implanting such heart valves |
US8608797B2 (en) | 2005-03-17 | 2013-12-17 | Valtech Cardio Ltd. | Mitral valve treatment techniques |
US8608726B2 (en) | 2005-03-24 | 2013-12-17 | The Cleveland Clinic Foundation | Vascular guidewire control apparatus |
US8864823B2 (en) | 2005-03-25 | 2014-10-21 | StJude Medical, Cardiology Division, Inc. | Methods and apparatus for controlling the internal circumference of an anatomic orifice or lumen |
EP2626039B1 (en) | 2005-03-25 | 2015-10-14 | St. Jude Medical, Cardiology Division, Inc. | Apparatus for controlling the internal circumference of an anatomic orifice or lumen |
US20060271171A1 (en) | 2005-04-01 | 2006-11-30 | Mcquinn Tim C | Artificial heart valve |
US8062359B2 (en) | 2005-04-06 | 2011-11-22 | Edwards Lifesciences Corporation | Highly flexible heart valve connecting band |
US7513909B2 (en) | 2005-04-08 | 2009-04-07 | Arbor Surgical Technologies, Inc. | Two-piece prosthetic valves with snap-in connection and methods for use |
US7722666B2 (en) | 2005-04-15 | 2010-05-25 | Boston Scientific Scimed, Inc. | Valve apparatus, system and method |
WO2006113906A1 (en) | 2005-04-20 | 2006-10-26 | The Cleveland Clinic Foundation | Apparatus and method for replacing a cardiac valve |
SE531468C2 (en) | 2005-04-21 | 2009-04-14 | Edwards Lifesciences Ag | An apparatus for controlling blood flow |
US8333777B2 (en) | 2005-04-22 | 2012-12-18 | Benvenue Medical, Inc. | Catheter-based tissue remodeling devices and methods |
US7914569B2 (en) | 2005-05-13 | 2011-03-29 | Medtronics Corevalve Llc | Heart valve prosthesis and methods of manufacture and use |
FR2885794B1 (en) | 2005-05-19 | 2007-08-17 | Perouse Soc Par Actions Simpli | NECESSARY FOR LANDING A CAVITY TREATMENT BODY AND METHOD FOR PREPARING A TREATMENT BODY THEREFOR |
EP3292838A1 (en) | 2005-05-24 | 2018-03-14 | Edwards Lifesciences Corporation | Rapid deployment prosthetic heart valve |
US8317855B2 (en) | 2005-05-26 | 2012-11-27 | Boston Scientific Scimed, Inc. | Crimpable and expandable side branch cell |
EP3482717B1 (en) | 2005-05-27 | 2023-09-06 | Edwards Lifesciences Corporation | Stentless support structure |
US8211169B2 (en) | 2005-05-27 | 2012-07-03 | Medtronic, Inc. | Gasket with collar for prosthetic heart valves and methods for using them |
US7500989B2 (en) | 2005-06-03 | 2009-03-10 | Edwards Lifesciences Corp. | Devices and methods for percutaneous repair of the mitral valve via the coronary sinus |
US20060287716A1 (en) | 2005-06-08 | 2006-12-21 | The Cleveland Clinic Foundation | Artificial chordae |
US7938851B2 (en) | 2005-06-08 | 2011-05-10 | Xtent, Inc. | Devices and methods for operating and controlling interventional apparatus |
US7780723B2 (en) | 2005-06-13 | 2010-08-24 | Edwards Lifesciences Corporation | Heart valve delivery system |
US8951285B2 (en) | 2005-07-05 | 2015-02-10 | Mitralign, Inc. | Tissue anchor, anchoring system and methods of using the same |
WO2007006057A1 (en) | 2005-07-06 | 2007-01-11 | The Cleveland Clinic Foundation | Apparatus and method for replacing a cardiac valve |
US7776084B2 (en) | 2005-07-13 | 2010-08-17 | Edwards Lifesciences Corporation | Prosthetic mitral heart valve having a contoured sewing ring |
EP1919397B1 (en) | 2005-07-13 | 2013-01-02 | Medtronic, Inc. | Two-piece percutaneous prosthetic heart valves |
DE102006017873A1 (en) | 2005-07-14 | 2007-01-25 | Qualimed Innovative Medizinprodukte Gmbh | Temporary stent |
US7927371B2 (en) | 2005-07-15 | 2011-04-19 | The Cleveland Clinic Foundation | Apparatus and method for reducing cardiac valve regurgitation |
CA2615467A1 (en) | 2005-07-15 | 2007-01-25 | The Cleveland Clinic Foundation | Apparatus and method for remodeling a cardiac valve annulus |
US7875056B2 (en) | 2005-07-22 | 2011-01-25 | Anpa Medical, Inc. | Wedge operated retainer device and methods |
EP1906873A2 (en) | 2005-07-27 | 2008-04-09 | Georgia Tech Research Corporation | Implantable prosthetic vascular valve |
US20070027533A1 (en) | 2005-07-28 | 2007-02-01 | Medtronic Vascular, Inc. | Cardiac valve annulus restraining device |
US20070027528A1 (en) | 2005-07-29 | 2007-02-01 | Cook Incorporated | Elliptical implantable device |
US20070055206A1 (en) | 2005-08-10 | 2007-03-08 | Guided Delivery Systems, Inc. | Methods and devices for deployment of tissue anchors |
US20070038295A1 (en) | 2005-08-12 | 2007-02-15 | Cook Incorporated | Artificial valve prosthesis having a ring frame |
CA2619429A1 (en) | 2005-08-22 | 2007-03-01 | Incept, Llc | Flared stents and apparatus and methods for making and using them |
WO2007025028A1 (en) | 2005-08-25 | 2007-03-01 | The Cleveland Clinic Foundation | Percutaneous atrioventricular valve and method of use |
US9492277B2 (en) | 2005-08-30 | 2016-11-15 | Mayo Foundation For Medical Education And Research | Soft body tissue remodeling methods and apparatus |
US20070078297A1 (en) | 2005-08-31 | 2007-04-05 | Medtronic Vascular, Inc. | Device for Treating Mitral Valve Regurgitation |
US20070185530A1 (en) | 2005-09-01 | 2007-08-09 | Chao Chin-Chen | Patent foramen ovale closure method |
US7846179B2 (en) | 2005-09-01 | 2010-12-07 | Ovalis, Inc. | Suture-based systems and methods for treating septal defects |
US8968379B2 (en) | 2005-09-02 | 2015-03-03 | Medtronic Vascular, Inc. | Stent delivery system with multiple evenly spaced pullwires |
BRPI0617066A2 (en) | 2005-09-07 | 2011-07-12 | Medtentia Ab | heart valve function enhancement devices and method |
US7731741B2 (en) | 2005-09-08 | 2010-06-08 | Boston Scientific Scimed, Inc. | Inflatable bifurcation stent |
US7530253B2 (en) | 2005-09-09 | 2009-05-12 | Edwards Lifesciences Corporation | Prosthetic valve crimping device |
US20070061010A1 (en) | 2005-09-09 | 2007-03-15 | Hauser David L | Device and method for reshaping mitral valve annulus |
US7569071B2 (en) | 2005-09-21 | 2009-08-04 | Boston Scientific Scimed, Inc. | Venous valve, system, and method with sinus pocket |
US20070078510A1 (en) | 2005-09-26 | 2007-04-05 | Ryan Timothy R | Prosthetic cardiac and venous valves |
CA2561034C (en) | 2005-09-30 | 2014-12-09 | Sherwood Services Ag | Flexible endoscopic catheter with an end effector for coagulating and transfecting tissue |
US7695510B2 (en) | 2005-10-11 | 2010-04-13 | Medtronic Vascular, Inc. | Annuloplasty device having shape-adjusting tension filaments |
US8038720B2 (en) | 2005-10-18 | 2011-10-18 | Wallace Jeffrey M | Methods and devices for intragastrointestinal prostheses |
US8167932B2 (en) | 2005-10-18 | 2012-05-01 | Edwards Lifesciences Corporation | Heart valve delivery system with valve catheter |
CN101466316B (en) | 2005-10-20 | 2012-06-27 | 阿普特斯内系统公司 | Devices systems and methods for prosthesis delivery and implantation including the use of a fastener tool |
DE102005051849B4 (en) | 2005-10-28 | 2010-01-21 | JenaValve Technology Inc., Wilmington | Device for implantation and attachment of heart valve prostheses |
WO2007053592A2 (en) | 2005-10-31 | 2007-05-10 | Cook Incorporated | Composite stent graft |
DE102005052628B4 (en) | 2005-11-04 | 2014-06-05 | Jenavalve Technology Inc. | Self-expanding, flexible wire mesh with integrated valvular prosthesis for the transvascular heart valve replacement and a system with such a device and a delivery catheter |
CA2629534C (en) | 2005-11-10 | 2015-02-24 | Arshad Quadri | Balloon-expandable, self-expanding, vascular prosthesis connecting stent |
US20070112418A1 (en) | 2005-11-14 | 2007-05-17 | Boston Scientific Scimed, Inc. | Stent with spiral side-branch support designs |
EP1954224B1 (en) | 2005-11-14 | 2013-05-29 | Covidien LP | Stent delivery system for ostial locations in a conduit |
ATE429194T1 (en) | 2005-11-16 | 2009-05-15 | Micardia Corp | MAGNETIC ATTACHMENT OF A CATHETER TO AN IMPLANT |
US8764820B2 (en) | 2005-11-16 | 2014-07-01 | Edwards Lifesciences Corporation | Transapical heart valve delivery system and method |
WO2007062054A2 (en) | 2005-11-21 | 2007-05-31 | The Brigham And Women's Hospital, Inc. | Percutaneous cardiac valve repair with adjustable artificial chordae |
US7632308B2 (en) | 2005-11-23 | 2009-12-15 | Didier Loulmet | Methods, devices, and kits for treating mitral valve prolapse |
US8043368B2 (en) | 2005-11-23 | 2011-10-25 | Traves Dean Crabtree | Methods and apparatus for atrioventricular valve repair |
JP4687436B2 (en) | 2005-12-13 | 2011-05-25 | ウシオ電機株式会社 | Excimer light therapy device |
US7901454B2 (en) | 2005-12-15 | 2011-03-08 | The Cleveland Clinic Foundation | Apparatus and method for treating a regurgitant valve |
US9125742B2 (en) | 2005-12-15 | 2015-09-08 | Georgia Tech Research Foundation | Papillary muscle position control devices, systems, and methods |
US20070142907A1 (en) | 2005-12-16 | 2007-06-21 | Micardia Corporation | Adjustable prosthetic valve implant |
US20070213813A1 (en) | 2005-12-22 | 2007-09-13 | Symetis Sa | Stent-valves for valve replacement and associated methods and systems for surgery |
EP1803420B1 (en) | 2005-12-28 | 2009-07-01 | Sorin Biomedica Cardio S.R.L. | Annuloplasty prosthesis with an auxetic structure |
US9375215B2 (en) | 2006-01-20 | 2016-06-28 | W. L. Gore & Associates, Inc. | Device for rapid repair of body conduits |
US7967857B2 (en) | 2006-01-27 | 2011-06-28 | Medtronic, Inc. | Gasket with spring collar for prosthetic heart valves and methods for making and using them |
WO2008029296A2 (en) | 2006-02-16 | 2008-03-13 | Endocor Pte Ltd. | Minimally invasive heart valve replacement |
US8403981B2 (en) | 2006-02-27 | 2013-03-26 | CardiacMC, Inc. | Methods and devices for delivery of prosthetic heart valves and other prosthetics |
US8219229B2 (en) * | 2006-03-02 | 2012-07-10 | Edwards Lifesciences Corporation | Virtual heart valve |
US7635386B1 (en) | 2006-03-07 | 2009-12-22 | University Of Maryland, Baltimore | Methods and devices for performing cardiac valve repair |
US7431692B2 (en) | 2006-03-09 | 2008-10-07 | Edwards Lifesciences Corporation | Apparatus, system, and method for applying and adjusting a tensioning element to a hollow body organ |
EP1998719A1 (en) | 2006-03-10 | 2008-12-10 | Arbor Surgical Technologies, Inc. | Valve introducers and methods for making and using them |
US20070219558A1 (en) | 2006-03-15 | 2007-09-20 | Allen Deutsch | Method and apparatus for arthroscopic surgery using suture anchors |
US20070225759A1 (en) | 2006-03-22 | 2007-09-27 | Daniel Thommen | Method for delivering a medical device to the heart of a patient |
DE102006013770A1 (en) | 2006-03-24 | 2007-09-27 | Occlutech Gmbh | Occlusion instrument and method for its production |
US8075615B2 (en) | 2006-03-28 | 2011-12-13 | Medtronic, Inc. | Prosthetic cardiac valve formed from pericardium material and methods of making same |
US20090254103A1 (en) | 2006-03-29 | 2009-10-08 | Deutsch Harvey L | Method and device for cavity obliteration |
CN101049269B (en) | 2006-04-03 | 2010-12-29 | 孟坚 | Medical use obstruction appliance |
US7625403B2 (en) | 2006-04-04 | 2009-12-01 | Medtronic Vascular, Inc. | Valved conduit designed for subsequent catheter delivered valve therapy |
US20070239208A1 (en) | 2006-04-05 | 2007-10-11 | Crawford Bruce S | Surgical implantation device and method |
US7591848B2 (en) | 2006-04-06 | 2009-09-22 | Medtronic Vascular, Inc. | Riveted stent valve for percutaneous use |
US7524331B2 (en) | 2006-04-06 | 2009-04-28 | Medtronic Vascular, Inc. | Catheter delivered valve having a barrier to provide an enhanced seal |
US7699892B2 (en) | 2006-04-12 | 2010-04-20 | Medtronic Vascular, Inc. | Minimally invasive procedure for implanting an annuloplasty device |
EP3593761A1 (en) | 2006-04-12 | 2020-01-15 | Medtronic Vascular, Inc. | Annuloplasty device having a helical anchor |
US20070244555A1 (en) | 2006-04-12 | 2007-10-18 | Medtronic Vascular, Inc. | Annuloplasty Device Having a Helical Anchor and Methods for its Use |
US20070244546A1 (en) | 2006-04-18 | 2007-10-18 | Medtronic Vascular, Inc. | Stent Foundation for Placement of a Stented Valve |
US7442207B2 (en) | 2006-04-21 | 2008-10-28 | Medtronic Vascular, Inc. | Device, system, and method for treating cardiac valve regurgitation |
WO2007124076A1 (en) | 2006-04-21 | 2007-11-01 | Abbott Laboratories | Guidewire handling device |
US8551161B2 (en) | 2006-04-25 | 2013-10-08 | Medtronic Vascular, Inc. | Cardiac valve annulus restraining device |
US9101338B2 (en) | 2006-05-03 | 2015-08-11 | Mayo Foundation For Medical Education And Research | Soft body tissue remodeling methods and apparatus |
JP2009536074A (en) | 2006-05-05 | 2009-10-08 | チルドレンズ・メディカル・センター・コーポレイション | Transcatheter heart valve |
CA2677968C (en) | 2006-05-15 | 2014-07-08 | Enovacor Aps | A system and a method for altering the geometry of the heart |
US20080234660A2 (en) | 2006-05-16 | 2008-09-25 | Sarah Cumming | Steerable Catheter Using Flat Pull Wires and Method of Making Same |
US8932348B2 (en) | 2006-05-18 | 2015-01-13 | Edwards Lifesciences Corporation | Device and method for improving heart valve function |
US7811316B2 (en) | 2006-05-25 | 2010-10-12 | Deep Vein Medical, Inc. | Device for regulating blood flow |
WO2007140309A2 (en) | 2006-05-25 | 2007-12-06 | Mitralign, Inc. | Lockers for surgical tensioning members and methods of using the same to secure surgical tensioning members |
US20070282429A1 (en) | 2006-06-01 | 2007-12-06 | Hauser David L | Prosthetic insert for improving heart valve function |
ITTO20060413A1 (en) | 2006-06-07 | 2007-12-08 | Arrigo Lessana | REPLACEMENT DEVICE OF THE TENDONE ROPES OF AN ATRIOVENTRICULAR VALVE |
BRPI0713403A2 (en) | 2006-06-14 | 2012-03-13 | Optivia Medical Llc | SYSTEMS AND METHODS OF INTRODUCING MEDICAL DEVICE |
CN101505686A (en) | 2006-06-20 | 2009-08-12 | 奥尔特克斯公司 | Prosthetic heart valves, support structures and systems and methods for implanting the same |
JP2009540952A (en) | 2006-06-20 | 2009-11-26 | エーオーテックス, インコーポレイテッド | Torque shaft and torque drive |
CA2657446A1 (en) | 2006-06-21 | 2007-12-27 | Aortx, Inc. | Prosthetic valve implantation systems |
US7934506B2 (en) | 2006-06-21 | 2011-05-03 | Koninklijke Philips Electronics N.V. | System and method for temporary tongue suspension |
US20070295172A1 (en) | 2006-06-23 | 2007-12-27 | Darian Swartz | Fastener Holding Device |
US8449605B2 (en) | 2006-06-28 | 2013-05-28 | Kardium Inc. | Method for anchoring a mitral valve |
US7955315B2 (en) | 2006-07-24 | 2011-06-07 | Ethicon, Inc. | Articulating laparoscopic device and method for delivery of medical fluid |
WO2008013915A2 (en) | 2006-07-28 | 2008-01-31 | Arshad Quadri | Percutaneous valve prosthesis and system and method for implanting same |
US7871432B2 (en) | 2006-08-02 | 2011-01-18 | Medtronic, Inc. | Heart valve holder for use in valve implantation procedures |
US20080039743A1 (en) | 2006-08-09 | 2008-02-14 | Coherex Medical, Inc. | Methods for determining characteristics of an internal tissue opening |
US8529597B2 (en) | 2006-08-09 | 2013-09-10 | Coherex Medical, Inc. | Devices for reducing the size of an internal tissue opening |
US8430926B2 (en) | 2006-08-11 | 2013-04-30 | Japd Consulting Inc. | Annuloplasty with enhanced anchoring to the annulus based on tissue healing |
WO2008022077A2 (en) | 2006-08-14 | 2008-02-21 | Buch Wally S | Methods and apparatus for mitral valve repair |
US20080097595A1 (en) | 2006-08-22 | 2008-04-24 | Shlomo Gabbay | Intraventricular cardiac prosthesis |
WO2008031103A2 (en) | 2006-09-08 | 2008-03-13 | Edwards Lifesciences Corporation | Integrated heart valve delivery system |
US8414643B2 (en) | 2006-09-19 | 2013-04-09 | Medtronic Ventor Technologies Ltd. | Sinus-engaging valve fixation member |
FR2906454B1 (en) | 2006-09-28 | 2009-04-10 | Perouse Soc Par Actions Simpli | IMPLANT INTENDED TO BE PLACED IN A BLOOD CIRCULATION CONDUIT. |
US20080082083A1 (en) | 2006-09-28 | 2008-04-03 | Forde Sean T | Perforated expandable implant recovery sheath |
US20080082159A1 (en) | 2006-09-28 | 2008-04-03 | Cook Incorporated | Stent for Endovascular Procedures |
US7534261B2 (en) | 2006-10-02 | 2009-05-19 | Edwards Lifesciences Corporation | Sutureless heart valve attachment |
US8029556B2 (en) | 2006-10-04 | 2011-10-04 | Edwards Lifesciences Corporation | Method and apparatus for reshaping a ventricle |
US8163011B2 (en) | 2006-10-06 | 2012-04-24 | BioStable Science & Engineering, Inc. | Intra-annular mounting frame for aortic valve repair |
US7879087B2 (en) | 2006-10-06 | 2011-02-01 | Edwards Lifesciences Corporation | Mitral and tricuspid annuloplasty rings |
US7674276B2 (en) | 2006-10-06 | 2010-03-09 | Biomet Sports Medicine, Llc | Rotational securing of a suture |
WO2008046092A2 (en) | 2006-10-13 | 2008-04-17 | Creighton University | Implantable valve prosthesis |
US8388680B2 (en) | 2006-10-18 | 2013-03-05 | Guided Delivery Systems, Inc. | Methods and devices for catheter advancement and delivery of substances therethrough |
US7935144B2 (en) * | 2006-10-19 | 2011-05-03 | Direct Flow Medical, Inc. | Profile reduction of valve implant |
US20090248143A1 (en) | 2006-10-24 | 2009-10-01 | Beth Israel Deaconess Medical Center | Percutaneous aortic valve assembly |
US7771467B2 (en) | 2006-11-03 | 2010-08-10 | The Cleveland Clinic Foundation | Apparatus for repairing the function of a native aortic valve |
CA2664557C (en) | 2006-11-07 | 2015-05-26 | David Stephen Celermajer | Devices and methods for the treatment of heart failure |
SE530568C2 (en) | 2006-11-13 | 2008-07-08 | Medtentia Ab | Medical device for improving function of heart valve, has flange unit connected to loop-shaped support and provided to be arranged against annulus when loop shaped support abut heart valve |
JP2010511469A (en) | 2006-12-05 | 2010-04-15 | バルテック カーディオ,リミティド | Segmented ring placement |
WO2010004546A1 (en) | 2008-06-16 | 2010-01-14 | Valtech Cardio, Ltd. | Annuloplasty devices and methods of delivery therefor |
US20080140003A1 (en) | 2006-12-06 | 2008-06-12 | Advanced Cardiovascular Systems, Inc. | Balloon catheter having a regrooming sheath and method for collapsing an expanded medical device |
WO2008070797A2 (en) | 2006-12-06 | 2008-06-12 | Medtronic Corevalve, Inc. | System and method for transapical delivery of an annulus anchored self-expanding valve |
US8070799B2 (en) | 2006-12-19 | 2011-12-06 | Sorin Biomedica Cardio S.R.L. | Instrument and method for in situ deployment of cardiac valve prostheses |
US8236045B2 (en) | 2006-12-22 | 2012-08-07 | Edwards Lifesciences Corporation | Implantable prosthetic valve assembly and method of making the same |
EP2111189B1 (en) | 2007-01-03 | 2017-04-05 | St. Jude Medical, Cardiology Division, Inc. | Implantable devices for controlling the size and shape of an anatomical structure or lumen |
US20100249920A1 (en) | 2007-01-08 | 2010-09-30 | Millipede Llc | Reconfiguring heart features |
US8133270B2 (en) | 2007-01-08 | 2012-03-13 | California Institute Of Technology | In-situ formation of a valve |
US20080167705A1 (en) | 2007-01-10 | 2008-07-10 | Cook Incorporated | Short wire stent delivery system with splittable outer sheath |
JP5313928B2 (en) | 2007-02-05 | 2013-10-09 | ボストン サイエンティフィック リミテッド | Percutaneous valves and systems |
EP3345572A1 (en) | 2007-02-14 | 2018-07-11 | Edwards Lifesciences Corporation | Suture and method for repairing heart |
US8529431B2 (en) * | 2007-02-14 | 2013-09-10 | Bfkw, Llc | Bariatric device and method |
US8623074B2 (en) | 2007-02-16 | 2014-01-07 | Medtronic, Inc. | Delivery systems and methods of implantation for replacement prosthetic heart valves |
US8070802B2 (en) | 2007-02-23 | 2011-12-06 | The Trustees Of The University Of Pennsylvania | Mitral valve system |
US20080208328A1 (en) | 2007-02-23 | 2008-08-28 | Endovalve, Inc. | Systems and Methods For Placement of Valve Prosthesis System |
US20080208327A1 (en) | 2007-02-27 | 2008-08-28 | Rowe Stanton J | Method and apparatus for replacing a prosthetic valve |
EP2120753B1 (en) | 2007-03-05 | 2022-09-28 | Tornier, Inc. | Tack anchor systems |
US8911461B2 (en) | 2007-03-13 | 2014-12-16 | Mitralign, Inc. | Suture cutter and method of cutting suture |
US8845723B2 (en) | 2007-03-13 | 2014-09-30 | Mitralign, Inc. | Systems and methods for introducing elements into tissue |
US8088154B2 (en) | 2007-03-31 | 2012-01-03 | Cook Medical Technologies Llc | Medical device delivery system with sheath separation |
US7896915B2 (en) | 2007-04-13 | 2011-03-01 | Jenavalve Technology, Inc. | Medical device for treating a heart valve insufficiency |
US9387308B2 (en) | 2007-04-23 | 2016-07-12 | Cardioguidance Biomedical, Llc | Guidewire with adjustable stiffness |
US8273115B2 (en) | 2007-04-24 | 2012-09-25 | W. L. Gore & Associates, Inc. | Side branched endoluminal prostheses and methods of delivery thereof |
US7776080B2 (en) | 2007-04-25 | 2010-08-17 | Abbott Cardiovascualr Systems Inc. | Stent delivery catheter system and method of implanting a self-expanding stent with embolic protection |
WO2008134457A1 (en) | 2007-04-27 | 2008-11-06 | Voyage Medical, Inc. | Complex shape steerable tissue visualization and manipulation catheter |
US8529620B2 (en) | 2007-05-01 | 2013-09-10 | Ottavio Alfieri | Inwardly-bowed tricuspid annuloplasty ring |
US8147504B2 (en) | 2007-05-05 | 2012-04-03 | Medtronic, Inc. | Apparatus and methods for delivering fasteners during valve replacement |
US7931660B2 (en) | 2007-05-10 | 2011-04-26 | Tyco Healthcare Group Lp | Powered tacker instrument |
EP2146669B1 (en) | 2007-05-11 | 2014-07-30 | Cook Medical Technologies LLC | Stent grafts for the thoracic aorta |
GR20070100291A (en) | 2007-05-14 | 2008-12-19 | Κωνστατινος Σπαργιας | Anti-restenosis drug covered and eluting baloons for valvuloplasty of aortic valve stenosiis for the prevention of restenosis. |
EP2150210B1 (en) | 2007-05-15 | 2016-10-12 | JenaValve Technology, Inc. | Handle for manipulating a catheter tip, catheter system and medical insertion system for inserting a self-expandable heart valve stent |
US8740937B2 (en) | 2007-05-31 | 2014-06-03 | Cook Medical Technologies Llc | Suture lock |
US20090112159A1 (en) | 2007-10-31 | 2009-04-30 | David Slattery | Delivery System With Profiled Sheath Having Balloon-Oriented Position |
BRPI0813773A2 (en) | 2007-06-26 | 2017-05-16 | St Jude Medical | apparatus for providing a protein heart valve in a patient. |
US9814611B2 (en) | 2007-07-31 | 2017-11-14 | Edwards Lifesciences Cardiaq Llc | Actively controllable stent, stent graft, heart valve and method of controlling same |
US9566178B2 (en) | 2010-06-24 | 2017-02-14 | Edwards Lifesciences Cardiaq Llc | Actively controllable stent, stent graft, heart valve and method of controlling same |
US8252035B2 (en) | 2007-08-01 | 2012-08-28 | Cappella, Inc. | Device delivery system with two stage withdrawal |
AU2008294012B2 (en) | 2007-08-24 | 2013-04-18 | St. Jude Medical, Inc. | Prosthetic aortic heart valves |
ES2396738T3 (en) | 2007-09-07 | 2013-02-25 | Sorin Biomedica Cardio S.R.L. | Microprocessor-controlled delivery system of a heart valve prosthesis |
US20120150218A1 (en) | 2007-09-13 | 2012-06-14 | Robert Tyler Sandgren | Medical device for occluding a heart defect and a method of manufacturing the same |
DE102007043830A1 (en) | 2007-09-13 | 2009-04-02 | Lozonschi, Lucian, Madison | Heart valve stent |
US8066755B2 (en) | 2007-09-26 | 2011-11-29 | Trivascular, Inc. | System and method of pivoted stent deployment |
BRPI0817708A2 (en) | 2007-09-26 | 2017-05-16 | St Jude Medical | prosthetic heart valve, and lamella structure for the same. |
WO2009045334A1 (en) | 2007-09-28 | 2009-04-09 | St. Jude Medical, Inc. | Collapsible/expandable prosthetic heart valves with native calcified leaflet retention features |
US20090088837A1 (en) | 2007-09-28 | 2009-04-02 | The Cleveland Clinic Foundation | Prosthetic chordae assembly and method of use |
US8454686B2 (en) | 2007-09-28 | 2013-06-04 | St. Jude Medical, Inc. | Two-stage collapsible/expandable prosthetic heart valves and anchoring systems |
US7981151B2 (en) | 2007-10-15 | 2011-07-19 | Edwards Lifesciences Corporation | Transcatheter heart valve with micro-anchors |
US8226709B2 (en) | 2007-10-19 | 2012-07-24 | Cordis Corporation | Method and system for plicating tissue in a minimally invasive medical procedure for the treatment of mitral valve regurgitation |
EP2217153B1 (en) | 2007-10-19 | 2021-03-03 | Ancora Heart, Inc. | Systems for cardiac remodeling |
JP2011500221A (en) | 2007-10-19 | 2011-01-06 | ガイデッド デリバリー システムズ, インコーポレイテッド | Tether termination equipment |
BRPI0819217B8 (en) | 2007-10-25 | 2021-06-22 | Symetis Sa | replacement valve for use within a human body, system for replacing a valve within a human body, and heart valve release system with stent |
US8715337B2 (en) | 2007-11-09 | 2014-05-06 | Cook Medical Technologies Llc | Aortic valve stent graft |
US8057532B2 (en) | 2007-11-28 | 2011-11-15 | Cook Medical Technologies Llc | Implantable frame and valve design |
EP4079261A1 (en) | 2007-12-14 | 2022-10-26 | Edwards Lifesciences Corporation | Leaflet attachment frame for a prosthetic valve |
EP2072027B1 (en) | 2007-12-21 | 2020-06-17 | Medtentia International Ltd Oy | pre-annuloplasty device and method |
US8277501B2 (en) | 2007-12-21 | 2012-10-02 | Boston Scientific Scimed, Inc. | Bi-stable bifurcated stent petal geometry |
US8613776B2 (en) | 2007-12-27 | 2013-12-24 | The Trustees Of Columbia University In The City Of New York | Systems and methods for forming patterned extracellular matrix materials |
FR2925838A1 (en) | 2007-12-28 | 2009-07-03 | Univ Franche Comte Etablisseme | AUTOMATED ANCILLARY INSERTION AND FIXATION BY STAPLING AN ANNULAR BODY, IN PARTICULAR A PROSTHESIS, ON AN ANNULAR RESILIENT VOLUME |
JP5591120B2 (en) | 2008-01-16 | 2014-09-17 | セント ジュード メディカル インコーポレイテッド | Collapsible / expandable prosthetic heart valve delivery and retrieval system |
WO2009090564A2 (en) | 2008-01-16 | 2009-07-23 | Simcha Milo | Adjustable annuloplasty rings |
WO2009094373A1 (en) | 2008-01-22 | 2009-07-30 | Cook Incorporated | Valve frame |
AU2009206340B2 (en) | 2008-01-24 | 2012-06-14 | Medtronic Vascular Inc. | Infundibular reducer device delivery system and related methods |
EP3572044B1 (en) * | 2008-01-24 | 2021-07-28 | Medtronic, Inc. | Stents for prosthetic heart valves |
US8157853B2 (en) | 2008-01-24 | 2012-04-17 | Medtronic, Inc. | Delivery systems and methods of implantation for prosthetic heart valves |
US20090222081A1 (en) | 2008-01-24 | 2009-09-03 | Coherex Medical, Inc. | Methods and apparatus for reducing valve prolapse |
WO2009100242A2 (en) | 2008-02-06 | 2009-08-13 | Guided Delivery Systems, Inc. | Multi-window guide tunnel |
US7741612B2 (en) | 2008-02-07 | 2010-06-22 | General Electric Company | Integrated neutron-gamma radiation detector with optical waveguide and neutron scintillating material |
CA2715448C (en) | 2008-02-25 | 2017-06-13 | Medtronic Vascular Inc. | Infundibular reducer devices |
US8728097B1 (en) | 2008-02-26 | 2014-05-20 | Mitralign, Inc. | Tissue plication devices and methods for their use |
US9241792B2 (en) | 2008-02-29 | 2016-01-26 | Edwards Lifesciences Corporation | Two-step heart valve implantation |
WO2009114316A2 (en) | 2008-03-03 | 2009-09-17 | Alaska Hand Research, Llc | Cannulated anchor and system |
US8382829B1 (en) | 2008-03-10 | 2013-02-26 | Mitralign, Inc. | Method to reduce mitral regurgitation by cinching the commissure of the mitral valve |
US8177836B2 (en) | 2008-03-10 | 2012-05-15 | Medtronic, Inc. | Apparatus and methods for minimally invasive valve repair |
US20090248148A1 (en) | 2008-03-25 | 2009-10-01 | Ellipse Technologies, Inc. | Systems and methods for adjusting an annuloplasty ring with an integrated magnetic drive |
US8545544B2 (en) | 2008-04-03 | 2013-10-01 | Gardia Medical Ltd. | Delivery catheter with constraining sheath and methods of deploying medical devices into a body lumen |
US20100121437A1 (en) | 2008-04-16 | 2010-05-13 | Cardiovascular Technologies, Llc | Transvalvular intraannular band and chordae cutting for ischemic and dilated cardiomyopathy |
US8262725B2 (en) | 2008-04-16 | 2012-09-11 | Cardiovascular Technologies, Llc | Transvalvular intraannular band for valve repair |
JP5324645B2 (en) | 2008-04-21 | 2013-10-23 | クイックリング メディカル テクノロジーズ リミテッド | Surgical stapling system |
US20090264859A1 (en) | 2008-04-21 | 2009-10-22 | Medtronic Vascular, Inc. | Catheter Having a Selectively Expandable Distal Tip |
US8696743B2 (en) | 2008-04-23 | 2014-04-15 | Medtronic, Inc. | Tissue attachment devices and methods for prosthetic heart valves |
EP3141219A1 (en) | 2008-04-23 | 2017-03-15 | Medtronic, Inc. | Stented heart valve devices |
US9173737B2 (en) | 2008-04-23 | 2015-11-03 | Medtronic, Inc. | Stented heart valve devices |
US8136218B2 (en) | 2008-04-29 | 2012-03-20 | Medtronic, Inc. | Prosthetic heart valve, prosthetic heart valve assembly and method for making same |
US20090276040A1 (en) | 2008-05-01 | 2009-11-05 | Edwards Lifesciences Corporation | Device and method for replacing mitral valve |
US8152844B2 (en) | 2008-05-09 | 2012-04-10 | Edwards Lifesciences Corporation | Quick-release annuloplasty ring holder |
US9061119B2 (en) | 2008-05-09 | 2015-06-23 | Edwards Lifesciences Corporation | Low profile delivery system for transcatheter heart valve |
US20110071626A1 (en) | 2008-05-12 | 2011-03-24 | Wright John T M | Device and Method for the Surgical Treatment of Ischemic Mitral Regurgitation |
US20090287304A1 (en) | 2008-05-13 | 2009-11-19 | Kardium Inc. | Medical Device for Constricting Tissue or a Bodily Orifice, for example a mitral valve |
GB0809357D0 (en) | 2008-05-22 | 2008-07-02 | Punjabi Prakash | Heart valve repair device |
US8317806B2 (en) | 2008-05-30 | 2012-11-27 | Ethicon Endo-Surgery, Inc. | Endoscopic suturing tension controlling and indication devices |
DK3263070T3 (en) | 2008-06-06 | 2020-01-20 | Edwards Lifesciences Corp | Low profile transcatheter heart valve |
US8591460B2 (en) | 2008-06-13 | 2013-11-26 | Cardiosolutions, Inc. | Steerable catheter and dilator and system and method for implanting a heart implant |
CA2725506C (en) | 2008-06-20 | 2019-03-05 | Vysera Biomedical Limited | A valve |
US8323335B2 (en) | 2008-06-20 | 2012-12-04 | Edwards Lifesciences Corporation | Retaining mechanisms for prosthetic valves and methods for using |
US8087142B2 (en) | 2008-07-02 | 2012-01-03 | Easylap Ltd. | Pivoting tacker |
WO2010000454A1 (en) | 2008-07-04 | 2010-01-07 | Corus Uk Limited | Method for coating a steel substrate, and coated steel substrate |
US8708934B2 (en) | 2008-07-11 | 2014-04-29 | Medtronic, Inc. | Reorientation of patient posture states for posture-responsive therapy |
US20100010538A1 (en) | 2008-07-11 | 2010-01-14 | Maquet Cardiovascular Llc | Reshaping the mitral valve of a heart |
US9226820B2 (en) | 2008-07-15 | 2016-01-05 | St. Jude Medical, Inc. | Axially anchoring collapsible and re-expandable prosthetic heart valves for various disease states |
DE202009018961U1 (en) | 2008-07-15 | 2014-11-26 | St. Jude Medical, Inc. | Heart valve prosthesis and arrangement for delivering a heart valve prosthesis |
AT507113B1 (en) | 2008-07-17 | 2010-07-15 | Siemens Vai Metals Tech Gmbh | METHOD AND APPARATUS FOR ENERGY AND CO2 EMISSION OPTIMIZED IRON PRODUCTION |
JP5123433B2 (en) | 2008-07-17 | 2013-01-23 | エヌヴェーテー アーゲー | Prosthetic heart valve system |
EP2334261B1 (en) | 2008-07-21 | 2021-01-13 | Jenesis Surgical, LLC | Endoluminal support apparatus and method of fabricating it |
US20100023118A1 (en) | 2008-07-24 | 2010-01-28 | Edwards Lifesciences Corporation | Method and apparatus for repairing or replacing chordae tendinae |
BRPI0916696A2 (en) | 2008-07-29 | 2015-11-17 | St Jude Medical Cardiology Div | method and system for long term adjustment of an implant device |
US8337390B2 (en) | 2008-07-30 | 2012-12-25 | Cube S.R.L. | Intracardiac device for restoring the functional elasticity of the cardiac structures, holding tool for the intracardiac device, and method for implantation of the intracardiac device in the heart |
US8778016B2 (en) | 2008-08-14 | 2014-07-15 | Edwards Lifesciences Corporation | Method and apparatus for repairing or replacing chordae tendinae |
US8652202B2 (en) | 2008-08-22 | 2014-02-18 | Edwards Lifesciences Corporation | Prosthetic heart valve and delivery apparatus |
JP5945119B2 (en) | 2008-09-05 | 2016-07-05 | クック・メディカル・テクノロジーズ・リミテッド・ライアビリティ・カンパニーCook Medical Technologies Llc | Apparatus and method for improved stent deployment |
US8777990B2 (en) | 2008-09-08 | 2014-07-15 | Howmedica Osteonics Corp. | Knotless suture anchor for soft tissue repair and method of use |
US9408649B2 (en) | 2008-09-11 | 2016-08-09 | Innovasis, Inc. | Radiolucent screw with radiopaque marker |
US8945211B2 (en) | 2008-09-12 | 2015-02-03 | Mitralign, Inc. | Tissue plication device and method for its use |
US8721714B2 (en) | 2008-09-17 | 2014-05-13 | Medtronic Corevalve Llc | Delivery system for deployment of medical devices |
US9314335B2 (en) | 2008-09-19 | 2016-04-19 | Edwards Lifesciences Corporation | Prosthetic heart valve configured to receive a percutaneous prosthetic heart valve implantation |
US8287591B2 (en) | 2008-09-19 | 2012-10-16 | Edwards Lifesciences Corporation | Transformable annuloplasty ring configured to receive a percutaneous prosthetic heart valve implantation |
US9375310B2 (en) | 2012-12-31 | 2016-06-28 | Edwards Lifesciences Corporation | Surgical heart valves adapted for post-implant expansion |
EP2350898B1 (en) | 2008-09-24 | 2020-05-20 | ResMed Sensor Technologies Limited | Contactless and minimal-contact monitoring of quality of life parameters for assessment and intervention |
CN102292053A (en) | 2008-09-29 | 2011-12-21 | 卡迪尔克阀门技术公司 | Heart valve |
WO2010040009A1 (en) | 2008-10-01 | 2010-04-08 | Cardiaq Valve Technologies, Inc. | Delivery system for vascular implant |
CN102245110A (en) | 2008-10-10 | 2011-11-16 | 导向传输系统股份有限公司 | Tether tensioning devices and related methods |
EP2349019B1 (en) | 2008-10-10 | 2020-03-25 | Ancora Heart, Inc. | Termination devices and related methods |
ES2409693T3 (en) | 2008-10-10 | 2013-06-27 | Sadra Medical, Inc. | Medical devices and supply systems to supply medical devices |
US8137398B2 (en) | 2008-10-13 | 2012-03-20 | Medtronic Ventor Technologies Ltd | Prosthetic valve having tapered tip when compressed for delivery |
US8986361B2 (en) | 2008-10-17 | 2015-03-24 | Medtronic Corevalve, Inc. | Delivery system for deployment of medical devices |
US8449625B2 (en) | 2009-10-27 | 2013-05-28 | Edwards Lifesciences Corporation | Methods of measuring heart valve annuluses for valve replacement |
US8696717B2 (en) | 2008-11-05 | 2014-04-15 | K2M, Inc. | Multi-planar, taper lock screw with additional lock |
EP4321134A2 (en) | 2008-11-21 | 2024-02-14 | Percutaneous Cardiovascular Solutions Pty Limited | Heart valve prosthesis and method |
DE102008058894B3 (en) | 2008-11-26 | 2010-06-17 | Vimecon Gmbh | laser applicator |
JP5530455B2 (en) | 2008-12-04 | 2014-06-25 | ジョージア テック リサーチ コーポレーション | Device for minimally invasive heart valve treatment |
US8308798B2 (en) | 2008-12-19 | 2012-11-13 | Edwards Lifesciences Corporation | Quick-connect prosthetic heart valve and methods |
JP5100850B2 (en) | 2008-12-19 | 2012-12-19 | パナソニック株式会社 | Exterior parts, manufacturing method thereof, and electronic equipment |
US8323312B2 (en) | 2008-12-22 | 2012-12-04 | Abbott Laboratories | Closure device |
US8147542B2 (en) | 2008-12-22 | 2012-04-03 | Valtech Cardio, Ltd. | Adjustable repair chords and spool mechanism therefor |
US8715342B2 (en) | 2009-05-07 | 2014-05-06 | Valtech Cardio, Ltd. | Annuloplasty ring with intra-ring anchoring |
US8241351B2 (en) | 2008-12-22 | 2012-08-14 | Valtech Cardio, Ltd. | Adjustable partial annuloplasty ring and mechanism therefor |
US8808368B2 (en) | 2008-12-22 | 2014-08-19 | Valtech Cardio, Ltd. | Implantation of repair chords in the heart |
WO2010073246A2 (en) | 2008-12-22 | 2010-07-01 | Valtech Cardio, Ltd. | Adjustable annuloplasty devices and adjustment mechanisms therefor |
US10517719B2 (en) | 2008-12-22 | 2019-12-31 | Valtech Cardio, Ltd. | Implantation of repair devices in the heart |
US8545553B2 (en) | 2009-05-04 | 2013-10-01 | Valtech Cardio, Ltd. | Over-wire rotation tool |
US8926697B2 (en) | 2011-06-23 | 2015-01-06 | Valtech Cardio, Ltd. | Closed band for percutaneous annuloplasty |
US9011530B2 (en) | 2008-12-22 | 2015-04-21 | Valtech Cardio, Ltd. | Partially-adjustable annuloplasty structure |
US8940044B2 (en) | 2011-06-23 | 2015-01-27 | Valtech Cardio, Ltd. | Closure element for use with an annuloplasty structure |
US20110011917A1 (en) | 2008-12-31 | 2011-01-20 | Hansen Medical, Inc. | Methods, devices, and kits for treating valve prolapse |
WO2010078121A2 (en) | 2008-12-31 | 2010-07-08 | Genesee Biomedical, Inc. | Semi-rigid annuloplasty ring and band |
US20100174363A1 (en) | 2009-01-07 | 2010-07-08 | Endovalve, Inc. | One Piece Prosthetic Valve Support Structure and Related Assemblies |
WO2010080884A1 (en) | 2009-01-07 | 2010-07-15 | Cook Incorporated | Implantable valve prosthesis with independent frame elements |
US8690911B2 (en) | 2009-01-08 | 2014-04-08 | Coherex Medical, Inc. | Medical device for modification of left atrial appendage and related systems and methods |
US8998982B2 (en) | 2009-01-12 | 2015-04-07 | Valve Medical Ltd. | Method and apparatus for fine adjustment of a percutaneous valve structure |
US9681950B2 (en) | 2009-01-12 | 2017-06-20 | Valve Medical Ltd. | System and method for placing a percutaneous valve device |
US9204965B2 (en) | 2009-01-14 | 2015-12-08 | Lc Therapeutics, Inc. | Synthetic chord |
US20100198192A1 (en) | 2009-01-20 | 2010-08-05 | Eugene Serina | Anchor deployment devices and related methods |
AU2010206732A1 (en) | 2009-01-22 | 2011-08-25 | St. Jude Medical, Cardiology Division, Inc. | Post-operative adjustment tool, minimally invasive attachment apparatus, and adjustable tricuspid ring |
BRPI1007540A2 (en) | 2009-01-22 | 2016-02-16 | St Jude Medical Cardiology Div | device and method for adjusting at least one of the shape and size of an anatomical or lumen orifice |
WO2010090721A1 (en) | 2009-02-06 | 2010-08-12 | St. Jude Medical, Inc. | Adjustable annuloplasty ring support |
US8574289B2 (en) | 2009-02-09 | 2013-11-05 | St. Jude Medical, Cardiology Division, Inc. | Inflatable minimally invasive system for delivering and securing an annular implant |
WO2010091653A1 (en) | 2009-02-11 | 2010-08-19 | Georg Lutter | Catheter |
EP2395923A1 (en) | 2009-02-16 | 2011-12-21 | Tigenix N.V. | Biopsy device |
US8353956B2 (en) | 2009-02-17 | 2013-01-15 | Valtech Cardio, Ltd. | Actively-engageable movement-restriction mechanism for use with an annuloplasty structure |
US8777998B2 (en) | 2009-02-23 | 2014-07-15 | Orthopediatrics Corp. | Pediatric long bone support or fixation plate |
US20110144703A1 (en) | 2009-02-24 | 2011-06-16 | Krause William R | Flexible Screw |
US20100217382A1 (en) | 2009-02-25 | 2010-08-26 | Edwards Lifesciences | Mitral valve replacement with atrial anchoring |
US20100217362A1 (en) | 2009-02-26 | 2010-08-26 | Parsons Chanda R | Article of Manufacture & Method for Moisturizing & Relieving Minor Pain |
BRPI1008902A2 (en) | 2009-02-27 | 2016-03-15 | St Jude Medical | prosthetic heart valve. |
US8021420B2 (en) | 2009-03-12 | 2011-09-20 | Medtronic Vascular, Inc. | Prosthetic valve delivery system |
US9078751B2 (en) | 2009-03-17 | 2015-07-14 | Mitrassist Medical Ltd. | Heart valve prosthesis with collapsible valve and method of delivery thereof |
US8052741B2 (en) | 2009-03-23 | 2011-11-08 | Medtronic Vascular, Inc. | Branch vessel prosthesis with a roll-up sealing assembly |
EP2413843B1 (en) | 2009-03-30 | 2020-04-22 | Suzhou Jiecheng Medical Technology Co. Ltd. | Sutureless valve prostheses and devices for delivery |
US9980818B2 (en) | 2009-03-31 | 2018-05-29 | Edwards Lifesciences Corporation | Prosthetic heart valve system with positioning markers |
WO2010117471A2 (en) | 2009-04-10 | 2010-10-14 | Lon Southerland Annest | An implantable scaffolding containing an orifice for use with a prosthetic or bio-prosthetic valve |
US20100262233A1 (en) | 2009-04-12 | 2010-10-14 | Texas Tech University System | Mitral Valve Coaptation Plate For Mitral Valve Regurgitation |
EP4119098A1 (en) | 2009-04-15 | 2023-01-18 | Edwards Lifesciences CardiAQ LLC | Vascular implant and delivery system |
CA2760461C (en) | 2009-04-29 | 2014-10-07 | The Cleveland Clinic Foundation | Apparatus and method for replacing a diseased cardiac valve |
WO2013069019A2 (en) | 2011-11-08 | 2013-05-16 | Valtech Cardio, Ltd. | Controlled steering functionality for implant-delivery tool |
WO2010128501A1 (en) | 2009-05-04 | 2010-11-11 | V-Wave Ltd. | Device and method for regulating pressure in a heart chamber |
US9968452B2 (en) | 2009-05-04 | 2018-05-15 | Valtech Cardio, Ltd. | Annuloplasty ring delivery cathethers |
WO2010129900A1 (en) | 2009-05-07 | 2010-11-11 | Georgia Tech Research Corporation | Implantable prosthetic vascular valves |
US8523881B2 (en) | 2010-07-26 | 2013-09-03 | Valtech Cardio, Ltd. | Multiple anchor delivery tool |
US20100286628A1 (en) | 2009-05-07 | 2010-11-11 | Rainbow Medical Ltd | Gastric anchor |
DE202009007113U1 (en) | 2009-05-18 | 2010-10-14 | Novomatic Automatenindustrie- Und Handelsgesellschaft M.B.H. & Co. Kg | Electronic game device |
US8075611B2 (en) | 2009-06-02 | 2011-12-13 | Medtronic, Inc. | Stented prosthetic heart valves |
WO2010139771A2 (en) | 2009-06-03 | 2010-12-09 | Symetis Sa | Closure device and methods and systems for using same |
US8348998B2 (en) | 2009-06-26 | 2013-01-08 | Edwards Lifesciences Corporation | Unitary quick connect prosthetic heart valve and deployment system and methods |
WO2010150178A2 (en) | 2009-06-26 | 2010-12-29 | Simcha Milo | Surgical stapler and method of surgical stapling |
EP2448522A4 (en) | 2009-07-02 | 2018-01-31 | The Cleveland Clinic Foundation | Apparatus and method for replacing a diseased cardiac valve |
US8439970B2 (en) | 2009-07-14 | 2013-05-14 | Edwards Lifesciences Corporation | Transapical delivery system for heart valves |
US20110022165A1 (en) | 2009-07-23 | 2011-01-27 | Edwards Lifesciences Corporation | Introducer for prosthetic heart valve |
US8845722B2 (en) | 2009-08-03 | 2014-09-30 | Shlomo Gabbay | Heart valve prosthesis and method of implantation thereof |
US8801706B2 (en) | 2009-08-27 | 2014-08-12 | Medtronic, Inc. | Paravalvular leak closure devices and methods |
KR101116867B1 (en) | 2009-08-28 | 2012-03-06 | 김준홍 | The device for delivering optimal tension safaely and effectively in cerclage annuloplasty procedure |
IN2012DN02038A (en) | 2009-08-28 | 2015-08-21 | 3F Therapeutics Inc | |
EP2475328B1 (en) | 2009-09-11 | 2014-08-27 | GI Dynamics, Inc. | Anchors with open heads |
EP2633821B1 (en) | 2009-09-15 | 2016-04-06 | Evalve, Inc. | Device for cardiac valve repair |
US8459302B2 (en) | 2009-09-21 | 2013-06-11 | Gulf Sea Ventures LLC | Fluid-directing multiport rotary valve |
US9730790B2 (en) | 2009-09-29 | 2017-08-15 | Edwards Lifesciences Cardiaq Llc | Replacement valve and method |
US20110077730A1 (en) | 2009-09-30 | 2011-03-31 | Fenster Michael S | Bifurcated balloon stent |
WO2011041571A2 (en) | 2009-10-01 | 2011-04-07 | Kardium Inc. | Medical device, kit and method for constricting tissue or a bodily orifice, for example, a mitral valve |
US20190060070A1 (en) | 2009-10-06 | 2019-02-28 | Adam Groothuis | Systems and methods for treating lumenal valves |
WO2011044486A1 (en) | 2009-10-09 | 2011-04-14 | Boston Scientific Scimed, Inc. | Stomach bypass for the treatment of obesity |
US20110093002A1 (en) | 2009-10-20 | 2011-04-21 | Wilson-Cook Medical Inc. | Stent-within-stent arrangements |
WO2011056578A2 (en) | 2009-10-26 | 2011-05-12 | Cardiokinetix, Inc. | Ventricular volume reduction |
US8690939B2 (en) | 2009-10-29 | 2014-04-08 | Valtech Cardio, Ltd. | Method for guide-wire based advancement of a rotation assembly |
US8277502B2 (en) | 2009-10-29 | 2012-10-02 | Valtech Cardio, Ltd. | Tissue anchor for annuloplasty device |
US9011520B2 (en) | 2009-10-29 | 2015-04-21 | Valtech Cardio, Ltd. | Tissue anchor for annuloplasty device |
CN102665612B (en) | 2009-11-05 | 2015-04-08 | 宾夕法尼亚大学理事会 | Valve prosthesis |
DE102009046769A1 (en) | 2009-11-17 | 2011-05-19 | Robert Bosch Gmbh | exhaust treatment device |
EP2506777B1 (en) | 2009-12-02 | 2020-11-25 | Valtech Cardio, Ltd. | Combination of spool assembly coupled to a helical anchor and delivery tool for implantation thereof |
US8449599B2 (en) | 2009-12-04 | 2013-05-28 | Edwards Lifesciences Corporation | Prosthetic valve for replacing mitral valve |
US20130190861A1 (en) | 2012-01-23 | 2013-07-25 | Tendyne Holdings, Inc. | Prosthetic Valve for Replacing Mitral Valve |
US8870950B2 (en) | 2009-12-08 | 2014-10-28 | Mitral Tech Ltd. | Rotation-based anchoring of an implant |
AU2010328106A1 (en) | 2009-12-08 | 2012-07-05 | Avalon Medical Ltd. | Device and system for transcatheter mitral valve replacement |
US8951595B2 (en) | 2009-12-11 | 2015-02-10 | Abbott Cardiovascular Systems Inc. | Coatings with tunable molecular architecture for drug-coated balloon |
CA2784499C (en) | 2009-12-15 | 2017-04-18 | Edwards Lifesciences Corporation | Expansion device for treatment of vascular passageways |
WO2011084342A1 (en) | 2009-12-17 | 2011-07-14 | Cook Medical Technologies Llc | Delivery system with retractable proximal end |
ES2647826T3 (en) | 2009-12-18 | 2017-12-26 | Coloplast A/S | A urological device |
US20110230961A1 (en) | 2010-01-05 | 2011-09-22 | Micardia Corporation | Dynamically adjustable annuloplasty ring and papillary muscle repositioning suture |
US9504562B2 (en) | 2010-01-12 | 2016-11-29 | Valve Medical Ltd. | Self-assembling modular percutaneous valve and methods of folding, assembly and delivery |
GB201001075D0 (en) | 2010-01-22 | 2010-03-10 | Cyclacel Ltd | Crystalline forms |
US8961596B2 (en) | 2010-01-22 | 2015-02-24 | 4Tech Inc. | Method and apparatus for tricuspid valve repair using tension |
US8475525B2 (en) | 2010-01-22 | 2013-07-02 | 4Tech Inc. | Tricuspid valve repair using tension |
US10932907B2 (en) | 2010-02-03 | 2021-03-02 | Medtronic, Inc. | Semi-flexible annuloplasty ring |
US9107749B2 (en) | 2010-02-03 | 2015-08-18 | Edwards Lifesciences Corporation | Methods for treating a heart |
US8926693B2 (en) | 2010-02-17 | 2015-01-06 | Medtronic, Inc. | Heart valve delivery catheter with safety button |
US20110208293A1 (en) | 2010-02-23 | 2011-08-25 | Medtronic, Inc. | Catheter-Based Heart Valve Therapy System with Sizing Balloon |
US9226826B2 (en) | 2010-02-24 | 2016-01-05 | Medtronic, Inc. | Transcatheter valve structure and methods for valve delivery |
US9522062B2 (en) | 2010-02-24 | 2016-12-20 | Medtronic Ventor Technologies, Ltd. | Mitral prosthesis and methods for implantation |
US9072603B2 (en) | 2010-02-24 | 2015-07-07 | Medtronic Ventor Technologies, Ltd. | Mitral prosthesis and methods for implantation |
US8545552B2 (en) | 2010-02-26 | 2013-10-01 | Silk Road Medical, Inc. | Systems and methods for transcatheter aortic valve treatment |
US8361144B2 (en) | 2010-03-01 | 2013-01-29 | Colibri Heart Valve Llc | Percutaneously deliverable heart valve and methods associated therewith |
EP3335670B1 (en) | 2010-03-05 | 2022-05-04 | Edwards Lifesciences Corporation | Retaining mechanisms for prosthetic valves |
US8795354B2 (en) | 2010-03-05 | 2014-08-05 | Edwards Lifesciences Corporation | Low-profile heart valve and delivery system |
US20110224785A1 (en) | 2010-03-10 | 2011-09-15 | Hacohen Gil | Prosthetic mitral valve with tissue anchors |
US20110238094A1 (en) * | 2010-03-25 | 2011-09-29 | Thomas Jonathan D | Hernia Patch |
WO2011120050A1 (en) | 2010-03-26 | 2011-09-29 | Thubrikar Aortic Valve, Inc. | Valve component, frame component and prosthetic valve device including the same for implantation in a body lumen |
US9320597B2 (en) | 2010-03-30 | 2016-04-26 | Medtronic, Inc. | Transcatheter prosthetic heart valve delivery system with recapturing feature and method |
US8491650B2 (en) | 2010-04-08 | 2013-07-23 | Medtronic, Inc. | Transcatheter prosthetic heart valve delivery system and method with stretchable stability tube |
US8512400B2 (en) | 2010-04-09 | 2013-08-20 | Medtronic, Inc. | Transcatheter heart valve delivery system with reduced area moment of inertia |
US8926692B2 (en) | 2010-04-09 | 2015-01-06 | Medtronic, Inc. | Transcatheter prosthetic heart valve delivery device with partial deployment and release features and methods |
US8512401B2 (en) | 2010-04-12 | 2013-08-20 | Medtronic, Inc. | Transcatheter prosthetic heart valve delivery system with funnel recapturing feature and method |
US20110251676A1 (en) | 2010-04-12 | 2011-10-13 | Medtronic Vascular, Inc. | Sheath for Controlled Delivery of a Heart Valve Prosthesis |
US8579963B2 (en) | 2010-04-13 | 2013-11-12 | Medtronic, Inc. | Transcatheter prosthetic heart valve delivery device with stability tube and method |
US20110257721A1 (en) | 2010-04-15 | 2011-10-20 | Medtronic, Inc. | Prosthetic Heart Valves and Delivery Methods |
US8357195B2 (en) | 2010-04-15 | 2013-01-22 | Medtronic, Inc. | Catheter based annuloplasty system and method |
US8740976B2 (en) | 2010-04-21 | 2014-06-03 | Medtronic, Inc. | Transcatheter prosthetic heart valve delivery system with flush report |
US9545306B2 (en) | 2010-04-21 | 2017-01-17 | Medtronic, Inc. | Prosthetic valve with sealing members and methods of use thereof |
US8623075B2 (en) | 2010-04-21 | 2014-01-07 | Medtronic, Inc. | Transcatheter prosthetic heart valve delivery system and method with controlled expansion of prosthetic heart valve |
US8876892B2 (en) | 2010-04-21 | 2014-11-04 | Medtronic, Inc. | Prosthetic heart valve delivery system with spacing |
EP2560589B1 (en) | 2010-04-23 | 2018-06-06 | Medtronic, Inc. | Delivery systems for prosthetic heart valves |
US8623079B2 (en) | 2010-04-23 | 2014-01-07 | Medtronic, Inc. | Stents for prosthetic heart valves |
US8568474B2 (en) | 2010-04-26 | 2013-10-29 | Medtronic, Inc. | Transcatheter prosthetic heart valve post-dilatation remodeling devices and methods |
EP2563278B1 (en) | 2010-04-27 | 2018-07-11 | Medtronic, Inc. | Transcatheter prosthetic heart valve delivery device with biased release features |
US9795482B2 (en) | 2010-04-27 | 2017-10-24 | Medtronic, Inc. | Prosthetic heart valve devices and methods of valve repair |
JP5688865B2 (en) | 2010-04-27 | 2015-03-25 | メドトロニック,インコーポレイテッド | Transcatheter prosthetic heart valve delivery device with passive trigger release |
US8974475B2 (en) | 2010-04-30 | 2015-03-10 | Medtronic, Inc. | Methods and devices for cardiac valve repair or replacement |
US8579964B2 (en) | 2010-05-05 | 2013-11-12 | Neovasc Inc. | Transcatheter mitral valve prosthesis |
AU2011250971B2 (en) | 2010-05-10 | 2015-05-07 | Hlt, Inc. | Stentless support structure |
US9554901B2 (en) | 2010-05-12 | 2017-01-31 | Edwards Lifesciences Corporation | Low gradient prosthetic heart valve |
US20110288435A1 (en) | 2010-05-19 | 2011-11-24 | George Michael Christy | Tactile sensory testing instrument |
US9433501B2 (en) | 2010-05-19 | 2016-09-06 | Direct Flow Medical, Inc. | Inflation media for implants |
US9603708B2 (en) | 2010-05-19 | 2017-03-28 | Dfm, Llc | Low crossing profile delivery catheter for cardiovascular prosthetic implant |
US10856978B2 (en) | 2010-05-20 | 2020-12-08 | Jenavalve Technology, Inc. | Catheter system |
US8790394B2 (en) | 2010-05-24 | 2014-07-29 | Valtech Cardio, Ltd. | Adjustable artificial chordeae tendineae with suture loops |
CA2799459A1 (en) | 2010-05-25 | 2011-12-01 | Jenavalve Technology Inc. | Prosthetic heart valve and transcatheter delivered endoprosthesis comprising a prosthetic heart valve and a stent |
US9023095B2 (en) | 2010-05-27 | 2015-05-05 | Idev Technologies, Inc. | Stent delivery system with pusher assembly |
US9561102B2 (en) | 2010-06-02 | 2017-02-07 | Medtronic, Inc. | Transcatheter delivery system and method with controlled expansion and contraction of prosthetic heart valve |
EP2575685B1 (en) | 2010-06-07 | 2019-02-13 | Valtech Cardio, Ltd. | Apparatus for guide-wire based advancement of a rotation assembly |
US9301864B2 (en) | 2010-06-08 | 2016-04-05 | Veniti, Inc. | Bi-directional stent delivery system |
US20130030522A1 (en) | 2010-06-16 | 2013-01-31 | Rowe Stanton J | Devices and methods for heart treatments |
EP3061422B1 (en) | 2010-06-21 | 2021-11-03 | Edwards Lifesciences CardiAQ LLC | Replacement heart valve |
US9326852B2 (en) | 2010-07-08 | 2016-05-03 | Benjamin Spenser | Method for implanting prosthetic valve |
US8408214B2 (en) | 2010-07-08 | 2013-04-02 | Benjamin Spenser | Method for implanting prosthetic valve |
US9095277B2 (en) | 2010-07-09 | 2015-08-04 | Mitralign, Inc. | Delivery catheter with forward-looking ultrasound imaging |
DK2590595T3 (en) | 2010-07-09 | 2015-12-07 | Highlife Sas | Transcatheter atrioventricular heart valve prosthesis |
US8657872B2 (en) | 2010-07-19 | 2014-02-25 | Jacques Seguin | Cardiac valve repair system and methods of use |
US8992604B2 (en) | 2010-07-21 | 2015-03-31 | Mitraltech Ltd. | Techniques for percutaneous mitral valve replacement and sealing |
US9132009B2 (en) | 2010-07-21 | 2015-09-15 | Mitraltech Ltd. | Guide wires with commissural anchors to advance a prosthetic valve |
US9763657B2 (en) | 2010-07-21 | 2017-09-19 | Mitraltech Ltd. | Techniques for percutaneous mitral valve replacement and sealing |
EP4098227A1 (en) | 2010-07-23 | 2022-12-07 | Edwards Lifesciences Corporation | Retaining mechanisms for prosthetic valves |
WO2012019052A2 (en) | 2010-08-04 | 2012-02-09 | Micardia Corporation | Percutaneous transcatheter repair of heart valves |
AU2011292463B2 (en) | 2010-08-17 | 2014-01-23 | St. Jude Medical, Inc. | Tip for medical implant delivery system |
CA2808639A1 (en) | 2010-08-17 | 2012-02-23 | Palmaz Scientific, Inc. | Transluminal cardiac ball valve and method for deployment thereof |
CN103153233B (en) | 2010-08-23 | 2016-02-10 | 爱德华兹生命科学公司 | Color-coded artificial valve's system and using method thereof |
US20120053680A1 (en) * | 2010-08-24 | 2012-03-01 | Bolling Steven F | Reconfiguring Heart Features |
US10105224B2 (en) | 2010-09-01 | 2018-10-23 | Mvalve Technologies Ltd. | Cardiac valve support structure |
US20120059337A1 (en) | 2010-09-01 | 2012-03-08 | Eran Eilat | Catheter with asymmetric or collapsible-expandable cross-section |
US9918833B2 (en) | 2010-09-01 | 2018-03-20 | Medtronic Vascular Galway | Prosthetic valve support structure |
CA2809909A1 (en) | 2010-09-01 | 2012-03-08 | Julie A. Logan | Cardiac valve support structure |
US9861350B2 (en) | 2010-09-03 | 2018-01-09 | Ancora Heart, Inc. | Devices and methods for anchoring tissue |
EP4119107A3 (en) | 2010-09-10 | 2023-02-15 | Boston Scientific Limited | Valve replacement devices, delivery device for a valve replacement device and method of production of a valve replacement device |
US10076327B2 (en) | 2010-09-14 | 2018-09-18 | Evalve, Inc. | Flexible actuator mandrel for tissue apposition systems |
US9439795B2 (en) | 2010-09-17 | 2016-09-13 | St. Jude Medical, Cardiology Division, Inc. | Retainers for transcatheter heart valve delivery systems |
WO2012039753A2 (en) | 2010-09-20 | 2012-03-29 | St. Jude Medical, Cardiology Division, Inc. | Valve leaflet attachment in collapsible prosthetic valves |
USD652927S1 (en) | 2010-09-20 | 2012-01-24 | St. Jude Medical, Inc. | Surgical stent |
USD660433S1 (en) | 2010-09-20 | 2012-05-22 | St. Jude Medical, Inc. | Surgical stent assembly |
USD660967S1 (en) | 2010-09-20 | 2012-05-29 | St. Jude Medical, Inc. | Surgical stent |
USD653341S1 (en) | 2010-09-20 | 2012-01-31 | St. Jude Medical, Inc. | Surgical stent |
EP3459500B1 (en) | 2010-09-23 | 2020-09-16 | Edwards Lifesciences CardiAQ LLC | Replacement heart valves and delivery devices |
EP3111889B1 (en) | 2010-09-24 | 2019-11-13 | Symetis SA | A transcatheter aortic valve implantation system |
USD650433S1 (en) | 2010-09-27 | 2011-12-13 | Xerox Corporation | Ink stick for a phase change ink jet printer |
US8845720B2 (en) | 2010-09-27 | 2014-09-30 | Edwards Lifesciences Corporation | Prosthetic heart valve frame with flexible commissures |
US8568475B2 (en) | 2010-10-05 | 2013-10-29 | Edwards Lifesciences Corporation | Spiraled commissure attachment for prosthetic valve |
ES2891075T3 (en) | 2010-10-05 | 2022-01-26 | Edwards Lifesciences Corp | prosthetic heart valve |
EP2629699B1 (en) | 2010-10-21 | 2017-01-04 | Medtronic, Inc. | Mitral bioprosthesis with low ventricular profile |
US8968335B2 (en) | 2010-10-27 | 2015-03-03 | Mitralign, Inc. | Hand operated device for controlled deployment of a tissue anchor and method of using the same |
GB2485338B (en) | 2010-11-02 | 2012-12-05 | Cook Medical Technologies Llc | Introducer assembly and dilator tip therefor |
US9468547B2 (en) | 2010-11-11 | 2016-10-18 | W. L. Gore & Associates, Inc. | Deployment of endoluminal devices |
US9414944B2 (en) | 2010-11-11 | 2016-08-16 | W. L. Gore & Associates, Inc. | Deployment sleeve shortening mechanism |
US9005279B2 (en) | 2010-11-12 | 2015-04-14 | Shlomo Gabbay | Beating heart buttress and implantation method to prevent prolapse of a heart valve |
US9095466B2 (en) | 2010-11-16 | 2015-08-04 | W. L. Gore & Associates, Inc. | Apposition fiber for use in endoluminal deployment of expandable devices in tortuous anatomies |
US20120130475A1 (en) | 2010-11-16 | 2012-05-24 | Shaw Edward E | Sleeves for expandable medical devices |
US9675487B2 (en) | 2010-11-17 | 2017-06-13 | Cook Medical Technologies Llc | Prosthesis deployment system for vascular repair |
WO2012068541A2 (en) | 2010-11-18 | 2012-05-24 | Pavilion Medical Innovations | Tissue restraining devices and methods of use |
US9078750B2 (en) | 2010-11-30 | 2015-07-14 | Edwards Lifesciences Corporation | Ergonomic mitral heart valve holders |
FR2968954B1 (en) | 2010-12-15 | 2012-12-21 | Oreal | PROCESS FOR COLORING KERATIN FIBERS USING A DIRECT DYE WITH PROTECTED DISULFIDE / THIOL / THIOL FUNCTION AND WATER VAPOR |
US20120158021A1 (en) | 2010-12-19 | 2012-06-21 | Mitralign, Inc. | Steerable guide catheter having preformed curved shape |
US8657866B2 (en) | 2010-12-22 | 2014-02-25 | Cook Medical Technologies Llc | Emergency vascular repair prosthesis deployment system |
AU2011349578B2 (en) | 2010-12-23 | 2016-06-30 | Twelve, Inc. | System for mitral valve repair and replacement |
WO2012095159A2 (en) | 2011-01-11 | 2012-07-19 | Hans Reiner Figulla | Prosthetic valve for replacing an atrioventricular heart valve |
EP2478868A1 (en) | 2011-01-25 | 2012-07-25 | The Provost, Fellows, Foundation Scholars, and the other Members of Board, of the College of the Holy and Undivided Trinity of Queen Elizabeth | Implant device |
US8845717B2 (en) | 2011-01-28 | 2014-09-30 | Middle Park Medical, Inc. | Coaptation enhancement implant, system, and method |
US8888843B2 (en) | 2011-01-28 | 2014-11-18 | Middle Peak Medical, Inc. | Device, system, and method for transcatheter treatment of valve regurgitation |
US8932343B2 (en) | 2011-02-01 | 2015-01-13 | St. Jude Medical, Cardiology Division, Inc. | Blunt ended stent for prosthetic heart valve |
JP2014511220A (en) | 2011-02-02 | 2014-05-15 | セント・ジュード・メディカル,インコーポレイテッド | System and method for loading a collapsible heart valve into a delivery device |
WO2012112967A1 (en) | 2011-02-18 | 2012-08-23 | Guided Delivery Systems Inc. | Systems and methods for variable stiffness tethers |
WO2012161769A1 (en) | 2011-02-18 | 2012-11-29 | Guided Delivery Systems Inc. | Implant retrieval device |
WO2012112378A2 (en) | 2011-02-18 | 2012-08-23 | Vascor Inc. | Blood flow assist systems |
US9155619B2 (en) | 2011-02-25 | 2015-10-13 | Edwards Lifesciences Corporation | Prosthetic heart valve delivery apparatus |
WO2012127309A1 (en) | 2011-03-21 | 2012-09-27 | Ontorfano Matteo | Disk-based valve apparatus and method for the treatment of valve dysfunction |
US9072511B2 (en) | 2011-03-25 | 2015-07-07 | Kardium Inc. | Medical kit for constricting tissue or a bodily orifice, for example, a mitral valve |
US9308087B2 (en) | 2011-04-28 | 2016-04-12 | Neovasc Tiara Inc. | Sequentially deployed transcatheter mitral valve prosthesis |
US9554897B2 (en) | 2011-04-28 | 2017-01-31 | Neovasc Tiara Inc. | Methods and apparatus for engaging a valve prosthesis with tissue |
US20120296349A1 (en) | 2011-05-17 | 2012-11-22 | Boston Scientific Scimed, Inc. | Percutaneous Mitral Annulus Mini-Plication |
WO2012158187A1 (en) | 2011-05-17 | 2012-11-22 | Boston Scientific Scimed, Inc. | Corkscrew annuloplasty device |
EP2709559B1 (en) | 2011-05-17 | 2015-01-21 | Boston Scientific Scimed, Inc. | Annuloplasty ring with anchors fixed by curing polymer |
US8945209B2 (en) | 2011-05-20 | 2015-02-03 | Edwards Lifesciences Corporation | Encapsulated heart valve |
US9180009B2 (en) | 2011-05-25 | 2015-11-10 | Medtronic, Inc. | Droop tester apparatus and method |
US9289282B2 (en) | 2011-05-31 | 2016-03-22 | Edwards Lifesciences Corporation | System and method for treating valve insufficiency or vessel dilatation |
US9402721B2 (en) | 2011-06-01 | 2016-08-02 | Valcare, Inc. | Percutaneous transcatheter repair of heart valves via trans-apical access |
US10117765B2 (en) | 2011-06-14 | 2018-11-06 | W.L. Gore Associates, Inc | Apposition fiber for use in endoluminal deployment of expandable implants |
US8840664B2 (en) | 2011-06-15 | 2014-09-23 | Edwards Lifesciences Corporation | Heart valve prosthesis anchoring device and methods |
US9011523B2 (en) | 2011-06-20 | 2015-04-21 | Jacques Seguin | Prosthetic leaflet assembly for repairing a defective cardiac valve and methods of using the same |
JP5872692B2 (en) | 2011-06-21 | 2016-03-01 | トゥエルヴ, インコーポレイテッド | Artificial therapy device |
EP2723274B1 (en) | 2011-06-23 | 2017-12-27 | Valtech Cardio, Ltd. | Closure element for use with annuloplasty structure |
US20140303719A1 (en) | 2011-06-24 | 2014-10-09 | Inceptus Medical, Llc | Percutaneously implantable artificial heart valve system and associated methods and devices |
US8920482B2 (en) | 2011-06-30 | 2014-12-30 | Cook Medical Technologies Llc | Stent delivery system |
AU2012281087B2 (en) | 2011-07-12 | 2016-07-21 | Rush University Medical Center | Vessel bifurcation stent deployment system with zippered catheters |
US20130018450A1 (en) | 2011-07-13 | 2013-01-17 | Hunt James B | Prosthesis delivery system with retention sleeve |
US8795357B2 (en) | 2011-07-15 | 2014-08-05 | Edwards Lifesciences Corporation | Perivalvular sealing for transcatheter heart valve |
US9339384B2 (en) | 2011-07-27 | 2016-05-17 | Edwards Lifesciences Corporation | Delivery systems for prosthetic heart valve |
US8852272B2 (en) | 2011-08-05 | 2014-10-07 | Mitraltech Ltd. | Techniques for percutaneous mitral valve replacement and sealing |
US20140324164A1 (en) | 2011-08-05 | 2014-10-30 | Mitraltech Ltd. | Techniques for percutaneous mitral valve replacement and sealing |
WO2013021374A2 (en) | 2011-08-05 | 2013-02-14 | Mitraltech Ltd. | Techniques for percutaneous mitral valve replacement and sealing |
EP2739214B1 (en) | 2011-08-05 | 2018-10-10 | Cardiovalve Ltd | Percutaneous mitral valve replacement and sealing |
US20130041451A1 (en) | 2011-08-09 | 2013-02-14 | Cook Medical Technologies Llc | Prosthesis deployment system for open surgical repair |
CA3040390C (en) | 2011-08-11 | 2022-03-15 | Tendyne Holdings, Inc. | Improvements for prosthetic valves and related inventions |
EP2742063A1 (en) | 2011-08-11 | 2014-06-18 | Yeda Research and Development Co. Ltd. | Compositions and methods for modulating apoptosis |
US20130331929A1 (en) | 2011-09-09 | 2013-12-12 | Endoluminal Sciences Pty Ltd. | Means for Controlled Sealing of Endovascular Devices |
US20130190857A1 (en) * | 2011-09-09 | 2013-07-25 | Endoluminal Sciences Pty Ltd. | Means for controlled sealing of endovascular devices |
US20130178929A1 (en) | 2011-09-09 | 2013-07-11 | National Cerebral And Cardiovascular Center | Valved stent, base material for forming valved stent, and method for producing valved stent |
US9358108B2 (en) | 2011-09-12 | 2016-06-07 | Highlife Sas | Transcatheter valve prosthesis |
CN103917194B (en) | 2011-09-12 | 2017-02-15 | 高品质生活简化股份公司 | Transcatheter valve prosthesis |
US9387075B2 (en) | 2011-09-12 | 2016-07-12 | Highlife Sas | Transcatheter valve prosthesis |
US9011468B2 (en) | 2011-09-13 | 2015-04-21 | Abbott Cardiovascular Systems Inc. | Independent gripper |
US8945177B2 (en) | 2011-09-13 | 2015-02-03 | Abbott Cardiovascular Systems Inc. | Gripper pusher mechanism for tissue apposition systems |
US8900295B2 (en) | 2011-09-26 | 2014-12-02 | Edwards Lifesciences Corporation | Prosthetic valve with ventricular tethers |
CA2854116C (en) | 2011-09-28 | 2019-04-30 | Mitracore Technologies Inc. | Apparatuses and methods for cutting a tissue bridge and/or removing a heart valve clip or suture |
US10624664B2 (en) | 2011-09-28 | 2020-04-21 | Evalve, Inc. | Apparatuses and methods for cutting a tissue bridge and/or removing a heart valve clip or suture |
US9554904B2 (en) | 2011-09-28 | 2017-01-31 | Medtronic CV Luxembourg S.a.r.l. | Distal tip assembly for a heart valve delivery catheter |
US8764798B2 (en) | 2011-10-03 | 2014-07-01 | Smith & Nephew, Inc. | Knotless suture anchor |
US9763780B2 (en) | 2011-10-19 | 2017-09-19 | Twelve, Inc. | Devices, systems and methods for heart valve replacement |
WO2013059743A1 (en) | 2011-10-19 | 2013-04-25 | Foundry Newco Xii, Inc. | Devices, systems and methods for heart valve replacement |
CA3090422C (en) | 2011-10-19 | 2023-08-01 | Twelve, Inc. | Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods |
CA2852369A1 (en) | 2011-10-21 | 2013-04-25 | Jenavalve Technology Inc. | Catheter system for introducing an expandable heart valve stent into the body of a patient, insertion system with a catheter system and medical device for treatment of a heart valve defect |
US9827093B2 (en) | 2011-10-21 | 2017-11-28 | Edwards Lifesciences Cardiaq Llc | Actively controllable stent, stent graft, heart valve and method of controlling same |
US8858623B2 (en) | 2011-11-04 | 2014-10-14 | Valtech Cardio, Ltd. | Implant having multiple rotational assemblies |
US20130116776A1 (en) | 2011-11-04 | 2013-05-09 | Valtech Cardio, Ltd. | External aortic ring and spool mechanism therefor |
EP2591754B1 (en) * | 2011-11-10 | 2015-02-25 | Medtentia International Ltd Oy | A device and a method for improving the function of a heart valve |
US9782282B2 (en) | 2011-11-14 | 2017-10-10 | W. L. Gore & Associates, Inc. | External steerable fiber for use in endoluminal deployment of expandable devices |
US9877858B2 (en) | 2011-11-14 | 2018-01-30 | W. L. Gore & Associates, Inc. | External steerable fiber for use in endoluminal deployment of expandable devices |
US9387097B2 (en) | 2011-11-16 | 2016-07-12 | W. L. Gore & Associates, Inc. | Implant assembly with tactile indicator |
FR2982763B1 (en) | 2011-11-17 | 2015-07-17 | Ct Hospitalier Regional Universitaire D Amiens | IMPLANT FOR PLACEMENT IN BLOOD CIRCULATION PASSAGE AND TREATMENT DEVICE THEREFOR |
US9445893B2 (en) * | 2011-11-21 | 2016-09-20 | Mor Research Applications Ltd. | Device for placement in the tricuspid annulus |
EP2785276A4 (en) * | 2011-12-01 | 2015-08-12 | Woodstock Man Pty Ltd | Endoluminal prosthesis |
US9364359B2 (en) | 2011-12-08 | 2016-06-14 | W. L. Gore & Associates, Inc. | Systems and methods for delivery of a medical device |
CA3097364C (en) | 2011-12-09 | 2023-08-01 | Edwards Lifesciences Corporation | Prosthetic heart valve having improved commissure supports |
EP2790609B1 (en) | 2011-12-12 | 2015-09-09 | David Alon | Heart valve repair device |
CN104114228B (en) | 2011-12-13 | 2016-06-08 | 心脏起搏器股份公司 | There is the implantable device of the top cover comprising identification tag or antenna connection features |
US9827092B2 (en) | 2011-12-16 | 2017-11-28 | Tendyne Holdings, Inc. | Tethers for prosthetic mitral valve |
US10321988B2 (en) | 2011-12-21 | 2019-06-18 | The Trustees Of The University Of Pennsylvania | Platforms for mitral valve replacement |
US9078747B2 (en) | 2011-12-21 | 2015-07-14 | Edwards Lifesciences Corporation | Anchoring device for replacing or repairing a heart valve |
FR2985659B1 (en) | 2012-01-13 | 2015-03-06 | Assist Publ Hopitaux De Paris | DEVICE FOR ANCHORING A PROTHETIC CARDIAC VALVE. |
KR101198775B1 (en) | 2012-01-18 | 2012-11-12 | 박광태 | Surgical instrument, and surgical mesh and surgical retractor for the same, and surgical method using the same |
EP2620125B1 (en) | 2012-01-24 | 2017-10-11 | Medtentia International Ltd Oy | An arrangement, a loop-shaped support, a prosthetic heart valve and a method of repairing or replacing a native heart valve |
US8961602B2 (en) | 2012-01-27 | 2015-02-24 | St. Jude Medical, Cardiology Division, Inc. | Adjustment suture markers for adjustable annuloplasty ring |
CA3208176A1 (en) | 2012-01-31 | 2013-08-08 | Mitral Valve Technologies Sarl | Mitral valve docking devices, systems and methods |
US9687371B2 (en) | 2012-02-14 | 2017-06-27 | W. L. Gore & Associates, Inc. | Endoprosthesis having aligned legs for ease of cannulation |
EP2818139A4 (en) | 2012-02-24 | 2015-10-21 | Terumo Corp | Stent-graft delivery device |
EP2819618B1 (en) | 2012-02-28 | 2018-05-02 | Mvalve Technologies Ltd. | Single-ring cardiac valve support |
US20130304197A1 (en) | 2012-02-28 | 2013-11-14 | Mvalve Technologies Ltd. | Cardiac valve modification device |
US20150094802A1 (en) | 2012-02-28 | 2015-04-02 | Mvalve Technologies Ltd. | Single-ring cardiac valve support |
US9180008B2 (en) | 2012-02-29 | 2015-11-10 | Valcare, Inc. | Methods, devices, and systems for percutaneously anchoring annuloplasty rings |
EP2819619B1 (en) | 2012-02-29 | 2019-01-16 | ValCare, Inc. | Percutaneous annuloplasty system with anterior-posterior adjustment |
US9579198B2 (en) | 2012-03-01 | 2017-02-28 | Twelve, Inc. | Hydraulic delivery systems for prosthetic heart valve devices and associated methods |
US9375308B2 (en) | 2012-03-13 | 2016-06-28 | W. L. Gore & Associates, Inc. | External steerable fiber for use in endoluminal deployment of expandable devices |
EP2641569B1 (en) | 2012-03-23 | 2015-01-28 | Sorin Group Italia S.r.l. | A collapsible valve prosthesis |
US8926694B2 (en) | 2012-03-28 | 2015-01-06 | Medtronic Vascular Galway Limited | Dual valve prosthesis for transcatheter valve implantation |
US9066800B2 (en) | 2012-03-28 | 2015-06-30 | Medtronic, Inc. | Dual valve prosthesis for transcatheter valve implantation |
US9011515B2 (en) | 2012-04-19 | 2015-04-21 | Caisson Interventional, LLC | Heart valve assembly systems and methods |
US9427315B2 (en) | 2012-04-19 | 2016-08-30 | Caisson Interventional, LLC | Valve replacement systems and methods |
US9314325B2 (en) | 2012-04-27 | 2016-04-19 | Cook Medical Technologies Llc | Anti-aspiration prosthesis |
US9427303B2 (en) | 2012-04-27 | 2016-08-30 | Cook Medical Technologies Llc | Anti-aspiration valve |
US9277990B2 (en) | 2012-05-04 | 2016-03-08 | St. Jude Medical, Cardiology Division, Inc. | Hypotube shaft with articulation mechanism |
DE202013011734U1 (en) | 2012-05-16 | 2014-04-29 | Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. | A catheter delivery system for inserting an expandable heart valve prosthesis and a medical device for treating a valvular defect |
DK2852354T3 (en) | 2012-05-20 | 2020-08-24 | Tel Hashomer Medical Res Infrastructure & Services Ltd | ARTIFICIAL MITRAL CLAP |
US9345573B2 (en) | 2012-05-30 | 2016-05-24 | Neovasc Tiara Inc. | Methods and apparatus for loading a prosthesis onto a delivery system |
DE102012010798A1 (en) | 2012-06-01 | 2013-12-05 | Universität Duisburg-Essen | Implantable device for improving or eliminating heart valve insufficiency |
US9918837B2 (en) | 2012-06-29 | 2018-03-20 | St. Jude Medical, Cardiology Division, Inc. | System to assist in the release of a collapsible stent from a delivery device |
US9241791B2 (en) | 2012-06-29 | 2016-01-26 | St. Jude Medical, Cardiology Division, Inc. | Valve assembly for crimp profile |
CA2875669C (en) | 2012-07-12 | 2017-02-14 | Boston Scientific Scimed, Inc. | Low profile heart valve delivery system and method |
WO2014022124A1 (en) | 2012-07-28 | 2014-02-06 | Tendyne Holdings, Inc. | Improved multi-component designs for heart valve retrieval device, sealing structures and stent assembly |
US9675454B2 (en) | 2012-07-30 | 2017-06-13 | Tendyne Holdings, Inc. | Delivery systems and methods for transcatheter prosthetic valves |
US9486349B2 (en) | 2012-08-10 | 2016-11-08 | W. L. Gore & Associates, Inc. | Systems and methods of deployment of endoluminal devices |
US9232995B2 (en) | 2013-01-08 | 2016-01-12 | Medtronic, Inc. | Valve prosthesis and method for delivery |
US10206775B2 (en) | 2012-08-13 | 2019-02-19 | Medtronic, Inc. | Heart valve prosthesis |
US9717595B2 (en) | 2012-09-05 | 2017-08-01 | Medtronic Vascular Galway | Trans-aortic delivery system with containment capsule centering device |
US20140067048A1 (en) | 2012-09-06 | 2014-03-06 | Edwards Lifesciences Corporation | Heart Valve Sealing Devices |
WO2014049106A1 (en) | 2012-09-27 | 2014-04-03 | Symetis Sa | Stent-valve, delivery apparatus, and stent-holder therefor |
CA2885354A1 (en) | 2012-09-29 | 2014-04-03 | Mitralign, Inc. | Plication lock delivery system and method of use thereof |
US20140099726A1 (en) | 2012-10-10 | 2014-04-10 | Two Pore Guys, Inc. | Device for characterizing polymers |
US20140106951A1 (en) | 2012-10-15 | 2014-04-17 | W. L. Gore & Associates, Inc. | Methods and systems for securing a sleeve for endoluminal devices |
US10376266B2 (en) | 2012-10-23 | 2019-08-13 | Valtech Cardio, Ltd. | Percutaneous tissue anchor techniques |
EP3517052A1 (en) | 2012-10-23 | 2019-07-31 | Valtech Cardio, Ltd. | Controlled steering functionality for implant-delivery tool |
US9763817B2 (en) | 2012-10-29 | 2017-09-19 | Cook Medical Technologies Llc | Delivery system with curved preloaded catheter |
US10010654B2 (en) | 2012-10-30 | 2018-07-03 | W. L. Gore & Associates, Inc. | Sleeve for medical device assembly |
US9023099B2 (en) | 2012-10-31 | 2015-05-05 | Medtronic Vascular Galway Limited | Prosthetic mitral valve and delivery method |
US9387105B2 (en) | 2012-11-12 | 2016-07-12 | W.L. Gore & Associates, Inc | Sleeves for expandable medical devices and methods of making the same |
US9610183B2 (en) | 2012-11-12 | 2017-04-04 | W.L. Gore & Associates, Inc. | Friction fiber sleeve retraction system |
US8628571B1 (en) | 2012-11-13 | 2014-01-14 | Mitraltech Ltd. | Percutaneously-deliverable mechanical valve |
US20140142688A1 (en) | 2012-11-20 | 2014-05-22 | Medtronic CV Luxembourg S.a.r.l. | Medical Device Delivery System and Methods of Delivering a Medical Device |
US9730793B2 (en) | 2012-12-06 | 2017-08-15 | Valtech Cardio, Ltd. | Techniques for guide-wire based advancement of a tool |
US9101469B2 (en) | 2012-12-19 | 2015-08-11 | W. L. Gore & Associates, Inc. | Prosthetic heart valve with leaflet shelving |
US10321986B2 (en) | 2012-12-19 | 2019-06-18 | W. L. Gore & Associates, Inc. | Multi-frame prosthetic heart valve |
EP2745812B1 (en) | 2012-12-19 | 2017-01-18 | Cook Medical Technologies LLC | Repositionable diameter constraints |
CN103908729B (en) | 2012-12-28 | 2016-12-28 | 米特拉利根公司 | Energy aid in tissue sting device and using method thereof |
US9066801B2 (en) | 2013-01-08 | 2015-06-30 | Medtronic, Inc. | Valve prosthesis and method for delivery |
US9993360B2 (en) | 2013-01-08 | 2018-06-12 | Endospan Ltd. | Minimization of stent-graft migration during implantation |
US9132007B2 (en) | 2013-01-10 | 2015-09-15 | Medtronic CV Luxembourg S.a.r.l. | Anti-paravalvular leakage components for a transcatheter valve prosthesis |
US20140194970A1 (en) | 2013-01-10 | 2014-07-10 | Trivascular, Inc. | Gate wire for contralateral leg access |
WO2014115273A1 (en) | 2013-01-23 | 2014-07-31 | テルモ株式会社 | Self-expanding stent system |
US9681952B2 (en) | 2013-01-24 | 2017-06-20 | Mitraltech Ltd. | Anchoring of prosthetic valve supports |
GB2510151B (en) | 2013-01-25 | 2015-07-22 | Cook Medical Technologies Llc | Vascular plug |
US9439763B2 (en) | 2013-02-04 | 2016-09-13 | Edwards Lifesciences Corporation | Prosthetic valve for replacing mitral valve |
CN105263442B (en) | 2013-02-04 | 2019-02-15 | 托尔福公司 | Hydraulic conveyor and correlation technique for artificial heart valve film device |
US9456897B2 (en) | 2013-02-21 | 2016-10-04 | Medtronic, Inc. | Transcatheter valve prosthesis and a concurrently delivered sealing component |
WO2014134183A1 (en) | 2013-02-26 | 2014-09-04 | Mitralign, Inc. | Devices and methods for percutaneous tricuspid valve repair |
JP6473089B2 (en) | 2013-03-05 | 2019-02-20 | メリット・メディカル・システムズ・インコーポレイテッドMerit Medical Systems,Inc. | Reinforcing valve |
US10583002B2 (en) | 2013-03-11 | 2020-03-10 | Neovasc Tiara Inc. | Prosthetic valve with anti-pivoting mechanism |
US8986375B2 (en) | 2013-03-12 | 2015-03-24 | Medtronic, Inc. | Anti-paravalvular leakage component for a transcatheter valve prosthesis |
EP2967870A4 (en) | 2013-03-13 | 2016-11-16 | Aortic Innovations Llc | Dual frame stent and valve devices and implantation |
US20140277358A1 (en) | 2013-03-13 | 2014-09-18 | DePuy Synthes Products, LLC | Striped stent introducer |
US10449333B2 (en) | 2013-03-14 | 2019-10-22 | Valtech Cardio, Ltd. | Guidewire feeder |
US9011526B2 (en) | 2013-03-14 | 2015-04-21 | Cormatrix Cardiovascular, Inc | Tubular extracellular matrix prosthetic valve |
US20140277427A1 (en) | 2013-03-14 | 2014-09-18 | Cardiaq Valve Technologies, Inc. | Prosthesis for atraumatically grasping intralumenal tissue and methods of delivery |
US9226839B1 (en) | 2013-03-14 | 2016-01-05 | W. L. Gore & Associates, Inc. | Torque sleeve |
US9681951B2 (en) | 2013-03-14 | 2017-06-20 | Edwards Lifesciences Cardiaq Llc | Prosthesis with outer skirt and anchors |
EP2968847B1 (en) | 2013-03-15 | 2023-03-08 | Edwards Lifesciences Corporation | Translation catheter systems |
KR102423195B1 (en) | 2013-03-15 | 2022-07-20 | 네비게이트 카디악 스트럭쳐스, 인크. | Catheter-guided replacement valves apparatus and methods |
US9232994B2 (en) | 2013-03-15 | 2016-01-12 | Medtronic Vascular Galway Limited | Stented prosthetic heart valve and methods for making |
CA2901008C (en) | 2013-03-15 | 2021-06-22 | Twelve, Inc. | Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods |
US20140296969A1 (en) | 2013-04-02 | 2014-10-02 | Tendyne Holdlings, Inc. | Anterior Leaflet Clip Device for Prosthetic Mitral Valve |
FR3004638B1 (en) | 2013-04-19 | 2015-05-29 | Invalv Lab | IMPLANT, IN PARTICULAR TO BE PLACED IN A CARDIAC AURICULO-VENTRICULAR VALVE, COMPRISING A PROXIMAL ARM SPLITTING SYSTEM |
DE102013208038B4 (en) | 2013-05-02 | 2016-09-08 | Michael Siegenthaler | Catheter-based cardiac assist system |
KR102245192B1 (en) | 2013-05-06 | 2021-04-29 | 온테라 인크. | Target detection with nanopore |
US20140329225A1 (en) | 2013-05-06 | 2014-11-06 | Two Pore Guys, Inc. | Target detection with nanopore |
US10188515B2 (en) | 2013-05-13 | 2019-01-29 | Medtronic Vascular Inc. | Devices and methods for crimping a medical device |
CA2908342C (en) | 2013-05-20 | 2021-11-30 | Edwards Lifesciences Corporation | Prosthetic heart valve delivery apparatus |
CN105578991B (en) | 2013-05-29 | 2017-11-14 | M阀门技术有限公司 | It is equipped with valve leaflets heart valve support device |
US9610159B2 (en) | 2013-05-30 | 2017-04-04 | Tendyne Holdings, Inc. | Structural members for prosthetic mitral valves |
US20140358224A1 (en) | 2013-05-30 | 2014-12-04 | Tendyne Holdlings, Inc. | Six cell inner stent device for prosthetic mitral valves |
CN106618802B (en) | 2013-06-06 | 2018-02-06 | 戴维·阿隆 | Heart valve repair and replacing |
US9788983B2 (en) | 2013-06-21 | 2017-10-17 | Abbott Cardiovascular Systems Inc. | Removable sheath assembly for a polymer scaffold |
US9999507B2 (en) | 2013-06-25 | 2018-06-19 | Mitralign, Inc. | Percutaneous valve repair by reshaping and resizing right ventricle |
US20140379076A1 (en) | 2013-06-25 | 2014-12-25 | Tendyne Holdings, Inc. | Halo Wire Fluid Seal Device for Prosthetic Mitral Valves |
WO2014210219A1 (en) | 2013-06-25 | 2014-12-31 | Two Pore Guys, Inc. | Multiplexed biomarker quantitation by nanopore analysis of biomarker-polymer complexes |
EP3019092B1 (en) | 2013-07-10 | 2022-08-31 | Medtronic Inc. | Helical coil mitral valve annuloplasty systems |
US10524904B2 (en) | 2013-07-11 | 2020-01-07 | Medtronic, Inc. | Valve positioning device |
US8870948B1 (en) | 2013-07-17 | 2014-10-28 | Cephea Valve Technologies, Inc. | System and method for cardiac valve repair and replacement |
US10597702B2 (en) | 2013-08-26 | 2020-03-24 | Ontera Inc. | Molecule detection using boronic acid substituted probes |
USD730521S1 (en) | 2013-09-04 | 2015-05-26 | St. Jude Medical, Cardiology Division, Inc. | Stent with commissure attachments |
USD730520S1 (en) | 2013-09-04 | 2015-05-26 | St. Jude Medical, Cardiology Division, Inc. | Stent with commissure attachments |
US9393111B2 (en) | 2014-01-15 | 2016-07-19 | Sino Medical Sciences Technology Inc. | Device and method for mitral valve regurgitation treatment |
US9421094B2 (en) | 2013-10-23 | 2016-08-23 | Caisson Interventional, LLC | Methods and systems for heart valve therapy |
US10299793B2 (en) | 2013-10-23 | 2019-05-28 | Valtech Cardio, Ltd. | Anchor magazine |
US10182908B2 (en) | 2013-11-28 | 2019-01-22 | Mvalve Technologies Ltd. | Intracardiac devices comprising stabilizing elements having improved fatigue resistance |
US10098734B2 (en) * | 2013-12-05 | 2018-10-16 | Edwards Lifesciences Corporation | Prosthetic heart valve and delivery apparatus |
US9610162B2 (en) | 2013-12-26 | 2017-04-04 | Valtech Cardio, Ltd. | Implantation of flexible implant |
US9980832B2 (en) | 2014-01-28 | 2018-05-29 | Sanford Health | Pararenal and thoracic arch stent graft and methods for use |
WO2015120122A2 (en) | 2014-02-05 | 2015-08-13 | Robert Vidlund | Apparatus and methods for transfemoral delivery of prosthetic mitral valve |
US9072604B1 (en) | 2014-02-11 | 2015-07-07 | Gilberto Melnick | Modular transcatheter heart valve and implantation method |
JP2017506119A (en) | 2014-02-21 | 2017-03-02 | マイトラル・ヴァルヴ・テクノロジーズ・エス・アー・エール・エル | Devices, systems, and methods for delivering prosthetic mitral valves and anchor devices |
USD755384S1 (en) | 2014-03-05 | 2016-05-03 | Edwards Lifesciences Cardiaq Llc | Stent |
CA2937566C (en) | 2014-03-10 | 2023-09-05 | Tendyne Holdings, Inc. | Devices and methods for positioning and monitoring tether load for prosthetic mitral valve |
WO2015152980A1 (en) | 2014-03-31 | 2015-10-08 | St. Jude Medical, Cardiology Division, Inc. | Paravalvular sealing via extended cuff mechanisms |
US10149758B2 (en) | 2014-04-01 | 2018-12-11 | Medtronic, Inc. | System and method of stepped deployment of prosthetic heart valve |
US9833346B2 (en) | 2014-04-04 | 2017-12-05 | W. L. Gore & Associates, Inc. | Deployment handle for a medical device deployment system |
WO2015169866A1 (en) | 2014-05-06 | 2015-11-12 | Dsm Ip Assets B.V. | Prosthetic valve and method of making a prosthetic valve |
US10195025B2 (en) | 2014-05-12 | 2019-02-05 | Edwards Lifesciences Corporation | Prosthetic heart valve |
EP3143165A4 (en) | 2014-05-15 | 2018-05-16 | Two Pore Guys, Inc. | Scaffold data storage and target detection in a sample using a nanopore |
EP3142608A4 (en) | 2014-05-16 | 2018-02-21 | Benichou, Netanel | Replacement heart valve |
CA3161000A1 (en) | 2014-05-19 | 2015-11-26 | Edwards Lifesciences Cardiaq Llc | Replacement mitral valve with annular flap |
EP3134033B1 (en) | 2014-05-29 | 2018-04-04 | Edwards Lifesciences CardiAQ LLC | Prosthesis and delivery device |
US9532870B2 (en) | 2014-06-06 | 2017-01-03 | Edwards Lifesciences Corporation | Prosthetic valve for replacing a mitral valve |
US9662203B2 (en) | 2014-06-11 | 2017-05-30 | Medtronic Vascular, Inc. | Prosthetic valve with vortice-inducing baffle |
EP3154473A4 (en) | 2014-06-11 | 2017-11-22 | Micro Interventional Devices, Inc. | System and method for heart valve anchoring |
US9974647B2 (en) | 2014-06-12 | 2018-05-22 | Caisson Interventional, LLC | Two stage anchor and mitral valve assembly |
US9180005B1 (en) | 2014-07-17 | 2015-11-10 | Millipede, Inc. | Adjustable endolumenal mitral valve ring |
WO2016016899A1 (en) | 2014-07-30 | 2016-02-04 | Mitraltech Ltd. | Articulatable prosthetic valve |
AU2015305868B2 (en) | 2014-08-18 | 2018-09-20 | Edwards Lifesciences Corporation | Frame with integral sewing cuff for prosthetic valves |
MX2017003790A (en) | 2014-09-26 | 2017-08-07 | Two Pore Guys Inc | Target sequence detection by nanopore sensing of synthetic probes. |
US10507101B2 (en) | 2014-10-13 | 2019-12-17 | W. L. Gore & Associates, Inc. | Valved conduit |
US9750607B2 (en) | 2014-10-23 | 2017-09-05 | Caisson Interventional, LLC | Systems and methods for heart valve therapy |
US9750605B2 (en) | 2014-10-23 | 2017-09-05 | Caisson Interventional, LLC | Systems and methods for heart valve therapy |
US10524792B2 (en) | 2014-12-04 | 2020-01-07 | Edwards Lifesciences Corporation | Percutaneous clip for repairing a heart valve |
WO2016093877A1 (en) | 2014-12-09 | 2016-06-16 | Cephea Valve Technologies, Inc. | Replacement cardiac valves and methods of use and manufacture |
US11141142B2 (en) * | 2014-12-15 | 2021-10-12 | Vivasure Medical Limited | Implantable sealable member with mesh layer |
US9855141B2 (en) | 2014-12-18 | 2018-01-02 | W. L. Gore & Associates, Inc. | Prosthetic valves with mechanically coupled leaflets |
US11098348B2 (en) | 2015-02-02 | 2021-08-24 | Ontera Inc. | Nanopore detection of target polynucleotides from sample background |
RU2712245C2 (en) | 2015-02-02 | 2020-01-27 | Онтера Инк. | Labile linkers for detecting biomarker |
US20160220367A1 (en) | 2015-02-04 | 2016-08-04 | Medtronic Vascular, Inc. | Balloon valvuloplasty delivery system |
US9974651B2 (en) | 2015-02-05 | 2018-05-22 | Mitral Tech Ltd. | Prosthetic valve with axially-sliding frames |
WO2016125160A1 (en) | 2015-02-05 | 2016-08-11 | Mitraltech Ltd. | Prosthetic valve with axially-sliding frames |
US10039637B2 (en) | 2015-02-11 | 2018-08-07 | Edwards Lifesciences Corporation | Heart valve docking devices and implanting methods |
EP3258883A4 (en) | 2015-02-20 | 2019-02-27 | 4C Medical Technologies, Inc. | Devices, systems and methods for cardiac treatment |
US9983191B2 (en) | 2015-03-11 | 2018-05-29 | Two Pore Guys, Inc. | Nanopore detection of small molecules through competition assays |
CN107613908B (en) | 2015-03-19 | 2020-03-10 | 凯森因特万逊奈尔有限公司 | Systems and methods for heart valve therapy |
CN107405198B (en) | 2015-03-20 | 2021-04-20 | 耶拿阀门科技股份有限公司 | Heart valve prosthesis delivery system and method of delivering a heart valve prosthesis with an introducer sheath |
US10456256B2 (en) * | 2015-03-23 | 2019-10-29 | St. Jude Medical, Cardiology Division, Inc | Heart valve repair |
US10441416B2 (en) | 2015-04-21 | 2019-10-15 | Edwards Lifesciences Corporation | Percutaneous mitral valve replacement device |
US10232564B2 (en) | 2015-04-29 | 2019-03-19 | Edwards Lifesciences Corporation | Laminated sealing member for prosthetic heart valve |
US10376363B2 (en) | 2015-04-30 | 2019-08-13 | Edwards Lifesciences Cardiaq Llc | Replacement mitral valve, delivery system for replacement mitral valve and methods of use |
EP4335415A2 (en) | 2015-05-14 | 2024-03-13 | Cephea Valve Technologies, Inc. | Replacement mitral valves |
US20160338706A1 (en) | 2015-05-20 | 2016-11-24 | Edwards Lifesciences Corporation | Atrial septal closure device for re-access |
CA2990872C (en) | 2015-06-22 | 2022-03-22 | Edwards Lifescience Cardiaq Llc | Actively controllable heart valve implant and methods of controlling same |
US10092400B2 (en) | 2015-06-23 | 2018-10-09 | Edwards Lifesciences Cardiaq Llc | Systems and methods for anchoring and sealing a prosthetic heart valve |
ITUB20152409A1 (en) | 2015-07-22 | 2017-01-22 | Sorin Group Italia Srl | VALVE SLEEVE FOR VALVULAR PROSTHESIS AND CORRESPONDING DEVICE |
WO2017030940A1 (en) | 2015-08-14 | 2017-02-23 | Caisson Interventional Llc | Systems and methods for heart valve therapy |
US11357499B2 (en) | 2015-08-18 | 2022-06-14 | Lsi Solutions, Inc. | Apparatus for mitral valve repair and methods thereof |
US10117744B2 (en) | 2015-08-26 | 2018-11-06 | Edwards Lifesciences Cardiaq Llc | Replacement heart valves and methods of delivery |
US10350066B2 (en) | 2015-08-28 | 2019-07-16 | Edwards Lifesciences Cardiaq Llc | Steerable delivery system for replacement mitral valve and methods of use |
JP6854282B2 (en) | 2015-09-18 | 2021-04-07 | テルモ株式会社 | Pressable implant delivery system |
US10456243B2 (en) | 2015-10-09 | 2019-10-29 | Medtronic Vascular, Inc. | Heart valves prostheses and methods for percutaneous heart valve replacement |
CA2998576A1 (en) | 2015-10-13 | 2017-04-20 | Venarum Medical, Llc | Implantable valve and method |
US10327929B2 (en) | 2015-10-30 | 2019-06-25 | Ram Medical Innovations, Llc | Apparatus and method for stabilization of procedural catheter in tortuous vessels |
US10376364B2 (en) | 2015-11-10 | 2019-08-13 | Edwards Lifesciences Corporation | Implant delivery capsule |
EP3377000B1 (en) | 2015-11-17 | 2023-02-01 | Boston Scientific Scimed, Inc. | Implantable device and delivery system for reshaping a heart valve annulus |
JP6795591B2 (en) | 2015-12-28 | 2020-12-02 | テンダイン ホールディングス,インコーポレイテッド | Atrial pocket closure for artificial heart valve |
US10321992B2 (en) | 2016-02-01 | 2019-06-18 | Medtronic, Inc. | Heart valve prostheses having multiple support arms and methods for percutaneous heart valve replacement |
US10265059B2 (en) | 2016-02-04 | 2019-04-23 | Edwards Lifesciences Corporation | Trans-septal closure and port device |
US10531866B2 (en) | 2016-02-16 | 2020-01-14 | Cardiovalve Ltd. | Techniques for providing a replacement valve and transseptal communication |
JP7097351B2 (en) | 2016-05-06 | 2022-07-07 | ザ ユナイテッド ステイツ オブ アメリカ, アズ リプレゼンテッド バイ ザ セクレタリー, デパートメント オブ ヘルス アンド ヒューマン サービス | Implant |
US11622852B2 (en) | 2016-05-17 | 2023-04-11 | Boston Scientific Scimed, Inc. | Replacement heart valve implant with inflow stitching |
US10716691B2 (en) | 2016-06-24 | 2020-07-21 | Edwards Lifesciences Corporation | Compact crimping device |
JP6881453B2 (en) | 2016-07-13 | 2021-06-02 | 株式会社ニコン | Fluid devices, manufacturing methods for fluid devices, and valves for fluid devices |
US10350062B2 (en) | 2016-07-21 | 2019-07-16 | Edwards Lifesciences Corporation | Replacement heart valve prosthesis |
WO2018025260A1 (en) | 2016-07-31 | 2018-02-08 | Mvalve Technologies Ltd. | Intracardiac devices comprising wire-supported valve leaflets |
US20190231525A1 (en) | 2016-08-01 | 2019-08-01 | Mitraltech Ltd. | Minimally-invasive delivery systems |
EP3848003A1 (en) | 2016-08-10 | 2021-07-14 | Cardiovalve Ltd. | Prosthetic valve with concentric frames |
USD800908S1 (en) | 2016-08-10 | 2017-10-24 | Mitraltech Ltd. | Prosthetic valve element |
EP3500214A4 (en) | 2016-08-19 | 2019-07-24 | Edwards Lifesciences Corporation | Steerable delivery system for replacement mitral valve and methods of use |
US10722359B2 (en) | 2016-08-26 | 2020-07-28 | Edwards Lifesciences Corporation | Heart valve docking devices and systems |
CR20190069A (en) | 2016-08-26 | 2019-05-14 | Edwards Lifesciences Corp | Heart valve docking coils and systems |
WO2018039631A1 (en) | 2016-08-26 | 2018-03-01 | Edwards Lifesciences Corporation | Multi-portion replacement heat valve prosthesis |
US10758348B2 (en) | 2016-11-02 | 2020-09-01 | Edwards Lifesciences Corporation | Supra and sub-annular mitral valve delivery system |
FR3058632B1 (en) | 2016-11-14 | 2019-01-25 | Laboratoires Invalv | DEVICE FOR TREATING A BIOLOGICAL VALVE WITH PUSH BODY OF THE VALVE |
US10603165B2 (en) | 2016-12-06 | 2020-03-31 | Edwards Lifesciences Corporation | Mechanically expanding heart valve and delivery apparatus therefor |
US10779837B2 (en) | 2016-12-08 | 2020-09-22 | Evalve, Inc. | Adjustable arm device for grasping tissues |
WO2018112429A1 (en) | 2016-12-16 | 2018-06-21 | Edwards Lifesciences Corporation | Deployment systems, tools, and methods for delivering an anchoring device for a prosthetic valve |
CN114617677A (en) | 2016-12-20 | 2022-06-14 | 爱德华兹生命科学公司 | System and mechanism for deploying a docking device for replacing a heart valve |
US10905554B2 (en) | 2017-01-05 | 2021-02-02 | Edwards Lifesciences Corporation | Heart valve coaptation device |
WO2018131043A1 (en) | 2017-01-11 | 2018-07-19 | Mitrassist Medical Ltd. | Multi-level cardiac implant |
EP4209196A1 (en) | 2017-01-23 | 2023-07-12 | Cephea Valve Technologies, Inc. | Replacement mitral valves |
CA3051272C (en) | 2017-01-23 | 2023-08-22 | Cephea Valve Technologies, Inc. | Replacement mitral valves |
US10675017B2 (en) | 2017-02-07 | 2020-06-09 | Edwards Lifesciences Corporation | Transcatheter heart valve leaflet plication |
WO2018148584A1 (en) | 2017-02-10 | 2018-08-16 | Millipede, Inc. | Implantable device and delivery system for reshaping a heart valve annulus |
US10952852B2 (en) | 2017-02-24 | 2021-03-23 | Abbott Cardiovascular Systems Inc. | Double basket assembly for valve repair |
US20180250126A1 (en) | 2017-03-06 | 2018-09-06 | Boston Scientific Scimed, Inc. | Replacement heart valve system having docking station with sacrificial valve |
US11224511B2 (en) | 2017-04-18 | 2022-01-18 | Edwards Lifesciences Corporation | Heart valve sealing devices and delivery devices therefor |
LT3558169T (en) | 2017-04-18 | 2022-02-10 | Edwards Lifesciences Corporation | Heart valve sealing devices and delivery devices therefor |
US10327895B2 (en) | 2017-05-05 | 2019-06-25 | Vdyne, Llc | Pressure differential actuated prosthetic medical device |
US10959846B2 (en) | 2017-05-10 | 2021-03-30 | Edwards Lifesciences Corporation | Mitral valve spacer device |
US11065119B2 (en) | 2017-05-12 | 2021-07-20 | Evalve, Inc. | Long arm valve repair clip |
US20210401571A9 (en) | 2017-05-31 | 2021-12-30 | Edwards Lifesciences Corporation | Sealing member for prosthetic heart valve |
US11026785B2 (en) | 2017-06-05 | 2021-06-08 | Edwards Lifesciences Corporation | Mechanically expandable heart valve |
US10709591B2 (en) | 2017-06-06 | 2020-07-14 | Twelve, Inc. | Crimping device and method for loading stents and prosthetic heart valves |
WO2018226915A1 (en) | 2017-06-08 | 2018-12-13 | Boston Scientific Scimed, Inc. | Heart valve implant commissure support structure |
US11793633B2 (en) | 2017-08-03 | 2023-10-24 | Cardiovalve Ltd. | Prosthetic heart valve |
CN116636958A (en) | 2017-08-03 | 2023-08-25 | 卡迪尔维尔福股份有限公司 | artificial heart valve |
US10537426B2 (en) | 2017-08-03 | 2020-01-21 | Cardiovalve Ltd. | Prosthetic heart valve |
US10575948B2 (en) | 2017-08-03 | 2020-03-03 | Cardiovalve Ltd. | Prosthetic heart valve |
US11246704B2 (en) | 2017-08-03 | 2022-02-15 | Cardiovalve Ltd. | Prosthetic heart valve |
US10888421B2 (en) | 2017-09-19 | 2021-01-12 | Cardiovalve Ltd. | Prosthetic heart valve with pouch |
WO2019027507A1 (en) | 2017-08-04 | 2019-02-07 | Mvrx, Inc. | Delivery system and methods for reshaping a heart valve annulus, including the use of magnetic tools |
CN111225633B (en) | 2017-08-16 | 2022-05-31 | 波士顿科学国际有限公司 | Replacement heart valve coaptation assembly |
CN111031966A (en) | 2017-08-24 | 2020-04-17 | 美敦力瓦斯科尔勒公司 | Transseptal delivery system with deflection section and method of use |
US11051940B2 (en) | 2017-09-07 | 2021-07-06 | Edwards Lifesciences Corporation | Prosthetic spacer device for heart valve |
US11337802B2 (en) | 2017-09-19 | 2022-05-24 | Cardiovalve Ltd. | Heart valve delivery systems and methods |
US10856982B2 (en) | 2017-09-19 | 2020-12-08 | St. Jude Medical, Cardiology Division, Inc. | Transapical mitral valve delivery system |
US9895226B1 (en) | 2017-10-19 | 2018-02-20 | Mitral Tech Ltd. | Techniques for use with prosthetic valve leaflets |
WO2019081453A1 (en) | 2017-10-23 | 2019-05-02 | Symetis Sa | Prosthetic valve leaflet |
US20190175339A1 (en) | 2017-12-12 | 2019-06-13 | Vdyne, Llc | Septomarginal trabecula attachment for heart valve repair |
GB201720803D0 (en) | 2017-12-13 | 2018-01-24 | Mitraltech Ltd | Prosthetic Valve and delivery tool therefor |
US20190183639A1 (en) | 2017-12-19 | 2019-06-20 | St. Jude Medical, Cardiology Division, Inc. | Transcatheter Mitral Valve: Off-Center Valve Design |
US10111751B1 (en) | 2018-01-09 | 2018-10-30 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
US10238493B1 (en) | 2018-01-09 | 2019-03-26 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
US10231837B1 (en) | 2018-01-09 | 2019-03-19 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
US10507109B2 (en) | 2018-01-09 | 2019-12-17 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
US10130475B1 (en) | 2018-01-09 | 2018-11-20 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
US10159570B1 (en) | 2018-01-09 | 2018-12-25 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
US10105222B1 (en) | 2018-01-09 | 2018-10-23 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
WO2019139904A1 (en) | 2018-01-09 | 2019-07-18 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
US10076415B1 (en) | 2018-01-09 | 2018-09-18 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
US10245144B1 (en) | 2018-01-09 | 2019-04-02 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
US10136993B1 (en) | 2018-01-09 | 2018-11-27 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
US10123873B1 (en) | 2018-01-09 | 2018-11-13 | Edwards Lifesciences Corporation | Native valve repair devices and procedures |
GB201800399D0 (en) | 2018-01-10 | 2018-02-21 | Mitraltech Ltd | Temperature-control during crimping of an implant |
US10568740B2 (en) | 2018-01-15 | 2020-02-25 | Vdyne, Llc | Device and method to plicate the tricuspid valve |
WO2019195860A2 (en) | 2018-04-04 | 2019-10-10 | Vdyne, Llc | Devices and methods for anchoring transcatheter heart valve |
US11389297B2 (en) | 2018-04-12 | 2022-07-19 | Edwards Lifesciences Corporation | Mitral valve spacer device |
EP3781085A1 (en) | 2018-04-19 | 2021-02-24 | Cardiovalve Ltd. | Prosthetic heart valve with pouch |
WO2019222367A1 (en) | 2018-05-15 | 2019-11-21 | Boston Scientific Scimed, Inc. | Replacement heart valve commissure assembly |
US10765511B2 (en) | 2018-06-22 | 2020-09-08 | Vdyne, Inc. | Transcatheter heart valve with plication tissue anchors |
US10779937B2 (en) | 2018-06-22 | 2020-09-22 | Vdyne, Inc. | Transcatheter heart valve with plication window and tissue anchors |
US11083571B2 (en) | 2018-06-27 | 2021-08-10 | Edwards Lifesciences Corporation | Frame for prosthetic heart valve |
US10779946B2 (en) | 2018-09-17 | 2020-09-22 | Cardiovalve Ltd. | Leaflet-testing apparatus |
US10321995B1 (en) | 2018-09-20 | 2019-06-18 | Vdyne, Llc | Orthogonally delivered transcatheter heart valve replacement |
US10945844B2 (en) | 2018-10-10 | 2021-03-16 | Edwards Lifesciences Corporation | Heart valve sealing devices and delivery devices therefor |
KR20210096173A (en) | 2018-11-29 | 2021-08-04 | 에드워즈 라이프사이언시스 코포레이션 | Catheterization method and device |
AU2020218519A1 (en) | 2019-02-06 | 2021-10-07 | inQB8 Medical Technologies, LLC | Intra-cardiac left atrial and dual support systems |
AU2020221912A1 (en) | 2019-02-11 | 2021-08-19 | Edwards Lifesciences Corporation | Heart valve sealing devices and delivery devices therefor |
US11464636B2 (en) | 2019-10-11 | 2022-10-11 | Evalve, Inc. | Repair clip for variable tissue thickness |
WO2021092460A1 (en) | 2019-11-08 | 2021-05-14 | Evalve, Inc. | Medical device delivery system with locking system |
CN115279278A (en) | 2020-02-04 | 2022-11-01 | 卡迪尔维尔福股份有限公司 | Stent guided steering of a catheter |
EP3908228B1 (en) | 2020-03-17 | 2022-08-24 | Cardiovalve Ltd. | Leaflet-grouping system |
-
2014
- 2014-01-23 US US14/161,921 patent/US9681952B2/en active Active
- 2014-01-23 WO PCT/IL2014/050087 patent/WO2014115149A2/en active Application Filing
- 2014-01-23 EP EP22204764.9A patent/EP4166111A1/en active Pending
- 2014-01-23 US US14/763,004 patent/US20150351906A1/en not_active Abandoned
- 2014-01-23 EP EP14710060.6A patent/EP2948103B1/en active Active
- 2014-01-23 ES ES14710060T patent/ES2934670T3/en active Active
-
2017
- 2017-05-19 US US15/600,190 patent/US10835377B2/en active Active
-
2018
- 2018-01-16 US US15/872,501 patent/US10631982B2/en active Active
- 2018-09-27 US US16/144,054 patent/US20190021857A1/en active Pending
-
2020
- 2020-02-26 US US16/802,353 patent/US11135059B2/en active Active
-
2021
- 2021-09-03 US US17/466,785 patent/US11844691B2/en active Active
-
2023
- 2023-10-31 US US18/385,643 patent/US20240058123A1/en active Pending
Patent Citations (11)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6010530A (en) * | 1995-06-07 | 2000-01-04 | Boston Scientific Technology, Inc. | Self-expanding endoluminal prosthesis |
US20040210304A1 (en) * | 1999-11-17 | 2004-10-21 | Corevalve, S.A. | Prosthetic valve for transluminal delivery |
US6458153B1 (en) * | 1999-12-31 | 2002-10-01 | Abps Venture One, Ltd. | Endoluminal cardiac and venous valve prostheses and methods of manufacture and delivery thereof |
US6669724B2 (en) * | 2001-06-05 | 2003-12-30 | M.I. Tech Co. Ltd. | Medical stent |
US20040260389A1 (en) * | 2003-04-24 | 2004-12-23 | Cook Incorporated | Artificial valve prosthesis with improved flow dynamics |
US7442204B2 (en) * | 2003-07-08 | 2008-10-28 | Ventor Technologies, Ltd. | Fluid flow prosthetic device |
US20070213810A1 (en) * | 2005-03-14 | 2007-09-13 | Richard Newhauser | Segmented endoprosthesis |
US20090088836A1 (en) * | 2007-08-23 | 2009-04-02 | Direct Flow Medical, Inc. | Translumenally implantable heart valve with formed in place support |
US20090240320A1 (en) * | 2008-03-18 | 2009-09-24 | Yosi Tuval | Valve suturing and implantation procedures |
US20110245911A1 (en) * | 2010-04-01 | 2011-10-06 | Medtronic, Inc. | Transcatheter Valve with Torsion Spring Fixation and Related Systems and Methods |
US20130304200A1 (en) * | 2011-10-19 | 2013-11-14 | Foundry Newco Xii, Inc. | Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods |
Cited By (334)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US11304803B2 (en) | 2004-10-02 | 2022-04-19 | Edwards Lifesciences Cardiaq Llc | Method for replacement of heart valve |
US20190029819A1 (en) * | 2004-10-02 | 2019-01-31 | Edwards Lifesciences Cardiaq Llc | Method for replacement of heart valve |
US11058536B2 (en) * | 2004-10-02 | 2021-07-13 | Edwards Lifesciences Cardiaq Llc | Method for replacement of heart valve |
US10561498B2 (en) * | 2005-03-17 | 2020-02-18 | Valtech Cardio, Ltd. | Mitral valve treatment techniques |
US9526613B2 (en) | 2005-03-17 | 2016-12-27 | Valtech Cardio Ltd. | Mitral valve treatment techniques |
US20170135815A1 (en) * | 2005-03-17 | 2017-05-18 | Valtech Cardio Ltd. | Mitral valve treatment techniques |
US9872769B2 (en) | 2006-12-05 | 2018-01-23 | Valtech Cardio, Ltd. | Implantation of repair devices in the heart |
US9974653B2 (en) | 2006-12-05 | 2018-05-22 | Valtech Cardio, Ltd. | Implantation of repair devices in the heart |
US9883943B2 (en) | 2006-12-05 | 2018-02-06 | Valtech Cardio, Ltd. | Implantation of repair devices in the heart |
US11213387B2 (en) | 2007-09-13 | 2022-01-04 | Georg Lutter | Truncated cone heart valve stent |
US10456248B2 (en) | 2007-09-13 | 2019-10-29 | Georg Lutter | Truncated cone heart valve stent |
US9730792B2 (en) | 2007-09-13 | 2017-08-15 | Georg Lutter | Truncated cone heart valve stent |
US10149756B2 (en) | 2008-09-29 | 2018-12-11 | Edwards Lifesciences Cardiaq Llc | Heart valve |
US11819404B2 (en) | 2008-09-29 | 2023-11-21 | Edwards Lifesciences Cardiaq Llc | Heart valve |
US10646334B2 (en) | 2008-09-29 | 2020-05-12 | Edwards Lifesciences Cardiaq Llc | Heart valve |
US11589983B2 (en) | 2008-09-29 | 2023-02-28 | Edwards Lifesciences Cardiaq Llc | Heart valve |
US9636224B2 (en) | 2008-12-22 | 2017-05-02 | Valtech Cardio, Ltd. | Deployment techniques for annuloplasty ring and over-wire rotation tool |
US9713530B2 (en) | 2008-12-22 | 2017-07-25 | Valtech Cardio, Ltd. | Adjustable annuloplasty devices and adjustment mechanisms therefor |
US11116634B2 (en) | 2008-12-22 | 2021-09-14 | Valtech Cardio Ltd. | Annuloplasty implants |
US9662209B2 (en) | 2008-12-22 | 2017-05-30 | Valtech Cardio, Ltd. | Contractible annuloplasty structures |
US10470882B2 (en) | 2008-12-22 | 2019-11-12 | Valtech Cardio, Ltd. | Closure element for use with annuloplasty structure |
US10856986B2 (en) | 2008-12-22 | 2020-12-08 | Valtech Cardio, Ltd. | Adjustable annuloplasty devices and adjustment mechanisms therefor |
US10517719B2 (en) | 2008-12-22 | 2019-12-31 | Valtech Cardio, Ltd. | Implantation of repair devices in the heart |
US9561104B2 (en) | 2009-02-17 | 2017-02-07 | Valtech Cardio, Ltd. | Actively-engageable movement-restriction mechanism for use with an annuloplasty structure |
US10350068B2 (en) | 2009-02-17 | 2019-07-16 | Valtech Cardio, Ltd. | Actively-engageable movement-restriction mechanism for use with an annuloplasty structure |
US11376119B2 (en) | 2009-04-15 | 2022-07-05 | Edwards Lifesciences Cardiaq Llc | Vascular implant and delivery system |
US10441412B2 (en) | 2009-04-15 | 2019-10-15 | Edwards Lifesciences Cardiaq Llc | Vascular implant and delivery system |
US11185412B2 (en) | 2009-05-04 | 2021-11-30 | Valtech Cardio Ltd. | Deployment techniques for annuloplasty implants |
US11076958B2 (en) | 2009-05-04 | 2021-08-03 | Valtech Cardio, Ltd. | Annuloplasty ring delivery catheters |
US11766327B2 (en) | 2009-05-04 | 2023-09-26 | Edwards Lifesciences Innovation (Israel) Ltd. | Implantation of repair chords in the heart |
US10548729B2 (en) | 2009-05-04 | 2020-02-04 | Valtech Cardio, Ltd. | Deployment techniques for annuloplasty ring and over-wire rotation tool |
US11844665B2 (en) | 2009-05-04 | 2023-12-19 | Edwards Lifesciences Innovation (Israel) Ltd. | Deployment techniques for annuloplasty structure |
US9968452B2 (en) | 2009-05-04 | 2018-05-15 | Valtech Cardio, Ltd. | Annuloplasty ring delivery cathethers |
US11723774B2 (en) | 2009-05-07 | 2023-08-15 | Edwards Lifesciences Innovation (Israel) Ltd. | Multiple anchor delivery tool |
US9592122B2 (en) | 2009-05-07 | 2017-03-14 | Valtech Cardio, Ltd | Annuloplasty ring with intra-ring anchoring |
US10856987B2 (en) | 2009-05-07 | 2020-12-08 | Valtech Cardio, Ltd. | Multiple anchor delivery tool |
US9937042B2 (en) | 2009-05-07 | 2018-04-10 | Valtech Cardio, Ltd. | Multiple anchor delivery tool |
US10524901B2 (en) | 2009-09-29 | 2020-01-07 | Edwards Lifesciences Cardiaq Llc | Replacement heart valve |
US10098737B2 (en) | 2009-10-29 | 2018-10-16 | Valtech Cardio, Ltd. | Tissue anchor for annuloplasty device |
US9968454B2 (en) | 2009-10-29 | 2018-05-15 | Valtech Cardio, Ltd. | Techniques for guide-wire based advancement of artificial chordae |
US10492909B2 (en) | 2009-12-02 | 2019-12-03 | Valtech Cardio, Ltd. | Tool for actuating an adjusting mechanism |
US9622861B2 (en) | 2009-12-02 | 2017-04-18 | Valtech Cardio, Ltd. | Tool for actuating an adjusting mechanism |
US10660751B2 (en) | 2009-12-08 | 2020-05-26 | Cardiovalve Ltd. | Prosthetic heart valve with upper skirt |
US11351026B2 (en) | 2009-12-08 | 2022-06-07 | Cardiovalve Ltd. | Rotation-based anchoring of an implant |
US11179236B2 (en) | 2009-12-08 | 2021-11-23 | Colorado State University Research Foundation | Device and system for transcatheter mitral valve replacement |
US11839541B2 (en) | 2009-12-08 | 2023-12-12 | Cardiovalve Ltd. | Prosthetic heart valve with upper skirt |
US10231831B2 (en) | 2009-12-08 | 2019-03-19 | Cardiovalve Ltd. | Folding ring implant for heart valve |
US11141268B2 (en) | 2009-12-08 | 2021-10-12 | Cardiovalve Ltd. | Prosthetic heart valve with upper and lower skirts |
US10485660B2 (en) | 2010-06-21 | 2019-11-26 | Edwards Lifesciences Cardiaq Llc | Replacement heart valve |
US11452597B2 (en) | 2010-06-21 | 2022-09-27 | Edwards Lifesciences Cardiaq Llc | Replacement heart valve |
US10639146B2 (en) | 2010-06-21 | 2020-05-05 | Edwards Lifesciences Cardiaq Llc | Replacement heart valve |
US11653910B2 (en) | 2010-07-21 | 2023-05-23 | Cardiovalve Ltd. | Helical anchor implantation |
US9579193B2 (en) * | 2010-09-23 | 2017-02-28 | Transmural Systems Llc | Methods and systems for delivering prostheses using rail techniques |
US20140018906A1 (en) * | 2010-09-23 | 2014-01-16 | Nasser Rafiee | Methods and systems for delivering prostheses using rail techniques |
US11571303B2 (en) | 2010-12-23 | 2023-02-07 | Twelve, Inc. | System for mitral valve repair and replacement |
US10517725B2 (en) | 2010-12-23 | 2019-12-31 | Twelve, Inc. | System for mitral valve repair and replacement |
US11712334B2 (en) | 2011-06-21 | 2023-08-01 | Twelve, Inc. | Prosthetic heart valve devices and associated systems and methods |
US11523900B2 (en) | 2011-06-21 | 2022-12-13 | Twelve, Inc. | Prosthetic heart valve devices and associated systems and methods |
US10751173B2 (en) | 2011-06-21 | 2020-08-25 | Twelve, Inc. | Prosthetic heart valve devices and associated systems and methods |
US10792152B2 (en) | 2011-06-23 | 2020-10-06 | Valtech Cardio, Ltd. | Closed band for percutaneous annuloplasty |
US11517436B2 (en) | 2011-08-05 | 2022-12-06 | Cardiovalve Ltd. | Implant for heart valve |
US11690712B2 (en) | 2011-08-05 | 2023-07-04 | Cardiovalve Ltd. | Clip-secured implant for heart valve |
US10702385B2 (en) | 2011-08-05 | 2020-07-07 | Cardiovalve Ltd. | Implant for heart valve |
US11517429B2 (en) | 2011-08-05 | 2022-12-06 | Cardiovalve Ltd. | Apparatus for use at a heart valve |
US11369469B2 (en) | 2011-08-05 | 2022-06-28 | Cardiovalve Ltd. | Method for use at a heart valve |
US11291547B2 (en) | 2011-08-05 | 2022-04-05 | Cardiovalve Ltd. | Leaflet clip with collars |
US11344410B2 (en) | 2011-08-05 | 2022-05-31 | Cardiovalve Ltd. | Implant for heart valve |
US11291546B2 (en) | 2011-08-05 | 2022-04-05 | Cardiovalve Ltd. | Leaflet clip with collars |
US11291545B2 (en) | 2011-08-05 | 2022-04-05 | Cardiovalve Ltd. | Implant for heart valve |
US11864995B2 (en) | 2011-08-05 | 2024-01-09 | Cardiovalve Ltd. | Implant for heart valve |
US10376361B2 (en) | 2011-08-05 | 2019-08-13 | Cardiovalve Ltd. | Techniques for percutaneous mitral valve replacement and sealing |
US10695173B2 (en) | 2011-08-05 | 2020-06-30 | Cardiovalve Ltd. | Techniques for percutaneous mitral valve replacement and sealing |
US11382737B2 (en) | 2011-08-11 | 2022-07-12 | Tendyne Holdings, Inc. | Prosthetic valves and related inventions |
US11364116B2 (en) | 2011-08-11 | 2022-06-21 | Tendyne Holdings, Inc. | Prosthetic valves and related inventions |
US11311374B2 (en) | 2011-08-11 | 2022-04-26 | Tendyne Holdings, Inc. | Prosthetic valves and related inventions |
US10617519B2 (en) | 2011-08-11 | 2020-04-14 | Tendyne Holdings, Inc. | Prosthetic valves and related inventions |
US9833315B2 (en) | 2011-08-11 | 2017-12-05 | Tendyne Holdings, Inc. | Prosthetic valves and related inventions |
US11484404B2 (en) | 2011-08-11 | 2022-11-01 | Tendyne Holdings, Inc. | Prosthetic valves and related inventions |
US11123180B2 (en) | 2011-08-11 | 2021-09-21 | Tendyne Holdings, Inc. | Prosthetic valves and related inventions |
US11123181B2 (en) | 2011-08-11 | 2021-09-21 | Tendyne Holdings, Inc. | Prosthetic valves and related inventions |
US11135055B2 (en) | 2011-08-11 | 2021-10-05 | Tendyne Holdings, Inc. | Prosthetic valves and related inventions |
US10639145B2 (en) | 2011-08-11 | 2020-05-05 | Tendyne Holdings, Inc. | Prosthetic valves and related inventions |
US11628063B2 (en) | 2011-10-19 | 2023-04-18 | Twelve, Inc. | Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods |
US10335278B2 (en) | 2011-10-19 | 2019-07-02 | Twelve, Inc. | Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods |
US10702380B2 (en) | 2011-10-19 | 2020-07-07 | Twelve, Inc. | Devices, systems and methods for heart valve replacement |
US11826249B2 (en) | 2011-10-19 | 2023-11-28 | Twelve, Inc. | Devices, systems and methods for heart valve replacement |
US10299927B2 (en) | 2011-10-19 | 2019-05-28 | Twelve, Inc. | Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods |
US10945835B2 (en) | 2011-10-19 | 2021-03-16 | Twelve, Inc. | Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods |
US11197758B2 (en) | 2011-10-19 | 2021-12-14 | Twelve, Inc. | Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods |
US11202704B2 (en) | 2011-10-19 | 2021-12-21 | Twelve, Inc. | Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods |
US10299917B2 (en) | 2011-10-19 | 2019-05-28 | Twelve, Inc. | Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods |
US11497603B2 (en) | 2011-10-19 | 2022-11-15 | Twelve, Inc. | Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods |
US11617648B2 (en) | 2011-10-19 | 2023-04-04 | Twelve, Inc. | Prosthetic heart valve devices, prosthetic mitral valves and associated systems and methods |
US9775709B2 (en) | 2011-11-04 | 2017-10-03 | Valtech Cardio, Ltd. | Implant having multiple adjustable mechanisms |
US11857415B2 (en) | 2011-11-08 | 2024-01-02 | Edwards Lifesciences Innovation (Israel) Ltd. | Controlled steering functionality for implant-delivery tool |
US9724192B2 (en) | 2011-11-08 | 2017-08-08 | Valtech Cardio, Ltd. | Controlled steering functionality for implant-delivery tool |
US10568738B2 (en) | 2011-11-08 | 2020-02-25 | Valtech Cardio, Ltd. | Controlled steering functionality for implant-delivery tool |
US9827092B2 (en) | 2011-12-16 | 2017-11-28 | Tendyne Holdings, Inc. | Tethers for prosthetic mitral valve |
US10952844B2 (en) | 2011-12-16 | 2021-03-23 | Tendyne Holdings, Inc. | Tethers for prosthetic mitral valve |
US10258468B2 (en) | 2012-03-01 | 2019-04-16 | Twelve, Inc. | Hydraulic delivery systems for prosthetic heart valve devices and associated methods |
US11129714B2 (en) | 2012-03-01 | 2021-09-28 | Twelve, Inc. | Hydraulic delivery systems for prosthetic heart valve devices and associated methods |
US10285810B2 (en) | 2012-04-19 | 2019-05-14 | Caisson Interventional, LLC | Valve replacement systems and methods |
US11051935B2 (en) | 2012-04-19 | 2021-07-06 | Caisson Interventional, LLC | Valve replacement systems and methods |
US9427315B2 (en) | 2012-04-19 | 2016-08-30 | Caisson Interventional, LLC | Valve replacement systems and methods |
US9427316B2 (en) | 2012-04-19 | 2016-08-30 | Caisson Interventional, LLC | Valve replacement systems and methods |
US10660750B2 (en) | 2012-04-19 | 2020-05-26 | Caisson Interventional, LLC | Heart valve assembly systems and methods |
US9566152B2 (en) | 2012-04-19 | 2017-02-14 | Caisson Interventional, LLC | Heart valve assembly and methods |
US10080656B2 (en) | 2012-04-19 | 2018-09-25 | Caisson Interventional Llc | Heart valve assembly systems and methods |
US9895221B2 (en) | 2012-07-28 | 2018-02-20 | Tendyne Holdings, Inc. | Multi-component designs for heart valve retrieval device, sealing structures and stent assembly |
US11759318B2 (en) | 2012-07-28 | 2023-09-19 | Tendyne Holdings, Inc. | Multi-component designs for heart valve retrieval device, sealing structures and stent assembly |
US11090155B2 (en) | 2012-07-30 | 2021-08-17 | Tendyne Holdings, Inc. | Delivery systems and methods for transcatheter prosthetic valves |
US10219900B2 (en) | 2012-07-30 | 2019-03-05 | Tendyne Holdings, Inc. | Delivery systems and methods for transcatheter prosthetic valves |
US10376266B2 (en) | 2012-10-23 | 2019-08-13 | Valtech Cardio, Ltd. | Percutaneous tissue anchor techniques |
US9949828B2 (en) | 2012-10-23 | 2018-04-24 | Valtech Cardio, Ltd. | Controlled steering functionality for implant-delivery tool |
US11890190B2 (en) | 2012-10-23 | 2024-02-06 | Edwards Lifesciences Innovation (Israel) Ltd. | Location indication system for implant-delivery tool |
US11344310B2 (en) | 2012-10-23 | 2022-05-31 | Valtech Cardio Ltd. | Percutaneous tissue anchor techniques |
US9730793B2 (en) | 2012-12-06 | 2017-08-15 | Valtech Cardio, Ltd. | Techniques for guide-wire based advancement of a tool |
US11844691B2 (en) | 2013-01-24 | 2023-12-19 | Cardiovalve Ltd. | Partially-covered prosthetic valves |
US10631982B2 (en) | 2013-01-24 | 2020-04-28 | Cardiovale Ltd. | Prosthetic valve and upstream support therefor |
US10449333B2 (en) | 2013-03-14 | 2019-10-22 | Valtech Cardio, Ltd. | Guidewire feeder |
US10716664B2 (en) | 2013-03-14 | 2020-07-21 | Edwards Lifesciences Cardiaq Llc | Prosthesis for atraumatically grasping intralumenal tissue and methods of delivery |
US10583000B2 (en) | 2013-03-14 | 2020-03-10 | Edwards Lifesciences Cardiaq Llc | Prosthesis for atraumatically grasping intralumenal tissue and methods of delivery |
US11324591B2 (en) | 2013-03-14 | 2022-05-10 | Edwards Lifesciences Cardiaq Llc | Prosthesis for atraumatically grasping intralumenal tissue and methods of delivery |
US11311379B2 (en) | 2013-04-02 | 2022-04-26 | Tendyne Holdings, Inc. | Prosthetic heart valve and systems and methods for delivering the same |
US10463494B2 (en) | 2013-04-02 | 2019-11-05 | Tendyne Holdings, Inc. | Prosthetic heart valve and systems and methods for delivering the same |
US11224510B2 (en) | 2013-04-02 | 2022-01-18 | Tendyne Holdings, Inc. | Prosthetic heart valve and systems and methods for delivering the same |
US10463489B2 (en) | 2013-04-02 | 2019-11-05 | Tendyne Holdings, Inc. | Prosthetic heart valve and systems and methods for delivering the same |
US10478293B2 (en) | 2013-04-04 | 2019-11-19 | Tendyne Holdings, Inc. | Retrieval and repositioning system for prosthetic heart valve |
US11364119B2 (en) | 2013-04-04 | 2022-06-21 | Tendyne Holdings, Inc. | Retrieval and repositioning system for prosthetic heart valve |
US10111747B2 (en) | 2013-05-20 | 2018-10-30 | Twelve, Inc. | Implantable heart valve devices, mitral valve repair devices and associated systems and methods |
US11234821B2 (en) | 2013-05-20 | 2022-02-01 | Twelve, Inc. | Implantable heart valve devices, mitral valve repair devices and associated systems and methods |
US10405976B2 (en) | 2013-05-30 | 2019-09-10 | Tendyne Holdings, Inc. | Structural members for prosthetic mitral valves |
US11617645B2 (en) | 2013-05-30 | 2023-04-04 | Tendyne Holdings, Inc. | Structural members for prosthetic mitral valves |
US10595996B2 (en) | 2013-06-25 | 2020-03-24 | Tendyne Holdings, Inc. | Thrombus management and structural compliance features for prosthetic heart valves |
US11471281B2 (en) | 2013-06-25 | 2022-10-18 | Tendyne Holdings, Inc. | Thrombus management and structural compliance features for prosthetic heart valves |
US10610354B2 (en) | 2013-08-01 | 2020-04-07 | Tendyne Holdings, Inc. | Epicardial anchor devices and methods |
US11612480B2 (en) | 2013-08-01 | 2023-03-28 | Tendyne Holdings, Inc. | Epicardial anchor devices and methods |
US11246562B2 (en) | 2013-10-17 | 2022-02-15 | Tendyne Holdings, Inc. | Apparatus and methods for alignment and deployment of intracardiac devices |
US10555718B2 (en) | 2013-10-17 | 2020-02-11 | Tendyne Holdings, Inc. | Apparatus and methods for alignment and deployment of intracardiac devices |
US10117741B2 (en) | 2013-10-23 | 2018-11-06 | Caisson Interventional, LLC | Methods and systems for heart valve therapy |
US9421094B2 (en) | 2013-10-23 | 2016-08-23 | Caisson Interventional, LLC | Methods and systems for heart valve therapy |
US10736736B2 (en) | 2013-10-23 | 2020-08-11 | Caisson Interventional, LLC | Methods and systems for heart valve therapy |
US11833035B2 (en) | 2013-10-23 | 2023-12-05 | Caisson Interventional Llc | Methods and systems for heart valve therapy |
US10299793B2 (en) | 2013-10-23 | 2019-05-28 | Valtech Cardio, Ltd. | Anchor magazine |
US10363135B2 (en) | 2013-10-29 | 2019-07-30 | Tendyne Holdings, Inc. | Apparatus and methods for delivery of transcatheter prosthetic valves |
US11096783B2 (en) | 2013-10-29 | 2021-08-24 | Tendyne Holdings, Inc. | Apparatus and methods for delivery of transcatheter prosthetic valves |
US9610162B2 (en) * | 2013-12-26 | 2017-04-04 | Valtech Cardio, Ltd. | Implantation of flexible implant |
US20170196691A1 (en) * | 2013-12-26 | 2017-07-13 | Valtech Cardio, Ltd. | Implantation of flexible implant |
US10973637B2 (en) * | 2013-12-26 | 2021-04-13 | Valtech Cardio, Ltd. | Implantation of flexible implant |
US10265170B2 (en) * | 2013-12-26 | 2019-04-23 | Valtech Cardio, Ltd. | Implantation of flexible implant |
US20150182336A1 (en) * | 2013-12-26 | 2015-07-02 | Valtech Cardio, Ltd. | Implantation of flexible implant |
US11464628B2 (en) | 2014-02-05 | 2022-10-11 | Tendyne Holdings, Inc. | Expandable epicardial pads and devices and methods for delivery of same |
US11589985B2 (en) | 2014-02-05 | 2023-02-28 | Tendyne Holdings, Inc. | Apparatus and methods for transfemoral delivery of prosthetic mitral valve |
US10201419B2 (en) | 2014-02-05 | 2019-02-12 | Tendyne Holdings, Inc. | Apparatus and methods for transfemoral delivery of prosthetic mitral valve |
US9986993B2 (en) | 2014-02-11 | 2018-06-05 | Tendyne Holdings, Inc. | Adjustable tether and epicardial pad system for prosthetic heart valve |
US11045183B2 (en) | 2014-02-11 | 2021-06-29 | Tendyne Holdings, Inc. | Adjustable tether and epicardial pad system for prosthetic heart valve |
US10004599B2 (en) | 2014-02-21 | 2018-06-26 | Edwards Lifesciences Cardiaq Llc | Prosthesis, delivery device and methods of use |
US10952849B2 (en) | 2014-02-21 | 2021-03-23 | Edwards Lifesciences Cardiaq Llc | Prosthesis, delivery device and methods of use |
US11633279B2 (en) | 2014-02-21 | 2023-04-25 | Edwards Lifesciences Cardiaq Llc | Prosthesis, delivery device and methods of use |
US11382753B2 (en) | 2014-03-10 | 2022-07-12 | Tendyne Holdings, Inc. | Devices and methods for positioning and monitoring tether load for prosthetic mitral valve |
US10517728B2 (en) | 2014-03-10 | 2019-12-31 | Tendyne Holdings, Inc. | Devices and methods for positioning and monitoring tether load for prosthetic mitral valve |
US11045313B2 (en) | 2014-05-19 | 2021-06-29 | Edwards Lifesciences Cardiaq Llc | Replacement mitral valve |
US10179044B2 (en) | 2014-05-19 | 2019-01-15 | Edwards Lifesciences Cardiaq Llc | Replacement mitral valve |
US10687939B2 (en) | 2014-06-06 | 2020-06-23 | Edwards Lifesciences Corporation | Prosthetic valve for replacing a mitral valve |
US11684471B2 (en) | 2014-06-06 | 2023-06-27 | Edwards Lifesciences Corporation | Prosthetic valve for replacing a native mitral or tricuspid valve |
US10010414B2 (en) | 2014-06-06 | 2018-07-03 | Edwards Lifesciences Corporation | Prosthetic valve for replacing a mitral valve |
US9974647B2 (en) | 2014-06-12 | 2018-05-22 | Caisson Interventional, LLC | Two stage anchor and mitral valve assembly |
US10835375B2 (en) | 2014-06-12 | 2020-11-17 | Caisson Interventional, LLC | Two stage anchor and mitral valve assembly |
US10695160B2 (en) * | 2014-07-17 | 2020-06-30 | Boston Scientific Scimed, Inc. | Adjustable endolumenal implant for reshaping the mitral valve annulus |
US20170209253A1 (en) * | 2014-07-17 | 2017-07-27 | Millipede, Inc. | Adjustable endolumenal implant for reshaping the mitral valve annulus |
US10492908B2 (en) | 2014-07-30 | 2019-12-03 | Cardiovalve Ltd. | Anchoring of a prosthetic valve |
US11701225B2 (en) | 2014-07-30 | 2023-07-18 | Cardiovalve Ltd. | Delivery of a prosthetic valve |
US10524910B2 (en) | 2014-07-30 | 2020-01-07 | Mitraltech Ltd. 3 Ariel Sharon Avenue | Articulatable prosthetic valve |
US11872130B2 (en) | 2014-07-30 | 2024-01-16 | Cardiovalve Ltd. | Prosthetic heart valve implant |
US9750607B2 (en) | 2014-10-23 | 2017-09-05 | Caisson Interventional, LLC | Systems and methods for heart valve therapy |
US11439506B2 (en) | 2014-10-23 | 2022-09-13 | Caisson Interventional Llc | Systems and methods for heart valve therapy |
US9750605B2 (en) | 2014-10-23 | 2017-09-05 | Caisson Interventional, LLC | Systems and methods for heart valve therapy |
US10603167B2 (en) | 2014-10-23 | 2020-03-31 | Caisson Interventional, LLC | Systems and methods for heart valve therapy |
US9750606B2 (en) | 2014-10-23 | 2017-09-05 | Caisson Interventional, LLC | Systems and methods for heart valve therapy |
US10786351B2 (en) | 2015-01-07 | 2020-09-29 | Tendyne Holdings, Inc. | Prosthetic mitral valves and apparatus and methods for delivery of same |
US10507105B2 (en) | 2015-02-05 | 2019-12-17 | Cardiovalve Ltd. | Prosthetic valve with tissue anchors free from lateral interconnections |
US10722360B2 (en) | 2015-02-05 | 2020-07-28 | Cardiovalve Ltd. | Prosthetic valve with radially-deflectable tissue anchors |
US10973636B2 (en) | 2015-02-05 | 2021-04-13 | Cardiovalve Ltd. | Prosthetic valve with tissue anchors free from lateral interconnections |
US10524903B2 (en) | 2015-02-05 | 2020-01-07 | Cardiovalve Ltd. | Prosthetic valve with aligned inner and outer frames |
US11534298B2 (en) | 2015-02-05 | 2022-12-27 | Cardiovalve Ltd. | Prosthetic valve with s-shaped tissue anchors |
US10449047B2 (en) | 2015-02-05 | 2019-10-22 | Cardiovalve Ltd. | Prosthetic heart valve with compressible frames |
US11801135B2 (en) | 2015-02-05 | 2023-10-31 | Cardiovalve Ltd. | Techniques for deployment of a prosthetic valve |
US9974651B2 (en) | 2015-02-05 | 2018-05-22 | Mitral Tech Ltd. | Prosthetic valve with axially-sliding frames |
US10390952B2 (en) | 2015-02-05 | 2019-08-27 | Cardiovalve Ltd. | Prosthetic valve with flexible tissue anchor portions |
US10918481B2 (en) | 2015-02-05 | 2021-02-16 | Cardiovalve Ltd. | Techniques for deployment of a prosthetic valve |
US10849748B2 (en) | 2015-02-05 | 2020-12-01 | Cardiovalve Ltd. | Prosthetic valve delivery system with independently-movable capsule portions |
US11793635B2 (en) | 2015-02-05 | 2023-10-24 | Cardiovalve Ltd. | Prosthetic valve with angularly offset frames |
US10758344B2 (en) | 2015-02-05 | 2020-09-01 | Cardiovalve Ltd. | Prosthetic valve with angularly offset frames |
US10736742B2 (en) | 2015-02-05 | 2020-08-11 | Cardiovalve Ltd. | Prosthetic valve with atrial arms |
US10610356B2 (en) | 2015-02-05 | 2020-04-07 | Tendyne Holdings, Inc. | Expandable epicardial pads and devices and methods for delivery of same |
US10682227B2 (en) | 2015-02-05 | 2020-06-16 | Cardiovalve Ltd. | Prosthetic valve with pivoting tissue anchor portions |
US11793638B2 (en) | 2015-02-05 | 2023-10-24 | Cardiovalve Ltd. | Prosthetic valve with pivoting tissue anchor portions |
US10888422B2 (en) | 2015-02-05 | 2021-01-12 | Cardiovalve Ltd. | Prosthetic valve with flexible tissue anchor portions |
US10463488B2 (en) | 2015-02-05 | 2019-11-05 | Cardiovalve Ltd. | Prosthetic valve with separably-deployable valve body and tissue anchors |
US11672658B2 (en) | 2015-02-05 | 2023-06-13 | Cardiovalve Ltd. | Prosthetic valve with aligned inner and outer frames |
US10463487B2 (en) | 2015-02-05 | 2019-11-05 | Cardiovalve Ltd. | Prosthetic valve delivery system with independently-movable capsule portions |
US10667908B2 (en) | 2015-02-05 | 2020-06-02 | Cardiovalve Ltd. | Prosthetic valve with S-shaped tissue anchors |
US10426610B2 (en) | 2015-02-05 | 2019-10-01 | Cardiovalve Ltd. | Prosthetic valve with radially-deflectable tissue anchors |
US10864078B2 (en) | 2015-02-05 | 2020-12-15 | Cardiovalve Ltd. | Prosthetic valve with separably-deployable valve body and tissue anchors |
US10357360B2 (en) | 2015-02-05 | 2019-07-23 | Cardiovalve Ltd. | Prosthetic valve with aligned inner and outer frames |
US10695177B2 (en) | 2015-02-05 | 2020-06-30 | Cardiovalve Ltd. | Prosthetic valve with aligned inner and outer frames |
US10449039B2 (en) | 2015-03-19 | 2019-10-22 | Caisson Interventional, LLC | Systems and methods for heart valve therapy |
US11497600B2 (en) | 2015-03-19 | 2022-11-15 | Caisson Interventional, LLC | Systems and methods for heart valve therapy |
US10667905B2 (en) | 2015-04-16 | 2020-06-02 | Tendyne Holdings, Inc. | Apparatus and methods for delivery, repositioning, and retrieval of transcatheter prosthetic valves |
US11523902B2 (en) | 2015-04-16 | 2022-12-13 | Tendyne Holdings, Inc. | Apparatus and methods for delivery, repositioning, and retrieval of transcatheter prosthetic valves |
US10441416B2 (en) | 2015-04-21 | 2019-10-15 | Edwards Lifesciences Corporation | Percutaneous mitral valve replacement device |
US11850147B2 (en) | 2015-04-21 | 2023-12-26 | Edwards Lifesciences Corporation | Percutaneous mitral valve replacement device |
US11389292B2 (en) | 2015-04-30 | 2022-07-19 | Edwards Lifesciences Cardiaq Llc | Replacement mitral valve, delivery system for replacement mitral valve and methods of use |
US10376363B2 (en) | 2015-04-30 | 2019-08-13 | Edwards Lifesciences Cardiaq Llc | Replacement mitral valve, delivery system for replacement mitral valve and methods of use |
US10226335B2 (en) | 2015-06-22 | 2019-03-12 | Edwards Lifesciences Cardiaq Llc | Actively controllable heart valve implant and method of controlling same |
US11083576B2 (en) | 2015-06-22 | 2021-08-10 | Edwards Lifesciences Cardiaq Llc | Actively controllable heart valve implant and method of controlling same |
US11844690B2 (en) | 2015-06-23 | 2023-12-19 | Edwards Lifesciences Cardiaq Llc | Systems and methods for anchoring and sealing a prosthetic heart valve |
US10842620B2 (en) | 2015-06-23 | 2020-11-24 | Edwards Lifesciences Cardiaq Llc | Systems and methods for anchoring and sealing a prosthetic heart valve |
US10092400B2 (en) | 2015-06-23 | 2018-10-09 | Edwards Lifesciences Cardiaq Llc | Systems and methods for anchoring and sealing a prosthetic heart valve |
US11576782B2 (en) | 2015-08-21 | 2023-02-14 | Twelve, Inc. | Implantable heart valve devices, mitral valve repair devices and associated systems and methods |
US10238490B2 (en) | 2015-08-21 | 2019-03-26 | Twelve, Inc. | Implant heart valve devices, mitral valve repair devices and associated systems and methods |
US10820996B2 (en) | 2015-08-21 | 2020-11-03 | Twelve, Inc. | Implantable heart valve devices, mitral valve repair devices and associated systems and methods |
US11278405B2 (en) | 2015-08-26 | 2022-03-22 | Edwards Lifesciences Cardiaq Llc | Delivery device and methods of use for transapical delivery of replacement valve |
US10575951B2 (en) | 2015-08-26 | 2020-03-03 | Edwards Lifesciences Cardiaq Llc | Delivery device and methods of use for transapical delivery of replacement mitral valve |
US10758345B2 (en) | 2015-08-26 | 2020-09-01 | Edwards Lifesciences Cardiaq Llc | Replacement heart valves and methods of delivery |
US10117744B2 (en) | 2015-08-26 | 2018-11-06 | Edwards Lifesciences Cardiaq Llc | Replacement heart valves and methods of delivery |
US11253364B2 (en) | 2015-08-28 | 2022-02-22 | Edwards Lifesciences Cardiaq Llc | Steerable delivery system for replacement mitral valve and methods of use |
US10350066B2 (en) | 2015-08-28 | 2019-07-16 | Edwards Lifesciences Cardiaq Llc | Steerable delivery system for replacement mitral valve and methods of use |
US10327894B2 (en) | 2015-09-18 | 2019-06-25 | Tendyne Holdings, Inc. | Methods for delivery of prosthetic mitral valves |
US11318012B2 (en) | 2015-09-18 | 2022-05-03 | Tendyne Holdings, Inc. | Apparatus and methods for delivery of prosthetic mitral valve |
US11096782B2 (en) | 2015-12-03 | 2021-08-24 | Tendyne Holdings, Inc. | Frame features for prosthetic mitral valves |
US10610358B2 (en) | 2015-12-28 | 2020-04-07 | Tendyne Holdings, Inc. | Atrial pocket closures for prosthetic heart valves |
US11464629B2 (en) | 2015-12-28 | 2022-10-11 | Tendyne Holdings, Inc. | Atrial pocket closures for prosthetic heart valves |
US10939998B2 (en) | 2015-12-30 | 2021-03-09 | Caisson Interventional, LLC | Systems and methods for heart valve therapy |
US10265166B2 (en) | 2015-12-30 | 2019-04-23 | Caisson Interventional, LLC | Systems and methods for heart valve therapy |
US11298117B2 (en) | 2016-02-16 | 2022-04-12 | Cardiovalve Ltd. | Techniques for providing a replacement valve and transseptal communication |
US10531866B2 (en) | 2016-02-16 | 2020-01-14 | Cardiovalve Ltd. | Techniques for providing a replacement valve and transseptal communication |
USD815744S1 (en) | 2016-04-28 | 2018-04-17 | Edwards Lifesciences Cardiaq Llc | Valve frame for a delivery system |
US10265172B2 (en) * | 2016-04-29 | 2019-04-23 | Medtronic Vascular, Inc. | Prosthetic heart valve devices with tethered anchors and associated systems and methods |
US11033390B2 (en) | 2016-04-29 | 2021-06-15 | Medtronic Vascular, Inc. | Prosthetic heart valve devices with tethered anchors and associated systems and methods |
US20170312078A1 (en) * | 2016-04-29 | 2017-11-02 | Medtronic Vascular, Inc. | Prosthetic heart valve devices with tethered anchors and associated systems and methods |
US10470877B2 (en) | 2016-05-03 | 2019-11-12 | Tendyne Holdings, Inc. | Apparatus and methods for anterior valve leaflet management |
US11253354B2 (en) | 2016-05-03 | 2022-02-22 | Tendyne Holdings, Inc. | Apparatus and methods for anterior valve leaflet management |
US11039921B2 (en) | 2016-06-13 | 2021-06-22 | Tendyne Holdings, Inc. | Sequential delivery of two-part prosthetic mitral valve |
US11090157B2 (en) | 2016-06-30 | 2021-08-17 | Tendyne Holdings, Inc. | Prosthetic heart valves and apparatus and methods for delivery of same |
US11701226B2 (en) | 2016-06-30 | 2023-07-18 | Tendyne Holdings, Inc. | Prosthetic heart valves and apparatus and methods for delivery of same |
US11065116B2 (en) | 2016-07-12 | 2021-07-20 | Tendyne Holdings, Inc. | Apparatus and methods for trans-septal retrieval of prosthetic heart valves |
US10856975B2 (en) | 2016-08-10 | 2020-12-08 | Cardiovalve Ltd. | Prosthetic valve with concentric frames |
US11779458B2 (en) | 2016-08-10 | 2023-10-10 | Cardiovalve Ltd. | Prosthetic valve with leaflet connectors |
US10646340B2 (en) | 2016-08-19 | 2020-05-12 | Edwards Lifesciences Corporation | Steerable delivery system for replacement mitral valve |
US10639143B2 (en) | 2016-08-26 | 2020-05-05 | Edwards Lifesciences Corporation | Multi-portion replacement heart valve prosthesis |
US11504229B2 (en) | 2016-08-26 | 2022-11-22 | Edwards Lifesciences Corporation | Multi-portion replacement heart valve prosthesis |
US11510778B2 (en) | 2016-11-02 | 2022-11-29 | Edwards Lifesciences Corporation | Supra and sub-annular mitral valve delivery system |
US10758348B2 (en) | 2016-11-02 | 2020-09-01 | Edwards Lifesciences Corporation | Supra and sub-annular mitral valve delivery system |
US11160653B2 (en) | 2017-03-27 | 2021-11-02 | Truleaf Medicai Ltd. | Docking elements |
US20210030538A1 (en) * | 2017-04-05 | 2021-02-04 | Opus Medical Therapies, LLC | Methods of implantation of transcatheter atrial sealing skirt, anchor, and tether |
US11389295B2 (en) | 2017-04-18 | 2022-07-19 | Twelve, Inc. | Delivery systems with tethers for prosthetic heart valve devices and associated methods |
US10575950B2 (en) | 2017-04-18 | 2020-03-03 | Twelve, Inc. | Hydraulic systems for delivering prosthetic heart valve devices and associated methods |
US10433961B2 (en) | 2017-04-18 | 2019-10-08 | Twelve, Inc. | Delivery systems with tethers for prosthetic heart valve devices and associated methods |
US10702378B2 (en) | 2017-04-18 | 2020-07-07 | Twelve, Inc. | Prosthetic heart valve device and associated systems and methods |
US11737873B2 (en) | 2017-04-18 | 2023-08-29 | Twelve, Inc. | Hydraulic systems for delivering prosthetic heart valve devices and associated methods |
US11654021B2 (en) | 2017-04-18 | 2023-05-23 | Twelve, Inc. | Prosthetic heart valve device and associated systems and methods |
US10792151B2 (en) | 2017-05-11 | 2020-10-06 | Twelve, Inc. | Delivery systems for delivering prosthetic heart valve devices and associated methods |
US11786370B2 (en) | 2017-05-11 | 2023-10-17 | Twelve, Inc. | Delivery systems for delivering prosthetic heart valve devices and associated methods |
US11559398B2 (en) | 2017-06-02 | 2023-01-24 | Twelve, Inc. | Delivery systems with telescoping capsules for deploying prosthetic heart valve devices and associated methods |
US10646338B2 (en) | 2017-06-02 | 2020-05-12 | Twelve, Inc. | Delivery systems with telescoping capsules for deploying prosthetic heart valve devices and associated methods |
US10709591B2 (en) | 2017-06-06 | 2020-07-14 | Twelve, Inc. | Crimping device and method for loading stents and prosthetic heart valves |
US11464659B2 (en) | 2017-06-06 | 2022-10-11 | Twelve, Inc. | Crimping device for loading stents and prosthetic heart valves |
US10813757B2 (en) | 2017-07-06 | 2020-10-27 | Edwards Lifesciences Corporation | Steerable rail delivery system |
US10729541B2 (en) | 2017-07-06 | 2020-08-04 | Twelve, Inc. | Prosthetic heart valve devices and associated systems and methods |
US10786352B2 (en) | 2017-07-06 | 2020-09-29 | Twelve, Inc. | Prosthetic heart valve devices and associated systems and methods |
US11883287B2 (en) | 2017-07-06 | 2024-01-30 | Edwards Lifesciences Corporation | Steerable rail delivery system |
US11123186B2 (en) | 2017-07-06 | 2021-09-21 | Edwards Lifesciences Corporation | Steerable delivery system and components |
US11877926B2 (en) | 2017-07-06 | 2024-01-23 | Twelve, Inc. | Prosthetic heart valve devices and associated systems and methods |
US11154399B2 (en) | 2017-07-13 | 2021-10-26 | Tendyne Holdings, Inc. | Prosthetic heart valves and apparatus and methods for delivery of same |
US11246704B2 (en) | 2017-08-03 | 2022-02-15 | Cardiovalve Ltd. | Prosthetic heart valve |
US10537426B2 (en) | 2017-08-03 | 2020-01-21 | Cardiovalve Ltd. | Prosthetic heart valve |
USD841813S1 (en) | 2017-08-03 | 2019-02-26 | Cardiovalve Ltd. | Prosthetic heart valve element |
USD841812S1 (en) | 2017-08-03 | 2019-02-26 | Cardiovalve Ltd. | Prosthetic heart valve element |
US11571298B2 (en) | 2017-08-03 | 2023-02-07 | Cardiovalve Ltd. | Prosthetic valve with appendages |
US11793633B2 (en) | 2017-08-03 | 2023-10-24 | Cardiovalve Ltd. | Prosthetic heart valve |
US10575948B2 (en) | 2017-08-03 | 2020-03-03 | Cardiovalve Ltd. | Prosthetic heart valve |
US11191639B2 (en) | 2017-08-28 | 2021-12-07 | Tendyne Holdings, Inc. | Prosthetic heart valves with tether coupling features |
US11304805B2 (en) | 2017-09-19 | 2022-04-19 | Cardiovalve Ltd. | Prosthetic valve with inflatable cuff configured to fill a volume between atrial and ventricular tissue anchors |
US11864996B2 (en) | 2017-09-19 | 2024-01-09 | Cardiovalve Ltd. | Prosthetic valve with protective sleeve around an outlet rim |
US11318015B2 (en) | 2017-09-19 | 2022-05-03 | Cardiovalve Ltd. | Prosthetic valve configured to fill a volume between tissue anchors with native valve tissue |
US10905548B2 (en) | 2017-09-19 | 2021-02-02 | Cardio Valve Ltd. | Prosthetic valve with protective sleeve around an outlet rim |
US10905549B2 (en) | 2017-09-19 | 2021-02-02 | Cardiovalve Ltd. | Prosthetic valve with overlapping atrial tissue anchors and ventricular tissue anchors |
US11819405B2 (en) | 2017-09-19 | 2023-11-21 | Cardiovalve Ltd. | Prosthetic valve with inflatable cuff configured for radial extension |
US11337804B2 (en) | 2017-09-19 | 2022-05-24 | Cardiovalve Ltd. | Prosthetic valve with radially-deformable tissue anchors configured to restrict axial valve migration |
US10888421B2 (en) | 2017-09-19 | 2021-01-12 | Cardiovalve Ltd. | Prosthetic heart valve with pouch |
US10799345B2 (en) | 2017-09-19 | 2020-10-13 | Cardiovalve Ltd. | Prosthetic valve with protective fabric covering around tissue anchor bases |
US11304804B2 (en) | 2017-09-19 | 2022-04-19 | Cardiovalve, Ltd. | Prosthetic valve with connecting struts of variable size and tissue anchoring legs of variable size that extend from junctions |
US11304806B2 (en) | 2017-09-19 | 2022-04-19 | Cardiovalve Ltd. | Prosthetic valve with atrial tissue anchors having variable flexibility and ventricular tissue anchors having constant flexibility |
US11337803B2 (en) | 2017-09-19 | 2022-05-24 | Cardiovalve Ltd. | Prosthetic valve with inner and outer frames connected at a location of tissue anchor portion |
US10881511B2 (en) | 2017-09-19 | 2021-01-05 | Cardiovalve Ltd. | Prosthetic valve with tissue anchors configured to exert opposing clamping forces on native valve tissue |
US11318014B2 (en) | 2017-09-19 | 2022-05-03 | Cardiovalve Ltd. | Prosthetic valve delivery system with multi-planar steering |
US11337802B2 (en) | 2017-09-19 | 2022-05-24 | Cardiovalve Ltd. | Heart valve delivery systems and methods |
US10856972B2 (en) | 2017-09-19 | 2020-12-08 | Cardiovalve Ltd. | Prosthetic valve with angularly offset atrial anchoring arms and ventricular anchoring legs |
US11872131B2 (en) | 2017-12-13 | 2024-01-16 | Cardiovalve Ltd. | Prosthetic valve and delivery tool therefor |
US11382746B2 (en) | 2017-12-13 | 2022-07-12 | Cardiovalve Ltd. | Prosthetic valve and delivery tool therefor |
US11872124B2 (en) | 2018-01-10 | 2024-01-16 | Cardiovalve Ltd. | Temperature-control during crimping of an implant |
US11633277B2 (en) | 2018-01-10 | 2023-04-25 | Cardiovalve Ltd. | Temperature-control during crimping of an implant |
US11684474B2 (en) | 2018-01-25 | 2023-06-27 | Edwards Lifesciences Corporation | Delivery system for aided replacement valve recapture and repositioning post-deployment |
US20210000593A1 (en) * | 2018-02-15 | 2021-01-07 | Tricares SAS | Stent and replacement heart valve prosthesis with improved fixation features |
AU2019228527B2 (en) * | 2018-02-28 | 2023-04-20 | Edwards Lifesciences Corporation | Prosthetic mitral valve with improved anchors and seal |
US11051934B2 (en) * | 2018-02-28 | 2021-07-06 | Edwards Lifesciences Corporation | Prosthetic mitral valve with improved anchors and seal |
US11786366B2 (en) | 2018-04-04 | 2023-10-17 | Vdyne, Inc. | Devices and methods for anchoring transcatheter heart valve |
WO2020061331A3 (en) * | 2018-09-20 | 2020-06-11 | Vdyne, Llc | Transcatheter deliverable prosthetic heart valves and methods of delivery |
US11273033B2 (en) | 2018-09-20 | 2022-03-15 | Vdyne, Inc. | Side-delivered transcatheter heart valve replacement |
US11344413B2 (en) | 2018-09-20 | 2022-05-31 | Vdyne, Inc. | Transcatheter deliverable prosthetic heart valves and methods of delivery |
US11395738B2 (en) | 2018-09-25 | 2022-07-26 | Truleaf Medical Ltd. | Docking elements |
US11071627B2 (en) | 2018-10-18 | 2021-07-27 | Vdyne, Inc. | Orthogonally delivered transcatheter heart valve frame for valve in valve prosthesis |
US11109969B2 (en) | 2018-10-22 | 2021-09-07 | Vdyne, Inc. | Guidewire delivery of transcatheter heart valve |
US11278437B2 (en) | 2018-12-08 | 2022-03-22 | Vdyne, Inc. | Compression capable annular frames for side delivery of transcatheter heart valve replacement |
US11253359B2 (en) | 2018-12-20 | 2022-02-22 | Vdyne, Inc. | Proximal tab for side-delivered transcatheter heart valves and methods of delivery |
US11273032B2 (en) | 2019-01-26 | 2022-03-15 | Vdyne, Inc. | Collapsible inner flow control component for side-deliverable transcatheter heart valve prosthesis |
US11185409B2 (en) | 2019-01-26 | 2021-11-30 | Vdyne, Inc. | Collapsible inner flow control component for side-delivered transcatheter heart valve prosthesis |
US11298227B2 (en) * | 2019-03-05 | 2022-04-12 | Vdyne, Inc. | Tricuspid regurgitation control devices for orthogonal transcatheter heart valve prosthesis |
US11076956B2 (en) | 2019-03-14 | 2021-08-03 | Vdyne, Inc. | Proximal, distal, and anterior anchoring tabs for side-delivered transcatheter mitral valve prosthesis |
US11173027B2 (en) | 2019-03-14 | 2021-11-16 | Vdyne, Inc. | Side-deliverable transcatheter prosthetic valves and methods for delivering and anchoring the same |
US11712335B2 (en) | 2019-05-04 | 2023-08-01 | Vdyne, Inc. | Cinch device and method for deployment of a side-delivered prosthetic heart valve in a native annulus |
US11202706B2 (en) | 2019-05-04 | 2021-12-21 | Vdyne, Inc. | Cinch device and method for deployment of a side-delivered prosthetic heart valve in a native annulus |
US11166814B2 (en) | 2019-08-20 | 2021-11-09 | Vdyne, Inc. | Delivery and retrieval devices and methods for side-deliverable transcatheter prosthetic valves |
US11179239B2 (en) | 2019-08-20 | 2021-11-23 | Vdyne, Inc. | Delivery and retrieval devices and methods for side-deliverable transcatheter prosthetic valves |
US11344412B2 (en) | 2019-08-20 | 2022-05-31 | Vdyne, Inc. | Delivery and retrieval devices and methods for side-deliverable transcatheter prosthetic valves |
US11331186B2 (en) | 2019-08-26 | 2022-05-17 | Vdyne, Inc. | Side-deliverable transcatheter prosthetic valves and methods for delivering and anchoring the same |
US11337807B2 (en) | 2019-08-26 | 2022-05-24 | Vdyne, Inc. | Side-deliverable transcatheter prosthetic valves and methods for delivering and anchoring the same |
US11648110B2 (en) | 2019-12-05 | 2023-05-16 | Tendyne Holdings, Inc. | Braided anchor for mitral valve |
US11648114B2 (en) | 2019-12-20 | 2023-05-16 | Tendyne Holdings, Inc. | Distally loaded sheath and loading funnel |
US11234813B2 (en) | 2020-01-17 | 2022-02-01 | Vdyne, Inc. | Ventricular stability elements for side-deliverable prosthetic heart valves and methods of delivery |
WO2021156866A1 (en) | 2020-02-04 | 2021-08-12 | Cardiovalve Ltd. | Support-guided steering of a catheter |
US11931258B2 (en) | 2020-04-30 | 2024-03-19 | Edwards Lifesciences Corporation | Steerable delivery system for replacement mitral valve and methods of use |
US11678980B2 (en) | 2020-08-19 | 2023-06-20 | Tendyne Holdings, Inc. | Fully-transseptal apical pad with pulley for tensioning |
Also Published As
Publication number | Publication date |
---|---|
EP4166111A1 (en) | 2023-04-19 |
US20140207231A1 (en) | 2014-07-24 |
US20170252159A1 (en) | 2017-09-07 |
US20180147059A1 (en) | 2018-05-31 |
US11844691B2 (en) | 2023-12-19 |
US20200360139A1 (en) | 2020-11-19 |
US10631982B2 (en) | 2020-04-28 |
US9681952B2 (en) | 2017-06-20 |
US20240058123A1 (en) | 2024-02-22 |
ES2934670T3 (en) | 2023-02-23 |
US10835377B2 (en) | 2020-11-17 |
US20210393402A1 (en) | 2021-12-23 |
US11135059B2 (en) | 2021-10-05 |
WO2014115149A2 (en) | 2014-07-31 |
US20190021857A1 (en) | 2019-01-24 |
EP2948103A2 (en) | 2015-12-02 |
WO2014115149A3 (en) | 2014-10-30 |
EP2948103B1 (en) | 2022-12-07 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US11135059B2 (en) | Prosthetic valve and upstream support therefor | |
US10433963B2 (en) | Tissue anchor and delivery tool | |
US20210085464A1 (en) | Adjustable annuloplasty devices and adjustment mechanisms therefor | |
US11517429B2 (en) | Apparatus for use at a heart valve | |
US11819411B2 (en) | Annuloplasty and tissue anchor technologies | |
US11116634B2 (en) | Annuloplasty implants | |
US9241702B2 (en) | Method and apparatus for tricuspid valve repair using tension | |
US8961596B2 (en) | Method and apparatus for tricuspid valve repair using tension | |
US20220047389A1 (en) | Tricuspid Valve Repair Using Tension |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
AS | Assignment |
Owner name: MITRALTECH LTD., ISRAEL Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:HAMMER, TAL;ZIPORY, YUVAL;REICH, TAL;AND OTHERS;SIGNING DATES FROM 20151022 TO 20151111;REEL/FRAME:037150/0691 |
|
AS | Assignment |
Owner name: CARDIOVALVE LTD., ISRAEL Free format text: CHANGE OF NAME;ASSIGNOR:MITRALTECH LTD.;REEL/FRAME:047208/0108 Effective date: 20180802 |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: FINAL REJECTION MAILED |
|
STCB | Information on status: application discontinuation |
Free format text: ABANDONED -- FAILURE TO RESPOND TO AN OFFICE ACTION |