All publications and patent applications mentioned in this specification are herein incorporated by reference in their entirety to the same extent as if each individual publication or patent application was specifically and individually indicated to be incorporated by reference.
Heart failure (HF) is a medical condition associated with the inability of the heart to effectively pump blood to the body. Heart failure affects millions of people worldwide, and may arise from multiple root causes, but is generally associated with myocardial stiffening, myocardial shape remodeling, and/or abnormal cardiovascular dynamics. Shape remodeling may include an increase in size in a heart ventricle, for example, ventricular dilation. Patients with valvular disease have abnormal anatomy and/or function of at least one valve. For example, a valve may suffer from insufficiency, also referred to as regurgitation, when the valve does not fully close and allows blood to flow retrograde. Valve stenosis can cause a valve to fail to open properly. Other diseases may also lead to dysfunction of the valves. Leaflets of the valve may fail to properly coapt (seal against one another) due to altered anatomy of the annulus, leaflets, and/or ventricle. While medications may be used to treat the disease, in many cases the defective valve may need to be repaired or replaced at some point during the patient's lifetime.
Described herein are systems, devices, and methods for treating a diseased valve (e.g., mitral valve). In some cases, the systems, devices, and methods are used to treat regurgitation and/or for performing valve replacement. In some cases, the system is used to repair aspects of a valve. In some cases, the system is used to replace a valve, or portions of the valve. In some embodiments, the systems described herein are delivered in a minimally invasive manner, for example endovascularly via one or more delivery catheters. In some embodiments, the systems described herein may be delivered via a transseptal approach.
In one aspect, it may be beneficial to provide a support member and anchored tether system to at least partially remodel a heart ventricle (e.g., reduce a size thereof), to remodel a portion of a native valve (e.g., annulus), and/or to provide a support structure for implantation of a prosthetic valve to improve heart function. In one aspect, it may be beneficial to provide a support member, a mating body, and anchored tether system to improve coaptation of native valve leaflets to improve heart function. In one aspect, it may be beneficial to provide an expandable frame in an atrium of a heart, and a support member operatively coupled with the frame and placed near a native valve annulus to improve heart function.
One aspect of the disclosure is a system for treating a diseased heart, the system comprising: an annular support member that is shaped and sized for placement near a native valve annulus; an anchor member comprising at least one anchor portion configured for implantation in tissue within a ventricle; and at least one tether that is configured for extension from the at least one anchor portion to the support member, the at least one tether configured to apply a tensioning force between the support member and the at least one anchor portion.
In this aspect, the at least one anchor portion may be configured for implantation in a ventricle wall or a papillary muscle.
In this aspect, the support member may be configured to alter a dimension of the native valve annulus.
In this aspect, the at least one tether may be configured to secure the support member to the native valve annulus.
In this aspect, the at least one anchor portion may comprise a coil near a distal end thereof.
In this aspect, the at least one anchor portion may comprise a taper that reduces to a point at a distal end thereof.
In this aspect, the at least one anchor portion may include an elongate tube having a first circumference, and wherein the at least one anchor portion comprises an expandable region configured to expand to a second circumference that is larger than the first circumference, wherein the expandable region is near a distal end of the at least one anchor portion.
In this aspect, the at least one anchor portion may comprise at least two expandable regions configured to expand to circumferences larger than the first circumference.
In this aspect, the support member may comprise a self-expanding material.
In this aspect, the system may further comprise a prosthetic valve that is sized and shaped to be placed within the support member.
In this aspect, the prosthetic valve may be configured to transition from an unexpanded configuration to an expanded configuration.
In this aspect, upon placement within the support member, the prosthetic valve may be configured to displace native valve leaflets.
In this aspect, the system may further comprise first and second flow meters that are coupled with the support member, and that are positioned and configured for inductive coupling.
In this aspect, the first and second flow meters may be disposed about a periphery of the support member.
In this aspect, the annular support member may be expandable and includes wires arranged to form an annular shape.
In this aspect, the wires may define an inner wall and outer wall.
In this aspect, the annular support member may be conically shaped.
In this aspect, the annular support member may be half-dome shaped.
In this aspect, the at least one anchor may include an expandable portion that is configured to expand from a first diameter to a second diameter.
In this aspect, the at least one anchor may include a collapsible tube having a pattern of cutouts that is configured to collapse the tube and form radially extending arms.
One aspect of the disclosure is a method of securing a support member near a native valve annulus of a heart, comprising: securing at least one anchor portion of an anchor member to tissue of a ventricle, the anchor member comprising a tether portion extending at least partially through the native valve annulus; delivering an annular support member to a position near the native valve annulus; coupling the support member with the tether portion; and applying a tension on the tether portion to provide a tensioning force between the at least one anchor portion and the support member.
In this aspect, delivering the support member may comprise securing the support member to the valve annulus and/or to a portion of the wall of the heart adjacent the valve annulus.
In this aspect, delivering the support member may comprise positioning the support member in a supra-annular position.
In this aspect, applying tension on the tether portion may comprise changing a dimension of the ventricle and/or the valve annulus.
In this aspect, applying tension on the tether portion may apply a pulling force on a wall of the ventricle to reduce a volume of the ventricle.
In this aspect, applying tension on the tether portion may cause a reduction in a size of the valve annulus.
In this aspect, the coupling the support member with the tether portion may be prior to delivering the support member.
In this aspect, delivering the support member may be to a left atrium of the heart.
In this aspect, the method may further comprise delivering a prosthetic valve to the support member.
In this aspect, delivering the prosthetic valve may comprise expanding the prosthetic valve from an unexpanded configuration to an expanded configuration to displace native leaflets of the valve.
In this aspect, the tether portion may extend through a commissure of the native valve.
In this aspect, securing the at least one anchor portion may comprise securing the at least one anchor portion to one or more of a ventricle wall and a papillary muscle.
In this aspect, securing the at least one anchor portion may comprise expanding an expandable portion of the at least one anchor portion.
In this aspect, expanding the expandable portion may comprise radially extending arms of a collapsible tube.
One aspect of the disclosure is a system for treating a diseased heart, the system comprising: an annular support member that is shaped and sized for placement near a native valve annulus, the support member having an opening; a mating body coupled to the support member and disposed within the opening such that a length of the mating body is positioned between native leaflets, the mating body arranged to provide a seal against the native leaflets; and an anchor member comprising at least one anchor portion configured for implantation in a ventricle wall, and at least one tether configured to extend from the at least one anchor portion to the support member.
In this aspect, the mating body may comprise a compliant material that is configured to accommodate a shape of the native leaflets.
In this aspect, the compliant material may comprise one or more of a fluid filled polymer, ePTFE and covered nitinol.
In this aspect the at least one tether may be configured to reduce a volume of the ventricle.
In this aspect, the at least one anchor may include an expandable portion that is configured to expand from a first diameter to a second diameter.
In this aspect, the at least one anchor may include a collapsible tube having a pattern of cutouts that is configured to collapse the tube and form radially extending arms.
One aspect of the disclosure is a system for treating a diseased valve, the system comprising: an annular support configured for placement adjacent to the diseased valve; an anchoring device configured for securing to an internal ventricle wall; and one or more tethers configured to tether the annular support to the anchoring device, the one or more tethers configured to provide a tensioning force on the annular support implanted adjacent to the diseased valve toward the anchoring device secured to the ventricle wall.
In this aspect, the tensioning force may be configured to stabilize and reduce ventricle dilation.
In this aspect, the tensioning force may be configured to reduce an annular dimension of the diseased valve.
In this aspect, the anchoring device may include an expandable portion that is configured to expand from a first diameter to a second diameter.
In this aspect, the anchoring device may include a collapsible tube having a pattern of cutouts that is configured to collapse the tube and form radially extending arms.
One aspect of the disclosure is an implant for treating a diseased valve, the implant comprising: a frame configured for placement adjacent to the diseased valve and having a central opening; a coaptation structure coupled to the frame and extending radially within the opening of the frame, the coaptation structure arranged for placement within the diseased valve for coaptation with native leaflets of the diseased valve; and an anchoring tab extending from the frame, the anchoring tab configured to secure the implant to the diseased valve.
In this aspect, the anchoring tab may include a hook portion configured to wrap around the native leaflets, pass through the native leaflets, or wrap around and pass through the native leaflets.
In this aspect, the hook portion may extend from a ventricle side of the implant.
In this aspect, the hook portion may be configured to couple with a tether coupled to an anchor secured to the ventricle wall.
In this aspect, the anchoring tab may extend within the central opening of the frame and radially inward with respect to the frame.
In this aspect, the anchoring tab may be arranged for placement within or near a commissure of the native leaflets.
In this aspect, the implant may include a first anchoring tab arranged for placement within or near the anterior commissure of the native leaflets, and a second anchoring tab arranged for placement within or near the posterior commissure of the native leaflets.
In this aspect, the frame may include a lip around a perimeter of the frame that is sized and shaped to promote ingrowth of tissue thereon.
In this aspect, the implant may further comprise a tether and an anchor, the having a proximal end coupled to the anchoring tab and a distal end coupled to the anchor, wherein the anchor is secured to tissue of a ventricle of the heart.
In this aspect, the anchor may include an expandable portion that is configured to expand from a first diameter to a second diameter.
In this aspect, the anchor may include a collapsible tube having a pattern of cutouts that is configured to collapse the tube and form radially extending arms.
One aspect of the disclosure is an implant for treating a diseased valve, the implant comprising: a frame comprising an opening having an inner wall and configured for placement adjacent to the diseased valve, wherein the frame is configured to transition to a radially expanded configuration upon application of a radially outward pressure to the inner wall, and to contract to a radially reduced configuration upon release of the radially outward pressure; and a series of hooks coupled with the frame and configured to secure the implant to the diseased valve, the series of hooks extending from a first side of the frame and arranged radially around the central opening of the frame, a least a portion of the series of hooks curved radially inward and configured to engage with tissue upon expansion of the frame and remain engaged with the tissue upon contraction of the frame.
In this aspect, a central opening of the frame may have a diameter that is less than a dimeter of an opening of the diseased valve.
In this aspect, the diameter of the central opening may range from 5% to 95% of the diameter of the diseased valve.
In this aspect, the frame may be made of a shape-memory material.
In this aspect, the frame may be made of a shape-memory wire.
In this aspect, the implant may further comprise a series of outward radiating petals configured to provide structural stiffness to the frame.
In this aspect, at least a portion of the implant may include a covering configured to promote ingrowth of tissue onto the implant.
In this aspect, the first side of the frame may be a ventricle side of the frame.
In this aspect, each of the series of hooks may be curved radially inward and is configured to engage with tissue upon expansion of the frame and remain engaged with the tissue upon contraction of the frame.
In this aspect, the frame may be in a lower energy state when in the radially reduced configuration compared to when the frame is in the radially expanded configuration.
In this aspect, the frame may be configured to compress into a delivery configuration within a delivery catheter.
In this aspect, the implant may further comprise a tether and an anchor, the having a proximal end coupled to the implant and a distal end coupled to the anchor, wherein the anchor is secured to tissue of a ventricle of the heart.
In this aspect, the anchor may include an expandable portion that is configured to expand from a first diameter to a second diameter.
In this aspect, the anchor may include a collapsible tube having a pattern of cutouts that is configured to collapse the tube and form radially extending arms.
One aspect of the disclosure is a method of treating a diseased valve, comprising: positioning an implant within the diseased valve using a delivery catheter with the implant positioned therein, the implant comprising a frame with an inner wall defining an opening, and a series of hooks coupled to the frame and arranged radially around the opening; radially expanding the frame by applying a radially outward pressure to the inner wall, wherein expanding the frame causes at least a portion of the series of hooks to engage with tissue of the diseased valve or around the diseased valve; and releasing the radially outward pressure from the inner wall to cause the frame to contract to a radially reduced deployed configuration, wherein the at least a portion of the series of hooks remain engaged with the tissue upon contraction of the frame, thereby securing the implant to the diseased valve.
In this aspect, applying the radially outward pressure to the inner wall may comprise inflating a balloon within the opening of the frame such that the balloon applies pressure against the inner wall of the frame.
In this aspect, releasing the radially outward pressure may comprise deflating the balloon.
In this aspect, method may further comprise allowing blood to flow through the opening of the frame within the diseased valve as the balloon is inflated and deflated.
In this aspect, method may further comprise removing the balloon from the opening of the frame.
In this aspect, the method may further comprise inserting a prosthetic valve within the opening of the frame.
In this aspect, the series of hooks may be curved radially inward such that the hooks remain engaged with the tissue upon contraction of the frame.
In this aspect, the method may further comprise connecting the implant via a tether to an anchor secured to tissue within a ventricle of the heart.
In this aspect, the anchor may include an expandable portion that is configured to expand from a first diameter to a second diameter.
In this aspect, the anchor may include a collapsible tube having a pattern of cutouts that is configured to collapse the tube and form radially extending arms.
One aspect of the disclosure is a system for treating a diseased heart, the system comprising: a support member (e.g., dock) comprising a body that is shaped and sized for placement near a native valve annulus, and accommodation of native valve leaflet function; and an anchor member comprising at least one anchor portion configured for implantation in a ventricle wall, and an elongate tether portion that is configured for extension from the at least one anchor portion to the support member, and to couple therewith; wherein the elongate tether portion in a first configuration is configured to accommodate relative movement of the support member therewith, and in a second configuration is configured to secure the support member near the native valve annulus.
In this aspect, the elongate tether portion in the second configuration may be configured to urge the support member to alter a dimension of the native valve annulus.
In this aspect, the elongate tether portion in the second configuration may be configured to urge the anchor member to alter a dimension of the ventricle wall.
In this aspect, the elongate tether portion in the second configuration may be further configured to secure the support member to the native valve annulus.
In this aspect, the at least one anchor portion may comprise a coil near a distal end thereof.
In this aspect, the at least one anchor portion may comprise a taper that reduces to a point at a distal end thereof.
In this aspect, the at least one anchor portion may be generally an elongate tube having a first circumference, and wherein the at least one anchor portion comprises a region having a second circumference that is larger than the first circumference, near a distal end thereof.
In this aspect, the at least one anchor portion may comprise at least two regions having circumferences larger than the first circumference.
In this aspect, the support member may comprise a self-expanding material (e.g., nitinol).
In this aspect, the system may further comprise a prosthetic valve that is sized and shaped to be placed within the support member.
In this aspect, the prosthetic valve may comprise an unexpanded configuration for delivery thereof, and an expanded configuration for placement within the support member.
In this aspect, upon placement within the support member, the prosthetic valve may be configured to displace native valve leaflets.
In this aspect, the system may further comprise first and second flow meters that are coupled with the support member, and that are positioned and configured for inductive coupling.
In this aspect, the first and second flow meters may be disposed about a periphery of the support member.
One aspect of the disclosure is a method of securing a support member near a native valve annulus of a heart, comprising: securing at least one anchor portion of an anchor member to a wall of the ventricle, the anchor member comprising a tether portion extending at least partially through the valve annulus; delivering a support member (e.g., dock or ring) to a position near the valve annulus; coupling the support member with the tether portion; tensioning the tether portion to urge the at least one anchor portion and the support member toward each other; and securing the support member near the native valve annulus.
In this aspect, securing the support member may comprise securing to the valve annulus and/or to a portion of the wall of the heart adjacent the valve annulus.
In this aspect, securing the support member may be to a supra-annular position.
In this aspect, tensioning the tether portion may comprise changing a dimension of a ventricle and/or a valve annulus of a heart.
In this aspect, tensioning may comprise pulling the wall of the ventricle to reduce the dimension thereof.
In this aspect, tensioning the tether portion may further comprise reducing a dimension of the valve annulus.
In this aspect, the coupling the support member with the tether portion may be prior to delivering the support member.
In this aspect, delivering the support member may be to a left atrium of the heart.
In this aspect, the method may further comprise delivering a prosthetic valve to the support member.
In this aspect, delivering the prosthetic valve may comprise expanding from an unexpanded configuration to an expanded configuration to displace native leaflets of the valve.
In this aspect, the tether portion may extend through a commissure of the valve.
One aspect of the disclosure is a system for treating a diseased heart, the system comprising: a support member (e.g., dock) comprising a body that is shaped and sized for placement near a native valve annulus, and having an opening for accommodation of native valve leaflet function; a mating body (also referred to as a coaptation structure or blocker) coupled to the support member and disposed within the opening such that a length of the mating body extends generally between native leaflets, the mating body configured for providing a seal for the native leaflets (e.g., coaptation therewith); and an anchor member comprising at least one anchor portion configured for implantation in a ventricle wall, and an elongate tether portion that is configured for extension from the at least one anchor portion to the support member, and to couple therewith; wherein the elongate tether portion in a first configuration is configured to accommodate relative movement of the support member therewith, and in a second configuration is configured to secure the support member near the native valve annulus.
In this aspect, the mating body may comprise a compliant material (e.g., fluid-filled polymer, ePTFE-covered nitinol) that is configured to accommodate a shape of the native leaflets.
In this aspect, the elongate tether portion in the second configuration may further be configured to reduce a dimension of the ventricle wall.
One aspect of the disclosure is a system for treating a diseased heart, the system comprising: a frame comprising a body that is configured to transition between at least a first configuration in which the frame has a reduced delivery profile, and a second expanded configuration in which the frame is shaped and sized for placement within an atrium of the heart, and for at least partial support by 1) a wall thereof and/or 2) a surface of a native valve annulus that is in fluid communication with the atrium; and a support (e.g., dock) configured for operative coupling with the frame and comprising a body that is shaped and sized for placement near the native valve annulus, the support having an opening for accommodation of native valve leaflet function; wherein when the system is implanted within the atrium of the heart, the support is positioned near the native valve annulus.
In this aspect, the frame may be self-expandable from the first configuration to the second expanded configuration.
In this aspect, in the second expanded configuration, the frame may be configured to anchor the support near the native valve annulus.
In this aspect, the support may further comprise a valve support that is configured to retain a prosthetic valve.
In this aspect, the method may further comprise a prosthetic valve supported within the valve support.
One aspect of the disclosure is a system for treating a diseased valve, the system comprising: a valve implant configured for placement adjacent to the diseased valve; an anchoring device configured for securing to an internal ventricle wall; and one or more tethers configured to tether the valve implant to the anchoring device, the one or more tethers configured to provide a tensioning force on the valve implant implanted adjacent to the diseased valve toward the anchoring device secured to the ventricle wall.
In this aspect, the tensioning force may be configured to stabilize and reduce ventricle dilation.
In this aspect, the tensioning force may be configured to reduce an annular dimension of the diseased valve.
One aspect of the disclosure is an implant for treating a diseased valve, the implant comprising: a frame configured for placement adjacent to the diseased valve and having a central opening; a coaptation structure coupled to the frame and extending radially within the opening of the frame, the coaptation structure arranged for placement within the diseased valve for coaptation with native leaflets of the diseased valve; and an anchoring tab extending from the frame, the anchoring tab configured to secure the implant to the diseased valve.
In this aspect, the anchoring tab may include a hook portion configured to wrap around the native leaflets, pass through the native leaflets, or wrap around and pass through the native leaflets.
In this aspect, the hook portion may extend from a ventricle side of the implant.
In this aspect, the hook portion may be configured to couple with a tether coupled to an anchor secured to the ventricle wall.
In this aspect, the anchoring tab may extend within the central opening of the frame and radially inward with respect to the frame.
In this aspect, the anchoring tab may be arranged for placement within or near a commissure of the native leaflets.
In this aspect, the implant may include a first anchoring tab arranged for placement within or near the anterior commissure of the native leaflets, and a second anchoring tab arranged for placement within or near the posterior commissure of the native leaflets.
In this aspect, the frame may include a lip around a perimeter of the frame that is sized and shaped to promote ingrowth of tissue thereon.
One aspect of the disclosure is an implant for treating a diseased valve, the implant comprising: a frame comprising an opening having an inner wall and configured for placement adjacent to the diseased valve, wherein the frame is configured to transition to a radially expanded configuration upon application of a radially outward pressure to the inner wall, and to contract to a radially reduced configuration upon release of the radially outward pressure; and a series of hooks coupled with the frame and configured to secure the implant to the diseased valve, the series of hooks extending from a first side of the frame and arranged radially around the central opening of the frame, a least a portion of the series of hooks curved radially inward and configured to engage with tissue upon expansion of the frame and remain engaged with the tissue upon contraction of the frame.
In this aspect, a central opening of the frame may have a diameter that is less than a dimeter of an opening of the diseased valve.
In this aspect, the diameter of the central opening may range from 5% to 95% of the diameter of the diseased valve.
In this aspect, the frame may be made of a shape-memory material.
In this aspect, the frame may be made of a shape-memory wire.
In this aspect, the implant may further comprise a series of outward radiating petals configured to provide structural stiffness to the frame.
In this aspect, at least a portion of the implant may include a covering configured to promote ingrowth of tissue onto the implant.
In this aspect, the first side of the frame may be a ventricle side of the frame.
In this aspect, each of the series of hooks may be curved radially inward and is configured to engage with tissue upon expansion of the frame and remain engaged with the tissue upon contraction of the frame.
In this aspect, the frame may be in a lower energy state when in the radially reduced configuration compared to when the frame is in the radially expanded configuration.
In this aspect, the frame may be configured to compress into a delivery configuration within a delivery catheter.
One aspect of the disclosure is a method of treating a diseased valve, comprising: positioning an implant within the diseased valve using a delivery catheter with the implant positioned therein, the implant comprising a frame with an inner wall defining an opening, and a series of hooks coupled to the frame and arranged radially around the opening; radially expanding the frame by applying a radially outward pressure to the inner wall, wherein expanding the frame causes at least a portion of the series of hooks to engage with tissue of the diseased valve or around the diseased valve; and releasing the radially outward pressure from the inner wall to cause the frame to contract to a radially reduced deployed configuration, wherein the at least a portion of the series of hooks remain engaged with the tissue upon contraction of the frame, thereby securing the implant to the diseased valve.
In this aspect, applying the radially outward pressure to the inner wall may comprise inflating a balloon within the opening of the frame such that the balloon applies pressure against the inner wall of the frame.
In this aspect, releasing the radially outward pressure may comprise deflating the balloon.
In this aspect, the method may further comprise allowing blood to flow through the opening of the frame within the diseased valve as the balloon is inflated and deflated.
In this aspect, the method may further comprise removing the balloon from the opening of the frame.
In this aspect, the method may further comprise inserting a prosthetic valve within the opening of the frame.
In this aspect, the series of hooks may be curved radially inward such that the hooks remain engaged with the tissue upon contraction of the frame.
One aspect of the disclosure is an anchoring device for securing to a heart wall, the anchoring device comprising: a central support including an opening; and a compression coil having a first annular coiled portion connected to a second annular coiled portion via a straight central connection portion, wherein the straight central connection portion of the compression coil is positioned through the opening of central support such that the first annular coiled portion is on a first side of the central support, and the second annular coiled portion is on a second side of the central support, wherein when the anchoring device is in a deployed configuration: the compression coil is configured to pass through the heart wall such that first coiled portion is positioned within the heart and the second coiled portion is positioned outside of the heart; and the first and second coiled portions are configured to apply a clamping force against the heart wall to secure the anchoring device to the heart wall.
In this aspect, the anchoring device may further comprise an annular washer engaged with and axially aligned with the central support, the annular washer radially extending outward from the central support, wherein when the anchoring device is in a deployed configuration, the washer is configured to radially distribute the clamping force applied to the heart wall.
In this aspect, the annular washer may include a convex surface configured to contact the heart wall.
In this aspect, the anchoring device may be configured to transition from a delivery configuration to the deployed configuration, wherein when the anchor is in a delivery configuration, the compression coil has a straightened shape with a sufficiently small profile for residing within a delivery catheter.
In this aspect, the compression coil may be made of a shape-memory material.
In this aspect, the anchoring device may be configured to couple with one or more tethers that are coupled to a valve implant, wherein the one or more tethers are configured to provide a tensioning force between the valve implant and the anchoring device.
One aspect of the disclosure is a method of securing an anchoring device to a heart wall, the method comprising: advancing a delivery catheter within the heart toward an anchoring site of the heart wall, wherein an inner lumen of the delivery catheter includes a central support of the anchoring device positioned therein; positioning the central support with respect to an anchoring site along the inner surface of the heart wall, wherein an opening of the central support is aligned with a target puncture location; advancing a wire of the anchoring device through the delivery catheter and the opening of the central support such that the wire passes through the heart wall at the target puncture location, wherein a distal portion of the wire passes through the heart wall and takes on a first coiled annular shape outside of the heart wall; and retracting the delivery catheter from the anchoring site such that a proximal portion of the wire takes on a second coiled annular shape inside the heart wall, wherein, when the wire is fully deployed from the delivery catheter, the distal and proximal portions of the wire cooperate to apply a clamping force against the heart wall to secure the anchoring device to the heart wall.
In this aspect, when the wire is fully deployed from the delivery catheter, a central straight portion of the wire may be positioned within the opening of the central support.
In this aspect, positioning the central support with respect to an anchoring site may include centering the central support with respect to an inner wall of the delivery catheter using one or more centering arms coupled to the central support.
In this aspect, the method may further comprise removing the one or more centering arms from the central support.
In this aspect, the method may further comprise, after passing the distal portion of the wire through the heart wall, deploying an annular washer over the anchoring site of the heart wall, the annular washer configured to radially distribute the clamping force applied to the heart wall.
In this aspect, the wherein deploying the annular washer may comprise: advancing the annular washer through the delivery catheter while in a radially contracted delivery state; and exposing the annular washer from the delivery catheter such that the annular washer expands to a radially expanded deployed state.
In this aspect, at least a portion of the annular washer may be positioned between the proximal portion of the wire and the heart wall when the wire is fully deployed.
In this aspect, passing the wire through the heart wall at the target puncture location may include puncturing the heart wall using a distal end of the wire.
In this aspect, the method may further comprise coupling one or more tethers to the anchoring device, the one or more tethers coupled to a valve implant, wherein the one or more tethers are configured to provide a tensioning force between the valve implant and the anchoring device.
One aspect of the disclosure is a system for treating a diseased valve, the system comprising: a valve implant configured for placement adjacent to the diseased valve; an anchoring device including a compression coil having a first annular portion connected to a second annular portion via a connection region, wherein the connection region of the compression coil is configured to pass through a ventricle wall such that the first annular portion is on one side of the ventricle wall and the second annular portion is on an opposing second side of the ventricle wall, wherein the first and second portions are configured to apply a clamping force against the ventricle wall to secure the anchoring device to the ventricle wall; and one or more tethers configured to tether the valve implant to the anchoring device, the one or more tethers configured to provide a tensioning force on the valve implant positioned adjacent to the diseased valve toward the anchoring device secured to the ventricle wall.
In this aspect, the anchoring device may further comprise a washer between the first annular portion of the compression coil and the ventricle wall, the washer configured to distribute the clamping force applied to the ventricle wall.
In this aspect, the connection region of the compression coil may be at a central region of the anchoring device.
In this aspect, the first and second annular portions may be configured to apply a compression force against the ventricle wall that is sufficient to reduce or prevent bleeding from the connection region of the compression coil passing through the ventricle wall.
In this aspect, the compression coil may be made of shape memory material that is biased to apply the clamping force against the ventricle wall between the first and second portions.
One aspect of the disclosure is an anchoring device for securing to a heart wall, the anchoring device comprising: an elongate body including a distal portion having one or more wings extending distally from a proximal portion of the elongate body, the one or more wings configured to be embedded within the heart wall, the one or more wings configured to transition from a delivery configuration to a deployed configuration, wherein: when the one or more wings are in the delivery configuration, the one or more wings are radially contracted and sharp distal ends of the one or more wings point in a distal direction, and when the one or more wings are in the deployed configuration, the one or more wings are radially expanded and curved such that the sharp distal ends point toward a proximal direction; and a flange coupled to the proximal portion of the elongate body, the flange configured to apply a compression force against an inner surface of the heart wall when the one or more wings are embedded within the heart wall in the deployed configuration.
In this aspect, the flange may comprise an engagement surface having one or more protruding hooks configured to engage with the inner surface of the heart wall.
In this aspect, the flange may comprise an engagement surface that having a tapered shape for engagement with a tapered inner surface of the heart.
In this aspect, the proximal portion of the elongate body may be positioned within an opening of the flange.
In this aspect, the opening of the flange and the proximal portion of the elongate body may be threaded.
In this aspect, the anchoring device further comprises a cinching nut configured to transition the one or more wings from the delivery configuration to the deployed configuration upon rotation of the cinching nut.
One aspect of the disclosure is a method of securing an anchoring device to a heart wall, the method comprising: advancing a delivery catheter within the heart toward an anchoring site of the heart wall, wherein an inner lumen of the delivery catheter includes an elongate body of the anchoring device positioned therein, the elongate body including a distal portion having one or more wings extending distally from a proximal portion of the elongate body; distally advancing the elongate body to puncture an inner surface of the heart wall using sharp distal ends of the one or more wings; radially expanding the one or more wings within the heart wall, wherein, when expanded, the one or more wings take on a curved shape such that the sharp distal ends point toward a proximal direction, thereby securing the anchoring device to the heart wall; and coupling a flange to the proximal portion of the elongate body such that the flange contacts the inner surface of the heart wall and applies a compression force against the inner surface of the heart wall.
In this aspect, coupling a flange to the proximal portion of the elongate body may comprise: advancing the flange in a contracted configuration within the delivery catheter toward the elongate body embedded within the heart wall; and releasing the flange from the delivery catheter such that the flange expands to an expanded configuration.
In this aspect, the flange may comprise an engagement surface that having a tapered shape for engagement with a tapered inner surface of the heart.
In this aspect, radially expanding the one or more wings within the heart wall may comprise rotating a cinch nut of the anchoring device.
In this aspect, method may further comprise coupling one or more tethers to the anchoring device, the one or more tethers coupled to a valve implant, wherein the one or more tethers are configured to provide a tensioning force between the valve implant and the anchoring device.
One aspect of the disclosure is a system for treating a diseased valve, the system comprising: a valve implant configured for placement adjacent to the diseased valve; an anchoring device including radially extending wing portions configured to engage with tissue within a ventricle wall, the anchoring device including a flange portion configured to apply a compression force against an inner surface of the ventricle wall to secure the anchoring device to the ventricle wall; and one or more tethers configured to tether the valve implant to the anchoring device, the one or more tethers configured to provide a tensioning force on the valve implant implanted adjacent to the diseased valve toward the anchoring device secured to the ventricle wall.
In this aspect, the flange portion may include protruding features configured to engage with tissue of the inner surface of the ventricle wall.
In this aspect, the protruding features may include a plurality of hooks.
In this aspect, the anchoring device may further comprise a cinch nut configured to cause the wing portions to expand from an elongated state to a radially expanded state upon rotation of the cinch nut.
In this aspect, the flange portion may be configured to apply the compression force sufficiently to reduce or prevent bleeding from puncture of the ventricle wall by the wings.
One aspect of the disclosure is an anchoring device for securing to a heart wall, the anchoring device comprising: an embedded member configured to pass at least partially through the heart wall; and an annular member coupled to the embedded member and configured to radially distribute a compression force applied against an inner surface of the heart wall.
In this aspect, the embedded member may be a compression coil having a first annular coiled portion connected to a second annular coiled portion via a straight central connection portion, wherein the straight central connection portion of the compression coil is positioned through an opening of central support such that the first annular coiled portion is on a first side of the central support, and the second annular coiled portion is on a second side of the central support.
In this aspect, the annular member may be an annular washer engaged with and axially aligned with the central support, the annular washer radially extending outward from the central support, wherein when the anchoring device is in a deployed configuration, the washer is configured to radially distribute the clamping force applied to the heart wall.
In this aspect, the embedded member may be an elongate body including a distal portion having one or more wings extending distally from a proximal portion of the elongate body, the one or more wings configured to be embedded within the heart wall, the one or more wings configured to transition from a delivery configuration to a deployed configuration.
In this aspect, the annular member is a flange coupled to the proximal portion of the elongate body, the flange configured to apply a compression force against an inner surface of the heart wall when the one or more wings are embedded within the heart wall in the deployed configuration.
These and other aspects are described herein.
Novel features of embodiments described herein are set forth with particularity in the appended claims. A better understanding of the features and advantages of the embodiments may be obtained by reference to the following detailed description that sets forth illustrative embodiments and the accompanying drawings.
for cross-ventricle anchoring within ventricle walls:
The disclosure herein relates to systems, devices, and methods for reducing (e.g., mitral) valve regurgitation and/or performing valve replacement. The devices may include a valve implant configured for placement adjacent to the diseased valve. The valve implant may be configured to repair aspects of a diseased valve or may be configured to replace the diseased valve, or portions of the diseased valve. In some cases, one or more tethers may be attached to the valve implant to apply a tensioning force against the valve implant to anchor and help secure the valve implant. The tethers may be coupled to one or more anchors attached to an inner surface of the heart, such as the inner surface of the ventricle.
In some cases, the mitral valve repair (
one in a treatment and the mitral valve replacement (
Some advantages of the dock implants 101 described herein (for use in mitral valve repair (phase 1)) may include: ability to reshape mitral annulus to reduce MR; reduced or no LVD exclusion risk; ability to optimize aorto-mitral angulation (AMA) for TMVR; easy transseptal delivery of repair dock (e.g., having a 28Fr catheter size or less); and/or the LV tethers may facilitate reverse remodeling. The tethered dock implant 101 may allow TMVr via ventriculoplasty. The tethers 104 may stabilize the left ventricle and facilitate reverse remodeling. The tethered dock implant 101 may be preset or adjusted AMA to avoid left ventricular outflow tract (LVOT) obstruction prior to valve implantation. The tethered dock implant 101 may be configured for a less than 28Fr transseptal delivery system. The tethered dock implant 101 may offer a preset valve landing zone for future TMVR, ViR-like procedure.
Some of the advantages of the valve replacement implants described herein (valve in ring (phase two)): ability for reintervention if MR returns; reduces or avoids left ventricle outflow tract (LVOT) obstruction; and/or easy transseptal delivery of transcatheter heart valve (THV) or ViR Procedure (e.g., having a 21Fr catheter size or less).
Deployment of the anchor 1252 in
Note that the mechanisms for using the anchors 1202 and 1252 shown in
The implant 1500 may include a coaptation structure 1540 configured for positioning at the level of native leaflet coaptation, such that the native leaflets 1515 can coapt against it, thereby preventing MR. The coaptation structure 1540 may extend radially inward within the opening of the frame 1541 to position the coaptation structure 1540 between the native leaflets 1515. The coaptation structure 1540 may be designed such that it is flexible enough so that the native leaflets 1515 can move it to the point of normal leaflet coaptation. The coaptation structure 1540 may be located at any point along the line of coaptation of the native leaflets 1515. The surfaces of the coaptation structure 1540 can improve closure of the native leaflets 1515, which may improve heart function. For example, improving heart function can comprise reducing mitral regurgitation. In some cases, the coaptation structure 1540 is arranged for positioning proximal to the posterior middle leaflet (P2). Such position may be preferred for the anterior leaflet engagement. The implant 1500 may work passively to aid in coaptation with the native leaflets 1515 and may be substantially non-thrombogenic.
In some cases, the implant 1500 may have different use conditions. For example, an initial use condition may involve positioning the implant 1500 within the diseased valve with the coaptation structure 1540 so that the coaptation structure 1540 may aid the native leaflets 1515 to reduce or eliminate MR. A second use condition may involve replacing the coaptation structure 1540 with a new valve prosthesis (e.g., at a later time) so that the frame 1541 circularizes the new prothesis. Additionally, the implant 1500 may be anchored in place, e.g., using any of anchor devices described herein.
The anchor 1500 may further include anchoring tabs 1577 that may be configured to anchor the implant 1500 within the valve annulus. The anchoring tabs 1577 may extend from the frame 1541 radially inward within the opening of the frame 1541. In some cases, the anchoring tabs 1577 may be arranged for positioning within or near the medial and lateral commissures, which may prevent or reduce leakage at the medial and/or lateral commissures. The anchoring tabs 1577 may have hook portions 1578 configured to wrap around and/or pass through the leaflets on a ventricle side of the implant 1500. In some cases, the hook portions 1578 may be configured to couple with tethers coupled to an anchor in the left ventricle, as described herein. The implant 1500 may be tethered to any of the anchor devices described herein.
In some examples, the implant 1500 may include a thin lip 1579 around a perimeter of the frame 1541. This arrangement may promote ingrowth of tissue onto the lip 1579 and the frame 1541.
In some cases, at least a portion of the implant 1500 may include a material that promotes ingrowth of tissues. For example, the implant 1500 may include a fabric and/or polymer (e.g., polytetrafluoroethylene) material configured to promote tissue growth. In some cases, the implant includes a tissue growth promoting covering and/or coating.
An atrial side of the implant 1800 may include a series of outwardly radiating petals 1648 to provide structural stiffness. A ventricle side of the implant 1800 may include a series of inwardly radiating one-way hooks 1650 that are configured to engage with tissue 1657 and secure the implant 1800 in place.
Once the one-way hooks 1650 are sufficiently engaged with the tissue 1657, the balloon 1655 may be deflated to retract the balloon 1655 an remove the radially outward force on the frame 1641. Due to their shapes, the inwardly curved hooks 1650 may remain engaged within the tissue 1657, thereby securing the implant 1600 within the valve.
In some cases, at least a portion of the implant 1600 may include a material that promotes ingrowth of tissues. For example, the implant 1600 may include a fabric and/or polymer (e.g., polytetrafluoroethylene) material configured to promote tissue growth. In some cases, the implant includes a tissue growth promoting covering and/or coating.
The implant 1600 may be tethered to any of the anchor devices described herein. Tethers for coupling the implant 1600 to the anchor maybe be coupled to the frame 1641 at any of a number of locations. In some cases, the tethers are coupled at or near a junction region 1652 where the one-way hooks 1650 are attached to the frame 1641.
The first and second portions 1781a and 1781b of the compression coil 1780 may be configured to apply a clamping force against the ventricle wall 1788 to secure the anchoring device 1700 to the ventricle wall 1788. The compression coil 1780 may act as a spring and be made of an elastic material capable of storing mechanical energy. The compression coil 1780 may be biased such that the first and second portions 1781a and 1781b apply the clamping force therebetween. In some cases, the compression coil 1780 may be made of a shape-memory material (e.g., nitinol). The compression coil 1780 may be in the form of a wire, where each of the first and second portions 1781a and 1781b of the compression coil 1780 is wound into a ring shape. The diameter of the wire may vary depending on a desired compression stiffness.
A washer 1785 (e.g., annular washer) may be positioned between the first and second portions of the compression coil and be configured to distribute the load from opposing sides of the compressions coil. When deployed within the ventricle wall 1788, as shown in
In some cases, at least a portion of the anchoring device 1700 may include a material that promotes ingrowth of tissues. For example, the device 1700 may include a fabric and/or polymer (e.g., polytetrafluoroethylene) material configured to promote tissue growth. In some cases, the device 1700 includes a tissue growth promoting covering and/or coating.
At
Once the second portion 1781b of the compression coil 1780 is determined to be sufficiently deployed, the washer 1785 may be delivered through the delivery catheter 1790 and positioned over the anchoring site as shown in
In some cases, at least a portion of the anchoring device 1800 may include a material that promotes ingrowth of tissues. For example, the device 1800 may include a fabric and/or polymer (e.g., polytetrafluoroethylene) material configured to promote tissue growth. In some cases, the device 1800 includes a tissue growth promoting covering and/or coating.
When expanded, the arms 1911 may be used to anchor the tube 1901 (and the anchor assembly) within the ventricle wall. In some examples, the arms 1911 may be used as a one of two retaining features to retain the anchor assembly coupled to the ventricle wall.
This application claims priority to U.S. Provisional Application No. 63/158,831, entitled “MITRAL VALVE IMPLANTS,” filed on Mar. 9, 2021, and to U.S. Provisional Patent Application No. 63/120,854, entitled “TETHERED STRUCTURAL HEART REMODELING,” filed on Dec. 3, 2020, each of which is herein incorporated by reference in its entirety.
Filing Document | Filing Date | Country | Kind |
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PCT/US2021/061787 | 12/3/2021 | WO |
Number | Date | Country | |
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63120854 | Dec 2020 | US | |
63158831 | Mar 2021 | US |