US20050027351A1 - Mitral valve regurgitation treatment device and method - Google Patents

Abstract

A method of treating regurgitation of a mitral valve in a patient's heart. The method includes the steps of: delivering a tissue shaping device to the coronary sinus; and deploying the tissue shaping device to reduce mitral valve regurgitation, the deploying step comprising applying a force through the coronary sinus wall toward the mitral valve solely proximal to a crossover point where a coronary artery passes between a coronary sinus and the mitral valve. The invention is also a set of devices for use in treating mitral valve regurgitation. The set includes a plurality of tissue shaping devices having different lengths, each of the tissue shaping devices being configured to be deliverable to a coronary sinus of a patient within a catheter having an outer diameter no greater than ten french.

Description

CROSS-REFERENCE TO RELATED CASES
• This application is a continuation-in-part of U.S. patent appl. Ser. No. 09/855,945, filed May 14, 2001, the disclosure of which is incorporated herein by reference.
BACKGROUND OF THE INVENTION
• This invention relates generally to devices and methods for shaping tissue by deploying one or more devices in body lumens adjacent to the tissue. One particular application of the invention relates to a treatment for mitral valve regurgitation through deployment of a tissue shaping device in the patient's coronary sinus or great cardiac vein.
• The mitral valve is a portion of the heart that is located between the chambers of the left atrium and the left ventricle. When the left ventricle contracts to pump blood throughout the body, the mitral valve closes to prevent the blood being pumped back into the left atrium. In some patients, whether due to genetic malformation, disease or injury, the mitral valve fails to close properly causing a condition known as regurgitation, whereby blood is pumped into the atrium upon each contraction of the heart muscle. Regurgitation is a serious, often rapidly deteriorating, condition that reduces circulatory efficiency and must be corrected.
• Two of the more common techniques for restoring the function of a damaged mitral valve are to surgically replace the valve with a mechanical valve or to suture a flexible ring around the valve to support it. Each of these procedures is highly invasive because access to the heart is obtained through an opening in the patient's chest. Patients with mitral valve regurgitation are often relatively frail thereby increasing the risks associated with such an operation.
• One less invasive approach for aiding the closure of the mitral valve involves the placement of a tissue shaping device in the cardiac sinus and vessel that passes adjacent the mitral valve. The tissue shaping device is designed to push the vessel and surrounding tissue against the valve to aid its closure. This technique has the advantage over other methods of mitral valve repair because it can be performed percutaneously without opening the chest wall. Examples of such devices are shown in U.S. patent appl. Ser. No. 10/142,637, “Body Lumen Device Anchor, Device and Assembly” filed May 8, 2002; U.S. patent appl. Ser. No. 10/331,143, “System and Method to Effect the Mitral Valve Annulus of a Heart” filed Dec. 26, 2002; and U.S. patent appl. Ser. No. 10/429,172, “Device and Method for Modifying the Shape of a Body Organ,” filed May 2, 2003. The disclosures of these patent applications are incorporated herein by reference.
• When deploying a tissue shaping device in a vein or artery to modify adjacent tissue, care must be taken to avoid constricting nearby arteries. For example, when treating mitral valve regurgitation, a tissue shaping device may be deployed in the coronary sinus to modify the shape of the adjacent mitral valve annulus. Coronary arteries such as the circumflex artery may cross between the coronary sinus and the heart, however, raising the danger that deployment of the support may limit perfusion to a portion of the heart by constricting one of those arteries. See, e.g., the following applications, the disclosures of which are incorporated herein by reference: U.S. patent appl. Ser. No. 09/855,945, “Mitral Valve Therapy Device, System and Method,” filed May 14, 2001 and published Nov. 14, 2002, as US 2002/0169504 A1; U.S. patent appl. Ser. No. 09/855,946, “Mitral Valve Therapy Assembly and Method,” filed May 14, 2001 and published Nov. 14, 2002, as US 2002/0169502 A1; and U.S. patent appl. Ser. No. 10/003,910, “Focused Compression Mitral Valve Device and Method” filed Nov. 1, 2001. It is therefore advisable to monitor cardiac perfusion during and after such mitral valve regurgitation therapy. See, e.g., U.S. patent appl. Ser. No. 10/366,585, “Method of Implanting a Mitral Valve Therapy Device,” filed Feb. 12, 2003, the disclosure of which is incorporated herein by reference.
BRIEF SUMMARY OF THE INVENTION
• The anatomy of the heart and its surrounding vessels varies from patient to patient. For example, the location of the circumflex artery and other key arteries with respect to the coronary sinus can vary. Specifically, the distance along the coronary sinus from the ostium to the crossing point with the circumflex artery can vary from patient to patient. In addition, the diameter and length of the coronary sinus can vary from patient to patient.
• We have invented tissue shaping devices, sets of tissue shaping devices and methods that maximize the therapeutic effect (i.e., reduction of mitral valve regurgitation) while minimizing adverse effects, such as an unacceptable constriction of the circumflex artery or other coronary arteries. The tissue shaping devices, sets of devices and methods of this invention enable the user to adapt the therapy to the patient's anatomy.
• In one embodiment, the invention is a method of treating regurgitation of a mitral valve in a patient's heart, the method including the steps of delivering a tissue shaping device to the coronary sinus, such as in a catheter having an outer diameter no more than nine or ten french; and deploying the tissue shaping device to reduce mitral valve regurgitation, with the deploying step including the step of applying a force through the coronary sinus wall toward the mitral valve solely proximal to a crossover point where a coronary artery passes between a coronary sinus and the mitral valve. In some embodiments, the device is deployed with its distal end proximal to the crossover point, and in some embodiments the distal end is deployed distal to the crossover point. The method may also include the step of determining the crossover point.
• In some embodiments the tissue shaping device includes a distal anchor, in which case the deploying step may include the step of anchoring the distal anchor proximal to the crossover point, such as by expanding the distal anchor through self-expansion or through the application of an actuation force. The anchoring force may be one-two pounds.
• In some embodiments, the deploying step further includes the step of applying a proximally directed force on the distal anchor—in some embodiments from outside the patient—such as by moving the proximal anchor proximally. The tissue shaping device may further include a proximal anchor and a connector disposed between the distal anchor and the proximal anchor, with the deploying step further including the step of anchoring the proximal anchor (e.g., in the coronary sinus or at least partially outside the coronary sinus), such as by expanding the proximal anchor through self-expansion or through the application of an actuation force. The step of anchoring the proximal anchor may be performed before or after the step of applying a proximally directed force on the distal anchor.
• The deploying step of the method may include the step of deploying a distal anchor of the device from a distal end of a catheter. The method may also include the step of recapturing the distal anchor into a catheter and optionally redeploying the distal anchor. The deploying step of the method may also include the step of deploying a proximal anchor of the device from a distal end of a catheter, and the may include the step of recapturing the proximal anchor into a catheter and optionally redeploying the distal anchor. The entire device may also be recaptured by a catheter and redeployed from the catheter.
• The method may also include the step of selecting the tissue shaping device from a set of tissue shaping devices that includes tissue shaping devices of a plurality of lengths and/or tissue shaping devices of a plurality of anchor sizes prior to the delivering step.
• The invention is also a set of devices for use in treating mitral valve regurgitation, with the set including a plurality of tissue shaping devices having different lengths, each of the tissue shaping devices being configured to be deliverable to a coronary sinus of a patient within a catheter having an outer diameter no greater than nine or ten french. In some embodiments the tissue shaping devices each include an anchor (such as a distal anchor or a proximal anchor) having an expanded configuration and an unexpanded configuration for delivery via catheter. In some embodiments, at least one tissue shaping device in the set has alength 60 mm or less and at least one tissue shaping device in the set has a length more than 60 mm. In some embodiments the distal anchor of each tissue shaping device in the set in its expanded configuration has a diameter equal to or greater than a coronary sinus diameter at a distal anchor location (e.g., about 7 mm. to about 16 mm.), and the proximal anchor of each tissue shaping device in the set in its expanded configuration has a diameter equal to or greater than a coronary sinus diameter at a proximal anchor location (e.g., about 9 mm. to about 20 mm.) In some sets, the anchors are self-expanding, in other sets the anchors are actuatable, while still other sets have at least one device with a self-expanding anchor and one with an actuatable anchor. The set may also include a catheter having an outer diameter no greater than nine to ten french.
• Another aspect of the invention is a set of devices for use in treating mitral valve regurgitation, with the set including a plurality of tissue shaping devices each with an anchor having an unexpanded configuration and an expanded configuration, the anchors having different diameters when in their expanded configurations, and each of the tissue shaping devices being configured to be deliverable to a coronary sinus of a patient within a catheter having an outer diameter no greater than nine to ten french. In some embodiments the anchor is a distal anchor (such as a self-expanding anchor or an actuatable anchor), and the devices further include a proximal anchor (such as a self-expanding anchor or an actuatable anchor) having an unexpanded configuration and an expanded configuration, the proximal anchors having different diameters when in their expanded configurations. In some embodiments the diameters of the distal anchors of the tissue shaping devices in the set in their expanded configurations range from about 7 mm. to about 16 mm., and in some embodiments the diameters of the proximal anchors of the tissue shaping devices in the set in their expanded configurations range from about 9 mm. to about 20 mm. The set may also include a catheter having an outer diameter no greater than nine to ten french.
• The invention will be described in more detail below with reference to the drawings.
BRIEF DESCRIPTION OF THE FIGURES
• FIG. 1 is a schematic view of a tissue shaping device according to a preferred embodiment as deployed within a coronary sinus.
• FIG. 2 is a schematic view of a tissue shaping device according to an alternative embodiment as deployed within a coronary sinus.
• FIG. 3 is a schematic view of a tissue shaping device being delivered to a coronary sinus within a catheter.
• FIG. 4 is a schematic view of a partially deployed tissue shaping device within a coronary sinus.
• FIG. 5 is a schematic view of a partially deployed and cinched tissue shaping device within a coronary sinus.
• FIG. 6 is an elevational view of yet another embodiment of a tissue shaping device according to this invention.
• FIG. 7 is a schematic drawing showing a method of determining the crossover point between a circumflex artery and a coronary sinus.
• FIG. 8 is a perspective drawing of a tissue shaping device according to one embodiment of this invention.
• FIG. 9 is a partial sectional view of the tissue shaping device ofFIG. 8 in an unexpanded configuration within a catheter.
• FIG. 10 is a perspective view of an anchor for use with a tissue shaping device according to this invention.
• FIG. 11 is a perspective view of another anchor for use with a tissue shaping device according to this invention.
• FIG. 12 is a perspective view of yet another anchor for use with a tissue shaping device according to this invention.
• FIG. 13 is a perspective view of still another anchor for use with a tissue shaping device according to this invention.
• FIG. 14 is a perspective view of another anchor for use with a tissue shaping device according to this invention.
• FIG. 15 is a perspective view of yet another anchor for use with a tissue shaping device according to this invention.
• FIG. 16 is a perspective view of part of an anchor for use with a tissue shaping device according to this invention.
• FIG. 17 is a perspective view of still another anchor for use with a tissue shaping device according to this invention.
• FIG. 18 is a perspective view of another anchor for use with a tissue shaping device according to this invention.
• FIG. 19 is a perspective view of yet another anchor for use with a tissue shaping. device according to this invention.
• FIG. 20 is a perspective view of still another anchor for use with a tissue shaping device according to this invention.
• FIG. 21 is a perspective view of a tandem anchor for use with a tissue shaping device according to this invention.
• FIG. 22 is a perspective view of a connector with integral anchor crimps for us in a tissue shaping device according to this invention.
• FIG. 23 is a perspective view of a tissue shaping device employing the connector ofFIG. 22.
• FIG. 24 is a perspective view of another connector for use with a tissue shaping device according to this invention.
• FIG. 25 is a perspective view of yet another connector for use with a tissue shaping device according to this invention.
• FIG. 26 is a side view of a connector for use with a tissue shaping device according to this invention.
• FIG. 27 is a side view of another connector for use with a tissue shaping device according to this invention.
• FIG. 28 is a perspective view of yet another tissue shaping device according to this invention.
• FIG. 29 is a side view of the tissue shaping device shown inFIG. 28.
• FIG. 30 is a schematic view of another embodiment demonstrating the method of this invention.
• FIG. 31 is a schematic view of yet another embodiment demonstrating the method of this invention.
DETAILED DESCRIPTION OF THE INVENTION
• FIG. 1 shows a partial view of ahuman heart10 and some surrounding anatomical structures. The main coronary venous vessel is thecoronary sinus12, defined as starting at theostium14 or opening to the right atrium and extending through the great cardiac vein to the anterior interventricular (“AIV”) sulcus orgroove16. Also shown is themitral valve20 surrounded by themitral valve annulus22 and adjacent to at least a portion of thecoronary sinus12. Thecircumflex artery24 shown inFIG. 1 passes between thecoronary sinus12 and the heart. The relative size and location of each of these structures vary from person to person.
• Disposed within thecoronary sinus12 is atissue shaping device30. As shown inFIG. 1, thedistal end32 ofdevice30 is disposed proximal tocircumflex artery24 to reshape the adjacentmitral valve annulus22 and thereby reduce mitral valve regurgitation. As shown inFIG. 1,device30 has adistal anchor34, aproximal anchor36 and aconnector38.
• In the embodiment ofFIG. 1,proximal anchor36 is deployed completely within the coronary sinus. In the alternative embodiment shown inFIG. 2, proximal anchor is deployed at least partially outside the coronary sinus.
• FIGS. 3-6 show a method according to this invention. As shown inFIG. 3, acatheter50 is maneuvered in a manner known in the art through theostium14 intocoronary sinus12. In order to be navigable through the patient's venous system,catheter50 preferably has an outer diameter no greater than ten french, most preferably with an outer diameter no more than nine french. Disposed withincatheter50 isdevice30 in an unexpanded configuration, and extending back throughcatheter50 fromdevice30 to the exterior of the patient is a tether orcontrol wire52. In some embodiments,control wire52 may include multiple tether and control wire elements, such as those described in U.S. patent application Ser. No. 10/331,143.
• According to one preferred embodiment, the device is deployed as far distally as possible without applying substantial compressive force on the circumflex or other major coronary artery. Thus, the distal end ofcatheter50 is disposed at a distal anchor location proximal of the crossover point between thecircumflex artery24 and thecoronary sinus12 as shown inFIG. 3. At this point,catheter50 is withdrawn proximally whiledevice30 is held stationary bycontrol wire52 to uncoverdistal anchor34 at the distal anchor location withincoronary sinus12. Alternatively, the catheter may be held stationary whiledevice30 is advanced distally to uncover the distal anchor.
• Distal anchor34 is either a self-expanding anchor or an actuatable anchor or a combination self-expanding and actuatable anchor. Once uncovered,distal anchor34 self-expands, or is expanded through the application of an actuation force (such as a force transmitted through control wire52), to engage the inner wall ofcoronary sinus12, as shown inFIG. 4. The distal anchor's anchoring force, i.e., the force with which the distal anchor resists moving in response to a proximally-directed force, must be sufficient not only to maintain the device's position within the coronary sinus but also to enable the device to be used to reshape adjacent tissue in a manner such as that described below. In a preferred embodiment,distal anchor34 engages the coronary sinus wall to provide an anchoring force of at least one pound, most preferably an anchoring force of at least two pounds. The anchor's expansion energy to supply the anchoring force comes from strain energy stored in the anchor due to its compression for catheter delivery, from an actuation force, or a combination of both, depending on anchor design.
• Whiledevice30 is held in place by the anchoring force ofdistal anchor34,catheter50 is withdrawn further proximally to a point just distal ofproximal anchor36, as shown inFIG. 5. A proximally directed force is then exerted ondistal anchor34 bycontrol wire52 throughconnector38. In this embodiment, the distance between the distal and proximal anchors along the connector is fixed, so the proximally directed force movesproximal anchor36 proximally with respect to the coronary sinus whiledistal anchor34 remains stationary with respect to the coronary sinus. This cinching action straightens that section ofcoronary sinus12, thereby modifying its shape and the shape of the adjacentmitral valve20, moving the mitral valve leaflets into greater coaptation and reducing mitral valve regurgitation. In some embodiments of the invention, the proximal anchor is moved proximally about 1-6 cm., most preferably at least 2 cm., in response to the proximally directed force. In other embodiments, such as embodiments in which the distance between the distal and proximal anchors is not fixed (e.g., where the connector length is variable), the proximal anchor may stay substantially stationary with respect to the coronary sinus despite the application of a proximally directed force on the distal anchor.
• After the appropriate amount of reduction in mitral valve regurgitation has been achieved (as determined, e.g., by viewing doppler-enhanced echocardiograms), the proximal anchor is deployed. Other patient vital signs, such as cardiac perfusion, may also be monitored during this procedure as described in U.S. patent application Ser. No. 10/366,585.
• In preferred embodiments, the proximal anchor's anchoring force, i.e., the force with which the proximal anchor resists moving in response to a distally-directed force, must be sufficient not only to maintain the device's position within the coronary sinus but also to enable the device to maintain the adjacent tissue's cinched shape. In a preferred embodiment, the proximal anchor engages the coronary sinus wall to provide an anchoring force of at least one pound, most preferably an anchoring force of at least two pounds. As with the distal anchor, the proximal anchor's expansion energy to supply the anchoring force comes from strain energy stored in the anchor due to its compression for catheter delivery, from an actuation force, or a combination of both, depending on anchor design.
• In a preferred embodiment, the proximal anchor is deployed by withdrawingcatheter50 proximally to uncoverproximal anchor36, then either permittingproximal anchor36 to self-expand, applying an actuation force to expand the anchor, or a combination of both. Thecontrol wire52 is then detached, andcatheter50 is removed from the patient. The device location and configuration as deployed according to this method is as shown inFIG. 1.
• Alternatively,proximal anchor36 may be deployed at least partially outside of the coronary sinus after cinching to modify the shape of the mitral valve tissue, as shown inFIG. 2. In both embodiments, becausedistal anchor34 is disposed proximal to the crossover point betweencoronary sinus12 andcircumflex artery24, all of the anchoring and tissue reshaping force applied to the coronary sinus bydevice30 is solely proximal to the crossover point.
• In alternative embodiments, the proximal anchor may be deployed prior to the application of the proximally directed force to cinch the device to reshape the mitral valve tissue. One example of a device according to this embodiment is shown inFIG. 6.Device60 includes a self-expandingdistal anchor62, a self-expandingproximal anchor64 and aconnector66. The design ofdistal anchor62 enables it to maintain its anchoring force when a proximally directed force is applied on it to cinch, while the design ofproximal anchor64 permits it to be moved proximally after deployment while resisting distal movement after cinching. Cinching after proximal anchor deployment is described in more detail in U.S. patent application Ser. No. 10/066,426, filed Jan. 30, 2002, the disclosure of which is incorporated herein by reference. In this embodiment as well,distal anchor62 is disposed proximal to the crossover point betweencoronary sinus12 andcircumflex artery24 so that all of anchoring and tissue reshaping force applied to the coronary sinus bydevice30 is solely proximal to the crossover point.
• It may be desirable to move and/or remove the tissue shaping device after deployment or to re-cinch after initial cinching. According to certain embodiments of the invention, therefore, the device or one of its anchors may be recaptured. For example, in the embodiment ofFIG. 1, after deployment ofproximal anchor36 but prior to disengagement ofcontrol wire52,catheter50 may be moved distally to placeproximal anchor36 back insidecatheter50, e.g., to the configuration shown inFIG. 5. From this position, the cinching force alongconnector38 may be increased or decreased, andproximal anchor36 may then be redeployed.
• Alternatively,catheter50 may be advanced distally to recapture bothproximal anchor36 anddistal anchor34, e.g., to the configuration shown inFIG. 3. From this position,distal anchor34 may be redeployed, a cinching force applied, andproximal anchor36 deployed as discussed above. Also from this position,device30 may be removed from the patient entirely by simply withdrawing the catheter from the patient.
• Fluoroscopy (e.g., angiograms and venograms) may be used to determine the relative positions of the coronary sinus and the coronary arteries such as the circumflex artery, including the crossover point between the vessels and whether or not the artery is between the coronary sinus and the heart. Radiopaque dye may be injected into the coronary sinus and into the arteries in a known manner while the heart is viewed on a fluoroscope.
• An alternative method of determining the relative positions of the vessels is shown inFIG. 7. In this method, guidewires70 and72 are inserted into thecoronary sinus12 and into thecircumflex artery24 or other coronary artery, and the relative positions of the guide wires are viewed on a fluoroscope to identify the crossover point74.
• FIG. 8 illustrates one embodiment of a tissue shaping device in accordance with the present invention. Thetissue shaping device100 includes a connector orsupport wire102 having aproximal end104 and a distal end106. Thesupport wire102 is made of a biocompatible material such as stainless steel or a shape memory material such as nitinol wire.
• In one embodiment of the invention,connector102 comprises a double length of nitinol wire that has both ends positioned within adistal crimp tube108. Proximal to the proximal end of thecrimp tube108 is adistal lock bump110 that is formed by the support wire bending away from the longitudinal axis of thesupport102 and then being bent parallel to the longitudinal axis of the support before being bent again towards the longitudinal axis of the support to form one half110aofdistal lock bump110. Fromdistal lock bump110, the wire continues proximally through aproximal crimp tube112. On exiting the proximal end of theproximal crimp tube112, the wire is bent to form an arrowhead-shapedproximal lock bump114. The wire of thesupport102 then returns distally through theproximal crimp tube112 to a position just proximal to the proximal end of thedistal crimp tube108 wherein the wire is bent to form a second half110bof thedistal lock110.
• At the distal end ofconnector102 is an actuatabledistal anchor120 that is formed of a flexible wire such as nitinol or some other shape memory material. As shown inFIG. 8, the wire forming the distal anchor has one end positioned within thedistal crimp tube108. After exiting the distal end of thecrimp tube108, the wire forms a figure eight configuration whereby it bends upward and radially outward from the longitudinal axis of thecrimp tube108. The wire then bends back proximally and crosses the longitudinal axis of thecrimp tube108 to form one leg of the figure eight. The wire is then bent to form a double loop eyelet orloop122 around the longitudinal axis of thesupport wire102 before extending radially outwards and distally back over the longitudinal axis of thecrimp tube108 to form the other leg of the figure eight. Finally, the wire is bent proximally into the distal end of thecrimp tube108 to complete thedistal anchor120.
• The distal anchor is expanded by using a catheter or locking tool to exert an actuationforce sliding eyelet122 of the distal anchor from a position that is proximal todistal lock bump110 on the connector to a position that is distal todistal lock bump110. The bent-out portions110aand110bofconnector110 are spaced wider than the width ofeyelet122 and provide camming surfaces for the locking action. Distal movement ofeyelet122 pushes these camming surfaces inward to permiteyelet122 to pass distally of thelock bump110, then return to their original spacing to keepeyelet122 in the locked position.
• Actuatableproximal anchor140 is formed and actuated in a similar manner by movingeyelet142 overlock bump114. Both the distal and the proximal anchor provide anchoring forces of at least one pound, and most preferably two pounds.
• FIG. 9 illustrates one method for delivering atissue shaping device100 in accordance with the present invention to a desired location in the body, such as the coronary sinus to treat mitral valve regurgitation. As indicated above,device100 is preferably loaded into and routed to a desired location within acatheter200 with the proximal and distal anchors in an unexpanded or deformed condition. That is,eyelet122 ofdistal anchor120 is positioned proximal to thedistal lock bump110 and theeyelet142 of theproximal anchor140 is positioned proximal to theproximal lock bump114. The physician ejects the distal end of the device from thecatheter200 into the coronary sinus by advancing the device or retracting the catheter or a combination thereof. A pusher (not shown) provides distal movement of the device with respect tocatheter200, and atether201 provides proximal movement of the device with respect tocatheter200.
• Because of the inherent elasticity of the material from which it is formed, the distal anchor begins to expand as soon as it is outside the catheter. Once the device is properly positioned,catheter200 is advanced to place an actuation force ondistal anchor eyelet122 to push it distally over thedistal lock bump110 so that thedistal anchor120 further expands and locks in place to securely engage the wall of the coronary sinus. Next, a proximally-directed force is applied toconnector102 anddistal anchor120 via a tether orcontrol wire201 extending through catheter outside the patient to apply sufficient pressure on the tissue adjacent the connector to modify the shape of that tissue. In the case of the mitral valve, fluoroscopy, ultrasound or other imaging technology may be used to see when the device supplies sufficient pressure on the mitral valve to aid in its complete closure with each ventricular contraction without otherwise adversely affecting the patient.
• The proximally directed reshaping force causes theproximal anchor140 to move proximally. In one embodiment, for example,proximal anchor140 can be moved about 1-6 cm., most preferably at least 2 cm., proximally to reshape the mitral valve tissue. Theproximal anchor140 is then deployed from the catheter and allowed to begin its expansion. The locking tool applies an actuation force onproximal anchor eyelet142 to advance it distally over theproximal lock bump114 to expand and lock the proximal anchor, thereby securely engaging the coronary sinus wall to maintain the proximal anchor's position and to maintain the reshaping pressure of the connector against the coronary sinus wall. Alternatively,catheter200 may be advanced to lockproximal anchor140.
• Finally, the mechanism for securing the proximal end of the device can be released. In one embodiment, the securement is made with abraided loop202 at the end oftether201 and alock wire204. Thelock wire204 is withdrawn thereby releasing theloop202 so it can be pulled through theproximal lock bump114 at the proximal end ofdevice100.
• Reduction in mitral valve regurgitation using devices of this invention can be maximized by deploying the distal anchor as far distally in the coronary sinus as possible. In some instances it may be desirable to implant a shorter tissue shaping device, such as situations where the patient's circumflex artery crosses the coronary sinus relatively closer to the ostium or situations in which the coronary sinus itself is shorter than normal. As can be seen fromFIG. 9,anchor120 in its unexpanded configuration extends proximally alongconnector102 withincatheter200. Making the device shorter by simply shortening the connector, however, may cause theeyelet122 and proximal portion of thedistal anchor120 to overlap with portions of the proximal anchor when the device is loaded into a catheter, thereby requiring the catheter diameter to be larger than is needed for longer versions of the device. For mitral valve regurgitation applications, a preferred catheter diameter is ten french or less (most preferably nine french), and the tissue shaping device in its unexpanded configuration must fit within the catheter.
• FIGS. 10-23 show embodiments of the device of this invention having flexible and expandable wire anchors which permit the delivery oftissue shaping devices 60 mm or less in length by a ten french (or less) catheter. In some embodiments, one or both of the anchors are provided with bending points about which the anchors deform when placed in their unexpanded configuration for delivery by a catheter or recapture into a catheter. These bending points enable the anchors to deform into configurations that minimize overlap with other elements of the device. In other embodiments, the distal anchor is self-expanding, thereby avoiding the need for a proximally-extending eyelet in the anchor's unexpanded configuration that might overlap with the unexpanded proximal anchor within the delivery and/or recapture catheter.
• FIG. 10 shows an actuatable anchor design suitable for a shorter tissue shaping device similar to the device shown inFIGS. 8 and 9. In this embodiment,distal anchor300 is disposed distal to aconnector302. As in the embodiment ofFIG. 8,anchor300 is formed in a figure eight configuration from flexible wire such as nitinol held by acrimp tube304. Aneyelet306 is formed around the longitudinal axis ofconnector302. A distally directed actuation force oneyelet306 moves it over alock bump308 formed inconnector302 to actuate and lockanchor300.
• FIG. 10 shows anchor300 in an expanded configuration. In an unexpanded configuration, such as a configuration suitable forloading anchor300 and the rest of the tissue shaping device into a catheter for initial deployment to treat mitral valve regurgitation,eyelet306 is disposed proximal to lockbump308, and the figure eight loops ofanchor300 are compressed againstcrimp304. In order to limit theproximal distance eyelet306 must be moved along the connector to compressanchor300 into an unexpanded configuration, bendingpoints310 are formed in the distal struts ofanchor300. Bending points310 are essentially kinks, i.e., points of increased curvature, formed in the wire. Whenanchor300 is compressed into an unexpanded configuration, bendingpoints310 deform such that theupper arms312 of the distal struts bend around bendingpoints310 and move toward thelower arms314 of the distal struts, thereby limiting thedistance eyelet306 and the anchor's proximal struts must be moved proximally along the connector to compress the anchor.
• Likewise, if distal anchor were to be recaptured into a catheter for redeployment or removal from the patient,anchor300 would deform about bendingpoints310 to limit the cross-sectional profile of the anchor within the catheter, even ifeyelet306 were not moved proximally overlock bump308 during the recapture procedure. Bending points may also be provided on the proximal anchor in a similar fashion.
• As stated above,distal anchor300 may be part of a tissue shaping device (such as that shown inFIGS. 8 and 9) having a proximal anchor and a connector disposed between the anchors. To treat mitral valve regurgitation,distal anchor300 may be deployed from a catheter and expanded with an actuation force to anchor against the coronary sinus wall to provide an anchoring force of at least one pound, preferably at least two pounds, and to lockanchor300 in an expanded configuration. A proximally directed force is applied todistal anchor300 throughconnector302, such as by moving the proximal anchor proximally about 1-6 cm., more preferably at least 2 cm., by pulling on a tether or control wire operated from outside the patient. The proximal anchor may then be deployed to maintain the reshaping force of the device.
• One aspect ofanchor300 is its ability to conform and adapt to a variety of vessel sizes. For example, whenanchor300 is expanded inside a vessel such as the coronary sinus, the anchor's wire arms may contact the coronary sinus wall before theeyelet306 has been advanced distally overlock bump308 to lock the anchor in place. While continued distal advancement ofeyelet306 will create some outward force on the coronary sinus wall, much of the energy put into the anchor by the anchor actuation force will be absorbed by the deformation of the distal struts about bendingpoints310, which serve as expansion energy absorption elements and thereby limit the radially outward force on the coronary sinus wall. This feature enables the anchor to be used in a wider range of vessel sizes while reducing the risk of over-expanding the vessel.
• FIG. 11 shows another anchor design suitable for a shorter tissue shaping device similar to the device shown inFIGS. 8 and 9. In this embodiment,distal anchor320 is disposed distal to aconnector322. As in the embodiment ofFIG. 8,anchor320 is formed in a figure eight configuration from flexible wire such as nitinol held by acrimp tube324. Unlike the embodiment ofFIG. 10, however,anchor320 is self-expanding and is not actuatable.Eyelet326 is held in place by asecond crimp325 to limit or eliminate movement of the anchor's proximal connection point proximally or distally, e.g., alongconnector322.
• FIG. 11 shows anchor320 in an expanded configuration. In an unexpanded configuration, such as a configuration suitable forloading anchor320 and the rest of the tissue shaping device into a catheter for initial deployment to treat mitral valve regurgitation, the figure eight loops ofanchor320 are compressed. Bending points330 are formed in the distal struts ofanchor320. Whenanchor320 is compressed into an unexpanded configuration, bendingpoints330 deform such that theupper arms332 of the distal struts bend around bendingpoints330 and move toward thelower arms334 of the distal struts. Depending upon the exact location of bendingpoints330, very little or none of the wire portion ofanchor320 is disposed proximally alongcrimp325 orconnector322 whenanchor320 is in its unexpanded configuration.
• Likewise, if distal anchor were to be recaptured into a catheter for redeployment or removal from the patient,anchor320 would deform about bendingpoints330 to limit the cross-sectional profile of the anchor within the catheter. Bending points may also be provided on the proximal anchor in a similar fashion.
• Distal anchor320 may be part of a tissue shaping device (such as that shown inFIGS. 8 and 9) having a proximal anchor and a connector disposed between the anchors. Due to the superelastic properties of its shape memory material,distal anchor320 may be deployed from a catheter to self-expand to anchor against the coronary sinus wall to provide an anchoring force of at least one pound, preferably at least two pounds. A proximally directed force may then be applied todistal anchor320 throughconnector322, such as by moving the proximal anchor proximally about 1-6 cm., more preferably at least 2 cm., by pulling on a tether or control wire operated from outside the patient. The proximal anchor may then be deployed to maintain the reshaping force of the device.
• FIG. 12 shows another embodiment of an anchor suitable for use in a shorter tissue shaping device. In this embodiment,distal anchor340 is disposed distal to aconnector342. As in the embodiment ofFIG. 11,anchor340 is formed in a figure eight configuration from flexible wire such as nitinol held by acrimp tube344. Also like that embodiment,anchor340 is self-expanding and is not actuatable. The loop ofanchor340 forming the anchor's proximal struts passes through aloop346 extending distally from asecond crimp345 to limit or eliminate movement of the anchor's proximal struts proximally or distally, e.g., alongconnector342.
• FIG. 12 shows anchor340 in an expanded configuration. Like the device ofFIG. 11, in an unexpanded configuration, such as a configuration suitable forloading anchor340 and the rest of the tissue shaping device into a catheter for initial deployment to treat mitral valve regurgitation, the figure eight loops ofanchor340 are compressed. Unlike theFIG. 11 embodiment, however, bendingpoints350 are formed in the proximal struts ofanchor340. Whenanchor340 is compressed into an unexpanded configuration, bendingpoints350 deform such that theupper arms352 of the distal struts bend around bendingpoints350 and move toward thelower arms354 of the distal struts. The amount of the wire portion ofanchor340 extending proximally alongcrimp345 andconnector342 in its unexpanded configuration depends on the location of bendingpoints350. In one embodiment, the bending points are formed at the tallest and widest part of the proximal struts.
• Distal anchor340 may be part of a tissue shaping device (such as that shown inFIGS. 8 and 9) having a proximal anchor and a connector disposed between the anchors. Due to the superelastic properties of its shape memory material,distal anchor340 may be deployed from a catheter to self-expand to anchor against the coronary sinus wall to provide an anchoring force of at least one pound, preferably at least two pounds. A proximally directed force may then be applied todistal anchor340 throughconnector342, such as by moving the proximal anchor proximally about 1-6 cm., more preferably at least 2 cm., by pulling on a tether or control wire operated from outside the patient. The proximal anchor may then be deployed to maintain the reshaping force of the device.
• Bending points350 also add to the anchoring force ofdistal anchor340, e.g., by causing the anchor height to increase as the proximal struts become more perpendicular to the connector in response to a proximally directed force, thereby increasing the anchoring force. In the same manner, bending points may be added to the distal struts of a proximal anchor to increase the proximal anchor's anchoring force in response to a distally directed force.
• FIG. 13 shows yet another embodiment of an anchor suitable for use in a shorter tissue shaping device. In this embodiment,distal anchor360 is disposed distal to aconnector362. As in the embodiment ofFIG. 12,anchor360 is formed in a figure eight configuration from flexible wire such as nitinol held by acrimp tube364. Also like that embodiment,anchor360 is self-expanding and is not actuatable. The loop ofanchor360 forming the anchor's proximal struts passes through aloop366 extending distally from asecond crimp365 to limit or eliminate movement of the anchor's proximal struts proximally or distally, e.g., alongconnector362.
• FIG. 13 shows anchor360 in an expanded configuration. Like the device ofFIG. 12, in an unexpanded configuration, such as a configuration suitable forloading anchor360 and the rest of the tissue shaping device into a catheter for initial deployment to treat mitral valve regurgitation, the figure eight loops ofanchor360 are compressed. Unlike theFIG. 12 embodiment, however, bendingpoints370 are formed in both the proximal struts and the distal struts ofanchor360.
• Anchor360 may be used as part of a tissue shaping device like the embodiments discussed above.
• FIG. 14 shows an actuatable anchor design-suitable for a shorter tissue shaping device similar to the device shown inFIGS. 8 and 9. In this embodiment,distal anchor380 is disposed distal to aconnector382. As in the other embodiments,anchor380 is formed in a figure eight configuration from flexible wire such as nitinol held by acrimp tube384. In contrast to the embodiment ofFIG. 10,eyelets386 and387 are formed in each of the anchor's proximal struts around the longitudinal axis ofconnector382. This arrangement reduces the radially outward force of the anchor. A distally directed actuation force oneyelets386 and387 move them over alock bump388 formed inconnector382 to actuate and lockanchor380.
• FIG. 14 shows anchor380 in an expanded configuration. In an unexpanded configuration, such as a configuration suitable forloading anchor380 and the rest of the tissue shaping device into a catheter for initial deployment to treat mitral valve regurgitation, eyelets386 and387 are disposed proximal to lockbump388 and the figure eight loops ofanchor380 are compressed againstcrimp384. In order to limit the proximal distance eyelets386 and387 must be moved to compressanchor380 into an unexpanded configuration, bendingpoints390 are formed in the distal struts ofanchor380. Whenanchor380 is compressed into an unexpanded configuration, bendingpoints390 deform such that theupper arms392 of the distal struts bend around bendingpoints390 and move toward thelower arms394 of the distal struts, thereby limiting the distance eyelets386 and387 and the anchor's proximal struts must be moved proximally along the connector to compress the anchor.
• If distal anchor were to be recaptured into a catheter for redeployment or removal from the patient,anchor380 would deform about bendingpoints390 to limit the cross-sectional profile of the anchor within the catheter, even ifeyelets386 and387 were not moved proximally overlock bump388 during the recapture procedure. Bending points may also be provided on the proximal anchor in a similar fashion.
• As with the other embodiments above,distal anchor380 may be part of a tissue shaping device (such as that shown inFIGS. 8 and 9) having a proximal anchor and a connector disposed between the anchors. To treat mitral valve regurgitation,distal anchor380 may be deployed from a catheter and expanded with an actuation force to anchor against the coronary sinus wall to provide an anchoring force of at least one pound, preferably at least two pounds, and to lockanchor380 in an expanded configuration. A proximally directed force is applied todistal anchor380 throughconnector382, such as by moving the proximal anchor proximally about 1-6 cm., more preferably at least 2 cm., by pulling on a tether or control wire operated from outside the patient. The proximal anchor may then be deployed to maintain the reshaping force of the device.
• As with other embodiments, one aspect ofanchor380 is its ability to conform and adapt to a variety of vessel sizes. For example, whenanchor380 is expanded inside a vessel such as the coronary sinus, the anchor's wire arms may contact the coronary sinus wall before theeyelets386 and387 have been advance distally overlock bump388 to lock the anchor in place. While continued distal advancement ofeyelet386 will create some outward force on the coronary sinus wall, much of the energy put into the anchor by the anchor actuation force will be absorbed by the deformation of the distal struts about bendingpoints390.
• FIG. 15 shows yet another embodiment of an actuatable anchor for use in a shorter tissue shaping device.Proximal anchor400 is disposed proximal to aconnector402. As in other embodiments,anchor400 is formed in a figure eight configuration from flexible wire such as nitinol held by acrimp tube404. Aneyelet406 is formed around alock bump408 extending proximally fromcrimp404. A distally directed actuation force oneyelet406 moves it overlock bump408 to actuate and lockanchor400.
• FIG. 15 shows anchor400 in an expanded configuration. Whenanchor400 is compressed into an unexpanded configuration, bendingpoints410 formed as loops in the anchor wire deform such that theupper arms412 of the distal struts bend around bendingpoints410 and move toward thelower arms414 of the distal struts. As with the other embodiments,proximal anchor400 may be part of a tissue shaping device (such as that shown inFIGS. 8 and 9) having a distal anchor and a connector disposed between the anchors.
• Like other embodiments, one aspect ofanchor400 is its ability to conform and adapt to a variety of vessel sizes. For example, whenanchor400 is expanded inside a vessel such as the coronary sinus, the anchor's wire arms may contact the coronary sinus wall before theeyelet406 has been advanced distally overlock bump408 to lock the anchor in place. While continued distal advancement ofeyelet406 will create some outward force on the coronary sinus wall, much of the energy put into the anchor by the anchor actuation force will be absorbed by the deformation of the distal struts about bendingpoints410, which serve as expansion energy absorption elements and thereby limit the radially outward force on the coronary sinus wall.
• In other embodiments, the looped bending points of theFIG. 15 embodiment may be formed on the anchor's proximal struts in addition to or instead of on the distal struts. The looped bending point embodiment may also be used in a distal anchor, as shown inFIG. 16 (without the crimp or connector). Note that in the embodiment ofFIG. 16 the proximal and distal struts ofanchor420 as well as theeyelet422 and bendingpoints424 are formed from a single wire.
• FIG. 17 shows an embodiment of adistal anchor440 similar to that ofFIG. 10 suitable for use in a shorter tissue shaping device. In this embodiment, however,extra twists442 are added at the apex of the anchor's figure eight pattern. As in theFIG. 10 embodiment, bendingpoints444 are formed in the anchor's distal struts. As shown,anchor440 is actuatable by movingeyelet446 distally over alock bump448 formed inconnector450.Anchor440 may also be made as a self-expanding anchor by limiting or eliminating movement of the proximal struts ofanchor440 alongconnector450, as in the embodiment shown inFIG. 11. As with other embodiments, the bending points help anchor440 adapt and conform to different vessel sizes. In addition, theextra twists442 also help the anchor adapt to different vessel diameters by keeping the anchor's apex together.
• As in the other embodiments,anchor440 is preferably formed from nitinol wire.Anchor440 may be used as part of a tissue shaping device in a manner similar to the anchor ofFIG. 10 (for the actuatable anchor embodiment) or the anchor ofFIG. 11 (for the self-expanding anchor embodiment).Anchor440 may also be used as a proximal anchor.
• FIG. 18 shows an embodiment of adistal anchor460 similar to that ofFIG. 17. In this embodiment, however, the bending points462 are formed in the anchor's proximal struts, as in the self-expanding anchor shown inFIG. 12. As in theFIG. 17 embodiment,extra twists464 are added at the apex of the anchor's figure eight pattern. As shown,anchor460 is actuatable by movingeyelet466 distally over alock bump468 formed inconnector470.Anchor460 may also be made as a self-expanding anchor by limiting or eliminating movement of the proximal connection point ofanchor460 alongconnector470, as in the embodiment shown inFIG. 11. As with the embodiment ofFIG. 17, the bending points help anchor460 adapt and conform to different vessel sizes. In addition, theextra twists464 also help the anchor adapt to different vessel diameters by keeping the anchor's apex together.
• As in the other embodiments,anchor460 is preferably formed from nitinol wire.Anchor460 may be used as part of a tissue shaping device in a manner similar to the anchor ofFIG. 10 (for the actuatable anchor embodiment) or the anchor ofFIG. 11 (for the self-expanding anchor embodiment).Anchor460 may also be used as a proximal anchor.
• FIG. 19 shows an embodiment of a self-expandingdistal anchor480 suitable for use in a shorter tissue shaping device. As in the other embodiments,anchor480 is formed in a figure eight configuration from flexible wire such as nitinol held by acrimp tube482. The base of the figure eight pattern is narrower in this embodiment, however, with the anchor's proximal struts484 passing throughcrimp482.
• Distal anchor480 may be part of a tissue shaping device (such as that shown inFIGS. 8 and 9) having a proximal anchor and a connector disposed between the anchors. To treat mitral valve regurgitation,distal anchor480 may be deployed from a catheter and allowed to self-expand to anchor against the coronary sinus wall to provide an anchoring force of at least one pound, preferably at least two pounds. A proximally directed force is applied todistal anchor480 throughconnector486, such as by moving the proximal anchor proximally about 1-6 cm., more preferably at least 2 cm., by pulling on a tether or control wire operated from outside the patient. The proximal anchor may then be deployed to maintain the reshaping force of the device.
• FIG. 20 shows an embodiment of a distal anchor suitable for use in a shorter tissue shaping device and similar to that ofFIG. 10. In this embodiment,distal anchor500 is disposed distal to aconnector502. As in other embodiments,anchor500 is formed in a figure eight configuration from flexible wire such as nitinol held by acrimp tube504. Aneyelet506 is formed around the longitudinal axis ofconnector502. A distally directed actuation force oneyelet506 moves it over alock bump508 formed inconnector502 to actuate and lockanchor500.
• The angle ofproximal struts501 and the angle ofdistal struts503 are wider than corresponding angles in theFIG. 10 embodiment, however, causinganchor500 to distend more in width than in height when expanded, as shown. In an unexpanded configuration, such as a configuration suitable forloading anchor500 and the rest of the tissue shaping device into a catheter for initial deployment to treat mitral valve regurgitation,eyelet506 is disposed proximal to lockbump508 and the figure eight loops ofanchor500 are compressed againstcrimp504. In order to limit theproximal distance eyelet506 must be moved along the connector to compressanchor500 into an unexpanded configuration, bendingpoints510 are formed in thedistal struts503, as in theFIG. 10 embodiment, to limit the width of the device in its unexpanded configuration within a catheter.
• Distal anchor500 may be part of a tissue shaping device (such as that shown inFIGS. 8 and 9) having a proximal anchor and a connector disposed between the anchors. To treat mitral valve regurgitation,distal anchor500 may be deployed from a catheter and expanded with an actuation force to anchor against the coronary sinus wall to provide an anchoring force of at least one pound, preferably at least two pounds, and to lockanchor500 in an expanded configuration. A proximally directed force is applied todistal anchor500 throughconnector502, such as by moving the proximal anchor proximally about 1-6 cm., more preferably at least 2 cm., by pulling on a tether or control wire operated from outside the patient. The proximal anchor may then be deployed to maintain the reshaping force of the device.
• The anchor shown inFIG. 20 may be used as a proximal anchor. This anchor may also be formed as a self-expanding anchor.
• FIG. 21 shows a tandem distal anchor according to another embodiment of this invention. Self-expandinganchor520 is formed in a figure eight configuration from flexible wire such as nitinol held by acrimp tube522.Eyelet524 is held in place by the distal end ofactuatable anchor540 to limit or eliminate proximal and distal movement of the proximal struts ofanchor520. As in the anchor shown inFIG. 11, bendingpoints530 are formed in the distal struts ofanchor520. Depending upon the exact location of bendingpoints530, very little or none of the wire portion ofanchor520 is disposed proximal to the distal end ofanchor540 whenanchor520 is in its unexpanded configuration.
• Likewise, if distal anchor were to be recaptured into a catheter for redeployment or removal from the patient,anchor520 would deform about bendingpoints530 to limit the cross-sectional profile of the anchor within the catheter. Bending points may also be provided on the proximal anchor in a similar fashion.
• Anchor540 is similar to anchor120 shown inFIG. 8.Anchor540 is formed in a figure eight configuration from flexible wire such as nitinol held by acrimp tube544. Aneyelet546 is formed around the longitudinal axis ofconnector542. A distally directed actuation force oneyelet546 moves it over alock bump548 formed inconnector542 to actuate and lockanchor540.
• Tandem anchors520 and540 may be part of a tissue shaping device (such as that shown inFIGS. 8 and 9) having a proximal anchor and a connector disposed between the anchors.Anchors520 and540 may be made from a single wire or from separate pieces of wire. To treat mitral valve regurgitation,distal anchors520 and540 may be deployed from a catheter. Self-expandinganchor520 will then self-expand, andactuatable anchor540 may be expanded and locked with an actuation force, to anchor both anchors against the coronary sinus wall to provide an anchoring force of at least one pound, preferably at least two pounds. A proximally directed force is applied toanchors520 and540 throughconnector542, such as by moving the proximal anchor proximally about 1-6 cm., more preferably at least 2 cm., by pulling on a tether or control wire operated from outside the patient. The proximal anchor may then be deployed to maintain the reshaping force of the device.
• While the anchor designs above were described as part of shorter tissue shaping devices, these anchors may be used in tissue shaping devices of any length.
• FIGS. 22 and 23 show an alternative embodiment in which the device'sconnector560 is made integral with the distal andproximal crimp tubes562 and564. In this embodiment,connector560 is formed by cutting away a section of a blank such as a nitinol (or other suitable material such as stainless steel) cylinder or tube, leavingcrimp tube portions562 and564 intact. The radius of the semi-circular cross-section connector is therefore the same as the radii of the two anchor crimp tubes.
• Other connector shapes are possible for an integral connector and crimp design, of course. For example, the device may be formed from a blank shaped as a flat ribbon or sheet by removing rectangular edge sections from a central section, creating an I-shaped sheet (e.g., nitinol or stainless steel) having greater widths at the ends and a narrower width in the center connector portion. The ends can then be rolled to form the crimp tubes, leaving the connector substantially flat. In addition, in alternative embodiments, the connector can be made integral with just one of the anchors.
• As shown inFIG. 23, adistal anchor566 is formed in a figure eight configuration from flexible wire such as nitinol.Distal anchor566 is self-expanding, and itsproximal struts568 are held in place bycrimp tube562. Optional bending points may be formed in the proximal struts568 ordistal struts570 ofanchor566.
• Aproximal anchor572 is also formed in a figure eight configuration from flexible wire such as nitinol with aneyelet574 on its proximal end. A distally directed actuation force oneyelet574 moves it over alock bump576 extending proximally fromcrimp tube564 to actuate and lockanchor572.Lock bump576 also serves as the connection point for a tether or control wire to deploy and actuate device in the manner described above with respect toFIGS. 8 and 9. Optional bending points may be formed in the proximal or distal struts ofanchor572.
• When deployed in the coronary sinus to treat mitral valve regurgitation, the tissue shaping devices of this invention are subjected to cyclic bending and tensile loading as the patient's heart beats.FIG. 24 shows an alternative connector for use with the tissue shaping devices of this invention that distributes over more of the device any strain caused by the beat to beat bending and tensile loading.
• Connector600 has aproximal anchor area602, adistal anchor area604 and acentral area606. The distal anchor area may be longer than the distal anchor attached to it, and the proximal anchor area may be longer than the proximal anchor attached to it. Anoptional lock bump608 may be formed at the proximal end ofconnector600 for use with an actuatable proximal anchor and for connecting to a tether or control wire, as described above. Anoptional bulb610 may be formed at the distal end ofconnector600 to prevent accidental distal slippage of a distal anchor.
• In order to reduce material fatigue caused by the heartbeat to heartbeat loading and unloading of the tissue shaping device, the moment of inertia ofconnector600 varies along its length, particularly in the portion of connector disposed between the two anchors. In this embodiment, for example,connector600 is formed as a ribbon or sheet and is preferably formed from nitinol having a rectangular cross-sectional area. The thickness ofconnector600 is preferably constant in theproximal anchor area602 and thedistal anchor area604 to facilitate attachment of crimps and other components of the anchors. Thecentral area606 has a decreasing thickness (and therefore a decreasing moment of inertia) from the border between,central area606 andproximal anchor area602 to a point about at the center ofcentral area606, and an increasing thickness (and increasing moment of inertia) from that point to the border betweencentral area606 anddistal anchor area604. The varying thickness and varying cross-sectional shape ofconnector600 change its moment of inertia along its length, thereby helping distribute over a wider area any strain from the heartbeat to heartbeat loading and unloading of the device and reducing the chance of fatigue failure of the connector material.
• FIG. 25 shows another embodiment of the connector. Like the previous embodiment,connector620 has aproximal anchor area622, adistal anchor area624 and acentral area626.Proximal anchor area622 has an optional two-tined prong628 formed at its proximal end to facilitate attachment of a crimp and other anchor elements.Bent prong portions629 may be formed at the proximal end of the prong to prevent accidental slippage of a proximal anchor. Anoptional bulb630 may be formed at the distal end ofconnector620 to prevent accidental distal slippage of a distal anchor.
• Like theFIG. 24 embodiment,connector620 is formed as a ribbon or sheet and is preferably formed from nitinol having a rectangular cross-sectional area. The thickness ofconnector620 is preferably constant in theproximal anchor area622 and thedistal anchor area624 to facilitate attachment of crimps and other components of the anchors. Thecentral area626 has a decreasing thickness (decreasing moment of inertia) from the border betweencentral area626 andproximal anchor area622 to a point about at the center ofcentral area626, and an increasing thickness (increasing moment of inertia) from that point to the border betweencentral area626 anddistal anchor area624. The varying thickness and varying cross-sectional shape ofconnector620 change its moment of inertia along its length, thereby helping distribute over a wider area any strain from the heartbeat to heartbeat loading and unloading of the device and reducing the chance of fatigue failure of the connector material.
• FIG. 26 shows aconnector640 in profile.Connector640 may be formed like theconnectors600 and620 orFIGS. 24 and 25, respectively, or may have some other configuration.Connector640 has aproximal anchor area642, adistal anchor area644 and acentral area646.Connector640 is preferably formed as a ribbon or sheet and is preferably formed from nitinol having a rectangular cross-sectional area.
• In the embodiment shown inFIG. 26, the thicknesses ofproximal anchor area642 anddistal anchor area644 are constant. The thickness ofcentral area646 decreases from the border betweencentral area646 andproximal anchor area642 to a point distal of that border and increases from a point proximal to the border betweendistal anchor area644 andcentral area646 to that border. The points in the central area where the thickness decrease ends and the thickness increase begins may be coincident or may be separated to form an area of uniform thickness withincentral area646. In this embodiment, the thickness of the central area changes as a function of the square root of the distance from the borders between the central area and the proximal and distal anchor areas.
• FIG. 27 shows yet another embodiment of the connector. As in the embodiment ofFIG. 26,connector650 may be formed like theconnectors600 and620 orFIGS. 24 and 25, respectively, or may have some other configuration.Connector650 has aproximal anchor area652, adistal anchor area654 and acentral area656.Connector650 is preferably formed as a ribbon or sheet and is preferably formed from nitinol having a rectangular cross-sectional area.
• In the embodiment shown inFIG. 27, the thicknesses ofproximal anchor area652 anddistal anchor area654 are constant. The thickness of aproximal portion658 ofcentral area656 decreases linearly from the border betweencentral area656 andproximal anchor area652 to a constantthickness center portion662 ofcentral area656, and the thickness of adistal portion660 ofcentral area656 increases linearly fromcenter portion662 to the border betweendistal anchor area654 andcentral area656.
• In other embodiments, the thickness of the connector may vary in other ways. In addition, the cross-sectional shape of the connector may be other than rectangular and may change over the length of the connector.
• FIGS. 28 and 29 show yet another embodiment of the invention.Tissue shaping device700 has aconnector706 disposed between aproximal anchor702 and adistal anchor704.Connector706 may be formed as a ribbon or sheet, such as the tapered connectors shown inFIGS. 24-27. Actuatableproximal anchor702 is formed in a figure eight configuration from flexible wire such as nitinol and is fastened toconnector706 with acrimp tube708. Likewise, self-expandingdistal anchor704 is formed in a figure eight configuration from flexible wire such as nitinol and is fastened toconnector706 with acrimp tube710. Aproximal lock bump716 extends proximally fromproximal anchor702 for use in actuating and lockingproximal anchor702 and for connecting to a tether or control wire, as described above.
• Bending points712 are formed in the loops ofproximal anchor702, and bendingpoints714 are formed in the loops ofdistal anchor704. When compressed into their unexpanded configurations for catheter-based delivery and deployment or for recapture into a catheter for redeployment or removal, the wire portions ofanchors702 and704 bend about bendingpoints712 and714, respectively, to limit the cross-sectional profile of the anchors within the catheter. The bending points also affect the anchor strength of the anchors and the adaptability of the anchors to different vessel diameters, as discussed above.
• In addition to different coronary sinus lengths and varying distances from the ostium to the crossover point between the coronary sinus and the circumflex artery, the diameter of the coronary sinus at the distal and proximal anchor points can vary from patient to patient. The anchors described above may be made in a variety of heights and combined with connectors of varying lengths to accommodate this patient to patient variation. For example, tissue shaping devices deployed in the coronary sinus to treat mitral valve regurgitation can have distal anchor heights ranging from about 7 mm. to about 16 mm. and proximal anchor heights ranging from about 9 mm. to about 20 mm.
• When treating a patient for mitral valve regurgitation, estimates can be made of the appropriate length for a tissue shaping device as well as appropriate anchor heights for the distal and proximal anchors. The clinician can then select a tissue shaping device having the appropriate length and anchor sizes from a set or sets of devices with different lengths and different anchor sizes, made, e.g., according to the embodiments described above. These device sets may be aggregated into sets or kits or may simply be a collection or inventory of different tissue shaping devices.
• One way of estimating the appropriate length and anchor sizes of a tissue shaping device for mitral valve regurgitation is to view a fluoroscopic image of a coronary sinus into which a catheter with fluoroscopically viewable markings has been inserted. The crossover point between the coronary sinus and the circumflex artery can be determined as described above, and the screen size of the coronary sinus length proximal to that point and the coronary sinus diameter at the intended anchor locations can be measured. By also measuring the screen distance of the catheter markings and comparing them to the actual distance between the catheter marking, the length and diameter measures can be scaled to actual size. A tissue shaping device with the appropriate length and anchor sizes can be selected from a set or inventory of devices for deployment in the patient to treat mitral valve regurgitation.
• FIG. 30 shows yet another embodiment of the method of this invention. In this embodiment, atissue shaping device800 formed from a substantially straightrigid member802 is disposed in thecoronary sinus804 to treat mitral valve regurgitation. When deployed as shown, the central portion ofrigid member802 exerts a remodeling force anteriorly through the coronary sinus wall toward themitral valve806, while the proximal anddistal ends808 and810, respectively, ofrigid member802 exert posteriorly-directed forces on the coronary sinus wall. According to this invention,device800 is disposed in relation to thecircumflex artery812 so that all of the anteriorly-directed forces fromrigid member802 are posterior to the crossover point betweenartery812 andcoronary sinus804, despite the fact thatdistal end810 ofdevice800 and a guidewire portion814 are distal to the crossover point.
• The device ofFIG. 30 may also include a less rigid portion at thedistal end810 ofmember802 to further eliminate any force directed toward the mitral valve distal to the crossover point. Further details of the device (apart from the method of this invention) may be found in U.S. patent application Ser. No. 10/112,354, published as U.S. patent appl. Publ. No. 2002/0183838, the disclosure of which is incorporated herein by reference.
• FIG. 31 shows another embodiment of the method of this invention.Device900 has a substantially straightrigid portion902 disposed between a proximalangled portion904 and a distalangled portion906 withincoronary sinus908. As shown, proximalangled portion904 extends through thecoronary sinus ostium910 within a catheter (not shown). Distalangled portion906 extends distally to a hookedportion912 that is preferably disposed in the AIV.
• To treat mitral valve regurgitation, the device'sstraight portion902 reshapes the coronary sinus and adjacent tissue to apply an anteriorally directed force through the coronary sinus wall toward themitral valve914. Due to the device's design, this reshaping force is applied solely proximal to the crossover point betweencoronary sinus908 and the patient'scircumflex artery916, despite the fact at least a part of the device'sdistal portion906 and hookedportion912 are disposed distal to the crossover point.
• Other modifications to the inventions claimed below will be apparent to those skilled in the art and are intended to be encompassed by the claims.

Claims (60)

1. A method of treating regurgitation of a mitral valve in a patient's heart, the method comprising:

delivering a tissue shaping device to the coronary sinus; and

deploying the tissue shaping device to reduce mitral valve regurgitation, the deploying step comprising applying a force through the coronary sinus wall toward the mitral valve solely proximal to a crossover point where a coronary artery passes between a coronary sinus and the mitral valve.

2. The method ofclaim 1 further comprising determining the crossover point.

3. The method ofclaim 1 wherein the delivering step comprises delivering the tissue shaping device to the coronary sinus in a catheter having an outer diameter no more than ten french.

4. The method ofclaim 3 wherein the delivering step comprises delivering the tissue shaping device to the coronary sinus in a catheter having an outer diameter no more than nine french.

5. The method ofclaim 1 wherein the deploying step comprises placing a distal end of the tissue shaping device proximal to the crossover point.

6. The method ofclaim 1 wherein the deploying step comprises placing a distal end of the tissue shaping device distal to the crossover point.

7. The method ofclaim 1 wherein the tissue shaping device comprises a distal anchor, the deploying step comprising anchoring the distal anchor proximal to the crossover point.

8. The method ofclaim 7 wherein the anchoring step comprises expanding the distal anchor.

9. The method ofclaim 8 wherein the anchoring step comprises permitting the distal anchor to self-expand.

10. The method ofclaim 8 wherein the anchoring step comprises applying an actuation force to the distal anchor.

11. The method ofclaim 7 wherein the anchoring step comprises anchoring the distal anchor with an anchoring force of at least one pound.

12. The method ofclaim 11 wherein the anchoring step comprises anchoring the distal anchor with an anchoring force of at least two pounds.

13. The method ofclaim 7 wherein the deploying step further comprises applying a proximally directed force on the distal anchor.

14. The method ofclaim 13 wherein the step of applying a proximally directed force comprises applying a proximally directed force on the distal anchor from outside the patient.

15. The method ofclaim 13 wherein the tissue shaping device further comprises a proximal anchor and a connector disposed between the distal anchor and the proximal anchor, the deploying step further comprising anchoring the proximal anchor.

16. The method ofclaim 15 wherein the step of anchoring the proximal anchor comprises anchoring the proximal anchor in the coronary sinus.

17. The method ofclaim 15 wherein the step of anchoring the proximal anchor comprises anchoring the proximal anchor at least partially outside the coronary sinus.

18. The method ofclaim 15 wherein the step of anchoring the proximal anchor is performed after the step of applying a proximally directed force on the distal anchor.

19. The method ofclaim 15 wherein the applying step comprises moving the proximal anchor proximally after the step of anchoring the distal anchor.

20. The method ofclaim 19 wherein the step of anchoring the proximal anchor is performed after the moving step.

21. The method ofclaim 15 wherein the step of anchoring the proximal anchor comprises expanding the proximal anchor.

22. The method ofclaim 21 wherein the anchoring step comprises permitting the proximal anchor to self-expand.

23. The method ofclaim 21 wherein the anchoring step comprises applying an actuating force to the proximal anchor.

24. The method ofclaim 1 wherein the tissue shaping device comprises a distal anchor, the deploying step further comprising deploying the distal anchor from a distal end of a catheter.

25. The method ofclaim 24 further comprising recapturing the distal anchor into a catheter.

26. The method ofclaim 25 further comprising anchoring the distal anchor after recapturing the distal anchor.

27. The method ofclaim 1 wherein the tissue shaping device comprises a proximal anchor, the deploying step further comprising deploying the proximal anchor from a distal end of a catheter.

28. The method ofclaim 27 further comprising recapturing the proximal anchor into a catheter.

29. The method ofclaim 28 further comprising anchoring the proximal anchor after recapturing the proximal anchor.

30. The method ofclaim 1 wherein the delivering step comprises delivering the tissue shaping device to the coronary sinus in a catheter, the deploying step further comprising deploying the tissue shaping device from a distal end of the catheter, the method further comprising recapturing the tissue shaping device into a catheter.

31. The method ofclaim 1 further comprising selecting the tissue shaping device from a set of tissue shaping devices comprising tissue shaping devices of a plurality of lengths prior to the delivering step.

32. The method ofclaim 1 wherein the tissue shaping device comprises an anchor, the method further comprising selecting the tissue shaping device from a set of tissue shaping devices comprising tissue shaping devices of a plurality of anchor sizes prior to the delivering step.

33. A set of devices for use in treating mitral valve regurgitation, the set comprising:

a plurality of tissue shaping devices having different lengths, each of the tissue shaping devices being configured to be deliverable to a coronary sinus of a patient within a catheter having an outer diameter no greater than ten french.

34. The set ofclaim 33 further comprising a catheter having an outer diameter no greater than nine french.

35. The set ofclaim 33 wherein the tissue shaping devices each comprise an anchor having an unexpanded configuration and an expanded configuration, each tissue shaping device being further configured to be deliverable to a coronary sinus of a patient within a catheter having an outer diameter no greater than ten french when its distal anchor is in its unexpanded configuration.

36. The set ofclaim 33 wherein the tissue shaping devices in the set each comprise:

a proximal anchor having an unexpanded configuration and an expanded configuration;

a distal anchor having an unexpanded configuration and an expanded configuration; and

a connector disposed between the proximal anchor and the distal anchor,

each tissue shaping device being further configured to be deliverable to a coronary sinus of a patient within a catheter having an outer diameter no greater than ten french when its proximal anchor and distal anchor are in their unexpanded configurations.

37. The set ofclaim 36 wherein at least one tissue shaping device in the set has a length 60 mm or less and at least one tissue shaping device in the set has a length more than 60 mm.

38. The set ofclaim 36 wherein the distal anchor of each tissue shaping device in the set has a diameter in its expanded configuration equal to or greater than a coronary sinus diameter at a distal anchor location.

39. The set ofclaim 38 wherein the diameters of the distal anchors of the tissue shaping devices in the set in their expanded configurations range from about 7 mm. to about 16 mm.

40. The set ofclaim 36 wherein the proximal anchor of each tissue shaping device in the set has a diameter in its expanded configuration equal to or greater than a coronary sinus diameter at a proximal anchor location.

41. The set ofclaim 40 wherein the diameters of the proximal anchors of the tissue shaping devices in the set in their expanded configurations range from about 9 mm. to about 20 mm.

42. The set ofclaim 36 wherein the distal anchor of each tissue shaping device in the set comprises a self-expanding anchor.

43. The set ofclaim 36 wherein the proximal anchor of each tissue shaping device in the set comprises a self-expanding anchor.

44. The set ofclaim 36 wherein the distal anchor of each tissue shaping device in the set comprises an actuatable anchor.

45. The set ofclaim 36 wherein the proximal anchor of each tissue shaping device in the set comprises an actuatable anchor.

46. The set ofclaim 36 wherein the distal anchor of at least one tissue shaping device in the set comprises a self-expanding anchor and the distal anchor of at least one tissue shaping device in the set comprises an actuatable anchor.

47. The set ofclaim 36 wherein the proximal anchor of at least one tissue shaping device in the set comprises a self-expanding anchor and the proximal anchor of at least one tissue shaping device in the set comprises an actuatable anchor.

48. The set ofclaim 33 wherein each of the tissue shaping devices is configured to be deliverable to a coronary sinus of a patient within a catheter having an outer diameter no greater than nine french.

49. A set of devices for use in treating mitral valve regurgitation, the set comprising:

a plurality of tissue shaping devices each comprising an anchor having an unexpanded configuration and an expanded configuration, the anchors having different diameters when in their expanded configurations, each of the tissue shaping devices being configured to be deliverable to a coronary sinus of a patient within a catheter having an outer diameter no greater than ten french.

50. The set ofclaim 49 wherein the anchor of each device is a distal anchor, the devices each further comprising a proximal anchor having an unexpanded configuration and an expanded configuration, the proximal anchors having different diameters when in their expanded configurations.

51. The set ofclaim 50 wherein the diameters of the distal anchors of the tissue shaping devices in the set in their expanded configurations range from about 7 mm. to about 16 mm.

52. The set ofclaim 50 wherein the diameters of the proximal anchors of the tissue shaping devices in the set in their expanded configurations range from about 9 mm. to about 20 mm.

53. The set ofclaim 52 wherein the distal anchor of each tissue shaping device in the set comprises a self-expanding anchor.

54. The set ofclaim 52 wherein the proximal anchor of each tissue shaping device in the set comprises a self-expanding anchor.

55. The set ofclaim 52 wherein the distal anchor of each tissue shaping device in the set comprises an actuatable anchor.

56. The set ofclaim 52 wherein the proximal anchor of each tissue shaping device in the set comprises an actuatable anchor.

57. The set ofclaim 52 wherein the distal anchor of at least one tissue shaping device in the set comprises a self-expanding anchor and the distal anchor of at least one tissue shaping device in the set comprises an actuatable anchor.

58. The set ofclaim 52 wherein the proximal anchor of at least one tissue shaping device in the set comprises a self-expanding anchor and the proximal anchor of at least one tissue shaping device in the set comprises an actuatable anchor.

59. The set ofclaim 49 further comprising a catheter having an outer diameter no greater than ten french.

60. The set ofclaim 49 wherein each of the tissue shaping devices is configured to be deliverable to a coronary sinus of a patient within a catheter having an outer diameter no greater than nine french.

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