US20120185040A1 - Devices, systems, and methods for retaining a native heart valve leaflet - Google Patents

Abstract

Devices, systems and methods retain a native heart valve leaflet to prevent retrograde flow. The devices, systems, and methods employ an implant that, in use, rests adjacent a valve annulus and includes a retaining structure that is sized and shaped to overlay at least a portion of one or more native valve leaflets. The retaining structure retains the leaflet or leaflets it overlays, to resist leaflet eversion and/or prolapse. In this way, the implant prevents or reduces regurgitation. The implant does not interfere significantly with the opening of and blood flow through the leaflets during periods of antegrade flow.

Description

RELATED APPLICATIONS
• This application is a divisional of U.S. patent application Ser. No. 12/386,821, filed 23 Apr. 2009 (now U.S. Pat. No. 8,142,494), which is a divisional of application Ser. No. 10/676,729, filed 1 Oct. 2003 (now U.S. Pat. No. 7,527,646).
• This application is also a continuation-in-part of U.S. patent application Ser. No. 09/666,617, filed Sep. 20, 2000, now U.S. Pat. No. 6,893,459 dated May 17, 2005, and entitled “Heart Valve Annulus Device and Methods of Using Same.”
• This application is also a continuation-in-part of Patent Cooperation Treaty Application Serial No. PCT/US 02/31376, filed Oct. 1, 2002 and entitled “Systems and Devices for Heart Valve Treatments,” which claimed the benefit of U.S. Provisional Patent Application Ser. No. 60/326,590, filed Oct. 1, 2001.
• This application also claims the benefit of U.S. Provisional Application Ser. No. 60/429,444, filed Nov. 26, 2002, and entitled “Heart Valve Remodeling Devices;” U.S. Provisional Patent Application Ser. No. 60/429,709, filed Nov. 26, 2002, and entitled “Neo-Leaflet Medical Devices;” and U.S. Provisional Patent Application Ser. No. 60/429,462, filed Nov. 26, 2002, and entitled “Heart Valve Leaflet Retaining Devices,” all of the above which are each incorporated herein by reference.
FIELD OF THIS INVENTION
• The invention is directed to devices, systems, and methods for improving the function of a heart valve, e.g., in the treatment of mitral valve regurgitation.
BACKGROUND OF THE INVENTIONI. The Anatomy of a Healthy Heart
• The heart (seeFIG. 1B) is slightly larger than a clenched fist. It is a double (left and right side), self-adjusting muscular pump, the parts of which work in unison to propel blood to all parts of the body. The right side of the heart receives poorly oxygenated (“venous”) blood from the body from the superior vena cava and inferior vena cava and pumps it through the pulmonary artery to the lungs for oxygenation. The left side receives well-oxygenation (“arterial”) blood from the lungs through the pulmonary veins and pumps it into the aorta for distribution to the body.
• The heart has four chambers, two on each side—the right and left atria, and the right and left ventricles. The atria are the blood-receiving chambers, which pump blood into the ventricles. A wall composed, of membranous and muscular parts, called the interatrial septum, separates the right and left atria. The ventricles are the blood-discharging chambers. A wall composed of membranous and muscular parts, called the interventricular septum, separates the right and left ventricles.
• The synchronous pumping actions of the left and right sides of the heart constitute the cardiac cycle. The cycle begins with a period of ventricular relaxation, called ventricular diastole. The cycle ends with a period of ventricular contraction, called ventricular systole.
• The heart has four valves (seeFIGS. 1B and 1C) that ensure that blood does not flow in the wrong direction during the cardiac cycle; that is, to ensure that the blood does not back flow from the ventricles into the corresponding atria, or back flow from the arteries into the corresponding ventricles. The valve between the left atrium and the left ventricle is the mitral valve. The valve between the right atrium and the right ventricle is the tricuspid valve. The pulmonary valve is at the opening of the pulmonary artery. The aortic valve is at the opening of the aorta.
• At the beginning of ventricular diastole (i.e., ventricular filling) (seeFIG. 1B), the aortic and pulmonary valves are closed to prevent back flow from the arteries into the ventricles. Shortly thereafter, the tricuspid and mitral valves open (asFIG. 1B shows), to allow flow from the atria into the corresponding ventricles. Shortly after ventricular systole (i.e., ventricular emptying) begins, the tricuspid and mitral valves close (see FIG.1C)—to prevent back flow from the ventricles into the corresponding atria—and the aortic and pulmonary valves open—to permit discharge of blood into the arteries from the corresponding ventricles.
• The opening and closing of heart valves occur primarily as a result of pressure differences. For example, the opening and closing of the mitral valve occurs as a result of the pressure differences between the left atrium and the left ventricle. During ventricular diastole, when ventricles are relaxed, the venous return of blood from the pulmonary veins into the left atrium causes the pressure in the atrium to exceed that in the ventricle. As a result, the mitral valve opens, allowing blood to enter the ventricle. As the ventricle contracts during ventricular systole, the intraventricular pressure rises above the pressure in the atrium and pushes the mitral valve shut.
• FIG. 1D shows a posterior oblique cutaway view of a healthyhuman heart100. Two of the four heart chambers are shown, theleft atrium170, and the left ventricle140 (not shown are the right atrium and right ventricle). Theleft atrium170 fills with, blood from the pulmonary veins. The blood then passes through the mitral valve (also known as the bicuspid valve, and more generally known as an atrioventricular valve) during ventricular diastole and into theleft ventricle140. During ventricular systole, the blood is then ejected out of theleft ventricle140 through theaortic valve150 and into theaorta160. At this time, the mitral valve should be shut so that blood is not regurgitated back into the left atrium.
• The mitral valve consists of two leaflets, ananterior leaflet110, and aposterior leaflet115, attached to chordae tendineae120 (or chords), which in turn are connected topapillary muscles130 within theleft atrium140. Typically, the mitral valve has a D-shapedanterior leaflet110 oriented toward the aortic valve, with a crescent shapedposterior leaflet115. The leaflets intersect with theatrium170 at themitral annulus190.
• In a healthy heart, these muscles and their chords support the mitral and tricuspid valves, allowing the leaflets to resist the high pressure developed during contractions (pumping) of the left and right ventricles. In a healthy heart, the chords become taut, preventing the leaflets from being forced into the left or right atria and everted. Prolapse is a term used to describe the condition wherein the coaptation edges of each leaflet initially may coapt and close, but then the leaflets rise higher and the edges separate and the valve leaks. This is normally prevented by contraction of the papillary muscles and the normal length of the chords. Contraction of the papillary muscles is simultaneous with the contraction of the ventricle and serves to keep healthy valve leaflets tightly shut at peak contraction pressures exerted by the ventricle.
II. Characteristics and Causes of Mitral Valve Dysfunction
• Valve malfunction can result from the chords becoming stretched, and in some cases tearing. When a chord tears, the result is a flailed leaflet. Also, a normally structured valve may not function properly because of an enlargement of the valve annulus pulling the leaflets apart. This condition is referred to as a dilation of the annulus and generally results from heart muscle failure. In addition, the valve may be defective at birth or because of an acquired disease, usually infectious or inflammatory.
• FIG. 2 shows a cutaway view of ahuman heart200 with a prolapsed mitral valve. The prolapsed valve does not form a tight seal during ventricular systole, and thus allows blood to be regurgitated back into the left atrium during ventricular contraction. The anterior220 and posterior225 leaflets are shown rising higher than normal (i.e., prolapsing) into the left atrium. The arrows indicate the direction of regurgitant flow. Among other causes, regurgitation can result from redundant valve leaflet tissue or from stretchedchords210 that are too long to prevent the leaflets from being blown into the atrium. As a result, the leaflets do not form a tight seal, and blood is regurgitated into the atrium.
• FIG. 3 shows a cutaway view of ahuman heart300 with a flailingmitral valve320. The flailing valve also does not form a tight seal during ventricular systole. Blood thus regurgitates back into the left atrium during ventricular contraction, as indicated by the arrows. Among other causes, regurgitation can also result from tornchords310.
• As a result of regurgitation, “extra” blood back flows into the left atrium. During subsequent ventricular diastole (when the heart relaxes), this “extra” blood returns to the left ventricle, creating a volume overload, i.e., too much blood, in the left ventricle. During subsequent ventricular systole (when the heart contracts), there is more blood in the ventricle than expected. This means that: (1) the heart must pump harder to move the extra blood; (2) too little blood may move from the heart to the rest of the body; and (3) over time, the left ventricle may begin to stretch and enlarge to accommodate the larger volume of blood, and the left ventricle may become weaker.
• Although mild cases of mitral valve regurgitation result in few problems, more severe and chronic cases eventually weaken the heart and can result in heart failure. Mitral valve regurgitation can be an acute or chronic condition. It is sometimes called mitral insufficiency.
III. Prior Treatment Modalities
• In the treatment of mitral valve regurgitation, diuretics and/or vasodilators can be used to help reduce the amount of blood flowing back into the left atrium. An intra-aortic balloon counterpulsation device is used if the condition is not stabilized with medications. For chronic or acute mitral valve regurgitation, surgery to repair or replace the mitral valve is often necessary.
• To date, invasive, open heart surgical approaches have been used to repair or replace the mitral valve with either a mechanical valve or biological tissue (bioprosthetic) taken from pigs, cows or horses.
• The need remains for simple, cost-effective, and less invasive devices, systems, and methods for treating dysfunction of a heart valve, e.g., in the treatment of mitral valve regurgitation.
SUMMARY OF THE INVENTION
• The invention provides devices, systems and methods that retain a native heart valve leaflet. The devices, systems, and methods include an implant that, in use, rests adjacent all or a portion of a valve annulus. The implant includes a retaining structure that is shaped to overlay at least a portion of one or more native valve leaflets. The implant further includes spaced-apart struts sized and configured to contact tissue near or within the heart valve annulus. The struts brace the retaining structure to resist leaflet eversion and/or prolapse. In this way, the implant prevents or reduces retrograde flow and regurgitation. The implant does not interfere with the opening of and blood flow through the leaflets during antegrade flow.
• Other features and advantages of the invention shall be apparent based upon the accompanying description, drawings, and claims.
DESCRIPTION OF THE DRAWINGS
• FIG. 1A is a perspective, anterior anatomic view of the interior of a healthy heart.
• FIG. 1B is a superior anatomic view of the interior of a healthy heart, with the atria removed, showing the condition of the heart valves during ventricular diastole.
• FIG. 1C is a superior anatomic view of the interior of a healthy heart, with the atria removed, showing the condition of the heart valves during ventricular systole.
• FIG. 1D is a posterior oblique cutaway view of a portion of a human heart, showing a healthy mitral valve during ventricular systole, with the leaflets properly coapting.
• FIG. 2 is a posterior oblique cutaway view of a portion of a human heart, showing a dysfunctional mitral valve during ventricular systole, with the leaflets not properly coapting, causing regurgitation.
• FIG. 3 is a posterior oblique cutaway view of a portion of a human heart, showing a dysfunctional mitral valve during ventricular systole, with the leaflets flailing, causing regurgitation.
• FIG. 4 is a perspective, anatomic view of a wire form implant that includes a retaining element to resist eversion and/or prolapse of a native valve leaflet, the implant being shown installed on a mitral valve annulus.
• FIG. 5 is a side elevation view of the implant shown inFIG. 4, shown outside of the body.
• FIG. 6 is a top view of the implant shown inFIG. 4, shown outside the body.
• FIG. 7 is a top view of another illustrative wire form implant of the type shown inFIG. 6.
• FIGS. 8 and 9 are top views of illustrative wire form implants of the type shown inFIGS. 4 and 5, which include retaining elements to resist eversion and/or prolapse of a native valve leaflet, and which also include both infra-annular struts and tabs and supra-annular pads to fix the position of the implants in a valve annulus.
• FIG. 10 is a perspective view of the implant shown inFIG. 9.
• FIG. 11 is a perspective, anatomic view of the wire form implant shown inFIG. 10, the implant being shown installed on a mitral valve annulus.
• FIGS. 12 to 14 are perspective, anatomic views showing the intravascular introduction and deployment of the implant shown inFIG. 11 on a mitral valve annulus.
• FIG. 15 is a perspective view of an illustrative wire form implant of the type shown inFIGS. 4 and 5, which include retaining elements to resist eversion and/or prolapse of a native valve leaflet, and which also include frameworks to orient and stabilize the position of the implants in a valve annulus.
• FIG. 16 is a top view of wire-form mesh implant that resists eversion and/or prolapse of a native valve leaflet.
• FIG. 17 is a perspective, anatomic view of the wire-form mesh implant shown inFIG. 16 installed on a mitral valve annulus.
• FIGS. 18 and 19 are top views of illustrative embodiments of implants of the types shown inFIGS. 5 and 6, showing implants that are narrow and do not peripherally rest on the entire valve annulus.
• FIG. 20 is a top view of an illustrative embodiment of a wire-form mesh implant of the type shown inFIGS. 16 and 17, being shown in a flattened condition for intravascular deployment, which, upon deployment, resists eversion and/or prolapse of a native valve leaflet, and which also include an auxiliary structure to orient and stabilize the position of the implants in a valve annulus, the implant inFIG. 20 also including infra-annular struts and tabs to fix the position of the implant in the valve annulus.
• FIG. 21 is a perspective, anatomic view of the wire-form mesh implant shown inFIG. 20, installed on a mitral valve annulus.
• FIGS. 22,23, and24 are top views of illustrative embodiments of wire-form mesh implants of the type shown inFIG. 20, which resist eversion and/or prolapse of a native valve leaflet, and which also include a combination of auxiliary structures and infra-annular struts and tabs to fix, orient, and stabilize the position of the implants in a valve annulus, the implants being shown in a flattened condition for intravascular deployment.
• FIG. 25 is a perspective view of illustrative embodiments of wire-form mesh implants of the type shown inFIG. 20, which resist eversion and/or prolapse of a native valve leaflet, and which also include a combination of auxiliary structures and infra-annular struts and tabs to fix, orient, and stabilize the position of the implants in a valve annulus, the implants being shown in an expanded condition after intravascular deployment.
DETAILED DESCRIPTION
• Although the disclosure hereof is detailed, and exact to enable those skilled in the art to practice the invention, the physical embodiments herein disclosed merely exemplify the invention, which may be embodied in other specific structure. While the preferred embodiment has been described, the details may be changed without departing from the invention, which is defined by the claims.
I. Implants for Retaining a Native Heart Valve Implant.
• A. Planar Wire-Form Implants
1. Overview
• FIGS. 4,5, and6 snow animplant400 sized and configured to retain at least one dysfunctional native heart valve leaflet. In use (see, in particular,FIG. 4), theimplant400 rests adjacent all or a portion of the native heart valve annulus, which, inFIG. 4, is in the atrium. Theimplant400 includes ascaffold410, at least a portion of which defines a pseudo-annulus. Thescaffold410 includes a retainingelement420 at or near the pseudo-annulus. The retainingelement420 is sized and shaped to overlay at least a portion of the superior surface at least one native valve leaflet. Theimplant400 allows the native leaflets to coexist with theimplant400.
• In its most basic form, the components of theimplant400 are made—e.g., by bending, shaping, joining, machining, molding, or extrusion—from a biocompatible metallic or polymer material, or a metallic or polymer material that is suitably coated, impregnated, or otherwise treated with a material or combination of materials to impart biocompatibility. The material is also desirably radio-opaque to facilitate fluoroscopic visualization. The implant material may be rigid, semi-rigid, or flexible.
• In the embodiment shown inFIG. 4, thescaffold410 is sized, and configured, to rest adjacent, all or a portion of the mitral annulus in the atrium. In the illustrated embodiment (FIG. 4), thescaffold410 forms an annular body that, at least in part, approximates the shape of the native annulus. For this reason, at least a portion of thescaffold410 is said to define a pseudo-annulus. Thescaffold410 includes the retainingelement420, which extends from the periphery of thescaffold410 radially into the pseudo-annulus.
• The retainingelement420 is sized and configured (seeFIG. 4) to overlay the superior surface of at least one native valve leaflet. In the illustrated embodiment, the retainingelement420 overlays regions of both leaflets. However, the retainingelement420 could be sized, configured, and oriented to overlay all or a portion of one leaflet or both leaflets. The size, configuration, and orientation of the retainingelement420 can vary, depending on patient needs, as will be described in greater detail later.
• When installed adjacent a mitral valve annulus, during ventricular systole the retainingelement420 exerts a restraining force on the superior surface of the leaflet or leaflets it overlays, resisting deflection of the leaflet or leaflets into the atrium and preventing leaflet eversion and/or prolapse as well as retrograde flow of blood through the valve during ventricular systole from the ventricle into the atrium. The restraining force also serves to keep valve leaflets tightly shut during peak ventricular systolic pressures. The retainingelement420 thus serves as a “backstop” for the leaflet or leaflets it overlays. During ventricular diastole this restraining force goes to zero and the retainingelement420 does not prevent opening of the native valve leaflet or leaflets during antegrade flow. During ventricular diastole, the native valve leaflet or leaflets open normally so that blood, flow occurs from the atrium into the ventricle. Theimplant400 thereby restores normal one-way function to the valve.
• As shown inFIGS. 5 and 6, in the illustrated embodiment, thescaffold410 and the retainingelement420 are shaped from a continuous length of wire-formed material. The shape and materials of thescaffold410 and retainingelement420 provide theimplant400 with spring-like characteristics. The retainingelement420 is shaped so that, during ventricular systole, it elastically resists eversion and/or prolapse of the leaflet or leaflets.
2. Fixation of Implants
• The spring-like bias of theimplant400 facilitates compliant fixation of the outer periphery of theimplant400 to or near the annulus. Thescaffold410 of theimplant400 dynamically conforms to the shape of the anatomy.
• AsFIGS. 5 and 6 show, thescaffold410 can also include supra-annular contact structures440. Thestructures440 are appended to thescaffold410 to provide multiple contact regions between theimplant400 and the atrial wall, above the valve annulus. The multiple regions of contact that thestructures440 provide uniformly distributes the resting forces of the implant, and help to prevent erosion of the atrial walls and migration of the implant.
• Alternatively or in combination with the supra-annular structures440, theimplant400 can include infra-annular contact struts430. Thestruts430 are appended to thescaffold410, extending below the plane of the annulus into the ventricular chamber. Thestruts430 are preferably configured to extend through the valve orifice on narrow connecting members, so that they will not interfere with the opening and closing of the valve. Thestruts430 fix and stabilize the implant within the annulus.
• In this arrangement, thestruts430 are desirably sized and configured to contact tissue near or within the mitral valve annulus to brace the retainingstructure420 to resist leaflet eversion and/or prolapse during ventricular systole. In this arrangement, it is also desirable that thescaffold410 be “elastic,” i.e., the material of thescaffold410 is selected to possess a desired spring constant. This means that thescaffold410 is sized and configured to possess a normal, unloaded, shape or condition, in which thescaffold410 is not in net compression, and thestruts450 are spaced apart farther than the longest cross-annulus distance between the tissue that thestruts430 are intended to contact. In the illustrated embodiment (FIG. 4), thescaffold410 shown resting along the major (i.e., longest) axis of the mitral valve annulus, with thestruts430 contact tissue at or near the leaflet commissures. However, other orientations are possible. Thestruts430 need not rest at or near the leaflet commissures, but may be significantly removed from the commissures, so as to gain padding from the leaflets. The spring constant imparts to thescaffold410 the ability to be elastically compressed out of its normal, unloaded condition, in response to external compression forces applied at thestruts430. Thescaffold410 is sized and configured to assume an elastically loaded, in net compression condition, during which thestruts430 are spaced apart a sufficiently shorter distance to rest in engagement with tissue at or near the leaflet commissures (or wherever tissue contact with thestruts430 is intended to occur) (seeFIG. 9A or9B). When in its elastically loaded, net compressed condition (seeFIGS. 9A and 9B), thescaffold410 can exert forces to the tissues through thestruts430. These forces hold the scaffold410 (and thus the retainingelement420 itself) against migration within the annulus. Furthermore, when thestruts430 are positioned at or near the commissures, they tend to outwardly displace tissue and separate tissue along the major axis of the annulus, which also typically stretches the leaflet commissures, shortens the minor axis, and/or reshapes surrounding anatomic structures. Thescaffold410 can also thereby reshape the valve annulus toward a shape more conducive to leaflet coaptation. It should be appreciated that, in order to be therapeutic, theimplant400 may only need to reshape the annulus during a portion of the heart cycle, such as during ventricular systolic contraction. For example, the implant may be sized to produce small or negligible outward displacement of tissue during ventricular diastole when the tissue is relaxed, but restrict the inward movement of tissue during ventricular systolic contraction.
• As just described, different forms of heart valve treatment can be provided using asingle implant400.
• Implants having one or more of the technical features just described, to thereby function in situ as a backstop or retainer for native leaflets, may be sized and configured in various ways. Various illustrative embodiments will now be described.
• FIG. 7 shows another illustrative embodiment of animplant400 including ascaffold410 that defines a pseudo-annulus and a retainingelement420 that functions as aleaflet retainer420. InFIG. 7, theimplant400 is shown in a flattened condition. Theimplant400 includes infra-annular struts430. Upon deployment, thestruts430 contact tissue near or within the heart valve annulus, and, in particular, between or nearly between the commissures of the leaflets, and extend into the ventricular side of the valve. As before described, thestruts430 function to brace and secure the implant in situ.
• FIG. 8 shows yet another illustrative embodiment of animplant400 including ascaffold410 that defines a pseudo-annulus and a retainingelement420 that functions as a leaflet retainer. Theimplant400 also includes infra-annular struts430. In addition, theimplant400 includes supra-annular contact structures440, used to disperse the loads experienced by the implant throughout the atrium.
• FIG. 9 shows other illustrative embodiment of animplant400 including ascaffold410 that defines a pseudo-annulus and a retainingelement420 that functions as a leaflet, retainer. InFIGS. 8 and 9, the retainingelement420 extends across the interior of the implant in a figure eight pattern and has two support struts430. Like the implant shown inFIG. 8, theimplant400 inFIG. 9 includes a plurality of infra-annular struts430 and a plurality of supra-annular contact structures440 that brace, fix, and stabilize the implants in situ.
• As can be seen in the perspective view inFIG. 10, one or more of thestruts430 can include a superior component that, rests on the atrial side of the valve, and an inferior component that rests on the ventricular side of the valve (seeFIG. 11). In this arrangement, thestruts430 place the implant near or within a heart valve annulus, e.g., between the commissures of the leaflets. As before described, the shape and tension of thescaffold410 can apply a force through thestruts430 that outwardly displaces tissue and stretches the annulus. The displacement of the tissue can remodel the annulus and promote normal valve function, free of eversion and/or prolapse, through a different mechanism than the retainingelements420.
• Any number of supra-annular contact structures440 can also be used, to disperse the loads experienced by the implant throughout the atrium.
• AsFIG. 15 shows, a givenimplant400 can include one or moreauxiliary structures450 to orient and stabilize theimplant400 within the left atrium. InFIG. 15, theimplant400 includes, in addition to thescaffold410 and the retainingelement420, an orientation andstabilization framework450. Theframework450 rises from thescaffold410 above the retainingelement420, e.g., with two substantially parallel arched wires, which connect to form a semicircular hoop above the restrainingelement420. Theframework450 helps to accurately position theimplant400 within the atrium, and also helps to secure theimplant400 within the atrium.
• Preferably theframework450 does not interfere with atrial function, but instead is compliant enough to contract with the atrium. As such, theimplant400 may have nonuniform flexibility to improve its function within the heart.
• Additionally, theimplant400 ofFIG. 15 has infra-annular struts430 that contact tissue near or within the heart valve annulus to brace theimplant400 and assist in positioning and anchoring of the implant.
• Theimplant400 may be additionally fixed to the annulus in various auxiliary ways. For example, theimplant400 may be secured to the annulus with sutures or other attachment means (i.e. barbs, hooks, staples, etc.). Still, the position and orientation of the implant is desirably braced or fixed by structures appended to or carried by the implant itself, obviating reliance upon such auxiliary fixation measures.
• InFIG. 15, the retainingelement420 is sized and, configured to cover the superior surface of a single leaflet.
• FIGS. 18 and 19 show other illustrative embodiments ofimplants400 sized and configured to function as leaflet retainers. In these embodiment, eachimplant400 includes a narrowleaflet retaining element420. The narrowleaflet retaining elements420 span the annulus, but the associatedscaffold410 need, not peripherally follow the entire annulus.
3. Deployment of Wire Form Implants
• Theimplant400 may be delivered percutaneously, thoracoscopically through the chest, or using open heart, surgical techniques. If delivered percutaneously, theimplant400 may be made from a superelastic material (for example superelastic Nitinol alloy) enabling it to be folded and collapsed such that it can be delivered in a catheter, and will subsequently self-expand into the desired shape and tension when released from the catheter. The deployment of an implant in this fashion will now be described.
• FIGS. 12 to 14 show a sequence of steps for a catheter-based, percutaneous deployment of animplant400 having the technical features described. Percutaneous vascular access is achieved by conventional methods into the femoral or jugular vein. Under image guidance (e.g., fluoroscopic, ultrasonic, magnetic resonance, computed tomography, or combinations thereof), a first catheter (not shown) is steered through the vasculature into the right atrium. A needle cannula carried on the distal end of the first catheter is deployed to pierce the septum between the right and left atrium. Aguide wire1710 is advanced trans-septally through the needle catheter into the left atrium. The first catheter is withdrawn, leaving theguide wire1710 behind.FIG. 12 shows theguide wire1710 introduced through thevena cava1730 and into the right atrium, and then through theseptum1720 between the right and left atriums, into the left atrium.
• AsFIG. 13 shows, under image guidance, animplant delivery catheter1820 is advanced over theguide wire1710 into the left atrium into proximity with the mitral valve. Alternatively, the implant delivery catheter58 can be deployed trans-septally by means of surgical access through the right atrium.
• Theimplant delivery catheter1820 carries within it a wire-form implant400 of a type shown inFIGS. 10 and 11, previously described. The implant10 is constrained, within thecatheter1820 in a collapsed, straightened condition. A push rod within thecatheter1820 expels the implant (seeFIG. 13). Free of thecatheter1820, theimplant400 will expand, asFIG. 14 shows. Progressively freed from thecatheter1820, theimplant400 shapes and seats about the annulus, as thestruts430 seat within the commissures and the retainingelements420 extend over the leaflets. The implant can also be positioned or repositioned under image guidance within the left atrium using a catheter-deployed grasping instrument.
• B. Wire-Form Mesh Implants
• FIGS. 16 and 17 show another embodiment of animplant400 including ascaffold410 that defines a pseudo-annulus and a retainingelement420 that functions as a leaflet retainer. In this embodiment, the retainingelement420 includes wire-form mesh that has been shaped to fit the heart anatomy (seeFIG. 16). The wire-form mesh can be secured within the atrium with sutures or other attachment means (i.e. barbs, hooks, staples, etc.). Alternatively, the body of the wire-form mesh can be secured by spring action between the body of the implant and the walls of the heart.
• InFIG. 20, another illustrative embodiment, of animplant400 including ascaffold410 that defines a pseudo-annulus and a retainingelement420. Theimplant400 is shown in a flattened out condition.FIG. 21 shows theimplant400 shown inFIG. 20 after deployment in a left atrium. Theimplant400 includes aleaflet retaining element420, upwardly extending stabilizationarch structures440, as well as infra-annular struts430, shaped and configured, as previously described. Thearch structures440 and struts430 cooperate to orient, and stabilize the implant in the desired position for retaining the valve leaflets.
• FIGS. 22,23, and24 show illustrative embodiments ofother implants400 of the type shown inFIGS. 20 and 21 in flattened out conditions. Each of theseimplants400 include ascaffold410 that defines a pseudo-annulus and a retainingelement420. In these embodiments, theimplants400 include, in addition to aleaflet retaining element420, a plurality ofarch structures440 that, when deployed, contact the interior of the atrium to support and align theimplant400, as well as infra-annular struts430 that contact tissue near or within the heart valve annulus to brace the retainingstructure420 to resist leaflet eversion and/or prolapse during ventricular systole.FIG. 25 shows various illustrative embodiments of animplant400 in a deployed conditioned.
• While the new devices and methods have been more specifically described in the context of the treatment of a mitral heart valve, it should be understood that other heart valve types can be treated in the same or equivalent fashion. By way of example, and not by limitation, the present systems and methods could be used, to resist or prevent retrograde flow in any heart valve annulus, including the tricuspid valve, the pulmonary valve, or the aortic valve. In addition, other embodiments and uses of the invention will be apparent to those skilled in the art from consideration of the specification and practice of the invention disclosed herein. The specification and examples should be considered exemplary and merely descriptive of key technical features and principles, and are not meant to be limiting. The true scope and spirit of the invention are defined by the following claims. As will be easily understood by those of ordinary skill in the art, variations and modifications of each of the disclosed embodiments can be easily made within the scope of this invention as defined by the following claims.

Claims (14)

1. An implant that retains a native heart valve leaflet within a heart chamber to resist retrograde flow comprising:

a scaffold sized and configured to rest adjacent all or a portion of a native heart valve annulus, at least a portion of the scaffold defining a pseudo-annulus and including a retaining structure near or within the pseudo-annulus that is sized and shaped to overlay at least a portion of one or more native valve leaflets,

the scaffold further sized and configured to contact tissue near or within the heart valve annulus to brace the retaining structure to resist leaflet eversion and/or prolapsed, and

an auxiliary structure to orient and stabilize the scaffold with the heart chamber.

2. An implant according toclaim 1

wherein the retaining structure comprises a wire-form structure.

3. An implant according toclaim 1

wherein at least one of the struts comprises a wire-form structure.

4. An implant according toclaim 1

wherein the retaining structure and the struts each comprises a wire-form structure.

5. An implant, according toclaim 1

wherein the scaffold is collapsible for placement within a catheter.

6. An implant, according toclaim 1

wherein the scaffold further includes spaced-apart struts for contacting tissue near or within the heart valve annulus to brace the retaining structure to resist leaflet eversion and/or prolapsed.

7. An implant, according toclaim 6

wherein at least, one of the struts carries a structure sized and configured to increase a surface area of contact with tissue at, above, or below the annulus.

8. An implant according toclaim 6

wherein the struts reshape the heart valve annulus.

9. An implant according toclaim 6

wherein the struts apply tension to tissue to reshape the heart valve annulus.

10. An implant according toclaim 6

wherein the struts displace tissue to reshape the heart valve annulus.

11. An implant according toclaim 1

wherein the scaffold includes a material and a shape to provide a spring-like bias to enable compliant contact with tissue near or within the heart valve annulus.

12. An implant according toclaim 1

further including a second heart valve treatment element appended to the scaffold to affect a heart valve function.

13. An implant according toclaim 12

wherein the second heart valve treatment element includes means for reshaping the heart valve annulus for leaflet coaptation.

14. An implant according toclaim 12

wherein the second heart valve treatment element includes means for separating tissue along an axis of the heart valve annulus for leafleted coaptation.

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