DEVICES FOR TREATING PARAVALVULAR LEAKAGE AND ASSOCIATED METHODS

Abstract

An elongate member has a longitudinal axis, and has an elongated configuration in which the elongate member defines (i) a first portion that defines a first-portion folding line, substantially orthogonal to the longitudinal axis, (ii) a second portion that defines a second-portion folding line, substantially parallel to the first-portion folding line, and (iii) an oblique folding line, longitudinally between the first portion and the second portion. The oblique folding line is nonparallel and nonorthogonal to the longitudinal axis. A tensioning member weaves longitudinally along the elongate member such that applying tension to the tensioning member transitions the elongate member toward a folded configuration by folding (i) the first and second portions about their respective folding lines, and (ii) the elongate member about the oblique folding line in a manner that positions the first-portion folding line nonparallel to the second-portion folding line.

Description

BACKGROUND

Paravalvular leakage is a complication associated with the implantation of a prosthetic valve. It may occur both in traditional surgical or minimally invasive transcatheter approaches. FIG. 1 illustrates an artificial valve 1600 that may include, for example, a multi-leaflet structure 1602 and that may be implemented in an appropriate manner as will be appreciated by those of ordinary skill in the art. Additionally, a small opening or space 1604 between the heart 1606 and the valve 1600 is shown as may occur in some instances of valve replacement. This opening or space 1604 results in undesired leaking during pumping of the heart and is termed a valvular or paravalvular leak.

Accordingly, devices and methods are needed for correcting paravalvular leakage after implantation of a stented prosthetic valve.

BRIEF SUMMARY OF THE INVENTION

One aspect of the present teachings includes an anchor for treating a paravalvular leakage. In various embodiments, the anchor includes at least one elongate anchor member. In some embodiments, the anchor includes one elongate anchor member. In some embodiments, the anchor includes two elongate anchor members. In yet other embodiments, the anchor includes three or more elongate anchor members. In certain embodiments, the two, three, or more elongate anchor members are made of a same material. In certain other embodiments, the two, three, or more elongate anchor members are made of different materials.

In some embodiments, the anchor has an elongate configuration where the elongate anchor member is relaxed and extended. In some embodiments, the anchor has a shortened configuration when the elongate anchor member(s) is folded or otherwise shortened. In certain embodiments, the anchor is in its shortened configuration when deployed and/or secured.

According to various embodiments of the present teachings, the elongate anchor member is made of a flexible material. In some embodiments, the flexible material is a surgical grade fabric. The elongate anchor member may also take various forms such as woven or nonwoven fabrics, polymers, metals, other suitable materials, or combinations thereof. For example, the surgical grade fabric used in various embodiments of the present teachings can be constructed from a polyester, such as Dacron®, RTM, PTFE, UHMPE, HDPE, polypropylene, polysulfone, or other biocompatible plastic.

In various embodiments, the elongate anchor member causes a tissue response, for example, tissue growth. In some embodiments, the surface finish of the anchor member is textured to induce tissue response and tissue in-growth for improved stabilization. In other embodiments, the anchor member comprises porous materials to promote tissue in-growth.

In various embodiments, one or more of the edges and/or other portions of the anchor member are modified, for example, to prevent from fraying. In some embodiments, one or more of the edges or other portions of the anchor member are coated with a material that locks the fibers in place. Other methods can also be used to lock the fibers at one or more edges of the anchor member in place.

In various embodiments, the anchor includes at least one tensioning member. In some embodiments, the tensioning member causes both ends of the elongate anchor member to move towards each other. This motion can create a shortened distal portion and/or a shortened proximal portion. In certain embodiments, doing so secures the paravalvular leakage between the distal and the proximal portions of the elongate anchor member.

In embodiments where an anchor of the present teachings includes two elongate anchor members, the tensioning member causes at least one of the two elongate anchor members to move towards the other elongate anchor member. In certain embodiments, the tensioning member causes both of the elongate anchor members to move towards each other. In embodiments where an anchor of the present teachings includes three or more elongate anchor members, the tensioning member causes at least one of the three or more elongate anchor members to move towards another elongate anchor member. In certain embodiments, the tensioning member causes all of the three or more elongate anchor members to move towards one another. This motion can create shorten elongate anchor members. In certain other embodiments, doing so secures the paravalvular leakage between two of the elongate anchor members.

According to various embodiments of the present teachings, the tensioning member is in the form of a suture, as defined herein. It will be appreciated that the tensioning member may take forms other than a suture, such as any other small-diameter members having a suitable tensile strength for the intended anchoring use.

In various embodiments, one or both of the tensioning member and the elongate anchor member are made of a resorbable polymer. In some embodiments, such a resorbable polymer is polyactic acid, polyglycolic acid, polycaprolactone, or a combination thereof. Other resorbable polymers that are known to those skilled in the art can also be used without undue experimentation and thus are within the scope of the present teachings. In various embodiments, the material that is used to make the anchor, i.e., the elongate anchor member(s), the tensioning member, or both, is multilayered. In some embodiments, the material includes a coating of resorbable polymer. In other some embodiments, the material includes a semipermeable polymer that optionally is impregnated with one or more of the compounds discussed herein. In certain embodiments, the one or more compounds is released in a controlled manner.

In various embodiments, the anchor, including the elongate anchor member(s), the tensioning member, or both, includes one or more compounds that address issues associated with the product performance. For example, one or more compounds can be embedded in the anchor member. In certain embodiments, the one or more compounds are released over time after implantation. These compounds can reduce calcification, protein deposition, thrombus formation, or a combination of some or all of these conditions. The one or more compounds can also be used to stimulate a biological response, for example, to induce tissue in-growth. In some embodiments, the compound is an anti-inflammatory agent. In some embodiments, the compound reduces tissue proliferation adjacent to the device. One with ordinary skill in the art would understand that numerous agents are available for the above applications and can select such an agent without undue experimentation for each of the applications. As such, anchors having one or more of the numerous agents are within the scope of the present teachings.

In various embodiments, the tensioning member extends through openings along the elongate anchor member as described herein such that tightening the tensioning member will cause the elongate anchor member to fold. Although certain examples of anchor deployment are described herein, one with ordinary skill in the art would appreciate that deployment of the anchor may take on various forms due to the flexible nature of the anchor member, especially when a highly flexible fabric or other materials is used. For example, a fabric material or other similarly flexible materials may be folded or otherwise deformed during a deployment to a leakage site.

Another aspect of the present teachings includes methods of treating a paravalvular leakage. In various embodiments, the method includes providing an anchor as described herein, positioning the anchor through a paravalvular leakage, deploying the anchor where at least a part of the distal portion of the elongate anchor member is on one side of the paravalvular leakage. In various embodiments, the method includes applying tension to the tensioning member so that at least a part of the distal portion of the elongate anchor member transitions from the elongate configuration to the shortened configuration. In various embodiments, the method includes deploying the anchor wherein at least a part of the proximal portion of the elongate anchor member is on the other side of the paravalvular leakage. In various embodiments, the method includes applying tension to the tensioning member so that at least a part of the proximal portion of the elongate anchor member transitions from the elongate configuration to the shortened configuration.

In various embodiments, the method includes providing an anchor as described herein, positioning the anchor through a paravalvular leakage, deploying the anchor where at least a part of a first elongate anchor member is on one side of the paravalvular leakage. In various embodiments, the method includes applying tension to the tensioning member so that at least a part of the first elongate anchor member transitions from the elongate configuration to the shortened configuration. In various embodiments, the method includes deploying the anchor wherein at least a part of a second elongate anchor member is on the other side of the paravalvular leakage. In various embodiments, the method includes applying tension to the tensioning member so that at least a part of the second elongate anchor member transitions from the elongate configuration to the shortened configuration. And in these embodiments, the anchor used in repairing a paravalvular leakage can include two or more elongate anchor members and a tensioning member can pass through one, two, or more of the elongate anchor members.

In various embodiments, anchors of the present teachings are used percutaneously. For example, the anchors are delivered percutaneously. In other embodiments, anchors of the present teachings are used in minimally invasive surgeries. In yet other embodiments, anchors of the present teachings are used in open-heart surgeries.

In various embodiments, the method includes introducing a catheter approximately at the paravalvular leakage site. In some embodiments, the method includes withdrawing the catheter to deploy the anchor where at least a part of the distal portion of the elongate anchor member is on one side of the paravalvular leakage. In some embodiments, the method includes withdrawing the catheter to deploy the anchor wherein at least a part of the proximal portion of the elongate anchor member is on the other side of the paravalvular leakage. In some embodiments, the method includes withdrawing the catheter to deploy the anchor where at least a part of a first elongate anchor member is on one side of the paravalvular leakage. In some embodiments, the method includes withdrawing the catheter to deploy the anchor wherein at least a part of a second elongate anchor member is on the other side of the paravalvular leakage.

In various embodiments, a clinician deploys a plurality of anchors in a paravalvular leakage, when necessary and practical.

In various embodiments, upon deployment, at least half number of the folds is distal to the paravalvular leakage and the rest of the folds are proximal to the paravalvular leakage. In other embodiments, upon deployment, less than half of the folds are distal to the paravalvular leakage and the rest of the folds are proximal to the paravalvular leakage. In yet other embodiments, upon deployment, more than half of the folds are distal to the paravalvular leakage and the rest of the folds are proximal to the paravalvular leakage.

In various embodiments, upon deployment, at least some of the folds is distal to the paravalvular leakage. In various embodiments, upon deployment, at least some of the folds are proximal to the paravalvular leakage. In other embodiments, upon deployment, less than half of the folds are distal to the paravalvular leakage. In other embodiments, upon deployment, less than half of the folds are proximal to the paravalvular leakage. In yet other embodiments, upon deployment, more than half of the folds are distal to the paravalvular leakage. In yet other embodiments, upon deployment, more than half of the folds are proximal to the paravalvular leakage.

In various embodiments, upon deployment, at least one of the folds is in the paravalvular leakage. In some embodiments, upon deployment, at least some of the folds are distal to the paravalvular leakage and at least one of the folds is in the paravalvular leakage. In some embodiments, at least some of the folds are proximal to the paravalvular leakage and at least one of the folds is in the paravalvular leakage. In certain embodiments, upon deployment, at least some of the folds are distal to the paravalvular leakage, at least one of the folds is in the paravalvular leakage, and at least some of the folds are proximal to the paravalvular leakage.

In various embodiments, upon deployment, at least a part of a first anchor member is distal to the paravalvular leakage. In various embodiments, upon deployment, at least a part of a second anchor member is proximal to the paravalvular leakage. In various embodiments, upon deployment, at least a part of an anchor member is in the paravalvular leakage. In some embodiments, upon deployment, at least a part of a first anchor member is distal to the paravalvular leakage and at least a part of a second anchor member is proximal to the paravalvular leakage. In certain embodiments, upon deployment, at least a part of a first anchor member is distal to the paravalvular leakage, at least a part of a second anchor member is proximal to the paravalvular leakage, and at least a part of a third anchor member is in the paravalvular leakage.

In various embodiments, the elongate anchor member also includes a marker. The marker can be in the form of threads, beads, or other forms. Without limiting the scope of the present teachings, the marker allows the anchor member to be visualized by using a radiographic imaging equipment using x-ray, magnetic resonance, ultrasound, fluoroscopic, or other visualization techniques. In some embodiments, markers are attached to the anchor member. For example, the markers can be wrapped, laminated, and/or bonded through a welding process. An adhesive such as cyanoacrylate or other adhesives known to those skilled in the art can also be used to attach a marker to the anchor member.

In some embodiments, the marker is a radiopaque marker. In certain embodiments, the radiopaque marker is made of titanium, tungsten, platinum, iridium, gold, an alloy of any of these materials, or a composite having any of the above materials. Other materials that are known to those skilled in the art can also be used.

In some embodiments, the marker is a paramagnetic marker. In certain embodiments, the paramagnetic marker is made of a material containing gadolinium, iron, platinum, manganese, cobalt, fluorine, or other paramagnetic materials. In yet other embodiments, the markers each comprises other MR visible materials that are known to those skilled in the arts.

In some embodiments, the marker is an echogenic marker. In certain embodiments, the echogenic marker is made of a material that is capable of reflecting increased ultrasound waves. Some echogenic materials are described herein elsewhere.

In various embodiments, the marker protrudes out of or is flush with the anchor. In various embodiments, the markers are arranged on the implant in a pattern.

In various embodiments, the anchor or a component thereof is treated so that the anchor or a part thereof is visible under a visualization technique. In some embodiments, the visualization technique is based on ultrasound. For example, the visualization technique is echocardiography. In some embodiments, an elongate anchor member of the present teachings is treated so that it is visible in a visualization technique. In certain embodiments, a part of the elongate anchor member is treated so that it is visible in a visualization technique. In some embodiments, a marker of the present teachings is treated so that it is visible in a visualization technique. In some embodiments, the treatment is performed on a surface of an anchor or a component thereof. In certain embodiments, a surface of at least a part of the elongate anchor member is treated so that the elongate anchor member is visible in a visualization technique. In certain embodiments, a surface of at least a part of the marker is treated so that the marker is visible in a visualization technique.

In various embodiments, the treatment is performed with an echogenic material. For example, the material can contain fluorine element. In some embodiments, the material includes a perfluoro compound. In certain embodiments, the material includes perflutren. In certain embodiments, the material includes perflexane. In certain embodiments, the material includes sulfur hexafluoride. In other embodiments, the material includes another echogenic material known to persons with ordinary skill in the art.

In various embodiments, the method includes locating a paravalvular leakage. For example, a paravalvular leakage can be detected and/or located by using echocardiography, computed tomography (CT), or cardiac magnetic resonance. In some embodiments, the method includes locating a paravalvular leakage by using echocardiography.

Yet another aspect of the present teachings includes a device used to treat a paravalvular leakage. In various embodiments, the device includes a catheter and an anchor as described herein. In some embodiments, the catheter includes a distal end and a lumen having an opening at the distal end. In some embodiments, the anchor is provided at least partially in the lumen.

BRIEF DESCRIPTION OF DRAWINGS

Without wishing to narrow the scope of the enclosed claims, the present teachings may best be understood by reference to the following description taken in conjunction with the accompanying drawings in which:

FIG. 1 shows an artificial valve implanted into a heart having a paravalvular leakage,

FIG. 2 is a perspective view of an exemplary anchor in accordance with the present teachings,

FIG. 3A is a side view of an anchor positioned in a paravalvular leakage in accordance with some embodiments of the present teachings,

FIG. 3B is a side view similar to FIG. 3A, but illustrating the distal portion of the exemplary anchor being moved toward the paravalvular leakage,

FIG. 3C is a side view similar to FIG. 3B, but showing the distal portion of the exemplary anchor fully compressed and engaged against the paravalvular leakage,

FIG. 3D is a side view similar to FIG. 3C but illustrating the proximal portion of the exemplary anchor being moved toward the paravalvular leakage,

FIG. 3E illustrates the proximal and distal portions of the exemplary anchor fully compressed against opposite sides of the paravalvular leakage,

FIG. 3F is an enlarged cross sectional view of an exemplary anchor fully deployed and fastened with a paravalvular leakage between proximal and distal anchor portions,

FIG. 3G is a side view of an anchor positioned in a paravalvular leakage in accordance with some embodiments of the present teachings,

FIG. 3H is a side view similar to FIG. 3A, but illustrating the distal portion of the exemplary anchor being moved toward the paravalvular leakage,

FIG. 3I is a side view similar to FIG. 3B, but showing the distal portion of the exemplary anchor fully compressed and engaged against the paravalvular leakage,

FIG. 3J is a side view similar to FIG. 3C but illustrating the proximal portion of the exemplary anchor being moved toward the paravalvular leakage,

FIG. 3K is a side view similar to FIG. 3C but illustrating the proximal portion of the exemplary anchor being moved toward the paravalvular leakage,

FIG. 3L is an enlarged cross sectional view of an exemplary anchor fully deployed and fastened with a paravalvular leakage between proximal and distal anchor portions,

FIG. 4 is a side elevation view of an exemplary anchor in accordance with some embodiments of the present teachings,

FIGS. 5A-5D are respective side views illustrating a sequence of steps used for securing the anchor to a paravalvular leakage in accordance with some embodiments of the present teachings,

FIG. 5E is a view similar to FIG. 5D, but illustrating an alternative tip and tensioning member arrangement in accordance with some embodiments of the present teachings,

FIG. 6A is a front view of the elongate anchor member of an anchor in accordance with some embodiments of the present teachings,

FIG. 6B is a front elevation view similar to FIG. 6A, but illustrating radiopaque markers in accordance with some embodiments of the present teachings,

FIG. 6C is a front elevation view of an alternative elongate anchor member having a varying width along its length in accordance with some embodiments of the present teachings,

FIG. 6D is a side elevation view of another alternative elongate anchor member utilizing more rigid fold sections separated by living hinges in accordance with some embodiments of the present teachings,

FIG. 7A is a perspective view of an anchor in accordance with some embodiments of the present teachings,

FIG. 7B is a perspective view of an anchor in accordance with some embodiments of the present teachings,

FIG. 7C is a perspective view of an anchor in accordance with some embodiments of the present teachings,

FIG. 8 is a perspective view of an anchor in accordance with some embodiments of the present teachings,

FIG. 9 is a perspective view of an anchor in accordance with some embodiments of the present teachings,

FIG. 10A is a perspective view of an anchor in accordance with some embodiments of the present teachings,

FIG. 10B is a side elevation view of the anchor in FIG. 10A,

FIG. 11 is a perspective view of an exemplary anchor deployed across a paravalvular leakage in accordance with the present teachings,

FIG. 12A is a perspective view of an anchor in accordance with some embodiments of the present teachings,

FIG. 12B is a cross-sectional view of an anchor deployed across a paravalvular leakage in accordance with some embodiments of the present teachings,

FIG. 12C is a side elevation view of the anchor of FIGS. 12A-12B, and

FIG. 12D is top plan view of the anchor of FIGS. 12A-12B.

DETAILED DESCRIPTION

Certain specific details are set forth in the following description and Figures to provide an understanding of various embodiments of the present teachings. Those of ordinary skill in the relevant art will understand that various features of the present teachings may be used alone or in numerous combinations depending on the needs and preferences of the user. Those skilled in the art can also practice other embodiments of the present teachings without one or more of the details described below. Thus, it is not the intention of the present teachings to restrict or in any way limit the scope of the appended claims to such details. While various processes are described with reference to steps and sequences in the following disclosure, the steps and sequences of steps should not be taken as required to practice all embodiments of the present teachings.

As used herein, the term “proximal” means closest to the operator (less into the body) and “distal” means furthest from the operator (further into the body). In positioning a medical device from a downstream access point, distal is more upstream and proximal is more downstream.

As used herein, the term “tensioning member” means a member which can take forms of a suture, cable, wire, or any other small diameter, flexible, semi-rigid or rigid material having a suitable tensile strength for the intended use. In addition, as used herein, the term “wire” can be a strand, a cord, a fiber, a yarn, a filament, a cable, a thread, or the like, and these terms may be used interchangeably.

The term “suture” used herein can be a strand, a wire, a cord, a fiber, a yarn, a filament, a cable, a thread, or the like, and these terms may be used interchangeably.

Unless otherwise specified, all numbers expressing quantities, measurements, and other properties or parameters used in the specification and claims are to be understood as being modified in all instances by the term “about.” Accordingly, unless otherwise indicated, it should be understood that the numerical parameters set forth in the following specification and attached claims are approximations. At the very least, and not as an attempt to limit the application of the doctrine of equivalents to the scope of the claims, numerical parameters should be read in light of the number of reported significant digits and the application of ordinary rounding techniques.

Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which these present teachings belong. Methods and materials similar or equivalent to those described herein can be used in the practice or testing of the present teachings. In case of conflict, the patent specification, including definitions, will control. In addition, the materials, methods, and examples are illustrative only and not intended to be limiting.

It will be appreciated that like reference numerals are used herein to refer to like elements in all embodiments and reference numerals with prime marks (′) or double prime marks (″) refer to like elements that have been modified in a manner as described herein or otherwise shown in the associated Figure.

Referring first to FIG. 2, an anchor 10 constructed in accordance with some embodiments of the present teachings generally includes a tensioning member 12, such as a suture, extending through spaced apart points along an elongate anchor member 14 of flexible material, such as a surgical grade fabric. It will be appreciated that the tensioning member 12 may take other forms other than suture material, such as cable or any other small diameter member having a high enough tensile strength for the intended use. The elongate anchor member 14 may also take various forms such as woven or nonwoven fabrics, polymers, metals, or other suitable materials or combinations of materials. One or more separate pledgets or other securement members (not shown) may be used in conjunction with the elongate anchor member 14 for added securement and/or concealing the elongate anchor member 14 and, for example, thereby inhibiting blood clotting within or adjacent to the folds that will be formed in the elongate anchor member 14.

A woven or nonwoven material may contain additional materials, such as threads, beads or other elements that cause at least portions of the elongate anchor member 14 to be radiopaque. Currently, a surgical grade fabric constructed from polyester, such as Dacron®, is contemplated for use in constructing the elongate anchor member 14. One of many possible alternative materials for use in constructing the elongate anchor member 14 is polytetrafluoroethylene (PTFE). Anchor 10 may be partly or wholly formed from materials that are absorbed into the patient's tissue over time, depending on the intended use. The edges and/or other portions of the elongate anchor member 14 may be suitably modified to prevent fraying, such as by being coated with a material that locks the fibers in place, or otherwise modified in a manner that locks the fibers at least at the edges of the elongate anchor member 14 in place.

The suture 12 may extend from a proximal portion 14a of the elongate anchor member 14 to a distal end portion 14b and then loop back through spaced apart points of the elongate anchor member 14 to the proximal portion 14a where a knot 16 or other stop member is located. As will become apparent, the suture 12 extends through spaced apart locations along the elongate anchor member 14 such that tensioning of the suture 12 or other tensioning member will cause the elongate anchor member 14 to form folded portions 14c when the tensioning member 12 is placed under tension or pulled. Thus, the elongate anchor member 14 is activated in this manner between essentially an elongate configuration, such as shown in FIG. 2, and a shortened configuration, such as a folded or otherwise shortened configuration having an expanded width in at least one dimension as compared to the elongate configuration. It will be appreciated that the deployment orientation may take on various forms due to the flexible nature of the elongate anchor member 14, especially when using a highly flexible fabric or other material. For example, a fabric material or other similarly flexible materials may be folded or otherwise deformed for carrying purposes within a catheter and/or during deployment to a paravalvular leakage site and then suitably activated at the leakage site.

More specifically referring to FIGS. 3A-3E, the elongate anchor member 14 and attached suture 12 are initially inserted through a paravalvular leakage site 20 as generally shown in FIG. 3A. One end or portion 12a of the suture 12 is then pulled and thereby placed under tension. It will be appreciated that, for catheter-based procedures, suture portion 12a may extend to a location outside the patient's body for pulling or tensioning, or it may be grasped by a suitable mechanism within the catheter and pulled or tensioned. Pulling suture portion 12a may initially draw the distal portion 14b of the elongate anchor member 14 toward the paravalvular leakage site 20 as shown in FIG. 3B. Once the distal portion 14b is compressed against the leakage site 20, the proximal portion 14a begins to be drawn and compressed against a proximal side of the paravalvular leakage site 20 as shown in FIGS. 3C-3E. This occurs because end 12a of the suture 12 is being pulled downwardly (as viewed for purposes of discussion in FIGS. 3C-3E) and, since the suture 12 is looped in a reverse direction through distal end portion 14b of the elongate anchor member 14, the knot 16 at the end of the suture 12 moves upwardly and brings the proximal portion 14a of the elongate anchor member 14 with it. In this manner, the proximal portion 14a of the elongate anchor member 14 is being folded and drawn along the suture 12 toward the paravalvular leakage 20 and then firmly compressed against the proximal side of the paravalvular leakage 20 as shown in FIG. 3E. As further shown in FIG. 3F, a suitable locker element, such as a crimp member 22, a knot or other element may be used to maintain the suture 12 and elongate anchor member 14 in the positions shown in FIG. 3F securely anchoring the proximal and distal portions 14a, 14b of the elongate anchor member 14 folded against opposite sides of the paravalvular leakage 20.

Anchors having two or more elongate anchor members can also be used to repair a paravalvular leakage. Thus, as shown in FIG. 3G, in various embodiments, an anchor includes a distal elongate anchor member 14b′, a proximal elongate anchor member 14a′, and a tensioning member 12 slideably connecting the distal elongate anchor member 14b′ and the proximal elongate anchor member 14a′. In some embodiments, one end of the tensioning member passes through the proximal elongate anchor member 14a′ and the distal elongate anchor member 14b′, loops back, passes through the distal elongate anchor member 14b′ and the proximal elongate anchor member 14a′, and forms a knot 16 around the tensioning member 12. In certain embodiments, the other end, or the proximal end 12a′, of the tensioning member extends through a delivery catheter and exists outside of the body. The passing through an elongate anchor member can be achieved by passing through one or two holes in the elongate anchor member or threading through the elongate anchor member itself.

Thus, the method of repairing a paravalvular leakage, in some embodiments, includes, as shown in FIG. 3G, inserting the distal elongate anchor member 14b′ and attached tensioning member 12 through a paravalvular leakage 20. In some embodiments, the method includes pulling the proximal end 12a of the tensioning member 12. The pulling of the tensioning member, in some embodiments, folds at least a portion of the distal elongate anchor member 14b′ and/or draws the distal elongate anchor member towards the paravalvular leakage site 20, as shown FIG. 3H. In some embodiments, the method includes continuing pulling the proximal end 12a of the tensioning member 12 to compress the distal elongate anchor member 14b′ against the paravalvular leakage 20, as shown in FIG. 3I. In some embodiments, the method includes folding at least a portion of the proximal elongate anchor member 14a′ and drawing the proximal elongate anchor member 14a′ towards the paravalvular leakage site 20, as shown in FIG. 3J. The folding of at least a portion of the proximal elongate anchor member 14a′ and/or the drawing of the proximal elongate anchor member 14a′, in certain embodiments, are achieved sequentially or simultaneously by continuing pulling the proximal end 12a of the tensioning member 12. As the distal elongate anchor member 14b′ and the proximal elongate anchor member 14a′ are compressed against the paravalvular leakage 20, in some embodiments, the method includes using a suitable locker element 22 to maintain the anchor 10 in the deployed configuration, as shown in FIG. 3L.

FIG. 4 is a side elevation view of an anchor 70 according to some embodiments of the present teachings. This anchor includes a distal tip 76. In addition, this anchor includes a proximal radiopaque band 90 and a distal radiopaque band 92. Both the radiopaque bands can be attached to the suture 72, as shown in FIG. 4, or otherwise secured to the suture 72, at the proximal end portion of the anchor member 74 and to either the interior or exterior of the distal tip 76, respectively, or any other part of the anchor 70. Without wishing to be bound by any particular theory, under a fluoroscope, these bands or other markers 90 and 92 will indicate to the clinician that the anchor 70 has been deployed, activated, fully compressed, and/or fastened, as necessary during the procedure.

The tip 76 itself may alternatively be formed from a radiopaque material. In this embodiment, the knot 94 formed in the suture 72 or other tensioning member is a slip knot through which another portion of the suture 72 slides during activation of the anchor 70. It will be appreciated that this slip knot 94 may be replaced by another element which serves substantially or approximately the same purpose but takes the form, for example, of a small tubular element or other feature similar in function to a slip knot.

In various embodiments, the elongate anchor member 74 may be about 40 mm long by about 3 mm wide. This may be desirable to achieve a lower profile. These embodiments may lead to more versatile applications, lower incidents of blood clotting, easier use, etc. Of course, any other desired dimensions and shapes may be used, depending on application needs.

As further shown in FIGS. 4 and 6A, the tensioning member or suture 72 can advantageously extend through respective fold portions 74c of the elongate anchor member 74 in essentially an hourglass configuration. Specifically, adjacent portions of the suture 72 located near the proximal and distal end portions 74a, 74b of the anchor member 74 are spaced farther apart than the adjacent portions of the suture 72 in the middle of the anchor member 74.

As further shown in FIG. 6B, radiopaque markers, such as distinct areas of dots 95, may be used for enabling the clinician to visualize the folds of the elongate anchor member 74 during deployment and securement of the elongate anchor member 74. These dots or other radiopaque markers may be printed on the anchor member 74. For example, dots 95 or other markers may be formed with a platinum powder base ink or other suitable material that is radiopaque and biologically compatible. This radiopaque material may also add stiffness to the fold sections 74c thereby helping to maintain the fold sections 74c flat and increasing retention force on the paravalvular leakage. Meanwhile, the fold lines 74d between fold sections 74c can remain highly flexible to create tight radius fold lines.

As further shown in FIG. 6A, each of the holes 96 that the tensioning member or suture 72 is received through may be marked by circles 98 surrounding each hole 96 or other markers for visualizing purposes during assembly of the tensioning member or suture 72 with the elongate anchor member 74. Optionally, holes 96 may be eliminated and the suture 72 may be threaded with a needle through the anchor member 74. One could also, for example, choose different sets of holes 96 along anchor member 74 for receiving the tensioning member or suture 72 thereby changing the width of the folds and/or number of folds and/or shape of the folds depending on the application needs or desires of the clinician.

The tensioning member or suture 72 may be threaded or otherwise attached along the anchor member 74 in any number of manners including, for example, x-patterns or other crossing patterns, zig-zag patterns, etc. that may alter the folded or otherwise shortened or compressed footprint of the anchor into various beneficial shapes, such as flower shapes, circular shapes or other rounded shapes, ball shapes or other configurations. Modifications of the manner in which the tensioning member or suture 72 is threaded or otherwise attached along the length of anchor member 74 may result in higher or lower tensioning force being required to compress the anchor and/or higher or lower friction holding force that may help maintain the anchor in the compressed or shortened configuration.

The width of the elongate anchor member 74′ may be varied along its length, such as by tapering, stepping, or forming an hourglass shape or shapes along the length of the anchor member 14. For example, as illustrated in FIG. 6C, having proximal and distal end portions 75, 77 of wider dimension than an intermediate or middle portion or portions 79 along the length of anchor member 74′ will allow these wider portions 75, 77 may cover over the more intermediate folded portions 79 and prevent unnecessary contact with adjacent tissue during use.

The elongate anchor member 74 may have variable stiffness including, for example, a relatively rigid perimeter or relatively rigid edges 74e, 74f (FIG. 6A) or intermittent relatively rigid sections 74c″ separated by flexible sections such as living hinges 74d″ (FIG. 6D) that may aid in folding and securing the elongate anchor member 74″ into a folded condition.

FIGS. 5A-5D illustrate a series of steps for deploying and securely fastening the anchor 70 to a paravalvular leakage site 100 according to some embodiments of the present teachings. Generally, as shown in FIG. 5A, the combination of the elongate anchor member 74 and tensioning member or suture 72 is deployed through the paravalvular leakage site 100. One end or portion 72a of the suture 72 that extends through the slip knot 94 is then pulled. This causes the distal portion 74b of the elongate anchor member 74 to fold and compress against the distal side of the paravalvular leakage 100. As shown in FIG. 5B, further pulling the tensioning member 72 causes the slip knot 94 to ride upwardly or distally along the suture 72 and against a proximal portion 74a of the elongate anchor member 74, thereby folding and compressing the proximal portion 74a against the proximal side of the paravalvular leakage 100 as shown in FIG. 5C. As shown in FIG. 5D, a suitable crimp or locking element 102 may be used to securely lock the slip knot 94 in place relative to the suture or tensioning member segment which extends therethrough. This will lock the entire anchor 70 in place with the respective proximal and distal folded anchor member portions 74a, 74b securely retaining the paravalvular leakage 100 therebetween. FIG. 5D shows the tip 76 acting as a retainer on top of the distal end portion 74b to assist in holding the distal end portion 74b in place.

FIG. 5E shows an alternative in which the tensioning member is threaded through at least one hole 76a more centrally located in the tip. Yet another alternative would be to thread the tensioning member through two centrally located holes instead of through the proximal end of the tip 76 and one centrally located hole 76a as shown in FIG. 5E. These alternatives allow the tip 76 to act more like a “T”-bar with forces acting in a more perpendicular or normal manner relative to the distal end portion 74b of the anchor member 74.

FIG. 7A illustrates an exemplary anchor of the present teachings. In various embodiments, the elongate anchor member has a rectangle profile as illustrated in FIG. 7A. In other embodiments, the elongate anchor member has an hour glass profile as illustrated in FIG. 7B. One skilled in the art would understand that the elongate anchor member can have other profiles, and accordingly, the embodiments discussed herein are not limiting to the scope of the present teachings.

Referring to FIG. 7A, an anchor 200 constructed in accordance with some embodiments of the present teachings generally includes a tensioning member 201 extending from a proximal end portion 212 of an elongate anchor member 210 to a distal end portion 214. In some embodiments, the tensioning member 201 loops back and extends from the distal end 214 to the proximal end portion 212. In some embodiments, the tensioning member 201 passes through a plurality of openings along the elongate anchor member 210. In some embodiments, one end of the tensioning member 201, after it extends from the proximal end to the distal end and loops back to the proximal end of the anchor member 210, forms a knot 220 around the other end portion of the tensioning member 201. In some embodiments, the knot 220 slides along the other end portion of the tensioning member 201 in such way that it pulls the free end of the tensioning member 201 proximally, causing the knot 220 moving distally and shortening the longitudinal length of the anchor member 210. By doing so in these embodiments, the elongate anchor member 210 is folded and the ends of the anchor member 210 are drawn toward each other. In certain embodiments, the elongate anchor member 210 also can include at least one pre-set folding line (not shown) which allows the elongate anchor member 210 to be fold at the pre-set folding line.

In various embodiments, an anchor, such as that referred to as anchor 200, shortens at one of the proximal and distal ends. For example, when the tensioning member 201 is pulled, at least a part of the distal portion 214 folds first while the proximal end 212 substantially maintains its elongated configuration. In some embodiments, this occurs when the distal portion 214 is deployed. In certain embodiments, this occurs when the distal portion 214 is deployed and the proximal portion 212 is not deployed, for example, because the proximal portion 212 is restrained in a delivery catheter (not shown). In other embodiments, when the tensioning member 201 is pulled, at least a part of the proximal portion 212 folds first while the distal portion 214 substantially maintains its elongated configuration. It will be appreciated by a person with ordinary skill in the art that an anchor of the present teachings may also be folded in a sequential manner under other circumstances.

As seen in FIG. 7A, in various embodiments, the elongate anchor member has two sets of openings 225, 226 (first openings 225 and second openings 226). In some embodiments, the tensioning member 201 extends from the proximal end portion 212 of the anchor member 210 to the distal end portion 214 of the anchor member 210 through the first set of openings 225. Upon reaching the distal end of the elongate anchor member 210, in some embodiments, the tensioning member 201 loops back and further extends from the distal end portion of the anchor member 210 to the proximal end of the anchor member through the second set of openings 226.

In certain embodiments, as shown in FIG. 7A, the tensioning member 201 extends from the proximal end of the anchor member 210 distally, travels from one side of the anchor member 210 to another side by passing through the first opening 225 closest to the proximal end of the anchor member 210 in the first set of openings 225; the tensioning member 201 further extends distally, passes through the next opening 225 distal to the first opening 225 in the first set of openings 225. The tensioning member extends further distally repeating above steps until it passes through the last opening 225 in the first set of openings 225 and reaches the distal end of the anchor member 210. In one embodiment of the present teachings, there are ten openings 225 in the first set of openings 225. Anchor members 210 having between four and twelve openings 225 in the first set of openings can be made and used by one with ordinary skill in the art without undue experimentation.

In various embodiments of the present teachings, upon reaching the distal end of the anchor member 210, the tensioning member 201 loops back, extends proximally, travels from one side of the anchor member 210 to another side by passing through the first opening 226 closest to the distal end of the anchor member 210 in the second set of openings 226. The tensioning member 201 further extends proximally, travels to the first side of the anchor member 210 by passing through the next opening 226 proximal to the first opening 226 in the second set of openings 226. The tensioning member 201 extends further proximally repeating the above steps until it passes through the last opening 226 in the second set of openings 226 and reaches the proximal end of the anchor member 210. In some embodiments of the present teachings, there are ten openings 226 in the second set of openings 226. Elongate anchor members 210 having between four and twelve openings 226 in this set can be made and used by one with ordinary skill in the art without undue experimentation.

In various embodiments of the present teachings, as illustrated in FIG. 7A, the tensioning member 201 extends from one side of the anchor member 210 distally, loops back, and ends on the same side of the anchor member 210. In other embodiments, the tensioning member 201 extends from one side of the anchor member 210 distally, loops back, and ends on a different side of the anchor member 210.

In various embodiments of the present teachings, the number of openings 225 in the first set and the number of openings 226 in the second set are the same as illustrated in FIG. 7A. In other embodiments, the number of openings 225 in the first set and the number of openings 226 in the second set are different.

In some embodiments, the first and second sets of openings 225, 226 are different as illustrated in FIG. 7A. In other embodiments, the first and second sets of openings 225, 226 share at least one opening as illustrated in FIG. 7C. This common opening is identified with reference character 227 in FIG. 7C.

As mentioned above, the anchor member 210 can have an hour glass profile as illustrated in FIG. 7B. In this embodiment, the anchor member 210 has a pair of sections 229 of increased width (with one being located at the proximal end portion 212 and one at the distal end portion 214).

According to various embodiments of the present teachings, at least one opening 225 in the first set of openings 225 has a corresponding opening 226 in the second set of openings 226 and together they form a pair of openings on the anchor members 210. In some embodiments, at least one pair of openings 225, 226 form a line perpendicular to the longitudinal axis of the anchor member 210. In other embodiments, at least one pair of the openings 225, 226 forms a line parallel to the longitudinal axis of the anchor member 210. In yet other embodiments, at least one pair of the openings 225, 226 form a line that forms an angle with the longitudinal axis of the anchor member 210. In some embodiments, lines formed by all of the pairs of openings 225, 226 are in the same orientation with one another. For example, they can be parallel to one another and/or perpendicular to the longitudinal axis of the anchor member 210 as illustrated in FIG. 7A. In another embodiment, they can all be parallel to the longitudinal axis of the anchor member 210. In yet other embodiments, the lines formed by all the pairs of openings 225, 226 can have random directions.

In various embodiments, the two openings 225, 226 in a pair are 2-3 mm apart from each other. In some embodiments, the distance between two opening 225, 226 is the same in each pair. In some embodiments, the distance between two openings 225, 226 is different from one pair to another.

In various embodiments, the distance between two adjacent openings 225, 225 (or 226, 226) in the same set, defined by the distance from one opening to the next closest one in the same set of openings (either 225 or 226), is about 5-12 mm. In some embodiments, the distances between each adjacent openings 225, 225 (or 226, 226) is the same as each other. In some embodiments, the distances between each adjacent openings is different from each other.

In various embodiments, at least one pair of the openings 225, 226 are at the lateral center of the anchor member. In some embodiments, all the pairs of openings 225, 226 are at the lateral center of the anchor member. In some embodiments, at least one pair of the openings 225, 226 is biased toward one side of the anchor member 210. In some embodiments, all the pairs of openings 225, 226 are biased toward the same side of the anchor member. In some embodiments, each of the pairs of openings is biased toward different sides of the anchor member 210.

In various embodiments, all the openings 225, 226 in at least one set of openings, or in both the sets of openings, form a straight line. In various embodiments, all the openings in at least one set of the openings, or in both the sets of openings, form a curved line.

FIG. 8 illustrates an exemplary elongate profile of an exemplary anchor 300 that includes an elongate anchor member 310 and wherein the openings 225 in the first set of openings 225 form a straight line parallel to the longitudinal axis of the anchor member 310, and the openings 226 in the second set of openings 226 form another straight line parallel to the longitudinal axis of the anchor member 310 and at a distance from the line formed by the first set of openings 225.

FIG. 9 illustrates an exemplary elongate profile of an exemplary anchor 400 that includes an elongate anchor member 410. The openings 225 in the first set of openings form a curve with the openings 225 in the middle portion of the anchor member closest to the lateral center of the anchor member 410, and the openings 226 in the second set of openings form another curve with the openings 226 in the middle portion of the anchor member 410 closest to the lateral center of the anchor member 410, and the two curves have a lateral distance from each other and together form an “hour glass” shape.

FIGS. 10A and 10B illustrate an exemplary elongate profile of an exemplary anchor 500 that includes an elongate anchor member 510. All openings 225, 226 in both sets of the openings are aligned with each other forming a straight line parallel to the longitudinal axis of the anchor member 510. FIG. 10B is a side elevation view of the anchor member 510 showing the routing of the tensioning member 201 through the anchor member 510.

In various embodiments, at least one pre-set folding line is created between two pairs of the openings 225, 226, as illustrated in FIG. 12A. The pre-set folding line can be made by heat setting with or without a mold. One skilled in the art would understand that other methods can also be used to create pre-set folding lines without undue experimentations. In some embodiments, the pre-set folding lines allow the elongate anchor member to fold at pre-defined places. In certain embodiments, a pre-set folding line is created between every two pairs of the openings 225, 226, for example, as illustrated in FIGS. 8-10.

According to various embodiments of the present teachings, the elongate anchor member (e.g., anchor member 210) shortens and creates folds as illustrated in FIG. 11. In some embodiments, the number of the folds in the anchor in its deployed profile ranges from 4 to 12. In various embodiments, the number of the folds is the same as the number of the openings in at least one set of the openings 225, 226. In other embodiments, the number of the folds has no particular relationship with the number of the openings in either set of the openings 225, 226. In various embodiments, the number of the folds is the same as the number of the pre-set folding lines plus one. In other embodiments, the number of the folds has no particular relationship with the number of the pre-set folding lines.

FIGS. 12A-D illustrate an exemplary embodiment of the present teachings. Specifically, FIGS. 12A and 12D illustrate an exemplary elongate profile and an exemplary deployed profile, respectively, of an anchor 600 of the present teachings. The anchor 600 includes an elongate anchor member 610. As shown in FIG. 12A, the elongate anchor member 610 has two sets of openings 225, 226 through which the tensioning member 201 weaves. The tensioning member 201 weaves through the first set of openings 225 as it extends from the proximal end to the distal end of the anchor member 610 and weaves through the second set of openings 226 as it returns from the distal end to the proximal end of the anchor member 610.

In various embodiments of the present teachings, at least one opening in the first set of openings corresponds with another opening in the second set of openings and together they form a pair of openings on the anchor member. As shown in FIG. 12A, there are 5 pairs of openings 225, 226 in the distal portion of the anchor member, and 3 pairs of openings 225, 226 in the proximal portion of the anchor member 510. As shown in FIG. 12A, each pair of the openings 225, 226 in the distal end section of the distal portion of the anchor member form an imaginary line and the imaginary lines from the opening pairs 225, 226 in the distal portion of the anchor member 610 are parallel to one another and perpendicular to the longitudinal axis of the anchor member 610, and at the lateral center of the anchor member 610; all openings 225, 226 in the proximal end section of the distal portion of the anchor member 610 align with one another and form an imaginary straight line that is parallel to the longitudinal axis of the entire distal portion of the anchor member 610, and at the lateral center of the entire distal portion of the anchor member 610. Thus, in the proximal portion of the anchor member 610, all openings 225, 226 from both set of openings align with one another and form an imaginary straight line that is parallel to the longitudinal axis of the anchor member 610 and at the lateral center of the anchor member 610. One skilled in the art should understand that the amount of pairs of opening in distal and/or proximal portions of the anchor member 610 can be of any number other than what has been described here.

FIG. 12A further illustrates exemplary pre-set folding lines in an elongate anchor member of the present teachings. As shown in FIG. 12A, the folding lines (indicated in the drawings as “L”) in the proximal portions and the distal end portion of the distal portion of the anchor member 610 are parallel to one another and perpendicular to the longitudinal axis of the anchor member 610. The pre-set folding lines L between the distal end section and proximal end section of the distal portion of the anchor member 610 are angled to the other pre-set folding lines L. Although specific pre-set folding patterns is shown in FIG. 12A, one with ordinary skill in the art would understand that other patterns, numbers can be incorporated to form pre-set folding lines L. For example, both the distal and proximal portions of the anchor member 610 are parallel to one another and perpendicular to the longitudinal axis of the anchor member 610, and only a middle portion 615 between the distal and proximal portions of the anchor member 610 are angled, so as to forming a transitional section across the paravalvular leakage upon deployment. Therefore what is shown in FIG. 12A should not be considered as being limiting.

FIG. 12A further illustrates an exemplary narrow section in the distal end portion of the anchor member. This narrow section is the result of radiopaque marker being crimped onto the anchor member. As described above, there are other ways of putting one or more radiopaque markers onto the anchor member. Thus, what is shown in this Figure should not limit the scope of the present teachings.

FIG. 12B illustrates an exemplary deployment profile of an embodiment of the present teachings across a paravalvular leakage site. There are 8 folds in the deployed anchor as shown in FIG. 12B, among which 5 are distal to the paravalvular leakage and 3 are proximal to the leakage. One skilled in the art would understand that the number of folds in each side of the paravalvular leakage should not be viewed as limiting. As shown in FIG. 12B, the folded panels at the proximal portion of the anchor member and at the proximal end section of the distal portion of the anchor member orientate in one direction, and the folded panels in the distal end portion of the anchor member orientate in another direction that is perpendicular to folded panels in the other direction. The transitional folds between the distal and proximal end section of the distal portion of the anchor member are located at the angled pre-set folding line. In this specific embodiment shown in FIG. 12B, the transitional folds are distal to the paravalvular leakage and are generally indicated with the reference character 601 (in other words, the change in folding direction is identified at 601). One skilled in the art should understand that the transitional folds can be proximal to the paravalvular leakage, or across the paravalvular leakage, and thus what has been illustrated here should not be viewed as limiting.

FIG. 12C is a view of the exemplary anchor shown in FIGS. 12A and B in its deployed configuration. The distal deployed anchor portion has a width “x” established by the width of the anchor and a length “y” determined by the distance between two pairs of the openings. The proximal deployed anchor portion has a width “y” established by the distance between the two pairs of the openings and a length “x” established by the width of the anchor. As shown in this view, the configuration in the exemplary embodiment shown in FIGS. 12A-D increases the overall width of the deployed anchor. This configuration prevents the tensioning member from cutting the panel and the paravalvular leakage and increases the retention force of the anchor against the leakage site.

In other words, as shown in FIG. 12D, at least two adjacent anchor panels 603, 605 are disposed in a crisscrossed manner in that the longitudinal axes of the adjacent anchor panels 603, 605 are disposed perpendicular to one another as shown.

Other arrangements can be incorporated into the two sets of openings. For example, all the openings from both sets of openings in the distal portion of the anchor member can align with each other to form an imaginary straight line that is parallel to the longitudinal axis of the anchor member, and/or each pair of the openings in the proximal portion of the anchor member can form an imaginary line and all the imaginary lines so formed are parallel to one another and perpendicular to the longitudinal axis of the anchor member. One skilled in the art would understand that openings in either or both set of the openings can form any configuration so long as it serves the intended purpose.

Although the present teachings have been described with reference to preferred embodiments, persons ordinarily skilled in the art will recognize that changes can be made in form and detail without departing from the spirit and scope of the present disclosure.

Claims

1. An apparatus for use at a heart of a subject, the apparatus comprising: an elongate member, having a longitudinal axis, and having an elongated configuration in which the elongate member defines: a first portion that defines a first-portion folding line, substantially orthogonal to the longitudinal axis,a second portion that defines a second-portion folding line, substantially parallel to the first-portion folding line, andan oblique folding line, longitudinally between the first portion and the second portion, the oblique folding line being nonparallel and nonorthogonal to the longitudinal axis; anda tensioning member weaving longitudinally along the elongate member such that application of tension to the tensioning member transitions the elongate member toward a folded configuration by folding: the first portion about the first-portion folding line,the second portion about the second-portion folding line, andthe elongate member about the oblique folding line in a manner that positions the first-portion folding line nonparallel to the second-portion folding line.

2. The apparatus according to claim 1, wherein in the folded configuration, the first-portion folding line is substantially orthogonal to the second-portion folding line.

3. The apparatus according to claim 1, wherein: the first-portion folding line partitions the first portion into a first panel and a second panel, andin the folded configuration, the first portion is folded about the first-portion folding line such that a surface of the first panel faces a surface of the second panel.

4. The apparatus according to claim 3, wherein: the second-portion folding line partitions the second portion into a third panel and a fourth panel, andin the folded configuration, the second portion is folded about the second-portion folding line such that a surface of the third panel faces a surface of the fourth panel.

5. The apparatus according to claim 4, wherein, in the folded configuration, the elongate member is folded about the oblique folding line such that the first panel lies transversally across the third panel.

6. The apparatus according to claim 4, wherein: in the elongated configuration, the first, second, third, and fourth panels are colinear on the longitudinal axis, andin the folded configuration: the first and second panels are disposed in a first rotational orientation that is generally transverse to the longitudinal axis, andthe second and third panels are disposed in a second rotational orientation that is generally transverse to the longitudinal axis, and that is rotationally offset with respect to the first rotational orientation.

7. The apparatus according to claim 1, wherein the elongate member is a first elongate member of a set of elongate members, the tensioning member weaving longitudinally along each of the elongate members of the set, in series.

8. The apparatus according to claim 7, wherein the elongate members of the set are positionable at the heart of the subject such that application of the tension to the tensioning member reduces a distance between at least two of the elongate members of the set.

9. The apparatus according to claim 1, wherein the oblique folding line is a first oblique folding line, and wherein the elongate member defines a second oblique folding line, longitudinally between the first portion and the second portion, the second oblique folding line being nonparallel and nonorthogonal to the longitudinal axis, and nonparallel to the first oblique folding line.

10. The apparatus according to claim 9, wherein the tensioning member weaves longitudinally along the elongate member such that application of the tension to the tensioning member transitions the elongate member toward the folded configuration by further folding the elongate member about the second oblique folding line.

11. The apparatus according to claim 1, wherein the first-portion folding line is a first first-portion folding line of a plurality of first-portion folding lines defined by the first portion, each first-portion folding line of the plurality of first-portion folding lines being substantially orthogonal to the longitudinal axis.

12. The apparatus according to claim 11, wherein, in the folded configuration, the first portion is folded about each first-portion folding line of the plurality of first-portion folding lines.

13. The apparatus according to claim 11, wherein, in both the elongated configuration and the folded configuration, the first-portion folding lines of the plurality of first-portion folding lines are substantially parallel to each other.

14. The apparatus according to claim 11, wherein the second-portion folding line is a first second-portion folding line of a plurality of second-portion folding lines defined by the second portion, each second-portion folding line of the plurality of second-portion folding lines being substantially orthogonal to the longitudinal axis.

15. The apparatus according to claim 14, wherein, in both the elongated configuration and the folded configuration, the second-portion folding lines of the plurality of second-portion folding lines are substantially parallel to each other.

16. The apparatus according to claim 14, wherein, in the folded configuration, the second portion folded about each second-portion folding line of the plurality of second-portion folding lines.

17. The apparatus according to claim 1, further comprising a catheter, wherein: the elongate member is deliverable, via the catheter, towards the heart in the elongated configuration,the elongate member is positionable at the heart such that the tensioning member extends, from the elongate member, through the catheter and out of the subject, andthe elongate member is transitionable towards the folded configuration via application of the tension to the tensioning member from outside of the subject.

18. An apparatus for use at a heart of a subject, the apparatus comprising: an elongate member having an elongated configuration, wherein in the elongated configuration, the elongate member has a longitudinal axis, and defines: a first portion that defines a first-portion folding line, substantially orthogonal to the longitudinal axis, the first-portion folding line partitioning the first portion into a first panel and a second panel,a second portion that defines a second-portion folding line, substantially parallel to the first-portion folding line, the second-portion folding line partitioning the second portion into a third panel and a fourth panel, andan oblique folding line, longitudinally between the first portion and the second portion, the oblique folding line being nonparallel and nonorthogonal to the longitudinal axis; anda tensioning member weaving longitudinally along the elongate member such that application of tension to the tensioning member transitions the elongate member toward a folded configuration by folding: the first portion about the first-portion folding line, such that a surface of the first panel faces a surface of the second panel,the second portion about the second-portion folding line, such that a surface of the third panel faces a surface of the fourth panel, andthe elongate member about the oblique folding line such that the first panel lies transversally across the third panel.