US20140067048A1 - Heart Valve Sealing Devices - Google Patents

Abstract

This disclosure pertains generally to prosthetic devices and related methods for helping to seal native heart valves and prevent or reduce regurgitation therethrough, as well as devices and related methods for implanting such prosthetic devices. In some cases, a spacer having a single anchor can be implanted within a native heart valve. In some cases, a spacer having dual anchors can be implanted within a native heart valve. In some cases, devices can be used to extend the effective length of a native heart valve leaflet.

Description

CROSS REFERENCE TO RELATED APPLICATIONS
• This application claims the benefit of U.S. Provisional Patent Application Nos. 61/697,706, filed Sep. 6, 2012, and 61/763,848, filed Feb. 12, 2013, which are each hereby incorporated herein by reference in their entirety.
FIELD
• This disclosure pertains generally to prosthetic devices and related methods for helping to seal native heart valves and prevent or reduce regurgitation therethrough, as well as devices and related methods for implanting such prosthetic devices.
BACKGROUND
• The native heart valves (i.e., the aortic, pulmonary, tricuspid and mitral valves) serve critical functions in assuring the forward flow of an adequate supply of blood through the cardiovascular system. These heart valves can be rendered less effective by congenital malformations, inflammatory processes, infectious conditions or disease. Such damage to the valves can result in serious cardiovascular compromise or death. For many years the definitive treatment for such disorders was the surgical repair or replacement of the valve during open heart surgery. However, such surgeries are highly invasive and are prone to many complications. Therefore, elderly and frail patients with defective heart valves often went untreated. More recently, transvascular techniques have been developed for introducing and implanting prosthetic devices in a manner that is much less invasive than open heart surgery. Such transvascular techniques have increased in popularity due to their high success rates.
• A healthy heart has a generally conical shape that tapers to a lower apex. The heart is four-chambered and comprises the left atrium, right atrium, left ventricle, and right ventricle. The left and right sides of the heart are separated by a wall generally referred to as the septum. The native mitral valve of the human heart connects the left atrium to the left ventricle. The mitral valve has a very different anatomy than other native heart valves. The mitral valve includes an annulus portion, which is an annular portion of the native valve tissue surrounding the mitral valve orifice, and a pair of cusps, or leaflets extending downward from the annulus into the left ventricle. The mitral valve annulus can form a “D” shaped, oval, or otherwise out-of-round cross-sectional shape having major and minor axes. The anterior leaflet can be larger than the posterior leaflet, forming a generally “C” shaped boundary between the abutting free edges of the leaflets when they are closed together.
• When operating properly, the anterior leaflet and the posterior leaflet function together as a one-way valve to allow blood to flow only from the left atrium to the left ventricle. The left atrium receives oxygenated blood from the pulmonary veins. When the muscles of the left atrium contract and the left ventricle dilates, the oxygenated blood that is collected in the left atrium flows into the left ventricle. When the muscles of the left atrium relax and the muscles of the left ventricle contract, the increased blood pressure in the left ventricle urges the two leaflets together, thereby closing the one-way mitral valve so that blood cannot flow back to the left atrium and is instead expelled out of the left ventricle through the aortic valve. To prevent the two leaflets from prolapsing under pressure and folding back through the mitral annulus toward the left atrium, a plurality of fibrous cords called chordae tendineae tether the leaflets to papillary muscles in the left ventricle.
• Mitral regurgitation occurs when the native mitral valve fails to close properly and blood flows into the left atrium from the left ventricle during the systole phase of heart contraction. Mitral regurgitation is the most common form of valvular heart disease. Mitral regurgitation has different causes, such as leaflet prolapse, dysfunctional papillary muscles and/or stretching of the mitral valve annulus resulting from dilation of the left ventricle. Mitral regurgitation at a central portion of the leaflets can be referred to as central jet mitral regurgitation and mitral regurgitation nearer to one commissure (i.e., location where the leaflets meet) of the leaflets can be referred to as eccentric jet mitral regurgitation.
• Some prior techniques for treating mitral regurgitation include stitching portions of the native mitral valve leaflets directly to one another. Other prior techniques include the use of a spacer implanted between the native mitral valve leaflets. Despite these prior techniques, there is a continuing need for improved devices and methods for treating mitral valve regurgitation.
SUMMARY
• This disclosure pertains generally to prosthetic devices and related methods for helping to seal native heart valves and prevent or reduce regurgitation therethrough, as well as devices and related methods for implanting such prosthetic devices.
• In some embodiments, a prosthetic device for treating heart valve regurgitation comprises a radially compressible and radially expandable body having a first end, a second end, and an outer surface extending from the first end to the second end and an anchor having a connection portion and a leaflet capture portion, wherein the connection portion is coupled to the body such that the leaflet capture portion is biased against the outer surface of the body when the body is in a radially expanded state, the prosthetic device is configured to capture a leaflet of a native heart valve between the leaflet capture portion of the anchor and the outer surface of the body, and the body is configured to prevent blood from flowing through the body in a direction extending from the first end to the second end and in a direction extending from the second end to the first end.
• In some embodiments, the outer surface of the body comprises a first side against which the anchor is biased and a second side opposite the first side, and the connection portion of the anchor is coupled to the body on the second side of the body. In some embodiments, the anchor comprises an elongated member that is coupled to the second side of the body at a connection location and the elongated member comprises a ventricular portion that extends from the connection location across the first end of the body. In some embodiments, the ventricular portion comprises first and second ventricular portions and the first ventricular portion is substantially parallel to the second ventricular portion.
• In some embodiments, the body is radially compressible to a compressed state in which a leaflet-receiving gap exists between the body and the leaflet capture portion of the anchor, and the body is resiliently radially self-expandable to the radially expanded state. In some embodiments, the anchor comprises a first clip portion and a second clip portion, and the device is configured to capture the leaflet between the first and second clip portions. In some embodiments, the body is formed from Nitinol and is radially self-expandable to the expanded state. In some embodiments, the body comprises a metallic frame and a blood-impermeable fabric mounted on the frame. In some embodiments, the body is configured to allow blood to flow around the body between the body and a non-captured leaflet during diastole, and configured to allow the non-captured leaflet to close around the body to prevent mitral regurgitation during systole.
• In some embodiments, the anchor is coupled to the first end of the body and the device further comprises an atrial stabilizing member extending from the second end of the body. In some embodiments, the body is configured to move within the native heart valve along with motion of the captured leaflet. In some embodiments, an atrial end portion of the body comprises a tapered shoulder that reduces in diameter moving toward the atrial end portion of the body. In some embodiments, the body comprises a crescent cross-sectional shape. In some embodiments, the anchor comprises first and second anchors and the device is configured to be secured to both native mitral valve leaflets.
• In some embodiments, a prosthetic device for treating heart valve regurgitation comprises a main body portion having a connection portion and a free end portion, wherein the connection portion is configured to be coupled to a first one of the two native mitral valve leaflets such that the device is implanted within a native mitral valve orifice, and when the device is implanted within the native mitral valve orifice, the free end portion moves laterally toward a second one of the two native mitral valve leaflets during systole, thereby helping to seal the orifice and reduce mitral regurgitation during systole, and the free end portion moves laterally away from the second native mitral valve leaflet during diastole to allow blood to flow from the left atrium to the left ventricle during diastole.
• In some embodiments, the connection portion of the main body is thicker than the free end portion. In some embodiments, the main body portion further comprises an atrial portion that contacts the native mitral valve annulus within the left atrium adjacent to the first native mitral valve leaflet. In some embodiments, the device further comprises a ventricular anchor that clips around a lower end of the first native mitral valve leaflet, thereby securing the device to the first native mitral valve leaflet. In some embodiments, the anchor comprises a paddle shape with a broad upper end portion and a relatively narrow neck portion, wherein the neck portion couples the upper end portion to the main body.
• In some embodiments, a prosthetic device comprises a sheet of flexible, blood-impermeable material configured to be implanted within a native mitral valve orifice and coupled to a first one of the two native mitral leaflets or to the native mitral annulus adjacent the first native mitral leaflet, wherein when implanted the sheet is configured to inflate with blood during systole such that a free portion of the sheet not coupled to the first native mitral leaflet or the mitral annulus adjacent the first native mitral leaflet moves laterally toward and seals against the second of the two native mitral leaflets to reduce mitral regurgitation, and when implanted the sheet is configured to deflate during diastole such that the portion of the sheet not coupled to the first native mitral leaflet or the native mitral annulus adjacent the first native mitral leaflet moves laterally away from the second native mitral leaflet to allow blood to flow from the left atrium to the left ventricle.
• In some embodiments, the sheet is supported by a rigid frame that is secured to the first native mitral leaflet. In some embodiments, the frame comprises a ventricular anchor that clips around a lower end of the first native mitral leaflet. In some embodiments, the frame comprises an atrial portion that contacts the native mitral annulus within the left atrium adjacent to the first native mitral leaflet. In some embodiments, an upper end of the sheet is secured directly to the native mitral annulus adjacent the first native mitral leaflet or to the first native mitral leaflet adjacent the native mitral annulus. In some embodiments, the upper end of the sheet is secured to native tissue via rigid anchors that puncture the native tissue.
• In some embodiments, the sheet comprises an annular cross-sectional profile perpendicular to an axis extending through the mitral orifice from the left atrium to the left ventricle. In some embodiments, the sheet comprises a closed atrial end and an open ventricular end. In some embodiments, the open lower end is biased toward an open position and is configured to collapse to a closed position during diastole. In some embodiments, the sheet is supported by a rigid frame that is secured to the first native mitral leaflet, and the frame comprises a plurality of longitudinal splines extending from the upper end of the sheet to the lower end of the sheet. In some embodiments, the splines are biased to cause the lower end of the sheet to open away from the first native leaflet.
• In some embodiments, a lower end of the sheet is tethered to a location in the left ventricle below the native mitral leaflets. In some embodiments, the lower end of the sheet is tethered to the papillary muscle heads in the left ventricle. In some embodiments, the lower end of the sheet is tethered to a lower end of the rigid frame. In some embodiments, opposing lateral ends of the lower end of the sheet are tethered to the lower end of the frame such that an intermediate portion of the lower end of the sheet can billow out away from the frame and toward the second leaflet during systole. In some embodiments, the sheet has a generally trapezoidal shape, with a broader portion adjacent to the mitral annulus and a narrower portion positioned between the native mitral leaflets.
• In some embodiments, a prosthetic device for treating heart valve regurgitation comprises a radially compressible and radially expandable body having a first end, a second end, and an outer surface extending from the first end to the second end, a first anchor coupled to the body and configured to capture the anterior native mitral valve leaflet between the first anchor and the body to secure the device to the anterior leaflet, and a second anchor coupled to the body and configured to capture the posterior native mitral valve leaflet between the second anchor and the body to secure the device to the posterior leaflet, wherein when the first and second anchors capture the anterior and posterior leaflets, the body is situated within a mitral valve orifice between the anterior and posterior leaflets, thereby decreasing a size of the orifice.
• In some embodiments, the body is radially compressible to a collapsed delivery configuration suitable for delivering the device to the native mitral valve, and radially expandable from the collapsed delivery configuration to an expanded, operational configuration suitable for operation in the native mitral valve. In some embodiments, the body is formed from Nitinol and is radially self-expandable from the collapsed configuration to the expanded configuration. In some embodiments, the device further comprises a sheet of blood impermeable fabric covering the body. In some embodiments, the body has an elliptical cross-sectional shape. In some embodiments, the body has a crescent cross-sectional shape. In some embodiments, the body comprises a prosthetic valve. In some embodiments, the body is configured to prevent blood from flowing through the body in a direction extending from the first end to the second end and in a direction from the second end to the first end.
• In some embodiments, a method of implanting a prosthetic sealing device at a native mitral valve of a heart comprises advancing a delivery catheter to a native mitral valve region of a heart from a left atrium of the heart, the delivery catheter housing the prosthetic sealing device in a radially compressed configuration, advancing the prosthetic sealing device distally relative to the delivery catheter such that an anchor of the prosthetic sealing device moves out of the catheter and forms a leaflet-receiving gap between an end portion of the anchor and the delivery catheter, positioning either a posterior or an anterior mitral valve leaflet in the gap, and advancing a radially compressed body of the prosthetic sealing device out of the delivery catheter such that the body self-expands radially toward the end portion of the anchor, reducing the gap, and capturing the leaflet between the body and the end portion of the anchor, wherein the body is configured to prevent the flow of blood through the body during systole and during diastole.
• In some embodiments, a non-captured one of the anterior and posterior leaflets is not secured to the prosthetic sealing device when the prosthetic sealing device is implanted at the native mitral valve. In some embodiments, advancing a delivery catheter through the native mitral valve from a left atrium comprises advancing the delivery catheter through an incision in a portion of a septum between the left atrium and a right atrium. In some embodiments, when the delivery catheter is advanced to the native mitral valve region of the heart, the anchor is held in a substantially straightened position within the delivery catheter extending distally from body of the prosthetic sealing device.
• In some embodiments, a method of implanting a prosthetic sealing device at a native mitral valve comprises advancing a delivery device to a native mitral valve region via a left ventricle, the delivery catheter housing the prosthetic sealing device in a compressed configuration, allowing an anchor of the prosthetic sealing device to move radially out of the delivery device while a body of the delivery device is in a compressed configuration, such that a leaflet-receiving gap forms between an end portion of the anchor and the delivery device, positioning either a posterior or an anterior mitral valve leaflet in the gap, and allowing the body of the prosthetic sealing device to radially self-expand such that the leaflet is captured between the body and the anchor, wherein the body is configured to prevent the flow of blood through the body during systole and during diastole.
• In some embodiments, a non-captured one of the anterior and posterior mitral valve leaflets is not secured to the prosthetic sealing device when the prosthetic sealing device is implanted at the native mitral valve. In some embodiments, advancing a delivery device to a native mitral valve region via a left ventricle comprises inserting the delivery device into the left ventricle through an incision in an apex of the left ventricle.
• In some embodiments, a method of implanting a prosthetic sealing device at a native mitral valve of a heart comprises advancing a delivery system to a native mitral valve region of a heart from a left ventricle of the heart, the delivery system housing the prosthetic sealing device in a radially compressed configuration, proximally retracting an outer sheath of the delivery system such that anchors of the prosthetic sealing device are not confined within the delivery system, advancing the delivery system toward the left atrium of the heart such that native mitral valve leaflets are positioned between the anchors of the prosthetic sealing device and the delivery system, proximally retracting an inner sheath of the delivery system such that a body of the prosthetic sealing device is not confined within the delivery system, wherein the body is configured to prevent the flow of blood through the body during systole and during diastole, and removing the delivery system from the native mitral valve region of the heart.
• In some embodiments, advancing the delivery system to the native mitral valve region from the left ventricle comprises inserting the delivery device into the left ventricle through an incision in an apex of the left ventricle. In some embodiments, when the delivery system is advanced to the native mitral valve region of the heart, the anchor is held in a substantially straightened position within the delivery catheter extending distally along a side of the body of the prosthetic sealing device.
• In some embodiments, a method of implanting a prosthetic sealing device at a native mitral valve of a heart comprises advancing a delivery system to a native mitral valve region of a heart from a left atrium of the heart, the delivery system housing the prosthetic sealing device in a radially compressed configuration, proximally retracting an outer sheath of the delivery system such that anchors of the prosthetic sealing device are not confined within the delivery system, retracting the delivery system toward the left atrium of the heart such that native mitral valve leaflets are positioned between the anchors of the prosthetic sealing device and the delivery system, proximally retracting an inner sheath of the delivery system such that a body of the prosthetic sealing device is not confined within the delivery system, wherein the body is configured to prevent the flow of blood through the body during systole and during diastole, and removing the delivery system from the native mitral valve region of the heart.
• In some embodiments, advancing the delivery system to the native mitral valve region from the left atrium comprises advancing the delivery system through an incision in a portion of a septum between the left atrium and a right atrium. In some embodiments, when the delivery system is advanced to the native mitral valve region of the heart, the anchor is held in a substantially straightened position within the delivery catheter extending proximally from body of the prosthetic sealing device.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 shows a portion of a human heart with an exemplary embodiment of a sealing device attached to the native posterior mitral leaflet.
• FIG. 2 shows a portion of a human heart with an exemplary embodiment of a sealing device attached to the native anterior mitral leaflet.
• FIG. 3 shows a portion of a human heart with an exemplary embodiment of a sealing device attached to the native posterior mitral leaflet and having an atrial anchor.
• FIG. 4 is an atrial end view of one embodiment of the sealing device ofFIG. 3 having a lattice-type atrial anchor.
• FIG. 5 is an atrial end view of another embodiment of the sealing device ofFIG. 3 having a loop-type atrial anchor.
• FIG. 6 is a side view of an exemplary sealing device.
• FIG. 7 is another side view of the sealing device ofFIG. 6.
• FIG. 8 is an atrial end view of the sealing device ofFIG. 6.
• FIG. 9 is an atrial end view of the sealing device ofFIG. 6 implanted at a native mitral valve.
• FIG. 10 shows a crescent-shaped embodiment of a sealing device.
• FIG. 11 shows a sealing device having an anchor that extends from one side of a body, around a ventricular end of the body, and along a second side of the body.
• FIGS. 12-15 show a method of deploying the sealing device ofFIG. 11 from a delivery sheath.
• FIG. 16 is a side view of another embodiment of a sealing device having an anchor that extends from one side of a body, around a ventricular end of the body, and along a second side of the body.
• FIG. 17 is another side view of the embodiment ofFIG. 16.
• FIG. 18 is an atrial end view of the embodiment ofFIG. 16.
• FIG. 19 is a side view of an embodiment similar to that shown inFIG. 16.
• FIG. 20 shows the embodiment ofFIG. 19 covered with a fabric layer.
• FIG. 21 is a ventricular end view of the embodiment ofFIG. 20 implanted at a native mitral valve.
• FIG. 22 shows a portion of a human heart with an exemplary sealing device being implanted at the mitral region in a transeptal approach.
• FIG. 23 shows a portion of a human heart with an exemplary sealing device being implanted at the mitral region in a transapical approach.
• FIG. 24 shows a human heart with an exemplary prosthetic device attached to a native mitral leaflet.
• FIG. 25 shows an exemplary prosthetic device being coupled to a native mitral leaflet in a transeptal approach.
• FIG. 26 shows an exemplary prosthetic device being coupled to a native mitral leaflet in a transapical approach.
• FIGS. 27 and 28 show another exemplary prosthetic device being coupled to a native mitral leaflet.
• FIGS. 29-31 show an exemplary prosthetic device attached to the mitral valve region of a human heart.
• FIGS. 32-34 show another exemplary prosthetic device attached to the mitral valve region of a human heart.
• FIG. 35 shows two exemplary prosthetic devices, each being coupled to a respective one of the native mitral valve leaflets.
• FIG. 36 shows two exemplary prosthetic devices, each being coupled to a respective one of the native mitral valve leaflets.
• FIG. 37 shows two exemplary prosthetic devices, each being coupled to a respective one of the native mitral valve leaflets.
• FIGS. 38-41 show an exemplary prosthetic device having two anchors.
• FIG. 42 shows an exemplary prosthetic device having two anchors, coupled to both of the native mitral valve leaflets.
• FIG. 43 shows an exemplary prosthetic device having two anchors, coupled to both of the native mitral valve leaflets, from an atrial view.
• FIG. 44 shows an exemplary prosthetic device having an elongated body and two anchors, coupled to both of the native mitral valve leaflets, from an atrial view.
• FIG. 45 shows an exemplary prosthetic device having a valve and two anchors, coupled to both of the native mitral valve leaflets, from an atrial view.
• FIG. 46 shows an exemplary prosthetic device having a crescent-shaped body and two anchors, coupled to both of the native mitral valve leaflets, from an atrial view.
• FIGS. 47-51 show exemplary prosthetic devices having three anchors.
• FIGS. 52-54 show the prosthetic device ofFIGS. 38-41 implanted at a native mitral valve.
• FIGS. 55 and 56 show another exemplary prosthetic device comprising a radially compressible and expandable body.
• FIGS. 57 and 58 show the prosthetic device ofFIGS. 55 and 56 with a fabric layer.
• FIGS. 59-63 show an exemplary prosthetic device with an exemplary delivery system, in various configurations.
• FIGS. 64-67 show various exemplary delivery approaches for delivering a prosthetic device to a native mitral valve.
• FIG. 68 shows an exemplary prosthetic device including a nosecone.
DETAILED DESCRIPTION
• Described herein are embodiments of prosthetic devices that are primarily intended to be implanted at one of the mitral, aortic, tricuspid, or pulmonary valve regions of a human heart, as well as apparatuses and methods for implanting the same. The prosthetic devices can be used to help restore and/or replace the functionality of a defective native mitral valve. The disclosed embodiments should not be construed as limiting in any way. Instead, the present disclosure is directed toward all novel and nonobvious features and aspects of the various disclosed embodiments, alone and in various combinations and sub-combinations with one another.
Prosthetic Spacers
• In some embodiments, a prosthetic device comprises a body and an anchor. The body is configured to be positioned within the native mitral valve orifice to help create a more effective seal between the native leaflets to prevent or minimize mitral regurgitation. The body can comprise a structure that is impervious to blood and that allows the native leaflets to close around the sides of the body during ventricular systole to block blood from flowing from the left ventricle back into the left atrium. The body is sometimes referred to herein as a spacer because the body can fill a space between improperly functioning native mitral leaflets that do not naturally close completely. In some embodiments, the body can comprise a prosthetic valve structure positioned within an annular body.
• The body can have various shapes. In some embodiments, the body can have an elongated cylindrical shape having a round cross-sectional shape. In other embodiments, the body can have an ovular cross-sectional shape, a crescent cross-sectional shape, or various other non-cylindrical shapes. The body can have an atrial or upper end positioned in or adjacent to the left atrium, a ventricular or lower end positioned in or adjacent to the left ventricle, and an annular side surface that extends between the native mitral leaflets.
• The anchor can be configured to secure the device to one or both of the native mitral leaflets such that the body is positioned between the two native leaflets. The anchor can attach to the body at a location adjacent the ventricular end of the body. The anchor can be configured to be positioned behind a native leaflet when implanted such that the leaflet is captured between the anchor and the body.
• The prosthetic device can be configured to be implanted via a delivery sheath. The body and the anchor can be compressible to a radially compressed state and can be self-expandable to a radially expanded state when compressive pressure is released. The device can be configured to allow the anchor to self-expand radially away from the still-compressed body initially in order to create a gap between the body and the anchor. The leaflet can then be positioned in the gap. The body can then be allowed to self-expand radially, closing the gap between the body and the anchor and capturing the leaflet between the body and the anchor. The implantation methods for various embodiments can be different, and are more fully discussed below with respect to each embodiment. Additional information regarding these and other delivery methods can be found in U.S. Patent Application Publication No. 2011/0137397 and U.S. Provisional Patent Application No. 61/760,577, which are incorporated by reference herein in their entirety.
• Some embodiments disclosed herein are generally configured to be secured to only one of the native mitral leaflets. However, other embodiments comprise more than one anchor and can be configured to be secured to both mitral leaflets. Unless otherwise stated, any of the embodiments disclosed herein that comprise a single anchor can optionally be secured to the anterior mitral leaflet or secured to the posterior mitral leaflet, regardless of whether the particular embodiments are shown as being secured to a particular one of the leaflets.
• Furthermore, some embodiments can optionally also include one or more atrial anchors, such as to provide additional stabilization. Unless otherwise stated, any of the embodiments disclosed herein can optionally include an atrial anchor or not include an atrial anchor, regardless of whether the particular embodiments are shown with an atrial anchor or not.
• Some of the disclosed prosthetic devices are prevented from atrial embolization by having the anchor hooked around a leaflet, utilizing the tension from native chordae tendinae to resist high systolic pressure urging the device toward the left atrium. During diastole, the devices can rely on the compressive forces exerted on the leaflet that is captured between the body and the anchor to resist embolization into the left ventricle.
• FIG. 1 shows an exemplary embodiment of aprosthetic device10 that comprises abody12 and ananchor14. Thedevice10 is secured to the posteriormitral leaflet8 with the free end of theleaflet8 captured between theanchor14 and thebody12. InFIG. 1, the anteriormitral leaflet6 is shown separated from thebody12 during diastole as blood flows from theleft atrium2 into theleft ventricle4. As the mitral leaflets open apart from each other, thedevice10 can move with theposterior leaflet8, allowing theanterior leaflet6 to open away from thebody12. During systole, the back pressure on the leaflets closes them together around thebody12 to prevent mitral regurgitation.FIG. 2 shows thedevice10 alternatively secured to the anteriormitral leaflet6 with the posteriormitral leaflet8 free to articulate toward and away from thedevice10.
• FIG. 3 shows aprosthetic device20 having abody22, aventricular anchor24, and anatrial anchor26. Thedevice20 is shown secured to theposterior leaflet8 via theventricular anchor24. Theatrial anchor26 can extend laterally from adjacent the atrial end of thebody22 toward the mitral annulus or other lateral portions of theleft atrium2 adjacent to theposterior leaflet8. Theatrial anchor26 can help stabilize the device. For example, theatrial anchor26 can prevent thebody22 from tilting and keep it oriented longitudinally along the blood flow direction through the mitral orifice. Theatrial anchor26 can also help prevent thedevice20 from embolizing into theleft ventricle4.
• FIGS. 4 and 5 are atrial end views showing two alternative embodiments of atrial anchors for thedevice20.FIG. 4 shows anatrial anchor26A that comprises a lattice-type framework supported by two connections to thebody22, whileFIG. 5 shows anatrial anchor26B that comprises a single elongated member extending in a loop between two connections to thebody22. In both embodiments, the atrial anchor comprises a relatively broader or wider end portion configured to engage with the atrial tissue so as to spread out the engagement forces to avoid tissue damage and promote increased tissue ingrowth.
• FIGS. 6-8 show three views of an exemplary embodiment of theprosthetic device20 having acylindrical body22, aventricular anchor24, and anatrial anchor26C. Theventricular anchor24, as shown inFIGS. 6 and 7, comprises an elongated member that extends from two connection points adjacent the ventricular end of thebody22 and along one side of the body toward the atrial end of the body. The ventricular anchor is contoured around the generally cylindrical side surface of thebody22. Theatrial anchor26C comprises a lattice-type framework made up of several diamond-shapedsegments29 coupled side-by-side in an arc. Theatrial anchor26C further comprises three connectingmembers27 coupling it to thebody22 adjacent the atrial end of the body. As shown inFIG. 6, theatrial member26C extends generally laterally to the same side of thebody22 as theventricular anchor24. The radially outward end portion of the atrial anchor can have an upward curvature to conform to the curved geometry of the left atrium. Each of the diamond-shapedsegments29 comprises radially outwardly pointingtip30 that can press into and/or penetrate adjacent tissue in some cases.
• Thedevice20 is shown in an expanded configuration inFIGS. 3-9. In a compressed delivery configuration, theatrial anchor26 can be folded down against the side of thebody22 or extended upwardly away from thebody22. Furthermore, theatrial anchor26 can be circumferentially compressed, especially embodiments having a lattice-type structure.
• Thebody22 can comprise anannular metal frame32 covered with a blood-impervious fabric28, as shown inFIGS. 6-9. One or both ends of the body can also be covered with the blood-impervious fabric28, as shown inFIG. 8. Theframe32 can comprise a mesh-like structure comprising a plurality of interconnected metal struts, like a conventional radially compressible and expandable stent. In other embodiments, the body can comprise a solid block of material, such as flexible sponge-like block. In some embodiments, thebody22 can be hollow or filled with material.
• Theframe32 can be formed from a self-expandable material, such as Nitinol. When formed from a self-expandable material, theframe32 can be radially compressed to a delivery configuration and can be retained in the delivery configuration by placing the device in the sheath of a delivery apparatus. When deployed from the sheath, theframe32 can self-expand to its functional size. In other embodiments, the frame can be formed from a plastically expandable material, such as stainless steel or a cobalt chromium alloy. When formed from a plastically expandable material, the prosthetic device can be crimped onto a delivery apparatus and radially expanded to its functional size by an inflatable balloon or an equivalent expansion mechanism It should be noted that any of the embodiments disclosed herein can comprise a self-expandable main body or a plastically expandable main body.
• FIG. 9 is a view from theleft atrium2 of thedevice20 ofFIGS. 6-8 implanted at a mitral valve. Thebody22 is positioned between thenative leaflets6,8 in a sealed position with theatrial anchor26C engaged with the atrial tissue adjacent the posteriormitral leaflet8. The atrial end of thebody22 is open while the ventricular end of the body is covered with theimpervious fabric28.
• FIG. 10 shows an exemplaryprosthetic device34 having a crescent shapedbody36. Thebody36 is configured to be positioned with the convex side facing the posteriormitral leaflet8 and the concave side facing the anteriormitral leaflet6. In this embodiment, thebody36 can comprise a flexible, sponge-like material. Consequently, thedevice34 can comprise two ventricular anchors to capture theanterior leaflet6. Afirst ventricular anchor44 is configured to be positioned behind the anterior leaflet while asecond ventricular anchor42 is configured to be positioned between thebody36 and the anterior leaflet. Theanterior leaflet6 is therefore captured and pinched between the twoanchors42,44 to secure thebody36 within the mitral orifice. Thedevice34 relies on the twoanchors42,44 to capture the leaflet because thebody36 in this embodiment may lack sufficient rigidity to grip the leaflet. Both of the ventricular anchors42,44 can extend from adjacent aventricular end40 of thebody36 and extend up toward anatrial end38 of the body along the same side of the body. In other embodiments, theanchors42,44 can be positioned on the convex side of thebody36 in order to secure the body to the posterior leaflet. In some embodiments, theanchor42 can be nested within theanchor44 to provide a smaller crimped profile. In other embodiments, theanchors42,44 can have various other shapes. In still other embodiments, thebody36 can be cylindrical or can have any of various other shapes described herein.
• FIG. 11 shows an exemplary embodiment of aprosthetic device50 having abody52 and ananchor54 that attaches to a first side of the body, extends around the ventricular end of the body, and extends along a second side of the body opposite the first side of the body. Thedevice50 is configured to capture a mitral leaflet between theanchor54 and the second side of thebody52 to secure the body within the mitral orifice. Thebody52 can comprise, for example, a radially compressible and expandable metal stent covered by a blood impermeable fabric, as described above.
• FIGS. 12-15 illustrate an exemplary method of deployment of thedevice50 from adelivery catheter56. InFIG. 12, thebody52 is shown in a radially compressed state within thecatheter56 with theanchor54 extending distally from the ventricular end of the body in a straightened, or unfurled, state. Thedevice50 can be resiliently deformed in this configuration such that thedevice50 resiliently returns to the configuration shown inFIG. 11 when released from constraint. Apusher member59 can be used to push thedevice50 distally relative to thecatheter56 or to hold thedevice50 steady as the catheter is retracted. InFIG. 13, thecatheter56 is retracted proximally from thedevice50 and/or thedevice50 is advanced distally from thecatheter56 such that theelongated anchor54 begins to extend out of thedistal outlet58 of the catheter. As theanchor54 moves out of theoutlet58, the anchor begins to naturally return toward the shape ofFIG. 11, curling gradually as it is freed from the confining forces of the catheter. InFIG. 14, theentire anchor54 has moved out of thecatheter56 and has returned to its natural shape ofFIG. 11. However, thebody52 is still held in radial compression by the catheter, creating agap60 between the second side of thebody52 and the end of theanchor54. A mitral leaflet can be positioned within thegap60 while the device is in the configuration ofFIG. 14. InFIG. 15, theventricular end62 of thebody52 begins to advance out of theoutlet58, allowing theventricular end62 of the body to radially expand while the atrial end64 of the body remains held in compression within the catheter. This causes thebody52 to expand gradually toward theanchor54, decreasing the width of thegap60, thereby capturing the leaflet within the gap. Once the atrial end64 of thebody52 is freed from thecatheter56, theentire body52 can expand to its fully expanded state shown inFIG. 11, pinching or compressing the leaflet between the end of theanchor54 and the side of the body. In the fully expanded state shown inFIG. 11, a gap remains between thebody52 and theanchor54, although the gap is desirably sized such that a leaflet is engaged by the body and the anchor when placed in the gap. In alternative embodiments, however, such a gap may not exist when the device is in its fully expanded state (i.e., theanchor54 contacts thebody52 when a leaflet is not positioned between these two components).
• FIGS. 16-18 show orthogonal views of an exemplary embodiment of adevice70 similar to thedevice50. Thedevice70 can be deployed from a catheter in the manner described above with respect toFIGS. 11-15. Thedevice70 comprises a radially self-expandable body72 and aventricular anchor74. Thebody72 can comprise a narrowedatrial end76 and atapered shoulder region77, such as to provide improved hemodynamics as blood flows around the shoulder region. Thebody72 has aventricular end78 opposite from theatrial end76. Theventricular anchor74 can comprise an elongated, curved member that connects to thebody72 at two connection points80,82 adjacent to theventricular end78 on a first side of the body (i.e., the right side of the body inFIG. 16). As shown inFIGS. 16-18, theanchor74 comprisesfirst portions84,86 that extend from the connection points80,82, respectively, around theventricular end78 of the body, to a second, opposite side of the body (i.e., the left side of the body inFIG. 16). Theanchor74 further comprisessecond portions88,90 that extend from thefirst portions84,86, respectively, along the second side of the body toward theatrial end76 of the body. Thesecond portions88,90 gradually expand apart from each other moving atrially toward anend portion92 of theanchor74. Thesecond portions88,90 and theend portion92 of theanchor74 can form a paddle shape, as shown inFIG. 17, and can have a circumferential curvature that substantially matches the curvature of thebody72.
• Note that, whileFIGS. 16-18 appear to show theend portion92 of the anchor passing within a portion of thebody72, theend portion92 actually extends around the outer surface of thebody72, as shown inFIGS. 19 and 20. The position of theend portion92 inFIGS. 16-18 illustrates the position that theanchor74 wants to resiliently move toward in the absence of resistance frombody72. When manufactured, theanchor74 is provided with a pre-bend that causes theend portion92 to press against the outer surface of thebody72, as shown inFIGS. 19 and 20. This provides thedevice70 the ability to apply a strong enough clamping force on a leaflet positioned between theend portion92 and thebody72, even when the leaflet is very thin.
• FIG. 20 also shows a blood-impervious fabric layer94 covering thebody72 which can prevent blood from flowing through thebody72. The fabric layer can comprise, for example, polyethylene terephthalate (PET) or polyurethane. Any of the spacers described herein (even if shown just as a frame) can include such a blood-impervious fabric layer covering the spacer, which can prevent blood from flowing through the spacer.
• Thedevice70 can be can be deployed from a delivery catheter according to the method illustrated with respect todevice50 inFIGS. 11-15, by releasing theanchor74 first to create a leaflet-receiving gap between theend portion92 and thebody72. After positioning a leaflet in the gap, thebody72 can subsequently be freed to self-expand radially toward theend portion92 to clamp the leaflet between theend portion92 and the second side of thebody72.
• Because theanchor74 extends around theventricular end78 of the body, thefirst portions84,86 can be provided with a larger radius of curvature compared to if theanchor74 was connected to thebody72 on the same side as theend portion92. This large radius of curvature of thefirst portions84,86 can provide greater control over the clamping forces between theend portion92 and thebody72, and provide a more robust and durable anchor configuration, reducing stress concentrations in theanchor74 and connection points80,82. Because the body is acting as a spacer, causing the blood to flow around it, theanchor74 can pass around theventricular end78 of the body without obstructing the flow of blood any more than necessary. Having theanchor members84,86 positioned below the ventricular end of the body may not be as desirable in embodiments where the body comprises an annular frame with a prosthetic valve within the annular frame, since themembers84,86 could restrict the flow of blood through the body to some degree.
• In the case of thedevice70, when the device is clipped onto a mitral leaflet between theend portion92 and the second side of thebody72, a majority of the blood flow passes around the other three sides of the body (i.e., the left, right, and bottom side inFIG. 18). This is illustrated inFIG. 21, which shows a ventricular end view of thedevice70 implanted in a mitral orifice with theposterior leaflet8 captured between theanchor74 and thebody72. Theanterior leaflet6 is opened away from thebody72 inFIG. 21, allowing blood to flow around three sides of the body during diastole. As shown inFIG. 21, thefirst members84,86 of theanchor74 extend across the body without blocking the flow of blood around the body. Though not shown, during systole, theanterior leaflet6 can close around thebody72 and create a seal with the body and the side portions of theposterior leaflet8 to prevent regurgitation into theleft atrium2. Thebody72 is shown inFIG. 21 covered with the blood-impervious fabric94 that extends around theatrial end76 of the body and is open on theventricular end78 of the body, preventing blood from flowing through thebody72. In some embodiments, theventricular end72 can also be covered by the fabric to fully enclose the body and provide improved hemodynamics.
• The exemplary prosthetic devices disclosed herein can be delivered to the mitral region via plural different approaches.FIG. 22 shows an exemplaryprosthetic device100 having asingle anchor102, being delivered with acatheter104 via an exemplary transeptal atrial approach. In the approach shown inFIG. 22, thecatheter104 passes through theinferior vena cava110, theright atrium112, and through an incision made in theseptum114, to reach theleft atrium2. Thedistal end portion106 of thecatheter104 serves as a sheath for containing theprosthetic device100 in a compressed state during delivery to the heart. The delivery apparatus can further include apusher member116 extending coaxially through thecatheter104. Once the catheter enters theleft atrium2, implantation of thedevice100 can be performed similar to the methods described in relation toFIGS. 11-21 herein. Alternatively, the prosthetic devices described herein can be implanted via an atrial approach using any of the methods and/or devices described in U.S. Patent Application Publication No. 2011/0137397 in relation toFIGS. 63-67 thereof, or in U.S. Provisional Patent Application No. 61/760,577.
• FIG. 23 shows an exemplaryprosthetic device120 having asingle anchor122, being delivered with adelivery device124 through the apex126 of the heart in an exemplary transapical approach. In the transapical approach shown inFIG. 23, theprosthetic device120 is held in a compressed configuration in a distal end of thedelivery device124 as the delivery device is inserted through an incision in theheart apex126 and delivered through theleft ventricle4 to the mitral region. Thedelivery device124 can have features that allow theanchor122 to radially expand out of thedelivery device124 and away from the still-compressed body of theprosthetic device120, as shown inFIG. 23, to capture one of the nativemitral leaflets6 or8. For example, thedelivery device124 can have an outer sheath configured to release theanchor122 while the body of the prosthetic device is held in a compressed state in an inner sheath, such as by providing a slot in the distal end portion ofsheath124 through which theanchor122 can extend. In some embodiments, thedelivery device124 can be similar to the delivery device 2000 described in U.S. Patent Application Publication No. 2011/0137397 (for example, with only one of the slots 2028 instead of two), and can be used to implant theprosthetic device120 via methods similar to those described therein in relation toFIGS. 49-62 thereof. Thedelivery device124 can also be similar to the delivery devices described in U.S. Provisional Patent Application No. 61/760,577, and can be used to implant prosthetic devices via methods similar to those described therein.
• FIG. 24 shows an exemplaryprosthetic device200 that is configured to inflate with blood and expand radially during systole and to collapse radially during diastole. Thedevice200 can comprise astructural portion202, ananchor204, and an inflatable portion, or parachute,206 having an annular cross-sectional profile. Thestructural portion202 can comprise a rigid member or frame that supports one side of theparachute206. Theanchor204 can comprise an extension of thestructural member202 or a separate member coupled to the structural member and is configured to attach thedevice200 to one of the native mitral leaflets, such as the posterior native leaflet as shown inFIG. 24, by capturing the leaflet between theanchor204 and thestructural portion202. Theparachute206 can comprise a flexible, blood-impermeable material, such as PET fabric or the like. Theparachute206 has an openlower end208 and a closedupper end210.
• During systole, as illustrated inFIG. 24, higher pressure in the left ventricle relative to the left atrium forces blood from the left ventricle into the openlower end208 of the parachute. The increased pressure in the parachute (labeled P₂inFIG. 24) exceeds the pressure in the left atrium (labeled P₁inFIG. 24), causing the parachute to inflate with blood and to expand radially and upwardly. At the same time, thenative leaflets6,8 are caused to collapse toward each other. Thedevice200 moves along with the leaflet to which it is attached and the other leaflet moves toward the expandingparachute206. When fully inflated, theparachute206 can seal the gap between the two nativemitral leaflets6,8 and prevent or reduce mitral regurgitation.
• During diastole (not shown), P₁exceeds P₂causing theparachute206 to deflate and collapse toward thestructural portion202. At the same time, the twonative leaflets6,8 are pushed apart. This allows blood to flow from the left atrium to the left ventricle with minimal obstruction by thecollapsed parachute206.
• In some embodiments, thedevice200 can comprise additional structural elements. For example, some embodiments can comprise longitudinal splines that extend from theupper end210 to thelower end208 to provide longitudinal rigidity to the parachute without impeding expansion/contraction in the radial direction, much like a common umbrella. In some embodiments, thedevice200 can comprise a structural member at thelower opening208 to prevent the lower opening from fully closing during diastole, such that blood can more easily enter the lower opening at the beginning of systole. In some embodiments, thedevice200 can comprise a biased portion that urges thelower opening208 toward an opened position. The biased portion can comprise a spring mechanism, resiliently flexible members, or other mechanisms. In some embodiments, thedevice200 can further comprise an atrial portion that extends from or adjacent to theupper end210 and contacts the atrial walls and/or the atrial side of the leaflet to which the device is attached. The atrial body can help secure the device within the mitral orifice and can prevent movement toward the left ventricle. The atrial body can comprise a separate component or an extension of thestructural member202. The atrial body can be configured like theatrial bodies26A,26B or26C described above, or can have other configurations.
• FIGS. 25-28 show aprosthetic spacer220 according to another embodiment, wherein thespacer220 is coupled to one of the native leaflets using, for example, sutures. Thespacer220 can be formed from any of various suitable materials, including bio-compatible materials such as pericardial tissue, polymers, sponge, or a gel or saline filled structure such as a balloon. The material composition of thespacer220 can be selected to increase desirable characteristics of thespacer220, such as performance, durability, promotion of native tissue growth, etc. Thespacer220 can be formed in any of various suitable shapes, such as a rectangle, a semi-elliptical ring or generally u-shape, or a semi-ellipse. As shown inFIG. 25, thespacer220 can be sutured to theposterior leaflet8 usingsutures222 via a transeptal approach, and as shown inFIG. 26, thespacer220 can be sutured to theposterior leaflet8 usingsutures222 via a transapical approach. In use, the opposite leaflet (the anterior leaflet in the illustrated embodiment) can coapt against thespacer220 to prevent or minimize regurgitation.
• FIG. 27 shows thespacer220 after it has been sutured to thenative posterior leaflet8. As shown, twosutures222 can be sufficient to couple thespacer220 to theleaflet8. Thesutures222 can be positioned as shown, with onesuture222 at either end of thespacer220, which spans across theleaflet8. In alternative embodiments, additional or fewer sutures can be used, and the sutures can be situated in alternative locations on thespacer220 and/or on theleaflet8.
• FIG. 28 shows thespacer220 being coupled to the posteriornative leaflet8 using a length ofelongated material224 and a pair ofslidable locking devices226. Theelongated material224 can comprise, for example, a length of thread or suture material, or a metal or polymeric wire, or other material suitable for suturing, such as biological tissue. In the illustrated embodiment, a single strand ofmaterial224 is used, although in alternative embodiments, two ormore strands224 can be used to couple thespacer220 to thenative leaflet8. In order to couple thespacer220 to thenative posterior leaflet8, one or both of theslidable locking devices226 can be guided along the strand ofmaterial224 toward thenative leaflet8, thereby decreasing the length of thestrand224 between the lockingdevices226 until thespacer220 is held firmly against theleaflet8 in a desired deployed configuration. Because thelocking devices226 are positioned behind theposterior leaflet8 in this configuration (that is, they are located between thenative leaflet8 and the wall of the left ventricle4), the potential for interference between the lockingdevices226 and the coaptation area of theleaflets6,8 is minimized. Once thespacer220 is situated in this configuration, anyexcess material228 can be trimmed to prevent interference of the material224 with the operation of the heart valve. The lockingdevices226 can be configured to be slid or passed over a suture in one direction and resist movement in the opposite direction. Examples of locking devices (also referred to as suture securement devices) that can be implemented in the embodiment ofFIG. 28 are disclosed in co-pending application Ser. No. 13/938,071, filed Jul. 9, 2013, which is incorporated herein by reference.
• FIGS. 25-28 show one spacer220 coupled or secured to theposterior leaflet8. In alternative embodiments, aspacer220 can be coupled as described above to theanterior leaflet6 in place of or in addition to thespacer220 coupled to theposterior leaflet8. Except where physically impossible, any of the embodiments described herein can be sutured to native tissue as described above with reference tospacer220, rather than or in addition to being clipped to the native leaflets using one or more anchors.
• By anchoring a prosthetic mitral device to one of the mitral leaflets, as disclosed herein, instead of anchoring the device to the walls of the left ventricle, to the walls of the left atrium, to the native valve annulus, and/or the annulus connection portions of the native leaflets, the device anchorage is made independent of the motions of the ventricular walls and atrial walls, which move significantly during contractions of the heart. This can provide a more stable anchorage for a prosthetic mitral device, and eliminate the risk of hook-type or cork screw-type anchors tearing or otherwise causing trauma to the walls of the left ventricle or left atrium. Furthermore, the device body can be held in a more consistent position with respect to the mitral leaflets as the leaflets articulate, eliminating undesirable motion imparted on the device from the contraction motions of the left ventricle walls and left atrium walls. Anchoring to a mitral leaflet can also allow for a shorter body length compared to devices having other anchorage means.
Leaflet Extension
• FIG. 29 shows another exemplaryprosthetic device300 implanted at the mitral valve region for treating regurgitation. Thedevice300 comprises a strong, flexible sheet of blood-impermeable material. Thedevice300 has anupper end302 that is secured to the mitral annulus and/or the region of a mitral valve leaflet adjacent to the mitral annulus. The portion of thedevice300 extending away from thisupper end portion302 is a free end portion of thedevice300. In the illustrated example, theupper end302 is attached to the mitral annulus above theposterior leaflet8. In other examples, the arrangement can be reversed with thedevice300 secured to theanterior leaflet6. Thedevice300 can be secured to the native tissue by various means, such as via suturing or via barbed anchors ormicroanchors304. Theupper end302 of thedevice300 can be wider than the free end portion of thedevice300, thus thedevice300 can have a generally trapezoidal shape.
• InFIG. 29, the lower end of theanterior leaflet6 is not shown in order to show the lower end of theposterior leaflet8 and thelower end306 of thedevice300 extending downwardly through the mitral orifice and into theleft ventricle4. Thelower end306 of the device can be shorter, longer, or about the same length as the leaflet to which it is attached. As shown inFIGS. 30 and 31, thelower end306 of the device in the illustrated embodiment extends below the lower end of the posterior leaflet during diastole (FIG. 31), and extends short of the lower end of theanterior leaflet6 during systole (FIG. 30). Thelower end306 can be tethered to a location in theleft ventricle4. For example, thelower end306 can be tethered to the papillary muscle heads310 viatethers308 and anchors312, as shown, (in a manner similar to the way in which thenative chordae tendineae314 tether thenative leaflet8 to the papillary muscles310), or can be tethered to the apex of the left ventricle.
• During systole, as shown inFIG. 30, thedevice300 inflates or fills with blood from theleft ventricle4 and expands laterally toward theanterior leaflet6. This causes the lower portion of thedevice300 to seal against theanterior leaflet6, blocking the flow of blood back into theleft atrium2. The lateral edges of thedevice300 can seal between the two native leaflets adjacent to the commissures where the native leaflets still naturally coapt with each other. Thetethers308 prevent thelower end306 of thedevice300 from moving toward and/or into theleft atrium2 and thereby breaking the seal with theanterior leaflet6. Thus, thedevice300 augments the native posterior leaflet and helps seal the mitral orifice in the case where thenative leaflets6,8 do not otherwise not fully coapt and allow regurgitation between them.
• During diastole, as shown inFIG. 31, high pressure in theleft atrium2 forces thedevice300 to collapse against theposterior leaflet8, allowing blood to flow into theleft ventricle4 with minimal obstruction from thedevice300.
• FIG. 32 shows another exemplaryprosthetic device400 implanted at the mitral valve region for treating mitral regurgitation. Thedevice400 comprises a rigid frame402 (e.g., a metal frame) that clips around theposterior leaflet8 with ananchor portion404 being positioned behind theposterior leaflet8 and anatrial portion406 being positioned along the atrial surface of the mitral annulus and/or the portion of the posterior leaflet adjacent to the annulus. Theframe402 can secure thedevice400 to theposterior leaflet8 without sutures or other tissue puncturing elements like theanchors304 inFIGS. 29-31. Thedevice400 also can be implanted on theanterior leaflet6. Thedevice400 further comprises a strong,flexible sheet408 of blood-impermeable material, like thedevice300. Anupper end410 of thesheet408 can be secured to theframe402 at or near theatrial portion406. The portion of thesheet408 extending away from thisupper end portion410 is a free end portion of thesheet408.
• InFIG. 32, the lower end of theanterior leaflet6 is not shown in order to show the lower end of theposterior leaflet8 and the lower portions of thedevice400 extending downwardly through the mitral orifice and into theleft ventricle4. Thelower end412 of thesheet408 can be shorter, longer, or about the same length as the lower end of the leaflet to which it is attached. As shown inFIGS. 33 and 34, thelower end412 of thesheet408 in the illustrated embodiment extends below the lower end of the posterior leaflet during diastole (FIG. 34), and extends short of the lower end of theanterior leaflet6 during systole (FIG. 33). Thelower end412 can be tethered to a location in theleft ventricle4 and/or can be tethered to one ormore points420 near the lower end of the frame402 (both tethering means are shown inFIGS. 33 and 34, though one can be used without the other). For example, in some embodiments, thelower end412 of thesheet408 can be tethered to the papillary muscle heads416 viatethers424 and anchors426 (in a manner similar to the way in which thenative chordae tendineae414 tether thenative leaflet8 to the papillary muscles416), and/or can be tethered to the apex of theleft ventricle4. In other embodiments, thesheet408 is tethered only to theframe402 and tethers extending down into theleft ventricle4 are optional. In such embodiments, one ormore tethers428 can extend from adjacent thelower end412 of the sheet, such as from the lowerlateral corners422, and attach to the lower end of the frame at ornear points420. In some embodiments, thesheet408 can adopt a three dimensional curvature when inflated, with the lower corners being held closer to the lower end of theframe402 while an intermediate portion of thelower edge412 is allowed to billow out (somewhat like a spinnaker sail) further toward theanterior leaflet6 to create a seal.
• During systole, as shown inFIG. 33, thesheet408 inflates or fills with blood from theleft ventricle4 and expands laterally toward theanterior leaflet6. This causes the lower portion of thesheet408 to seal against theanterior leaflet6, blocking the flow of blood back into theleft atrium2. The lateral edges of thesheet408 can seal between the two native leaflets adjacent to the commissures where the native leaflets naturally coapt with each other. Thus, thedevice400 augments the native posterior leaflet and helps seal the mitral orifice in the case where thenative leaflets6,8 do not otherwise not fully coapt and allow regurgitation between them.
• During diastole, as shown inFIG. 34, high pressure in theleft atrium2 forces thesheet408 to collapse against theposterior leaflet8, allowing blood to flow into theleft ventricle4 with minimal obstruction from thedevice400.
• FIGS. 35 and 36 show embodiments ofprosthetic devices460,470 which can be used to extend the effective length of thenative leaflets6,8. As shown inFIG. 35, aprosthetic device460 can include abody462 and aclip464 for clipping thedevice460 to one of the anterior or posteriornative leaflets6,8. As shown inFIG. 36, aprosthetic device470 can include abody472 and one ormore sutures474 for coupling thedevice470 to one of the anterior or posteriornative leaflets6,8. In use, thedevices460,470 have free end portions extending away from the native leaflets which extend the effective length of the native leaflets, thereby increasing the chance of and extent of coaptation between them, as described more fully below. Thebodies462,472 can comprise a material which is stiff enough to reduce the chance of leaflet prolapse, and flexible enough to increase the extent of leaflet coaptation. Suitable materials can include, for example, biological materials such as pericardial tissue, goretex, silicone, polyurethane, or other polymeric materials.FIG. 35 shows that adevice460 can be used on each of the anterior and posteriornative leaflets6,8, andFIG. 36 shows that adevice470 can be used on each of the anterior and posteriornative leaflets6,8, but in alternative embodiments, only one such device can be used, or onedevice460 and onedevice470 can be used.FIG. 35 shows that tethers461 can be used to tether free end portions of thebodies462 to locations in the left ventricle, thus reducing the chances of prolapse of theprosthetic devices460 during systole. Thetethers461 are optional, and can be used in a similar fashion in combination with thedevices470,500,502, or any other suitable devices described herein.
• FIG. 37 shows exemplaryprosthetic devices500,502 which combine features of the prosthetic spacers and the leaflet extensions described above.Prosthetic device500 is shown coupled to the posteriornative leaflet8 while theprosthetic device502 is shown coupled to the anteriornative leaflet6. Theprosthetic devices500,502 include relatively thickupper portions504,506, which function in a manner similar to the prosthetic spacers described above, and relatively thin, elongatefree end portions508,510, which function in a manner similar to thedevices300,400, described above. Thefree end portions508,510 can have respectivedistal end portions514,516, which represent the effective distal ends of the extended leaflets.
• In use, thefree end portions508,510 extend the effective length of the respective leaflets, and can facilitate initiation of leaflet coaptation during ventricular systole. During systole, the leaflets are urged toward one another due to the pressures extant in the left ventricle and left atrium. Due to the extended effective length of the leaflets, theend portions514,516 are more likely to coapt than were the ends of the native leaflets without the extensions. Once coaptation is initiated, and thus blood flow from the left ventricle to the left atrium at least partially impeded, the pressure in the left ventricle can increase, further increasing the pressure differential between the left ventricle and the left atrium and urging theleaflets6,8, further toward one another.
• As a result, the portions of theleaflets6,8, and theirrespective extensions502,500 which coapt, increases (both in the direction from theend portions514,516 toward theleft atrium2, and from the locations of thedevices500,502, toward the commissure points of the mitral valve), leading to a cycle of increasingly impeded blood flow, increased pressure differential, and increased coaptation of the leaflets. Thus, by facilitating initiation of coaptation, thefree end portions508,510 can help to reduce regurgitation of blood from the left ventricle to the left atrium during ventricular systole. Further, theupper portions504,506 can further help to prevent regurgitation in the manner described above with respect toprosthetic device10. In cases where thenative leaflets6,8, do not experience sufficient coaptation to prevent regurgitation, the relatively thickupper portions504,506, can help to increase their coaptation and thereby reduce regurgitation.
• FIG. 37 shows that thedevices500,502 can be sutured to thenative leaflets8,6, withsutures512, but in alternative embodiments, thedevices500,502 can be clipped to thenative leaflets8,6, as described above. In alternative embodiments, only one of thedevices500,502 can be used rather than both.
Spacers Having Plural Anchors
• In some embodiments, prosthetic devices can include a body and a plurality of anchors such that the body can be clipped to more than one leaflet. Such embodiments can be used to effectively couple two or more leaflets to one another. Thus, such a device can be used to bring native leaflets closer to one another and restrict their mobility in order help increase the chance of or extent of coaptation between the leaflets.
• FIGS. 38-41 show aprosthetic spacer600 having abody602, afirst anchor604 and asecond anchor606. Thebody602 and anchors604,606 can be fabricated from any of various suitable materials, and the body is desirably made from a relatively compressible material so that its profile can be reduced for delivery into a patient's heart within a delivery catheter. Alternatively, thebody602 can be inflatable (e.g., to be inflated with a fluid such as saline or a curing epoxy or polymer) or otherwise expandable (e.g., it can be fabricated from a frame comprising a self-expanding material such as Nitinol) such that the cross section of thebody602 can be reduced for delivery into a patient's heart and then expanded to a final, deployed configuration therein. An inflatable spacer can be particularly advantageous because it can allow enhanced customization of the spacer, and can allow fine control over the final, deployed size and configuration of the spacer.
• FIGS. 38 and 39 show that the anchors can have similar structures. Eachanchor604,606 can be made from a single piece of relatively rigid metallic material (e.g., an elongated wire) which can include first and secondinner portions608,610, first and secondbottom portions612,614, and amain loop portion616 extending between and connecting the upper ends of thebottom portions612,614. Theinner portions608,610 can be coupled rigidly to the inside of thebody602. Theinner portions608,610 can extend downwardly out of the lower end ofbody602 to the respectivebottom portions612,614, which can each curve upwardly around the lower end of thebody602 to meet themain loop portion616.
• FIGS. 39 and 40 show that the structure of theanchors604,606, and their connections to thebody602, biases themain loop portions616 of theanchors604,606, into contact with the sides of thebody602. Thus, in use, thespacer600 can be clipped to the anterior and posteriornative leaflets6,8, with one of theleaflets6,8 clipped between theanchor604 and thebody602, and the other of theleaflets6,8, clipped between theanchor606 and thebody602.FIG. 41 shows that theanchors604,606 can be splayed apart so that gaps exist between theanchors604,606, and thebody602. Thus, thespacer600 can be introduced into the region of a patient's native mitral valve in a closed configuration with theanchors604,606 against the side of the body602 (FIGS. 38-40). Theanchors604,606 can then be splayed apart or expanded into an open configuration (FIG. 41) so the spacer can be positioned with thenative leaflets6,8, in the gaps between theanchors604,606 and thebody602, after which theanchors604,606 can be allowed to return to the closed configuration under their own resiliency to capture theleaflets6,8, and clip thespacer600 thereto.
• FIG. 42 shows that in use, theprosthetic spacer600 can be clipped to the posterior nativemitral valve leaflet8 using thefirst anchor604, as described above with regard toprosthetic spacer10 and shown inFIG. 1, and can be clipped to the anterior nativemitral valve leaflet6 using thesecond anchor606, as described above with regard toprosthetic spacer10 and shown inFIG. 2.FIG. 43 shows that when theprosthetic spacer600 is clipped to both of theleaflets6,8, (e.g., at the A2 and P2 regions of the leaflets, as identified by Carpentier nomenclature) it brings them together, decreasing the overall area of the mitral valve orifice, and dividing the mitral valve orifice into twoorifices618,620 during diastole. Thus, the area through which mitral regurgitation can occur is reduced, leaflet coaptation can be initiated at the location of thespacer600, and the leaflets can fully coapt more easily, thereby preventing or minimizing mitral regurgitation.
• FIGS. 44 and 45 show alternative embodiments of dual anchor spacers clipped to the A2 and P2 regions of the anterior and posteriornative leaflets6,8, as viewed from the left atrium.FIG. 44 shows anembodiment640 in which the shape of the body of thespacer640 is relatively elongate such that thespacer640 extends substantially between thecommissures650,652 of the mitral valve. As shown, in this embodiment, thenative leaflets6,8 are brought toward one another by the anchors of thespacer640, the overall area of the valve orifice is reduced, and the orifice is divided into fourorifices642,644,646,648 during diastole. Thus, the area through which mitral regurgitation can occur is reduced, leaflet coaptation can be initiated at the location of thespacer640, and the leaflets can fully coapt more easily, thereby preventing or minimizing mitral regurgitation. In addition, the shape of thespacer640 can more effectively treat eccentric jet mitral regurgitation, because the extension of the body of thespacer640 to thecommissures650,652 helps theleaflets6,8, to coapt across the entirety of the native mitral valve orifice.
• FIG. 45 shows an embodiment of a dual-anchor spacer660 in which the body of thespacer660 comprises a prosthetic valve having one or moreflexible leaflets666 that permit blood to flow into the left ventricle during diastole and block the back flow of blood into the left atrium during systole. In this embodiment, thenative leaflets6,8 are brought closer to one another and the native mitral valve orifice is divided into twoorifices662,664 during diastole. Because the body of thespacer660 comprises a prosthetic valve, rather than a solid piece of material, the total effective open area between the leaflets during diastole (e.g., the area through which blood can flow) is greater in this embodiment than in the embodiment illustrated inFIGS. 43 and 44.
• In alternative embodiments, the body of a dual anchor spacer can have various alternative shapes. For example, cross-sectional profile of the body can be circular, elliptical, or as shown inFIG. 46, can have a generally crescent shape. A spacer body having a crescent shape such asspacer body680 inFIG. 46 (viewed from the left atrium) can be particularly advantageous because it can conform to the overall crescent shape of the anterior andposterior leaflets6,8 of the native mitral valve. In such an embodiment, theconcave side682 of the crescent shapedbody680 can face the anteriornative leaflet6 while theconvex side684 of the crescent shapedbody680 can face the posteriornative leaflet8.FIG. 46 shows that in such an embodiment, the native mitral valve orifice can be divided into twoorifices686,688, each on theconcave side682 of thespacer680, as theconvex side684 can conform to the posteriornative leaflet8 such that no openings exist between them.
• FIGS. 47-51 show embodiments of spacers having three anchors, which can be clipped to leaflets in the tricuspid valve of the human heart in a manner similar to that described above with regard to spacers in the mitral valve.FIG. 47 shows atricuspid spacer700 having acircular body712 and threeanchors702.FIG. 48 shows thespacer700 implanted in the tricuspid valve (as viewed from the right ventricle, as blood is being pumped out of the right ventricle), with each of the threeanchors702 clipped to arespective leaflet704 of the tricuspid valve, and thereby coupling them to one another.FIG. 49 shows thespacer700 clipped to theleaflets704 of the tricuspid valve as blood is pumped from the right atrium to the right ventricle throughorifices706,708,710.FIG. 50 shows an alternativetricuspid spacer720 having abody722 and threeclips724. As shown, thebody722 can have a generally Y shape.FIG. 51 shows an alternativetricuspid spacer730 having abody732 and threeclips734. As shown, thebody732 can have a generally triangular shape.
• FIGS. 52-54 show an exemplarydual anchor spacer750 having abody752 and first andsecond anchors754,756, positioned within a native mitral valve.FIG. 52 shows thespacer750 as seen from theleft ventricle4.FIG. 53 shows thespacer750 as viewed from theleft atrium2 during systole, andFIG. 54 shows thespacer750 from theleft atrium2 during diastole. As can be seen inFIG. 53, no openings appear through which regurgitant flow can occur. As can be seen inFIG. 54, twoopenings758,760 exist through which blood can flow from theleft atrium2 to theleft ventricle4 during diastole, as is desirable.
• A suitable delivery sequence for delivering a prosthetic spacer such asspacer750 to the mitral valve region of a patient's heart can comprise compressing a spacer to a compressed, delivery configuration, delivering the spacer to the coaptation line of a patient's native mitral valve, expanding the spacer until regurgitation in the patient's mitral valve is adequately reduced (an inflatable device can allow a physician to make fine adjustments to the final size and configuration of the spacer based on information received during the delivery process), manipulating the anchors of the spacer to an open position, capturing the native leaflets between the anchors and the body of the spacer, and then manipulating the anchors to a closed position, thereby clipping the spacer to the native mitral valve leaflets.
• FIGS. 55 and 56 show an exemplarydual anchor spacer800 comprising amain body802 and first andsecond anchors804,806. Themain body802 can comprise a plurality ofinterconnected struts808 which together form a plurality of open cells and are arranged to form a generally annular shape having first andsecond end portions816,818. Thebody802 can be formed to be radially self-expandable. For example, thebody802 can be fabricated from a shape-memory material such as Nitinol, which can allow thespacer800 to be radially compressed to a compressed delivery configuration, delivered to one of a patient's native heart valves, then self-expanded to an expanded functional configuration for use within the patient's heart.
• Thefirst anchor804 can comprise first andsecond end portions810,812 which can be coupled to thefirst end portion816 of themain body802, and aloop portion814 which can extend between the first andsecond end portions810,812. The first andsecond end portions810,812 can extend away from thefirst end portion816 of thebody802, then curl back and extend toward thesecond end portion818 of themain body802. Theloop portion814 can be coupled to thefirst end portion810, extend generally toward thesecond end portion818 of themain body802, curl back and extend toward thefirst end portion816 of themain body802, and be coupled to thesecond end portion812.
• Thus, thefirst anchor804 can be coupled to thefirst end portion816 of themain body802 and extend along the side of themain body802 toward itssecond end portion818. Thesecond anchor806 can have a similar structure, and can be coupled to themain body802 such that it extends along an opposing side of themain body802. In this embodiment, thespacer800 can be clipped to native tissues by pinching the native tissues between theanchors804,806 and the respective sides of themain body802. Theanchors804,806 can be made from various suitable materials, and in one exemplary embodiment can be fabricated from the shape-memory material Nitinol. Theanchors804,806 in the illustrated embodiment are fabricated from separate pieces of material from themain body802, and are coupled to themain body802 usingcoupling mechanisms820. Thecoupling mechanisms820 can be, for example, crimping rings that extend around a strut at thefirst end816 of themain body802 and an adjacent portion of an anchor. In alternative embodiments, however, theanchors804,806 and themain body802 can be fabricated integrally with one another (i.e., from a single piece of material). As best shown inFIG. 56, themain body802 can have a generally elliptical or oval shape when viewed on end, but in alternative embodiments, the main body can be formed to have any of various suitable shapes when viewed on end, such as a circle.
• FIGS. 57 and 58 show thespacer800 covered in a bloodimpermeable fabric material822, such as made of polyethylene terephthalate (PET) or polyurethane Thefabric material822 can be relatively thick, strong, and soft, such as a knitted lofty cloth. Thefabric material822 can be selected to provide a softer surface for contact with the native tissue, thus reducing trauma caused to the native tissues by the implantation of thespacer800, can be selected to promote native tissue ingrowth into thespacer800, and/or can be selected to improve the seal formed between native tissues and the portions of thespacer800 they come into contact with. Additionally,FIG. 58 shows that afabric layer824 can be disposed to cover all or substantially all of the opening at the center of themain body802. Thelayer824 can be blood impermeable, thereby blocking the flow of blood through thespacer800. Thelayer824 can be formed from the same material asfabric822, and together thefabric822 andlayer824 can work to prevent the regurgitant flow of blood through a heart valve when the spacer has been implanted therein.
• FIGS. 59-63 illustrate exemplary systems and methods which can be used to implant thespacer800 in a native heart valve.FIGS. 59-61 illustrate exemplary systems and steps which can be used to crimp thespacer800 to a compressed, delivery configuration, suitable for delivery to a patient's native heart valve within adelivery device850.FIG. 59 shows thespacer800 with itsmain body802 positioned in a crimper mechanism900 capable of crimping themain body802 to a compressed configuration. As shown, theanchors804,806 can remain outside the crimper mechanism900 as it is used to crimp themain body portion802. For example, U.S. Pat. No. 7,530,253, which is hereby incorporated herein by reference, describes an exemplary prosthetic valve crimping device that can be used to crimp thespacer800.
• In some embodiments, thedelivery device850 can be similar to the delivery device 2000 described in U.S. Patent Application Publication No. 2011/0137397 or the delivery devices described in U.S. Provisional Patent Application No. 61/760,577, and can be used to implant prosthetic devices via methods similar to those described therein.FIG. 59 shows that thedelivery device850 can include aninner sheath852 provided with a pair ofslots854 disposed on opposing sides of theinner sheath852, and aninternal locking element856, which is axially adjustable relative to theinner sheath852 along a central longitudinal axis of theinner sheath852. Theinternal locking element856 can comprise a generally cruciform shape, having fourextension portions858 between which are defined fourvoids860. As best shown inFIG. 59, two of thevoids860 can be aligned with the twoslots854, which can also be aligned with the portions of theanchors804,806 which are coupled to thebody802 of thespacer800. Thus, in this embodiment, the lockingelement856 can be retracted into theinner sheath852, thereby pulling themain body portion802 of thespacer800 into theinner sheath852 in the same direction. As best shown inFIG. 60, as thespacer800 is pulled into theinner sheath852, the first andsecond end portions810,812 of each of the anchors extend from thefirst end portion816 of thespacer800, through therespective voids860 in the locking element, and then curl out of theslots854 in the sides of theinner sheath852, extending along the sides of thebody802 toward thesecond end portion818 of themain body802. In this way, thebody802 of thespacer800 can be pulled into theinner sheath852 and thereby compressed to a compressed delivery configuration.
• As shown inFIG. 61, after themain body portion802 has been situated within theinner sheath852, anouter sheath862 can be extended toward the distal end of thedevice850 so as to enclose theanchors804,806, thereby causing them to wrap around theinner sheath852 and be confined between theinner sheath852 andouter sheath862.
• FIGS. 62 and 63 show aspacer800 covered in fabric as described above and situated within adelivery device870 in two different configurations.FIG. 62 shows thespacer800 having itsmain body portion802 situated within aninner sheath872 of thedelivery device870 such that theanchors804,806 extend toward a distal end portion of thedelivery device870. In this embodiment, anouter sheath874 can be extended distally to retain and secure theanchors804,806 against the sides of theinner sheath872. Such a configuration can be used to deliver the spacer transapically, as described below. In some embodiments, retraction of theouter sheath874 can allow theanchors804,806 to self-expand to a splayed-apart configuration.
• FIG. 62 also shows that forcible expanders, or levers,876 can be used to force theanchors804,806 to splay apart. Theforcible expanders876 can be radially self-expanding levers which radially self-expand when theouter sheath874 is retracted or are otherwise configured to radially expand away from the inner sheath when they are actuated by a physician (such as by actuating a control knob on a handle that is operatively connected to the expanders876). Theexpanders876 can alternatively be sutures or other mechanisms which can be actuated by a physician to force theanchors804,806 to splay apart. In some embodiments, retraction of theouter sheath874 can allow theanchors804,806 to self-expand to a first splayed-apart configuration, andforcible expanders876 can be actuated to force theanchors804,806 to further radially expand to a second splayed-apart configuration. In such an embodiment, theexpanders876 can be actuated to cause theanchors804,806 to radially expand to the second splayed apart configuration, and can then be actuated to allow theanchors804,806 to move radially inward and return to the first splayed-apart configuration.
• FIGS. 62 and 63 illustrate thespacer800 situated within thedelivery system870 such that theanchors804,806 extend generally along the outside of thebody802 toward thesecond end portion818 of thespacer800. In alternative embodiments, however, the configuration of thebody802 and anchors804,806 within thedelivery system870, and the deployment of thespacer800 from thedelivery system870, can be similar to that illustrated inFIGS. 12-15 with respect todevice50 anddelivery catheter56.
• FIG. 63 shows thespacer800 having itsmain body portion802 situated within theinner sheath872 of thedelivery device870 such that theanchors804,806 extend toward a proximal end portion of thedelivery device870. In this embodiment, theouter sheath874 can be extended distally to retain and secure theanchors804,806 against the sides of theinner sheath872. Such a configuration can be used to deliver the spacer transatrially, as described below.
• Prosthetic spacers described herein can be delivered using minimally invasive approaches.FIGS. 64-67 show various approaches by which aprosthetic spacer800 can be delivered to the region of a patient's mitral valve using adelivery system920. For example, a prosthetic spacer can be delivered via a transapical approach (FIG. 64), via a transeptal approach (FIG. 65), via a transatrial approach (FIG. 66), or via a transfemoral approach (FIG. 67).FIGS. 64-67 show that thedelivery system920 can comprise anouter sheath922, aninner sheath924, and aguidewire930 which can extend through theouter sheath922 andinner sheath924. Thedelivery system920 can also include a pusher element (not illustrated inFIGS. 64-67, but similar to those described above), which can be actuated to move thespacer800 within theinner sheath924. Theouter sheath922,inner sheath924, guidewire930, and pusher element can each be retracted proximally or extended distally with respect to one another. Theguidewire930 can be used to guide the delivery of the other components of thesystem920 to an appropriate location within a patient's vasculature. Theguidewire930 can extend through a small opening or pore in thespacer800, for example in thefabric layer824, the small opening or pore being small enough that substantial blood cannot flow therethrough.
• FIGS. 64 and 67 show that the deployment of thespacer800 to a native mitral valve via the transapical approach can be similar to the deployment of thevalve800 via the transfemoral approach, at least because in both cases the valve is delivered to the mitral valve from the left ventricle. In preparing thedelivery system920 for delivery of thespacer800 via the transapical or the transfemoral approach, thespacer800 can be situated within thesystem920 with thesecond end portion818 of thespacer800 disposed at the distal end of the system920 (such as shown inFIG. 62). In the transapical and the transfemoral approaches, thedelivery system920 can be used to first deliver thespacer800 to the region of the native mitral valve from the left ventricle. In the transapical approach, thedelivery device920 is inserted into the left ventricle via an opening in the chest and the apex of the heart. In the transfemoral approach, thedelivery device920 can be inserted into a femoral artery and advanced through the aorta in a retrograde direction until the distal end of the delivery device is in the left ventricle. Theouter sheath922 can then be retracted proximally such that theanchors804,806 are no longer confined within theouter sheath922. In some embodiments, theanchors804,806 can be configured to self-expand to a splayed apart configuration shown inFIGS. 64 and 67. In other embodiments, as described above, thedelivery system920 can include a mechanism for forcing theanchors804,806 to splay apart to the splayed-apart configuration (such as described above with respect to the embodiment ofFIG. 62).
• Thedevice920 can then be distally advanced so that the native mitral valve leaflets are positioned between the splayed apart anchors804,806, and thebody802. Theinner sheath924 can then be retracted so that thebody802 is no longer confined within theinner sheath924 and can radially expand to an expanded configuration between the native mitral valve leaflets. In some embodiments, thebody802 can expand such that the native leaflets are pinched between thebody802 and theanchors804,806. In alternative embodiments, as described above, the mechanism for forcing theanchors804,806 to splay apart can be actuated to allow theanchors804,806 to move radially inward toward themain body802, thereby pinching the native leaflets between themain body802 and theanchors804,806.
• FIGS. 65 and 66 show that the deployment of thespacer800 to a native mitral valve via the transseptal approach can be similar to the deployment of thevalve800 via the transatrial approach, at least because in both cases the valve is delivered to the mitral valve from the left atrium. In preparing thedelivery system920 for delivery of thespacer800 via the transseptal or the transatrial approach, thespacer800 can be situated within thesystem920 with thefirst end portion816 of thespacer800 disposed at the distal end of the system920 (such as shown inFIG. 63). In these approaches, thedelivery system920 can be used to first deliver thespacer800 to the region of the native mitral valve from the left atrium. Theouter sheath922 can then be retracted proximally such that theanchors804,806 are no longer confined within theouter sheath922. In some embodiments, theanchors804,806 can be configured to self-expand to a splayed apart configuration shown inFIGS. 65 and 66. In other embodiments, as described above, thedelivery system920 can include a mechanism for forcing theanchors804,806 to splay apart to the splayed-apart configuration.
• Thesystem920 can then be proximally retracted so that the native mitral valve leaflets are positioned between the splayed apart anchors804,806, and thebody802. Theinner sheath924 can then be retracted so that thebody802 is no longer confined within theinner sheath924 and can radially expand to an expanded configuration between the native mitral valve leaflets. In some embodiments, thebody802 can expand such that the native leaflets are pinched between thebody802 and theanchors804,806. In alternative embodiments, as described above, the mechanism for forcing theanchors804,806 to splay apart can be actuated to allow theanchors804,806 to move radially inward toward themain body802, thereby pinching the native leaflets between themain body802 and theanchors804,806.
• In any of the four approaches described above, once the native leaflets have been captured by thespacer800, thedelivery system920 can be retracted and removed from the patient's vasculature. Thespacer800 can remain in the native mitral valve region, with themain body802 being situated between the two native leaflets, thereby helping to reduce or prevent mitral regurgitation. It will be understood that similar techniques can be used to deliver a spacer to the native aortic, tricuspid, or pulmonary valves, depending on the needs of the patient.
• In any of the four approaches described above, a marker catheter or other similar device can be used to help coordinate delivery and ensure that a desirable delivery position is achieved. An exemplary suitable marker catheter can include a standard catheter designed for angiograms, for example, a catheter made of a relatively low-density plastic material having relatively high-density metal marker bands (e.g., radiopaque marker bands) disposed at regular intervals thereon. Thus, the device can be introduced into a patient's vasculature and can be viewed under echocardiography or fluoroscopy. Alternatively, a marker wire can be used in place of the marker catheter. Another suitable alternative technique is left atrium angiography, which can help a physician visualize components of a patient's heart.
• A marker catheter or marker wire can be introduced into a patient's vasculature and advanced to specific areas of the vasculature near a patient's heart. For example, a marker catheter can be advanced from a patient's jugular or femoral vein into the right atrium, then into the patient's coronary sinus. As another example, a marker catheter can be advanced from a patient's femoral artery to the patient's circumflex artery. As another example, a marker catheter can be advanced into a patient's left atrium. Once situated in the coronary sinus, circumflex artery, left atrium, or other suitable area of a patient's vasculature, the marker catheter can be used to aid a physician in delivering and ensuring desirable implantation of a prosthetic device. For example, the coronary sinus extends around the heart near the location and elevation of the mitral valve and thus can help a physician to properly size and position a prosthetic device for implantation.
• For example, the patient's vasculature can be viewed under echocardiography, fluoroscopy, or other visualization technique which allows a physician to view the prosthetic device being delivered and the marker catheter. A physician can first view the devices along an axis extending from the patient's left atrium to the patient's left ventricle (referred to as a “short axis”). By viewing the devices along the short axis, a physician can deploy (such as by inflating a balloon on which an implantable device is mounted) an implantable prosthetic device and expand portions of the device to desired sizes and/or configurations based on the size and location of the marker catheter, which can provide an estimate of the size of features of the native mitral valve. Alternatively or additionally, a physician can use the marker catheter to obtain an estimate of the size of a patient's native heart valve, from which estimate a prosthetic device to be implanted in the patient's native heart valve can be selected from a set of devices having differing sizes, e.g., a set of devices having differing diameters.
• A physician can also view the devices along an axis perpendicular to the short axis (referred to as a “long axis”). The long axis can have several orientations, such as from commissure to commissure, but in one specific embodiment, the long axis is oriented from the A2 location to the P2 location of the native mitral valve. By viewing the devices along the long axis, a physician can align an implantable prosthetic device relative to the marker catheter at a desirable location along the short axis, such that an atrial anchor of the implantable device is situated in the left atrium (above the marker catheter) and a ventricular anchor of the implantable device is situated in the left ventricle (below the marker catheter).
• FIG. 68 shows an exemplarydual anchor spacer950 which can be delivered to the region of the native mitral valve via any suitable delivery method, for example, using the transapical, transeptal, transatrial, or transfemoral techniques described above. Thespacer950 can include amain body952, afirst anchor954, asecond anchor956, and anosecone958. Thespacer950 can also include a taperedportion962, which can couple themain body portion952 to aneck portion964. Thetaperer portion962 can have a variable width which can taper from the width of themain body952 to the width of theneck portion964. Theneck portion964 can be configured to receive a portion of thenosecone958 therein, and can be coupled to thenosecone958. Themain body952 and anchors954,956 can be fabricated from various materials, as described above with regard to other embodiments, and thenosecone958 can be fabricated from various suitable materials such as a long term implantable silicone or other suitable elastomers.
• Thenosecone958 can have a small pore, or opening, or slit,966, which can extend through and along the length of thenosecone958. In accordance with suitable delivery methods making use of a guidewire such asguidewire930, the guidewire can extend through theopening966, thus eliminating the need for an opening or pore in a fabric layer. Thespacer950 can facilitate crossing of a native heart valve due to its tapered tip, which can also provide improvements in hydrodynamics during diastolic blood flow. When a guidewire is removed from theopening966, the opening can close under its own resiliency and/or blood pressure, thus leaving a sealed spacer implanted at a native heart valve. Alternatively, or in addition, theopening966 can be sufficiently small to prevent significant amounts of blood from travelling through thenosecone958.
• The multi-anchor spacers described herein offer several advantages over previous techniques for treating regurgitation in heart valves. For example, the multi-anchor spacers described herein can be used to treat patients whose native leaflets fail to coapt at all, whereas many previous techniques required some amount of native coaptation to be efficacious. Additionally, the spacers described herein (e.g., spacer640) can treat eccentric jet regurgitation more readily than other known techniques. While embodiments have been illustrated with two and three anchors, the techniques described herein are generally application to spacers having any number of anchors.
General Considerations
• For purposes of this description, certain aspects, advantages, and novel features of the embodiments of this disclosure are described herein. The disclosed methods, apparatuses, and systems should not be construed as limiting in any way. Instead, the present disclosure is directed toward all novel and nonobvious features and aspects of the various disclosed embodiments, alone and in various combinations and sub-combinations with one another. The methods, apparatuses, and systems are not limited to any specific aspect or feature or combination thereof, nor do the disclosed embodiments require that any one or more specific advantages be present or problems be solved.
• Although the operations of some of the disclosed methods are described in a particular, sequential order for convenient presentation, it should be understood that this manner of description encompasses rearrangement, unless a particular ordering is required by specific language. For example, operations described sequentially may in some cases be rearranged or performed concurrently. Moreover, for the sake of simplicity, the attached figures may not show the various ways in which the disclosed methods can be used in conjunction with other methods. As used herein, the terms “a”, “an” and “at least one” encompass one or more of the specified element. That is, if two of a particular element are present, one of these elements is also present and thus “an” element is present. The terms “a plurality of” and “plural” mean two or more of the specified element.
• As used herein, the term “and/or” used between the last two of a list of elements means any one or more of the listed elements. For example, the phrase “A, B, and/or C” means “A,” “B,” “C,” “A and B,” “A and C,” “B and C” or “A, B and C.”
• As used herein, the term “coupled” generally means physically coupled or linked and does not exclude the presence of intermediate elements between the coupled items absent specific contrary language.
• In view of the many possible embodiments to which the principles disclosed herein may be applied, it should be recognized that the illustrated embodiments are only preferred examples and should not be taken as limiting the scope of the disclosure. Rather, the scope is defined by the following claims. We therefore claim all that comes within the scope and spirit of these claims.

Claims (22)

We claim:

1. A prosthetic device for treating heart valve regurgitation comprising:

a radially compressible and radially expandable body having a first end, a second end, and an outer surface extending from the first end to the second end; and

an anchor having a connection portion and a leaflet capture portion, wherein:

the connection portion is coupled to the body such that the leaflet capture portion is biased against the outer surface of the body when the body is in a radially expanded state;

the prosthetic device is configured to capture a leaflet of a native heart valve between the leaflet capture portion of the anchor and the outer surface of the body; and

the body is configured to prevent blood from flowing through the body in a direction extending from the first end to the second end and in a direction extending from the second end to the first end.

2. The device ofclaim 1, wherein:

the outer surface of the body comprises a first side against which the anchor is biased and a second side opposite the first side; and

the connection portion of the anchor is coupled to the body on the second side of the body.

3. The device ofclaim 2, wherein:

the anchor comprises an elongated member that is coupled to the second side of the body at a connection location; and

the elongated member comprises a ventricular portion that extends from the connection location across the first end of the body.

4. The device ofclaim 3, wherein the ventricular portion comprises first and second ventricular portions and the first ventricular portion is substantially parallel to the second ventricular portion.

5. The device ofclaim 1, wherein:

the body is radially compressible to a compressed state in which a leaflet-receiving gap exists between the body and the leaflet capture portion of the anchor; and

the body is resiliently radially self-expandable to the radially expanded state.

6. The device ofclaim 1, wherein the anchor comprises a first clip portion and a second clip portion, and wherein the device is configured to capture the leaflet between the first and second clip portions.

7. The device ofclaim 1, wherein the body is formed from Nitinol and is radially self-expandable to the expanded state.

8. The device ofclaim 1, wherein the body comprises a metallic frame and a blood-impermeable fabric mounted on the frame.

9. The device ofclaim 1, wherein the body is configured to allow blood to flow around the body between the body and a non-captured leaflet during diastole, and configured to allow the non-captured leaflet to close around the body to prevent mitral regurgitation during systole.

10. The device ofclaim 1, wherein:

the anchor is coupled to the first end of the body; and

the device further comprises an atrial stabilizing member extending from the second end of the body.

11. The device ofclaim 1, wherein the body is configured to move within the native heart valve along with motion of the captured leaflet.

12. The device ofclaim 1, wherein an atrial end portion of the body comprises a tapered shoulder that reduces in diameter moving toward the atrial end portion of the body.

13. The device ofclaim 1, wherein the body comprises a crescent cross-sectional shape.

14. The device ofclaim 1, wherein the anchor comprises first and second anchors.

15. The device ofclaim 14, wherein the device is configured to be secured to both native mitral valve leaflets.

16. A method of implanting a prosthetic sealing device at a native mitral valve of a heart, the method comprising:

advancing a delivery catheter to a native mitral valve region of a heart from a left atrium of the heart, the delivery catheter housing the prosthetic sealing device in a radially compressed configuration;

advancing the prosthetic sealing device distally relative to the delivery catheter such that an anchor of the prosthetic sealing device moves out of the catheter and forms a leaflet-receiving gap between an end portion of the anchor and the delivery catheter;

positioning either a posterior or an anterior mitral valve leaflet in the gap; and

advancing a radially compressed body of the prosthetic sealing device out of the delivery catheter such that the body self-expands radially toward the end portion of the anchor, reducing the gap, and capturing the leaflet between the body and the end portion of the anchor, wherein the body is configured to prevent the flow of blood through the body during systole and during diastole.

17. The method ofclaim 16, wherein a non-captured one of the anterior and posterior leaflets is not secured to the prosthetic sealing device when the prosthetic sealing device is implanted at the native mitral valve.

18. The method ofclaim 16, wherein advancing a delivery catheter through the native mitral valve from a left atrium comprises advancing the delivery catheter through an incision in a portion of a septum between the left atrium and a right atrium.

19. The method ofclaim 16, wherein when the delivery catheter is advanced to the native mitral valve region of the heart, the anchor is held in a substantially straightened position within the delivery catheter extending distally from body of the prosthetic sealing device.

20. A method of implanting a prosthetic sealing device at a native mitral valve, the method comprising:

advancing a delivery device to a native mitral valve region via a left ventricle, the delivery catheter housing the prosthetic sealing device in a compressed configuration;

allowing an anchor of the prosthetic sealing device to move radially out of the delivery device while a body of the prosthetic sealing device is in a compressed configuration, such that a leaflet-receiving gap forms between an end portion of the anchor and the delivery device;

positioning either a posterior or an anterior mitral valve leaflet in the gap; and

allowing the body of the prosthetic sealing device to radially self-expand such that the leaflet is captured between the body and the anchor, wherein the body is configured to prevent the flow of blood through the body during systole and during diastole.

21. The method ofclaim 20, wherein a non-captured one of the anterior and posterior mitral valve leaflets is not secured to the prosthetic sealing device when the prosthetic sealing device is implanted at the native mitral valve.

22. The method ofclaim 20, wherein advancing a delivery device to a native mitral valve region via a left ventricle comprises inserting the delivery device into the left ventricle through an incision in an apex of the left ventricle.

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