Patent Grant
9937042
The present invention relates in general to valve repair, and more specifically to repair of an atrioventricular valve of a patient.
Ischemic heart disease causes mitral regurgitation by the combination of ischemic dysfunction of the papillary muscles, and the dilatation of the left ventricle that is present in ischemic heart disease, with the subsequent displacement of the papillary muscles and the dilatation of the mitral valve annulus. Dilation of the annulus of the mitral valve prevents the valve leaflets from fully coapting when the valve is closed. Mitral regurgitation of blood from the left ventricle into the left atrium results in increased total stroke volume and decreased cardiac output, and ultimate weakening of the left ventricle secondary to a volume overload and a pressure overload of the left atrium.
Dilation of the annulus of the mitral valve prevents the valve leaflets from fully coapting when the valve is closed. Mitral regurgitation of blood from the left ventricle into the left atrium results in increased total stroke volume and decreased cardiac output, and ultimate weakening of the left ventricle secondary to a volume overload and a pressure overload of the left atrium.
US Patent Application Publication 2007/0055206 to To et al., which is incorporated herein by reference, describes devices, methods, and kits for deployment of tissue anchors. In some variations, the devices comprise a shaft defining a lumen for housing at least one anchor therein (the anchor having an eyelet) and a mechanism for deploying the anchor distally from the lumen, wherein the inner diameter of the lumen is the same size or smaller than the diameter of the eyelet of the anchor to be disposed therein when the anchor is in an expanded configuration. In some variations, the methods comprise loading an anchor within a lumen of a shaft (where the anchor comprises an eyelet and the shaft has a slot therethrough), passing a linking member through the slot and through the eyelet of the anchor, and deploying the anchor. Other methods comprise loading an anchor within a lumen of a shaft, and deploying the anchor distally from the lumen.
US Patent Application Publication 2007/0080188 to Spence et al., which is incorporated herein by reference, describes systems and methods for securing tissue including the annulus of a mitral valve. The systems and methods may employ catheter based techniques and devices to plicate tissue and perform an annuloplasty. Magnets may be used for guidance in deploying fasteners from a catheter. The fasteners are cinched with a flexible tensile member.
U.S. Pat. No. 6,619,291 to Hlavka et al., which is incorporated herein by reference, describes a minimally invasive method of performing annuloplasty. A method for performing a procedure on a mitral valve of a heart includes inserting an implant into a left ventricle and orienting the implant in the left ventricle substantially below the mitral valve. The implant and tissue around the mitral valve are connected and tension is provided to the implant, in one embodiment, in order to substantially reduce an arc length associated with the mitral valve. In another embodiment, the implant is inserted into the left ventricle through the aorta and the aortic valve.
US Patent Application Publication 2006/0241656 to Starksen et al., which is incorporated herein by reference, describes devices, systems and methods for facilitating positioning of a cardiac valve annulus treatment device, thus enhancing treatment of the annulus. Methods generally involve advancing an anchor delivery device through vasculature of the patient to a location in the heart for treating the valve annulus, contacting the anchor delivery device with a length of the valve annulus, delivering a plurality of coupled anchors from the anchor delivery device to secure the anchors to the annulus, and drawing the anchors together to circumferentially tighten the valve annulus. Devices generally include an elongate catheter having at least one tensioning member and at least one tensioning actuator for deforming a distal portion of the catheter to help it conform to a valve annulus. The catheter device may be used to navigate a subannular space below a mitral valve to facilitate positioning of an anchor delivery device.
US Patent Application Publication 2007/0051377 to Douk et al., which is incorporated herein by reference, describes a catheter-based, annulus reduction device and system for cardiac valve repair and method of using the same. The system is usable for treating mitral valve regurgitation and comprises a catheter, a reduction ring carried within the catheter, the reduction ring including a plurality of exit ports formed in a side wall of the reduction ring and filament received in the reduction ring. The filament includes a plurality of radially extendible barbs corresponding to the sidewall openings. The reduction ring carrying the filament is deployed adjacent a mitral valve annulus and the filament is translated relative to the reduction ring to deploy the barbs through the exit ports and into the annulus and to further translate the reduction ring with deployed barbs to reshape the annulus.
US Patent Application Publication 2006/0025787 to Morales et al., which is incorporated herein by reference, describes methods and devices that provide constriction of a heart valve annulus to treat cardiac valve regurgitation and other conditions. Embodiments typically include a device for attaching a cinching or tightening apparatus to a heart valve annulus to reduce the circumference of the annulus, thus reducing valve regurgitation. Tightening devices may include multiple tethered clips, multiple untethered crimping clips, stabilizing devices, visualization devices, and the like. In one embodiment, a plurality of tethered clips is secured circumferentially to a valve annulus, and the tether coupling the clips is cinched to reduce the circumference of at least a portion of the annulus. Methods and devices may be used in open heart surgical procedures, minimally invasive procedures, catheter-based procedures, and/or procedures on beating hearts or stopped hearts.
U.S. Pat. No. 7,431,692 to Zollinger et al., which is incorporated herein by reference, describes an adjustable support pad for adjustably holding a tensioning line used to apply tension to a body organ. The adjustable support pad can include a locking mechanism for preventing slidable movement of the tensioning element in one or both directions. The locking mechanism may include spring-loaded locks, rotatable cam-like structures, and/or rotatable spool structures. The adjustable support pad may be formed from rigid, semi-rigid, and/or flexible materials, and may be formed to conform to the outer surface of a body organ. The adjustable support pad can be configured to adjustably hold one or more separate tensioning lines, and to provide for independent adjustment of one or more tensioning lines or groups thereof.
US Patent Application Publication 2007/0016287 to Cartledge et al., which is incorporated herein by reference, describes an implantable device for controlling shape and/or size of an anatomical structure or lumen. The implantable device has an adjustable member configured to adjust the dimensions of the implantable device. The implantable device is housed in a catheter and insertable from a minimally invasive surgical entry. An adjustment tool actuates the adjustable member and provide for adjustment before, during or after the anatomical structure or lumen resumes near normal to normal physiologic function.
US Patent Application Publication 2004/0236419 to Milo, which is incorporated herein by reference, describes methods for reconfiguring an atrioventricular heart valve that may use systems comprising a partial or complete annuloplasty rings proportioned to reconfigure a heart valve that has become in some way incompetent, a pair of trigonal sutures or implantable anchors, and a plurality of staples which may have pairs of legs that are sized and shaped for association with the ring at spaced locations along its length. These systems permit relative axial movement between the staples and the ring, whereby a patient's heart valve can be reconfigured in a manner that does not deter subtle shifting of the native valve components. Shape-memory alloy material staples may have legs with free ends that interlock following implantation. Annuloplasty rings may be complete or partial and may be fenestrated. One alternative method routes a flexible wire, preferably of shape-memory material, through the bights of pre-implanted staples. Other alternative systems use linkers of shape-memory material having hooked ends to interengage with staples or other implanted supports which, following implantation, decrease in effective length and pull the staples or other supports toward one another so as to create desired curvature of the reconfigured valve. These linkers may be separate from the supports or may be integral with them and may have a variety of shapes and forms. Various ones of these systems are described as being implanted non-invasively using a delivery catheter.
US Patent Application Publication 2005/0171601 to Cosgrove et al., which is incorporated herein by reference, describes an annuloplasty repair segment and template for heart valve annulus repair. The elongate flexible template may form a distal part of a holder that also has a proximal handle. Alternatively, the template may be releasably attached to a mandrel that slides within a delivery sheath, the template being released from the end of the sheath to enable manipulation by a surgeon. A tether connecting the template and mandrel may also be provided. The template may be elastic, temperature responsive, or multiple linked segments. The template may be aligned with the handle and form a two- or three-dimensional curve out of alignment with the handle such that the annuloplasty repair segment attached thereto conforms to the curve. The template may be actively or passively converted between its straight and curved positions. The combined holder and ring is especially suited for minimally-invasive surgeries in which the combination is delivered to an implantation site through a small access incision with or without a cannula, or through a catheter passed though the patient's vasculature.
U.S. Pat. No. 6,296,656 to Bolduc et al. describes a helical fastener having a high retentive surface area. The helical fastener has a first end for enhancing penetration into tissue and a second end comprising a coil sectioning a diameter of the fastener for receiving longitudinal and rotational forces. The helical fasteners are attached to body tissue by a fastener applicator having a proximal portion comprising a handle and an actuator and an elongate distal portion for housing a plurality of fasteners. A transferring action of the actuator provides longitudinal and rotational movement of the fasteners out of the distal portion and into body tissue.
U.S. Pat. No. 7,229,452 to Kayan describes a surgical tack for securing a surgical mesh material to body tissue. The tack includes a pair of legs and an arcuate cross-member. A surgical tack applier is also disclosed, for applying the surgical tack. The applier includes an elongate tubular portion having a jacket with a main channel and a pair of longitudinally extending sub-channels. A rotatable drive rod having a helical thread is coupled to the applier, and the sub-channels receive the legs of the tack. The helical thread receives the arcuate cross-member of the surgical tack. Rotation of the drive rod drives the tack from the distal end of the applier.
The following patents and patent application publications, all of which are incorporated herein by reference, may be of interest:
U.S. Pat. No. 5,306,296 to Wright et al.
U.S. Pat. No. 5,674,279 to Wright et al.
U.S. Pat. No. 5,961,539 to Northrup, III et al.
U.S. Pat. No. 6,524,338 to Gundry
U.S. Pat. No. 6,569,198 to Wilson et al.
U.S. Pat. No. 6,602,288 to Cosgrove et al.
U.S. Pat. No. 6,602,289 to Colvin et al.
U.S. Pat. No. 6,689,164 to Seguin
U.S. Pat. No. 6,702,826 to Liddicoat et al.
U.S. Pat. No. 6,718,985 to Hlavka et al.
U.S. Pat. No. 6,764,510 to Vidlund et al.
U.S. Pat. No. 7,004,176 to Lau
U.S. Pat. No. 7,101,395 to Tremulis et al.
U.S. Pat. No. 7,175,660 to Cartledge et al.
U.S. Pat. No. 7,186,262 to Saadat
U.S. Pat. No. 7,686,822 to Shayani
US Patent Application Publication 2002/0087048 to Brock et al.
US Patent Application Publication 2002/0173841 to Ortiz et al.
US Patent Application Publication 2003/0050693 to Quijano et al.
US Patent Application Publication 2003/0167062 to Gambale et al.
US Patent Application Publication 2004/0024451 to Johnson et al.
US Patent Application Publication 2004/0122514 to Fogarty et al.
US Patent Application Publication 2004/0148021 to Cartledge et al.
US Patent Application Publication 2005/0055087 to Starksen
US Patent Application Publication 2005/0288781 to Moaddeb et al.
US Patent Application Publication 2006/0069429 to Spence et al.
US Patent Application Publication 2007/0162111 to Fukamachi et al.
US Patent Application Publication 2007/0255400 to Parravicini et al.
US Patent Application Publication 2008/0004697 to Lichtenstein et al.
PCT Publication WO 01/26586 to Seguin
PCT Publication WO 02/085251 to Hlavka et al.
PCT Publication WO 02/085252 to Hlavka et al.
PCT Publication WO 06/097931 to Gross et al.
PCT Publication WO 07/136783 to Cartledge et al.
PCT Publication WO 08/068756 to Gross et al.
PCT Publication WO 10/004546 to Gross et al.
The following articles, all of which are incorporated herein by reference, may be of interest:
In some embodiments of the present invention, an adjustable partial annuloplasty ring is provided for repairing a dilated valve annulus of an atrioventricular valve, such as a mitral valve. The annuloplasty ring comprises a flexible sleeve and a plurality of anchors. An anchor deployment manipulator is advanced into a lumen of the sleeve, and, from within the lumen, deploys the anchors through a wall of the sleeve and into cardiac tissue, thereby anchoring the sleeve around a portion of the valve annulus. The anchors are typically deployed from a distal end of the manipulator while the distal end is positioned such that a central longitudinal axis through the distal end of the manipulator forms an angle with a surface of the cardiac tissue of between about 45 and 90 degrees, e.g., between about 75 and 90 degrees, such as about 90 degrees. Typically, the anchors are deployed from the distal end of the manipulator into the cardiac tissue in a direction parallel to the central longitudinal axis through the distal end of the manipulator.
In some embodiments of the present invention, the anchors are deployed from the left atrium into the upper region of the ventricular wall near the atrium, tissue of which generally provides more secure anchoring than does the atrial wall. The above-mentioned angle of deployment enables such deployment into the upper region of the ventricular wall.
In some embodiments of the present invention, the anchor deployment manipulator comprises a steerable outer tube in which is positioned an anchor driver having an elongated, flexible shaft. Rotation of the anchor driver screws the anchors into the cardiac tissue. The anchors may, for example, be helical in shape. For some applications, the plurality of anchors are applied using the manipulator by loading a first one of the anchors onto the anchor driver, and deploying the anchor into the cardiac tissue. The anchor driver is withdrawn from the body of the subject, and a second one of the anchors is loaded onto the anchor driver. The anchor driver is reintroduced into the sleeve of the annuloplasty ring, and the second anchor is deployed. These steps are repeated until all of the anchors have been deployed. Alternatively, the anchor driver is configured to simultaneously hold a plurality of anchors, and to deploy them one at a time.
Typically, the manipulator is gradually withdrawn in a proximal direction during the anchoring procedure as anchors are deployed. The first anchor is thus deployed most distally in the sleeve (generally at or within a few millimeters of the distal tip of the sleeve), and each subsequent anchor is deployed more proximally.
The annuloplasty ring is typically configured to be placed only partially around the valve annulus (i.e., to assume a C-shape), and, once anchored in place, to be contracted so as to circumferentially tighten the valve annulus. To this end, the annuloplasty ring comprises a flexible contracting member such as a wire, which is typically positioned within the lumen of the sleeve. The annuloplasty ring further comprises a contracting mechanism which facilitates contracting of the annuloplasty ring. For some applications, the contracting mechanism comprises a spool to which a first end of the contracting member is coupled. The spool is positioned in a vicinity of either the proximal or the distal end of the sleeve. A second end of the contracting member is coupled to the sleeve in a vicinity of the end of the sleeve opposite the end to which the spool is positioned. Rotation of the spool winds a portion of the contracting member around the spool, thereby pulling the far end of the ring toward the spool and tightening the ring. For some applications, the spool is positioned in a vicinity of the distal end of the sleeve, and is oriented such that a driving interface thereof is accessible from within the sleeve. A screwdriver tool is inserted into the sleeve, and used to rotate the spool via the driving interface of the spool.
All of the tools and elements of the annuloplasty system that are introduced into left atrium are contained within the sleeve of the annuloplasty ring, which reduces the risk that any elements of the system will accidentally be released to the blood circulation, or damage surrounding tissue. In addition, the lumen of the sleeve provides guidance if it should be necessary to return to a previously deployed anchor, such as to tighten, loosen, remove, or relocate the anchor. For some applications, the anchors comprise helical screws, which facilitate such adjusting or removing.
The annuloplasty ring may be advanced toward the annulus of a valve in any suitable procedure, e.g., a transcatheter procedure, a minimally invasive procedure, or an open heart procedure.
In some embodiments of the present invention, an anchor tissue deployment system comprises an anchor deployment tool and a plurality of tissue anchors. The anchor deployment tool comprises a flexible outer tube, a flexible inner shaft, which is positioned within the flexible outer tube, and a rotating deployment element, which is coupled to the distal end of the shaft. The anchor deployment tool is configured to provide an anchor storage area. The storage area initially stores the plurality of tissue anchors, such that the flexible inner shaft passes through channels that pass through each of the anchors, and the anchors are within the flexible outer tube. The rotating deployment element is configured to directly engage the anchors in the anchor storage area one at a time, advance each of the anchors while engaged in a distal direction, and deploy each of the anchors through the distal end of the outer tube and into tissue of a subject. Typically, the anchor deployment tool is configured to provide steering functionality to a distal anchor manipulation area of the anchor deployment tool between the anchor storage area and the distal tube end.
For some applications, the anchor deployment tool is configured such that, as the rotating deployment element advances each of the anchors in the distal direction, only the single anchor currently being advanced is within the distal anchor manipulation area of the anchor deployment tool. For some applications, the anchor deployment tool is configured to deploy each of the anchors into the tissue in a direction parallel to a central longitudinal axis of the outer tube through the distal tube end, and parallel to a central longitudinal axis of the anchor.
For some applications, the rotating deployment element is configured to pass through one or more of the anchors without engaging the anchors when the rotating deployment element is withdrawn in a proximal direction within the outer tube, and to directly engage one of the anchors when the rotating deployment element is advanced in the distal direction against the one of the anchors. Typically, the rotating deployment element is configured to assume a radially-compressed state when passing through the one or more of the anchors without engaging the anchors, and to assume a radially-expanded state when engaging the one of the anchors.
For some applications, the anchor deployment tool further comprises an anchor restraining mechanism in a vicinity of the distal anchor storage end. The mechanism is configured to temporarily restrain at least the distal-most anchor currently stored in the anchor storage area from advancing in the distal direction.
For some applications, each of the anchors comprises a helical tissue coupling element, and a tool-engaging head, fixed to one end of the tissue coupling element. The tool-engaging head is shaped so as to define an engaging opening that is at least partially non-circular, and that passes entirely through the tool-engaging head along the axis. The end of the tissue coupling element is fixed to the tool-engaging head near an outer perimeter of the tool-engaging head, such that the tissue coupling element does not block the engaging opening. The tissue coupling element and the tool-engaging head together define a channel along an entire length of the tissue anchor, which channel is sized and shaped such that a right circular cylinder could be placed within the channel, coaxial with the tissue anchor, and along the entire length of the tissue anchor. The cylinder typically has a diameter of at least 1 mm, such as at least 2 mm.
For some applications, the rotating deployment element is capable of unscrewing an already-deployed anchor from the tissue, withdrawing the anchor in a proximal direction, and subsequently redeploying the anchor into the tissue. For some applications, to enable such redeployment, the rotating deployment element is configured to selectively assume (a) a locked state, in which the rotating deployment element engages one of the anchors, such that the rotating deployment element can withdraw the anchor in the proximal direction, and (b) an unlocked state, in which the rotating deployment element does not engage the anchor.
For some applications, the anchor deployment system is used to deploy anchors for coupling an annuloplasty ring to tissue of a native cardiac valve of the subject, such as a mitral valve. For example, the annuloplasty ring may comprise a sleeve having a lumen, and the anchor deployment tool may be configured to be removably positioned within the lumen of the sleeve, and, while so positioned, to deploy the anchors from the distal tube end through a wall of the sleeve into the tissue. Alternatively applications for the anchor deployment system include delivery anchors via a working channel of an endoscope, such as to mount and secure a support mesh for treating a hernia.
There is therefore provided, in accordance with an embodiment of the present invention, apparatus including an annuloplasty system for use on a subject, which includes:
an annuloplasty ring, which includes a sleeve having a lumen;
at least one anchor, shaped so as to define a coupling head and a tissue coupling element, which tissue coupling element is shaped so as to define a longitudinal axis, and is configured to penetrate cardiac tissue of the subject in a direction parallel to the longitudinal axis; and
an anchor deployment manipulator, configured to be removably positioned within the lumen of the sleeve, and, while so positioned, to deploy the tissue coupling element from a distal end of the deployment manipulator through a wall of the sleeve into the cardiac tissue in the direction parallel to the longitudinal axis of the tissue coupling element and parallel to a central longitudinal axis of the deployment manipulator through the distal end of the deployment manipulator.
Typically, the annuloplasty ring includes a partial annuloplasty ring.
For some applications, the coupling element is shaped so as to define a shape selected from the group consisting of: a helix, a spiral, and a screw shaft.
In an embodiment, the annuloplasty ring includes a spool coupled to the sleeve, and a flexible contracting member that is coupled to the spool and the sleeve, such that winding the contracting member around the spool tightens the ring.
In an embodiment, the deployment manipulator includes steering functionality. For some applications, the deployment manipulator includes a tube, which is configured to provide the steering functionality; and an anchor driver, which includes an elongated, flexible shaft which is at least partially positioned within the tube.
In an embodiment, the deployment manipulator is configured to deploy the at least one anchor from the distal end of the deployment manipulator through the wall of the sleeve into the cardiac tissue, while the distal end of the deployment manipulator is positioned such that the central longitudinal axis through the distal end of the deployment manipulator forms an angle of between 45 and 90 degrees with the wall of the sleeve at a point at which the anchor penetrates the wall. For some applications, the point on the wall is a first point on the wall, and the angle is a first angle, the at least one anchor is a first anchor of a plurality of anchors that also includes a second anchor most recently deployed before the first anchor through a second point on the wall, and the deployment manipulator is configured to deploy the first anchor while the distal end of the deployment manipulator is positioned such that the central longitudinal axis forms a second angle of between 45 and 90 degrees with a line defined by the first point and the second point.
For some applications, the apparatus further includes a pusher element which is positioned within the sleeve, and which is configured to, upon being pushed distally, move the distal end of the deployment manipulator proximally within the sleeve by engaging an interior surface of the sleeve.
There is further provided, in accordance with an embodiment of the present invention, a method including:
positioning an anchor deployment manipulator at least partially within a lumen of a sleeve of an annuloplasty ring;
placing, into an atrium of a subject in a vicinity of an annulus of an atrioventricular valve, at least a portion of the sleeve that contains a distal end of the deployment manipulator; and
deploying at least one anchor from the distal end of the deployment manipulator through a wall of the sleeve such that a coupling element of the anchor enters cardiac tissue of the subject in a direction parallel to a central longitudinal axis of the deployment manipulator through the distal end of the deployment manipulator.
In an embodiment, deploying includes deploying the at least one anchor from the distal end of the deployment manipulator through the wall of the sleeve into the cardiac tissue, while the distal end of the deployment manipulator is positioned such that the central longitudinal axis of the deployment manipulator through the distal end of the deployment manipulator forms an angle of between 45 and 90 degrees with the wall of the sleeve at a point at which the anchor penetrates the wall. For some applications, the point on the wall is a first point on the wall, and the angle is a first angle, the at least one anchor is a first anchor of a plurality of anchors that also includes a second anchor most recently deployed before the first anchor through a second point on the wall, and deploying the first anchor includes deploying the first anchor while the distal end of the deployment manipulator is positioned such that the central longitudinal axis forms a second angle of between 45 and 90 degrees with a line defined by the first point and the second point.
Typically, the annuloplasty ring includes a partial annuloplasty ring, and positioning the deployment manipulator includes positioning the deployment manipulator within the lumen of the partial annuloplasty ring.
In an embodiment, the deployment manipulator includes steering functionality, and placing the sleeve includes steering the deployment manipulator using the steering functionality.
For some applications, deploying the anchor includes deploying the anchor from the atrium into an upper region of a ventricular wall near the atrium.
For some applications, the method further includes positioning a pusher element at least partially within the lumen of the sleeve of the annuloplasty ring; and moving the distal end of the deployment manipulator proximally within the sleeve by pushing the pusher element distally such that the pusher element engages an interior surface of the sleeve.
In an embodiment, the method further includes tightening the annuloplasty ring by winding a flexible contracting member of the ring around a spool coupled to the ring.
There is still further provided, in accordance with an embodiment of the present invention, apparatus including an annuloplasty system for use on a subject, which includes:
an annuloplasty ring, which includes a sleeve having a lumen;
at least one anchor; and
an anchor deployment manipulator, configured to be removably positioned within the lumen of the sleeve, and, while so positioned, to deploy the at least one anchor from a distal end of the deployment manipulator through a wall of the sleeve into cardiac tissue of the subject, while the distal end of the deployment manipulator is positioned such that a central longitudinal axis of the deployment manipulator through the distal end of the deployment manipulator forms an angle of between 45 and 90 degrees with the wall of the sleeve at a point at which the anchor penetrates the wall.
Typically, the annuloplasty ring includes a partial annuloplasty ring.
In an embodiment, the deployment manipulator includes steering functionality.
For some applications, the point on the wall is a first point on the wall, and the angle is a first angle, the at least one anchor is a first anchor of a plurality of anchors that also includes a second anchor most recently deployed before the first anchor through a second point on the wall, and the anchor deployment manipulator is configured to deploy the first anchor while the distal end of the deployment manipulator is positioned such that the central longitudinal axis forms a second angle of between 45 and 90 degrees with a line defined by the first point and the second point.
For some applications, the anchor is shaped so as to define a coupling head and a tissue coupling element, which tissue coupling element is shaped so as to define a longitudinal axis, and is configured to penetrate cardiac tissue of the subject in a direction parallel to the longitudinal axis, and the anchor deployment manipulator is configured to deploy the anchor from the distal end of the deployment manipulator such that the coupling element enters the cardiac tissue in a direction parallel to the central longitudinal axis of the deployment manipulator through the distal end of the deployment manipulator.
For some applications, the anchor is shaped so as to define a coupling head and a tissue coupling element, which is shaped so as to define a shape selected from the group consisting of: a helix, a spiral, and a screw shaft.
There is additionally provided, in accordance with an embodiment of the present invention, a method including:
positioning an anchor deployment manipulator at least partially within a lumen of a sleeve of an annuloplasty ring;
placing, into an atrium of a subject in a vicinity of an annulus of an atrioventricular valve, at least a portion of the sleeve that contains a distal end of the deployment manipulator; and
deploying at least one anchor from the distal end of the deployment manipulator through a wall of the sleeve into cardiac tissue of the subject, while the distal end of the deployment manipulator is positioned such that a central longitudinal axis of the deployment manipulator through the distal end of the deployment manipulator forms an angle of between 45 and 90 degrees with the wall of the sleeve at a point at which the anchor penetrates the wall.
For some applications, deploying includes deploying the at least one anchor while the angle is between 75 and 90 degrees.
In an embodiment, the deployment manipulator includes steering functionality, and placing the sleeve includes steering the deployment manipulator using the steering functionality.
Typically, the annuloplasty ring includes a partial annuloplasty ring, and positioning the anchor deployment manipulator includes positioning the anchor deployment manipulator at least partially within the lumen of the partial annuloplasty ring.
For some applications, the point on the wall is a first point on the wall, and the angle is a first angle, the at least one anchor is a first anchor of a plurality of anchors that also includes a second anchor most recently deployed before the first anchor through a second point on the wall, and deploying the first anchor includes deploying the first anchor while the distal end of the deployment manipulator is positioned such that the central longitudinal axis forms a second angle of between 45 and 90 degrees with a line defined by the first point and the second point.
For some applications, deploying the anchor includes deploying the anchor from the distal end of the deployment manipulator such that a coupling element of the anchor enters the cardiac tissue in a direction parallel to the central longitudinal axis.
For some applications, the anchor is shaped so as to define a coupling head and a tissue coupling element, which is shaped so as to define a shape selected from the group consisting of: a helix, a spiral, and a screw shaft, and deploying the anchor includes screwing the tissue coupling element into the cardiac tissue.
In an embodiment, the method further includes tightening the annuloplasty ring by winding a flexible contracting member of the ring around a spool coupled to the ring.
For some applications, deploying the anchor includes deploying the anchor from the atrium into an upper region of a ventricular wall near the atrium.
For some applications, the deployment manipulator includes an anchor driver positioned within a sheath, the at least one anchor includes a plurality of anchors, and deploying the at least one anchor includes:
For some applications, placing the at least a portion of the sleeve includes placing the at least a portion of the sleeve into a right atrium of the subject in a vicinity of a tricuspid valve. Alternatively, placing the at least a portion of the sleeve includes placing the at least a portion of the sleeve into a left atrium of the subject in a vicinity of the annulus of a mitral valve.
There is yet additionally provided, in accordance with an embodiment of the present invention, a method including:
positioning, during a transcatheter procedure, an anchor deployment manipulator at least partially in an atrium of a subject;
placing, into the atrium in a vicinity of an annulus of an atrioventricular valve, at least a portion of an annuloplasty ring; and
coupling the annuloplasty ring to cardiac tissue by deploying at least one anchor from the deployment manipulator in the atrium and into an upper region of a ventricular wall near the atrium.
Typically, the atrioventricular valve is selected from the group consisting of: a mitral valve and a tricuspid valve.
In an embodiment, positioning the anchor deployment manipulator includes positioning at least a distal end of the deployment manipulator within a lumen of a sleeve of the annuloplasty ring, and coupling includes coupling the ring to the cardiac tissue by deploying the at least one anchor from the distal end of the deployment manipulator in the atrium, through a wall of the sleeve, and into the upper region of the ventricular wall. For some applications, deploying the anchor includes deploying the anchor into the upper region of the ventricular wall while the distal end of the deployment manipulator is positioned such that a central longitudinal axis of the deployment manipulator through the distal end of the deployment manipulator forms an angle of between 45 and 90 degrees with the wall of the sleeve at a point at which the anchor penetrates the wall.
For some applications, deploying the anchor includes deploying the anchor from the distal end of the deployment manipulator into the upper region of ventricular wall such that a coupling element of the anchor enters the ventricular wall in a direction parallel to a central longitudinal axis of the deployment manipulator through the distal end of the deployment manipulator.
There is also provided, in accordance with an embodiment of the present invention, apparatus including an annuloplasty system for use on a subject, the system including:
an annuloplasty ring, which includes a sleeve having a lumen;
at least one anchor;
an anchor deployment manipulator, which is configured to be removably positioned within the lumen of the sleeve, and which is configure to deploy the at least one anchor through a wall of the sleeve into cardiac tissue of the subject; and
a pusher element which is positioned within the sleeve, and which is configured to, upon being pushed distally, move the distal end of the deployment manipulator proximally within the sleeve by engaging an interior surface of the sleeve.
In an embodiment, the deployment manipulator includes an outer tube that is shaped so as to define an opening that is within 3 mm of a distal end of the tube; and an anchor driver that is positioned at least partially within the outer tube, and which is configured to deploy the at least one anchor, and the pusher element is positioned such that a proximal portion thereof is within the outer tube, and a distal portion thereof extends out of the tube through the opening and into the lumen of the sleeve.
In an embodiment, the deployment manipulator includes an outer tube; and an anchor driver that is positioned at least partially within the outer tube, and which is configured to deploy the at least one anchor, and the pusher element is positioned outside of the outer tube.
For some applications, the pusher element is configured to, upon being pushed distally, move the distal end of the deployment manipulator proximally within the sleeve by engaging a distal end of the sleeve. Alternatively or additionally, the pusher element is configured to, upon being pushed distally, move the distal end of the deployment manipulator proximally within the sleeve by engaging the wall of the sleeve.
Typically, the annuloplasty ring includes a partial annuloplasty ring.
In an embodiment, the annuloplasty ring includes a spool coupled to the sleeve, and a flexible contracting member that is coupled to the spool and the sleeve, such that winding the contracting member around the spool tightens the ring.
There is further provided, in accordance with an embodiment of the present invention, a method including:
positioning an anchor deployment manipulator and a pusher element at least partially within a lumen of a sleeve of an annuloplasty ring;
placing, into an atrium of a subject in a vicinity of an annulus of an atrioventricular valve, at least a portion of the sleeve that contains a distal end of the deployment manipulator and a distal end of the pusher element;
moving the distal end of the deployment manipulator proximally within the sleeve by pushing the pusher element distally such that the pusher element engages an interior surface of the sleeve; and
after moving the distal end of the deployment manipulator, deploying an anchor from the distal end of the deployment manipulator through a wall of the sleeve into cardiac tissue.
For some applications, the deployment manipulator includes an outer tube that is shaped so as to define an opening that is within 3 mm of a distal end of the tube, and positioning the pusher element at least partially within the lumen of the sleeve includes positioning the pusher element such that (a) a distal portion of the pusher element extends out of the tube through the opening and into the lumen of the sleeve, and (b) a proximal portion of the pusher element passes through the tube from the opening to a proximal end of the tube.
For some applications, the deployment manipulator includes an outer tube, and positioning the pusher element at least partially within the lumen of the sleeve includes positioning the pusher element outside of the outer tube.
For some applications, moving includes moving the distal end of the deployment manipulator by pushing the pusher element distally such that the pusher element engages a distal end of the sleeve. Alternatively or additionally, moving includes moving the distal end of the deployment manipulator by pushing the pusher element distally such that the pusher element engages the wall of the sleeve.
For some applications, moving the distal end of the deployment manipulator includes moving the distal end of the deployment manipulator a certain distance by pushing the pusher element the certain distance.
There is still further provided, in accordance with an embodiment of the present invention, apparatus including an annuloplasty ring for use on a subject, which includes:
a sleeve shaped so as to define a lumen therein that is open at a proximal end of the sleeve;
a contracting mechanism, coupled to the sleeve in a vicinity of a distal end of the sleeve; and
an elongated contracting member, a first end of which is coupled to the contracting mechanism, and a second end of which is coupled to the sleeve in a vicinity of the proximal end of the sleeve,
wherein the contracting mechanism includes a driving interface that is positioned so as to be accessible from within the lumen of the sleeve, and
wherein the contracting mechanism is configured such that rotation of the driving interface shortens the ring by tightening the elongated contracting member.
Typically, the annuloplasty ring includes a partial annuloplasty ring.
For some applications, the apparatus further includes a screwdriver tool, which includes a head and a shaft, and the screwdriver tool is configured to be removably inserted partially into the lumen of the sleeve via the proximal end of the sleeve, such that the head is removably coupled from within the lumen to the driving interface of the contracting mechanism.
In an embodiment, the apparatus further includes at least one anchor; and an anchor deployment manipulator, configured to be removably positioned within the lumen of the sleeve, and, while so positioned, to deploy the anchor from a distal end of the deployment manipulator through a wall of the sleeve into cardiac tissue of the subject.
There is additionally provided, in accordance with an embodiment of the present invention, a method including:
coupling a sleeve of an annuloplasty ring to cardiac tissue of a subject at a plurality of sites in a vicinity of an annulus of an atrioventricular valve;
partially inserting a screwdriver tool into a lumen of the sleeve, the tool having a head and a shaft; and
rotating the screwdriver tool such that the head, while within the lumen of the sleeve, shortens the ring by rotating a contracting mechanism of the ring that tightens an elongated contracting member coupled to the sleeve.
Typically, the annuloplasty ring includes a partial annuloplasty ring, and coupling includes coupling the sleeve of the partial annuloplasty ring to the cardiac tissue.
There is further provided, in accordance with an application of the present invention, apparatus including:
a plurality of tissue anchors, which are shaped so as to define respective channels along entire longitudinal lengths of the anchors; and
an anchor deployment tool, which includes:
wherein the anchor deployment tool is configured to provide an anchor storage area, which is configured to initially store the plurality of tissue anchors, such that the flexible inner shaft passes through the channels of the anchors, and the anchors are within the flexible outer tube, and
wherein the rotating deployment element is configured to directly engage the anchors in the anchor storage area one at a time, advance each of the anchors while engaged in a distal direction, and deploy each of the anchors through the distal tube end and into tissue of a subject.
Typically, the anchor deployment tool is configured such that, as the rotating deployment element advances each of the anchors in the distal direction, only the single anchor currently being advanced is within a distal anchor manipulation area of the anchor deployment tool between the distal anchor storage area end and the distal tube end.
For some applications, the anchor deployment tool is configured to deploy each of the anchors into the tissue in a direction parallel to a central longitudinal axis of the outer tube through the distal tube end, and parallel to a central longitudinal axis of the anchor.
For some applications, the anchor storage area has a distal anchor storage end at a distance of between 1 and 90 cm from the distal tube end, such as between 5 and 25 cm.
For some applications, the anchor deployment tool is configured to provide steering functionality to a distal anchor manipulation area of the anchor deployment tool between the distal anchor storage area end and the distal tube end. For some applications, the flexible outer tube is configured to provide the steering functionality to the distal anchor manipulation area. Alternatively or additionally, the flexible inner shaft is configured to provide the steering functionality to the distal anchor manipulation area.
For some applications, the rotating deployment element is configured to pass through one or more of the anchors without engaging the anchors when the rotating deployment element is withdrawn in a proximal direction within the outer tube, and to directly engage one of the anchors when the rotating deployment element is advanced in the distal direction against the one of the anchors. Typically, the rotating deployment element is configured to assume a radially-compressed state when passing through the one or more of the anchors without engaging the anchors, and to assume a radially-expanded state when engaging the one of the anchors.
For some applications, the anchor deployment tool further includes a spring, which is arranged to apply a distally-directed force to a proximal-most one of the anchors stored within the anchor storage area, which force advances the anchors remaining in the anchor storage area in the distal direction, when the rotating deployment element advances a distal-most one of the anchors out of the anchor storage area in the distal direction. Alternatively, for some applications, the anchor storage area is configured to provide a plurality of anchor storage locations, the anchors are initially stored in respective ones of at least a portion of the anchor storage locations, and when the rotating deployment element advances a distal-most one of the anchors out of the anchor storage area in the distal direction, the anchors remaining in the anchor storage area remain in their respective initial anchor storage locations.
For some applications, the plurality of anchors includes at least 6 anchors.
For some applications, the anchor deployment tool further includes an anchor restraining mechanism in a vicinity of a distal end of the anchor storage area, which mechanism is configured to temporarily restrain at least a distal-most one of the anchors currently stored in the anchor storage area from advancing in the distal direction.
For some applications, each of the anchors has a central longitudinal axis, and includes:
a helical tissue coupling element, having proximal and distal ends; and
a tool-engaging head, fixed to the proximal end of the tissue coupling element, which tool-engaging head is shaped so as to define a non-circular engaging opening that passes entirely through the tool-engaging head along the axis,
wherein the tissue coupling element and the tool-engaging head together define the channel of the tissue anchor along an entire length of the tissue anchor, which channel is sized and shaped such that a right circular cylinder could be placed within the channel, coaxial with the tissue anchor, and along the entire length of the tissue anchor, and
wherein the rotating coupling element is configured to removably engage the tool-engaging head.
For some applications, the cylinder has a diameter of at least 1 mm, such as at least 2 mm.
For some applications, the apparatus further includes an annuloplasty ring, which includes a sleeve having a lumen, and the anchor deployment tool is configured to be removably positioned within the lumen of the sleeve, and, while so positioned, to deploy the anchors from the distal tube end through a wall of the sleeve into the tissue.
For some applications, the distance between the distal anchor storage end and the distal tube end is between 5 and 25 cm.
For some applications, the anchor deployment tool further includes a hemostasis valve, which includes a distal port to which a proximal end of the flexible outer tube is sealingly coupled. The flexible inner shaft passes through the valve, which maintains a seal around the inner shaft, while allowing the inner shaft to slide distally and proximally through the valve.
For some applications, the rotating deployment element is capable of unscrewing an already-deployed one of the anchors from the tissue, withdrawing the anchor in a proximal direction, and subsequently redeploying the anchor into the tissue.
For some applications, the rotating deployment element includes a locking mechanism that is configured to selectively assume (a) a locked state, in which the locking mechanism, even upon withdrawal of the rotating deployment element in a proximal direction, prevents disengagement of the rotating deployment element from one of the anchors which the rotating deployment element engages, and (b) an unlocked state, in which the locking mechanism does not prevent disengagement of the rotating deployment element from the anchor upon the withdrawal of the rotating deployment element in the proximal direction.
There is further provided, in accordance with an application of the present invention, apparatus including a tissue anchor, which has a central longitudinal axis, and which includes:
a helical tissue coupling element, having proximal and distal ends; and
a tool-engaging head, fixed to the proximal end of the tissue coupling element, which tool-engaging head is shaped so as to define a non-circular engaging opening that passes entirely through the tool-engaging head along the axis,
wherein the tissue coupling element and the tool-engaging head together define a channel along an entire length of the tissue anchor, which channel is sized and shaped such that a right circular cylinder could be placed within the channel, coaxial with the tissue anchor, and along the entire length of the tissue anchor.
For some applications, the cylinder has a diameter of at least 1 mm, such as at least 2 mm.
For some applications, the proximal end of the tissue coupling element is fixed to the tool-engaging head near an outer perimeter of the tool-engaging head, such that the tissue coupling element does not block the engaging opening. For some applications, a distance between (a) a center of the proximal end of the tissue coupling element and (b) the outer perimeter of the tool-engaging head is no more than 30% of a width of the tool-engaging head.
For some applications, a portion of the helical tissue coupling element, at the proximal end which is fixed to the tool-engaging head, is generally straight and oriented at angle of between 0 and 15 degrees with the central longitudinal axis.
There is still further provided, in accordance with an application of the present invention, apparatus including:
a plurality of tissue anchors; and
an anchor deployment tool, which (a) is configured to provide an anchor storage area that is configured to initially store the plurality of tissue anchors, and (b) includes a rotating deployment element, which is:
For some applications, the rotating deployment element includes a locking mechanism that is configured to selectively assume (a) a locked state, in which the locking mechanism, even upon withdrawal of the rotating deployment element in the proximal direction, prevents disengagement of the rotating deployment element from one of the anchors which the rotating deployment element engages, and (b) an unlocked state, in which the locking mechanism does not prevent disengagement of the rotating deployment element from the anchor upon the withdrawal of the rotating deployment element in the proximal direction.
There is additionally provided, in accordance with an application of the present invention, a method including:
providing an anchor deployment tool, which includes a flexible outer tube, a flexible inner shaft, which is positioned within the flexible outer tube, and a rotating deployment element, which is coupled to a distal shaft end of the flexible inner shaft;
providing a plurality of tissue anchors, which are shaped so as to define respective channels along entire longitudinal lengths of the anchors, and which are initially stored within an anchor storage area provided by the anchor deployment tool, such that the flexible inner shaft passes through the channels of the anchors, and the anchors are within the flexible outer tube; and
using the rotating deployment element, directly engaging the anchors in the anchor storage area one at a time, advancing each of the anchors while engaged in a distal direction, and deploying each of the anchors through the distal tube end and into tissue of a subject.
For some applications, advancing each of the anchors includes advancing each of the anchors in the distal direction such that only the single anchor currently being advanced is within a distal anchor manipulation area of the anchor deployment tool between the distal anchor storage area end and the distal tube end.
For some applications, deploying includes deploying each of the anchors into the tissue in a direction parallel to a central longitudinal axis of the outer tube through the distal tube end, and parallel to a central longitudinal axis of the anchor.
For some applications, deploying includes steering a distal anchor manipulation area of the anchor deployment tool between the distal anchor storage area end and the distal tube end.
For some applications, directly engaging, advancing, and deploying the anchors includes directly engaging, advancing, and deploying a first one of the anchors into the tissue at a first site; and, thereafter, directly engaging, advancing, and deploying a second one of the anchors into the tissue at a second site, different from the first site. For some applications, directly engaging the second anchor includes withdrawing the rotating deployment element in a proximal direction within the outer tube, such that the rotating deployment element passes through one or more of the anchors without engaging the anchors; and directly engaging the second anchor by advancing the rotating deployment element in the distal direction against the second anchor. For some applications, withdrawing includes withdrawing the rotating deployment element such that the rotating deployment element assumes a radially-compressed state when passing through the one or more of the anchors without engaging the anchors, and engaging includes engaging the second anchor when the rotating deployment element assumes a radially-expanded state.
For some applications, providing the plurality of anchors includes providing at least 6 anchors.
For some applications, deploying includes deploying each of the anchors into cardiac tissue of the subject. For some applications, deploying includes removably positioning the anchor deployment tool within a lumen of a sleeve of an annuloplasty ring, and, while so positioned, to deploying the anchors from the distal tube end through a wall of the sleeve into the tissue.
For some applications, providing the anchor deployment tool includes providing the anchor deployment tool in which the anchor storage area has a distal anchor storage end at a distance of between 1 and 90 cm from the distal tube end, such as between 5 and 25 cm.
For some applications, the method further includes, using the rotating deployment element, unscrewing an already-deployed one of the anchors from the tissue, withdrawing the anchor in a proximal direction, and subsequently redeploying the anchor into the tissue. For some applications, the rotating deployment element includes a locking mechanism that is configured to selectively assume a locked state, in which the locking mechanism, even upon withdrawal of the rotating deployment element in the proximal direction, prevents disengagement of the rotating deployment element from the anchor, the method further includes causing the locking mechanism to assume the locked state, and withdrawing the anchor includes withdrawing the anchor in the proximal direction while the rotating deployment element is in the locked state.
There is yet additionally provided, in accordance with an application of the present invention, a method including:
providing a tissue anchor having proximal and distal ends, which has a central longitudinal axis, and which includes a helical tissue coupling element, and a tool engaging head, fixed to the proximal end of the tissue coupling element, which tool-engaging head is shaped so as to define a non-circular engaging opening that passes entirely through the tool-engaging head along the axis, wherein the tissue coupling element and the tool-engaging head together define a channel along an entire length of the tissue anchor, which channel is sized and shaped such that a right circular cylinder could be placed within the channel, coaxial with the tissue anchor, and along the entire length of the tissue anchor; and
coupling the tissue anchor to tissue of a subject, by rotating the tissue coupling element into the tissue.
For some applications, a distance between (a) a center of the proximal end of the tissue coupling element and (b) the outer perimeter of the tool-engaging head is no more than 30% of a width of the tool-engaging head, and coupling includes coupling a sheet to the tissue using the tissue anchor, sensing increased resistance to rotation of the tissue coupling element when the sheet resists the rotation, and, responsively the sensed increased resistance, ceasing rotating the tissue coupling element into the tissue.
There is also provided, in accordance with an application of the present invention, a method including:
providing a plurality of tissue anchors;
providing an anchor deployment tool, which (a) is configured to provide an anchor storage area, which is configured to initially store the plurality of tissue anchors, and (b) includes a rotating deployment element;
using the rotating deployment element, directly engaging the anchors in the anchor storage area one at a time, advancing each of the anchors while engaged in a distal direction, and deploying each of the anchors through the distal tube end and into tissue of a subject by screwing the anchor into the tissue; and
subsequently, using the rotating deployment element, unscrewing an already-deployed one of the anchors from the tissue, withdrawing the anchor in a proximal direction, and subsequently redeploying the anchor into the tissue.
For some applications, the rotating deployment element includes a locking mechanism that is configured to selectively to assume a locked state, in which the locking mechanism, even upon withdrawal of the rotating deployment element in the proximal direction, prevents disengagement of the rotating deployment element from the anchor, the method further includes causing the locking mechanism to assume the locked state, and withdrawing the anchor includes withdrawing the anchor in the proximal direction while the rotating deployment element is in the locked state.
The present invention will be more fully understood from the following detailed description of embodiments thereof, taken together with the drawings, in which:
Annuloplasty ring 22 further comprises a contracting mechanism 40, which facilitates contracting of the annuloplasty ring. Contracting mechanism 40 is described in more detail hereinbelow. In addition, the ring comprises a plurality of anchors 38, typically between about 5 and about 20 anchors, such as about 10 or about 16 anchors. In
Flexible sleeve 26 may comprise a braided, knitted, or woven mesh or a tubular structure comprising ePTFE. For some applications, the braid comprises metal and fabric fibers. The metal fibers, which may comprise Nitinol for example, may help define the shape of the sleeve, e.g., hold the sleeve open to provide space for passage and manipulation of deployment manipulator 24 within the sleeve. The fabric fibers may promote tissue growth into the braid. Optionally, the sleeve is somewhat elastic, which gives the sleeve a tendency to longitudinally contract, thereby helping tighten the sleeve. For example, the sleeve may be bellows- or accordion-shaped.
Typically, the sleeve is configured to have a tendency to assume a straight shape. This straightness helps the surgeon locate the next site for each subsequent anchor during the implantation procedure, as described hereinbelow with reference to
For some applications, the sleeve is configured to have a controllably variable stiffness. For example, a somewhat stiff wire may be placed in the sleeve to provide the stiffness, and subsequently be removed at the conclusion of the implantation procedure when the stiffness is no longer useful.
Elongated contracting member 30 comprises a wire, a ribbon, a rope, or a band, which typically comprises a flexible and/or superelastic material, e.g., nitinol, polyester, stainless steel, or cobalt chrome. In some embodiments, contracting member 30 comprises a braided polyester suture (e.g., Ticron). In some embodiments, contracting member 30 is coated with polytetrafluoroethylene (PTFE). In some embodiments, contracting member 30 comprises a plurality of wires that are intertwined to form a rope structure.
For some applications, contracting member 30 is positioned at least partially within a lumen of the sleeve 26, such as entirely within the lumen (as shown in
In an embodiment of the present invention, contracting mechanism 40 comprises a housing 44 which houses a spool 46, i.e., a rotatable structure, to which a first end 47 of contracting member 30 is coupled. Spool 46 is positioned in a vicinity of (e.g., within 1 cm of) either a distal end 51 of sleeve 26, as shown in
Alternatively, in some configurations, spool 46 is positioned at an intermediary position along the sleeve, rather than in a vicinity of one of the ends. For these configurations, contracting member 30 comprises two contracting members, which are respectively connected to the two ends of the sleeve, and both of which are connected to the spool. Rotating the spool contracts both contracting members. These configurations may be implemented using techniques described in U.S. patent application Ser. No. 12/341,960 to Cabiri, which published as US Patent Application Publication 2010/0161047 and is incorporated herein by reference, with reference to
Spool 46 is shaped to provide a hole 42 or other coupling mechanism for coupling first end 47 of contracting member 30 to the spool, and thereby to contracting mechanism 40. Spool 46 is shaped to define a driving interface 48. For some applications, driving interface 48 is female. For example, the interface may be shaped to define a channel which extends through the cylindrical portion of spool 46 from an opening provided by an upper surface 50 of spool 46 to an opening provided by a lower surface 52 of spool 46. Alternatively, driving interface 48 is shaped so as to define an indentation (e.g., a groove) that does not extend entirely through the cylindrical portion of the spool. Further alternatively, driving interface 48 is male, and defines a protrusion, e.g., a hexagonal head or a head having another shape.
A distal portion of a screwdriver tool 80, which is described hereinbelow with reference to
Spool 46 typically comprises a locking mechanism that prevents rotation of the spool after contracting member 30 has been tightened. For example, locking techniques may be used that are described with reference to FIG. 4 of above-mentioned U.S. application Ser. No. 12/341,960 to Cabiri.
Alternatively, in an embodiment of the present invention, contracting mechanism 40 is configured to tighten contracting member 30, crimp the contracting member to hold the contracting member taut, and subsequently cut the excess length of the contracting member.
In an embodiment of the present invention, at least one of anchors 38 is deployed from a distal end 60 of manipulator 24 while the distal end is positioned such that a central longitudinal axis 62 through distal end 60 of manipulator 24 forms an angle α (alpha) of between about 45 and 90 degrees with the wall of sleeve 26 at the point at which the anchor penetrates the wall, such as between about 75 and 90 degrees, e.g., about 90 degrees. (In
For some applications, at least one of anchors 38 is deployed from distal end 60 of manipulator 24 while distal end 60 is positioned such that longitudinal axis 62 through distal end 60 of manipulator 24 forms an angle β (beta) of between about 45 and 90 degrees (such as between about 75 and 90 degrees, e.g., about 90 degrees) with a line 65 defined by (a) a first point 67 at which the anchor currently being deployed penetrates the wall of the sleeve and (b) a second point 69 at which a most recently previously deployed anchor penetrates the wall of sleeve 26. Typically, all of the anchors are deployed at such angles, with the exception of the first anchor deployed near the distal end of the sleeve.
Typically, the anchors are deployed from distal end 60 of manipulator 24 into the cardiac tissue in a direction parallel to central longitudinal axis 62.
In an embodiment of the present invention, anchor deployment manipulator 24 comprises an outer tube 66 and an anchor driver 68 which is at least partially positioned within tube 66. Anchor driver 68 comprises an elongated, flexible shaft 70, having at its distal end a driver head 72. Rotation of the anchor driver screws the anchors into the cardiac tissue. Each of anchors 38 is shaped so as to define a coupling head 74 and a tissue coupling element 76. The anchors are typically rigid. Tissue coupling elements 76 may, for example, be helical or spiral in shape (e.g., having the shape of a corkscrew), as shown in the figures, may comprises screws, or may have other shapes. Coupling heads 74 may be either male (e.g., a hex or square protrusion) or female (e.g., a straight slot, a hex opening, a Phillips opening, or a Robertson opening). The use of helical anchors, which are screwed into the cardiac tissue, generally minimizes the force that needs to be applied during deployment of the anchors into the cardiac tissue. Alternatively, the anchors may comprise staples, clips, spring-loaded anchors, or other tissue anchors described in the references incorporated hereinabove in the Background section, or otherwise known in the art. For some applications, outer tube 66 of deployment manipulator 24 is steerable, as known in the catheter art, while for other applications, a separate steerable tube is provided, as described hereinbelow with reference to
In an embodiment of the present invention, each of tissue coupling elements 76 is shaped so as to define a longitudinal axis 78 (shown in
For some applications, the plurality of anchors are applied using the manipulator by loading a first one of the anchors onto the anchor driver, and deploying the anchor into the cardiac tissue. The anchor driver is withdrawn from the subject's body (typically while leaving outer tube 66 of the deployment manipulator in place in the sleeve), and a second one of the anchors is loaded onto the anchor driver. The anchor driver is reintroduced into the outer tube of the manipulator, and the second anchor is deployed. These steps are repeated until all of the anchors have been deployed. Alternatively, the entire deployment manipulator, including the anchor driver, is removed from the body and subsequently reintroduced after being provided with another anchor. Further alternatively, the deployment manipulator is configured to simultaneously hold a plurality of anchors, and to deploy them one at a time (configuration not shown).
Typically, the first anchor 38 is deployed most distally in sleeve 26 (generally at or within a few millimeters of a distal end 51 of the sleeve), and each subsequent anchor is deployed more proximally, such that manipulator 24 is gradually withdrawn in a proximal direction during the anchoring procedure.
Reference is now made to
In the configuration shown in
In the configuration shown in
For some applications, contracting mechanism 40 is positioned in a vicinity of (e.g., within 1 cm of) distal end 51 of sleeve 26, and access to driving interface 48 is provided from outside sleeve 26, as described with reference to
For some applications in which access to driving interface 48 is provided from outside sleeve 26, the screwdriver tool is initially removably attached to the driving interface, prior to the commencement of the implantation procedure, and is subsequently decoupled from the driving interface after spool 46 has been rotated. In these applications, contracting mechanism 40 may be positioned in a vicinity of distal end 51 or proximal end 49 of sleeve 26, or at an intermediate location along the sleeve. Optionally, at least a portion of a shaft of the screwdriver tool is positioned within sheath 104, which is described hereinbelow with reference to
Reference is now made to
The procedure typically begins by advancing a semi-rigid guidewire 102 into a right atrium 120 of the patient, as shown in
As show in
In an embodiment of the present invention, sheath 104 is advanced through an inferior vena cava 122 of the patient (as shown) and into right atrium 120 using a suitable point of origin typically determined for a given patient.
Sheath 104 is advanced distally until the sheath reaches the interatrial septum.
As shown in
The advancement of sheath 104 through the septum and into the left atrium is followed by the extraction of the dilator and needle 106 from within sheath 104, as shown in
As shown in
As shown in
As shown in
For some applications, in order to provide the second and subsequent anchors, anchor driver 68 is withdrawn from the subject's body via sheath 104 (typically while leaving outer tube 66 of the deployment manipulator in place in the sleeve), provided with an additional anchor, and then reintroduced into the subject's body and into the outer tube. Alternatively, the entire deployment manipulator, including the anchor driver, is removed from the body and subsequently reintroduced upon being provided with another anchor. Further alternatively, deployment manipulator 24 is configured to simultaneously hold a plurality of anchors, and to deploy them one at a time at the selected sites.
As shown in
As described hereinabove with reference to
For some applications, sleeve 26 is filled with a material (e.g., polyester, polytetrafluoroethylene (PTFE), polyethylene terephthalate (PET), or expanded polytetrafluoroethylene (ePTFE)) after being implanted. The material is packed within at least a portion, e.g., 50%, 75%, or 100%, of the lumen of sleeve 26. The filler material functions to prevent (1) formation within the lumen of sleeve 26 of clots or (2) introduction of foreign material into the lumen which could obstruct the sliding movement of contracting member 30.
For some applications, proximal end 49 of sleeve 26 is closed upon completion of the implantation procedure. Alternatively, the proximal end of the sleeve may have a natural tendency to close when not held open by manipulator 24.
Reference is made to
Annuloplasty ring 22 may be advanced toward annulus 140 in any suitable procedure, e.g., a transcatheter procedure, a minimally invasive procedure, or an open heart procedure (in which case one or more elements of system 20 are typically rigid). Regardless of the approach, the procedure typically includes the techniques described hereinabove with reference to
For some applications, following initial contraction of annuloplasty ring 22 during the implantation procedure, the ring may be further contracted or relaxed at a later time after the initial implantation. Using real-time monitoring, tactile feedback and optionally in combination with fluoroscopic imaging, a screwdriver tool or anchor driver 68 of deployment manipulator 24 is reintroduced into the heart and used to contract or relax annuloplasty ring 22.
Reference is now made to
Pusher element 200 helps move the distal end of deployment manipulator 24 from a first site of the annulus at which the manipulator has already deployed a first anchor (e.g., anchor 38A in
For some applications, as manipulator 24 is positioned at successive deployment sites of the cardiac tissue, pusher element 200 is extended respective distances through opening 206, each of which distances is successively greater. For other applications, after manipulator 24 is positioned at each successive deployment site, the pusher element is pulled back in a proximal direction, and again extended a desired distance in a distal direction, such that the pusher element pushes again the wall of the sleeve (at a different location on the wall for each successive relocation of manipulator 24).
This technique thus aids in locating each subsequent anchoring site for manipulator 24. The pusher element may also help control the distance between adjacent anchoring sites, because they surgeon may push the pusher element a known distance after deploying each anchor.
Pusher element 200 typically comprises a strip, wire, ribbon, or band, and has a cross-section that is circular, elliptical, or rectangular. Pusher element 200 typically comprises a flexible and/or superelastic material, such as a metal such as nitinol, stainless steel, or cobalt chrome. Distal end 212 of pusher element 200 is dull, so that it does not penetrate sleeve 26. For example, the distal end may be folded back, as shown in
Pulling wire 340 holds sleeve 26 surrounding deployment manipulator 24. As the pulling wire is released in a distal direction as deployment manipulator 24 is withdrawn in a proximal direction, the release of the sleeve allows the sleeve to gradually be removed from around the deployment manipulator. In
For some applications, control handle 346 is configured to release pulling wire 340 incrementally, such that each time the wire is further released by a set distance. As a result, the deployment manipulator is withdrawn from the sleeve by this set distance, and subsequently-deployed anchors are approximately this set distance apart from one another. For example, the handle may comprise a control ring 350 that is coupled to proximal portions 344 of the wire, and removably engages slots 352 on the handle that are spaced apart by this set distance. Upon completion of the implantation procedure, in order to detach the pulling wire from the sleeve, one end of the wire may be cut or released, and the wire detached from the sleeve by pulling on the other end of the wire.
(Although in the embodiment described with reference to
Although annuloplasty ring 22 has been described hereinabove as comprising a partial annuloplasty ring, in some embodiments of the present invention, the ring instead comprises a full annuloplasty ring.
In some embodiments of the present invention, system 20 is used to treat an atrioventricular valve other than the mitral valve, i.e., the tricuspid valve. In these embodiments, annuloplasty ring 22 and other components of system 20 described hereinabove as being placed in the left atrium are instead placed in the right atrium. Although annuloplasty ring 22 is described hereinabove as being placed in an atrium, for some application the ring is instead placed in either the left or right ventricle.
For some applications, techniques described herein are practiced in combination with techniques described in one or more of the references cited in the Background section of the present patent application.
Additionally, the scope of the present invention described hereinabove with reference to
As shown in
The portion of tool 430 between distal anchor storage area end 441 and distal tube end 442 of outer tube 434 serves as a distal anchor manipulation area 450 of tool 430. Anchor manipulation area 450 is typically flexible and steerable. Typically, only one anchor at a time is deployed through anchor manipulation area 450 and into the tissue of the subject, such that no more than exactly one anchor is within anchor manipulation area 450 at any given time. As a result, anchor manipulation area 450 retains its flexibility. Because the anchors are typically rigid, when more than one of the anchors are longitudinally contiguously positioned within tool 430, the area of the tool in which the anchors are positioned becomes fairly stiff, substantially losing the flexibility it would otherwise have. Thus, while anchor storage area 440 is fairly rigid, anchor manipulation area 450 remains flexible because it only contains exactly one anchor at a given time. The stiffness of the area of the tool in which the anchors are positioned also may enable the user to better control the exact location of distal-most anchor 432 currently stored in anchor storage area 440.
The steering functionality of distal anchor manipulation area 450 typically allows the area near the distal end of tool 430 to be positioned with six degrees of freedom. For some applications, flexible outer tube 434 is configured to provide the steering functionality to distal anchor manipulation area 450. Flexible outer tube 434 comprises one or more steering wires, the pulling and releasing of which cause deflection of distal tube end 442, using deflection techniques known in the catheter art. Alternatively or additionally, flexible inner shaft 436 is configured to provide the steering functionality to distal anchor manipulation area 450. Flexible inner shaft 436 comprises one or more steering wires for deflecting the distal end of the inner shaft. Still further alternatively or additionally, a separate flexible tube is provided for providing the steering functionality. The separate tube is positioned within flexible outer tube 434 or around the outer tube, and comprises one or more steering wires for deflecting the distal end of the inner shaft. The curvature of the tool may be pre-shaped, or bendable by application of an external force (such as a conventional colonoscope) or using an internal or external wire (configuration not shown). For some applications, the steering functionality is provided by a combination of more than one of flexible outer tube 434, flexible inner shaft 436, and the separate flexible tube, e.g., by (a) flexible outer tube 434 and flexible inner shaft 436, (b) flexible outer tube 434 and the separate flexible tube, (c) flexible inner shaft 436 and the separate flexible tube, or (d) all of flexible outer tube 434, flexible inner shaft 436, and the separate flexible tube.
For some applications, an external control handle is provided for controlling tool 430. The control handle comprises circuitry for manipulating the steering wires to provide the steering functionality.
For some applications, flexible inner shaft 436 comprises stainless steel SS 304, Nitinol, PEEK®, polyester, or another polymer. For some applications, outer tube 434 comprises stainless steel SS 304, Nitinol, PEEK®, polyester, or another polymer. For some applications, flexible inner shaft 436 has a diameter of at least 0.8 mm, no more than 3 mm, and/or between 0.8 and 3 mm, such as between 1 and 2 mm. For some applications, outer tube 434 has an outer diameter of at least 2 mm, no more than 4 mm, and/or between 2 and 4 mm, e.g., 3 mm or 3.2 mm. For some applications, outer tube 434 has an inner diameter of at least 1.5 mm, no more than 3.5 mm, and/or between 1.5 and 3.5 mm, e.g., 2.6 mm.
For some applications, anchor deployment tool 430 further comprises a hemostasis valve 480, as shown in
Reference is made to
As shown in the blow-up of
For some applications, tool 430 provides an anchor restraining mechanism 470 in a vicinity of distal anchor storage area end 441. Anchor restraining mechanism 470 is configured to temporarily restrain at least the distal-most anchor 432 currently stored in anchor storage area 440 from advancing in a distal direction as another one of the anchors is deployed through anchor manipulation area 450 and into the tissue of the subject. Optionally, anchor restraining mechanism 470 is also configured to temporarily restrain at least the distal-most anchor 432 from withdrawing in a proximal direction as inner shaft 436 is withdrawn in the proximal direction to load a subsequent one of the anchors.
For some applications, as shown in the blow-up of
For some applications, anchor restraining mechanism 470 comprises a set 473 of one or more proximal tabs 474 for temporarily restraining the distal-most anchor 432 currently stored in anchor storage area 440 from withdrawing in the proximal direction. The proximal tabs may be cut out of flexible outer tube 434, as shown, or they may be provided as separate elements coupled to the outer tube. The distal ends of the proximal tabs engage the proximal end of the tool-engaging head of distal-most anchor 432. For some applications, set 473 comprises two proximal tabs 474, typically on opposite sides of the outer tube (typically axially aligned with each other), as shown, while for other applications, the set comprises exactly one proximal tab, or three or more proximal tabs, e.g., three or four proximal tabs (typically axially aligned with one another).
Reference is made to
As shown in
Typically, anchor 432 is deployed from distal tube end 442 of outer tube 434 of tool 430 into cardiac tissue 490 in a direction parallel to a central longitudinal axis 492 of outer tube 434 through distal tube end 442, and/or parallel to central longitudinal axis 500 of anchor 432, as described hereinbelow with reference to
Also as shown in
As shown in
As shown
Reference is made to
Sets 473 thus provide respective anchor storage locations. Therefore, the anchor restraining mechanism comprises a number of sets 473 greater than or equal to the number of anchors 432 initially stored in anchor storage area 440. For some applications, anchor restraining mechanism 470 comprises between 6 and 20 sets 473, such as between 8 and 16 sets 473. For some applications, each of sets 473 comprises two proximal tabs 474, typically on opposite sides of the outer tube (typically axially aligned with each other), as shown, while for other applications, each of the sets comprises exactly one proximal tab, or three or more proximal tabs, e.g., three or four proximal tabs (typically axially aligned with one another).
For some applications, each of sets 473 (except the proximal-most set 473) additionally functions as a distal tab 472 for the anchor proximally adjacent to the set. For example, set 473A, in addition to engaging distal-most anchor 432A, also prevents distal motion of second-to-distal-most anchor 432.
Unlike in the configuration described hereinabove with reference to
Reference is now made to
Typically, helical tissue coupling element 460 has an inner diameter D1 of at least 1.5 mm, no more than 2.5 mm, and/or between 1.5 and 2.5 mm, e.g., 1.8 mm, along an entire length thereof along a central longitudinal axis 500 of anchor 432 (although inner diameter D1 is shown as being constant along the entire length of coupling element 460, the inner diameter optionally varies along the length of the coupling element). Inner diameter D1 is sufficiently large to allow passage through helical tissue coupling element 460 of flexible inner shaft 436 and rotating deployment element 438, optionally even when rotating deployment element 438 is in its radially-expanded state, as described hereinbelow with reference to
Tool-engaging head 462 is shaped so as to define an engaging opening 502 that passes entirely through the tool-engaging head along axis 500. The engaging opening is typically at least partially non-circular, in order to engage rotating deployment element 438. For example, as shown in
A portion of deployment element 438 may pass partially or completely through distal non-engaging surface 464, without engaging this surface. The non-engaging surface may serve as a shoulder, which pushes against tissue 490, providing resistance when the anchor has been sufficiently screwed into the tissue. Optionally, deployment element 438 does not pass entirely through distal non-engaging surface 464, such that the deployment element does not press against or into the tissue. Alternatively, the deployment element may protrude slightly from the distal non-engaging surface 464, as shown in
Engaging opening 502 typically has a cross-sectional area (perpendicular to axis 500) of at least 0.8 mm2, such as at least 1.2 mm2. The area is sufficient large to allow passage through engaging opening 502 of flexible inner shaft 436 and rotating deployment element 438, when the rotating deployment element assumes its radially-compressed state by being withdrawn in a proximal direction (from tissue coupling element 460 toward tool-engaging head 462), as described hereinbelow with reference to
For some applications, the anchor is used to couple a sheet of material, such as a fabric, to tissue 490. For these applications, because the tissue coupling element is fixed near the edge of the tool-engaging head, the sheet resists further rotation of the anchor once the anchor is fully screwed into the tissue and the tool-engaging head contacts the sheet. Such resistance prevents accidental over-rotation of the anchor, which could tear the tissue or the sheet. In contrast, in anchors in which the tissue coupling element is fixed at or near the center of the tool-engaging head, the sheet does not resist rotation of the anchor after the anchor has been fully screwed into the tissue and the tool-engaging head contacts the sheet. For some applications, the surgeon or a sensor sense increased resistance to rotation of the tissue coupling element when the sheet resists the rotation, and, responsively the sensed increased resistance, the surgeon ceases rotating the tissue coupling element into the tissue
For some applications, anchor deployment system 420 comprises a torque-limiting element, as is known for conventional screwdrivers, to prevent over-application of torque. Alternatively or additionally, for some applications, anchor deployment system 420 comprises a sensor (e.g., a torque transducer), for measuring the resistance to rotation of anchor 432. When the measured resistance exceeds a threshold value, the system generates a signal alerting the surgeon, and/or discontinues rotation of inner shaft 436. The increased resistance is typically caused by the sheet, as described above, and/or the non-engaging surface (shoulder) of the anchor head, as described above.
For some applications, a proximal-most portion 506 of helical tissue coupling element 460, at the end which is fixed to tool-engaging head 462, is generally straight and oriented generally parallel to axis 500, i.e., at angle of between 0 and 15 degrees with the axis, such as 0 degrees. Proximal-most portion 506 typically has a length of between 0.5 and 2 mm, such as about 1 mm.
The outer perimeter of tool-engaging head 462 is typically circular, and an outer diameter D3 of tool-engaging head 462 may be, for example, at least 2 mm, no more than 7 mm, and/or between 2 and 7 mm, such as between 2.5 and 5 mm, e.g., 2.4 mm, 2.5 mm, or 3 mm.
The outer diameter of anchor 432 is typically equal to outer diameter D3 of tool-engaging head 462, or, alternatively, to outer diameter D2 of coupling element 460. The outer diameter of anchor 432 may be, for example, at least 2 mm, no more than 7 mm, and/or between 2 and 7 mm, such as between 2.5 and 5 mm. The entire length of anchor 432, measured along axis 500, is typically at least 2.5 mm, no more than 6 mm, and/or between 2.5 and 6 mm, such as between 3 and 4.5 mm.
The proximal end of tissue coupling element 460 is typically fixed to tool-engaging head 462 near the outer perimeter of the tool-engaging head, such that the tissue coupling element does not block engaging opening 502. For example, as labeled in the top-view of the anchor in
Anchor 432, including both helical tissue coupling element 460 and tool-engaging head 462, is thus shaped so as to provide a channel along the entire length of the anchor, through which flexible inner shaft 436 can pass, and through which rotating deployment element 438 can pass when in its radially-compressed state, as described hereinabove with reference to
Reference is made to
Rotating deployment element 438 is typically configured to assume a radially-expanded state as its resting state, as shown in
As shown in
Reference is now made to
For some applications, locking mechanism 528 comprises a pin 530. In order to cause the locking mechanism to assume the locked position, pin 530 is advanced distally between engagement elements 520A and 520B. The pin holds the engagement elements in their radially-expanded state, as described hereinabove with reference to
Providing this selective, actively-controllable engagement and release of the anchor allows rotating deployment element 438 to be used to unscrew an already-deployed anchor from the tissue, and/or to proximally withdraw an anchor, without deployment element 438 unintentionally disengaging from the anchor head. Such unscrewing or proximal withdrawal may allow an anchor to be repositioned if it is initially coupled to the tissue in an incorrect location. Rotating deployment element 438 is capable of performing this redeployment for both (a) the anchor that has been most recently deployed into the tissue, and to which the deployment element 438 is still coupled, and (b) an anchor that was previously deployed, and from which deployment element 438 has already been decoupled (and, optionally, even after another anchor has subsequently been deployed). In the latter case, deployment element 438 re-engages the anchor that is to be redeployed.
Reference is now made to
Annuloplasty ring 622 is used to repair a dilated valve annulus of an atrioventricular valve, such as mitral valve 630. For some applications, the annuloplasty ring is configured to be placed only partially around the valve annulus (e.g., to assume a C-shape), and, once anchored in place, to be contracted so as to circumferentially tighten the valve annulus. The annuloplasty ring comprises a flexible sleeve 626 and a plurality of anchors 432. Anchor deployment tool 430 is advanced into a lumen of sleeve 626, and, from within the lumen, deploys the anchors through a wall of the sleeve and into cardiac tissue, thereby anchoring the sleeve around a portion of the valve annulus. For some application, annuloplasty ring 622 is implemented using techniques described in U.S. application Ser. No. 12/437,103, filed May 7, 2009, and/or U.S. application Ser. No. 12/689,635, filed Jan. 19, 2010, both of which are assigned to the assignee of the present application and are incorporated herein by reference. For some application, annuloplasty ring 622 comprises a contracting mechanism 640. The contracting mechanism comprises a rotatable structure, such as a spool, arranged such that rotation of the rotatable structure contracts the implant structure. The implant further comprises a longitudinal member, such as a wire, which is coupled to the contracting mechanism. A rotation tool is provided for rotating the rotatable structure. The tool is configured to be guided along (e.g., over, alongside, or through) the longitudinal member, to engage the rotatable structure, and to rotate the rotatable structure in response to a rotational force applied to the tool.
As shown in
As show in
For some applications of the present invention, sheath 604 is advanced through inferior vena cava 623 of the patient (as shown) and into right atrium 6 using a suitable point of origin typically determined for a given patient.
Sheath 604 is advanced distally until the sheath reaches the interatrial septum, and guidewire 602 is withdrawn, as shown in
As shown in
The advancement of sheath 604 through the septum and into the left atrium is followed by the extraction of the dilator and needle 606 from within sheath 604, as shown in
As shown in
As shown in
As shown in
The techniques described hereinabove with reference to
As shown in
Alternatively, annuloplasty ring 622 is implanted by right or left thoracotomy, mutatis mutandis.
For some applications of the present invention, annuloplasty ring 622 is used to treat an atrioventricular valve other than the mitral valve, i.e., the tricuspid valve. For these applications, ring 622 and other components of system 420 described hereinabove as being placed in the left atrium are instead placed in the right atrium. Although annuloplasty ring 622 is described hereinabove as being placed in an atrium, for some application the ring is instead placed in either the left or right ventricle.
In an application of the present invention, anchor deployment system 420 is used in combination with mitral valve repair system 400, described with reference to
For some applications, techniques described hereinabove with reference to
Additionally, the scope of the present invention described hereinabove with reference to
It will be appreciated by persons skilled in the art that the present invention is not limited to what has been particularly shown and described hereinabove. Rather, the scope of the present invention includes both combinations and subcombinations of the various features described hereinabove, as well as variations and modifications thereof that are not in the prior art, which would occur to persons skilled in the art upon reading the foregoing description.
The present application is a continuation of U.S. application Ser. No. 13/749,153, filed Jan. 24, 2013, which is: (a) a continuation-in-part of U.S. application Ser. No. 12/437,103, filed May 7, 2009, now U.S. Pat. No. 8,715,342; and (b) a continuation-in-part of International Appl. No. PCT/IL2011/000600, filed Jul. 26, 2011, which published as PCT Publication WO 2012/014201, which is a continuation-in-part of U.S. application Ser. No. 12/843,412, filed Jul. 26, 2010, now U.S. Pat. No. 8,523,881. All of the above-mentioned applications are assigned to the assignee of the present application and are incorporated herein by reference.
| Number | Name | Date | Kind |
|---|---|---|---|
| 3604488 | Wishart | Sep 1971 | A |
| 3656185 | Carpentier | Apr 1972 | A |
| 3840018 | Heifetz | Oct 1974 | A |
| 3881366 | Bradley et al. | May 1975 | A |
| 3898701 | La Russa | Aug 1975 | A |
| 4042979 | Angell | Aug 1977 | A |
| 4118805 | Reimels | Oct 1978 | A |
| 4214349 | Munch | Jul 1980 | A |
| 4261342 | Aranguren Duo | Apr 1981 | A |
| 4290151 | Massana | Sep 1981 | A |
| 4434828 | Trincia | Mar 1984 | A |
| 4473928 | Johnson | Oct 1984 | A |
| 4602911 | Ahmadi et al. | Jul 1986 | A |
| 4625727 | Leiboff | Dec 1986 | A |
| 4712549 | Peters et al. | Dec 1987 | A |
| 4778468 | Hunt et al. | Oct 1988 | A |
| 4917698 | Carpenter et al. | Apr 1990 | A |
| 4961738 | Mackin | Oct 1990 | A |
| 5061277 | Carpentier et al. | Oct 1991 | A |
| 5064431 | Gilbertson et al. | Nov 1991 | A |
| 5104407 | Lam et al. | Apr 1992 | A |
| 5108420 | Marks | Apr 1992 | A |
| 5201880 | Wright | Apr 1993 | A |
| 5258008 | Wilk | Nov 1993 | A |
| 5300034 | Behnke | Apr 1994 | A |
| 5306296 | Wright et al. | Apr 1994 | A |
| 5325845 | Adair | Jul 1994 | A |
| 5346498 | Greelis et al. | Sep 1994 | A |
| 5450860 | O'Connor | Sep 1995 | A |
| 5474518 | Farrer Velazquez | Dec 1995 | A |
| 5477856 | Lundquist | Dec 1995 | A |
| 5593424 | Northrup, III | Jan 1997 | A |
| 5601572 | Middleman | Feb 1997 | A |
| 5626609 | Zvenyatsky et al. | May 1997 | A |
| 5669919 | Sanders et al. | Sep 1997 | A |
| 5674279 | Wright et al. | Oct 1997 | A |
| 5683402 | Cosgrove et al. | Nov 1997 | A |
| 5702397 | Goble et al. | Dec 1997 | A |
| 5702398 | Tarabishy | Dec 1997 | A |
| 5709695 | Northrup, III | Jan 1998 | A |
| 5716370 | Williamson et al. | Feb 1998 | A |
| 5716397 | Myers | Feb 1998 | A |
| 5728116 | Rosenman | Mar 1998 | A |
| 5730150 | Peppel et al. | Mar 1998 | A |
| 5749371 | Zadini et al. | May 1998 | A |
| 5810882 | Bolduc | Sep 1998 | A |
| 5824066 | Gross | Oct 1998 | A |
| 5830221 | Stein et al. | Nov 1998 | A |
| 5843120 | Israel et al. | Dec 1998 | A |
| 5855614 | Stevens et al. | Jan 1999 | A |
| 5876373 | Giba et al. | Mar 1999 | A |
| 5935098 | Blaisdell et al. | Aug 1999 | A |
| 5957953 | DiPoto | Sep 1999 | A |
| 5961440 | Schweich et al. | Oct 1999 | A |
| 5961539 | Northrup, III et al. | Oct 1999 | A |
| 5984959 | Robertson | Nov 1999 | A |
| 6042554 | Rosenman | Mar 2000 | A |
| 6045497 | Schweich et al. | Apr 2000 | A |
| 6050936 | Schweich et al. | Apr 2000 | A |
| 6059715 | Schweich et al. | May 2000 | A |
| 6074401 | Gardiner et al. | Jun 2000 | A |
| 6074417 | Peredo | Jun 2000 | A |
| 6102945 | Campbell | Aug 2000 | A |
| 6106550 | Magovern | Aug 2000 | A |
| 6110200 | Hinnenkamp | Aug 2000 | A |
| 6143024 | Campbell | Nov 2000 | A |
| 6159240 | Sparer | Dec 2000 | A |
| 6165119 | Schweich et al. | Dec 2000 | A |
| 6174332 | Loch | Jan 2001 | B1 |
| 6183411 | Mortier | Feb 2001 | B1 |
| 6187040 | Wright | Feb 2001 | B1 |
| 6315784 | Djurovic | Feb 2001 | B1 |
| 6217610 | Carpentier | Apr 2001 | B1 |
| 6231602 | Carpentier | May 2001 | B1 |
| 6251092 | Qin et al. | Jun 2001 | B1 |
| 6296656 | Bodluc et al. | Oct 2001 | B1 |
| 6319281 | Patel | Nov 2001 | B1 |
| 6332893 | Mortier et al. | Dec 2001 | B1 |
| 6355030 | Aldrich et al. | Mar 2002 | B1 |
| 6368348 | Gabbay | Apr 2002 | B1 |
| 6402780 | Williamson, IV | Jun 2002 | B2 |
| 6406420 | McCarthy et al. | Jun 2002 | B1 |
| 6406493 | Tu | Jun 2002 | B1 |
| 6419696 | Ortiz et al. | Jul 2002 | B1 |
| 6451054 | Stevens | Sep 2002 | B1 |
| 6461366 | Seguin | Oct 2002 | B1 |
| 6470892 | Forsell | Oct 2002 | B1 |
| 6503274 | Howanec | Jan 2003 | B1 |
| 6524338 | Gundry | Feb 2003 | B1 |
| 6533772 | Sherts et al. | Mar 2003 | B1 |
| 6537314 | Langberg et al. | Mar 2003 | B2 |
| 6547801 | Dargent | Apr 2003 | B1 |
| 6554845 | Fleenor | Apr 2003 | B1 |
| 6564805 | Garrison et al. | May 2003 | B2 |
| 6565603 | Cox | May 2003 | B2 |
| 6569198 | Wilson et al. | May 2003 | B1 |
| 6579297 | Bicek et al. | Jun 2003 | B2 |
| 6589160 | Schweich et al. | Jul 2003 | B2 |
| 6602288 | Cosgrove | Aug 2003 | B1 |
| 6602289 | Colvin et al. | Aug 2003 | B1 |
| 6613078 | Barone | Sep 2003 | B1 |
| 6613079 | Wolinsky et al. | Sep 2003 | B1 |
| 6619291 | Hlavka et al. | Sep 2003 | B2 |
| 6626899 | Houser et al. | Sep 2003 | B2 |
| 6626930 | Allen et al. | Sep 2003 | B1 |
| 6629534 | St. Goar et al. | Oct 2003 | B1 |
| 6629921 | Schweich et al. | Oct 2003 | B1 |
| 6651671 | Donlon et al. | Nov 2003 | B1 |
| 6652556 | VanTassel | Nov 2003 | B1 |
| 6682558 | Tu et al. | Jan 2004 | B2 |
| 6689125 | Keith et al. | Feb 2004 | B1 |
| 6689164 | Seguin | Feb 2004 | B1 |
| 6695866 | Kuehn et al. | Feb 2004 | B1 |
| 6702826 | Liddicoat et al. | Mar 2004 | B2 |
| 6702846 | Mikus et al. | Mar 2004 | B2 |
| 6706065 | Langberg | Mar 2004 | B2 |
| 6709385 | Forsell | Mar 2004 | B2 |
| 6709456 | Langberg et al. | Mar 2004 | B2 |
| 6711444 | Koblish | Mar 2004 | B2 |
| 6718985 | Hlavka et al. | Apr 2004 | B2 |
| 6719786 | Ryan | Apr 2004 | B2 |
| 6723038 | Schroeder et al. | Apr 2004 | B1 |
| 6726716 | Marquez | Apr 2004 | B2 |
| 6726717 | Alfieri et al. | Apr 2004 | B2 |
| 6730121 | Ortiz et al. | May 2004 | B2 |
| 6749630 | McCarthy et al. | Jun 2004 | B2 |
| 6752813 | Goldfarb et al. | Jun 2004 | B2 |
| 6764510 | Vidlund et al. | Jul 2004 | B2 |
| 6770083 | Seguin | Aug 2004 | B2 |
| 6786924 | Ryan et al. | Sep 2004 | B2 |
| 6786925 | Schoon | Sep 2004 | B1 |
| 6790231 | Liddicoat | Sep 2004 | B2 |
| 6797001 | Mathis | Sep 2004 | B2 |
| 6797002 | Spence et al. | Sep 2004 | B2 |
| 6802319 | Stevens et al. | Oct 2004 | B2 |
| 6805710 | Bolling et al. | Oct 2004 | B2 |
| 6805711 | Quijano et al. | Oct 2004 | B2 |
| 6855126 | Flinchbaugh | Feb 2005 | B2 |
| 6858039 | McCarthy | Feb 2005 | B2 |
| 6884250 | Monassevitch et al. | Apr 2005 | B2 |
| 6893459 | Macoviak | May 2005 | B1 |
| 6908482 | McCarthy et al. | Jun 2005 | B2 |
| 6918917 | Nguyen et al. | Jul 2005 | B1 |
| 6926730 | Nguyen et al. | Aug 2005 | B1 |
| 6960217 | Bolduc | Nov 2005 | B2 |
| 6964684 | Ortiz | Nov 2005 | B2 |
| 6964686 | Gordon | Nov 2005 | B2 |
| 6976995 | Mathis | Dec 2005 | B2 |
| 6986775 | Morales et al. | Jan 2006 | B2 |
| 6989028 | Lashinski et al. | Jan 2006 | B2 |
| 6997951 | Solem | Feb 2006 | B2 |
| 7004176 | Lau | Feb 2006 | B2 |
| 7011669 | Kimblad | Mar 2006 | B2 |
| 7011682 | Lashinski et al. | Mar 2006 | B2 |
| 7037334 | Hlavka et al. | May 2006 | B1 |
| 7077850 | Kortenbach | Jul 2006 | B2 |
| 7077862 | Vidlund | Jul 2006 | B2 |
| 7087064 | Hyde | Aug 2006 | B1 |
| 7101395 | Tremulis | Sep 2006 | B2 |
| 7101396 | Artof et al. | Sep 2006 | B2 |
| 7112207 | Allen et al. | Sep 2006 | B2 |
| 7118595 | Ryan | Oct 2006 | B2 |
| 7125421 | Tremulis et al. | Oct 2006 | B2 |
| 7150737 | Purdy et al. | Dec 2006 | B2 |
| 7159593 | McCarthy | Jan 2007 | B2 |
| 7166127 | Spence | Jan 2007 | B2 |
| 7169187 | Datta et al. | Jan 2007 | B2 |
| 7172625 | Shu et al. | Feb 2007 | B2 |
| 7175660 | Cartledge et al. | Feb 2007 | B2 |
| 7186262 | Saadat | Mar 2007 | B2 |
| 7186264 | Liddicoat | Mar 2007 | B2 |
| 7189199 | McCarthy et al. | Mar 2007 | B2 |
| 7192443 | Solem | Mar 2007 | B2 |
| 7220277 | Arm et al. | May 2007 | B2 |
| 7226467 | Lucatero et al. | Jun 2007 | B2 |
| 7226477 | Cox | Jun 2007 | B2 |
| 7226647 | Kasperchik et al. | Jun 2007 | B2 |
| 7229452 | Kayan | Jun 2007 | B2 |
| 7238191 | Bachmann | Jul 2007 | B2 |
| 7288097 | Seguin | Oct 2007 | B2 |
| 7294148 | McCarthy | Nov 2007 | B2 |
| 7297150 | Cartledge et al. | Nov 2007 | B2 |
| 7311728 | Solem et al. | Dec 2007 | B2 |
| 7311729 | Mathis | Dec 2007 | B2 |
| 7314485 | Mathis | Jan 2008 | B2 |
| 7316710 | Cheng et al. | Jan 2008 | B1 |
| 7329279 | Haug et al. | Feb 2008 | B2 |
| 7329280 | Bolling et al. | Feb 2008 | B2 |
| 7335213 | Hyde et al. | Feb 2008 | B1 |
| 7361190 | Shoulian | Apr 2008 | B2 |
| 7364588 | Mathis | Apr 2008 | B2 |
| 7377941 | Rhee | May 2008 | B2 |
| 7390329 | Westra et al. | Jun 2008 | B2 |
| 7404824 | Webler et al. | Jul 2008 | B1 |
| 7431692 | Zollinger et al. | Oct 2008 | B2 |
| 7442207 | Rafiee | Oct 2008 | B2 |
| 7452376 | Lim et al. | Nov 2008 | B2 |
| 7455690 | Cartledge et al. | Nov 2008 | B2 |
| 7485142 | Milo | Feb 2009 | B2 |
| 7485143 | Webler et al. | Feb 2009 | B2 |
| 7500989 | Solem et al. | Mar 2009 | B2 |
| 7507252 | Lashinski et al. | Mar 2009 | B2 |
| 7510575 | Spenser et al. | Mar 2009 | B2 |
| 7510577 | Moaddeb | Mar 2009 | B2 |
| 7527647 | Spence | May 2009 | B2 |
| 7530995 | Quijano | May 2009 | B2 |
| 7549983 | Roue et al. | Jun 2009 | B2 |
| 7559936 | Levine | Jul 2009 | B2 |
| 7563267 | Goldfarb et al. | Jul 2009 | B2 |
| 7563273 | Goldfarb et al. | Jul 2009 | B2 |
| 7569062 | Kuehn | Aug 2009 | B1 |
| 7588582 | Starksen et al. | Sep 2009 | B2 |
| 7591826 | Alferness | Sep 2009 | B2 |
| 7604646 | Goldfarb et al. | Oct 2009 | B2 |
| 7608091 | Goldfarb et al. | Oct 2009 | B2 |
| 7608103 | McCarthy | Oct 2009 | B2 |
| 7618449 | Tremulis et al. | Nov 2009 | B2 |
| 7625403 | Krivoruchko | Dec 2009 | B2 |
| 7632303 | Stalker et al. | Dec 2009 | B1 |
| 7635329 | Goldfarb et al. | Dec 2009 | B2 |
| 7635386 | Gammie | Dec 2009 | B1 |
| 7655015 | Goldfarb et al. | Feb 2010 | B2 |
| 7666204 | Thornton | Feb 2010 | B2 |
| 7682319 | Martin | Mar 2010 | B2 |
| 7682369 | Seguin | Mar 2010 | B2 |
| 7686822 | Shayani | Mar 2010 | B2 |
| 7699892 | Rafiee | Apr 2010 | B2 |
| 7704269 | Goar | Apr 2010 | B2 |
| 7704277 | Zakay et al. | Apr 2010 | B2 |
| 7722666 | Lafontaine | May 2010 | B2 |
| 7736388 | Goldfarb et al. | Jun 2010 | B2 |
| 7748389 | Salahieh et al. | Jul 2010 | B2 |
| 7753924 | Starksen et al. | Jul 2010 | B2 |
| 7758632 | Hojeibane et al. | Jul 2010 | B2 |
| 7780726 | Seguin | Aug 2010 | B2 |
| 7871368 | Zollinger et al. | Jan 2011 | B2 |
| 7871433 | Lattouf | Jan 2011 | B2 |
| 7883475 | Dupont et al. | Feb 2011 | B2 |
| 7883538 | To et al. | Feb 2011 | B2 |
| 7927370 | Webler et al. | Apr 2011 | B2 |
| 7927371 | Navia | Apr 2011 | B2 |
| 7942927 | Kaye et al. | May 2011 | B2 |
| 7947056 | Griego et al. | May 2011 | B2 |
| 7955377 | Melsheimer | Jun 2011 | B2 |
| 7988725 | Gross | Aug 2011 | B2 |
| 7992567 | Hirotsuka | Aug 2011 | B2 |
| 7993368 | Gambale et al. | Aug 2011 | B2 |
| 7993397 | Lashinski | Aug 2011 | B2 |
| 8012201 | Lashinski et al. | Sep 2011 | B2 |
| 8034103 | Burriesci | Oct 2011 | B2 |
| 8052592 | Goldfarb et al. | Nov 2011 | B2 |
| 8057493 | Goldfarb et al. | Nov 2011 | B2 |
| 8062355 | Figulla et al. | Nov 2011 | B2 |
| 8070804 | Hyde | Dec 2011 | B2 |
| 8070805 | Vidlund | Dec 2011 | B2 |
| 8075616 | Solem | Dec 2011 | B2 |
| 8100964 | Spence | Jan 2012 | B2 |
| 8123800 | McCarthy | Feb 2012 | B2 |
| 8123801 | Milo | Feb 2012 | B2 |
| 8323334 | Deem | Feb 2012 | B2 |
| 8142493 | Spence et al. | Mar 2012 | B2 |
| 8142495 | Hasenkam | Mar 2012 | B2 |
| 8142496 | Berreklouw | Mar 2012 | B2 |
| 8147542 | Maisano et al. | Apr 2012 | B2 |
| 8152844 | Rao | Apr 2012 | B2 |
| 8163013 | Machold | Apr 2012 | B2 |
| 8187299 | Goldfarb et al. | May 2012 | B2 |
| 8187324 | Webler | May 2012 | B2 |
| 8202315 | Hlavka | Jun 2012 | B2 |
| 8206439 | Gomez-Duran | Jun 2012 | B2 |
| 8226711 | Mortier | Jul 2012 | B2 |
| 8231671 | Kim | Jul 2012 | B2 |
| 8241351 | Cabiri | Aug 2012 | B2 |
| 8252050 | Maisano et al. | Aug 2012 | B2 |
| 8277502 | Miller | Oct 2012 | B2 |
| 8287584 | Salahieh | Oct 2012 | B2 |
| 8287591 | Keidar | Oct 2012 | B2 |
| 8303608 | Goldfarb et al. | Nov 2012 | B2 |
| 8328868 | Paul | Dec 2012 | B2 |
| 8333777 | Schaller | Dec 2012 | B2 |
| 8343173 | Starksen et al. | Jan 2013 | B2 |
| 8343174 | Goldfarb | Jan 2013 | B2 |
| 8343213 | Salahieh et al. | Jan 2013 | B2 |
| 8349002 | Milo | Jan 2013 | B2 |
| 8353956 | Miller et al. | Jan 2013 | B2 |
| 8357195 | Kuehn | Jan 2013 | B2 |
| 8382829 | Call et al. | Feb 2013 | B1 |
| 8388680 | Starksen et al. | Mar 2013 | B2 |
| 8393517 | Milo | Mar 2013 | B2 |
| 8430926 | Kirson | Apr 2013 | B2 |
| 8449599 | Chau et al. | May 2013 | B2 |
| 8454686 | Alkhatib | Jun 2013 | B2 |
| 8460370 | Zakay et al. | Jun 2013 | B2 |
| 8460371 | Hlavka et al. | Jun 2013 | B2 |
| 8475491 | Milo | Jul 2013 | B2 |
| 8480732 | Subramanian | Jul 2013 | B2 |
| 8500800 | Maisano et al. | Aug 2013 | B2 |
| 8518107 | Tsukashima et al. | Aug 2013 | B2 |
| 8523881 | Cabiri | Sep 2013 | B2 |
| 8523940 | Richardson | Sep 2013 | B2 |
| 8545553 | Zipory | Oct 2013 | B2 |
| 8551161 | Dolan | Oct 2013 | B2 |
| 8585755 | Chau et al. | Nov 2013 | B2 |
| 8591576 | Hasenkam | Nov 2013 | B2 |
| 8608797 | Gross | Dec 2013 | B2 |
| 8628569 | Benichou et al. | Jan 2014 | B2 |
| 8628571 | Hacohen et al. | Jan 2014 | B1 |
| 8641727 | Starksen et al. | Feb 2014 | B2 |
| 8652202 | Alon et al. | Feb 2014 | B2 |
| 8652203 | Quadri et al. | Feb 2014 | B2 |
| 8679174 | Ottma et al. | Mar 2014 | B2 |
| 8685086 | Navia et al. | Apr 2014 | B2 |
| 8690939 | Miller et al. | Apr 2014 | B2 |
| 8715342 | Zipory et al. | May 2014 | B2 |
| 8728097 | Sugimoto et al. | May 2014 | B1 |
| 8728155 | Montorfano et al. | May 2014 | B2 |
| 8734467 | Miller et al. | May 2014 | B2 |
| 8740920 | Goldfarb et al. | Jun 2014 | B2 |
| 8747463 | Fogarty et al. | Jun 2014 | B2 |
| 8778021 | Cartledge | Jul 2014 | B2 |
| 8784481 | Alkhatib et al. | Jul 2014 | B2 |
| 8790367 | Nguyen et al. | Jul 2014 | B2 |
| 8790394 | Miller et al. | Jul 2014 | B2 |
| 8795298 | Hernlund et al. | Aug 2014 | B2 |
| 8795355 | Alkhatib et al. | Aug 2014 | B2 |
| 8795356 | Quadri et al. | Aug 2014 | B2 |
| 8795357 | Yohanan et al. | Aug 2014 | B2 |
| 8808366 | Braido et al. | Aug 2014 | B2 |
| 8808368 | Maisano et al. | Aug 2014 | B2 |
| 8808371 | Cartledge | Aug 2014 | B2 |
| 8845717 | Khairkhahan et al. | Sep 2014 | B2 |
| 8845723 | Spence et al. | Sep 2014 | B2 |
| 8852261 | White | Oct 2014 | B2 |
| 8852272 | Gross et al. | Oct 2014 | B2 |
| 8858623 | Miller et al. | Oct 2014 | B2 |
| 8864822 | Spence et al. | Oct 2014 | B2 |
| 8870948 | Erzberger et al. | Oct 2014 | B1 |
| 8870949 | Rowe | Oct 2014 | B2 |
| 8888843 | Khairkhahan et al. | Nov 2014 | B2 |
| 8894702 | Quadri et al. | Nov 2014 | B2 |
| 8911461 | Traynor et al. | Dec 2014 | B2 |
| 8911494 | Hammer et al. | Dec 2014 | B2 |
| 8926695 | Gross et al. | Jan 2015 | B2 |
| 8926696 | Cabiri et al. | Jan 2015 | B2 |
| 8926697 | Gross et al. | Jan 2015 | B2 |
| 8932343 | Alkhatib et al. | Jan 2015 | B2 |
| 8932348 | Solem et al. | Jan 2015 | B2 |
| 8940042 | Miller et al. | Jan 2015 | B2 |
| 8940044 | Hammer et al. | Jan 2015 | B2 |
| 8945211 | Sugimoto | Feb 2015 | B2 |
| 8951285 | Sugimoto et al. | Feb 2015 | B2 |
| 8951286 | Sugimoto et al. | Feb 2015 | B2 |
| 8961595 | Alkhatib | Feb 2015 | B2 |
| 8961602 | Kovach et al. | Feb 2015 | B2 |
| 8979922 | Jayasinghe et al. | Mar 2015 | B2 |
| 8986370 | Annest | Mar 2015 | B2 |
| 9005273 | Salahieh et al. | Apr 2015 | B2 |
| 9011520 | Miller et al. | Apr 2015 | B2 |
| 9011530 | Reich et al. | Apr 2015 | B2 |
| 9017399 | Gross et al. | Apr 2015 | B2 |
| 9023100 | Quadri et al. | May 2015 | B2 |
| 9034032 | McLean et al. | May 2015 | B2 |
| 9072603 | Tuval et al. | Jul 2015 | B2 |
| 9119719 | Zipory et al. | Sep 2015 | B2 |
| 9125632 | Loulmet et al. | Sep 2015 | B2 |
| 9125742 | Yoganathan et al. | Sep 2015 | B2 |
| 9173646 | Fabro | Nov 2015 | B2 |
| 9180005 | Lashinski et al. | Nov 2015 | B1 |
| 9180007 | Reich et al. | Nov 2015 | B2 |
| 9192472 | Gross et al. | Nov 2015 | B2 |
| 9226825 | Starksen et al. | Jan 2016 | B2 |
| 9277994 | Miller et al. | Mar 2016 | B2 |
| 9326857 | Cartledge et al. | May 2016 | B2 |
| 9427316 | Schweich, Jr. et al. | Aug 2016 | B2 |
| 9474606 | Zipory et al. | Oct 2016 | B2 |
| 20010021874 | Carpentier | Sep 2001 | A1 |
| 20010044656 | Williamson | Nov 2001 | A1 |
| 20020022862 | Grafton et al. | Feb 2002 | A1 |
| 20020029080 | Mortier | Mar 2002 | A1 |
| 20020042621 | Liddicoat et al. | Apr 2002 | A1 |
| 20020082525 | Oslund et al. | Jun 2002 | A1 |
| 20020087048 | Brock et al. | Jul 2002 | A1 |
| 20020103532 | Langberg et al. | Aug 2002 | A1 |
| 20020133180 | Ryan et al. | Sep 2002 | A1 |
| 20020151916 | Muramatsu | Oct 2002 | A1 |
| 20020151961 | Lashinski | Oct 2002 | A1 |
| 20020151970 | Garrison | Oct 2002 | A1 |
| 20020169358 | Mortier et al. | Nov 2002 | A1 |
| 20020173841 | Ortiz et al. | Nov 2002 | A1 |
| 20020177904 | Huxel et al. | Nov 2002 | A1 |
| 20020188301 | Dallara et al. | Dec 2002 | A1 |
| 20020198586 | Inoue | Dec 2002 | A1 |
| 20030018358 | Saadat | Jan 2003 | A1 |
| 20030050693 | Quijano et al. | Mar 2003 | A1 |
| 20030078465 | Pai et al. | Apr 2003 | A1 |
| 20030078653 | Vesely | Apr 2003 | A1 |
| 20030083742 | Spence | May 2003 | A1 |
| 20030100943 | Bolduc | May 2003 | A1 |
| 20030105519 | Fasol et al. | Jun 2003 | A1 |
| 20030114901 | Loeb et al. | Jun 2003 | A1 |
| 20030120340 | Liska et al. | Jun 2003 | A1 |
| 20030130731 | Vidlund | Jul 2003 | A1 |
| 20030144657 | Bowe et al. | Jul 2003 | A1 |
| 20030167062 | Gambale et al. | Sep 2003 | A1 |
| 20030171760 | Gambale | Sep 2003 | A1 |
| 20030191528 | Quijano et al. | Oct 2003 | A1 |
| 20030199974 | Lee et al. | Oct 2003 | A1 |
| 20030204195 | Keane | Oct 2003 | A1 |
| 20030229350 | Kay | Dec 2003 | A1 |
| 20030229395 | Cox | Dec 2003 | A1 |
| 20030233142 | Morales et al. | Dec 2003 | A1 |
| 20040010287 | Bonutti | Jan 2004 | A1 |
| 20040019359 | Worley et al. | Jan 2004 | A1 |
| 20040019377 | Taylor | Jan 2004 | A1 |
| 20040024451 | Johnson et al. | Feb 2004 | A1 |
| 20040039442 | St. Goar et al. | Feb 2004 | A1 |
| 20040049207 | Goldfarb et al. | Mar 2004 | A1 |
| 20040059413 | Argento | Mar 2004 | A1 |
| 20040092962 | Thornton et al. | May 2004 | A1 |
| 20040122448 | Levine | Jun 2004 | A1 |
| 20040122514 | Forgarty et al. | Jun 2004 | A1 |
| 20040127982 | Machold et al. | Jul 2004 | A1 |
| 20040127983 | Mortier et al. | Jul 2004 | A1 |
| 20040133220 | Lashinski et al. | Jul 2004 | A1 |
| 20040133274 | Webler | Jul 2004 | A1 |
| 20040133374 | Kattan | Jul 2004 | A1 |
| 20040138744 | Lashinski et al. | Jul 2004 | A1 |
| 20040138745 | Macoviak et al. | Jul 2004 | A1 |
| 20040148019 | Vidlund et al. | Jul 2004 | A1 |
| 20040148020 | Vidlund et al. | Jul 2004 | A1 |
| 20040148021 | Cartledge et al. | Jul 2004 | A1 |
| 20040153146 | Lashinski et al. | Aug 2004 | A1 |
| 20040172046 | Hlavka | Sep 2004 | A1 |
| 20040176788 | Opolski | Sep 2004 | A1 |
| 20040181287 | Gellman | Sep 2004 | A1 |
| 20040186566 | Hindrichs | Sep 2004 | A1 |
| 20040193191 | Starksen et al. | Sep 2004 | A1 |
| 20040236419 | Milo | Nov 2004 | A1 |
| 20040243227 | Starsken et al. | Dec 2004 | A1 |
| 20040249453 | Cartledge | Dec 2004 | A1 |
| 20040260317 | Bloom et al. | Dec 2004 | A1 |
| 20040260393 | Rahdert et al. | Dec 2004 | A1 |
| 20040260394 | Douk et al. | Dec 2004 | A1 |
| 20040267358 | Reitan | Dec 2004 | A1 |
| 20050004668 | Aklog et al. | Jan 2005 | A1 |
| 20050010287 | Macoviak et al. | Jan 2005 | A1 |
| 20050010787 | Tarbouriech | Jan 2005 | A1 |
| 20050016560 | Voughlohn | Jan 2005 | A1 |
| 20050055038 | Kelleher et al. | Mar 2005 | A1 |
| 20050055087 | Starksen | Mar 2005 | A1 |
| 20050060030 | Lashinski et al. | Mar 2005 | A1 |
| 20050065601 | Lee et al. | Mar 2005 | A1 |
| 20050070999 | Spence | Mar 2005 | A1 |
| 20050075727 | Wheatley | Apr 2005 | A1 |
| 20050085903 | Lau | Apr 2005 | A1 |
| 20050090827 | Gedebou | Apr 2005 | A1 |
| 20050096740 | Langberg et al. | May 2005 | A1 |
| 20050107812 | Starksen et al. | May 2005 | A1 |
| 20050107871 | Realyvasquez et al. | May 2005 | A1 |
| 20050119734 | Spence | Jun 2005 | A1 |
| 20050125002 | Baran et al. | Jun 2005 | A1 |
| 20050125011 | Spence et al. | Jun 2005 | A1 |
| 20050131533 | Alfieri | Jun 2005 | A1 |
| 20050137686 | Salahieh et al. | Jun 2005 | A1 |
| 20050137688 | Salahieh et al. | Jun 2005 | A1 |
| 20050137695 | Salahieh | Jun 2005 | A1 |
| 20050159728 | Armour et al. | Jul 2005 | A1 |
| 20050171601 | Cosgrove et al. | Aug 2005 | A1 |
| 20050177180 | Kaganov | Aug 2005 | A1 |
| 20050177228 | Solem et al. | Aug 2005 | A1 |
| 20050187613 | Bolduc et al. | Aug 2005 | A1 |
| 20050192596 | Jugenheimer et al. | Sep 2005 | A1 |
| 20050197696 | Gomez Duran | Sep 2005 | A1 |
| 20050203549 | Realyvasquez | Sep 2005 | A1 |
| 20050203606 | VanCamp | Sep 2005 | A1 |
| 20050216039 | Lederman | Sep 2005 | A1 |
| 20050216079 | MaCoviak | Sep 2005 | A1 |
| 20050222665 | Aranyi | Oct 2005 | A1 |
| 20050222678 | Lashinski et al. | Oct 2005 | A1 |
| 20050256532 | Nayak et al. | Nov 2005 | A1 |
| 20050267478 | Corradi et al. | Dec 2005 | A1 |
| 20050273138 | To et al. | Dec 2005 | A1 |
| 20050288776 | Shaoulian et al. | Dec 2005 | A1 |
| 20050288778 | Shaoulian | Dec 2005 | A1 |
| 20050288781 | Moaddeb et al. | Dec 2005 | A1 |
| 20060004442 | Spenser et al. | Jan 2006 | A1 |
| 20060004443 | Liddicoat | Jan 2006 | A1 |
| 20060020326 | Bolduc et al. | Jan 2006 | A9 |
| 20060020327 | Lashinski et al. | Jan 2006 | A1 |
| 20060020336 | Liddicoat | Jan 2006 | A1 |
| 20060025787 | Morales et al. | Feb 2006 | A1 |
| 20060025855 | Lashinski et al. | Feb 2006 | A1 |
| 20060025858 | Alameddine | Feb 2006 | A1 |
| 20060030885 | Hyde | Feb 2006 | A1 |
| 20060041319 | Taylor et al. | Feb 2006 | A1 |
| 20060052868 | Mortier | Mar 2006 | A1 |
| 20060058871 | Zakay et al. | Mar 2006 | A1 |
| 20060069429 | Spence et al. | Mar 2006 | A1 |
| 20060074486 | Liddicoat | Apr 2006 | A1 |
| 20060085012 | Dolan | Apr 2006 | A1 |
| 20060095009 | Lampropoulos | May 2006 | A1 |
| 20060106423 | Weisel | May 2006 | A1 |
| 20060116757 | Lashinski et al. | Jun 2006 | A1 |
| 20060122633 | To | Jun 2006 | A1 |
| 20060129166 | Lavelle | Jun 2006 | A1 |
| 20060149280 | Harvine et al. | Jul 2006 | A1 |
| 20060149368 | Spence | Jul 2006 | A1 |
| 20060161265 | Levine et al. | Jul 2006 | A1 |
| 20060184240 | Jiminez | Aug 2006 | A1 |
| 20060184242 | Lichtenstein | Aug 2006 | A1 |
| 20060195134 | Crittenden | Aug 2006 | A1 |
| 20060241622 | Zergiebel | Oct 2006 | A1 |
| 20060241656 | Starksen et al. | Oct 2006 | A1 |
| 20060241748 | Lee et al. | Oct 2006 | A1 |
| 20060247763 | Slater | Nov 2006 | A1 |
| 20060259135 | Navia | Nov 2006 | A1 |
| 20060271175 | Woolfson | Nov 2006 | A1 |
| 20060282161 | Huyn et al. | Dec 2006 | A1 |
| 20060287661 | Bolduc | Dec 2006 | A1 |
| 20060287716 | Banbury et al. | Dec 2006 | A1 |
| 20070001627 | Lin et al. | Jan 2007 | A1 |
| 20070016287 | Cartledge et al. | Jan 2007 | A1 |
| 20070016288 | Gurskis | Jan 2007 | A1 |
| 20070021781 | Jervis | Jan 2007 | A1 |
| 20070027533 | Douk | Feb 2007 | A1 |
| 20070027536 | Mihaljevic et al. | Feb 2007 | A1 |
| 20070038221 | Fine | Feb 2007 | A1 |
| 20070039425 | Wang | Feb 2007 | A1 |
| 20070049942 | Hindrichs et al. | Mar 2007 | A1 |
| 20070049970 | Belef et al. | Mar 2007 | A1 |
| 20070051377 | Douk et al. | Mar 2007 | A1 |
| 20070055206 | To et al. | Mar 2007 | A1 |
| 20070061010 | Hauser et al. | Mar 2007 | A1 |
| 20070066863 | Rafiee et al. | Mar 2007 | A1 |
| 20070078297 | Rafiee et al. | Apr 2007 | A1 |
| 20070080188 | Spence et al. | Apr 2007 | A1 |
| 20070083168 | Whiting et al. | Apr 2007 | A1 |
| 20070100427 | Perouse | May 2007 | A1 |
| 20070112359 | Kimura | May 2007 | A1 |
| 20070112422 | Dehdashtian | May 2007 | A1 |
| 20070112425 | Schaller et al. | May 2007 | A1 |
| 20070118151 | Davidson | May 2007 | A1 |
| 20070118154 | Crabtree | May 2007 | A1 |
| 20070118213 | Loulmet | May 2007 | A1 |
| 20070118215 | Moaddeb | May 2007 | A1 |
| 20070142907 | Moaddeb | Jun 2007 | A1 |
| 20070162111 | Fukamachi et al. | Jul 2007 | A1 |
| 20070198082 | Kapadia et al. | Aug 2007 | A1 |
| 20070213582 | Zollinger et al. | Sep 2007 | A1 |
| 20070219558 | Deutsch | Sep 2007 | A1 |
| 20070233239 | Navia et al. | Oct 2007 | A1 |
| 20070239208 | Crawford | Oct 2007 | A1 |
| 20070244555 | Rafiee et al. | Oct 2007 | A1 |
| 20070244556 | Rfiee et al. | Oct 2007 | A1 |
| 20070244557 | Rafiee et al. | Oct 2007 | A1 |
| 20070250160 | Rafiee | Oct 2007 | A1 |
| 20070255397 | Ryan et al. | Nov 2007 | A1 |
| 20070255400 | Parravicini et al. | Nov 2007 | A1 |
| 20070270755 | Von Oepen et al. | Nov 2007 | A1 |
| 20070270943 | Solem et al. | Nov 2007 | A1 |
| 20070276437 | Call | Nov 2007 | A1 |
| 20070282375 | Hindrichs et al. | Dec 2007 | A1 |
| 20070282429 | Hauser et al. | Dec 2007 | A1 |
| 20070295172 | Swartz | Dec 2007 | A1 |
| 20070299424 | Cumming et al. | Dec 2007 | A1 |
| 20080004697 | Lichtenstein et al. | Jan 2008 | A1 |
| 20080027483 | Cartledge | Jan 2008 | A1 |
| 20080027555 | Hawkins | Jan 2008 | A1 |
| 20080035160 | Wodson et al. | Feb 2008 | A1 |
| 20080039935 | Buch | Feb 2008 | A1 |
| 20080051703 | Thornton et al. | Feb 2008 | A1 |
| 20080058595 | Snoke et al. | Mar 2008 | A1 |
| 20080065011 | Marchand et al. | Mar 2008 | A1 |
| 20080065204 | Macoviak | Mar 2008 | A1 |
| 20080071366 | Tuval | Mar 2008 | A1 |
| 20080086138 | Stone et al. | Apr 2008 | A1 |
| 20080086203 | Roberts | Apr 2008 | A1 |
| 20080091257 | Andreas et al. | Apr 2008 | A1 |
| 20080097523 | Bolduc et al. | Apr 2008 | A1 |
| 20080103572 | Gerber | May 2008 | A1 |
| 20080125861 | Webler et al. | May 2008 | A1 |
| 20080140116 | Bonutti | Jun 2008 | A1 |
| 20080167714 | St. Goar | Jul 2008 | A1 |
| 20080177382 | Hyde et al. | Jul 2008 | A1 |
| 20080195126 | Solem | Aug 2008 | A1 |
| 20080195200 | Vidlund | Aug 2008 | A1 |
| 20080208265 | Frazier et al. | Aug 2008 | A1 |
| 20080221672 | Lamphere | Sep 2008 | A1 |
| 20080228265 | Spence et al. | Sep 2008 | A1 |
| 20080243245 | Thambar | Oct 2008 | A1 |
| 20080262480 | Stahler et al. | Oct 2008 | A1 |
| 20080262609 | Gross et al. | Oct 2008 | A1 |
| 20080275300 | Rothe | Nov 2008 | A1 |
| 20080275469 | Fanton | Nov 2008 | A1 |
| 20080275551 | Alfieri | Nov 2008 | A1 |
| 20080281411 | Berreklouw | Nov 2008 | A1 |
| 20080288044 | Osborne | Nov 2008 | A1 |
| 20080288062 | Andrieu et al. | Nov 2008 | A1 |
| 20080300537 | Bowman | Dec 2008 | A1 |
| 20080300629 | Surti | Dec 2008 | A1 |
| 20090028670 | Garcia et al. | Jan 2009 | A1 |
| 20090043153 | Zollinger et al. | Feb 2009 | A1 |
| 20090043381 | Macoviak | Feb 2009 | A1 |
| 20090054969 | Salahieh | Feb 2009 | A1 |
| 20090062866 | Jackson | Mar 2009 | A1 |
| 20090076586 | Hauser | Mar 2009 | A1 |
| 20090076600 | Quinn | Mar 2009 | A1 |
| 20090088837 | Gillinov | Apr 2009 | A1 |
| 20090093877 | Keidar et al. | Apr 2009 | A1 |
| 20090099650 | Bolduc | Apr 2009 | A1 |
| 20090105816 | Olsen et al. | Apr 2009 | A1 |
| 20090125102 | Cartledge | May 2009 | A1 |
| 20090149872 | Gross et al. | Jun 2009 | A1 |
| 20090177274 | Scorsin | Jun 2009 | A1 |
| 20090171439 | Nissl | Jul 2009 | A1 |
| 20090177266 | Powell et al. | Jul 2009 | A1 |
| 20090177277 | Milo | Jul 2009 | A1 |
| 20090222083 | Nguyen et al. | Sep 2009 | A1 |
| 20090248148 | Shaolian | Oct 2009 | A1 |
| 20090254103 | Deustch | Oct 2009 | A1 |
| 20090259307 | Gross et al. | Oct 2009 | A1 |
| 20090264994 | Saadat | Oct 2009 | A1 |
| 20090264995 | Subramanian | Oct 2009 | A1 |
| 20090287231 | Brooks et al. | Nov 2009 | A1 |
| 20090287304 | Dahlgren | Nov 2009 | A1 |
| 20090299409 | Coe | Dec 2009 | A1 |
| 20090326648 | Machold et al. | Dec 2009 | A1 |
| 20100001038 | Levin | Jan 2010 | A1 |
| 20100010538 | Juravic | Jan 2010 | A1 |
| 20100023117 | Yoganathan | Jan 2010 | A1 |
| 20100023118 | Medlock et al. | Jan 2010 | A1 |
| 20100030014 | Ferrazzi | Feb 2010 | A1 |
| 20100030328 | Seguin | Feb 2010 | A1 |
| 20100042147 | Janovsky et al. | Feb 2010 | A1 |
| 20100049313 | Alon et al. | Feb 2010 | A1 |
| 20100063542 | Van der Burg | Mar 2010 | A1 |
| 20100063550 | Felix | Mar 2010 | A1 |
| 20100063586 | Hasenkam | Mar 2010 | A1 |
| 20100076499 | McNamara et al. | Mar 2010 | A1 |
| 20100094248 | Nguyen et al. | Apr 2010 | A1 |
| 20100114180 | Rock | May 2010 | A1 |
| 20100121349 | Meier | May 2010 | A1 |
| 20100121435 | Subramanian et al. | May 2010 | A1 |
| 20100121437 | Subramanian et al. | May 2010 | A1 |
| 20100130992 | Machold et al. | May 2010 | A1 |
| 20100152845 | Bloom | Jun 2010 | A1 |
| 20100161041 | Maisano et al. | Jun 2010 | A1 |
| 20100161042 | Maisano et al. | Jun 2010 | A1 |
| 20100161043 | Maisano et al. | Jun 2010 | A1 |
| 20100161047 | Cabiri | Jun 2010 | A1 |
| 20100168845 | Wright | Jul 2010 | A1 |
| 20100174358 | Rabkin et al. | Jul 2010 | A1 |
| 20100179574 | Longoria | Jul 2010 | A1 |
| 20100198347 | Zakay et al. | Aug 2010 | A1 |
| 20100211166 | Miller et al. | Aug 2010 | A1 |
| 20100217184 | Koblish et al. | Aug 2010 | A1 |
| 20100217382 | Chau | Aug 2010 | A1 |
| 20100234935 | Bashiri et al. | Sep 2010 | A1 |
| 20100249915 | Zhang | Sep 2010 | A1 |
| 20100249920 | Bolling | Sep 2010 | A1 |
| 20100262232 | Annest | Oct 2010 | A1 |
| 20100262233 | He | Oct 2010 | A1 |
| 20100280603 | Maisano et al. | Nov 2010 | A1 |
| 20100280604 | Zipory | Nov 2010 | A1 |
| 20100280605 | Hammer | Nov 2010 | A1 |
| 20100286628 | Gross | Nov 2010 | A1 |
| 20100286767 | Zipory | Nov 2010 | A1 |
| 20100305475 | Hinchliffe et al. | Dec 2010 | A1 |
| 20100324598 | Anderson | Dec 2010 | A1 |
| 20110004210 | Johnson | Jan 2011 | A1 |
| 20110004298 | Lee et al. | Jan 2011 | A1 |
| 20110009956 | Cartledge et al. | Jan 2011 | A1 |
| 20110011917 | Loulmet | Jan 2011 | A1 |
| 20110026208 | Otsuro et al. | Feb 2011 | A1 |
| 20110029066 | Gilad | Feb 2011 | A1 |
| 20110035000 | Nieminen et al. | Feb 2011 | A1 |
| 20110066231 | Cartledge | Mar 2011 | A1 |
| 20110067770 | Pederson et al. | Mar 2011 | A1 |
| 20110071626 | Wright et al. | Mar 2011 | A1 |
| 20110082538 | Dahlgren et al. | Apr 2011 | A1 |
| 20110087146 | Ryan et al. | Apr 2011 | A1 |
| 20110093002 | Rucker et al. | Apr 2011 | A1 |
| 20110106245 | Miller et al. | May 2011 | A1 |
| 20110106247 | Miller | May 2011 | A1 |
| 20110118832 | Punjabi | May 2011 | A1 |
| 20110137410 | Hacohen | Jun 2011 | A1 |
| 20110144703 | Krause | Jun 2011 | A1 |
| 20110166649 | Gross | Jul 2011 | A1 |
| 20110184510 | Maisano et al. | Jul 2011 | A1 |
| 20110190879 | Bobo et al. | Aug 2011 | A1 |
| 20110202130 | Cartledge | Aug 2011 | A1 |
| 20110208283 | Rust | Aug 2011 | A1 |
| 20110224785 | Hacohen | Sep 2011 | A1 |
| 20110230941 | Markus | Sep 2011 | A1 |
| 20110230961 | Langer | Sep 2011 | A1 |
| 20110238088 | Bolduc et al. | Sep 2011 | A1 |
| 20110257433 | Walker | Oct 2011 | A1 |
| 20110257633 | Cartledge | Oct 2011 | A1 |
| 20110257728 | Kuehn | Oct 2011 | A1 |
| 20110264208 | Duffy | Oct 2011 | A1 |
| 20110276062 | Bolduc | Nov 2011 | A1 |
| 20110282361 | Miller et al. | Nov 2011 | A1 |
| 20110288435 | Christy et al. | Nov 2011 | A1 |
| 20110288635 | Miller | Nov 2011 | A1 |
| 20110301498 | Maenhout et al. | Dec 2011 | A1 |
| 20110301698 | Miller et al. | Dec 2011 | A1 |
| 20120022557 | Cabiri | Jan 2012 | A1 |
| 20120022639 | Hacohen et al. | Jan 2012 | A1 |
| 20120022640 | Gross et al. | Jan 2012 | A1 |
| 20120022644 | Reich | Jan 2012 | A1 |
| 20120035712 | Maisano et al. | Feb 2012 | A1 |
| 20120078355 | Zipory | Mar 2012 | A1 |
| 20120078359 | Li et al. | Mar 2012 | A1 |
| 20120089022 | House et al. | Apr 2012 | A1 |
| 20120095552 | Spence | Apr 2012 | A1 |
| 20120109155 | Robinson et al. | May 2012 | A1 |
| 20120136436 | Cabin | May 2012 | A1 |
| 20120143323 | Hasenkam | Jun 2012 | A1 |
| 20120150290 | Gabbay | Jun 2012 | A1 |
| 20120158021 | Morrill | Jun 2012 | A1 |
| 20120179086 | Shank | Jul 2012 | A1 |
| 20120191182 | Hauser et al. | Jul 2012 | A1 |
| 20120197388 | Khairkhahan et al. | Aug 2012 | A1 |
| 20120239142 | Liu et al. | Sep 2012 | A1 |
| 20120245604 | Tegzes | Sep 2012 | A1 |
| 20120271198 | Whittaker et al. | Oct 2012 | A1 |
| 20120283757 | Miller | Nov 2012 | A1 |
| 20120296349 | Smith et al. | Nov 2012 | A1 |
| 20120296417 | Hill et al. | Nov 2012 | A1 |
| 20120296419 | Richardson | Nov 2012 | A1 |
| 20120123531 | Tsukashima et al. | Dec 2012 | A1 |
| 20120310330 | Buchbinder et al. | Dec 2012 | A1 |
| 20120323313 | Seguin | Dec 2012 | A1 |
| 20120330410 | Hammer | Dec 2012 | A1 |
| 20120330411 | Gross | Dec 2012 | A1 |
| 20130023758 | Fabro | Jan 2013 | A1 |
| 20130030522 | Rowe et al. | Jan 2013 | A1 |
| 20130035759 | Gross et al. | Feb 2013 | A1 |
| 20130046373 | Cartledge et al. | Feb 2013 | A1 |
| 20130079873 | Migliazza | Mar 2013 | A1 |
| 20130085529 | Housman | Apr 2013 | A1 |
| 20130090724 | Subramanian | Apr 2013 | A1 |
| 20130096672 | Reich | Apr 2013 | A1 |
| 20130096673 | Hill | Apr 2013 | A1 |
| 20130116776 | Gross et al. | May 2013 | A1 |
| 20130116780 | Miller | May 2013 | A1 |
| 20130123910 | Cartledge | May 2013 | A1 |
| 20130131791 | Hlavka et al. | May 2013 | A1 |
| 20130131792 | Miller | May 2013 | A1 |
| 20130166017 | Cartledge et al. | Jun 2013 | A1 |
| 20130172992 | Gross et al. | Jul 2013 | A1 |
| 20130190863 | Call et al. | Jul 2013 | A1 |
| 20130190866 | Zipory | Jul 2013 | A1 |
| 20130197632 | Kovach | Aug 2013 | A1 |
| 20130204361 | Adams | Aug 2013 | A1 |
| 20130226289 | Shaolian | Aug 2013 | A1 |
| 20130226290 | Yellin et al. | Aug 2013 | A1 |
| 20130268069 | Zakai et al. | Oct 2013 | A1 |
| 20130289718 | Tsukashima et al. | Oct 2013 | A1 |
| 20130304093 | Serina et al. | Nov 2013 | A1 |
| 20130325118 | Cartledge | Dec 2013 | A1 |
| 20140018914 | Zipory et al. | Jan 2014 | A1 |
| 20140088368 | Park | Mar 2014 | A1 |
| 20140094826 | Sutherland et al. | Apr 2014 | A1 |
| 20140094903 | Miller et al. | Apr 2014 | A1 |
| 20140094906 | Spence et al. | Apr 2014 | A1 |
| 20140135799 | Henderson | May 2014 | A1 |
| 20140142619 | Serina et al. | May 2014 | A1 |
| 20140142695 | Gross et al. | May 2014 | A1 |
| 20140148849 | Serina et al. | May 2014 | A1 |
| 20140148898 | Gross et al. | May 2014 | A1 |
| 20140155783 | Starksen et al. | Jun 2014 | A1 |
| 20140163670 | Alon et al. | Jun 2014 | A1 |
| 20140163690 | White | Jun 2014 | A1 |
| 20140188108 | Goodine et al. | Jul 2014 | A1 |
| 20140188140 | Meier et al. | Jul 2014 | A1 |
| 20140188215 | Hlavka et al. | Jul 2014 | A1 |
| 20140194976 | Starksen et al. | Jul 2014 | A1 |
| 20140222137 | Miller et al. | Aug 2014 | A1 |
| 20140243859 | Robinson | Aug 2014 | A1 |
| 20140243894 | Groothuis et al. | Aug 2014 | A1 |
| 20140243963 | Sheps et al. | Aug 2014 | A1 |
| 20140257475 | Gross et al. | Sep 2014 | A1 |
| 20140275757 | Goodwin et al. | Sep 2014 | A1 |
| 20140276648 | Hammer et al. | Sep 2014 | A1 |
| 20140296962 | Cartledge et al. | Oct 2014 | A1 |
| 20140303649 | Nguyen et al. | Oct 2014 | A1 |
| 20140303720 | Sugimoto et al. | Oct 2014 | A1 |
| 20140309661 | Sheps et al. | Oct 2014 | A1 |
| 20140309730 | Alon | Oct 2014 | A1 |
| 20140324164 | Gross et al. | Oct 2014 | A1 |
| 20140343668 | Zipory et al. | Nov 2014 | A1 |
| 20140379006 | Sutherland et al. | Dec 2014 | A1 |
| 20150012087 | Miller et al. | Jan 2015 | A1 |
| 20150018940 | Quill et al. | Jan 2015 | A1 |
| 20150051697 | Spence et al. | Feb 2015 | A1 |
| 20150081014 | Gross et al. | Mar 2015 | A1 |
| 20150112432 | Reich et al. | Apr 2015 | A1 |
| 20150127097 | Neumann et al. | May 2015 | A1 |
| 20150182336 | Zipory et al. | Jul 2015 | A1 |
| 20150230924 | Miller | Aug 2015 | A1 |
| 20150272586 | Herman et al. | Oct 2015 | A1 |
| 20150272734 | Sheps et al. | Oct 2015 | A1 |
| 20150282931 | Brunnett et al. | Oct 2015 | A1 |
| 20150297212 | Reich et al. | Oct 2015 | A1 |
| 20150351906 | Hammer et al. | Dec 2015 | A1 |
| 20160113767 | Miller et al. | Apr 2016 | A1 |
| 20160317302 | Madjarov et al. | Nov 2016 | A1 |
| Number | Date | Country |
|---|---|---|
| 2671966 | Jun 2008 | CA |
| 101653365 | Feb 2010 | CN |
| 0611561 | Aug 1994 | EP |
| 0954257 | Aug 2000 | EP |
| 1258437 | Nov 2002 | EP |
| 0871417 | Oct 2003 | EP |
| 1266641 | Oct 2004 | EP |
| 1034753 | Feb 2005 | EP |
| 1990014 | Nov 2008 | EP |
| 1562522 | Dec 2008 | EP |
| 1258232 | Jan 2009 | EP |
| 1420723 | Jan 2009 | EP |
| 1903991 | Sep 2009 | EP |
| 1418865 | Oct 2009 | EP |
| 2119399 | Nov 2009 | EP |
| 1531762 | Apr 2010 | EP |
| 2273928 | Jan 2011 | EP |
| 1450733 | Feb 2011 | EP |
| 2445417 | May 2012 | EP |
| 2088965 | Nov 2012 | EP |
| 1861045 | Mar 2015 | EP |
| 1465555 | May 2015 | EP |
| 223448 | Dec 2012 | IL |
| 9205093 | Apr 1992 | WO |
| 9310714 | Jun 1993 | WO |
| 0614342 | Sep 1994 | WO |
| 9639963 | Dec 1996 | WO |
| 9640344 | Dec 1996 | WO |
| 9701369 | Jan 1997 | WO |
| 9846149 | Oct 1998 | WO |
| 1999030647 | Jun 1999 | WO |
| WO 2000009048 | Feb 2000 | WO |
| 0022981 | Apr 2000 | WO |
| 1006905 | Jun 2000 | WO |
| 0126586 | Apr 2001 | WO |
| 0156457 | Aug 2001 | WO |
| 02085250 | Oct 2002 | WO |
| 02085251 | Oct 2002 | WO |
| 02085252 | Oct 2002 | WO |
| 03028558 | Apr 2003 | WO |
| 03047467 | Jun 2003 | WO |
| 2003046947 | Jun 2003 | WO |
| 2003105667 | Dec 2003 | WO |
| 04103434 | Dec 2004 | WO |
| 05021063 | Mar 2005 | WO |
| 05046488 | May 2005 | WO |
| 2005062931 | Jul 2005 | WO |
| 06012013 | Feb 2006 | WO |
| 06012038 | Feb 2006 | WO |
| 06086434 | Aug 2006 | WO |
| 06097931 | Sep 2006 | WO |
| 06105084 | Oct 2006 | WO |
| 06116558 | Nov 2006 | WO |
| 07011799 | Jan 2007 | WO |
| 2007080595 | Jul 2007 | WO |
| 07121314 | Oct 2007 | WO |
| 07136783 | Nov 2007 | WO |
| 07136981 | Nov 2007 | WO |
| WO 2008014144 | Jan 2008 | WO |
| WO 2008031103 | Mar 2008 | WO |
| 08068756 | Jun 2008 | WO |
| 2009130631 | Oct 2009 | WO |
| 10004546 | Jan 2010 | WO |
| 2010000454 | Jan 2010 | WO |
| 2010006905 | Jan 2010 | WO |
| 2010044851 | Apr 2010 | WO |
| WO 2010065274 | Jun 2010 | WO |
| 10073246 | Jul 2010 | WO |
| 2010085649 | Jul 2010 | WO |
| 2010128502 | Nov 2010 | WO |
| 2010128503 | Nov 2010 | WO |
| 2010150178 | Dec 2010 | WO |
| 2011051942 | May 2011 | WO |
| 11067770 | Jun 2011 | WO |
| 2011089401 | Jul 2011 | WO |
| 2011089601 | Jul 2011 | WO |
| 2011111047 | Sep 2011 | WO |
| 2011148374 | Dec 2011 | WO |
| 2011154942 | Dec 2011 | WO |
| 2012011108 | Jan 2012 | WO |
| 2012014201 | Feb 2012 | WO |
| 2012068541 | May 2012 | WO |
| 2012106346 | Aug 2012 | WO |
| 2012176195 | Dec 2012 | WO |
| 2013021374 | Feb 2013 | WO |
| 2013021375 | Feb 2013 | WO |
| 2013069019 | May 2013 | WO |
| 2013088327 | Jun 2013 | WO |
| 2014064694 | May 2014 | WO |
| 2014064695 | May 2014 | WO |
| 2014064964 | May 2014 | WO |
| 2014076696 | May 2014 | WO |
| 2014087402 | Jun 2014 | WO |
| 2014115149 | Jul 2014 | WO |
| 2014195786 | Dec 2014 | WO |
| 2015059699 | Apr 2015 | WO |
| WO 2016087934 | Jun 2016 | WO |
| Entry |
|---|
| O'Reilly S et al., “Heart valve surgery pushes the envelope,” Medtech Insight 8(3): 73, 99-108 (2006). |
| Dieter RS, “Percutaneous valve repair: Update on mitral regurgitation and endovascular approaches to the mitral valve,” Applications in Imaging, Cardiac Interventions, Supported by an educational grant from Amersham Health pp. 11-14 (2003). |
| Swain CP et al., “An endoscopically deliverable tissue-transfixing device for securing biosensors in the gastrointestinal tract,” Gastrointestinal Endoscopy 40(6): 730-734 (1994). |
| Odell JA et al., “Early Results o4yf a Simplified Method of Mitral Valve Annuloplasty,” Circulation 92:150-154 (1995). |
| U.S. Appl. No. 60/873,075, filed Dec. 5, 2006. |
| An International Preliminary Report on Patentability dated Nov. 9, 2011, which issued during the prosecution of Applicant's PCT/IL2010/000357. |
| U.S. Appl. No. 60/902,146, filed Feb. 16, 2007. |
| An International Preliminary Preliminary Report on Patentability dated Jun. 5, 2012, which issued during the prosecution of Applicant's PCT/IL2010/001024. |
| U.S. Appl. No. 61/001,013, filed Oct. 29, 2007. |
| An International Preliminary Report on Patentability dated Nov. 27, 2012, which issued during the prosecution of Applicant's PCT/IL2011/000404. |
| U.S. Appl. No. 61/132,295, filed Jun. 16, 2008. |
| Notice of Allowance dated Apr. 27, 2012, which issued during the prosecution of U.S. Appl. No. 12/341,960. |
| “Two dimensional real-time ultrasonic imaging of the heart and great vessels”, Mayo Clin Proc. vol. 53:271-303, 1978. |
| An Office Action dated Mar. 29, 2011, which issued during the prosecution of U.S. Appl. No. 12/341,960. |
| An Office Action dated Aug. 2, 2011, which issued during the prosecution of U.S. Appl. No. 12/435,291. |
| A Restriction Requirement dated Mar. 30, 2012, which issued during the prosecution of U.S. Appl. No. 12/785,717. |
| An International Search Report and a Written Opinion both dated Jun. 10, 2010, which issued during the prosecution of Applicant's PCT/IL09/01209. |
| An Office Action dated Jan. 27, 2012, which issued during the prosecution of U.S. Appl. No. 12/548,991. |
| An Office Action dated Apr. 6, 2010, which issued during the prosecution of Applicant's U.S. Appl. No. 12/484,512. |
| An Office Action dated Nov. 5, 2012, which issued during the prosecution of U.S. Appl. No. 12/795,026. |
| An International Search Report and a Written Opinion both dated Aug. 17, 2010, which issued during the prosecution of Applicant's PCT/IL10/00357. |
| An Office Action dated Sep. 16, 2009 which issued during the prosecution of U.S. Appl. No. 11/950,930. |
| Alfieri et al., “An effective technique to correct anterior mitral leaflet prolapse,” J Card 14(6):468-470 (1999). |
| A Restriction Requirement dated Nov. 19, 2012, which issued during the prosecution of U.S. Appl. No. 12/926,673. |
| Alfieri et al., “The double orifice technique in mitral valve repair: a simple solution for complex problems,” Journal of Thoracic Cardiovascular Surgery 122:674-681 (2001). |
| A Supplementary European Search Report dated Jan. 20, 2015, which issued during the prosecution of European Patent Application No. 12803037.6. |
| An International Preliminary Report on Patentability dated Jun. 29, 2011, which issued during the prosecution of Applicant's PCT/IL2009/001209. |
| Alfieri, “The edge-to-edge repair of the mitral valve,” [Abstract] 6th Annual NewEra Cardiac Care: Innovation & Technology, Heart Surgery Forum pp. 103. (2000). |
| Dang NC et al. “Simplified Placement of Multiple Artificial Mitral Valve Chords,” The Heart Surgery Forum #2005-1005, 8 (3) (2005). |
| An International Search Report and a Written Opinion both dated Feb. 10, 2011 which issued during the prosecution of Applicant's PCT/IL10/00890. |
| Alfieri et al.“Novel Suture Device for Beating-Heart Mitral Leaflet Approximation”, Ann Thorac Surg. 2002, 74:1488-1493. |
| A Notice of Allowance dated Jun. 26, 2012, which issued during the prosecution of U.S. Appl. No. 12/608,316. |
| A Notice of Allowance dated Jul. 30, 2015, which issued during the prosecution of U.S. Appl. No. 13/319,007. |
| An Office Action dated Jan. 23, 2012, which issued during the prosecution of U.S. Appl. No. 12/692,061. |
| An International Search Report dated May 19, 2011, which issued during the prosecution of Applicant's PCT/IL2011/00064. |
| A Supplementary European Search Report dated Feb. 1, 2011, which issued during the prosecution of European Patent Application No. EP 07849540. |
| An International Search Report together with Written Opinion both dated Mar. 30, 2011, which issued during the prosecution of Applicant's PCT/IL2010/001024. |
| An Office Action dated Aug. 6, 2012, which issued during the prosecution of U.S. Appl. No. 12/548,991. |
| An Office Action dated Jul. 20, 2012, which issued during the prosecution of U.S. Appl. No. 12/843,412. |
| An Office Action dated Aug. 24, 2012, which issued during the prosecution of U.S. Appl. No. 12/563,930. |
| An Office Action dated May 10, 2012, which issued during the prosecution of U.S. Appl. No. 12/795,026. |
| An Office Action dated Mar. 9, 2012, which issued during the prosecution of U.S. Appl. No. 12/689,635. |
| A Restriction Requirement dated Sep. 14, 2012, which issued during the prosecution of U.S. Appl. No. 12/795,192. |
| An Office Action dated Sep. 28, 2011, which issued during the prosecution of U.S. Appl. No. 12/437,103. |
| An International Search Report and Written Opinion dated Nov. 8, 2010, which issued during the prosecution of Applicant's PCT/IL2010/000358. |
| An Office Action dated Dec. 29, 2011, which issued during the prosecution of U.S. Appl. No. 12/563,952. |
| An International Search Report and a Written Opinion both dated Nov. 23, 2011, which issued during the prosecution of Applicant's PCT/IL2011/000446. |
| An International Search Report with Written Opinion both dated Feb. 2, 2012, which issued during the prosecution of Applicant's PCT/IL2011/000600. |
| An International Preliminary Report on Patentability dated Nov. 9, 2011 which issued during the prosecution of Applicant's PCT/IL2010/000358. |
| An Office Action dated Aug. 4, 2010, which issued during the prosecution of U.S. Appl. No. 12/341,960. |
| An Office Action dated Nov. 14, 2011, which issued during the prosecution of U.S. Appl. No. 12/608,316. |
| An Office Action dated Aug. 15, 2013, which issued during the prosecution of U.S. Appl. No. 12/795,192. |
| An Office Action dated Jan. 17, 2013, which issued during the prosecution of U.S. Appl. No. 12/795,192. |
| An Office Action dated Feb. 12, 2013, which issued during the prosecution of U.S. Appl. No. 12/926,673. |
| An Office Action dated Dec. 7, 2011, which issued during the prosecution of U.S. Appl. No. 12/435,291. |
| An Office Action dated Oct. 27, 2011, which issued during the prosecution of U.S. Appl. No. 12/563,952. |
| A Notice of Allowance dated May 24, 2012, which issued during the prosecution of U.S. Appl. No. 12/563,952. |
| An Office Action dated Jul. 5, 2012, which issued during the prosecution of U.S. Appl. No. 12/563,930. |
| A Notice of Allowance dated Apr. 3, 2013, which issued during the prosecution U.S. Appl. No. 12/563,930. |
| An Office Action dated Apr. 2, 2013, which issued during the prosecution of U.S. Appl. No. 12/785,717. |
| An Advisory Action dated Sep. 6, 2012 which issued during the prosecution of U.S. Appl. No. 12/548,991. |
| A Restriction Requirement dated Feb. 4, 2013 which issued during the prosecution of U.S. Appl. No. 13/141,606. |
| An Office Action dated Feb. 14, 2013 which issued during the prosecution of U.S. Appl. No. 13/167,492. |
| An International Search Report and a Written Opinion both dated Feb. 22, 2013 which issued during the prosecution of Applicant's PCT/IL201/050451. |
| An Office Action dated Apr. 1, 2013 which issued during the prosecution of U.S. Appl. No. 13/167,476. |
| A Restriction Requirement dated Jun. 7, 2013 which issued during the prosecution of U.S. Appl. No. 13/141,606. |
| An Office Action dated Aug. 23, 2013 which issued during the prosecution of U.S. Appl. No. 13/167,444. |
| U.S. Appl. No. 61/265,936, filed Dec. 2, 2009. |
| U.S. Appl. No. 61/283,445, filed Dec. 2, 2009. |
| U.S. Appl. No. 61/207,908, filed Feb. 17, 2009. |
| Amplatzer Cardiac Plug brochure (English pages), AGA Medical Corporation (Plymouth, MN) (copyright 2008-2010, downloaded Jan. 11, 2011). |
| An Office Action dated Dec. 16, 2013, which issued during the prosecution of U.S. Appl. No. 13/666,262. |
| Notice of Allowance dated Nov. 19, 2013, which issued during the prosecution of U.S. Appl. No. 12/795,192. |
| An Office Action dated Oct. 2, 2013, which issued during the prosecution of U.S. Appl. No. 13/167,492. |
| An Office Action dated Nov. 21, 2013, which issued during the prosecution of U.S. Appl. No. 13/167,476. |
| An Office Action dated Dec. 18, 2013, which issued during the prosecution of U.S. Appl. No. 13/666,141. |
| A Restriction Requirement dated Apr. 19, 2010 which issued during the U.S. Appl. No. 12/341,960. |
| An Office Action dated Jun. 13, 2012, which issued during the prosecution of U.S. Appl. No. 12/437,103. |
| An Office Action dated Nov. 30, 2012, which issued during the prosecution of U.S. Appl. No. 12/689,635. |
| An Office Action dated Oct. 22, 2013, which issued during the prosecution of U.S. Appl. No. 12/926,673. |
| A Restriction Requirement dated Oct. 25, 2012 which issued during the prosecution of U.S. Appl. No. 13/167,444. |
| An Office Action dated Jan. 17, 2013, which issued during the prosecution of U.S. Appl. No. 13/167,444. |
| A Restriction Requirement dated Nov. 2, 2012, which issued during the prosecution of U.S. Appl. No. 13/167,492. |
| An International Preliminary Report on Patentability dated Feb. 4, 2014, which issued during the prosecution of Applicant's PCT/IL2011/000446. |
| A Supplementary European Search Report dated Dec. 4, 2012, which issued during the prosecution of European Patent Application No. EP 09834225.6. |
| A Supplementary European Search Report dated Mar. 28, 2013, which issued during the prosecution of European Patent Application No. EP 1077 2091.4. |
| U.S. Appl. No. 61/733,979, filed Dec. 6, 2012. |
| U.S. Appl. No. 61/717,303, filed Oct. 23, 2012. |
| U.S. Appl. No. 61/820,979, filed May 8, 2013. |
| U.S. Appl. No. 61/745,848, filed Dec. 6, 2012. |
| An Office Action dated May 19, 2011, which issued during the prosecution of U.S. Appl. No. 12/706,868. |
| An Office Action dated Sep. 1, 2011, which issued during the prosecution of U.S. Appl. No. 12/706,868. |
| An Office Action dated Dec. 27, 2013, which issued during the prosecution of U.S. Appl. No. 12/785,717. |
| An Office Action dated May 30, 2012, which issued during the prosecution of U.S. Appl. No. 12/706,868. |
| An International Preliminary Report on Patentability dated Jan. 29, 2013, which issued during the prosecution of Applicant's PCT/IL2011/000600. |
| An International Search Report and a Written Opinion both dated Dec. 6, 2012 which issued during the prosecution of Applicant's PCT/IL2012/000250. |
| An Office Action dated Jun. 18, 2015, which issued during the prosecution of U.S. Appl. No. 14/551,951. |
| U.S. Appl. No. 61/557,082, filed Nov. 8, 2011. |
| A Restriction Requirement dated Jul. 12, 2011, which issued during the prosecution of U.S. Appl. No. 12/437,103. |
| An Office Action dated Mar. 27, 2013, which issued during the prosecution of U.S. Appl. No. 12/843,412. |
| An Office Action dated May 6, 2013, which issued during the prosecution of U.S. Appl. No. 12/689,693. |
| A Restriction Requirement dated May 1, 2012, which issued during the prosecution of U.S. Appl. No. 12/843,412. |
| Langer et al. Ring plus String: Papillary muscle repositioning as an adjunctive repair technique for ischemic mitral regurgitation, The Journal of Thoracic Cardiovascular surgery vol. 133 No. 1, Jan. 2007. |
| Langer et al. Ring+String, Successful Repair technique for ischemic mitral regurgitation with severe leaflet Tethering, The Department of Thoracic Cardiovascular surgery, Hamburg, Germany, Nov. 2008. |
| U.S. Appl. No. 61/555,570, filed Nov. 4, 2011. |
| A Notice of Allowance dated Sep. 18, 2012, which issued during the prosecution of U.S. Appl. No. 12/706,868. |
| An Office Action dated Aug. 13, 2012, which issued during the prosecution of U.S. Appl. No. 13/044,694. |
| An Office Action dated Dec. 31, 2012, which issued during the prosecution of U.S. Appl. No. 13/044,694. |
| A Restriction Requirement dated Apr. 1, 2011, which issued during the prosecution of U.S. Appl. No. 12/608,316. |
| Agarwal et al. International Cardiology Perspective Functional Tricuspid Regurgitation, Circ Cardiovasc Interv 2009;2;2;565-573 (2009). |
| An Office Action dated Oct. 6, 2010, which issued during the prosecution of Applicant's U.S. Appl. No. 12/484,512. |
| An Office Action dated Jul. 6, 2012, which issued during the prosecution of U.S. Appl. No. 12/692,061. |
| An Interview Summary dated Jul. 27, 2011, which issued during the prosecution of U.S. Appl. No. 12/341,960. |
| A Notice of Allowance dated May 2, 2013, which issued during the prosecution of U.S. Appl. No. 12/843,412. |
| An Office Action dated Jul. 18, 2013, which issued during the prosecution of U.S. Appl. No. 13/044,694. |
| Search Report in European Patent Application 10772090.6 dated Jan. 17, 2014. |
| An Office Action dated Feb. 3, 2014, which issued during the prosecution of U.S. Appl. No. 12/689,693. |
| Communication regarding amended claims filed dated Dec. 27, 2012, regarding European App No. 11792047.0. |
| Notice of Allowance dated Mar. 6, 2014, which issued during the prosecution of U.S. Appl. No. 12/437,103. |
| An Office Action dated Oct. 9, 2013, which issued during the prosecution of U.S. Appl. No. 12/996,954. |
| AMPLATZER® Septal Occluder. A patient guide to the Non-Surgical Closuer of the Atrial Septal Defect Using the AMPLATZER Septal Occluder System, AGA Medical Corporation, Apr. 2008. |
| Notice of Allowance dated Sep. 12, 2014, which issued during the prosecution of U.S. Appl. No. 11/950,930. |
| An Office Action dated Dec. 19, 2013, which issued during the prosecution of U.S. Appl. No. 14/027,934. |
| An International Preliminary Report on Patentability dated Dec. 18, 2010, which issued during the prosecution of Applicant's PCT/IL09/00593. |
| An English translation of an Office Action dated Apr. 23, 2014 which issued during the prosecution of Chinese Patent Application No. 201080059948.4. |
| An Office Action dated Jun. 23, 2014, which issued during the prosecution of U.S. Appl. No. 12/548,991. |
| Notice of Allowance dated Jun. 11, 2014, which issued during the prosecution of U.S. Appl. No. 12/689,693. |
| Notice of Allowance dated Jun. 25, 2014, which issued during the prosecution of U.S. Appl. No. 13/666,262. |
| An International Search Report and Written Opinion both dated Apr. 9, 2014, which issued during the prosecution of Applicant's PCT/IL13/50860. |
| An International Search Report & Written Opinion both dated May 12, 2015, which issued during the prosecution of Applicant's PCT/IL2014/050914. |
| An Office Action dated Jun. 11, 2014, which issued during the prosecution of U.S. Appl. No. 14/027,934. |
| An Office Action dated Jun. 2, 2014, which issued during the prosecution of U.S. Appl. No. 13/319,030. |
| Brennan, Jennifer, 510(k) Summary of safety and effectiveness, Jan. 2008. |
| A communication from the European Patent Office dated Sep. 28, 2011 which issued during the prosecution of European Application No. 09834225.6. |
| A Restriction Requirement dated Sep. 17, 2012, which issued during the prosecution of U.S. Appl. No. 12/689,693. |
| An Office Action dated Aug. 22, 2014, which issued during the prosecution of U.S. Appl. No. 14/027,934. |
| An Office Action dated Aug. 26, 2014 which issued during the prosecution of U.S. Appl. No. 13/167,444. |
| Communication dated Jul. 25, 2014, issued by the State Intellectual Property Office of the P.R. of China in counterpart Application No. 200980157331.3. |
| A Notice of Allowance dated Sep. 3, 2014, which issued during the prosecution of U.S. Appl. No. 12/689,693. |
| Communication from the European Patent Office dated Jun. 11, 2015, which issued during the prosecution of European Patent Application No. 11811934. |
| Supplementary European Search Report dated Oct. 23, 2014 which issued during the prosecution of Applicant's European App No. 10826224.7. |
| An International Search Report & Written Opinion both dated Mar. 21, 2014, which issued during the prosecution of Applicant's PCT/IL13/50992. |
| A Notice of Allowance dated Feb. 2, 2015, which issued during the prosecution of U.S. Appl. No. 13/504,870. |
| An Office Action dated Oct. 14, 2014, which issued during the prosecution of U.S. Appl. No. 13/319,030. |
| Alfieri et al., “The edge to edge technique,” The European Association for Cardio-Thoracic Surgery 14th Annual Meeting Oct. 7-11, Book of Procees. (2000). |
| An Office Action dated Sep. 29, 2014, which issued during the prosecution of U.S. Appl. No. 13/504,870. |
| An Office Action dated Oct. 3, 2014, which issued during the prosecution of U.S. Appl. No. 13/749,153. |
| An International Search Report & Written Opinion both dated Sep. 8, 2009, which issued during the prosecution of Applicant's PCT/IL09/00593. |
| An International Search Report and Written Opinion both dated Nov. 14, 2011, which issued during the prosecution of Applicant's PCT/IL2011/000404. |
| Dictionary.com definition of “lock”, Jul. 29, 2013. |
| A Restriction Requirement dated Jan. 6, 2012, which issued during the prosecution of U.S. Appl. No. 12/795,026. |
| A Restriction Requirement dated Nov. 14, 2011 which issued during the prosecution of U.S. Appl. No. 12/548,991. |
| An International Preliminary Report on Patentability dated Apr. 28, 2015, which issued during the prosecution of Applicant's PCT/IL2013/050861. |
| A Notice of Allowance dated May 22, 2013, which issued during the prosecution of U.S. Appl. No. 12/689,635. |
| An International Preliminary Report on Patentability dated May 1, 2012, which issued during the prosecution of Applicant's PCT/IL2010/000890. |
| A Notice of Allowance dated Jan. 7, 2014, which issued during the prosecution of U.S. Appl. No. 12/926,673. |
| An Office Action dated May 5, 2011, which issued during the prosecution of U.S. Appl. No. 12/706,868. |
| Supplementary European Search Report dated Aug. 4, 2014 which issued during the prosecution of Applicant's European App No. 11 81 1934.6. |
| An Office Action dated Aug. 5, 2010 which issued during the prosecution of U.S. Appl. No. 11/950,930. |
| An Office Action dated Feb. 17, 2010 which issued during the prosecution of U.S. Appl. No. 11/950,930. |
| Restriction Requirement dated Nov. 14, 2011, which issued during the prosecution of U.S. Appl. No. 12/689,635. |
| Supplementary European Search Report dated Jan. 21, 2014 which issued during the prosecution of Applicant's European App No. 11 78 6226. |
| An Office Action dated Jun. 4, 2014, which issued during the prosecution of U.S. Appl. No. 12/840,463. |
| Maisano, The double-orifice technique as a standardized approach to treat mitral . . . , European Journal of Cardio-thoracic Surgery 17 (2000) 201-205. |
| Amplatzer® Cribriform Occluder. A patient guide to Percutaneous, Transcatheter, Atrial Septal Defect Closuer, AGA Medical Corporation, Apr. 2008. |
| An Office Action dated Jun. 10, 2014, which issued during the prosecution of U.S. Appl. No. 13/167,492. |
| An Office Action dated May 28, 2015, which issued during the prosecution of U.S. Appl. No. 14/128,756. |
| An Office Action dated Apr. 2, 2015, which issued during the prosecution of U.S. Appl. No. 14/027,934. |
| An Office Action dated Mar. 23, 2015, which issued during the prosecution of U.S. Appl. No. 13/707,013. |
| Supplementary European Search Report dated Dec. 23, 2014 which issued during the prosecution of Applicant's European App No. 10834311. |
| An Office Action dated Mar. 24, 2015, which issued during the prosecution of U.S. Appl. No. 12/996,954. |
| An Office Action dated Mar. 23, 2015, which issued during the prosecution of European Patent Application No. EP 09834225.6. |
| Supplementary European Search Report dated Mar. 23, 2015, which issued during the prosecution of Applicant's European App No. 11792047.0. |
| Notice of Allowance dated Dec. 20, 2013, which issued during the prosecution of U.S. Appl. No. 12/437,103. |
| Supplementary European Search Report dated Apr. 29, 2015, which issued during the prosecution of Applicant's European App No. 14200202.0. |
| An International Preliminary Report on Patentability dated Dec. 23, 2014, which issued during the prosecution of Applicant's PCT/IL2012/050451. |
| An International Search Report and a Written Opinion both dated Apr. 15, 2014, which issued during the prosecution of Applicant's PCT/IL2013/050861. |
| An International Preliminary Report on Patentability dated Dec. 23, 2013, which issued during the prosecution of Applicant's PCT/IL2012/000250. |
| An Office Action dated Aug. 7, 2015, which issued during the prosecution of U.S. Appl. No. 14/128,756. |
| An Invitation to pay additional fees dated Jan. 31, 2014, which issued during the prosecution of Applicant's PCT/IL2013/050861. |
| An Invitation to pay additional fees dated Jan. 31, 2014, which issued during the prosecution of Applicant's PCT/IL2013/050860. |
| An Office Action dated Sep. 19, 2014, which issued during the prosecution of U.S. Appl. No. 13/044,694. |
| A communication from the European Patent Office dated Oct. 19, 2012 which issued during the prosecution of European Application No. 11792047.0. |
| An Office Action dated Oct. 5, 2012, which issued during the prosecution of U.S. Appl. No. 12/996,954. |
| An Office Action dated Oct. 5, 2015, which issued during the prosecution of U.S. Appl. No. 14/246,417. |
| An Office Action dated Oct. 1, 2015, which issued during the prosecution of U.S. Appl. No. 14/141,228. |
| Supplementary European Search Report dated Sep. 25, 2015, which issued during the prosecution of Applicant's European App No. 09794095.1. |
| An Office Action dated Apr. 7, 2015, which issued during the prosecution of U.S. Appl. No. 13/319,007. |
| An Office Action dated Jan. 13, 2015, which issued during the prosecution of U.S. Appl. No. 13/707,013. |
| An Office Action dated Jan. 5, 2016, which issued during the prosecution of U.S. Appl. No. 14/027,934. |
| An Office Action dated Mar. 16, 2015, which issued during the prosecution of U.S. Appl. No. 14/084,426. |
| An Office Action dated Mar. 24, 2015, which issued during the prosecution of U.S. Appl. No. 14/486,226. |
| Notice of Allowance dated May 22, 2015, which issued during the prosecution of U.S. Appl. No. 13/749,153. |
| An Office Action dated Jun. 18, 2015, which issued during the prosecution of U.S. Appl. No. 13/319,030. |
| An Office Action dated Jun. 13, 2014, which issued during the prosecution of U.S. Appl. No. 13/141,606. |
| An English translation of an Office Action dated Jul. 17, 2015 which issued during the prosecution of Chinese Patent Application No. 201080059948.4. |
| Notice of Allowance dated Sep. 29, 2014, which issued during the prosecution of U.S. Appl. No. 13/141,606. |
| Notice of Allowance dated Sep. 14, 2015, which issued during the prosecution of U.S. Appl. No. 13/707,013. |
| An International Preliminary Report on Patentability dated Jun. 9, 2015, which issued during the prosecution of Applicant's PCT/IL2013/050992. |
| Notice of Allowance dated Jul. 24, 2015, which issued during the prosecution of U.S. Appl. No. 13/707,013. |
| Notice of Allowance dated Jul. 8, 2015, which issued during the prosecution of U.S. Appl. No. 13/707,013. |
| Search Report in European Patent Application 10826224.7 dated Nov. 16, 2015. |
| Notice of Allowance dated Dec. 24, 2014, which issued during the prosecution of U.S. Appl. No. 12/795,026. |
| An English Translation of an Office Action dated Nov. 24, 2015, which issued during the prosecution of Israel Patent Application No. 223448. (the relevant part only). |
| Notice of Allowance dated Nov. 12, 2015, which issued during the prosecution of U.S. Appl. No. 13/319,007. |
| Notice of Allowance dated Jan. 7, 2016, which issued during the prosecution of U.S. Appl. No. 13/319,007. |
| Notice of Allowance dated Apr. 20, 2011, which issued during the prosecution of U.S. Appl. No. 12/484,512. |
| Notice of Allowance dated Mar. 23, 2011, which issued during the prosecution of U.S. Appl. No. 12/484,512. |
| Notice of Allowance dated Jun. 3, 2014, which issued during the prosecution of U.S. Appl. No. 12/785,717. |
| Notice of Allowance dated Nov. 13, 2014, which issued during the prosecution of U.S. Appl. No. 12/795,026. |
| Notice of Allowance dated Feb. 19, 2014, which issued during the prosecution of U.S. Appl. No. 12/795,192. |
| An English translation of an Office Action dated Dec. 16, 2015 which issued during the prosecution of Chinese Patent Application No. 201080059948.4. |
| An English translation of an Office Action dated Dec. 12, 2013 which issued during the prosecution of Chinese Patent Application No. 200980157331.3. |
| Notice of Allowance dated Nov. 17, 2015, which issued during the prosecution of U.S. Appl. No. 14/486,226. |
| European Search Report dated Nov. 4, 2015, which issued during the prosecution of European Patent Application No. EP 1077 2091.4. |
| U.S. Appl. No. 61/782,121, filed Mar. 14, 2013. |
| Interview Summary Report dated Apr. 4, 2012, which issued during the prosecution of U.S. Appl. No. 12/563,952. |
| Notice of Allowance dated Jan. 29, 2016, which issued during the prosecution of U.S. Appl. No. 14/551,951. |
| Notice of Allowance dated Mar. 25, 2015, which issued during the prosecution of U.S. Appl. No. 13/749,153. |
| Notice of Allowance dated Aug. 3, 2015, which issued during the prosecution of U.S. Appl. No. 13/749,153. |
| Notice of Allowance dated Dec. 9, 2014, which issued during the prosecution of U.S. Appl. No. 13/167,476. |
| Notice of Allowance dated Nov. 7, 2014, which issued during the prosecution of U.S. Appl. No. 13/167,492. |
| Notice of Allowance dated Jan. 22, 2015, which issued during the prosecution of U.S. Appl. No. 13/167,444. |
| An International Preliminary Report on Patentability dated Apr. 28, 2015, which issued during the prosecution of Applicant's PCT/IL2013/050860. |
| An Office Action dated Jan. 6, 2016, which issued during the prosecution of U.S. Appl. No. 14/128,756. |
| An Office Action dated Apr. 8, 2016, which issued during the prosecution of U.S. Appl. No. 14/141,228. |
| An Office Action dated Apr. 7, 2016, which issued during the prosecution of U.S. Appl. No. 14/242,151. |
| An Office Action dated Jan. 4, 2016, which issued during the prosecution of U.S. Appl. No. 14/589,100. |
| An Office Action dated Sep. 4, 2015, which issued during the prosecution of U.S. Appl. No. 14/589,100. |
| An Office Action dated Jul. 8, 2015, which issued during the prosecution of U.S. Appl. No. 14/141,228. |
| An International Preliminary Report on Patentability dated Jun. 10, 2009, which issued during the prosecution of Applicant's PCT/IL07/01503. |
| Notice of Allowance dated Aug. 19, 2013, which issued during the prosecution of U.S. Appl. No. 11/908,906. |
| An Office Action dated Jun. 8, 2012, which issued during the prosecution of U.S. Appl. No. 11/908,906. |
| An Office Action dated Dec. 21, 2012, which issued during the prosecution of U.S. Appl. No. 11/908,906. |
| An Office Action dated Aug. 5, 2011, which issued during the prosecution of U.S. Appl. No. 11/908,906. |
| An International Preliminary Report on Patentability dated Sep. 18, 2007, which issued during the prosecution of Applicant's PCT/IL2006/000342. |
| An International Search Report and a Written Opinion both dated May 30, 2007, which issued during the prosecution of Applicant's PCT/IL2006/000342. |
| An Advisory Action dated Feb. 4, 2014, which issued during the prosecution of U.S. Appl. No. 13/167,476. |
| An Office Action dated Oct. 23, 2012, which issued during the prosecution of Japanese Patent Application No. 2009-539871. |
| U.S. Appl. No. 60/662,616, filed Mar. 17, 2005. |
| U.S. Appl. No. 60/700,542, filed Jul. 18, 2005. |
| Notice of Allowance dated Jul. 7, 2015, which issued during the prosecution of U.S. Appl. No. 12/996,954. |
| Notice of Allowance dated Oct. 20, 2015, which issued during the prosecution of U.S. Appl. No. 12/996,954. |
| An International Search Report and a Written Opinion both dated May 28, 2014, which issued during the prosecution of Applicant's PCT/IL14/050027. |
| An International Search Report and a Written Opinion both dated Jan. 25, 2016, which issued during the prosecution of Applicant's PCT/IL2015/051027. |
| An Office Action dated Jan. 5, 2016, which issued during the prosecution of U.S. Appl. No. 14/084,426. |
| An English Translation of an Office Action dated May 31, 2012, which issued during the prosecution of Israel Patent Application No. 209946. (the relevant part only). |
| An Office Action dated May 4, 2016, which issued during the prosecution of U.S. Appl. No. 14/589,100. |
| An Office Action dated Jun. 17, 2016, which issued during the prosecution of U.S. Appl. No. 14/357,040. |
| An Office Action dated Jun. 14, 2016, which issued during the prosecution of U.S. Appl. No. 14/273,155. |
| An Office Action dated May 23, 2016, which issued during the prosecution of U.S. Appl. No. 14/209,171. |
| Notice of Allowance dated May 3, 2016, which issued during the prosecution of U.S. Appl. No. 13/319,030. |
| An Office Action dated May 11, 2016, which issued during the prosecution of U.S. Appl. No. 14/128,756. |
| Notice of Allowance dated May 6, 2016, which issued during the prosecution of U.S. Appl. No. 14/667,090. |
| Notice of Allowance dated Apr. 12, 2016, which issued during the prosecution of U.S. Appl. No. 14/667,090. |
| Ahmadi, A., G. Spillner, and Th Johannesson. “Hemodynamic changes following experimental production and correction of acute mitral regurgitation with an adjustable ring prosthesis.” The Thoracic and cardiovascular surgeon 36.06 (1988): 313-319. |
| Ahmadi, Ali, et al. “Percutaneously adjustable pulmonary artery band.” The Annals of thoracic surgery 60 (1995): S520-S522. |
| An English Translation of an Office Action dated Sep. 15, 2016, which issued during the prosecution of Israel Patent Application No. 243837. (the relevant part only). |
| An Invitation to pay additional fees dated Aug. 18, 2016, which issued during the prosecution of Applicant's PCT/IL2016/050433. |
| An Office Action dated Jul. 20, 2016, which issued during the prosecution of U.S. Appl. No. 14/246,417. |
| Assad, Renato S. “Adjustable Pulmonary Artery Banding.” (2014). |
| Daebritz, S., et al. “Experience with an adjustable pulmonary artery banding device in two cases: initial success-midterm failure.” The Thoracic and cardiovascular surgeon 47.01 (1999): 51-52. |
| Elliott, Daniel S., Gerald W. Timm, and David M. Barrett. “An implantable mechanical urinary sphincter: a new nonhydraulic design concept.” Urology 52.6 (1998): 1151-1154. |
| European Search Report dated Jul. 15, 2016, which issued during the prosecution of Applicant's European App No. 13849947.0. |
| European Search Report dated Jul. 8, 2016, which issued during the prosecution of Applicant's European App No. 13849843.1. |
| European Search Report dated Jun. 24, 2016, which issued during the prosecution of European Patent Application No. EP 12847363. |
| Park, Sang C., et al. “A percutaneously adjustable device for banding of the pulmonary trunk.” International journal of cardiology 9.4 (1985): 477-484. |
| Swenson, Orvar. “Internal device for control of urinary incontinence.” Journal of pediatric surgery 7.5 (1972): 542-545. |
| Swenson et al., “An Improved Mechanical Device for Control of Urinary Incontinence,” Investigative Urology, 15(5):389-391 (1978). |
| Swenson, “An Experimental Implantable Urinary Sphincter,” Investigative Urology, 14(2):100-103 (1976). |
| International Search Report and Written Opinion for PCT/IL2016/050433 dated Oct. 17, 2016. |
| Office Action for U.S. Appl. No. 14/567,472 dated Oct. 21, 2016. |
| Notice of Allowance for U.S. Appl. No. 14/084,426 dated Aug. 22, 2016. |
| An Office Action dated Dec. 20, 2016, which issued during the prosecution of UK Patent Application No. 1611910.9. |
| Notice of Allowance dated Jan. 3, 2017, which issued during the prosecution of U.S. Appl. No. 14/128,756. |
| Notice of Allowance dated Dec. 19, 2016, which issued during the prosecution of U.S. Appl. No. 14/242,151. |
| An Office Action dated Dec. 13, 2016, which issued during the prosecution of European Patent Application No. 11786226.8. |
| An Office Action dated Feb. 2, 2017, which issued during the prosecution of U.S. Appl. No. 14/209,171. |
| An Office Action dated Jan. 20, 2017, which issued during the prosecution of U.S. Appl. No. 14/650,114. |
| An Office Action dated Feb. 10, 2017, which issued during the prosecution of U.S. Appl. No. 14/990,172. |
| Notice of Allowance dated Dec. 30, 2016, which issued during the prosecution of U.S. Appl. No. 13/319,030. |
| An Office Action dated Mar. 24, 2017, which issued during the prosecution of U.S. Appl. No. 14/273,155. |
| An Office Action dated Apr. 6, 2017, which issued during the prosecution of U.S. Appl. No. 14/437,062. |
| Notice of Allowance dated Apr. 13, 2017, which issued during the prosecution of U.S. Appl. No. 14/650,114. |
| An Office Action dated Feb. 27, 2017, which issued during the prosecution of U.S. Appl. No. 15/249,957. |
| An Office Action dated Jan. 25, 2017, which issued during the prosecution of Applicant's Chinese App No. 201510681407.X. |
| An Office Action dated Mar. 3, 2017, which issued during the prosecution of Applicant's European App No. 11792047.0. |
| Notice of Allowance dated Mar. 1, 2017, which issued during the prosecution of U.S. Appl. No. 14/357,040. |
| Number | Date | Country | |
|---|---|---|---|
| 20160008132 A1 | Jan 2016 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 13749153 | Jan 2013 | US |
| Child | 14837783 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 12437103 | May 2009 | US |
| Child | 13749153 | US | |
| Parent | PCT/IL2011/000600 | Jul 2011 | US |
| Child | 12437103 | US | |
| Parent | 12843412 | Jul 2010 | US |
| Child | PCT/IL2011/000600 | US |
