Abstract:
Apparatus and methods are described herein for use in the delivery of a prosthetic mitral valve. In some embodiments, a method includes after deploying a prosthetic mitral valve within a mitral annulus of a heart, inserting a delivery sheath into the patients body and disposing a distal end near the apex of the heart. A tissue dilator device can be inserted through a lumen of the delivery sheath and used to dilate tissue near the apex of the heart to create space for an epicardial pad device. After dilating the tissue, the tissue dilator device can be removed and an epicardial pad device can be attached to a tether extending from the prosthetic valve. The pad can be secured at the apex of the heart to secure the prosthetic valve and tether in a desired position. In some embodiments, the epicardial pad device can be an expandable epicardial pad device.
Abstract:
Apparatus is provided including a first tissue-engaging element (60a), a first flexible longitudinal member (2612) coupled at a first end portion (2613) thereof to at least a portion of the first tissue-engaging element (60a), and a first flexible-longitudinal-member-coupling element (2614) coupled to the first flexible longitudinal member (2612) at a second end portion (2615) of the first flexible longitudinal member (2612). Apparatus includes a second tissue-engaging element (60b), a second flexible longitudinal member (2660) coupled at a first end portion thereof to at least a portion of the second tissue-engaging element (60b), and a second flexible-longitudinal-member-coupling element (2650) coupled to the second flexible longitudinal member (2660) at a second end portion (2662) of the second flexible longitudinal member (2660), the first and second flexible-longitudinal-member-coupling elements (2614, 2650) being couplable to couple together the first and second flexible longitudinal elements (2612, 2660). Other applications are also described.
Abstract:
Apparatus is provided including a first tissue-engaging element (60a), a first flexible longitudinal member (2612) coupled at a first end portion (2613) thereof to at least a portion of the first tissue-engaging element (60a), and a first flexible-longitudinal-member-coupling element (2614) coupled to the first flexible longitudinal member (2612) at a second end portion (2615) of the first flexible longitudinal member (2612). Apparatus includes a second tissue-engaging element (60b), a second flexible longitudinal member (2660) coupled at a first end portion thereof to at least a portion of the second tissue-engaging element (60b), and a second flexible-longitudinal-member-coupling element (2650) coupled to the second flexible longitudinal member (2660) at a second end portion (2662) of the second flexible longitudinal member (2660), the first and second flexible-longitudinal-member-coupling elements (2614, 2650) being couplable to couple together the first and second flexible longitudinal elements (2612, 2660). Other applications are also described.
Abstract:
One embodiment is directed to a system for providing surgical access across a wall of a tissue structure, comprising a delivery member, a first helical member, an anchor member removably coupled to the helical member distal end, and a suture member coupled distally to a portion of the anchor member and extending proximally to a position wherein at least a portion of it may be freely manipulated by an operator; wherein upon rotation of the delivery member in a first direction, the first helical member and coupled anchor member are advanced across at least a portion of the wall of the tissue structure, pulling along the distal portion of the suture member in a deployed suture pattern which remains coupled to the anchor member, the deployed suture pattern being characterized in that it is substantially helical with between about one and three helical loops.
Abstract:
Methods and apparatus for controlled grasping and cinching or locking of a tissue anchor are provided. In one variation, a tube is provided having a lumen and a resilient member that obstructs the lumen. A grasper may be advanced coaxially through the lumen, such that it reversibly displaces the resilient member and extends beyond the lumen's outlet to engage an element of the tissue anchor. The grasper then may be retracted within the tube, such that the resilient member again obstructs the lumen of the tube. Continued retraction of the grasper may act to cinch the anchor, for example, via interaction between the anchor and the obstructing resilient member. During cinching, a cinching mechanism of the anchor optionally may be positioned at least partially within the tube to enhance lateral stability. Furthermore, feedback indicative of a degree of cinching or locking may be provided during cinching.
Abstract:
Devices and methods used in termination of a tissue tightening procedure are described. Termination includes the cinching of a tether to tighten the tissue, locking the tether to maintain tension, and cutting excess tether. In procedures involving anchors secured to the tissue, the tether is coupled to the anchors and the tissue is tightened via tension applied to the anchors by cinching the tether. In general, the devices and methods can be used in minimally invasive surgical procedures, and can be applied through small incisions or intravascularly. A method for tightening tissue by fixedly coupling a first anchor to a tether and slidably coupling a second anchor to the tether, securing both anchors to the tissue, applying tension to the tether intravascularly, fixedly coupling the tether to the second anchor, and cutting the tether is described. The tissue to be tightened can comprise heart tissue, in particular heart valve annulus tissue. Various devices and methods for locking the tether in place and cutting excess tether are described.
Abstract:
The present invention provides tissue capture devices (318) configured to hold tissue in a distorted configuration. The devices (318) may hold precaptured tissue in a distorted configuration or it may change their shape to cause the tissue to become deformed. Some embodiments of the device (318) alter the configuration in areas that remain external to the tissue, while other embodiments change their configuration in areas that are implanted in the tissue. Other embodiments may be mechanically altered to hold the tissue in a distorted shape.
Abstract:
Surgical tissue fasteners and related deployment systems and methods are disclosed. A tissue fastener used to join multiple tissue layers includes a first member, a second member, and a connecting member connecting the first and second members. In some embodiments, the first and second members are configured to expand from a delivered state to a deployed state in which the fastener secures the tissue layers together. Other tissue fastener embodiments include means for applying a substantially constant force on the tissue layers and/or means for adjusting a length of the connecting member between the first and second members.
Abstract:
The present invention provides methods and devices 100 for grasping 106, and optional repositioning and fixation of the valve leaflets LF to treat cardiac valve regurgitation, particularly mitral valve regurgitation. Such grasping will typically be atraumatic providing a number of benefits. For example, atraumatic grasping may allow repositioning of the devices relative to the leaflets and repositioning of the leaflets themselves without damage to the leaflets. However, in some cases it may be necessary or desired to include grasping which pierces or otherwise permanently affects the leaflets. In some of these cases, the grasping step includes fixation 115.
Abstract:
The present invention provides methods and devices for grasping, and optional repositioning and fixation of the valve leaflets to treat cardiac valve regurgitation, particularly mitral valve regurgitation. Such grasping will typically be atraumatic providing a number of benefits. For example, atraumatic grasping may allow repositioning of the devices relative to the leaflets and repositioning of the leaflets themselves without damage to the leaflets. However, in some cases it may be necessary or desired to include grasping which pierces or otherwise permanently affects the leaflets. In some of these cases, the grasping step includes fixation.