US20210030539A1 - Commissure Attachment Features for Improved Delivery Flexibility and Tracking - Google Patents

Abstract

A prosthetic heart valve includes a collapsible and expandable stent having a proximal end and a distal end. A plurality of commissure attachment features (“CAFs”) is disposed on the stent, with each CAF including a body and a plurality of eyelets. The eyelets may be arranged in a single column or in a plurality of rows and columns. The prosthetic heart valve also includes a collapsible and expandable valve assembly including a plurality of leaflets connected to the plurality of commissure attachment features. The bodies of the CAFs may include a number of other features including, for example, a slot extending between columns of eyelets.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application is a divisional of U.S. patent application Ser. No. 15/892,749, filed Feb. 9, 2018, which is a divisional of U.S. patent application Ser. No. 14/475,874, filed Sep. 3, 2014 and issued as U.S. Pat. No. 9,968,448 on May 15, 2018, which claims the benefit of the filing date of U.S. Provisional Patent Application No. 61/873,418, filed Sep. 4, 2013, the disclosures of which are all hereby incorporated by reference herein.
BACKGROUND
• The present disclosure relates to heart valve replacement and, in particular, to collapsible prosthetic heart valves. More particularly, the present disclosure relates to commissure attachment features used with collapsible prosthetic heart valves.
• Prosthetic heart valves that are collapsible to a relatively small circumferential size can be delivered into a patient less invasively than valves that are not collapsible. For example, a collapsible valve may be delivered into a patient via a tube-like delivery apparatus such as a catheter, a trocar, a laparoscopic instrument, or the like. This collapsibility can avoid the need for a more invasive procedure such as full open-chest, open-heart surgery.
• Collapsible prosthetic heart valves typically take the form of a valve structure mounted on a stent. There are two types of stents on which the valve structures are ordinarily mounted: a self-expanding stent and a balloon-expandable stent. To place such valves into a delivery apparatus and ultimately into a patient, the valve must first be collapsed or crimped to reduce its circumferential size.
• When a collapsed prosthetic valve has reached the desired implant site in the patient (e.g., at or near the annulus of the patient's heart valve that is to be replaced by the prosthetic valve), the prosthetic valve can be deployed or released from the delivery apparatus and re-expanded to full operating size. For balloon-expandable valves, this generally involves releasing the entire valve, assuring its proper location, and then expanding a balloon positioned within the valve stent. For self-expanding valves, on the other hand, the stent automatically expands as the sheath covering the valve is withdrawn.
• When using collapsible prosthetic heart valves, it may be desirable for the valve to be capable of collapsing (or crimping) to a small profile, such that, when collapsed, it may be contained within a relatively small delivery system. The ability of a collapsible prosthetic heart valve to collapse to a small profile may be at least partially dependent on the amount of material forming the stent supporting the valve. Similarly, the flexibility of the collapsible prosthetic heart valve may be dependent, at least in part, on the amount of material, as well as the geometry of material, in the stent supporting the valve. Increased flexibility may be desirable, for example, because increased flexibility of the collapsible valve may lead to increased flexibility in the delivery system. Increased flexibility in the delivery system may lead to reduced likelihood of vascular trauma or stroke as a result of delivery, and may facilitate the tracking of the aortic arch by the delivery system during delivery. Generally, tracking refers to the ability of the delivery system and/or collapsible prosthetic heart valve to bend or otherwise change shape with respect to the constraints of the anatomy through which they are moving. Preferably, design changes that reduce the profile of the collapsible valve and/or increase flexibility do not significantly negatively affect other characteristics of the valve, such as valve durability and hemodynamics.
BRIEF SUMMARY
• In one embodiment, a prosthetic heart valve includes a collapsible and expandable stent having a proximal end and a distal end, the stent including a plurality of struts defining a plurality of open cells. The valve also includes a plurality of commissure attachment features disposed on the stent, each commissure attachment feature including a body and a plurality of eyelets arranged in at least two rows and at least two columns. The body may include a slot extending from a distal end of the body between two of the columns of eyelets toward a proximal end of the body, the slot dividing the body into a first portion and a second portion. The valve may further include a collapsible and expandable valve assembly including a plurality of leaflets connected to the plurality of commissure attachment features,
• In another embodiment, a prosthetic heart valve includes a collapsible and expandable stent having a proximal end and a distal end, the stent including a plurality of struts defining a plurality of open cells. The valve also includes a plurality of commissure attachment features disposed on the stent, each commissure attachment feature including a body having a longitudinal axis and a plurality of eyelets arranged in one column, the plurality of eyelets including a generally rectangular proximalmost eyelet and at least two generally rectangular eyelets positioned distal to the proximalmost eyelet. The at least two distal eyelets may each be wider than the proximalmost eyelet. The valve may further include a collapsible and expandable valve assembly including a plurality of leaflets connected to the plurality of commissure attachment features.
• In still a further embodiment, a prosthetic heart valve includes a collapsible and expandable stent having a proximal end and a distal end, the stent including a plurality of struts defining a plurality of open cells. The valve may further include a plurality of commissure attachment features disposed on the stent, each commissure attachment feature including a body having a longitudinal axis and a plurality of eyelets arranged in at least two rows and at least two columns, at least one of the eyelets having an open side. The valve may further include a collapsible and expandable valve assembly including a plurality of leaflets connected to the plurality of commissure attachment features.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1A is an enlarged partial side view of a collapsible prosthetic heart valve according to the prior art.
• FIG. 1B is an enlarged, schematic side view of a portion of a prosthetic heart valve showing the distribution of load in the valve assembly.
• FIG. 2A is a front view of a commissure attachment feature according to the prior art.
• FIG. 2B is a front view of another commissure attachment feature according to the prior art.
• FIGS. 3A-3J are front views of different commissure attachment features according to different aspects of the disclosure.
• FIG. 4A is a front view of another commissure attachment feature according to an aspect of the disclosure.
• FIG. 4B is a front view of suture attachments on the commissure attachment feature ofFIG. 4A.
• FIG. 4C is a rear view of the suture attachments inFIG. 4B.
• FIG. 4D is a front view of suture attachments on the commissure attachment feature ofFIG. 3G.
• FIG. 4E is a rear view of the suture attachments inFIG. 4D.
DETAILED DESCRIPTION
• As used herein, the term “proximal,” when used in connection with a prosthetic heart valve, refers to the end of the heart valve closest to the heart when the heart valve is implanted in a patient, whereas the term “distal,” when used in connection with a prosthetic heart valve, refers to the end of the heart valve farthest from the heart when the heart valve is implanted in a patient.
• FIG. 1 shows a portion of a collapsibleprosthetic heart valve100 according to the prior art.Prosthetic heart valve100 is designed to replace the function of a native aortic valve of a patient. Examples of collapsible prosthetic heart valves are described in U.S. Patent Publication No. 2012/0071969 and U.S. patent application Ser. No. 13/781,201, the entire disclosures of both of which are hereby incorporated by reference herein. The prosthetic heart valve has an expanded condition and a collapsed condition. Although the disclosure provided herein is applied to a prosthetic heart valve for replacing a native aortic valve, it is not so limited, and may be applied to prosthetic valves for replacing other types of cardiac valves.
• Prosthetic heart valve100 includes a stent orframe102, which may be wholly or partly formed of any biocompatible material, such as metals, synthetic polymers, or biopolymers capable of functioning as a stent. Suitable biopolymers include, but are not limited to, elastin, and mixtures or composites thereof. Suitable metals include, but are not limited to, cobalt, titanium, nickel, chromium, stainless steel, and alloys thereof, including nitinol. Suitable synthetic polymers for use as a stent include, but are not limited to, thermoplastics, such as polyolefins, polyesters, polyamides, polysulfones, acrylics, polyacrylonitriles, polyetheretherketone (PEEK), and polyaramides.Stent102 may have anannulus section110, anaortic section111 and atransition section113 disposed between the annulus section and the aortic section. Each of theannulus section110, thetransition section113 and theaortic section111 ofstent102 includes a plurality ofcells112 connected to one another around the stent. Theannulus section110 and theaortic section111 ofstent102 may include one or more annular rows ofcells112 connected to one another. For instance,annulus section110 may have two annular rows ofcells112. Whenprosthetic heart valve100 is in the expanded condition, eachcell112 may be substantially diamond shaped. Regardless of its shape, eachcell112 is formed by a plurality ofstruts114. For example, acell112 may be formed by fourstruts114.
• Stent102 may include commissure attachment features (“CAF”)116.CAFs116 may include eyelets for facilitating the suturing of avalve assembly104, described below, to thestent102.
• Valve assemblies, such asvalve assembly104, are described in U.S. Pat. Nos. 8,092,523 and 8,353,954, the entire disclosures of both of which are hereby incorporated herein by reference.Valve assembly104 may be attached in theannulus section110 ofstent102, and may be wholly or partly formed of any suitable biological material or polymer. Examples of biological materials suitable forvalve assembly104 include, but are not limited to, porcine or bovine pericardial tissue. Examples of polymers suitable forvalve assembly104 include, but are not limited to, polyurethane and polyester.
• Valve assembly104 may include acuff106 disposed on the lumenal surface ofannulus section110, on the ablumenal surface ofannulus section110, or on both surfaces, and the cuff may cover all or part of either or both of the lumenal and ablumenal surfaces of the annulus section.Cuff106 and/or the sutures used to attachvalve assembly104 tostent102 may be formed from or include ultra-high-molecular-weight polyethylene, such as Force Fiber®, available from Teleflex Incorporated of Limerick, Pa.FIG. 1 showscuff106 disposed on the lumenal surface ofannulus section110 so as to cover part of the annulus section while leaving another part thereof uncovered.Cuff106 may be attached tostent102 by one or more strings or sutures passing through the cuff and around selectedstruts114 of the stent.Valve assembly104 may further include a plurality ofleaflets108 which collectively function as a one-way valve. A first edge of eachleaflet108 may be attached tostent102 between twoadjacent CAFs116 by any suitable attachment means, such as by sutures, staples, adhesives, laser, heat or ultrasonic bonding or the like. For example, the first edge of eachleaflet108 may be sutured tostent102 by passing strings or sutures through thecuff106 ofvalve assembly104.Leaflets108 may be attached tostent102 along at least somestruts114 of the stent and through the eyelets inCAFs116 to enhance the structural integrity ofvalve assembly104. A second or free edge of eachleaflet108 may coapt with the corresponding free edges of the other leaflets, thereby enabling the leaflets to function collectively as a one-way valve.
• In operation, the embodiments ofprosthetic heart valve100 described above may be used to replace a native heart valve, such as the aortic valve, a surgical heart valve or a heart valve that has undergone a surgical procedure. The prosthetic heart valve may be delivered to the desired site (e.g., near a native aortic annulus) using any suitable delivery device. During delivery, the prosthetic heart valve is disposed inside the delivery device in the collapsed condition. The delivery device may be introduced into a patient using a transfemoral, transapical, transseptal, tranxaxillary or other approach. Once the delivery device has reached the target site, the user may deploy the prosthetic heart valve. Upon deployment, the prosthetic heart valve expands into secure engagement within the native aortic annulus. When the prosthetic heart valve is properly positioned inside the heart, it works as a one-way valve, allowing blood to flow in one direction and preventing blood from flowing in the opposite direction.
• As described above,prosthetic valve100, and particularlystent102, is preferably both flexible and capable of being collapsed to a small profile. One way to decrease the profile ofvalve100 in the collapsed configuration and to increase the flexibility of the valve is by modifyingCAFs116. However,CAFs116 may also need to be configured to robustly holdleaflets108 attached thereto, for example, because the point of attachment between the leaflets and a CAF may be a point of high stress during normal valve operation.FIG. 1B is a partial side view of aprosthetic heart valve100′ having astent102′ and avalve assembly104′ disposed in theannulus section110′ of the stent. Withinheart valve100′,leaflets108′ are attached to cuff106′ via sutures. Specifically,FIG. 1B shows the load distribution in the valve assembly. Whenleaflets108′ coapt to form a closed configuration, load is transferred from the leaflet structure to the leaflet-commissure feature junction, as indicated by “A”. Generally, darker shading represents higher loads, although, most noteworthy, the load distribution diagram shows that high point loads are generated at regions “A” where the leaflets are joined to commissure features116′. If the point loads at regions “A” are sufficiently high, the leaflets may tear from the commissure feature. Thus, regions A may be prone to failure. Thus, it would be preferable to have a CAF that is flexible and that facilitates crimping or collapsing of the valve to a small profile while still effectively distributing loads.
• FIG. 2A illustrates a previous version of a CAF200acoupled to struts214afor attaching a valve assembly to the stent. Commis sure feature200ais formed of a body202ahaving a pair of eyelets204a. Leaflets (not shown) may be attached via sutures to CAF200athrough eyelets204aand struts214. Load is distributed across the area of CAF200aas shown by dashed lines inFIG. 2A. Specifically, stress from the leaflets is distributed across area L1 of CAF200a.FIG. 2B illustrates an alternate CAF200bcoupled to struts214baccording to the prior art. CAF200bis formed of abody202bhaving a plurality ofeyelets204barranged in rows and/or columns. Leaflets (not shown) may be attached via sutures, glue, staples or any suitable means to CAF200bthrougheyelets204band struts214b. Stress from the leaflets is distributed across area L2 of CAF200b, as shown by dashed lines inFIG. 2B. CAF200bprovides a larger area L2 across which the stress from the leaflets is distributed when compared to area L1 of CAF200a. A larger area for distributing loads may decrease the chance of failure at the CAF-leaflet attachment.
• FIGS. 3A-K andFIG. 4A illustrate several embodiments of CAFs according to aspects of the present disclosure. It will be appreciated that the commissure features described in these figures are exemplary and should not be considered limiting. Moreover, the described features in the following embodiments may be combined or modified in any desirable manner.
• FIG. 3A illustrates a CAF300aaccording to one embodiment of the present disclosure. CAF300aincludes a body302ahaving a proximal end310a, a distal end320a, and a plurality of eyelets304adisposed therein. Body302ais coupled tostruts314aat its proximal end310aand distal end320a. Specifically, the CAF300aofFIG. 3A includes three rows of eyelets304aalong the length of body302, each row including two eyelets so as to form two columns of eyelets. An elongated eyelet306ais positioned proximal to the three rows of eyelets304a. However, elongated eyelet306amay be positioned above or in between other rows of eyelets304a, depending, for example, on the particular suture pattern desired. The rows of eyelets304amay be evenly spaced and of the same shape and size, as illustrated inFIG. 3A, so as to be symmetrical with respect to a longitudinal axis L of body302a. As depicted, eyelets304a, not including elongated eyelet306a, are all in the shape of similarly sized squares. Leaflets (not shown) may be attached via sutures to CAF300athrough eyelets304aand306a. When placing a suture through the various eyelets304aand306a, the suture may be tied off in a knot to secure the suture. The knot may be positioned within the boundaries of elongated eyelet306a, which may, for example, help protect the knot from being damaged by nearby structures. CAF300aalso includes recesses308adisposed near the proximal end310aof body302a(adjacent the ends of elongated eyelet306a). Recesses308amay be formed as indentations or depressions in body302a, and sutures may be wrapped around or disposed within the recesses. Such recesses may be useful in not only securing and guiding a suture, but also in protecting the suture from adjacent cells, a delivery system, or other anatomical bodies that may damage it.
• FIG. 3B illustrates aCAF300baccording to another embodiment of the disclosure.CAF300bis similar to CAF300aofFIG. 3A, with at least one exception. Thebody302bofCAF300bis narrower than the body302aofFIG. 3A distal to the recess308a. More particularly, to createbody302bofCAF300b, the recess308aof body302aof CAF300ais extended along the entire length of the body in the distal direction. Material proximal to recess308bmay be unmodified, leaving a recess that is bounded by material only on the proximal side. In other words,body302bincludes a pair of projections or ears309b. The projections309bmay be positioned on each side ofbody302bnear a proximal portion thereof, with the projections extending circumferentially away from the longitudinal axis of the body farther than any other portion of the body distal to the projection. Projections309bmay function similarly to recesses308ain that each projection may tend to keep a suture from sliding proximally alongbody302b. In addition to preventing suture slippage, projections309bmay act as a stopper, such that when the stent is crimped or collapsed, adjacent struts that move closer tobody302bcontact the projections, rather than contacting and possibly damaging the suture. In practice, the sutures may tend to migrate proximally, rather than distally, alongbody302b, such that the lack of material distal to recess308bdoes not make it significantly more likely that a suture will slip distally alongbody302b. As described above, the removal of material from thebody302bofCAF300bmay result in the stent being able to collapse to a smaller profile, having better tracking capabilities, and being more flexible.
• FIG. 3C illustrates a CAF300caccording to a further embodiment of the disclosure, which is similar to CAF300aofFIG. 3A with at least one exception. Again, CAF300cincludes generally square or rectangular eyelets304c, along with an elongated eyelet306c. However, the eyelets304care smaller in size than eyelets304aof CAF300a. In particular, the width of eyelets304cmay be decreased such that the backbone311cof body302cof CAF300cis wider. Backbone311cmay be at least partially defined by a portion of body302cthat exists between pairs of eyelets304cin different columns in the same row. Increasing the width of backbone311cmay impart additional rigidity to CAF300c. This, in turn, may allow for the removal of material in another portion of CAF300c, which may result in a decrease in rigidity of the CAF. Thus, by increasing the width of backbone311c, and decreasing the width of, for example, body302c, overall rigidity may be maintained while resulting in a net decrease in size and increase in flexibility of CAF300c. Eyelets304cpreferably remain large enough to allow a needle carrying a suture to pass through.
• FIG. 3D illustrates a CAF300daccording to an additional embodiment of the disclosure, which is similar to CAF300cofFIG. 3C with at least one exception. The width of body302dis decreased in comparison to that of body302cof CAF300c, much in thesame way body302bofCAF300bis narrowed in comparison to body302aof CAF300a. This results in a recess308dextending in the distal direction along the entire length of body302dor, in other words, a laterally extending protrusion309dnear the proximal end of body302d. As illustrated, body302dmay include two such protrusions309dextending laterally in opposite directions from opposing edges of the body. As discussed in relation to CAFs300band300a, the reduced width of body302dmay allow for a smaller crimping profile, while the increased width of backbone311dand the reduced size ofeyelets304dprovide rigidity body302dhaving a reduced width.
• FIG. 3E illustrates a CAF300eaccording to yet another embodiment of the disclosure. CAF300eis similar to CAF300cofFIG. 3C, with at least one exception. In particular, whereas CAF300cincludes three rows and two columns of eyelets304c, CAF300eincludes only two rows and two columns of eyelets304ein addition to elongated eyelet306e. Decreasing the height of body302ein comparison to that of body302cof CAF300cmay increase the ability of the stent to track in the blood vessels, for example when the stent is delivered across the aortic arch. In addition, two struts314edistal to CAF300emeet and extend proximally as a single strut connecting to the distal end of CAF300e. Although shown with a relativelylarge backbone311eand relatively small eyelets304e, the eyelets may be larger and the backbone smaller, similar to the configuration illustrated with respect to CAF300ainFIG. 3A.
• FIG. 3F illustrates aCAF300faccording to still another embodiment of the disclosure, which is similar to CAF300eofFIG. 3E with at least one exception. Specifically,CAF300fincludes the same configuration ofeyelets304fas CAF300e, but has a reducedwidth body302f, resulting in anextended recess308for, stated another way, aprotrusion309f, similar to some of the embodiments described above. In this embodiment,protrusion309fextends farther laterally from the edge ofbody302fthan any other portion of the edge. The distal end ofCAF300fmay be attached to astrut314fin a similar configuration to the configuration of CAF300e. This particular embodiment may provide increased tracking ability and reduced crimping profile.
• FIG. 3G illustrates aCAF300gaccording to a further embodiment of the disclosure.CAF300gis similar toCAF300fofFIG. 3F, with at least one exception. The distal end ofCAF300gis connected to struts314gthat merge with thebody302gofCAF300g. This is slightly different thanCAF300f, which includes twostruts314fthat meet distal tobody302fand extend to the body as a single strut.
• FIG. 3H illustrates aCAF300haccording to another embodiment of the disclosure, which is similar toCAF300fofFIG. 3G with at least one exception. InCAF300h, aslot316hextends proximally throughbody302hfrom the distal end thereof towardelongated eyelet306h, dividingbody302hinto two portions. As illustrated,slot316hextends proximally along or nearly along a center longitudinal axis ofbody302hbetween the two columns ofeyelets304h, stopping short ofelongated eyelet306h.Struts314hare connected to the distal end ofbody302h, onestrut314hbeing connected to one portion of the body and anotherstrut314hbeing connected to the other portion of the body. Slot316hmay provide increased flexibility toCAF300h, allowing, for example, better tracking ability of the stent. In the illustrated embodiment, the increased flexibility and/or tracking ability may result from an increased ability for the stent body to twist as a result of the described features. It should be understood thatslot316hmay extend more or less proximally than illustrated, for example by only extending toeyelets304hin the most distal row and not extending toeyelets304hin the most proximal row. Alternatively, slot316hmay extend more proximally such that the proximal end of the slot is positioned proximally of alleyelets304h. Other aspects ofCAF300hmay also be varied, including having a non-reduced-width body302h, such as that illustrated inFIG. 3E. Similarly, the number, size, and position ofeyelets304hand/orelongated eyelet306hmay be varied while retaining theslot316h.
• FIG. 3I illustrates a CAF300iaccording to still a further embodiment of the disclosure. CAF300iis similar toCAF300hofFIG. 3H, with at least one exception. Generally, CAF300iincludes a reduced width body302iincluding two rows and two columns of eyelets304iand anelongated eyelet306i. Similar toCAF300h, CAF300iincludes a slot316iextending proximally along body302ibetween the two columns of eyelets304i, dividing the body into two portions, with a strut314iconnected to the distal end of each portion of the body. Unlike other embodiments, however, additional material of body302imay be removed to increase the flexibility of CAF300i. For example, one or more recesses318imay be formed in body302ialong the edges of slot316i. As illustrated, two slot recesses318iare formed along slot316i, each slot recess318ibeing generally circular or semi-circular, although the slot recesses may take other shapes. In other words, each slot recess318imay be thought of as either a semi-circular (or other shaped) recess defined on one side of the slot, or as a circular (or other shaped) recess defined by two opposed slot recesses318i. Also, each slot recess318iis preferably formed so that it does not laterally align, or only partially laterally aligns, with any eyelets304i. That is, in each row of eyelets304i, a proximal and a distal boundary of the eyelets in that particular row define a space between the two boundaries. Because CAF300iincludes two rows of eyelets304i, two of these spaces exist, one space corresponding to the eyelets in each row. No slot recess318iis positioned entirely within either of these spaces. By forming slot recesses318ithat, at most, only partially align laterally with eyelets304i, the flexibility of CAF300iis increased while still maintaining the structural integrity of body302i, which might be compromised if slot recesses318ifully or mostly aligned laterally with the eyelets.
• Body302imay also include body recesses320ialong its side edges. As illustrated, body302iincludes four body recesses320i, each of which is generally semi-circular shaped, although they may take other shapes. Also as illustrated, body recesses320iare formed on the edges of body302iopposite slot316isuch that the body recesses do not laterally align, or only partially laterally align, with any eyelets304ior withelongated eyelet306i. That is, no body recess320iis positioned entirely within any space defined between the proximal and distal boundaries of the eyelets304iin a particular row. Similar to slot recesses318i, by forming body recesses320ithat, at most, only partially laterally align with eyelets304iand withelongated eyelet306i, the flexibility of CAF300iis increased while still maintaining the structural integrity of body302i, which might be compromised if body recesses320ifully or mostly aligned laterally with eyelets304iand/oreyelet306i.
• FIG. 3J illustrates aCAF300jaccording to another embodiment of the disclosure.CAF300jis similar toCAF300gofFIG. 3G, with at least one exception. More particularly, thebody302jofCAF300jincludes onlyelongated eyelets306j. In the illustrated embodiment,body302jincludes threeelongated eyelets306jgenerally arranged in a single column. The proximalmost elongatedeyelet306jmay take the general form of a rectangle, while eachelongated eyelet306jdistal to the proximalmost eyelet may also take the general form of a rectangle, but may be wider than the proximalmost eyelet. Preferably, the two distalmostelongated eyelets306jare substantially identical to one another and all threeelongated eyelets306jare centered along a longitudinal axis ofbody302j. Although the particular number, shape, size, and positioning ofelongated eyelets306jmay be varied, the illustrated configuration may be desirable for increasing the flexibility ofbody302jwhile maintaining the ability of sutures to be passed througheyelets306jand secured to thebody302jofCAF300j.
• FIG. 4A illustrates aCAF400 according to another embodiment of the disclosure, which is similar toCAF300gofFIG. 3G with at least one exception. More particularly, portions ofbody402 are removed in comparison tobody302g, such that at least some of eyelets404a-dare enclosed on only three sides. This may be true, for example, if eyelets404a-dare generally rectangular. In other words, eyelets404a-dare not fully enclosed bybody402 as they are in the other embodiments described herein.Body402 may also include a fully enclosedelongated eyelet406 as in the other embodiments described herein.Body402 may be formed such that the portions of the body on the proximal and distal sides of each eyelet404a-din a column have aprotrusion409 extending generally parallel to the longitudinal axis of the body.Protrusions409 may help prevent sutures (illustrated inFIG. 4B) attached tobody402 through eyelets404a-dfrom slipping off the body. Although not illustrated,CAF400 may be modified to include a slot, such as that described with respect toCAF300hor300i.
• FIG. 4B illustratesCAF400 ofFIG. 4A with an exemplary suture pattern from the outer diameter or ablumenal side of the stent.FIG. 4C illustratesCAF400 with the same suture pattern viewed from the inner diameter or lumenal side of the stent.Tabs451,461 of twodifferent leaflets450,460 are illustrated inFIG. 4C, although they are omitted inFIG. 4B for clarity. Also, inFIG. 4C, much ofbody402 ofCAF400 is illustrated in broken lines behind theleaflets450,460. The following describes the use of a single suture S to attachleaflets450,460 toCAF400. It will be understood, however, that multiple sutures may be used for this purpose. For example, one suture may attachfirst leaflet450 toCAF400, while a second, separate suture attachessecond leaflet460 to the CAF.
• The suture pattern may begin at any point at or nearCAF400 and terminate at any other point. In at least some examples, the suture pattern begins and terminates at the same position. For the sake of illustration, the suture pattern will be described as beginning at point p1, withineyelet404d. As used herein, with reference toFIG. 4B, the term “out” indicates passing the suture S from the lumenal side of the valve through the tab of theleaflet450 or460 and past the stent structure to the ablumenal side of the valve. The term “in” indicates passing the suture S from the ablumenal side of the valve past the stent structure and through the tab of theleaflet450 or460 to the lumenal side of the valve.
• The suture pattern may begin by passing a leading end of suture S out througheyelet404dat point p1. Suture S may then be advanced in through point p2 throughleaflet450 in eyelet404c, back out through point p3 through the leaflet ineyelet404d, and finally in through point p4 through the leaflet in eyelet404c, essentially forming two loops of the suture. Suture S may then be directed up above the top ofleaflets450,460 and, advanced out from betweenstruts414 and wrapped around the strut that is nearer eyelets404c-d. Advancing suture S from point p5 to point p6 in this manner essentially wraps the suture around one ofstruts414. Suture S may then be passed behind bothstruts414, and wrapped around the other strut by passing the suture out at point p7 and in at point p8, point p8 being positioned between the two struts414.
• From point p8, suture S may be advanced down, passing the leading end of suture S out of eyelet404athroughleaflet460 at point p9. Then, suture S may be passed in througheyelet404bthroughleaflet460 at point p10, out eyelet404athrough the leaflet at point p11, and back intoeyelet404band through the leaflet at point p12, forming two loops between eyelets404a-b. From point p12, the leading end of suture S may be passed out ofelongated eyelet406 throughleaflet460 near point p13 and wrapped aroundCAF400 near aprotrusion409 by advancing the suture in through the leaflet near point p14. The leading end of suture S may then be passed out ofelongated eyelet406 throughleaflet460. Then, the trailing end of suture S, which is trailing from the initial point of insertion p1, may be passed out ofelongated eyelet406 throughleaflet450 near point p16. The trailing end of suture S may then be passed intoleaflet450 near anotherprotrusion409 near point p17. Finally the trailing end of suture S may be passed out ofelongated eyelet406 andleaflet450. At this point, the leading and trailing ends of suture S may be joined, for example by tying or knotting the ends to secure the suture. The particular suture pattern described above is symmetrical without any cross-over through theleaflets450,460, as the cross-over occurs above thefree edges452,462 of the leaflets around struts414. This configuration may result in less or no interference with movement of the free edges of the leaflets with reduced abrasion while maintaining a secure connection between theleaflets450,460 andCAF body400. Also, this configuration allows for maintaining a secure connection without the need for a third proximal row of eyelets.
• ForCAF400, since the suture S runs generally vertically up thebody402 of the CAF, eyelets404a-dmay be open on one side without significantly affecting the stability of the sutures. As described above in relation toFIG. 4A,protrusions409 may help suture S resist slipping laterally out from eyelets404a-d. Other suture patterns are described in greater detail in U.S. patent application Ser. No. 13/781,201, the entire contents of which are hereby incorporated by reference herein.
• It should also be noted that, although other suture patterns may be used forCAF400 or any other CAF described herein, the same suture pattern described with respect toCAF400 may be used for other CAFs described herein. For example,CAF300gis illustrated inFIGS. 4D-E with the identical suture pattern as described in relation toCAF400.
• Although the invention herein has been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the principles and applications of the present invention. It is therefore to be understood that numerous modifications may be made to the illustrative embodiments and that other arrangements may be devised without departing from the spirit and scope of the present invention as defined by the appended claims. It will be appreciated that the various dependent claims and the features set forth therein can be combined in different ways than presented in the initial claims. It will also be appreciated that the features described in connection with individual embodiments may be shared with others of the described embodiments.
• The following Paragraphs summarize certain aspects of the disclosure.
• Paragraph A: A prosthetic heart valve, comprising: a collapsible and expandable stent having a proximal end and a distal end, the stent including a plurality of struts defining a plurality of open cells; a plurality of commissure attachment features disposed on the stent, each commissure attachment feature including a body and a plurality of eyelets arranged in at least two rows and at least two columns, the body including a slot extending from a distal end of the body between two of the columns of eyelets toward a proximal end of the body, the slot dividing the body into a first portion and a second portion; and a collapsible and expandable valve assembly including a plurality of leaflets connected to the plurality of commissure attachment features, wherein at least one of the struts is connected to a distal end of the first portion of the body, and at least another of the struts is connected to a distal end of the second portion of the body.
• Paragraph B: The prosthetic heart valve of Paragraph A, wherein the slot extends along a longitudinal axis of the body.
• Paragraph C: The prosthetic heart valve of Paragraph A, wherein the body includes an elongated eyelet positioned proximally of the plurality of eyelets.
• Paragraph D: The prosthetic heart valve of Paragraph C, wherein a proximal end of the slot is positioned distal to the elongated eyelet.
• Paragraph E: The prosthetic heart valve of Paragraph D, wherein the proximal end of the slot is positioned proximally of the plurality of eyelets.
• Paragraph F: The prosthetic heart valve of Paragraph C, wherein a proximal end of the slot is positioned distal to the eyelets in at least one row.
• Paragraph G: The prosthetic heart valve of Paragraph A, further comprising a first slot recess positioned in the slot.
• Paragraph H: The prosthetic heart valve of Paragraph G, wherein the first slot recess is generally semi-circular and formed in the first portion of the body.
• Paragraph I: The prosthetic heart valve of Paragraph G, wherein the first slot recess includes a first generally semi-circular recess portion formed in the first portion of the body and a second generally semi-circular recess portion formed in the second portion of the body.
• Paragraph J: The prosthetic heart valve of Paragraph I, wherein, for each row of eyelets, a space is defined between a proximal boundary of each eyelet in the row and a distal boundary of each eyelet in the row, and the first slot recess is not positioned entirely within any of the spaces.
• Paragraph K: The prosthetic heart valve of Paragraph I, further comprising a second slot recess positioned in the slot, the second slot recess including a third generally semi-circular recess portion formed in the first portion of the body and a fourth generally semi-circular recess portion formed in the second portion of the body.
• Paragraph L: The prosthetic heart valve of Paragraph K, wherein, for each row of eyelets, a space is defined between a proximal boundary of each eyelet in the row and a distal boundary of each eyelet in the row, and neither the first slot recess nor the second slot recess is positioned entirely within any of the spaces.
• Paragraph M: The prosthetic heart valve of Paragraph A, further comprising a first body recess formed in a first edge of the body opposite the slot, the first body recess being generally semi-circular.
• Paragraph N: The prosthetic heart valve of Paragraph M, wherein, for each row of eyelets, a space is defined between a proximal boundary of each eyelet in the row and a distal boundary of each eyelet in the row, and the first body recess is not positioned entirely within any of the spaces.
• Paragraph O: The prosthetic heart valve of Paragraph M, further comprising a second body recess formed in a second edge of the body opposite the slot, the second body recess being generally semi-circular.
• Paragraph P: The prosthetic heart valve of Paragraph O, wherein, for each row of eyelets, a space is defined between a proximal boundary of each eyelet in the row and a distal boundary of each eyelet in the row, and neither the first body recess nor the second body recess is positioned entirely within any of the spaces.
• Paragraph Q: The prosthetic heart valve of Paragraph A, wherein the plurality of eyelets comprises four eyelets arranged in two rows and two columns and a fifth elongated eyelet positioned proximally of the four eyelets.
• Paragraph R: The prosthetic heart valve of Paragraph A, further comprising: a first protrusion near a proximal end of the body, the first protrusion extending laterally from a first edge of the body in a first direction; and a second protrusion near the proximal end of the body, the second protrusion extending laterally from a second edge of the body in a second direction opposite the first direction.
• Paragraph S: The prosthetic heart valve of Paragraph R, wherein the first protrusion extends farther laterally from the first edge of the body than any other portion of the first edge of the body and the second protrusion extends farther laterally from the second edge of the body than any other portion of the second edge of the body.
• Paragraph T: The prosthetic heart valve of Paragraph A, wherein the proximal end of body includes at least one projection extending circumferentially away from a longitudinal axis of the body farther than any other portion of the body.
• Paragraph U: A prosthetic heart valve, comprising: a collapsible and expandable stent having a proximal end and a distal end, the stent including a plurality of struts defining a plurality of open cells; a plurality of commissure attachment features disposed on the stent, each commissure attachment feature including a body having a longitudinal axis and a plurality of eyelets arranged in one column, the plurality of eyelets including a generally rectangular proximalmost eyelet and at least two generally rectangular eyelets positioned distal to the proximalmost eyelet, the at least two distal eyelets each being wider than the proximalmost eyelet; and a collapsible and expandable valve assembly including a plurality of leaflets connected to the plurality of commissure attachment features.
• Paragraph V: The prosthetic heart valve of Paragraph U, wherein the proximalmost eyelet and the at least two distal eyelets are each centered along the longitudinal axis of the body.
• Paragraph W: The prosthetic heart valve of Paragraph U, wherein the at least two distal eyelets are substantially identical to one another.
• Paragraph X: The prosthetic heart valve of Paragraph U, wherein a proximal end of the body includes at least one projection extending circumferentially away from the longitudinal axis of the body farther than any other portion of the body.
• Paragraph Y: A prosthetic heart valve, comprising: a collapsible and expandable stent having a proximal end and a distal end, the stent including a plurality of struts defining a plurality of open cells; a plurality of commissure attachment features disposed on the stent, each commissure attachment feature including a body having a longitudinal axis and a plurality of eyelets arranged in at least two rows and at least two columns, at least one of the eyelets having an open side; and a collapsible and expandable valve assembly including a plurality of leaflets connected to the plurality of commissure attachment features.
• Paragraph Z: The prosthetic heart valve of Paragraph Y, wherein at least four of the plurality of eyelets are generally rectangular, each of the at least four eyelets having an open side.
• Paragraph AA: The prosthetic heart valve of Paragraph Z, further comprising protrusions on portions of the body on proximal and distal sides of each of the at least four eyelets, the protrusions extending generally parallel to the longitudinal axis of the body adjacent the open sides of the eyelets.
• Paragraph BB: The prosthetic heart valve of Paragraph Y, wherein a proximal end of the body includes at least one projection extending circumferentially away from the longitudinal axis of the body farther than any other portion of the body.

Claims (20)

1. A prosthetic heart valve, comprising:

a collapsible and expandable stent having an inflow end and an outflow end, the stent including a plurality of struts defining a plurality of open cells, and a plurality of commissure attachment features; and

a collapsible and expandable valve assembly including a plurality of leaflets connected to the plurality of commissure attachment features, the valve assembly adapted to allow blood to flow from the inflow end to the outflow end, and to substantially block blood from flowing from the outflow end to the inflow end,

wherein each commissure attachment feature includes a body having three elongated eyelets arranged in a single column, each eyelet being shaped as a rectangle.

2. The prosthetic heart valve ofclaim 1, wherein the body of each commissure attachment feature has exactly three elongated eyelets and is devoid of other eyelets.

3. The prosthetic heart valve ofclaim 1, wherein the three elongated eyelets include a first proximalmost eyelet, a second middle eyelet, and a third distalmost eyelet, the second eyelet being positioned between the first eyelet and the third eyelet, the first eyelet being positioned nearer the inflow end than are the second and third eyelets, the first eyelet having a width that is smaller than a width of the second eyelet and is smaller than a width of the third eyelet.

4. The prosthetic heart valve ofclaim 3, wherein the width of the second eyelet and the width of the third eyelet are substantially identical.

5. The prosthetic heart valve ofclaim 1, wherein the three elongated eyelets are all centered along a central longitudinal axis of the body.

6. The prosthetic heart valve ofclaim 1, further comprising a first protrusion at a proximal edge of the body, the first protrusion extending laterally from a first side edge of the body in a first direction, and a second protrusion at the proximal edge of the body, the second protrusion extending laterally from a second side edge of the body in a second direction opposite the first direction.

7. A prosthetic heart valve, comprising:

a collapsible and expandable stent having an inflow end and an outflow end, the stent including a plurality of struts defining a plurality of open cells;

a plurality of commissure attachment features disposed on the stent, each commissure attachment feature including a body having a plurality of eyelets arranged in at least two columns, the body having a proximal edge, a distal edge, first and second outer edges connecting the proximal and distal edges, the proximal edge being positioned nearer than inflow end than is the distal edge, the body including a slot extending between the at least two columns of eyelets from an open distal end to a closed proximal end spaced apart from the proximal edge of the body, the slot dividing the body into a first portion and a second portion; and

a collapsible and expandable valve assembly including a plurality of leaflets connected to the plurality of commissure attachment features, the valve assembly being oriented to allow flow of blood within the stent toward the outflow end of the stent and to substantially block the flow of blood within the stent toward the inflow end of the stent,

wherein the first outer edge includes a first semi-circular suture-receiving recess, and the second outer edge includes a second semi-circular suture-receiving recess, the first and second semi-circular suture-receiving recesses each extending inwardly toward the slot.

8. The prosthetic heart valve ofclaim 7, wherein the body includes an elongated eyelet positioned closer to the inflow end than are the plurality of eyelets.

9. The prosthetic heart valve ofclaim 8, wherein the closed proximal end of the slot is positioned nearer the outflow end than is the elongated eyelet.

10. The prosthetic heart valve ofclaim 9, wherein the closed proximal end of the slot is positioned closer to the inflow end than are the plurality of eyelets.

11. The prosthetic heart valve ofclaim 7, wherein the slot extends parallel to a longitudinal axis of the body.

12. The prosthetic heart valve ofclaim 11, wherein the plurality of eyelets in each of the at least two columns are arranged along an axis parallel to the longitudinal axis of the body in an expanded condition of the stent.

13. The prosthetic heart valve ofclaim 7, further comprising a first slot recess positioned in the slot, the first slot recess being generally semi-circular and formed in the first portion of the body so that the first slot recess extends toward the first outer edge of the body.

14. The prosthetic heart valve ofclaim 13, further comprising a second slot recess positioned in the slot, the second slot recess being generally semi-circular and formed in the second portion of the body so that the second slot recess extends toward the second outer edge of the body.

15. The prosthetic heart valve ofclaim 14, wherein the first and second slot recesses are aligned with each other in a circumferential direction of the stent.

16. The prosthetic heart valve ofclaim 15, wherein the plurality of eyelets are arranged in two rows, the first and second slot recesses being positioned between the two rows of eyelets.

17. The prosthetic heart valve ofclaim 7, further comprising a first protrusion at the proximal edge of the body, the first protrusion extending laterally from the first outer edge of the body in a first direction, and a second protrusion at the proximal edge of the body, the second protrusion extending laterally from the second outer edge of the body in a second direction opposite the first direction.

18. The prosthetic heart valve ofclaim 7, wherein the first and second semi-circular suture-receiving recesses are aligned with each other in a circumferential direction of the stent.

19. The prosthetic heart valve ofclaim 18, wherein the plurality of eyelets are arranged in two rows, the first and second semi-circular suture-receiving recesses being positioned between the two rows of eyelets.

20. The prosthetic heart valve ofclaim 7, wherein two adjacent leaflets of the plurality of leaflets are sutured to a corresponding one of the commissure attachment features so that at least one suture passes through the plurality of eyelets and wraps around the first and second suture-receiving recesses.

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