Partially-covered prosthetic valves

Information

  • Patent Grant
  • 11844691
  • Patent Number
    11,844,691
  • Date Filed
    Friday, September 3, 2021
    2 years ago
  • Date Issued
    Tuesday, December 19, 2023
    6 months ago
Abstract
An implant includes an expandable frame having a continuous lumen and has (a) an upstream row of upstream cells and (b) at least two downstream rows of downstream cells. An upstream portion of each cell is shaped by ascending and descending struts that form a respective peak that points in an upstream direction. A valve member is disposed within the lumen and facilitates unidirectional flow of blood from an upstream end of the frame to a downstream end of the frame. A covering has (i) a first portion entirely covering an outer surface of a downstream row of downstream cells, and (ii) a second portion partially covering an outer surface of an upstream row of downstream cells. Outer surfaces of the peaks of the upstream row of downstream cells are disposed upstream of an upstream end of the covering at the outer surface. Other embodiments are also described.
Description
FIELD OF THE INVENTION

Some applications of the present invention relate in general to valve replacement. More specifically, some applications of the present invention relate to prosthetic cardiac valves and techniques for implantation thereof.


BACKGROUND

Ischemic heart disease causes regurgitation of a heart valve by the combination of ischemic dysfunction of the papillary muscles, and the dilatation of the ventricle that is present in ischemic heart disease, with the subsequent displacement of the papillary muscles and the dilatation of the valve annulus.


Dilation of the annulus of the valve prevents the valve leaflets from fully coapting when the valve is closed. Regurgitation of blood from the ventricle into the atrium results in increased total stroke volume and decreased cardiac output, and ultimate weakening of the ventricle secondary to a volume overload and a pressure overload of the atrium.


SUMMARY OF THE INVENTION

For some applications of the invention, tissue anchors coupled to tethers are transluminally anchored to ventricular tissue of a native valve. A prosthetic valve component, such as a prosthetic valve assembly, a prosthetic valve body, or a support, is transluminally slid along a guide member coupled to the tethers, and is anchored to the tethers.


For some applications, a prosthetic valve assembly comprises (1) a valve body shaped to define a lumen therethrough, and a valve member disposed within the lumen, (2) an upstream support configured to be placed against an upstream surface of a native heart valve, and (2) a flexible sheet that couples the upstream support to the valve body.


For some applications, the prosthetic valve assembly comprises eyelets to facilitate sliding along the guide member.


For some applications, the prosthetic valve assembly has a compressed delivery state in which the valve body and the upstream support are articulatably coupled to each other by the sheet. For such applications, a delivery tool houses the prosthetic valve assembly such that the valve body and upstream support are articulatable with respect to each other during transluminal delivery.


For some applications, the prosthetic valve assembly comprises tethers that, when tensioned, move the valve body closer to the support. For such applications, the assembly typically comprises tissue-engaging elements that protrude from the valve body, and the tethers are tensioned to sandwich tissue of the native valve between the tissue-engaging elements and the support.


For some applications, one or more forces is measured during implantation, and distributed among various anchoring elements. For some such applications, an intracorporeal spring is used that is extracorporeally observable using imaging techniques. For some such applications, the spring facilitates force distribution.


For some applications, a prosthetic valve assembly comprises a flexible sheet forms a pocket between the sheet and a frame of the assembly, and facilitates sealing between the assembly and tissue of the native valve.


For some applications of the invention, tissue anchors coupled to longitudinal members that are reversibly couplable to wires are transluminally advanced to the ventricle downstream of a native heart valve, and are anchored there. A prosthetic valve support comprising an upstream support portion is slid, in a compressed delivery configuration, over the wires and part of each longitudinal member, and into an atrium upstream of the native valve where it is deployed (e.g., expanded) and placed against an upstream surface (e.g., an atrial surface) of the native valve. A locking member is also slid over the wires and part of each longitudinal member, and locks to the longitudinal member, thereby securing the prosthetic valve support against the upstream surface of the native valve. A prosthetic valve is subsequently transluminally advanced to the native valve, and is implanted by coupling the prosthetic valve to leaflets of the native valve and to the prosthetic valve support.


For some applications of the invention, a tubular member is slidable over the wire and the longitudinal member, and when disposed over the wire and the long member, inhibits decoupling of the wire from the longitudinal member. For such applications, the prosthetic valve support and the locking member are typically slidable over the tubular member.


For some applications of the invention, a control rod, reversibly coupled to the locking member, is slid over the tubular member so as to push the locking member and the prosthetic valve support over the tubular member. For some such applications, the control rod is used to lock the locking member to the longitudinal member.


There is therefore provided, in accordance with an application of the present invention, apparatus for use with a native valve of a heart of a subject, the apparatus including:

    • a valve body:
      • including (1) a first frame shaped to define a lumen therethrough, and (2) a valve member disposed within the lumen,
      • having a compressed state in which the first frame has a first diameter, and
      • having an expanded state in which the first frame has a second diameter that is greater than the first diameter;
    • an upstream support:
      • configured to be placed against an upstream surface of the native valve,
      • including a second frame,
        • having a compressed state, and
        • having an expanded state in which the second frame is annular, has an inner perimeter that defines an opening through the second frame, and has an outer perimeter; and
    • a flexible sheet that couples the upstream support to the valve body.


In an application, the upstream support is coupled to the valve body only via the sheet.


In an application:

    • the valve body has an upstream end, a downstream end, and a longitudinal axis therebetween along which the lumen is defined, and
    • when the valve body is in the expanded state thereof and the upstream support is in the expanded state thereof:
      • the first frame is attached to the second frame at the inner perimeter of the second frame, and
      • the sheet is attached to the valve body and to the upstream support in a manner that defines a pocket region between the sheet and at least the inner perimeter of the second frame, the sheet not being attached to the first frame or the second frame in the pocket region.


In an application, the sheet provides fluid communication between the opening and the lumen.


In an application, the sheet is not attached to the inner perimeter of the second frame.


In an application, the sheet is not attached to an upstream end of the valve body.


In an application, the sheet is generally annular when the valve body is in the expanded state thereof and the upstream support is in the expanded state thereof.


In an application, the sheet is generally frustoconical when the valve body is in the expanded state thereof and the upstream support is in the expanded state thereof.


In an application, the sheet is attached to the inner perimeter of the second frame.


In an application, the sheet is circumferentially attached to the second frame at a radius that is greater than a radius of the inner perimeter.


In an application, the sheet is circumferentially attached to the second frame at the outer perimeter of the second frame.


In an application, the sheet is attached to an upstream end of the valve body.


In an application, the first frame is generally cylindrical in both the compressed state thereof and the expanded state thereof.


In an application, the second frame is generally cylindrical in the compressed state thereof.


In an application, the valve body includes at least one downstream anchor, configured such that, in the expanded configuration of the valve body, the anchor protrudes radially outward from the first frame.


In an application, the apparatus further includes at least one tensioning element, coupled to the valve body and to the upstream support, a length of the tensioning element between the valve body and the upstream portion being adjustable such that a distance between the first frame and the second frame is adjustable.


In an application, the at least one tensioning element includes a tether.


In an application, the at least one tensioning element is coupled to the first frame, and slidably coupled to the second frame.


In an application, the valve body, the upstream support and the sheet together define a prosthetic valve assembly, the prosthetic valve assembly:

    • having an expanded state in which the valve body is in the expanded state thereof and the second frame of the upstream support is in the expanded state thereof,
    • having a compressed state in which:
      • the prosthetic valve assembly has a longitudinal axis,
      • the valve body is in the compressed state thereof at a first zone of the longitudinal axis,
      • the upstream support is in the compressed state thereof at a second zone of the longitudinal axis, and
      • the prosthetic valve assembly defines an articulation zone, between the first zone and the second zone, in which at least part of the sheet is disposed, in which neither the first frame nor the second frame is disposed, and about which the valve body and the upstream support are articulatable with respect to each other.


In an application, the apparatus further includes a delivery tool:

    • including a first housing configured to house and maintain at least part of the upstream support in the compressed state thereof, and defining a first housing orifice through which the at least part of the upstream support is removable from the first housing,
    • including a second housing configured to house and maintain at least part of the valve body in the compressed state thereof, and defining a second housing orifice through which the at least part of the valve body is removable from the second housing,
    • having a contracted state in which the second housing is disposed at a first distance from the first housing, and in which the delivery tool is configured to transluminally advance the prosthetic valve assembly in the compressed state thereof, to the native valve, and
    • having an extended state in which the second housing is disposed at a second distance from the first housing, the second distance being greater than the first distance, and the apparatus is configured such that, when the at least part of the upstream support is housed by the first housing and the at least part of the valve body is housed by the second housing, transitioning of the delivery tool from the contracted state into the extended state exposes at least part of at least one component selected from the group consisting of: the valve body and the upstream support, from the housing that houses the selected component.


In an application:

    • the apparatus is configured to be used with at least two guide members,
    • the prosthetic valve assembly includes at least two eyelets, each eyelet being slidable over a respective one of the guide members, and
    • the apparatus is configured such that the eyelets of the prosthetic valve assembly protrude radially outward and radially beyond an outer surface of the second housing while: (1) the at least part of the valve body, in the compressed state thereof, is housed by the second housing, and (2) the at least part of the upstream support, in the compressed state thereof, is housed by the first housing.


In an application, the eyelets are pivotably coupled to the valve body.


In an application, the delivery tool further includes at least two reference-force tubes, each reference-force tube configured (1) to be slidable over a respective one of the guide members, and (2) to apply a distally-directed force to the prosthetic valve assembly.


In an application, in the compressed state of the prosthetic valve assembly, each reference-force tube extends distally (1) through a lumen defined by the second frame of the upstream support, (2) through the sheet, and (3) along an outside of at least part of the valve body.


In an application, the apparatus further includes at least two locking members, each locking member:

    • having an unlocked state in which the locking member is slidable along a respective one of the guide members,
    • being transitionable into a locked state in which (1) the locking member is locked to the respective one of the guide members, and (2) the sliding of the eyelet over the guide member is inhibited.


In an application, the apparatus further includes the at least two guide members:

    • each guide member includes:
      • a tubular member, shaped to define a lumen therethrough,
      • a tether, coupled at a distal end thereof to a tissue anchor configured to be anchored to ventricular tissue of the heart, at least a proximal portion of the tether being disposed within the lumen of the tubular member, and
      • a pull-wire, coupled at a distal portion thereof to the proximal portion of the tether, at least the distal portion of the pull-wire being disposed within the lumen of the tubular member,
    • the tubular member inhibits decoupling of the pull-wire from the tether while the distal portion of the pull-wire and the proximal portion of the tether are disposed within the lumen of the tubular member, and
    • while the tubular member of each guide member is disposed within the respective locking member, the tubular member inhibits transitioning of the locking member into the locked state.


In an application, the apparatus is configured such that, for each respective guide member and locking member, while (1) the tubular member is disposed within the locking member, (2) the distal portion of the pull-wire and the proximal portion of the tether are disposed within the lumen of the tubular member, and (3) the tissue anchor is coupled to the ventricular tissue:

    • proximal sliding of the tubular member with respect to the tether facilitates automatic transitioning of the locking member into the locked state, and
    • further proximal sliding of the tubular member with respect to the tether facilitates decoupling of the pull-wire from the tether.


In an application, at least one housing selected from the group consisting of: the first housing and the second housing has a lateral wall that is shaped to define at least two slits, the eyelets being configured to protrude radially outward from the delivery tool via the slits.


In an application, each slit of the at least one selected housing is continuous with the orifice of the at least one selected housing.


In an application, the eyelets are coupled to and protrude radially outward from the valve body.


In an application, the eyelets are pivotably coupled to the valve body.


In an application:

    • the articulation zone defined by the prosthetic valve assembly includes a first articulation zone, and
    • while (1) the at least part of the valve body, in the compressed state thereof, is housed by the second housing, (2) the at least part of the upstream support, in the compressed state thereof, is housed by the first housing, and (3) the delivery tool is in the contracted state thereof, the apparatus defines a second articulation zone at a longitudinal zone of the apparatus (a) between the second housing and the first housing, and (b) in which is disposed at least part of the first articulation zone.


In an application, the delivery tool further includes a housing-control rod that extends through the first housing and is coupled to the second housing such that a first portion of the housing-control rod is disposed within the first housing, a second portion of the housing-control rod is disposed within the second housing, and a third portion of the housing-control rod (1) is disposed within the second articulation zone, and (2) is more flexible than at least one portion of the housing-control rod selected from the group consisting of: the first portion and the second portion.


In an application:

    • the delivery tool further includes (1) a control rod assembly including at least a first housing-control rod coupled to the first housing, and (2) a second housing-control rod, more flexible than the first housing-control rod, extending through the first housing-control rod, extending through the second articulation zone, and coupled to the second housing.


In an application, the second housing orifice faces the first housing orifice.


In an application:

    • the delivery tool further includes a flexible control rod assembly including (1) a first housing-control rod coupled to the first housing, (2) a second housing-control rod coupled to the second housing, and (3) a prosthesis-control rod reversibly couplable to the prosthetic valve assembly,
    • longitudinal movement of the second housing-control rod with respect to the first housing-control rod transitions the delivery tool between the contracted state and the extended state thereof, and
    • the valve body is removable from the second housing by moving the second housing-control rod with respect to the prosthesis-control rod.


In an application, the prosthesis-control rod is reversibly couplable to the prosthetic valve assembly by being reversibly couplable to the valve body.


In an application, at least part of the second housing-control rod is disposed within and slidable through the prosthesis-control rod, and at least part of the prosthesis-control rod is disposed within and slidable through the first housing-control rod.


In an application, the outer perimeter of the second frame has a third diameter that is greater than the second diameter.


In an application, the inner perimeter has a fourth diameter that is greater than the second diameter.


In an application, when the valve body is in the expanded state thereof and the upstream support is in the expanded state thereof, a gap is defined between the first frame and the second frame, the sheet spanning the gap.


In an application, no metallic structure is disposed within the gap.


In an application, the sheet is configured to inhibit expansion of the second frame.


In an application, the apparatus is configured such that when the second frame expands from the compressed state thereof toward the expanded state thereof, the sheet retains the second frame in a generally frustoconical shape by inhibiting expansion of at least the outer perimeter of the second frame.


In an application, the sheet extends over at least part of the second frame to serve as a covering of the upstream support.


In an application, the covering defines a tissue-contacting surface of the upstream support.


In an application, the sheet extends over at least part of the first frame to serve as a covering of the valve body.


In an application, the covering is disposed on an inner surface of the first frame.


There is further provided, in accordance with an application of the present invention, apparatus for use with a native valve of a heart of a subject, the apparatus including:

    • a prosthetic valve, configured to be percutaneously delivered to the native valve;
    • an annular upstream support, configured to be placed against an upstream surface of the native valve, and to support the prosthetic valve at the native valve;
    • a tissue anchor, including a tissue-engaging element configured to be anchored to ventricular muscle tissue of the heart;
    • a tether, coupled to the tissue anchor; and
    • a spring, couplable to the tether so as to elastically couple the tissue-engaging element to the prosthetic valve.


In an application, the spring is shaped to define a repeating pattern.


In an application, the spring is pre-loaded.


In an application, the spring is a constant-force spring.


In an application, the spring is configured to facilitate extracorporeal fluoroscopic observation of a state of the spring.


In an application, the spring is coupled to a plurality of radiopaque markers such that a juxtaposition of the markers changes as the state of the spring changes, the juxtaposition of the markers being extracorporeally fluoroscopically observable.


In an application, the spring is coupled to at least one radiopaque marker, and the apparatus further includes an intracorporeal reference, a juxtaposition between the radiopaque marker and the intracorporeal reference being extracorporeally fluoroscopically observable.


In an application, the intracorporeal reference includes a scale including a plurality of radiopaque markers.


In an application, the plurality of radiopaque markers includes a first plurality of radiopaque markers, and the at least one radiopaque marker includes a second plurality of radiopaque markers.


In an application, the spring is configured to provide distinct indication that is observable using fluoroscopy, when the spring is experiencing a force that is within a margin force from a target force.


In an application, the spring is configured to provide the distinct indication when the spring experiences a force that is above 300 g force.


In an application, the spring is configured to provide the distinct indication when the spring experiences a force that is above 400 g force.


In an application, the spring is configured to provide the distinct indication when the spring experiences a force that is about 500 g force.


In an application, the spring is coupled to the prosthetic valve, and is intracorporeally lockable to the tether subsequently to anchoring of the tissue anchor to the ventricular muscle tissue.


In an application, the spring is slidable along at least part of the tether, and is intracorporeally couplable to the tether by inhibiting the sliding.


In an application, the prosthetic valve includes a generally cylindrical valve body having an upstream end, and the spring includes an elastically-deformable appendage that protrudes laterally from the valve body.


In an application:

    • the prosthetic valve includes a generally cylindrical valve body having an upstream end, a downstream end, and a longitudinal lumen therebetween, and
    • the spring (1) includes a compression spring having a longitudinal axis, and (2) is disposed laterally from, the valve body such that the longitudinal axis of the spring is generally parallel with the longitudinal lumen.


In an application, the prosthetic valve includes:

    • a generally cylindrical valve body having an upstream end, a downstream end, and a longitudinal lumen therebetween; and
    • one or more tissue-engaging legs, protruding laterally outward from the valve body, and configured to be placed against a ventricular surface of the native valve.


In an application, the prosthetic valve is couplable to the upstream support intracorporeally by being expanded within an opening defined by the upstream support while the upstream support is disposed against the upstream surface.


In an application, the apparatus is configured such that the coupling of the prosthetic valve to the upstream support couples the tether to the prosthetic valve.


In an application, the apparatus is configured to sandwich a portion of the native valve between the tissue-engaging legs and the upstream support by providing a space having a height between the tissue-engaging legs and the upstream support.


In an application, the apparatus is configured to facilitate altering the height without altering a force on the spring.


In an application, the apparatus is configured such that altering the height automatically alters a force on the spring.


In an application, the apparatus is configured to facilitate altering the height by moving the valve body through the opening defined by the upstream support.


There is further provided, in accordance with an application of the present invention, apparatus for use with a native heart valve of a subject, the apparatus including:

    • a valve body:
      • having an upstream end, a downstream end, and a longitudinal axis therebetween,
      • including a lateral wall that circumscribes the longitudinal axis and defines a longitudinal lumen, and
      • including a valve member disposed within the lumen;
    • an upstream support having an inner perimeter couplable to the valve body at a first longitudinal position of the valve body, the upstream support being configured to extend radially outward from the valve body and the inner perimeter; and
    • a flexible sheet defining a first aperture, a second aperture and a lateral wall therebetween, a first portion of the sheet that defines the first aperture being circumferentially attached to the upstream support portion at a radius that is greater than a radius of the inner perimeter, and a second portion of the sheet that defines the second aperture being circumferentially attached to the valve body at a second longitudinal position of the valve body, such that a pocket region is defined between the sheet and at least the first longitudinal position.


In an application, the second longitudinal position is closer to the downstream end of the valve body than is the first longitudinal position.


In an application, the first aperture is larger than the second aperture.


In an application, the sheet is attached to the upstream support at an outer perimeter of the upstream support.


In an application, the sheet assumes a frustoconical shape.


In an application, the sheet assumes a funnel shape.


In an application, the apparatus is provided with the inner perimeter of the upstream support pre-coupled to the valve body at the first longitudinal position of the valve body.


In an application, the apparatus is configured such that the inner perimeter of the upstream support is intracorporeally couplable to the valve body at the first longitudinal position of the valve body.


There is further provided, in accordance with an application of the present invention, apparatus for use with a native heart valve disposed between an atrium and a ventricle of a heart of a subject, the apparatus including:

    • an annular upstream support defining an opening therethrough, and configured to be placed against an upstream surface of the native heart valve;
    • a tubular valve body having an upstream end, a downstream end and a lumen therebetween, the lumen having a first diameter, and the valve body being separated from the upstream element by a gap between the upstream end of the valve body and the upstream element;
    • one or more tissue-engaging elements that protrude radially outward from the valve body so as to define a second diameter that is greater than the first diameter; and
    • a flexible sheet shaped to define a conduit, a downstream portion of the sheet being coupled to the valve body, an upstream portion of the sheet being coupled to the upstream element, and the sheet spanning the gap.


In an application, the apparatus further includes at least one tether, a first portion of the tether being coupled to the valve body and a second portion of the tether being coupled to the upstream support, such that tensioning of at least a portion of the tether reduces the gap.


In an application, the apparatus is configured such that tensioning of at least the portion of the tether rumples the sheet.


There is further provided, in accordance with an application of the present invention, apparatus for use with a native heart valve disposed between an atrium and a ventricle of a heart of a subject, the apparatus including:

    • an annular upstream element defining an opening therethrough, and configured to be placed against an upstream surface of the native heart valve;
    • a flexible sheet, shaped to define a conduit, and coupled to the upstream element such that the conduit is in fluid communication with the opening; and
    • a valve body, coupled to the flexible sheet such that the conduit provides fluid communication between the prosthetic valve and the upstream element.


In an application, the valve body includes:

    • a generally cylindrical frame shaped to define a lumen therethrough, and
    • a valve member coupled to the frame and disposed within the lumen.


In an application, the frame is separated from the upstream element by a gap, and the conduit spans the gap.


There is further provided, in accordance with an application of the present invention, apparatus, for use with a guide member that extends into a subject, the apparatus including:

    • a delivery tool, including a housing, the housing:
      • being transluminally advanceable into the subject,
      • shaped to define an orifice at an end of the housing, and
      • having a lateral wall shaped to define a slit that is continuous with the orifice;
    • an implant:
      • configured to be housed by the housing, and
      • including an eyelet that (1) is slidable over the guide member, and (2) when the implant is housed by the housing, extends through the slit and radially beyond the lateral wall such that the eyelet facilitates transluminal sliding of the implant and the housing along the guide member and into the subject,


        the apparatus being configured such that, while (1) the implant remains within the subject, and (2) the guide member remains disposed through the eyelet, (1) the implant is removable from the housing via the orifice, and (2) the housing is removable from the subject.


In an application, the implant is configured to be implanted by being intracorporeally locked to the guide member.


In an application, the implant has a compressed state and an expanded state, is configured to be housed by the housing while in the compressed state, and is configured to automatically expand toward the expanded state when removed from the housing.


There is further provided, in accordance with an application of the present invention, a method for use with a native valve of a heart of a subject, the method including:

    • transluminally anchoring a tissue anchor to ventricular tissue of a subject using an anchor-manipulation tool, the tissue anchor being coupled to a first portion of a tether;
    • transluminally delivering an annular upstream support and a prosthetic valve to the heart, the prosthetic valve including (1) a valve body shaped to define a lumen therethrough, and (2) one or more tissue-engaging legs configured to protrude laterally outward from the valve body;
    • pressing the tissue-engaging legs in an upstream direction against a ventricular surface of the native valve by applying a force to the prosthetic valve while measuring the force;
    • applying, to the tether, a tension that changes a shape of a spring coupled to the tether, while observing the shape of the spring using imaging; and
    • at least in part responsively to the observed shape of the spring, facilitating holding of the upstream support against an upstream surface of the native valve by locking a second portion of the tether to at least one component selected from the group consisting of: the prosthetic valve and the upstream support.


In an application, measuring the force includes measuring the force using an extracorporeal force meter.


In an application, measuring the force includes observing a shape of the tissue-engaging legs using imaging.


In an application, applying the tension includes applying the tension while applying the force.


In an application, locking the second portion to the selected component includes locking the second portion to the prosthetic valve.


In an application, locking the second portion to the selected component includes locking the second portion to the upstream support.


In an application, locking the second portion includes locking the second portion when the observed shape indicates that the spring is experiencing between 400 g force and 600 g force.


In an application, locking the second portion includes locking the second portion subsequently to applying the tension, and applying the force includes applying the force subsequently to locking the second portion.


In an application:

    • anchoring the tissue anchor coupled to the tether includes anchoring a first tissue anchor coupled to a first tether, and applying the tension includes applying a first tension that changes a shape of a first spring coupled to the first tether,
    • the method further includes:
      • anchoring a second tissue anchor to the ventricular tissue, the second tissue anchor being coupled to a first portion of a second tether; and
      • applying, to the second tether, a second tension that changes a shape of a second spring coupled to the second tether, while observing the shape of the second spring using imaging, and
    • facilitating holding of the prosthetic valve against the upstream surface includes, at least in part responsively to the observed shape of the second spring, facilitating holding of the prosthetic valve against the upstream surface by locking a second portion of the second tether to the selected at least one component.


In an application, facilitating holding includes locking the second portion of the first tether and the second portion of the second tether to the selected at least one component, at least in part responsively to a ratio between tension in the first tether and tension in the second tether, the ratio being derived from the observed shape of the first spring and the observed shape of the second spring.


In an application, locking includes locking the second portion to the at least one component at least in part responsively to the observed shape.


In an application, locking includes locking the second portion to the at least one component at least in part responsively to the measured force.


In an application, applying the force includes moving the valve body in an upstream direction through an opening defined by the upstream support, and the method further includes coupling the prosthetic valve to the upstream support by expanding the valve body within the opening.


In an application, coupling the prosthetic valve to the upstream support includes coupling the prosthetic valve to the upstream support at least in part responsively to the measured force.


There is further provided, in accordance with an application of the present invention, a method, including:

    • transluminally advancing a plurality of tissue anchors, coupled to a respective plurality of springs, into a body of a subject;
    • anchoring the plurality of tissue anchors to tissue of the subject;
    • tensioning at least one of the springs;
    • using imaging, while the tension is applied to the at least one spring, observing a state of the at least one spring; and
    • at least in part responsively to the observed state of at least one spring, adjusting a tension on at least one of the springs.


There is further provided, in accordance with an application of the present invention, a method, for use with a native valve of a heart of a subject, the method including:

    • applying a first tension to a tether that couples (a) a tissue anchor anchored to ventricular tissue of a subject, to (b) a prosthetic valve body, the tether having a length between the tissue anchor and the valve body;
    • by applying an atrially-directed force to the prosthetic valve body, pressing, against tissue of the native valve, a tissue-engaging element that protrudes radially from the valve body
    • transluminally advancing a prosthetic valve body to a native valve of the subject;
    • while applying the atrially-directed force, measuring:
      • a pressing force of the tissue-engaging element against the tissue of the native valve, and
      • a second tension on the tether, the second tension differing from the first tension at least in part due to the atrially-directed force; and
    • at least in part responsively to the measured pressing force and the measured second tension, performing an action selected from the group consisting of: adjusting the length of the tether between the tissue anchor and the valve body, and locking the valve body to the tether.


There is further provided, in accordance with an application of the present invention, a method for use with a native valve of a heart of a subject, the method including:

    • transluminally delivering a tissue anchor to a ventricle of the heart, and anchoring the tissue anchor to ventricular muscle tissue of the subject;
    • transluminally delivering an upstream support to an atrium of the heart, and placing the upstream support against an upstream surface of an annulus of the native valve; and
    • changing a shape of the upstream support by tensioning a tether coupled to upstream support and to the tissue anchor; and
    • extracorporeally fluoroscopically observing the shape change of the upstream support.


In an application, tensioning the tether coupled to the upstream support includes tensioning a tether that is coupled to a valve body coupled to the upstream support.


In an application, before the tensioning, the upstream support is generally flat annular, and changing the shape includes making the support assume a frustoconical shape.


In an application, before the tensioning, the upstream support is frustoconical, and changing the shape includes changing a slant of the frustoconical shape.


There is further provided, in accordance with an application of the present invention, apparatus for use with a valve of a heart of a subject, the apparatus including:

    • a transluminally-deliverable tissue anchor;
    • a tether, a first end thereof coupled to the tissue anchor; and
    • a delivery tool, including:
      • a steerable catheter having a longitudinal axis, and being transluminally deliverable to the valve, and
      • an obstructing element:
        • disposed at a longitudinal site of the catheter,
        • configured to extend laterally outward from the catheter, and
        • dimensioned, when extending laterally outward from the catheter, to inhibit movement of at least the longitudinal site through the valve by abutting tissue of the valve, and
      • an anchor manipulator:
        • reversibly couplable to the tissue anchor,
        • slidable through the catheter, and
        • configured to drive the anchor into ventricular tissue of the heart of the subject.


In an application, the anchor manipulator is slidably coupled to the catheter such that a distal end of the anchor manipulator is slidable distally no more than a pre-determined distance from the longitudinal site.


In an application, the apparatus further includes an implant, intracorporeally lockable to the tether.


In an application, the apparatus further includes a guide member, reversibly couplable to the tether, and the implant is intracorporeally slidable along the guide member toward the tether and the implant.


In an application, the tether has exactly one locking site at which the implant is lockable to the tether.


In an application, the exactly one locking site is disposed at a pre-determined distance from the anchor that is pre-determined at least in part dependently on a distance between the longitudinal site and a distal end of the catheter.


There is further provided, in accordance with an application of the present invention, a method, including:

    • transluminally anchoring a tissue anchor to tissue of a subject using an anchor-manipulation tool;
    • subsequently applying to the anchor a pulling force having a given magnitude;
    • using imaging, observing a movement of the tissue anchor in response to the pulling force; and
    • at least in part responsively to the observed movement, performing an action selected from the group consisting of: de-anchoring the tissue anchor from the tissue, and decoupling the anchor-manipulation tool from the tissue anchor.


There is further provided, in accordance with an application of the present invention, apparatus, for implantation at a native valve of a heart of a subject, the native valve being disposed between an atrium and a ventricle of the heart, the apparatus including:

    • a tubular valve body:
      • having an upstream portion, configured to be disposed in the atrium of the heart of the subject,
      • having a downstream portion, configured to be disposed in the ventricle of the subject,
      • having an elastic portion, disposed between the upstream portion and the downstream portion, and elastically coupling the upstream portion to the downstream portion, and
      • shaped to define a continuous lumen through the upstream portion, the elastic portion, and the downstream portion; and
    • at least one valve member, disposed in the lumen of the valve body, and configured to facilitate flow of blood of the subject from the upstream portion of the valve body to the downstream portion of the valve body, and to inhibit flow of the blood from the downstream portion of the valve body to the upstream portion of the valve body.


In an application, the at least one valve member is coupled to the downstream portion of the valve body.


In an application, the native valve includes a plurality of native leaflets, and the downstream portion of the valve body is configured to be coupled to the native leaflets.


In an application, the apparatus further includes a plurality of clips, configured to facilitate the coupling of the downstream portion of the valve body to the native leaflets.


In an application, each clip:

    • includes at least two clip arms, articulatably coupled to each other, and
    • is reversibly closeable.


In an application, the clips are coupled to the downstream portion of the valve body, and the downstream portion of the valve body is configured to be coupled to the native leaflets by the clips being coupled to the native leaflets.


In an application, each clip of the plurality of clips is articulatably coupled to the downstream portion of the valve body.


In an application, the native valve includes an annulus having an upstream surface, and the apparatus further includes a prosthetic valve support:

    • including (1) an upstream support portion, configured to be placed against the upstream surface of the annulus of the native valve, and (2) the plurality of clips, coupled to the upstream support portion,
    • shaped to define an opening therethrough that is configured to receive the prosthetic valve,
    • and the clips are configured to facilitate the coupling of the downstream portion of the valve body to the native leaflets by coupling the prosthetic valve support to the native leaflets.


There is further provided, in accordance with an application of the present invention, apparatus for use with a native valve of a heart of a subject, the native valve having a plurality of leaflets that meet at a plurality of commissures, the apparatus including:

    • at least one tissue anchor, configured to be anchored to a first site within a ventricle of the heart of the subject;
    • at least one longitudinal member, coupled at a distal end thereof to a respective one of the at least one tissue anchors;
    • an upstream support, including an upstream support portion configured to be slidable over the longitudinal member and placed against an upstream surface of the native valve; and
    • at least one locking member, configured to be slidable over a respective one of the at least one longitudinal members, and to be lockable to the respective longitudinal member such that a portion of the respective longitudinal member that is disposed between the respective anchor and the upstream support portion is longer than 1 cm.


In an application, the longitudinal member is flexible.


In an application, the longitudinal member includes a suture.


There is further provided, in accordance with an application of the present invention, a method for use with a native valve of a heart of a subject, the native valve having a plurality of leaflets that meet at a first commissure and at a second commissure, the method including:

    • anchoring a first tissue anchor to a first site within a ventricle of the heart of the subject, the first tissue anchor being coupled to a distal end of a first longitudinal member;
    • anchoring a second tissue anchor to a second site within the ventricle of the heart of the subject, the second tissue anchor being coupled to a distal end of a second longitudinal member;
    • subsequently, placing at least an upstream support portion of a prosthetic valve support against an upstream surface of the native valve, the valve being disposed between the ventricle and an atrium of the heart of the subject; and
    • securing the upstream support portion against the upstream surface of the valve by:
      • coupling the upstream support portion to the first longitudinal member such that at least part of a portion of the first longitudinal member that is disposed between the upstream support portion and the first tissue anchor, is disposed between the first and second leaflets at the first commissure, and
      • coupling the upstream support portion to the second longitudinal member such that at least part of a portion of the second longitudinal member that is disposed between the upstream support portion and the first tissue anchor, is disposed between the first and second leaflets at the second commissure.


In an application, anchoring, placing, and securing include anchoring, securing, and placing without the use of cardiopulmonary bypass.


In an application, anchoring to the first site and anchoring to the second site include anchoring to myocardium.


In an application, placing the upstream support portion against the upstream surface includes sliding the upstream support portion over at least part of the first longitudinal member.


In an application, coupling the upstream support portion to the first longitudinal member and to the second longitudinal member includes coupling the upstream support portion to the first longitudinal member in the atrium of the heart of the subject, and coupling the upstream support portion to the second longitudinal member includes coupling the upstream support portion to the second longitudinal member in the atrium of the heart of the subject.


In an application, the leaflets move in response to beating of the heart of the subject, and securing the upstream support portion includes securing the upstream support portion without eliminating the movement of the native leaflets.


In an application, coupling the upstream support portion to the first longitudinal member includes coupling the upstream support portion to the first longitudinal member such that a length of the portion of the first longitudinal member is greater than 1 cm.


In an application, the method further includes:

    • transluminally advancing at least the first tissue anchor to the first site while the respective longitudinal member coupled thereto is disposed within a respective tubular member; and
    • subsequently to anchoring the at least first tissue anchor, and before coupling the upstream support portion to the respective longitudinal member, sliding the at least first tubular member off of at least part of the respective longitudinal member.


In an application, sliding the at least first tubular member includes sliding at least part of the at least first tubular member through a channel defined by a locking member, and coupling the upstream support portion to the respective longitudinal member includes locking the locking member to the respective longitudinal member by narrowing at least a portion of the channel.


In an application:

    • advancing the at least first tissue anchor includes advancing the at least first tissue anchor while (1) the respective longitudinal member is reversibly coupled to a portion of a wire, and (2) the respective tubular member inhibits the portion of the wire from decoupling from the portion of the wire, and
    • the method further includes facilitating decoupling of the wire from the respective longitudinal member by sliding the at least first tubular member off of the portion of the wire.


In an application:

    • advancing the at least first tissue anchor includes advancing the at least first tissue anchor while (1) the respective longitudinal member is shaped to define a loop, and is coupled to the portion of the wire by the portion of the wire being threaded through the loop, and (2) the respective tubular member inhibits the portion of the wire from unthreading from the loop, and
    • facilitating decoupling of the wire from the respective longitudinal member includes facilitating unthreading of the wire from the loop by sliding the at least first tubular member off of the portion of the wire.


In an application, sliding the at least first tubular member off of the portion of the wire includes sliding the at least first tubular member off of the portion of the wire by applying less than 500 g of pulling force to the at least first tubular member.


In an application, applying less than 500 g of pulling force to the at least first tubular member includes applying less than 300 g of pulling force to the at least first tubular member.


In an application, the method further includes, subsequently to securing the upstream support portion, coupling a prosthetic valve to the prosthetic valve support.


In an application, the upstream support portion has an inner edge that defines an opening through the upstream support portion, and coupling the prosthetic valve to the prosthetic valve support includes placing at least a portion of the prosthetic valve within the opening, and expanding at least the portion of the prosthetic valve such that at least the portion of the prosthetic valve applies a radially-expansive force against the inner edge of the upstream support portion.


In an application, the prosthetic valve includes one or more tissue-engaging elements, each of the one or more tissue-engaging elements including at least two arms, and the method further includes, subsequent to securing the upstream support portion, coupling the prosthetic valve to at least one of the leaflets by sandwiching the at least one of the leaflets between the at least clip arms of the one or more tissue-engaging elements.


In an application, coupling the prosthetic valve to the at least one of the leaflets includes coupling the prosthetic valve to the at least one of the leaflets before coupling the prosthetic valve to the prosthetic valve support.


In an application:

    • the prosthetic valve includes a valve body, having an outer surface,
    • the at least two arms include a first arm and a second arm, the first arm being longer than the second arm, and
    • the method further includes:
      • delivering, within a delivery tube, the prosthetic valve in a delivery configuration thereof, in which the first arm and the second arm are constrained against the outer surface of the valve body;
      • facilitating deflection of the first arm away from the outer surface of the prosthetic valve, by advancing a first portion of the prosthetic valve out of the delivery tube such that the first arm automatically deflects away from the outer surface of the prosthetic valve; and
      • facilitating deflection of the second arm away from the outer surface of the prosthetic valve, by advancing a second portion of the prosthetic valve out of the delivery tube such that the second arm automatically deflects away from the outer surface of the prosthetic valve.


In an application:

    • facilitating deflection of the first arm includes facilitating deflection of the first arm a first angle from the outer surface of the prosthetic valve, and
    • the method further includes facilitating deflection of the first arm away from the outer surface of the prosthetic valve a second angle that is greater than the first angle, by applying a force to the first arm using the delivery tube:
      • subsequently to facilitating deflection of the first arm the first angle, and
      • prior to facilitating deflection of the second arm.


In an application, applying the force to the first arm using the delivery tube includes pushing on the first arm by sliding the delivery tube over at least part of the prosthetic valve.


There is further provided, in accordance with an application of the present invention, apparatus for use with a body of a subject, the apparatus including:

    • at least a first implantable member;
    • a first longitudinal member, coupled at a distal end thereof to the first implantable member;
    • a second longitudinal member, at least a portion of the second longitudinal member being reversibly couplable to the first longitudinal member; and
    • a tubular member:
      • slidable over the first and second longitudinal members,
      • shaped to define a lumen therethrough, and
      • configured, when the portion of the second longitudinal member is (1) coupled to the first longitudinal member, and (2) disposed within the lumen of the tubular member, to inhibit decoupling of the portion of the second longitudinal member from the first longitudinal member.


In an application, the portion of the second longitudinal member is configured, when (1) the portion of the second longitudinal member is coupled to the first longitudinal member, and (2) the portion of the second longitudinal member is disposed outside of the lumen of the tubular member, to be decouplable from the first longitudinal member by the second longitudinal member being pulled away from the first longitudinal member.


In an application, at least one longitudinal member selected from the group consisting of: the first longitudinal member and the second longitudinal member, is flexible.


In an application, the tubular member is more rigid than the first longitudinal member.


In an application, the tubular member fits snugly over at least the portion of the second longitudinal member.


In an application, the first implantable member includes a tissue anchor, configured to be anchored to a tissue of the subject.


In an application, the apparatus further includes a second implantable member, slidable over the tubular member, and couplable to the first longitudinal member while the portion of the second longitudinal member is coupled to the first longitudinal member.


In an application, the portion of the second longitudinal member is reversibly couplable to the first longitudinal member at a first site of the first longitudinal member, and the second implantable member is couplable to the first longitudinal member at a second site of the first longitudinal member that is distal to the first site of the longitudinal member.


In an application, the apparatus further includes a locking member having an unlocked state and a locked state, and configured to be slid over the tubular member in the unlocked state and to be locked to the first longitudinal member by being transitioned to the locked state.


In an application, the locking member is configured to facilitate coupling of the second implantable member to the first longitudinal member.


In an application, the locking member is configured to be coupled to the first longitudinal member at least 1 cm away from the first implantable member.


There is further provided, in accordance with an application of the present invention, apparatus for use at a native valve of a heart of a subject, the apparatus including:

    • a tissue anchor, configured to be transluminally, transcatheterally advanced to a ventricle of the heart of the subject, and to be coupled to tissue of the ventricle;
    • a longitudinal member, coupled at a distal end thereof to the tissue anchor;
    • a wire, a portion of the wire being reversibly couplable to the longitudinal member;
    • a tubular member:
      • slidable over the longitudinal member and the wire,
      • shaped to define a lumen therethrough, and
    • configured, when the portion of the wire is (1) coupled to the longitudinal member, and (2) disposed within the lumen of the tubular member, to inhibit decoupling of the portion of the wire from the longitudinal member;
    • a prosthetic valve support including an upstream support portion slidable over the tubular member, and to be placed against an upstream surface of an annulus of the native valve by sliding over the tubular member; and
    • a locking member, slidable over the tubular element and lockable to the longitudinal member.


In an application, the locking member is configured to be locked to the longitudinal member at a site of the longitudinal member that is distal to a site of the longitudinal member to which the portion of the wire is reversibly couplable.


In an application, the tubular member is configured to be slid out of the locking member before the locking member is locked to the longitudinal member.


In an application, the apparatus further includes a control rod, slidable over the tubular member, the locking member being reversibly coupled to a control rod, the control rod being configured to restrain the locking member in an unlocked configuration thereof, and to facilitate locking of the locking member by ceasing to restrain the locking member in the unlocked configuration.


In an application, the control rod is configured to decouple from the locking member when the control rod ceases to restrain the locking member in the unlocked configuration thereof.


In an application, the control rod is configured to cease to restrain the locking member in the unlocked configuration thereof by the control rod being rotated with respect to the locking member.


In an application:

    • the prosthetic valve support is shaped to define a hole through which the tubular member is slidable,
    • at least while the control rod is coupled to the locking member, the control rod is not slidable through the hole defined by the prosthetic valve support, and the control rod is configured to facilitate the sliding of the prosthetic valve support over the tubular member by pushing the prosthetic valve support over the tubular member.


The present invention will be more fully understood from the following detailed description of applications thereof, taken together with the drawings, in which:





BRIEF DESCRIPTION OF THE DRAWINGS


FIGS. 1A-F are schematic illustrations of a system for implanting a prosthetic valve support and a prosthetic valve at a native valve of a heart of a subject, in accordance with some applications of the invention;



FIG. 2 is a schematic illustration of the prosthetic valve being retrieved into a delivery tube, in accordance with some applications of the invention;



FIGS. 3A-C are schematic illustrations of the introduction of guide members through the prosthetic valve support and a delivery tube, in accordance with some applications of the invention;



FIGS. 4A-C are schematic illustrations of a locking member, and control thereof, in accordance with some applications of the invention;



FIG. 5 is a schematic illustration of steps in the delivery and anchoring of tissue anchors, in accordance with some applications of the invention;



FIG. 6 is a schematic illustration of a system for use with a prosthetic valve support, in accordance with some applications of the invention;



FIGS. 7A-C are schematic illustrations of a system for facilitating transluminal delivery of a prosthetic valve assembly, in accordance with some applications of the invention;



FIGS. 8A-H are schematic illustrations of a technique for use with the system of FIGS. 7A-C, to transluminally implant a prosthetic valve assembly, in accordance with some applications of the invention;



FIGS. 9A-B, 10A-B, 11A-B, 12A-B, 13A-B, and 14A-B are schematic illustrations of prosthetic valve assemblies, in accordance with some applications of the invention;



FIGS. 15A-C are schematic illustrations of a tool for facilitating application of force between a prosthetic valve assembly and tethers, in accordance with some applications of the invention;



FIG. 16 is a schematic illustration of a system comprising a prosthetic valve assembly and one or more springs, via which the prosthetic valve assembly is elastically coupled to one or more tissue anchors, in accordance with some applications of the invention;



FIG. 17 is a schematic illustration of a system comprising a prosthetic valve assembly and one or more springs, via which the prosthetic valve assembly is elastically coupled to one or more tissue anchors, in accordance with some applications of the invention;



FIGS. 18A-B are schematic illustrations of springs coupled to respective tethers so as to elastically couple a tissue anchor to a prosthetic valve assembly, in accordance with some applications of the invention;



FIGS. 19A-B are schematic illustrations of a system for facilitating delivery of a prosthetic valve body, in accordance with some applications of the invention;



FIG. 20 is a schematic illustration showing examples in which force measurements described herein may be combined to facilitate implantation of a prosthetic valve, in accordance with some applications of the invention;



FIGS. 21A-B are schematic illustrations of a prosthetic valve assembly, in accordance with some applications of the invention;



FIGS. 22A-B are schematic illustrations of a prosthetic valve assembly comprising a prosthetic valve having a tubular valve body that comprises an upstream portion, a downstream portion, and an elastic portion disposed between the upstream portion and the downstream portion, in accordance with some applications of the invention; and



FIGS. 23-24 are schematic illustrations of systems for facilitating anchoring of a tissue anchor in the heart of a subject, in accordance with some applications of the invention.





DETAILED DESCRIPTION OF EMBODIMENTS

Reference is made to FIGS. 1A-F, which are schematic illustrations of a system 40 for implanting an upstream prosthetic valve support 42 and a prosthetic valve 44 at a native valve 10 of a heart 4 of a subject, in accordance with some applications of the invention. Typically, applications of the invention are for use with the mitral valve of the subject (that is, native valve 10 comprises the mitral valve of the subject), but it is to be noted that applications of the invention may be used at other heart valves of the subject, such as the tricuspid valve, the aortic valve, or the pulmonary valve, mutatis mutandis.


Reference is now made to FIGS. 1A-B. A sheath 46 is advanced transluminally (e.g., transfemorally) to right atrium 12 of the heart, and is typically advanced through the fossa ovalis into left atrium 6 of the heart using standard transseptal techniques. For some applications, sheath 46 is steerable. For some such applications, sheath 46 is steerable in two axes. One or more (typically two) tissue anchors 48 are advanced through sheath 46, between leaflets 14 of the native valve, and into left ventricle 8 of the heart, and are there anchored to tissue (e.g., ventricular muscle tissue) of the heart. FIG. 1A shows a first tissue anchor 48a being anchored at a first ventricular site, and FIG. 1B shows a second tissue anchor 48b being anchored at a second ventricular site. Typically, anchors 48 are anchored to muscle of the heart, such as to the walls of ventricle 8 and/or to papillary muscles. Typically, and as shown, anchors 48 comprise helical anchors that are anchored by being rotated. However, other types of anchors may be used, such as barbed or harpoon-like anchors, e.g., that are anchored by being pushed into the tissue.


State A of FIGS. 1A and 1B show a catheter 50 having been advanced through sheath 46 and into ventricle 8, and an anchor-delivery tube 52 having been advanced through catheter 50 to the respective ventricular site. Typically, and as shown, the distal end of delivery tube 52 is placed against the tissue at the ventricular site. Typically, at least a distal portion of catheter 50 is steerable (e.g., independently of sheath 46).


State B of FIGS. 1A and 1B each show a respective anchor 48 being anchored to a respective ventricular site. Typically, anchor 48 is reversibly coupled to an anchor manipulator 54 (e.g., an anchor driver), which is slidable through at least part of tube 52, and which is configured to apply a force (e.g., a rotational force) to the anchor so as to anchor the anchor at the ventricular site. For some applications, anchor manipulator 54 and anchor 48 are advanced from outside the subject to the ventricular site only once the distal end of tube 52 is disposed against the ventricular site. For some applications, the manipulator and anchor are disposed within, and advanced with, tube 52. For some applications, anchor 48 is anchored by rotating anchor manipulator 54 and tube 52 together. For some applications, a separate anchor manipulator 54 is used to deliver and anchor each anchor 48 (e.g., each anchor 48 may be provided pre-coupled to a respective anchor manipulator). For some applications, one anchor manipulator 54 may be used to deliver and anchor all (e.g., both) anchors 48 (e.g., each anchor 48 may be configured to be sequentially coupled to the anchor manipulator outside the body of the subject by the operating physician). It is to be noted that typically anchor 48 is not exposed from tube 52 other than when being anchored. It is hypothesized that for some applications this reduces a likelihood of inadvertently engaging and/or damaging tissue of the heart (e.g., chordae tendineae).


For some applications, subsequent to anchoring each tissue anchor 48 to the tissue, a testing pulling force of known magnitude is applied to the anchor (e.g., by applying the pulling force to anchor manipulator 54), and movement of the tissue anchor in response to the pulling force is observed using imaging (e.g., fluoroscopy). The observed movement may be used to confirm successful and/or stable anchoring (e.g., relatively little movement may indicate firm anchoring in firm tissue) or to determine sub-optimal anchoring (e.g., relatively large movement may indicate weak anchoring and/or anchoring in weak tissue). Thus, at least in part responsively to the observed movement, the operating physician may decouple manipulator 54 from anchor 48, or may de-anchor the anchor from the tissue using the manipulator.


State C of FIGS. 1A and 1B show anchor manipulator 54 having been decoupled from anchor 48, and the manipulator and tube 52 being withdrawn proximally into catheter 50. Each anchor 48 is provided pre-coupled to a guide member 56 (e.g., a first guide member 56a, and a second guide member 56b), described in more detail hereinbelow (e.g., with reference to FIGS. 1D and 4A-C). As manipulator 54 and tube 52 are withdrawn, guide member 56 is exposed from tube 52.


Typically, and as shown in FIGS. 1A-B, the same catheter 50 is used to deliver both anchors 48. For such applications, and as shown in states B and C of FIG. 1B, when delivering second tissue anchor 48b, anchor-delivery tube 52 fits alongside first guide member 56a within catheter 50. Alternatively, and as described hereinbelow with reference to FIG. 5, a separate catheter is used for each anchor, in which case the second catheter fits alongside first guide member 56a within sheath 46.


State D of FIGS. 1A and 1B show catheter 50 having been withdrawn proximally, into atrium 6. For some applications, catheter 50 is withdrawn completely from the body of the subject. For some applications, catheter 50 is used for delivery of components during later steps in the procedure. Guide members 56 extend from atrium 6, between leaflets 14, and to respective ventricular sites. Typically, guide members 56 do not eliminate functioning of leaflets 14 and/or valve 10. For some applications, guide members 56 are configured to automatically move toward respective commissures 16 (e.g., into the joining corners at the commissures of leaflets 14). For some applications, and as shown in FIG. 1C, prosthetic valve support 42 (e.g., deployment thereof) pushes guide members 56 toward the respective commissures.


Reference is now made to FIG. 1C, which shows prosthetic valve support being delivered to, and deployed at, native valve 10. Prosthetic valve support 42 is advanced through sheath 46 and into atrium 6. Typically, support 42 is delivered in a compressed configuration thereof, within a housing, such as a delivery tube 80. For some applications, catheter 50 is used to facilitate delivery of prosthetic valve support 42 and delivery tube 80 (e.g., the support and delivery tube are advanced through catheter 50). For some applications, a different catheter is used to facilitate delivery of prosthetic valve support 42 and delivery tube 80. For some applications, prosthetic valve support 42 and delivery tube 80 are advanced directly through sheath 46.


Prosthetic valve support 42 comprises an annular upstream support portion 43 which, in the delivery configuration of the prosthetic valve support, is generally cylindrical, and which, once the prosthetic valve is deployed and expands to an uncompressed configuration thereof, is generally annular. For some applications, upstream support portion 43 is generally frustoconical in the uncompressed configuration thereof. Typically, a distal end of upstream support portion 43 in the compressed, cylindrical configuration, defines an inner perimeter of the upstream support portion in the uncompressed configuration, the inner perimeter defining an opening through the upstream support portion.


State A of FIG. 1C shows delivery tube 80, containing support 42, having been delivered to atrium 6 over guide members 56, and support 42 starting to be subsequently exposed from the delivery tube, and automatically expanding. Upstream support portion 43 of prosthetic valve support 42 is shaped to define holes 82 through which guide members 56 are slidable, thereby facilitating sliding of the prosthetic valve support over guide members 56. Typically, holes 82 are disposed opposite each other around the generally annular shape of upstream support portion 43. For some applications, holes 82 are defined and/or reinforced by an eyelet 84 or pledget (visible in states B and C of FIG. 1C). Guide members 56 extend proximally from delivery tube 80, e.g., via holes in a proximal end of the delivery tube, such that the delivery tube, and prosthetic valve support 42, in the compressed state within the delivery tube, are slidable over the guide members, the guide members thereby facilitating delivery of the prosthetic valve support within the delivery tube. Introduction of guide members 56 through the prosthetic valve support and delivery tube are described hereinbelow with reference to FIGS. 3A-C.


State B of FIG. 1C shows prosthetic valve support 42 (e.g., upstream support portion 43 thereof) having been completely deployed from delivery tube 80, and having automatically expanded to the uncompressed configuration thereof. Guide members 56 are typically pushed toward commissures 16 by the expansion of support 42. For some applications, delivery tube 80 is subsequently removed from the body of the subject. A tubular control rod 86 is advanced over each guide member 56 toward prosthetic valve support 42, and is used to push prosthetic valve support 42 (e.g., upstream support portion 43 thereof) toward the annulus of valve 10. Control rods 86 have a cross-sectional diameter that is larger than that of holes 82, and may thereby be used to push against upstream support portion 43 without passing through the holes.


Typically, prosthetic valve support 42 (e.g., upstream support portion 43 thereof) is provided with one or more (e.g., two) control filaments 88 reversibly coupled thereto. Typically, filaments 88 are coupled to upstream support portion 43 at sites that are disposed opposite each other around the generally annular shape of the upstream support portion, and disposed evenly between holes 82. That is, in the expanded configuration of upstream support portion 43, a straight line between holes 82 is typically perpendicular to a straight line between the sites at which filaments 88 are coupled to the upstream support portion. It should be noted that other numbers and arrangements of control filaments may also be used. Typically, each control filament 88 (1) comprises two portions of a loop of filament that passes through upstream support portion 43, loops around a downstream surface of the upstream support portion (i.e., the surface that is placed in contact with the annulus of the native valve), and passes back through the upstream support portion, and (2) is decouplable from the upstream support portion by releasing a first end of the filament and pulling a second end, thereby unthreading and/or unlooping the control filament from the upstream support portion.


Control filaments 88 facilitate some manipulation of prosthetic valve support 42 following deployment from delivery tube 80. Typically, control rods 86 further facilitate such manipulation. State C of FIG. 1C shows such manipulation of prosthetic valve support 42. For example, it may be desirable to rotate the prosthetic valve support (e.g., to position and/or orient the upstream support portion correctly with respect to native valve 10, to control the order in which different regions of upstream support portion 43 contact the native valve, and/or to uncoil control rods 86 and/or control filaments 88 from each other).


Reference is now made to FIG. 1D, which show steps in securing prosthetic valve support 42 against the upstream surface (e.g., the atrial surface) of native valve 10. Each guide member 56 typically comprises a tether (e.g., a longitudinal member 102), a pull-wire 104 reversibly coupled to the longitudinal member, and a tubular member 100 in which the longitudinal member and the pull-wire are disposed, the tubular member fitting snugly over the longitudinal member and the pull-wire so as to inhibit the pull-wire from becoming decoupled from the longitudinal member (e.g., to maintain a state of coupling therebetween). Pull-wire 104 may or may not be metallic and may have various cross-sectional shapes (e.g., circular or rectangular). Typically, (1) longitudinal member 102 defines a loop (e.g., a closed loop) (2) a portion (e.g., a distal portion) of pull-wire 104 is threaded through the loop defined by member 102 (e.g., is looped through the loop), and (3) the snug fitting of tubular member 100 over member 102 and pull-wire 104 inhibits the portion of the pull-wire from unthreading from the loop. It is to be noted that, although longitudinal member 102 is shown as defining a loop that extends most (e.g., all) of the length of the longitudinal member, the loop may alternatively be defined only at a proximal end of the longitudinal member.


For some applications, longitudinal member 102 and pull-wire 104 are coupled via complementary screw threads. For example, longitudinal member 102 may comprise, or be coupled to, a screw at a proximal end thereof, and pull-wire 104 may comprise, or be coupled to, a socket at a distal end thereof. For some applications, tubular member 100 is used to decouple (e.g., unscrew) pull-wire 104 from longitudinal member 102.


Tubular member 100 is typically more rigid than pull-wire 104 and/or longitudinal member 102 (although it is still sufficiently flexible to be transluminally delivered). This rigidity reduces a likelihood of twisting, kinking, snagging, and/or other undesirable phenomenon or interactions within the transluminal delivery system (e.g., within sheath 46, catheter 50, and/or anchor-delivery tube 52). For some applications tubular member 100 has a smoother surface than does pull-wire 104 or longitudinal member 102. For some applications, tubular member 100, which is necessarily wider than pull-wire 104 and/or longitudinal member 102, is also more visible using imaging techniques such as fluoroscopy. This advantageously allows an operating physician to monitor the intracorporeal juxtaposition of the tubular members and, if necessary, to intervene, such as by revolving the tubular members (e.g., proximal ends thereof) around each other.


As described hereinabove, control rods 86 are used to push prosthetic valve support 42 toward the annulus of valve 10 by sliding the control rod over a respective guide member 56 (i.e., over the tubular member 100 of the respective guide member). Each control rod 86 is reversibly coupled at a distal end thereof to a respective locking member 110 that, in an unlocked state thereof, is slidable over guide member 56. Thereby, the pushing of prosthetic valve support 42 is typically performed by pushing with both control rod 86 and locking member 110. State A of FIG. 1D shows control rods 86 and respective locking members 110 having been slid over respective tubular members 100 of respective guide members 56, such that prosthetic valve support 42 has been pushed against the annulus of valve 10. Typically, a counter force (e.g., a proximal pulling force) is applied to guide member 56 (e.g., to tubular member 100, longitudinal member 102, and pull-wire 104) so as to facilitate such sliding.


State B of FIG. 1D shows tubular member 110 having been pulled proximally such that the distal end of the tubular member is disposed proximal to locking member 110, thereby exposing, from the tubular member, progressive portions of longitudinal member 102, at least until the tubular member is not disposed between the longitudinal member and the locking member (e.g., such that the locking member can directly contact the longitudinal member). Typically, and as shown in state B of FIG. 1D, tubular member 100 is pulled proximally such that the distal end thereof is disposed distal to the point at which longitudinal member 102 and pull-wire 104 are coupled, thereby retaining the coupling therebetween. While in this state, locking member 110 is locked to longitudinal member 102 (e.g., to a portion of the longitudinal member that is disposed within a channel of the locking member). For some applications, locking member 110 locks automatically in response to withdrawal of tubular member 100. For some applications, locking of locking member 110 is independent of the withdrawal of the tubular member. An embodiment of locking member 110 and control thereof is described in more detail hereinbelow with respect to FIGS. 4A-C. It is to be noted that the scope of the invention also comprises the use of other locking members such as crimp-based locking members, and also comprises other locking techniques such as tying.


Subsequently, and as shown in state C of FIG. 1D, tubular member 100 is pulled further proximally, such that the distal end of the tubular member is disposed proximal to the point at which longitudinal member 102 and pull-wire 104 are coupled, such that the pull-wire is decouplable from the longitudinal member (e.g., unthreadable from the loop defined by the longitudinal member).


Typically, anchors 48 and longitudinal members 102 are configured to withstand a pulling force of at least 500 g, so as to withstand forces within the beating heart. The apparatus is typically configured such that a pulling force required to pull tubular member 100 proximally, is less than 500 g, such as less than 300 g. For some applications, such a configuration is achieved at least in part by reducing friction between tubular member 100 and pull-wire 104, such as by thermally treating the pull-wire 104.


Subsequently, control rod 86, tubular member 100, and pull-wire 104 are pulled proximally, as shown in state D of FIG. 1D, thereby separating the control rod from locking member 110, and the pull-wire from longitudinal member 102. In order for control rod 86 to be pulled proximally, the control rod is decoupled from locking member 110 prior to said pulling. For some applications, the decoupling of control rod 86 from locking member 110 is synchronous with the locking of the locking member (e.g., the same action locks the locking member and decouples the control rod from the locking member, such as described hereinbelow with respect to FIGS. 4A-C). For some applications, the decoupling of the control rod from the locking member is independent of the locking of the locking member.


It is to be noted that, as shown in FIG. 1D, for some applications, prosthetic valve support 42 (e.g., upstream support portion 43 thereof) is secured to the upstream surface of the annulus of native valve 10, only by anchors 48 that are anchored to tissue in ventricle 8 of the subject. It is also to be noted that prosthetic valve support 42 is coupled to longitudinal members 102 in atrium 6 of the subject. Typically, a distance L1 between each anchor 48 and the point of upstream support portion 43 to which it is coupled (e.g., to a respective hole 82 and/or locking member 110) is greater than 0.5 cm, e.g., greater than 1 cm, such as greater than 2 cm. That is, the length of each longitudinal member 102 that is disposed between a respective anchor and upstream support portion 43 is typically greater than 0.5 cm, e.g., greater than 1 cm, such as greater than 2 cm. The length of each longitudinal member 102 that is disposed between the respective anchor and the upstream support portion is typically less than 10 cm (e.g., less than 7 cm, such as less than 5 cm). Thereby, the ventricular sites at which anchors 48 are anchored are typically more than 0.5 cm (e.g., more than 1 cm, such as more than 2 cm) away from prosthetic valve support 42.


Reference is now made to FIG. 1E-F, which show steps in the delivery and implantation of prosthetic valve 44 at native valve 10, facilitated by prosthetic valve support 42. Prosthetic valve 44 is advanced in a delivery configuration (e.g., in a compressed state), through sheath 44, typically within a delivery tube 120. Prosthetic valve 44 comprises a stent-like valve body 122, typically comprising an expandable frame that typically contains a shape-memory material such as nitinol. Valve body 122 is shaped to define a lumen therethrough, and an inner surface of the valve body is typically lined with a covering, such as a fabric. One or more prosthetic valve members (not shown for clarity), such as prosthetic leaflets, are coupled to valve body 122 and disposed within the lumen thereof.


Prosthetic valve 44 further comprises one or more tissue-engaging elements 124. Typically, and as shown, valve 44 comprises two tissue-engaging elements 124 coupled to valve body 122 at sites that are on opposite sides of the circumference of the valve body. Each tissue-engaging element 124 typically comprises two arms 126 (e.g., a first clip arm 126a and a second clip arm 126b). For some applications, and as shown, each arm 126 defines an arc that is coupled to valve body 122 at the base of the arc. For example, and as shown, each arm 126 may comprise a single arc of the same shape-memory material as the frame of valve body 122. For some applications, one or both arms 126 of each tissue-engaging element 124 may be covered in a covering, such as a fabric.


When valve 44 is in the compressed state thereof within delivery tube 120, arms 126 are held against valve body 122 with a tip 127 of each arm disposed proximally to a site at which that arm is coupled to the valve body. Each tissue-engaging element 124 is configured such that a tip 127a of arm 126a is disposed distal to a tip 127b of arm 126b. For example, arm 126a may be shorter than arm 126b. Alternatively or additionally, arm 126a may be coupled to valve body 122 at a site that is distal to a site at which arm 126b is coupled to the valve body.


Prosthetic valve 44, within delivery tube 120, is advanced distally between leaflets 14 of native valve 10, and the prosthetic valve is progressively advanced distally out of a distal end of the delivery tube, as shown in states A-B of FIG. 1E. It is to be noted that leaflets 14 typically continue to function following implantation of prosthetic valve support 42, and may further continue to function while delivery tube 120 is disposed therebetween; the leaflets typically coapt around the delivery tube. At a given degree of advancement of prosthetic valve 44 out of delivery tube 120, first arm 126a is deployed: tip 127a of each first arm 126a becomes exposed from the delivery tube and each arm 126a responsively deflects radially outward from valve body 122, toward a pre-set position (state B of FIG. 1E). Tip 127b of each arm 126b remains within delivery tube 120. Throughout the procedure, as distal portions of valve body 122 are progressively exposed from delivery tube 120, they typically automatically expand toward an expanded state


Subsequently, and as shown in state D of FIG. 1E, prosthetic valve 44 and delivery tube 120 are moved proximally (e.g., atrially) such that arm 126a of each tissue-engaging element 124 engages (e.g., captures) a leaflet 14 of native valve 10, e.g., such that a portion of each leaflet is disposed between (1) each arm 126a and (2) a respective second arm 126b and valve body 122. Optionally, subsequently to deployment of first arm 126a and prior to moving prosthetic valve 44 proximally, the first arm is deflected further from valve body 122 than its pre-set position by applying a force to the first arm using the delivery tube. That is, an angle between the first arm and an outer surface of the valve body is increased by applying the force to the first arm using the delivery tube.


Typically, the force is applied by moving delivery tube 120 distally with respect to the prosthetic valve (e.g., sliding the delivery tube over at least part of the prosthetic valve), so as to push the arm, as shown in state C of FIG. 1E. It is hypothesized that such “opening” of tissue-engaging element 124 facilitates engagement of leaflets 14 (e.g., engagement of a larger portion of leaflets 14). Subsequently, delivery tube 120 is returned proximally with respect to prosthetic valve 44, such that arm 126a returns toward its pre-set position (state D of FIG. 1E). For some applications, until at least the step shown in state D of FIG. 1E, prosthetic valve 44 is retrievable into delivery tube 120 and removable from the body of the subject, e.g., as described hereinbelow with respect to FIG. 2.


Subsequently, delivery tube 120 is pulled further proximally with respect to prosthetic valve 44, such that tip 127b of second arm 126b of each tissue-engaging element 124 becomes exposed from the delivery tube, and each arm 126b responsively deflects radially outward from valve body 122, toward a pres-set position (state A of FIG. 1F), thereby coupling the tissue-engaging element to the leaflet by sandwiching a portion of a leaflet 14 between the first and second arms of each tissue-engaging element. Second arm 126b is typically configured, when completely unrestricted (e.g., in the absence of leaflet 14) to have a pre-set position that is close to that of first arm 126a, planar with that of first arm 126a, and/or further from valve body 122 than is arm 126a. For some applications, the difference in size and/or position of the arc of second arm 126b to that of first arm 126a facilitates the second arm to move into plane with, and/or beyond the plane of, the first arm.


Subsequently, prosthetic valve 44 is fully deployed by a proximal end of the prosthetic valve (e.g., valve body 122 thereof) being exposed from delivery tube 120 (e.g., by further withdrawing the delivery tube proximally with respect to the prosthetic valve)(state C of FIG. 1F). The proximal end of prosthetic valve 44 responsively (e.g., automatically) expands toward the expanded state thereof. Expansion of the prosthetic valve (e.g., of valve body 122 thereof) applies a radially-expansive force against prosthetic valve support 42 (e.g., against an inner perimeter of upstream support portion 43 thereof), thereby coupling the prosthetic valve to the prosthetic valve support. Typically, prosthetic valve support 42 (e.g., the inner perimeter of upstream support portion 43) restricts expansion of prosthetic valve 44, at least in part.


For some applications, and as shown in state B of FIG. 1F, subsequently to the coupling of tissue-engaging elements 124 to leaflets 14, and prior to coupling of prosthetic valve 44 to prosthetic valve support 42, the prosthetic valve is pulled proximally, e.g., so as to align a portion of valve body 122 with upstream support portion 43 and/or to drawn leaflets 14 toward the upstream support portion.


It is to be noted that, for some applications, each tissue-engaging element 124 comprises only one arm 126. For some such applications, the one arm 126 comprises and/or functions like first arm 126a described herein. For some such applications, the one arm 126 is configured to couple to the leaflet by sandwiching a portion of the leaflet between the one arm and valve body 122. For some such applications, the one arm 126 is configured, when the prosthetic valve is pulled proximally as shown in state B of FIG. 1F, to sandwich a portion of the leaflet between the one arm and prosthetic valve support 42 (e.g., upstream support portion 43 thereof).


State D of FIG. 1F shows the implanted (e.g., final) state of prosthetic valve support 42 and prosthetic valve 44, following implantation thereof at native valve 10. For some applications, in this implanted state, prosthetic valve support 42 and prosthetic valve 44 are inhibited from moving upstream (e.g., atrially) both by tissue anchors 48 and by tissue-engaging elements 124. That is, for some applications, resistance to forces on support 42 and valve 44 from the functioning of the heart of the subject, is provided in part by anchors 48 and in part by elements 124. For some applications, in this implanted state, prosthetic valve support 42 and prosthetic valve 44 are inhibited from moving upstream mostly (e.g., solely) by tissue-engaging elements 124. That is, for some applications, resistance to forces on support 42 and valve 44 from the functioning of the heart of the subject, is provided mostly (e.g., solely) by elements 124. For some such applications, anchors 48 and longitudinal members 102 are thereby only required until prosthetic valve 44 has been implanted. It is to be noted that in both cases, prosthetic valve support 42 (e.g., upstream support portion 43 thereof) inhibits movement ventricularly of prosthetic valve 44, and of the prosthetic valve support itself.


Reference is again made to FIGS. 1D-F. For some applications, locking of locking members 110 to longitudinal members 102 and/or decoupling of pull-wires 104 from longitudinal members 102 (FIG. 1D) is not performed until after implantation of prosthetic valve 44 (FIGS. 1E-F). For such applications, it is thereby possible to adjust the length of the portion of longitudinal members 102 (e.g., tension on the longitudinal members) after implantation of prosthetic valve 44. For some applications, a similar advantage is conferred by locking members being reversibly lockable, being locked before implantation of prosthetic valve 44, and subsequently to implantation of the prosthetic valve, being unlocked to allow re-adjustment of longitudinal members 102.


Reference is again made to FIGS. 1A-F. For some applications, anatomical dimensions of native valve 10 and/or surrounding tissues are determined (e.g., measured), and prosthetic valve support 42 and/or prosthetic valve 44 are selected accordingly (e.g., from a selection of prosthetic valve supports and/or prosthetic valves of different sizes). For example, an optimal lumen size (e.g., transverse cross-sectional area) for a prosthetic valve may be determined according to an area of the lumen defined by the annulus of the native valve of the subject. Responsively, a prosthetic valve having a lumen of that particular size may be selected. Similarly, a prosthetic valve support having an inner perimeter that defines an opening having a particular cross-sectional area may be selected, so as to restrict the expansion of a prosthetic valve to have a lumen of that particular size. Alternatively or additionally, a prosthetic valve support having an outer perimeter of a particular size may be selected according to determined dimensions of the annulus of the valve and/or walls of the atrium. It is to be noted that selecting a size according to determined anatomical dimensions may only in some cases comprise selecting a size that matches the anatomical dimensions. For example, an optimal size for the transverse cross-sectional area of a prosthetic valve is typically less than 90% of the area defined by the annulus of the native valve, so as to allow the leaflets of the native valve to coapt around the prosthetic valve and facilitate sealing.


Because prosthetic valve support 42 is typically implantable without eliminating functioning of the native leaflets, for some applications, the prosthetic valve support is implantable without the use of cardiopulmonary bypass. For some applications, prosthetic valve 44 is also implantable without the use of cardiopulmonary bypass.


Reference is made to FIG. 2, which is a schematic illustration of prosthetic valve 44 being retrieved into delivery tube 120, in accordance with some applications of the invention. As described hereinabove, for some applications, until at least the step shown in state D of FIG. 1E, prosthetic valve 44 is retrievable into delivery tube 120 and removable from the body of the subject. Delivery tube 120 is moved distally with respect to prosthetic valve 44, in a manner similar to that used to push arms 127a, described with reference to FIG. 1E (state C), but such that delivery tube 120 is slid over the site at which arms 127a are coupled to valve body 122, thereby pushing arms 127a to deflect distally. Prosthetic valve 44, including at least part of arms 127a, is drawn into delivery tube 120 (e.g., by sliding the prosthetic valve distally and/or the delivery tube proximally), and is typically subsequently removed from the body of the subject.


Reference is made to FIGS. 3A-C, which are schematic illustrations of the introduction of guide members 56 through prosthetic valve support 42 and delivery tube 80, in accordance with some applications of the invention. As described hereinabove (e.g., with reference to FIG. 1C), prosthetic valve support 42 is slidable toward native valve 10, over guide members 56, including while the prosthetic valve support is compressed within delivery tube 80. Following coupling of anchors 48 to the ventricular sites, guide members 56 extend from the anchors to outside of the body of the subject, and have respective free proximal ends 57. Before introduction of support 42 within tube 80 into the body of the subject (e.g., into sheath 46), guide members 56 are threaded through holes 82 in upstream support portion 43 of prosthetic valve 42, and through delivery tube 80, e.g., by the operating physician.


Typically, prosthetic valve support 42 is provided in the compressed state thereof, within delivery tube 80, e.g., as a unit 140, coupled to a distal end of a controller 142 that is used to move the unit transluminally (e.g., within sheath 46). Unit 140 comprises (e.g., is provided having) one or more introducer tubes 144, each introducer tube being shaped to define a lumen therethrough, and having an open distal end 143 and an open proximal end 145. Distal end 143 of each tube is disposed outside a distal end of support 42 and/or tube 80, and proximal end 145 of each tube is disposed outside a proximal end of the support and/or tube 80. Each introducer tube 144 passes (1) from the distal end thereof, (2) through a respective hole 82 in upstream support portion 43 from the downstream surface of the support portion (which defines an outer surface of the support portion in the compressed state thereof) to an upstream surface of the support portion (which defines an inner surface of the support portion in the compressed state thereof), and (3) to the proximal end thereof.


As shown in FIG. 3A, free proximal end 57 of each guide member 56 is advanced through a respective introducer tube 144, thereby threading the guide member through upstream support portion 43 of prosthetic valve support 42. Typically, and as shown in FIG. 3B, introducer tubes 144 are subsequently removed, prior to introduction of unit 140 into the body of the subject. That is, introducer tubes 144 are typically temporary. FIG. 3C shows upstream support portion 43 of prosthetic valve support 42 having been partially exposed from delivery tube 80, in order to illustrate the resulting threading of guide members 56 through upstream support portion 43.


Reference is made to FIGS. 4A-C, which are schematic illustrations of locking member 110, and control thereof, in accordance with some applications of the invention. As described hereinabove, locking member 110 is slidable over guide member 56 (e.g., over tubular member 100 thereof). As also described hereinabove, locking member 110 is configured to lock to longitudinal member 102.



FIG. 4A shows locking member 110 in the unlocked state thereof, in which the locking member typically defines a channel therethrough through which tubular member 100 and longitudinal member 102, either within the tubular member or outside of the tubular member, are slidable. The channel of locking member 110 is defined by a generally tubular portion 160 of the locking member. Tubular portion 160 defines one or more, such as two, oblique slits 162 in the lateral walls thereof. Locking member 110 comprises locking element, such as a locking bar 164, that is disposed generally orthogonally to the channel of the locking member, and passes through the slits (e.g., through both slits) of the tubular member. When locking bar 164 is slid distally and/or proximally, the locking bar thereby moves across at least part of the channel defined by tubular portion 160. Locking member 110 further comprises a spring 166 that is configured to push locking bar 164 in a given direction (e.g., distally), thereby transitioning the locking member into the locked configuration thereof (i.e., locking the locking member)(FIG. 4B).


Locking member 110 is typically controllable using a holding member 112 that inhibits (e.g., prevents) the locking member from locking, such as by inhibiting movement of locking bar 164. As described hereinabove, each control rod 86, used to push prosthetic valve support 42 toward the annulus of valve 10, is reversibly coupled at a distal end thereof to a respective locking member 110, such that the pushing is typically performed by pushing with control rod 86 and locking member 110. For some applications, and as shown in FIGS. 4A-C, holding member 112 comprises and/or is defined by control rod 86. For such applications, control rod 86 defines one or more slits 168 in a lateral wall thereof (e.g., two slits 168 on opposite sides of the lateral wall of the control rod). Typically, slits 168 are L-shaped, thereby providing (1) a holding region 170 that is generally orthogonal to the proximal-distal (e.g., longitudinal) axis of control rod 86, and (2) a release region 172 that is generally parallel with the proximal-distal axis of the control rod, and that is open to the distal end of the control rod. Locking bar 164 is configured such that ends thereof extend at least into (e.g., through) slits 168.


In the unlocked state in which locking member 110 is advanced over guide member 56 toward upstream support portion 43 and the annulus of the native valve, the ends of locking bar 164 are disposed in holding region 170 of each slit 168, and the locking bar is thereby inhibited from moving distally and locking the locking member (FIG. 4A). In order to lock the locking member, control rod 86 is rotated with respect to locking member 110, such that the ends of locking bar 164 move into release region 172 of each slit 168. In this position, spring 166 is thereby able to move locking bar toward the distal end of release region 172, thereby locking the locking member (FIG. 4B).


As described hereinabove, tubular member 100 is typically withdrawn from locking member 110 before the locking member is locked, and the locking member is locked to longitudinal member 102, e.g., by locking bar 164 sandwiching longitudinal member 102 against the inner surface of the channel of the locking member (e.g., effectively narrowing the channel at the site of the locking bar). Movement of the ends of locking bar 164 into and through release region 172 also decouples control rod 86 from the locking member, allowing the control rod to be removed from the body of the subject (typically along with tubular member 100)(FIG. 4C). For some applications, longitudinal member 102 comprises suture. For some applications, long member 102 comprises a polymer, such as polyester. For some applications, longitudinal member 102 comprises a metal. For example, the longitudinal member may comprise one or more wires, such as a plurality of wires twisted or braided into a cable. It is hypothesized that for some applications, a metallic composition reduces compressibility of longitudinal member 102 and/or facilitates locking of locking member 110 to the longitudinal member.


It is to be noted that locking member 110 thereby (1) when unlocked, facilitates sliding therethrough of a relatively wide element, tubular member 100, and (2) when locked, locks to a relatively narrow element, longitudinal member 102. To facilitate this, between the locked and unlocked states, locking bar 164 thereby moves a sufficient distance across the channel defined by locking member 110. That is, locking bar 164 moves a larger distance than would be necessary to lock a similar locking member that does not facilitate, in the unlocked state thereof, sliding therethrough of a tubular member that is wider than the longitudinal element.


Reference is again made to FIGS. 1D and 4A-C. It is to be noted that locking member 110 is typically configured to lock to longitudinal member 102 independently of (e.g., in the absence of) a complementary element, such as teeth, on the longitudinal member. For some applications, locking member 110 is configured to be coupled to any part of longitudinal member 102.


Reference is made to FIG. 5, which is a schematic illustration of steps in the delivery of tissue anchors 48 to ventricle 8, and anchoring of the anchors in the ventricle, in accordance with some applications of the invention. For some applications, the steps shown in FIG. 5 (and/or states A-D thereof) can be used in place of the steps shown in FIG. 1B (and/or states A/D thereof), mutatis mutandis (e.g., after the steps shown in FIG. 1A and/or before the steps shown in FIG. 1C). FIG. 1B shows one delivery catheter 50 being used to deliver both anchors 48, and when delivering second tissue anchor 48b, anchor-delivery tube 52 fitting alongside first guide member 56a within catheter 50. As stated hereinabove, for some applications, a separate catheter is used for each anchor. FIG. 5 shows one such application.


Typically, first anchor 48a is delivered and anchored as described hereinabove with reference to FIG. 1A, wherein catheter 50 in FIG. 1A comprises a first catheter 50a. Subsequently, and as shown in FIG. 5, a second catheter 50b is advanced through sheath 46, such that second catheter 50b is disposed alongside first guide member 56a within sheath 46. It is to be noted that, in both FIG. 1B and FIG. 5, two anchors 48 are anchored at respective ventricular sites, and two respective guide members 56, extend from the anchors, through atrium 6, and typically out of the body of the subject.


Reference is made to FIG. 6, which is a schematic illustration of a system 180 for use with prosthetic valve support 42, in accordance with some applications of the invention. For such applications of the invention, prosthetic valve support 42 is slidable toward native valve 10 over guide members 56, including while the prosthetic valve support is compressed within delivery tube 80. Following coupling of anchors 48 to the ventricular sites, guide members 56 extend from the anchors to outside of the body of the subject, and have respective free proximal ends 57. Before introduction of support 42 within tube 80 into the body of the subject (e.g., into sheath 46), guide members 56 are threaded through holes 82 in upstream support portion 43 of prosthetic valve 42, and through delivery tube 80, e.g., by the operating physician.



FIGS. 3A-C and the descriptions thereof describe prosthetic valve support 42 being provided as a unit 140 comprising introducer tubes 144, which are removed subsequently to advancement of guide members 56 through upstream support portion 43 and prior to introduction of the unit into the body of the subject. FIG. 6 shows system 180, in which prosthetic valve support is provided within delivery tube 80, e.g., as a unit 182, coupled to a distal end of controller 142, described hereinabove.


Unit 182 comprises (e.g., is provided having) one or more introducer tubes 184, each introducer tube being shaped to define a lumen therethrough, and having an open distal end 183. Distal end 183 of each tube is disposed outside a distal end of support 42 and/or tube 80, and each introducer tube 184 extends out of a proximal end of the support and/or tube 80. Similarly to unit 140 described with reference to FIGS. 3A-C, each introducer tube 144 of system 180 passes from the distal end thereof, through a respective hole in upstream support portion 43 from the downstream surface of the support portion (which defines an outer surface of the support portion in the compressed state thereof) to an upstream surface of the support portion (which defines an inner surface of the support portion in the compressed state thereof). In contrast to unit 140, introducer tubes 184 extend from a proximal end of delivery tube 80 to a proximal end portion of the apparatus. In further contrast to unit 140, tubes 184 remain in place as unit 182 is advanced transluminally over guide members 56. Tubes 184 are typically flexible to facilitate transluminal advancement thereof.


A locking member 190 is disposed over each introducer tube 184, such that the introduction of guide member 56 through the introducer tube also introduces the guide member through the locking member. Locking member 190 is slidable over guide member 56 (e.g., over tubular member 100 thereof), and is configured to lock to longitudinal member 102. Typically, locking member 190 is identical to locking member 110, described hereinabove, except that locking member 190 is configured (e.g., dimensioned) to be slidable also over introducer tube 184. Each locking member 190 is disposed at the distal end of a respective tubular control rod 192, which is typically identical to control rod 86, described hereinabove, except that control rod 192 is configured (e.g., dimensioned) to be slidable also over introducer tube 184.


The use of system 180, including introducer tubes 184, advantageously (1) removes the requirement for two separate introductions of proximal end 57 of guide member 56 (i.e., through an introducer tube and subsequently through a locking member and control rod); and (2) facilitates control rods 192 (and locking members 190) being present in the atrium of the subject during expansion of prosthetic valve support 42, thereby reducing an interval between the expansion of the prosthetic valve support and pressing of the prosthetic valve support against the annulus of the native valve.


Reference is made to FIGS. 7A-C, which are schematic illustrations of a system 200 for facilitating transluminal delivery of a prosthetic valve assembly 202, in accordance with some applications of the invention. FIG. 7A shows prosthetic valve assembly 202 in an expanded state thereof. Prosthetic valve assembly comprises (1) a prosthetic valve body 204, which comprises a first frame 206 (e.g., a wire frame), and is shaped to define a lumen 208 therethrough, (2) an annular upstream support 210, which comprises a second frame 212 (e.g., a wire frame), is shaped to define an opening through the upstream support, and is configured to be placed against an upstream surface (e.g., an atrial surface) of native valve 10 (e.g., of an annulus thereof), and (3) a flexible sheet 214 that couples the first frame to the second frame. In the expanded state of assembly 202 (and thereby of body 204), frame 206 of body 204 is generally cylindrical, and has a diameter d1. In the expanded state of assembly 202 (and thereby of upstream support 210), frame 212 of support 210 is typically generally annular, and has an outer perimeter 213 that has a diameter d2, which is greater than diameter d1.


Sheet 214 may be a fabric, a film, and/or another sheet-like structure, and may comprise a natural material, a polymer, a biomaterial, and/or any other suitable material. Typically, sheet 214 comprises polyester, PTFE, and/or pericardial tissue.


For some applications, and as shown in FIG. 7A, in the expanded state of assembly 202, and in the absence of external forces (e.g., if the assembly were resting on a table surface), sheet 214 is generally annular and flat, and an upstream end 218 of frame 206 is disposed generally on a plane defined by support 210. For such applications, an inner perimeter 211 of frame 212 defines an opening that has a diameter d3 that is greater than diameter d1.


For some applications, in such an expanded and unconstrained state, sheet 214 is generally frustoconical or funnel-shaped, and upstream end 218 of frame 206 is disposed below the plane defined by support 210. (For some such frustoconical or funnel-shaped arrangements, the sheet may also be considered to be annular.)


For some applications, in such an expanded and unconstrained state, sheet 214 is generally tubular, upstream end 218 of frame 206 is disposed below the plane defined by support 210. For such applications, diameter d3 is typically generally equal to diameter d1.


Typically, one or both of frames 206 and 212 is covered on at least one side by a covering 220. For some applications, sheet 214 comprises a portion of covering 220, e.g., the sheet is defined by a portion of the covering that is disposed between frames 206 and 212. For some applications, and as shown in FIG. 7A, covering 220 is disposed (1) on a tissue-facing side of frame 212 (e.g., defines a tissue-contacting surface of support 210), and (2) on an inner surface of frame 206 (i.e., lines the frame, and defines lumen 208).


A valve member 205 (e.g., comprising one or more prosthetic leaflets; shown in FIGS. 8D-G) is coupled to frame 206, is disposed within lumen 208, and provides valve (e.g., one-way) functionality to assembly 202. Valve member 205 may alternatively or additionally comprise a different valve member, such as a mechanical valve member.


At least two eyelets 222 are disposed on an outer surface of body 204 (i.e., protrude radially outward from body 204). Typically, eyelets 222 are pivotably coupled to body 204, e.g., such that the eyelets can pivot (e.g., rotate) in both directions by at least 5 degrees (e.g., more than 5 degrees and/or less than 90 degrees, such as between 5 and 90 degrees, e.g., between 5 and 60 degrees, such as between 5 and 45 degrees). For some applications, the eyelets can pivot in a plane parallel to a plane defined by a tangent of the valve body at the site to which the eyelet is coupled, as shown in the blowup box. Alternatively or additionally, the eyelets can pivot in a plane that is orthogonal to the plane defined by the tangent, e.g., such that the eyelets can point toward and/or away from the valve body. For some applications, eyelets 222 are sutured to body 204. Eyelets 222 are arranged in at least one pair; each eyelet of the pair being disposed on the opposite side of body 206 from the other eyelet of the pair.



FIG. 7B shows system 200 in a delivery configuration thereof. System 200 comprises a delivery tool 230, which comprises a first housing 232 (e.g., a proximal housing) and a second housing 234 (e.g., a distal housing), which are articulatably coupled to each other via a flexible control rod assembly 240 disposed through the housings.


In the delivery configuration of system 200, assembly 202 is in a compressed state thereof, in which prosthetic valve body 204 (in a compressed state thereof) is generally cylindrical, and upstream support 210 (in a compressed state thereof) is also generally cylindrical. Typically, in the delivery configuration of system 200, sheet 214 is also generally cylindrical. Assembly 202, in the compressed configuration thereof, (1) has a central longitudinal axis, at one zone (e.g., at one end) of which body 204 is disposed, and at another zone (e.g., the other end) of which support 210 is disposed, and (2) defines an articulation zone 236 in which (a) at least part of sheet 214 is disposed, and (b) neither frame 206 of body 204 nor frame 212 of support 210 is disposed, and about which body 204 and support 210 are articulatable with respect to each other.


In the delivery configuration of system 200, at least part of support 210 is disposed within housing 232 (which maintains the at least part of the support in the compressed state thereof), and at least part of body 204 is disposed within housing 234 (which maintains the at least part of the support in the compressed state thereof). Housing 232 defines an orifice 233 through which support 210 is introducible into the housing, and removable from the housing. Housing 234 defines an orifice 235 that faces orifice 233, and through which body 204 is introducible into the housing, and removable from the housing. In the delivery configuration, eyelets 222 protrude radially outward beyond the surface of delivery tool 230 (e.g., beyond a lateral wall of housing 234). Typically, housing 234 (e.g., the lateral wall thereof) is shaped to define a respective slit 237 for each eyelet, through which the eyelet protrudes beyond the surface of the housing. Each slit 237 is continuous with (i.e., is in communication with) orifice 235 such that, as described hereinbelow, during deployment of valve body 204, eyelet 222 can slide out of the slit at the orifice.


In the delivery configuration of system 200, tool 230 is in a contracted state, in which housing 232 is disposed at a distance d4 from housing 234 (e.g., orifice 233 is disposed at distance d4 from orifice 235). Distance d4 is typically greater than 1.5 mm and/or less than 30 mm, such as between 1.5 mm and 30 mm (e.g., between 10 and 15 mm). In this state, at least part of sheet 214 is exposed between the housings. The at least part of sheet 214 (and thereby of articulation zone 236) that is exposed between housings 232 and 234 facilitates articulation of housing 234 containing body 204 with respect to housing 232 containing support 210, and thereby defines an articulation zone 238 of system 200 in the delivery configuration thereof. Typically at least part of control rod assembly 240 is flexible, so as to facilitate articulation at articulation zone 238. For example, although assembly 240 as a whole is typically sufficiently flexible so as to facilitate its transluminal delivery to the heart, control rods 244 and 246 may be more flexible than control rod 240 (e.g., more flexible than required for transluminal delivery to the heart alone), so as to facilitate articulation at articulation zone 238. For some such applications, respective portions of control rods 244 and 246 that are disposed within articulation zone 238 when tool 230 is in the contracted state (FIG. 7C) are more flexible than adjacent portions of the control rods (e.g., portions disposed within housings 232 and 234 when tool 230 is in the contracted state). For example, and as shown, a portion 245 of control rod 244 may be narrower than adjacent portions of the control rod.


Control rod assembly 240 comprises (1) a first housing-control rod 242, coupled to first housing 232, (2) a second housing-control rod 244, coupled to second housing 234, and (3) a prosthesis-control rod 246, coupled to a mount 248 that is reversibly couplable to valve assembly 202, e.g., via a plurality of recesses 250 in the mount which receive respective portions of assembly 202. Typically, assembly 202 is couplable to mount 248 by valve body 204 being coupled to the mount, and further typically by a plurality of protrusions 252 of frame 206 being disposed within respective recesses 250. Housing 234 retains this coupling by inhibiting body 204 from expanding radially away from mount 248.


Typically, at least part of second housing-control rod 244 is disposed within and slidable through prosthesis-control rod 246, and at least part of the prosthesis-control rod is disposed within and slidable through first housing-control rod 242 (e.g., coaxially).


System 200 (e.g., tool 230 thereof) further comprises at least two flexible reference-force tubes 260, which extend, (a) from a proximal end of the system (e.g., from an extracorporeal portion of the system, such as from a handle of tool 230), (b) through a proximal end of housing 232, (c) through a lumen 254 defined by support 210 in the compressed state thereof, (d) through sheet 214, (e) along the outside of at least part of body 204, and typically (f) until a distal portion of body 204. A locking member 262 is disposed between each eyelet 222 and a respective tube 260. Typically, locking members 262 are not directly coupled to body 204, but are instead each held in position between eyelet 222 and tube 260 by a guide member 256 being disposed through the eyelet, the tube, and the locking member. For some applications, locking member 262 is integral with eyelet 222 (e.g., eyelet 222 is configured to and/or shaped to define locking member 262).


For some applications, guide members 256 are identical to guide members 56, described hereinabove. Guide members 256 are described in more detail hereinbelow.


Reference is now made to FIGS. 8A-H, which are schematic illustrations of a technique for use with system 200, to transluminally implant prosthetic valve assembly 202, in accordance with some applications of the invention. Typically, sheath 46 is advanced transluminally (e.g., transfemorally) to right atrium 12 of heart 4, through the fossa ovalis, and into left atrium 6 using standard transseptal techniques, as described hereinabove with reference to FIGS. 1A-B. Subsequently, first tissue anchor 48a and second tissue anchor 48b are anchored at respective ventricular sites, e.g., as described with reference to FIGS. 1A-B and/or 5, mutatis mutandis.


A guide member 256 is coupled to each tissue anchor (e.g., the tissue anchors are provided pre-coupled to the guide members), such that after anchoring of the tissue anchors, each guide member extends from the anchor, out of the body of the subject, e.g., as described hereinabove with respect to guide member 56, mutatis mutandis. A proximal end of each guide member 256 is introduced through a respective eyelet 222, locking member 262, and reference-force tube 260, such that system 200 appears as shown in FIG. 7B. As described hereinabove, each guide member 256 typically holds each locking member 262 in place between its respective eyelet 222 and reference-force tube 260.


System 200 (e.g., assembly 202 within delivery tool 230) is subsequently advanced along guide members 256 and via sheath 46 to left atrium 6 (FIG. 8A). Once exposed outside of the distal end of sheath 46, system 200 is guided by guide members 256 generally toward the ventricular sites at which anchors 48 are anchored. Articulation of system 200 (e.g., at articulation zone 238, and/or at another articulation zone 239 proximal to housing 232) facilitates transluminal advancement of the system past curves in the vasculature. The articulation also facilitates movement of system 200 from the distal end of sheath 46 and between leaflets 14 of valve 10, e.g., by facilitating steering of the system along a path defined by guide members 256. This steering is typically further facilitated by (1) the position of eyelets 222 at a distal portion of system 200 (e.g., at a distal portion of housing 234), which turns the housing in response to encountering a turn in members 256, and/or (2) the pivotable coupling of eyelets 222 to body 204, described hereinabove; pivoting of eyelet 222 reduces a likelihood of the eyelet snagging on guide member 256 when encountering a turn in the guide member. For some applications, eyelets 222 are internally coated with a material having a low coefficient of friction, such as polytetrafluoroethylene, to further facilitate sliding of the eyelet over guide member 256.


It is to be noted that, due to the described articulation, a distance d5 between a proximal end of housing 232 and a distal end of housing 234 may be greater than for a similar system that does not articulate. For example, distance d5 may be greater than a distance d6 along an atrioventricular axis between (a) a height on the atrioventricular axis of the upstream surface of native valve 10, and (b) a height on the atrioventricular axis of the transseptal entry point into left atrium 6 (e.g., the fossa ovalis). For some applications, distance d5 may be greater than the overall height of left atrium 6. Distance d5 is typically greater than 25 mm and/or less than 100 mm, such as between 25 mm and 100 mm (e.g., 35-60 mm, such as 40-50 mm).


Reference is made to FIG. 8B. System 200 is advanced such that distal housing 234, containing valve body 204 in the compressed state thereof, passes between leaflets 14 of native valve 10. Valve body 204 is withdrawn out of orifice 235 of housing 234 by moving control rod 244 with respect to control rod 246. For example, and as shown in FIGS. 8B-C, control rod 244 (and thereby housing 234) may be moved distally into ventricle 8, while control rod 246 (and thereby mount 248 and valve body 204) remains stationary, thereby increasing the distance between housing 232 and housing 234.


When protrusions 252 of frame 206 become withdrawn from housing 234, the portion of valve body 204 coupled to the mount expands (e.g., automatically), thereby disengaging the protrusions from recesses 250 of mount 248, and decoupling the valve body from the mount (FIG. 8C). For clarity, FIGS. 8C-D show the distal portion of valve body 204 expanding before the proximal portion of the valve body. It is to be noted, however, that portions of the valve body typically expand as they become exposed from housing 234, and therefore the proximal portion of the valve body typically expands while the distal portion of the valve body is still disposed within housing 234.



FIG. 8D shows valve body 204 having been completely removed from housing 234, and support 210 having been removed from proximal housing 232 by control rod 242 (and thereby housing 232) being withdrawn proximally, thereby further increasing the distance between housing 232 and housing 234. Typically, an opposing reference force is provided by reference-force tubes 260, so as to hold assembly 202 in place at the native valve while housing 232 is withdrawn.


During the withdrawal of valve body 204 from housing 234, eyelets 222 typically slide through slits 237, and out of the slits at orifice 235.


For some applications, support 210 is deployed from housing 232 before valve body 204 is deployed from housing 234.


Subsequently, tension is applied to guide members 256 while an opposing reference force is provided to assembly 202 by tubes 260, thereby reducing a length of each guide member 256 that is disposed between eyelet 222 and its respective tissue anchor 48 (FIG. 8E). That is, each guide member 256 is slid proximally with respect to its respective reference-force tube 260. Typically, the reference-force is provided to assembly 202 by a distal end of each reference-force tube 260 abutting a respective locking member; the reference force being transferred via the locking member (and typically further via eyelet 222 to valve body 204).


For some applications this tensioning moves valve body 204 at least slightly distally into ventricle 8, such that sheet 214 becomes at least slightly frustoconical (e.g., as shown in FIG. 8E). For some applications this tensioning deforms support 210 and/or deflects the support with respect to body 204, e.g., such that the support becomes less flat (e.g., less planar). For example, before tensioning, support 210 may be flat annular (as shown in FIG. 8D), and after tensioning the support may be frustoconical (as shown in FIG. 8E). Alternatively, and as described in more detail with reference to FIGS. 14A-B, mutatis mutandis, the prosthetic valve assembly may be configured such that the upstream support is frustoconical before tensioning, and the tensioning changes a slant of the frustoconical shape. For example, before tensioning, the upstream support may be frustoconical with the larger base of the frustum closer to a ventricular end of an atrioventricular axis than is the smaller base of the frustum, and after tensioning the support may become flatter, or may even invert, such that it becomes frustoconical with the smaller base closer to the ventricular end of the atrioventricular axis (e.g., the conformation shown in FIG. 8E, mutatis mutandis).


For some applications, tensioning is performed before deployment of support 210 from housing 232.


Each guide member 256 typically comprises a tether 282 (e.g., a longitudinal member), a pull-wire 284, and a tubular member 280 in which the pull-wire and the tether are disposed. A distal portion of pull-wire 284 is reversibly coupled to a proximal portion of tether 282, and tubular member 280 fits snugly over at least the distal portion of the pull-wire and the proximal portion of the tether so as to inhibit the pull-wire from becoming decoupled from the tether (e.g., to maintain a state of coupling therebetween). For some applications, and as shown, the reversible coupling is provided by pull-wire 284 and tether 282 defining respective mating surfaces. For some applications, the reversible coupling is provided as described hereinabove for guide member 56.


When each guide member 256 (e.g., the tether 282 thereof) is tensioned, the guide member is withdrawn proximally until at least part of tether 282 (within tubular member 280) is disposed within locking member 262 (e.g., at least until the proximal portion of the tether has passed through the locking member; FIG. 8E state B).


Reference is now made to FIG. 8F. Once a desired tension is obtained, the tension is fixed. Tubular member 280 is withdrawn proximally with respect to tether 282, pull-wire 284 and locking member 262 (FIG. 8F). State A of FIG. 8F shows tubular member 280 having been withdrawn until eyelet 222. State B of FIG. 8F shows tubular member 280 having been withdrawn until a distal end of the tubular member is disposed proximal to locking member 262, thereby exposing tether 282 to the locking member.


Typically, locking member 262 is biased (e.g., shape-set) to assume a locked state, and while tubular member 280 is disposed within the locking member, the tubular member inhibits locking of the locking member to tether 282 (or to pull-wire 284), and the removal of the tubular member from within the locking member facilitates automatic locking of the locking member to the tether (i.e., transitioning of the locking member into a locked state). Tubular member 280 is slidable through locking member 262 despite such biasing of the locking member, e.g., due to (a) the tubular member having a smooth surface, and/or (b) the tubular member retaining locking elements 263 of the locking member at an angle alpha_1 with respect to the tubular member, which is shallower than an angle alpha_2 with respect to tether 282 that the locking elements assume when the tubular element is withdrawn (compare FIG. 8F state A to state B).


Typically, tether 282 defines a plurality of nodules 286, which facilitate locking of locking member 262 to the tether. For some applications, locking elements 263 and nodules 286 function as a ratchet. For some such applications, subsequently to transitioning of locking member 262 into the locked state thereof, one-way movement of tether 282 through the locking member is possible, thereby facilitating further increase, but not reduction, of tension.


Reference is now made to FIG. 8G. Tubular member 280 and pull-wire 284 are decoupled from tether 282 and prosthetic valve assembly 202, and delivery tool 230 is withdrawn proximally (e.g., into sheath 46, and out of the body of the subject). Typically, housing 234 and mount 248 are withdrawn via the lumen of valve body 204 (e.g., between the prosthetic leaflets disposed therein). For some applications, housing 234, rods 244 and 246, and mount 248 are withdrawn prior to the tensioning step (e.g., prior to withdrawal of reference-force tubes 260, such as between the step shown in FIG. 8D and the step shown in FIG. 8E, mutatis mutandis).


Typically, tubular member 280 and pull-wire 284 are decoupled from tether 282 by withdrawing the tubular member further proximally, such that the distal portion of pull-wire 284 and the proximal portion of tether 282 are exposed from the tubular member (state A of FIG. 8G). Reference force for this withdrawal is provided by the anchored tether 282, and optionally also by reference-force tubes 260. Tubular member 280, pull-wire 284, and reference-force tube 260 are then withdrawn (state B of FIG. 8H).



FIG. 8H is a schematic illustration of prosthetic valve assembly 202 following implantation at native valve 10 of heart 4. Assembly 202 provides replacement one-way valve functionality in which blood flows from atrium 6, through the opening defined by upstream support 210, past sheet 214, through lumen 208 of valve body 204, and into atrium 8. Sheet 214 thereby defines and/or serves as a conduit that provides fluid communication between the opening defined by upstream support 210 (e.g., by frame 212 thereof) and lumen 208 of valve body 204. Further typically, this conduit is uninterrupted except for holes (not shown) that may remain where reference-force tubes 260 originally extended through the sheet.


Regurgitation through these holes is typically minimal or absent due to their small size. The holes may be slit-like (rather than punched holes), such that in the absence of reference-force tubes 260 the holes become generally closed. Additionally, coaptation of leaflets 14 and tissue growth over the holes may further facilitate sealing. Alternatively or additionally, the holes may be defined by tubular protrusions 215 that extend from sheet 214 (shown in the “optional” box, FIG. 7B). Tubular protrusions 215 may comprise the same material as sheet 214, or may comprise a different material. Tubular protrusions 215 may be flexible or rigid. The tubular protrusions are configured to provide a channel through which tubes 260 may pass, but which, in the absence of tubes 260, inhibit movement of fluid therethrough. For example, tubes 215 may inhibit fluid flow due to the ratio between their length and lumen diameter, and/or may act as duckbill valves. Therefore, sheet 214 typically provides a generally sealed conduit between upstream support 210 and valve body 204.


The positioning of prosthetic valve assembly 202 at the native valve typically results in leaflets 14 of the native valve coapting around valve body 204, thereby providing sealing that inhibits (e.g., prevents) perivalvular leakage.


The positioning of prosthetic valve assembly typically also places sheet 214 in contact with the annulus and/or leaflets of the native valve. In general, a prosthetic valve implanted at a native valve encounters forces due to beating of the heart and/or the resulting flow of blood. Small movements (e.g., oscillations) resulting from these forces may inhibit tissue growth (e.g., fibrosis) that would otherwise facilitate sealing between the prosthetic valve and the native valve. For some applications, such movements are reduced (e.g., dampened) at sites at which the contact between assembly 202 and the surrounding tissue is provided by sheet 214, e.g., due to flexibility of the sheet. Thereby sheet 214 typically provides stabilized (e.g., more constant) contact with tissue than would a less flexible structure in the same position; this is hypothesized to improve tissue growth and thereby sealing. Furthermore, sheet 214 itself may be configured to promote tissue growth thereon, e.g., due to surface treatments and/or impregnation, and/or structure, such as weave and/or porosity, thereby further facilitating sealing.


Reference is made to FIGS. 9A-14B, which are schematic illustrations of prosthetic valve assemblies, in accordance with some applications of the invention. Each prosthetic valve assembly shown in FIGS. 9A-14B comprises a valve body, an upstream support, and a sheet, which are typically identical, mutatis mutandis, to valve body 204, upstream support 210 and sheet 214 described hereinabove, except for where noted.



FIGS. 9A-B show, prosthetic valve assembly 202 described hereinabove, in a simplified (e.g., two-dimensional) schematic manner that illustrates the arrangement of valve body 204, upstream support 210 and sheet 214, in the compressed state (FIG. 9A) and the expanded (e.g., implanted) state (FIG. 9B). FIGS. 9A-B are included at least in part in order to facilitate interpretation of the simplified schematic illustrations of the prosthetic valve assemblies of FIGS. 10A-14B. FIG. 9A, like FIGS. 10A, 11A, 12A and 13A, shows the prosthetic valve assembly in the compressed state as if it were contained in the delivery tool thereof (e.g., tool 230), but for clarity does not show the delivery tool. Typically, sheet 214 is attached at least to inner perimeter 211 of upstream support 210, and to an upstream end 207 of frame 206 of valve body 204.



FIGS. 10A-B show a prosthetic valve assembly 302, which comprises a valve body 304 comprising a first frame 306, an upstream support 310 comprising a second frame 312, and a flexible sheet 314. In the expanded state of support 310 (FIG. 10B), frame 312 defines an outer perimeter 313 and an inner perimeter 311 that defines an opening through the support. During implantation, support 310 is placed against the upstream surface of the native valve, and valve body 304 is subsequently intracorporeally coupled (e.g., directly coupled) to the support by being expanded within the opening of the support, e.g., as described hereinabove with reference to FIG. 1F, mutatis mutandis.


Sheet 314 is not attached to inner perimeter 311 of frame 312, but rather is circumferentially attached to frame 312 at a radius that is greater than that of the inner perimeter. For example, sheet 314 may be attached to frame 312 at outer perimeter 313. Sheet 314 is also not attached to an upstream end 307 of valve body 304. Thereby a pocket region 316 is defined between sheet 314 and at least inner perimeter 311, in which sheet 314 is not attached to frame 312 or frame 306.


In the compressed state (FIG. 10A), sheet 314 is disposed alongside and outside at least part of frame 312 and at least part of frame 306. Frame 312 is configured such that when the frame is in the compressed state, inner perimeter 311 defines a downstream end of the frame (e.g., of the cylindrical shape of the frame), and outer perimeter 313 defines an upstream end. Therefore, when frame 312 expands, the upstream end of the frame expands radially outward more than does the downstream end of the frame.



FIGS. 11A-B show a prosthetic valve assembly 342, which comprises a valve body 344 comprising a first frame 346, an upstream support 350 comprising a second frame 352, and a flexible sheet 354. In the expanded state of support 350 (FIG. 11B), frame 352 defines an outer perimeter 353 and an inner perimeter 351 that defines an opening through the support. During implantation, support 350 is placed against the upstream surface of the native valve, and valve body 344 is subsequently intracorporeally coupled (e.g., directly coupled) to the support by being expanded within the opening of the support, e.g., as described hereinabove with reference to FIG. 1F, mutatis mutandis.


Sheet 354 is not attached to inner perimeter 351 of frame 352, but rather is circumferentially attached to frame 352 at a radius that is greater than that of the inner perimeter. For example, sheet 354 may be attached to frame 352 at outer perimeter 353. Sheet 354 is also not attached to an upstream end 347 of valve body 344. Thereby a pocket region 356 is defined between sheet 354 and at least inner perimeter 351, in which sheet 354 is not attached to frame 352 or frame 346.


Frame 352 is configured such that when the frame is in the compressed state, the frame has a generally cylindrical shape that defines a lumen therethrough, inner perimeter 351 defines an upstream end of the frame (e.g., of the cylindrical shape of the frame), and outer perimeter 353 defines a downstream end. Therefore, when frame 352 expands, the downstream end of the frame expands radially outward more than does the upstream end of the frame. In the compressed state (FIG. 11A), sheet 354 is disposed alongside and outside of at least part of frame 346, and through at least part of the lumen defined by frame 352.



FIGS. 12A-B show a prosthetic valve assembly 382, which comprises a valve body 384 comprising a first frame 386, an upstream support 390 comprising a second frame 392, and a flexible sheet 394. In the expanded state of support 390 (FIG. 12B), frame 392 defines an outer perimeter 393 and an inner perimeter 391 that defines an opening through the support. Frame 392 is coupled to frame 386 prior to implantation (e.g., assembly 382 is provided with frame 392 coupled to frame 386). For some applications, frames 392 and 386 are integral, e.g., are defined by respective regions of a single frame. During implantation, valve body 384 is advanced between leaflets of the native valve, and support 390 is placed against the upstream surface of the native valve (e.g., as described with reference to FIGS. 8B-D, mutatis mutandis.


Sheet 394 is not attached to inner perimeter 391 of frame 392, but rather is circumferentially attached to frame 392 at a radius that is greater than that of the inner perimeter. For example, sheet 394 may be attached to frame 392 at outer perimeter 393. Sheet 394 is also not attached to an upstream end 387 of valve body 384. Thereby a pocket region 396 is defined between sheet 394 and at least inner perimeter 391, in which sheet 394 is not attached to frame 392 or frame 386.


Assembly 382 is configured such that, in the compressed state thereof (FIG. 12A), frames 386 and 392 are generally collinear, and form a generally continuous cylinder. Frame 392 is configured such that in the compressed state, outer perimeter 393 defines an upstream end of the frame (and thereby of assembly 382). Therefore, when frame 392 expands, the upstream end of the frame expands radially outward more than does the downstream end of the frame. In the compressed state, sheet 394 is disposed alongside and outside of at least part of frame 386, and at least part of frame 392.



FIGS. 13A-B show a prosthetic valve assembly 402, which comprises a valve body 404 comprising a first frame 406, an upstream support 410 comprising a second frame 412, and a flexible sheet 414. In the expanded state of support 410 (FIG. 13B), frame 412 defines an outer perimeter 413 and an inner perimeter 411 that defines an opening through the support. Frame 412 is coupled to frame 406 prior to implantation (e.g., assembly 402 is provided with frame 412 coupled to frame 406). For some applications, frames 412 and 406 are integral, e.g., are defined by respective regions of a single frame. During implantation, valve body 404 is advanced between leaflets of the native valve, and support 410 is placed against the upstream surface of the native valve (e.g., as described with reference to FIGS. 8B-D, mutatis mutandis.


Sheet 414 is not attached to inner perimeter 411 of frame 412, but rather is circumferentially attached to frame 412 at a radius that is greater than that of the inner perimeter. For example, sheet 414 may be attached to frame 412 at outer perimeter 413. Sheet 414 is also not attached to an upstream end 407 of valve body 404. Thereby a pocket region 416 is defined between sheet 414 and at least inner perimeter 411, in which sheet 414 is not attached to frame 412 or frame 406.


Assembly 402 is configured such that, in the compressed state thereof (FIG. 13A), frame 412 is disposed generally alongside at least a portion of frame 406. Frame 412 is configured such that in the compressed state, outer perimeter 413 defines a downstream end of the frame. Therefore, when frame 412 expands, the downstream end of the frame expands radially outward more than does the upstream end of the frame. In the compressed state, sheet 414 is disposed alongside and outside of at least part of frame 406.



FIGS. 14A-B show a prosthetic valve assembly 422 an expanded state thereof, implanted at native valve 10, in accordance with some applications of the invention. Assembly 422 comprises a valve body 424 comprising a first frame 426, an upstream support 430 comprising a second frame 432, and a sheet 434.


Frame 426 of valve body 424 has an upstream end 427 and a downstream end 429. In the expanded state, in the absence of external forces, an outer perimeter 433 of second frame 432 of upstream support 430 is disposed closer to downstream end 429 than is an inner perimeter 431 of the second frame. For example, upstream support 430 may define a frustum, the larger base of which is disposed closer to downstream end 429 (and closer to a ventricular end of an atrioventricular axis) than is the smaller base of the frustum. For some applications, the assembly is thus configured such that, when placed at the native valve, outer perimeter 433 of the upstream support contacts the upstream surface of the native valve (e.g., the valve annulus), and the inner perimeter of the upstream support does not (FIG. 14A). For some such applications, frame 432 may be flat annular in the absence of external forces, and in the expanded state, sheet 434 retains the second frame in the frustoconical shape by inhibiting expansion of the second frame (e.g., expansion of at least outer perimeter 433 thereof). For some applications, frame 432 curves downward toward the tissue that outer perimeter 433 contacts (configuration not shown).


Sheet 434 is not attached to inner perimeter 431 of frame 432, but rather is circumferentially attached to frame 432 at a radius that is greater than that of the inner perimeter. For example, sheet 434 may be attached to frame 432 at outer perimeter 433. Sheet 434 is also not attached to upstream end 427 of valve body 424. Thereby a pocket region 436 is defined between sheet 434 and at least inner perimeter 431, in which sheet 434 is not attached to frame 432 or frame 426.


For some such applications, such a configuration provides a spring functionality that allows valve body 424 to move along an atrioventricular axis while outer perimeter 433 and/or portions of sheet 434 remain in contact with tissue (FIG. 14B). For example, assembly 422 may be implanted using techniques described with reference to FIGS. 8A-H, mutatis mutandis, and the spring functionality may allow movement of valve body 424 ventricularly during tensioning of tethers 282 while maintaining contact between outer perimeter 433 and the atrial surface. Similarly, such a configuration may allow oscillation of valve body 424 along the atrioventricular axis (e.g., caused by beating of the heart and the resulting blood flow), while maintaining constant contact between outer perimeter 433 and the tissue.


For some applications, a compressed state of assembly 422 is as described for one or more of the prosthetic valve assemblies described with reference to FIGS. 10A-13B, mutatis mutandis. For example, for some applications frame 426 of body 424 is coupled to frame 432 of support 430 prior to implantation (e.g., assembly 422 is provided with frame 426 coupled to frame 432), such as described for assembly 382 and/or assembly 402, mutatis mutandis. Alternatively, frame 426 is intracorporeally coupled to frame 432, e.g., as described for assembly 302 and/or assembly 342, and/or with reference to FIG. 1F, mutatis mutandis.


For some applications, assembly 422 is implanted as described for one or more of the prosthetic valve assemblies described with respect to FIGS. 10A-13B, mutatis mutandis.


Reference is again made to FIGS. 9A-B, 10A-B, and 11A-B. As described hereinabove, in its compressed state, assembly 202 defines an articulation zone in which (a) at least part of sheet 214 is disposed, and (b) neither frame 206 of body 204 nor frame 212 of support 210 is disposed, and about which body 204 and support 210 are articulatable with respect to each other. It is to be noted that in their compressed states, assemblies 302 and 342 also define respective articulation zones 336, 376. For each assembly, at least part of the respective sheet is disposed in the articulation zone, neither the respective frame of the valve body nor the respective frame of the support is disposed in the articulation zone, and the respective valve body and support are articulatable with respect to each other, about the articulation zone.


Reference is again made to FIGS. 10A-B, 11A-B, 12A-B, 13A-B, and 14A-B. As described hereinabove, assemblies 302, 342, 382, 402 and 422 each define a respective pocket region between the respective sheet and at least the inner perimeter of the frame of the upstream support. As also described hereinabove, (e.g., with reference to assembly 202), placement of the flexible sheet of the prosthetic valve assembly in contact with tissue provides stabilized contact with the tissue, and thereby improves tissue growth and sealing. Provision of a pocket region such as those described hereinabove is hypothesized to further improve sealing (e.g., by further facilitating tissue growth). For example, such configurations (1) may provide a greater surface area of the flexible sheet and/or a greater tissue-contact area of the sheet (e.g., due to an angle of the sheet), and/or (2) may hold the flexible sheet under less tension (e.g., compared to assembly 202), such that the sheet is freer to move with movement of the valve assembly and/or tissue, thereby dampening movements that may otherwise inhibit tissue growth and/or sealing. This is illustrated in FIGS. 14A-B, which show an example of the contact between flexible sheet 434 and tissue (e.g., leaflets 14). For some applications, the sheet is elastic, so as to further facilitate maintenance of contact despite movement of the frames of the prosthetic valve assembly with respect to the native valve.


As described hereinabove, the respective pocket region of each assembly 302, 342, 382, 402 and 422 is defined by the manner in which the sheet of the assembly is coupled to the frames of the assembly. When the assembly is in the expanded state thereof, the sheet is typically frustoconical and/or funnel-shaped. This shape is defined by a lateral wall (i.e., the sheet itself), and first and second apertures (at either end of the shape), the first aperture being larger than the second aperture. A portion of the sheet that defines the first aperture is circumferentially attached to the frame of the upstream support at a radius that is greater than a radius of the inner perimeter of the support. A portion of the sheet that defines the second aperture is circumferentially attached to the frame of the valve body at a longitudinal site that is closer to a downstream end of the valve body than is the longitudinal site at which the upstream support is coupled to the valve body.


For some applications, the sheet extends radially past the radius at which it is coupled to the upstream support. As described hereinabove, for some applications the sheet is coupled to the upstream support at an outer perimeter of the upstream support. For some applications, the sheet extends radially past the outer perimeter of the upstream support.


Reference is made to FIGS. 15A-C, which are schematic illustrations of a tool 460 for facilitating application of force between prosthetic valve assembly 202 and guide members 256 (e.g., tethers 282 thereof), in accordance with some applications of the invention. For some applications, tool 460 serves as a tension-detector tool. For some applications, tool 460 alternatively or additionally serves as a tension-applicator tool.


The boxes on the right-hand side of FIGS. 15A-C shows assembly 202 being implanted at native valve 10, as described hereinabove. The box of FIG. 15A shows assembly 202 having been deployed (e.g., delivered and expanded) at the native valve, e.g., as described with reference to FIG. 8D. The box of FIG. 15B shows tethers 282 of guide members 256 having been tensioned with respect to assembly 202, e.g., as described with reference to FIG. 8E. The box of FIG. 15C shows tubular member 280 of each guide member 256 having been withdrawn proximally so as to (1) facilitate locking of the respective locking member 262 to its respective tether 282, e.g., as described with reference to FIG. 8F, and (2) decouple pull-wire 284 from tether 282, e.g., as described with reference to FIG. 8G.


The left-hand side of FIGS. 15A-C shows (1) a proximal end of system 200 (e.g., a proximal end of delivery tool 230 thereof, e.g., including a handle 231 thereof), including a proximal portion of pull-wire 284, a proximal portion of tubular member 280, and a proximal portion of reference-force tube 260, and (2) tool 460 coupled to the proximal portion of pull-wire 284 and the proximal portion of reference-force tube 260. The left-hand side of FIGS. 15A-C shows one tool 460 being used with one pull-wire 284, tubular member 280, tube 260 and tool 460 (and one handle 231). However it is to be noted that tool 460 is typically used with each guide member (e.g., each tether 282), either sequentially, or by providing more than one tool 460 for use at generally the same time.


Tool 460 comprises a pull-wire-coupling element 462, configured to be coupled to the proximal portion of pull-wire 284 (e.g., to a grip 464 of the pull-wire), and a reference-force-tube-coupling element 466, configured to be coupled to the proximal portion of reference-force tube 260 (e.g., to a grip 468 of the tubular member). Coupling elements 462 and 466 are coupled to each other via an adjustment member 470 that facilitates adjustment of a distance between the coupling elements. Adjustment member 470 may comprise screw threads, a ratchet mechanism, or any other suitable adjustment mechanism.


Pull-wire-coupling element 462 is coupled to the proximal portion of pull-wire 284 (e.g., to a grip 464 of the pull-wire), and reference-force-tube-coupling element 466 is coupled to the proximal portion of reference-force tube 260 (e.g., to a grip 468 of the tubular member), typically subsequently to delivery of prosthetic valve assembly 202 to the native valve (FIG. 15A). A distance d7 exists between coupling elements 462 and 466.


Subsequently, adjustment member 470 is used (e.g., actuated) so as to change (e.g., increase) the distance between coupling elements 462 and 466 (FIG. 15B; distance d8). This reduces the length of tether 282 that is disposed distal to the distal end of reference-force tube 282, (and thereby the length of the tether that is disposed between eyelet 222 and anchor 48), thereby applying tension to the tether). Typically, a length indicator 471 (e.g., a rule) is provided on tool 460 that indicates the change in length that has been made. Further typically, tool 460 comprises a force detector 472 that detects and displays a force differential (e.g., a linear force differential) between coupling elements 462 and 466, and thereby provides an indication of the tensile state of tether 282.


When a desired tensile state of tether 282 has been achieved (e.g., an absolute value and/or a value relative to other detected forces, such as the tensile state of the other tether 282), the tension is fixed, and pull-wire 284 is decoupled from tether 282 (FIG. 15C). As described with reference to FIG. 8F, this is achieved by withdrawing tubular member 280 proximally with respect to tether 282, pull-wire 284 and locking member 262. FIG. 15C shows a proximal portion of tubular member 280 (e.g., a grip 474 thereof) being withdrawn proximally with respect to (1) pull-wire 284 (and therefore with respect to tether 282 to which the pull-wire is coupled), and (2) reference-force tube 260 (and therefore with respect to locking member 262 which the distal end of the reference-force tube abuts). This is illustrated by a distance d10 between grips 468 and 474 in FIG. 15C, which is greater than a distance d9 between grips 468 and 474 in FIG. 15B. This thereby facilitates (1) locking of locking member 262 to tether 282, and (2) subsequently (i.e., after further proximal withdrawal of the tubular member), decoupling of pull-wire 284 from the tether.


For some applications, this is performed by one continuous movement of tubular member 280. For some applications, visual and/or tactile indicators allow the operating physician to lock locking member 262 to tether 282 without decoupling pull-wire 284 from the tether. This may advantageously allow the physician to further increase the tension on the tether (e.g., by using the ratchet functionality described with reference to FIG. 8F) before decoupling the pull-wire from the tether.


Although tool 460 is described hereinabove for facilitating implantation of assembly 202, the tool may also be used, mutatis mutandis, in combination with other systems described herein, such as system 40 described hereinabove and/or assembly 552 described hereinbelow (e.g., for tensioning tethers 582 thereof).


Reference is now made to FIG. 16, which is a schematic illustration of a system 480 comprising a prosthetic valve assembly 482 and one or more springs 484 via which the prosthetic valve assembly is elastically coupled to one or more tissue anchors 48, in accordance with some applications of the invention. For illustrative purposes, system 480 is shown as comprising system 200 (e.g., comprising prosthetic valve assembly 202), described hereinabove, with the addition of springs 484. However it is to be noted that the techniques described with reference to FIG. 16 may alternatively or additionally be used to facilitate implantation of other prosthetic valves and/or prosthetic valve assemblies described herein, mutatis mutandis (e.g., springs 484 may be added to other prosthetic valves and/or prosthetic valve assemblies described herein).


Each spring 484 is disposed outside of valve body 204, typically laterally outside the valve body, and further typically between eyelet 222 and locking member 262 (e.g., coupling the eyelet to the locking member). For example, and as shown, spring 484 may have a longitudinal axis that is generally parallel with lumen 208 of the valve body. When reference-force tube 260 provides the reference force to locking member 262 during tensioning of guide member 256 (e.g., tether 282 thereof), the reference force is transferred via spring 484. Typically spring 484 serves as a compression spring, such that increasing tension on guide member 256 (e.g., the tether 282 thereof) compresses the spring.


For some applications, spring 484 provides an indication of a state of the spring that is observable and recognizable using imaging techniques (e.g., fluoroscopy). That is, spring 484 is configured to change shape in response to a force applied to it, in a manner that is observable and recognizable using fluoroscopy. This functionality therefore provides intracorporeal measurement of tension on tether 282 (in a manner that is itself observable extracorporeally). It is hypothesized that for some applications, this intracorporeal measurement advantageously detects the tension with reduced interference (e.g., noise) that may be present in extracorporeal measurement techniques. For example, for some applications, extracorporeal measurement of the tension by extracorporeally measuring tension on pull-wire 284 (e.g., tension with respect to reference-force tube 280) may be inhibited by interference by inherent elasticity of the pull-wire and other elements of the system, and by friction between elements of the system.


For some applications, the shape of spring 484 alone provides the tension indication. For such applications, spring 484 may be coated with a radiopaque material such as tantalum. For some applications, spring 484 has (e.g., comprises and/or is coupled to) one or more radiopaque markers 486, and the juxtaposition of the markers facilitates extracorporeal detection of the shape of the spring. For example, when spring 484 serves as a compression spring, a reduction of a distance d11 (compare d11 to d11′) between adjacent markers 486 indicates an increase in tension on tether 282.


For some applications, an intracorporeal reference (e.g., a scale) 488 is provided, to facilitate identification of shape change of spring 484 (e.g., to facilitate quantification of the shape change by (1) comparing the position of markers 486 to reference 488, and/or (2) comparing the juxtaposition of markers 486 to the juxtaposition of elements of the scale. For example, and as shown in FIG. 16, scale 488 may itself also comprise a plurality of radiopaque markers 490 disposed on valve body 204 (e.g., coupled to frame 206) at known (e.g., regular) intervals, and distance d11 (observed using fluoroscopy) is compared to a distance d12 between adjacent markers 490 (observed using fluoroscopy) in order to determine the actual change in distance d11. That is, an observed relative change between d11 and d12 is used to determine an actual absolute change in d11.


For some applications, spring 484 also alters the relationship between (a) changes in the length of tether 282 disposed between eyelet 222 and anchor 48 and (b) tension on the tether. For example, for system 200 described hereinabove (i.e., in the absence of spring 484), starting with slack on tether 282 between the eyelet and the anchor, as the length of the tether between the eyelet and the anchor is reduced, tension on tether 282 may remain constant and low despite the reduction in the length of the tether, until the tether encounters resistance provided by tissue anchor 48, at which point tension increases relatively quickly for every unit reduction in length. For system 480 (i.e., using spring 484), the relationship between (a) the length of tether 282 disposed between the eyelet and the anchor, and (b) the tension on the tether, is smoother (e.g., the transition between before and after resistance from the anchor is encountered is smoother). That is, spring 484 absorbs some of the applied tensile force and in exchange provides additional length to the tether. This is hypothesized to advantageously provide more flexibility to the operating physician to adjust the length of tether 282 disposed between the eyelet and the anchor, with reduced changes to tension on the tether.


For some applications, spring 484 is configured so as to provide a desired tension (e.g., a desired resistance) over a range of lengths of tether 282 (e.g., over a range of compression states of the spring). That is, the spring constant of the spring is sufficiently low that a change in resistance is minimized per unit length change. For example, the spring constant may be less than 50 g/mm.


For some applications, the desired tension is above 300 g force and/or below 700 g force, e.g., above 400 g force, and/or below 600 g force, such as between 400 g force and 600 g force, e.g., about 500 g force. For example, a desired target tether tension may be 500 g force, and spring 484 may be configured to provide, over a range of compression states of the spring, resistance that results in a tether tension that is within a margin tension (e.g., within 200 g force, such as within 100 g force) of the target force.


For some applications, spring 484 is configured to provide a distinct indication, observable using fluoroscopy, when the spring experiences a force that is within a margin force (i.e., a force that corresponds to being within the margin tension). For example, spring 484 may undergo (e.g., suddenly undergo) a more obvious shape change when such a force is experienced.


For some applications, spring 484 is configured to act as a constant-force spring or similar, so as to facilitate the behavior described above. For some applications, spring 484 is pre-loaded (e.g., pre-tensioned or pre-compressed).


Reference is made to FIG. 17, which is a schematic illustration of a system 500 comprising a prosthetic valve assembly 502 and one or more springs 504 via which the prosthetic valve assembly is elastically coupled to one or more tissue anchors 48, in accordance with some applications of the invention. For illustrative purposes, system 500 is shown as comprising system 200 (e.g., comprising prosthetic valve assembly 202), described hereinabove, with the addition of springs 504. However it is to be noted that the techniques described with reference to FIG. 17 may alternatively or additionally be used to facilitate implantation of other prosthetic valves and/or prosthetic valve assemblies described herein, mutatis mutandis (e.g., springs 504 may be added to other prosthetic valves and/or prosthetic valve assemblies described herein).


Each spring 504 is disposed outside of valve body 204, typically laterally outside the valve body, and further typically is disposed functionally between locking member 262 and anchor 48 (e.g., between locking member 262 and eyelet 222, or between eyelet 222 and anchor 48. For some applications, and as shown, spring 504 is a cantilever spring, and may be defined by a protrusion of frame 206 that extends away (e.g., laterally away) from valve body 204. That is, spring 504 may comprise an elastically-deformable appendage. For some applications, the protrusion is shaped to define a loop 506 that provides spring 504 with constant-force-spring functionality.


Typically, spring 504 provides similar functionality to spring 484, described hereinabove, mutatis mutandis. For example, for some applications, spring 504 provides an indication of a state of the spring that is observable and recognizable using fluoroscopy. That is, spring 504 is configured to change shape in response to a force applied to it, in a manner that is detectable and recognizable using fluoroscopy. For some applications, spring 504 also alters the relationship between (a) the length of tether 282 disposed between eyelet 222 and anchor 48 and (b) tension on the tether, e.g., as described hereinabove with reference to spring 484, mutatis mutandis.


Reference is made to FIGS. 18A-B, which are schematic illustrations of springs coupled to tether 282 so as to elastically couple tissue anchor 48 (e.g., a tissue-engaging element 49 thereof) to prosthetic valve assembly 202 (e.g., to valve body 204 thereof), in accordance with some applications of the invention. FIG. 18A shows a spring 520 disposed partway along tether 282. FIG. 18B shows a spring 530, one end of which is coupled to anchor 48 (e.g., to an anchor head 47 thereof) and the other end of which is coupled to tether 282. Springs 520 and 530 are typically tension springs. For some applications, spring 530 is rigidly coupled to anchor head 47.


For illustrative purposes, springs 520 and 530 are shown being used with system 200 (e.g., with prosthetic valve assembly 202), described hereinabove. However it is to be noted that the techniques described with reference to FIGS. 18A-B may alternatively or additionally be used to facilitate implantation of other prosthetic valves and/or prosthetic valve assemblies described herein, mutatis mutandis.


Typically, springs 520 and 530 provide similar functionality to springs 484 and 504, described hereinabove, mutatis mutandis. For example, for some applications, springs 520 and 530 provide an indication of a state of the spring that is observable and recognizable using fluoroscopy. That is, the springs are configured to change shape in response to a force applied to them, in a manner that is detectable and recognizable using fluoroscopy. For some applications, springs 520 and 530 also alter the relationship between (a) the length of tether 282 disposed between eyelet 222 and anchor 48 and (b) tension on the tether, e.g., as described hereinabove with reference to springs 484 and 504, mutatis mutandis.


Reference is again made to FIGS. 16, and 18A-B. Springs 484, 520 and 530 are shown as helical springs. However it is to be noted that each of these springs may have a shapes other than a helix. For example, each of these springs may have a zigzag shape. For some applications, the use of a spring that defines a repeating (e.g., oscillating) pattern such as a helix or a zigzag facilitates fluoroscopic identification of the state of the spring. For example, whereas a linear elastically-stretchable member (e.g., a strip of elastic rubber) remains linear when stretched, the shape of a helical or zigzag spring changes as force increases.


Reference is made to FIGS. 19A-B, which are schematic illustrations of a system 700 for facilitating delivery of a prosthetic valve body 702, in accordance with some applications of the invention. System 700 comprises a delivery tool 704 that comprises a distal housing 706, configured to house valve body 702 in a compressed state thereof, a proximal portion 708, and a flexible longitudinal portion 710 (e.g., a catheter) therebetween. Proximal portion 708 typically comprises a handle 712. Housing 706 is configured to be transluminally advanced to the heart of the subject (e.g., as described herein, mutatis mutandis, while proximal portion 708 remains outside the body of the subject. Proximal portion 708 (e.g., handle 712 thereof) comprises a force detector 716 that detects a force between (a) the proximal portion, and (b) housing 706 and/or valve body 702 coupled thereto. Typically, force detector 716 detects tension. That is, the force detector detects resistance of valve body 702 to a proximally-directed force applied by tool 704 (e.g., when tool 704 is moved proximally).


Housing 706 is advanced through native valve 10 and into ventricle 8, and valve body 702 is partly advanced out of the housing, and automatically expands toward an expanded state (FIG. 19A). Valve body 702 is coupled to a plurality of tissue-engaging elements (e.g., tissue-engaging legs) 714 that protrude radially out from the valve body when exposed from housing 706. Tissue-engaging elements 714 are configured to engage leaflets 14 of the native valve, thereby facilitating anchoring of the valve body.


Typically system 700 is used for implantation of valve body 702 at a native valve at which a prosthetic valve support (e.g., an upstream support) has already been delivered, and to which the valve body is intracorporeally coupled (e.g., as described elsewhere herein). For example, and as shown in FIGS. 19A-B, system 700 may be used to implant valve body at native valve 10 after implantation of support 42 at the native valve. As described with reference to FIGS. 1A-D, support 42 is secured against the upstream surface of native valve 10 by being anchored, via tethers (e.g., longitudinal members 102), to ventricular muscle tissue. (The tethers are not visible in FIGS. 19A-B.)


Pulling housing 706 and valve body 702 proximally (i.e., atrially) while tissue-engaging elements 714 are protruding pushes the tissue-engaging elements against leaflets 14, reducing a height of a gap between the tissue-engaging elements and support 42, and sandwiching the leaflets against the support (FIG. 19B). Resistance to proximal movement of valve body 702 (e.g., due to support 42 and leaflets 14) is detected and displayed by force detector 716. The operating physician is thereby able to couple valve body 702 to support 42 (e.g., by fully deploying the valve body within the opening defined by the support) while a desired degree of tension is observed. The coupling of the valve body to the support fixes the degree of tension, such that leaflets 14 remain sandwiched, and the valve body remains secured to the native valve.


For some applications, alternatively or additionally to using extracorporeal force detector 716, the force encountered by tissue-engaging elements 714 is observed using fluoroscopy (e.g., by observing a shape and/or position of the tissue-engaging elements). For such applications, the tissue-engaging elements are typically configured to facilitate such observation, as described herein for various springs. For some applications, elements 714 are configured (e.g., shaped) to define a loop, e.g., as described hereinabove for springs 504, mutatis mutandis.


For some applications, valve body 702 is coupled via tethers to tissue anchors that are anchored to ventricular muscle tissue, as described elsewhere herein. For some such applications, a spring couples the valve body to each tissue anchor (e.g., as described with reference to FIGS. 16-18B, mutatis mutandis). For some applications in which a spring couples the valve body to each tissue anchor, reducing the height of the gap automatically (and typically immediately) alters a force on the spring (e.g., when the valve body is locked to the tether before reducing the height of the gap). For some applications in which a spring couples the valve body to each tissue anchor, reducing the height of the gap does not necessarily alter the force on the spring (e.g., when the valve body is slidably couplable to the tether until after the height is reduced, and is subsequently locked to the tether. For example, tool 230 and/or tool 460 may be used, mutatis mutandis, to measure and control tension and length of the tether until the valve body is locked to the tether.


It is to be noted that the above technique may be used for prosthetic valve assemblies in which the valve body is pre-coupled to the upstream support, mutatis mutandis. For such applications, the proximal pulling force is not a sandwiching force, but rather is a testing force, typically used in combination with another testing force, e.g., as described hereinbelow, e.g., with reference to FIG. 20.


Reference is made to FIG. 20, which is a schematic illustration showing examples in which force measurements described herein may be combined to facilitate implantation of a prosthetic valve, in accordance with some applications of the invention. Each apparatus and technique described herein for measuring force (e.g., tension) is described in a particular context (e.g., with reference to a particular prosthetic valve assembly, prosthetic valve body, and/or support) for the purpose of clarity. It is to be understood that the apparatus and techniques described in one context may be used to measure force in another context (e.g., to facilitate controlled implantation of a different prosthetic valve assembly, prosthetic valve body, and/or support), and may be combined with one or more of the other apparatus and/or techniques.



FIG. 20 shows examples of combinations of apparatus and techniques described herein, which include:


(1) Extracorporeal detection of tension on tethers (box 722). This is described, for example, with reference to force detector 472 of tool 460 of FIGS. 15A-C.


(2) Extracorporeal detection of atrially-directed force of valve-mounted tissue-engaging elements against tissue (e.g., leaflets or annulus) of the native valve (box 742). This is described, for example, with reference to FIGS. 19A-B.


(3) Extracorporeal detection of sandwiching force (box 720). That is, extracorporeal detection of the force of tissue-engaging elements coupled to the valve body against the native valve tissue and/or the upstream support. This is described, for example, (a) with reference to FIGS. 19A-B, and (b) with reference to force detector 472 of tool 460 (FIGS. 15A-C) being used to augment the apparatus and facilitate the techniques described with reference to FIGS. 21A-B.


(4) Intracorporeal detection (observed using imaging) of tension on tethers (724). This is described, for example, with reference to the springs described with reference to FIGS. 16, 17, and 18A-B.


(5) Intracorporeal detection (observed using imaging) of atrially-directed force of valve-mounted tissue-engaging elements against tissue (e.g., leaflets or annulus) of the native valve (box 744). This is described, for example, with reference to FIGS. 19A-B.


(6) Intracorporeal detection (observed using imaging) of sandwiching force (box 726). This is described, for example, with reference to one or more of the springs described with reference to FIGS. 16, 17, and 18A-B being used to augment the apparatus and facilitate the techniques described with reference to FIGS. 21A-B.


(7) Intracorporeal detection (observed using imaging) of ventricularly-directed force of the upstream support against the native annulus (box 728). For some applications, this is achieved by using imaging (e.g., fluoroscopy) to extracorporeally observe intracorporeal changes in the shape of the upstream support (e.g., changes described with reference to FIGS. 8D-E, 14A-B, and/or 15A-B), in a similar manner to that described for extracorporeally observing changes in the shape of springs (e.g., described with reference to FIGS. 16, 17, and 18A-B), mutatis mutandis.


It is hypothesized that combining two or more of the force-measurement techniques described herein may provide synergistic benefits when implanting an implant (e.g., a prosthetic valve assembly, prosthetic valve body, and/or prosthetic valve support), so as to facilitate controlled implantation (box 730). The ability to control various forces that secure the implant allows, inter alia, the forces to be spread as desired by the operating physician. For example, it may be desirable:

    • that tension is equally (or otherwise) distributed between the tethers,
    • that tension on a given tether is optimized (discussed hereinbelow),
    • that, during operation of the valve, resistance to a force that pushes the valve body in an atrial direction (e.g., during ventricular systole) is optimally balanced between the various anchoring elements, such as between (a) tissue anchors 48 and tethers coupled thereto and (b) other tissue-engaging elements (e.g., tissue-engaging elements 714 (FIGS. 19A-B) or tissue-engaging elements 580 (FIGS. 21A-B), thereby balancing the anchoring forces between different tissue sites, and/or
    • that sandwiching forces are greater than, equal to, or less than the tensile force provided by the tethers.


It is to be noted that the example combinations provided hereinabove are intended to be illustrative, and not limiting.


As described hereinabove, it may be desirable to that tension on a given tether is optimized. For example, it may be desirable that tension on the given tether to be maximized within a tension range that is known to be supported by (1) the tissue anchor to which the tether is coupled, and (2) the tissue to which the tissue anchor is anchored. For some applications, subsequently to anchoring the tissue anchor, the operating physician applies a testing pulling force to the tissue anchor. The testing pulling force is used to confirm that the anchored tissue anchor is capable of supporting an overload tension that is greater than an expected tension that it is expected that the anchor will encounter during operation. The expected tension may be determined at least in part based on possible ventricular blood pressure and the cross-sectional area of the lumen of the valve body.


For some applications, the testing pulling force is applied (e.g., via the tether or via the anchor manipulator), and movement of the tissue anchor is observed using imaging, e.g., as described with reference to FIGS. 1A-B). For some applications, the testing pulling force is applied while measuring tension using an extracorporeal force detector such as detector 472 (FIGS. 15A-C), mutatis mutandis.


For some applications, the testing pulling force is applied by applying tension to the tether, and the tension is measured using intracorporeal springs and fluoroscopy, as described hereinabove, mutatis mutandis. It is to be noted that, for such applications, the same technique is used (1) to confirm that the anchored tissue anchor is capable of supporting the overload tension, and (2) to facilitate the application of the tension (e.g., the anchoring tension) that will be fixed when the locking member is locked to the tether.


As described hereinabove, it may be desirable that, during operation of the valve, resistance to a force that pushes the valve body in an atrial direction (e.g., during ventricular systole) is optimally balanced between the various anchoring elements. For some applications, the following technique is used:


(1) Anchor at least one tissue anchor coupled to a respective at least one tether (e.g., within guide members).


(2) Advance a valve body that comprises at least one tissue-engaging element (e.g., a tissue-engaging leg) over at least part of the tether (e.g., by advancing over a guide member), such that a length of the tether is disposed between the valve body and the tissue anchor. Examples of such tissue-engaging elements are described with reference to FIGS. 19A-B and 21A-B. The valve body may or may not be pre-coupled to an upstream support.


(3) Apply a first tension to the tether (measured intracorporeally or extracorporeally).


(4) Apply proximal pulling force to the valve body such that the tissue-engaging element applies force against tissue of the native valve, such as leaflets and/or annulus. This pulling typically automatically increases the tension on the tether.


(5) While applying the proximal pulling force, intracorporeally and/or extracorporeally measure (a) force of tissue-engaging element against tissue, and (b) tension on the tether (e.g., the change in tension on the tether caused by the proximal pulling.


(6) At least in part based on measurements (a) and (b) of step 5, adjust the length of the tether disposed between the valve body and the tissue anchor, and/or lock the valve body to the tether (i.e., fix the length of the tether disposed between the valve body and the tissue anchor).


It is hypothesized that the above technique provides a prediction of the force distribution between the various anchoring elements that will exist during operation of the prosthetic valve assembly (e.g., during the lifetime thereof). For example, the technique provides a prediction of force distribution between the ventricular anchors and the valve-mounted tissue-engaging elements if/when atrially-directed force increases (e.g., as will be encountered during ventricular systole and/or increases in systemic blood pressure). Based on this indication, the technique facilitates adjustment of this distribution, via adjustment of the length of tethers disposed between the valve body and the tissue anchors.


Reference is made to FIGS. 21A-B, which are schematic illustrations of a prosthetic valve assembly 552, in accordance with some applications of the invention. Prosthetic valve assembly 552 comprises (1) a prosthetic valve body 554, which comprises a first frame 556 (e.g., a wire frame), and is shaped to define a lumen therethrough, (2) an annular upstream support 560, which comprises a second frame 562 (e.g., a wire frame), is shaped to define an opening through the upstream support, and is configured to be placed against an upstream surface (e.g., an atrial surface) of native valve 10 (e.g., of an annulus thereof), and (3) a flexible sheet 564 that couples the first frame to the second frame. FIG. 21A shows assembly 552 in an expanded state thereof (e.g., in the absence of external forces, such as if the assembly were resting on a table surface). In the expanded state of assembly 552 (and thereby of body 554), frame 556 of body 554 is generally cylindrical, and has a diameter d13. In the expanded state of assembly 552 (and thereby of upstream support 560), frame 562 of support 560 is typically generally annular, and has an outer perimeter 563 that has a diameter d14, which is greater than diameter d13.


Assembly 552 comprises one or more tissue-engaging elements 580 (e.g., legs) that protrude radially outward from valve body 554 so as to define a diameter d15, which is greater than diameter d13. Typically, and as shown in FIGS. 21A-B, frame 556 of body 554 is shaped to define tissue-engaging elements 580. Assembly 552 further comprises one or more tensioning elements (e.g., contraction wires) such as one or more tethers 582, a first portion (e.g., a distal end) of each tether being coupled to valve body 554, and a second portion of each tether being coupled (e.g., slidably coupled) to a portion of assembly 552 that is configured to be placed upstream of valve body 554. For example, and as shown, the second portion of each tether 582 may be slidably coupled to an upstream region of sheet 564. Alternatively or additionally, the second portion of each tether 582 may be slidably coupled to frame 562 of support 560. For some applications, this is facilitated by frame 562 being shaped to define one or more respective protrusions that protrude radially inward from the annular shape of the frame, to the site at which each tether 582 is shown in FIG. 21A passing through the sheet.


For some applications, except for (1) the presence of tissue-engaging elements 580 and tethers 582, and (2) the absence of eyelets 222, assembly 552 is identical to (e.g., comprises the same components as, and/or has identical functionality to) assembly 202, described hereinabove. Identically-named components of system 202 and system 552 are typically identical in structure and/or function.


For some applications, assembly 202 comprises tissue-engaging elements 580 and/or tethers 582. For some applications, assembly 552 comprises eyelets 222 and/or locking members 262 for sliding over and locking to guide members.


Both support 560 of assembly 552 and support 210 of assembly 202 may be flat annular (e.g., as shown for support 210) or frustoconical (as shown for support 560).



FIG. 21B shows assembly 552 being implanted. Following transluminal delivery to native heart valve 10, valve body 554 is typically deployed first (i.e., before support 560), as shown in state A of FIG. 21B. For some applications, valve body is deployed sufficiently far into the ventricle that tissue-engaging elements 580 can expand freely without interfering with leaflets 14 of the native valve, and valve assembly is subsequently moved atrially into the position shown in state A of FIG. 21B.


Subsequently, upstream support 560 is deployed, e.g., by a delivery housing 584 thereof being retracted (state B of FIG. 21B). Support 560 becomes placed against the upstream (e.g., atrial) surface of native valve 10, such as against the annulus of the valve and/or against the upstream surface of native leaflets 14. Typically, immediately subsequently to deployment of body 554 and support 560, assembly 552 has a total height d16 from a proximal end of support 560 to a distal end of body 554 (e.g., a height along an atrioventricular axis), and a distance d17 (e.g., a gap) measured along the height exists between a distal end of frame 562 and a proximal-most part of frame 554 (e.g., tissue-engaging elements 580 defined by the frame).


Subsequently, tethers 582 are tensioned so as to draw support 560 and body 554 closer to each other, thereby reducing the total height of assembly 552 to height d18, and reducing the distance between the distal end of frame 562 and the proximal-most part of frame 554 to a distance d19 (state C of FIG. 21B). This moves body 554 and tissue-engaging elements 580 closer to leaflets 14, thereby sandwiching the leaflets between the tissue-engaging elements and support 560, and thereby anchoring assembly 552 at the native valve. Sheet 564 maintains fluid communication (e.g., sealed fluid communication) through assembly 252, while also allowing the described contraction of the assembly. Typically, this characteristic is due to sheet 564 having tensile strength, but not compressive strength, and therefore rumpling when tethers 582 are tensioned.


Tensioning of tethers 582 may be accomplished by any suitable technique. For some applications, the tensioning is performed using control rods 86 and locking members 110, e.g., as described with reference to FIGS. 1C-D, mutatis mutandis. For some applications, the tensioning is performed using reference-force tubes and locking members, e.g., as described with reference to FIGS. 7B-8H, mutatis mutandis. For some applications, support 560 comprises a ratchet mechanism that facilitates the tensioning by allowing only one-way movement of tether 582 through the support. For some applications, assembly 552 comprises a spool mechanism for each tether, and tensioning is performed by rotating the spool mechanism.


For some applications, assembly 552 has a compressed state (e.g., for transluminal delivery) in which the assembly defines an articulation zone between frames 556 and 562, e.g., as described hereinabove for assembly 202, mutatis mutandis.


For some application, one or more of the techniques described hereinabove may be used to (1) control applied to tethers 582, and/or (2) facilitate intracorporeal measurement of tension on the tethers (and optionally fluoroscopic detection of that measurement). For example, assembly 552 may comprise a tension spring midway along each tether 582, and/or may comprise a compression spring at the coupling point of support 560 and the tether (e.g., between the support and a locking member 262 configured to lock a respective tether to the support). Alternatively or additionally, for applications in which the tensioning is performed using reference-force tubes and locking members (e.g., as described with reference to FIGS. 7B-8H), tool 460 may be used, mutatis mutandis, to extracorporeally detect the tension applied to tethers 582.


Reference is made to FIGS. 22A-B, which are schematic illustrations of a prosthetic valve assembly 602, comprising a prosthetic valve 603 having a tubular valve body 604 that comprises an upstream portion 606, a downstream portion 608, and an elastic portion 610 disposed between the upstream portion and the downstream portion, in accordance with some applications of the invention. Prosthetic valve 603 (e.g., valve body 604 thereof) is shaped to define a continuous lumen through portions 606, 610, and 608. Prosthetic valve 603 is configured to be implanted at native valve 10 such that upstream portion 606 is disposed in atrium 6 of the heart of the subject, and such that downstream portion 608 is disposed in ventricle 8 of the heart of the subject. For example, prosthetic valve 603 may be coupled to a prosthetic valve support 612 that has been previously placed against (e.g., coupled to) to the native valve, and that defines an opening. Support 612 may comprise (1) a support described elsewhere herein (e.g., support 42 described with reference to FIGS. 1A-F and 19A-B, support 310 described with reference to FIGS. 10A-B, and/or support 350, described with reference to FIGS. 11A-B, and/or (2) a support described in U.S. Provisional Patent application 61/756,034 to HaCohen et al., from which the present application claims priority, and which is incorporated herein by reference.


For some applications, and as shown in FIG. 22B, prosthetic valve support 612 comprises one or more tissue-engaging elements 618, an annular upstream support portion 620, and a flexible stabilizing member 622, such as a stabilizing band, coupled to the tissue-engaging elements, and configured to form a ring that is shaped to define an opening therethrough. Tissue-engaging elements 618 may comprise, as shown in FIGS. 22A-B, clips configured to be coupled to leaflets 14 of the native valve.


Tubular valve body 604 typically comprises a frame 614, such as a stent-like wire frame. As shown in FIG. 22A, prosthetic valve 603 typically further comprises a covering 616, disposed over (e.g., covering) an inner surface of frame 614, thereby providing a sealed lumen from an upstream end to a downstream end of the tubular valve body. Typically, an excess of covering 616 is provided in the vicinity of elastic portion 610, so as to facilitate elastic stretching of the elastic portion.


Typically, prosthetic valve 603 comprises an expandable prosthetic valve, and is deployed such that it (1) expands within the opening defined by upstream support portion 620 and/or the opening defined by stabilizing member 622, (2) applies a radially-expansive force against the upstream support portion and/or the stabilizing member, and (3) thereby becomes coupled thereto. Typically, and as shown in FIG. 22B, downstream portion 608 is expanded and coupled to stabilizing member 622 before upstream portion 606 is expanded and coupled to upstream support portion 620. While downstream portion 608 is coupled to member 622, and before upstream portion 606 is coupled to portion 620, elastic portion 610 may be stretched and compressed e.g., such as by moving upstream portion 606 further upstream and downstream. Such stretching and compressing changes a length of prosthetic valve 603, and for some applications, facilitates the coupling of a pre-determined portion of the prosthetic valve (e.g., of upstream portion 606) to upstream support portion 620, irrespective, to some degree, of (a) a distance between tissue-engaging elements 618 and upstream support portion 620, and/or (b) a dimension of native valve 10 (e.g., a length of leaflets 14). For some applications, such stretching and compressing adjusts a degree of tension of elastic portion 610, and may alternatively or additionally facilitate “tightening” of leaflets 14 against the implanted apparatus, such as drawing of the leaflets toward upstream support portion 620.


For some applications, prosthetic valve 603 may be used in combination with other apparatus and techniques described herein. For example, valve body 604 may be substituted for another valve body described herein, mutatis mutandis, including valve bodies that are described herein as being intracorporeally coupled to an upstream support, and valve bodies that are described herein as being provided pre-coupled to an upstream support (either directly, or via a flexible sheet).


Reference is again made to FIGS. 22A-B, which are schematic illustrations of apparatus 680 comprising an implant 682 for replacing the native valve. Implant 682 comprises frame 614 which is expandable and which is shaped to define a continuous lumen 615 through the frame. Frame 614 is shaped so as to define at least one upstream row 684 of upstream cells. Frame 614 is also shaped so as to define at least two downstream rows 686 of downstream cells, comprising an upstream row 687 of downstream cells and a downstream row 689 of downstream cells. An upstream portion 690 of each cell is shaped by ascending struts 691 and descending struts 693 that form a respective peak 695 that points in an upstream direction. At least one valve member is disposed within lumen 615 and is configured to facilitate unidirectional flow of blood of the subject from an upstream end 617 of frame 614 to a downstream end 619 of frame 614.


As described hereinabove, prosthetic valve 603 typically comprises a covering 616. Covering 616 has (i) a first portion 700 that entirely covers an outer surface of the downstream row 689 of downstream cells, and (ii) a second portion 702 that partially covers an outer surface of the upstream row 687 of downstream cells such that outer surfaces of the peaks 695 of the upstream row 687 of downstream cells are disposed upstream of an upstream end 704 of second portion 702 of covering 616.


For some applications, frame 614 is shaped to define exactly four rows of cells 1R, 2R, 3R, and 4R.


As shown, each cell defines a window 706, and each row of cells defines respective junctions 708 between adjacent cells. Upstream end 704 of second portion 702 of covering 616 spans a respective window 706a of each cell of the upstream row 687 of downstream cells at a longitudinal level 710 of frame 614 that is at junctions 708 between the adjacent cells, such that for each window 706 of each cell of the upstream row 687 of downstream cells:

    • a downstream portion 705 of the window 706 is covered at the outer surface 720 of the upstream row 687 of downstream cells, and
    • an upstream portion 707 of the window 706 is uncovered at the outer surface 720 of the upstream row 687 of downstream cells.


Typically, covering 616 extends in the upstream direction, from a downstream perimeter 722 of the frame. A third portion 730 of covering 616 lines an inner surface 732 of frame 614 and extends around the downstream end 619 of frame 614 to meet the first portion 700 of covering 616. The upstream row 684 of upstream cells defines respective spaces 734 between respective junctions 708 of the ascending struts 691 and descending struts 693 at peaks 695 of upstream row 684 of upstream cells. An upstream end 736 of third portion 730 of covering 616 spans the respective spaces 734 between the respective junctions 708 of the ascending struts 691 and descending struts 693 at the peaks 695 of the upstream row 684 of upstream cells.


As shown in FIG. 22B, for some applications of the present invention, implant 682 comprises a first tissue-engaging element 740 configured to engage a first leaflet of the native valve, and a second tissue-engaging element 742 configured to engage a second leaflet of the native valve.


Reference is made to FIGS. 23-24, which are schematic illustrations of respective systems for facilitating anchoring of a tissue anchor in the heart of a subject, in accordance with some applications of the invention. Each system comprises a delivery tool that comprises (1) a steerable catheter configured to be transluminally advanced to the heart of the subject (e.g., via sheath 46), and (2) an obstructing element disposed at a longitudinal site of the catheter, and configured to extend laterally (e.g., radially) outward from the catheter so as to inhibit movement of at least the longitudinal site of the catheter through the heart valve by abutting tissue of the heart valve.



FIG. 23 shows a system 640, comprising a delivery tool 642 that comprises a catheter 644 and an obstructing element 646. Obstructing element 646 is typically collapsible for transluminal delivery (e.g., via sheath 46), and expandable in atrium 6 of the heart. For some applications, element 646 is configured to expand automatically upon becoming exposed from the distal end of sheath 46. Obstructing element 646 is disposed at a longitudinal site 648 of catheter 644, and is dimensioned, when in the expanded state thereof, to not pass through native valve 10 (i.e., between leaflets 14 of the native valve). When a distal end 645 of the catheter is extended through native valve 10, obstructing element 646 abuts the atrial surface of the native valve (e.g., one or more leaflets, or the annulus), and thereby inhibits movement of at least longitudinal site 648 of the catheter from passing through the valve. Therefore a known length d20 of catheter 644 (i.e., the length between longitudinal site 648 and distal end 645) is disposed downstream of the atrial surface of valve 10. Distal end 645 is thereby placeable against ventricular tissue at ventricular sites that are disposed at a distance from the atrial surface (e.g., from a portion of the atrial surface that element 646 abuts) that is generally equal to d20. A distal portion 652 of catheter 644, disposed distal to longitudinal site 648, is typically steerable, so as to facilitate placement of distal end 645 against many (e.g., any) ventricular site that is disposed at that distance from the atrial surface.


A tissue anchor 48 is advanced through catheter 644 using an anchor manipulator 650, and anchored to tissue at the ventricular site at which distal end 645 is disposed. Typically, little or none of anchor 48 or manipulator 650 becomes exposed from distal end 645 during anchoring.



FIG. 24 shows a system 660, comprising a delivery tool 662 that comprises a catheter 664 and an obstructing element 666. Obstructing element 666 is typically collapsible for transluminal delivery (e.g., via sheath 46), and expandable in atrium 6 of the heart, and may be identical to obstructing element 646, described hereinabove. For some applications, element 666 is configured to expand automatically upon becoming exposed from the distal end of sheath 46. Obstructing element 666 is disposed at a longitudinal site 668 of catheter 664, and is dimensioned, when in the expanded state thereof, to not pass through native valve 10 (i.e., between leaflets 14 of the native valve). When a distal end 665 of the catheter is extended through native valve 10, obstructing element 666 abuts the atrial surface of the native valve (e.g., one or more leaflets, or the annulus), and thereby inhibits movement of at least longitudinal site 668 of the catheter from passing through the valve. Therefore a known length d21 of catheter 664 (i.e., the length between longitudinal site 668 and distal end 665) is disposed downstream of the atrial surface of valve 10.


Length d21 of system 660 is typically shorter than length d20 of system 640, and in contrast to system 640, for system 660, catheter 664 is not configured for distal end 665 to be placed against ventricular tissue. Rather, an anchor manipulator 670 advances tissue anchor 48 through catheter 664, out of the distal end 665, and toward a ventricular site at which it anchors the tissue anchor. Typically, anchor manipulator 670 is slidably coupled to catheter 664 such that a distal end of the anchor manipulator is slidable distally no more than a pre-determined distance d22 from longitudinal site 668 (and thereby no more than a pre-determined distance from distal end 665 of catheter 664). Anchor manipulator 670 is thereby used to anchor anchor 48 at a ventricular site that is disposed at a distance from the atrial surface (e.g., from a portion of the atrial surface that element 666 abuts) that is generally equal to d22. Typically, anchor manipulator 670 (or at least a distal portion 672 thereof that is exposable from distal end 665 of catheter 664) is steerable independently of catheter 664.


It is to be noted that, for systems 640 and 660, the distance from the atrial surface at which anchor 48 is anchored is generally equal, but not necessarily exactly equal, to d20 or d22. For example, anchor 48 may be anchored at a site that is closer to another portion of the atrial surface than to the portion of the atrial surface that the obstructing element abuts. Alternatively or additionally, curvature of the catheter and/or the anchor manipulator may result in a direct distance between the atrial surface and the tissue anchor being smaller than d20 or d22.


Typically, anchor 48 is coupled to a tether, guide member, and/or other longitudinal member (e.g., as described hereinabove with reference to other systems). When the anchor driver is decoupled from the anchor and withdrawn proximally, the tether extends proximally from the anchor (e.g., out of the body of the subject) so that an implant, such as a prosthetic valve, prosthetic valve support, and/or a prosthetic valve assembly (e.g., those described hereinabove) may be advanced therealong and/or locked thereto, e.g., as described hereinabove for other systems, mutatis mutandis. Because the distance between the tissue anchor and the atrial surface is known, for some applications the tether coupled to the tissue anchor may comprise fewer locking sites for locking to the implant, a relatively shorter locking site, and/or only one locking site. It is hypothesized that this may provide the possibility of using simpler, smaller and/or more effective mechanisms to lock the implant to the tether.


Reference is again made to FIGS. 7A-C, 8A-H, 9A-B, 15A-C, 16, 17, 18A-B, and 21A-B. The flexible sheets described hereinabove typically have tensile strength but very low compressive strength along the longitudinal axis of assembly 202. Due to this characteristic, inter alia, implant-control rod 246 is coupled (via mount 248) to assembly 202 by being coupled to valve body 204, such that when the valve body is pushed distally, the valve body pulls upstream support 210 via sheet 214. (It is hypothesized that it would be less effective for the implant-control rod to be coupled to the support, because in such a case sheet 214 may rumple and the support may move toward the valve body, possibly reducing articulation at the articulation zone. Nevertheless, for applications in which such reduced articulation is in any case sufficient, the implant-control rod may be coupled to the support) This characteristic of the flexible sheet also facilitates the height-adjustment of assembly 552 and its sandwiching of the native leaflets by tensioning tethers 582.


Although each of the prosthetic valve assemblies is shown implanted in a generally symmetrical state, it is to be noted that for some applications this characteristic of the sheet facilitates asymmetrical implantation. For example, the assembly may better conform to the native anatomy, and/or one tether of assembly 552 may be tensioned more than another so as to alter the anchoring, sealing, and/or flow characteristics of the assembly, e.g., in response to the native anatomy.


For some applications it may be advantageous for the valve body to be disposed at a particular rotational orientation within ventricle 8, and for the upstream support to be disposed at a particular rotational orientation within atrium 6. For example, for prosthetic valve assemblies such as assembly 202 that are tethered to ventricular anchors, it may be advantageous for each eyelet to be aligned with a respective anchor, and for the point at which each guide members passes through the upstream support to be aligned with a respective commissure. Alternatively or additionally, the upstream support may be geometrically asymmetric, and a particular rotational orientation with respect to atrial tissue may be advantageous. (Examples of such upstream supports are described in PCT patent application publication WO/2013/021374 to Gross et. al, which is incorporated herein by reference.) Alternatively or additionally, the upstream support may be asymmetric with respect to rigidity (i.e., some regions of the support may be more rigid than others). Alternatively or additionally, it may be advantageous to place the holes in sheet 214 through which tubes 260 pass in a particular rotational orientation with respect to the native valve.


For some applications, the sheet facilitates implantation of the upstream support in a different rotational position to its valve body, e.g., by twisting. For example, the upstream support may be implanted at more than 5 degrees (e.g., more than 10 degrees, such as more than 20 degrees) rotational offset with respect to the valve body.


Reference is again made to FIGS. 7A-14B, 16-18B, and 21A-B. For some applications the first frame of the valve body is coupled to the second frame of the upstream support by the sheet (e.g., generally only by the sheet) in the compressed state (e.g., assemblies 202, 302, 342 and 552) and/or in the expanded state (e.g., assemblies 202 and 552). As used in the present application, including in the claims, (a) the first and second frames being “coupled by the sheet”, and/or (b) the sheet “coupling the first frame to the second frame”, do not include applications in which the frames are primarily and/or independently coupled to each other by a different means, and the covering extends over both frames. For example, the first and second frames are not “coupled to each other by the sheet” (1) in assemblies 382, 402 and 422, in which the frames are provided pre-coupled directly to each other, or (2) in the expanded state of assemblies 302 and 342, in which the frames are intracorporeally coupled directly to each other.


For applications in which the first frame of the valve body is coupled to the second frame of the upstream support by the sheet, a gap typically exists between the first frame and the second frame. For some such applications, no metallic structure is disposed within the gap.


For some applications (including some applications in which the first and second frames are coupled independently of the sheet), the flexible sheet comprises, in addition to the sheet-like structure, one or more flexible longitudinal members, such as metallic or polymer wires (e.g., embedded within or attached to a surface of the sheet-like structure). These flexible longitudinal members may provide a small amount of rigidity to the sheet without detracting from the general nature of the sheet. For example, the flexible longitudinal members may facilitate opening of the sheet during deployment of the prosthetic valve assembly.


It is to be noted that for applications in which the first and second frames are coupled by the sheet, even when the sheet comprises flexible longitudinal members that are metallic wires, the frame of the valve body and the frame of the upstream support are typically distinct from each other, and can be considered to be coupled to each other by the sheet (e.g., generally only by the sheet).


For some applications, within the total height of the prosthetic valve assembly, a distance exists within which no rigid and/or metallic structure is disposed. For example, for assembly 552, typically no rigid and/or metallic structure is disposed within distance d17 and/or distance d19. It is to be noted that a similar distance exists for assembly 202 between frames 210 and 206 (e.g., when implanted; see FIGS. 8F-G). For some applications, for assembly 552, only sheet 564 and tethers 582 are disposed within distances d17 and d19. However, for some applications, tissue-engaging elements 580 extend proximally toward frame 562 such that the distance in which no rigid and/or metallic structure is disposed is reduced and/or absent (e.g., when tethers 582 are tensioned).


Reference is again made to FIGS. 1A-F, 3A-C, 6 and 7A-8H. For some applications of the invention, tissue anchor 48 and/or the guide member coupled thereto (e.g., guide member 56, guide member 256, and/or the components thereof) are included as components of the provided apparatus. That is, they are typically provided with the prosthetic valve assembly. For some applications of the invention, the tissue anchor and/or the guide member coupled thereto are not included as components of the provided apparatus (e.g., they are obtained separately).


It will be understood that, although the terms “first, “second,” etc. may be used in the present application (including the specification and the claims) to describe various elements and/or directions, these terms should not be limiting. These terms are only used to distinguish one element and/or direction from another. Thus, a “first” element described herein could also be termed a “second” element without departing from the teachings of the present disclosure.


As used in the present application, including in the claims, a “central longitudinal axis” of a structure (e.g., an elongate structure) is the set of all centroids of transverse cross-sectional sections of the structure along the structure. Thus the cross-sectional sections are locally perpendicular to the central longitudinal axis, which runs along the structure. (If the structure is circular in cross-section, the centroids correspond with the centers of the circular cross-sectional sections.)


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.

Claims
  • 1. Apparatus, for use at a native valve of a heart of a subject, the apparatus comprising an implant for replacing the native valve, the implant comprising: an expandable frame shaped to define a continuous lumen through the frame, the frame being shaped so as to define: (a) at least one upstream row of upstream cells, and(b) at least two downstream rows of downstream cells defined by an upstream row of downstream cells and a downstream row of downstream cells,an upstream portion of each cell being shaped by ascending and descending struts that form a respective peak that points in an upstream direction;at least one valve member, disposed within the lumen, and configured to facilitate unidirectional flow of blood of the subject from an upstream end of the frame to a downstream end of the frame; anda covering that has (i) a first portion that entirely covers an outer surface of the downstream row of downstream cells, and (ii) a second portion that partially covers an outer surface of the upstream row of downstream cells such that outer surfaces of the peaks of the upstream row of downstream cells are disposed upstream of an upstream end of the second portion of the covering.
  • 2. The apparatus according to claim 1, wherein the covering comprises a fabric covering.
  • 3. The apparatus according to claim 1, wherein the expandable frame is shaped to define exactly four rows of cells.
  • 4. The apparatus according to claim 1, wherein: each cell defines a window,each row of cells defines respective junctions between adjacent cells, andthe upstream end of the second portion of the covering spans a respective window of each cell of the upstream row of downstream cells at a longitudinal level of the frame that is at the junctions between the adjacent cells, such that for each window of each cell of the upstream row of downstream cells: a downstream portion of the window is covered at the outer surface of the upstream row of downstream cells, andan upstream portion of the window is uncovered at the outer surface of the upstream row of downstream cells.
  • 5. The apparatus according to claim 1, wherein the upstream end of the second portion of the covering surrounds the frame at a generally constant height above the downstream end of the frame.
  • 6. The apparatus according to claim 1, wherein the covering extends in the upstream direction, from a downstream perimeter of the frame.
  • 7. The apparatus according to claim 1, wherein a third portion of the covering lines an inner surface of the frame and extends around the downstream end of the frame to meet the first portion of the covering.
  • 8. The apparatus according to claim 7, wherein: the upstream row of upstream cells defines respective spaces between respective junctions of the ascending and descending struts at the peaks of the upstream row of upstream cells, andan upstream end of the third portion of the covering spans the respective spaces between the respective junctions of the ascending and descending struts at the peaks of the upstream row of upstream cells.
  • 9. The apparatus according to claim 7, wherein: the upstream row of upstream cells defines respective spaces between respective junctions of the ascending and descending struts at the peaks of the upstream row of upstream cells, andan upstream end of the third portion of the covering surrounds the frame at the upstream row of upstream cells at a generally constant height above the downstream end of the frame.
  • 10. The apparatus according to claim 1, wherein the implant further comprises: a first tissue-engaging element configured to engage a first leaflet of the native valve, anda second tissue-engaging element configured to engage a second leaflet of the native valve.
  • 11. The apparatus according to claim 10, wherein the implant is implantable such that: the first and second tissue-engaging elements are coupled to the leaflets,subsequently, the two downstream rows of downstream cells of the frame expand and are disposed at least in part within a ventricle of the heart, andsubsequently, the upstream row of upstream cells of the frame expands and is disposed at least in part within an atrium of the heart.
  • 12. Apparatus, for use at a native valve of a heart of a subject, the apparatus comprising an implant for replacing the native valve, the implant comprising: an expandable frame shaped to define a continuous lumen through the frame, the frame being shaped so as to define: (a) a downstream row of downstream cells, and(b) an upstream row of cells upstream of the downstream row of downstream cells,an upstream portion of each cell being shaped by ascending and descending struts that form a respective peak that points in an upstream direction;at least one valve member, disposed within the lumen, and configured to facilitate unidirectional flow of blood of the subject from an upstream end of the frame to a downstream end of the frame; anda covering that has (i) a first portion that entirely covers an outer surface of the downstream row of downstream cells, and (ii) a second portion that partially covers an outer surface of the upstream row of cells such that outer surfaces of the peaks of the upstream row of cells are disposed upstream of an upstream end of the second portion of the covering.
  • 13. The apparatus according to claim 12, wherein the covering comprises a fabric covering.
  • 14. The apparatus according to claim 12, wherein the expandable frame is shaped to define exactly four rows of cells.
  • 15. The apparatus according to claim 12, wherein: each cell defines a window,each row of cells defines respective junctions between adjacent cells, andthe upstream end of the second portion of the covering spans a respective window of each cell of the upstream row of cells at a longitudinal level of the frame that is at the junctions between the adjacent cells, such that for each window of each cell of the upstream row of cells: a downstream portion of the window is covered at the outer surface of the upstream row of cells, andan upstream portion of the window is uncovered at the outer surface of the upstream row of cells.
  • 16. The apparatus according to claim 12, wherein the upstream end of the second portion of the covering surrounds the frame at a generally constant height above the downstream end of the frame.
  • 17. The apparatus according to claim 12, wherein the covering extends in the upstream direction, from a downstream perimeter of the frame.
  • 18. The apparatus according to claim 12, wherein a third portion of the covering lines an inner surface of the frame and extends around the downstream end of the frame to meet the first portion of the covering.
  • 19. The apparatus according to claim 12, wherein the implant further comprises: a first tissue-engaging element configured engage a first leaflet of the native valve, anda second tissue-engaging element configured to engage a second leaflet of the native valve.
  • 20. The apparatus according to claim 19, wherein the implant is implantable such that: the first and second tissue-engaging elements are coupled to the leaflets, andsubsequently, the downstream row of downstream cells of the frame expands and is disposed at least in part within a ventricle of the heart.
  • 21. The apparatus according to claim 20, wherein the implant is implantable such that, subsequently to the expanding of the downstream row of downstream cells of the frame, the upstream row of cells upstream of the downstream row of downstream cells of the frame expands.
CROSS-REFERENCES TO RELATED APPLICATIONS

The present application is a continuation of U.S. patent application Ser. No. 16/802,353 to Hammer et al., filed Feb. 26, 2020, and entitled “Prosthetic valve and upstream support therefor” (now U.S. Pat. No. 11,135,059), which is a continuation of U.S. patent application Ser. No. 15/872,501 to Hammer et al., filed Jan. 16, 2018, and entitled “Prosthetic valve and upstream support therefor” (now U.S. Pat. No. 10,631,982), which is a continuation of U.S. patent application Ser. No. 14/763,004 to Hammer et al., filed Jul. 23, 2015, and entitled “Ventricularly-anchored prosthetic valves,” which published as US 2015/0351906, which is a national phase of PCT/IL2014/050087 to Hammer et al., filed Jan. 23, 2014, and entitled “Ventricularly-anchored prosthetic valves,” which published as WO 2014/115149, and which claims priority from U.S. provisional patent application 61/756,049 to HaCohen et al., filed Jan. 24, 2013, and entitled “Ventricularly-anchored prosthetic valve support”; and U.S. provisional patent application 61/756,034 to HaCohen et al., filed Jan. 24, 2013, and entitled “Tissue-engaging elements”, and is related to: US patent application publication 2012/0022639 to Hacohen et al., filed Jul. 21, 2010 (now U.S. Pat. No. 9,132,009); US patent application publication 2012/0022640 to Gross et al., filed Feb. 24, 2011 (now U.S. Pat. No. 8,992,604); U.S. patent application Ser. No. 13/811,308 to Gross et al., filed Jan. 21, 2013, which published as US 2013/0172992 (now U.S. Pat. No. 9,017,399); U.S. patent application Ser. No. 13/412,814 to Gross et al., filed Mar. 6, 2012, which published as US 2013/0035759 (now U.S. Pat. No. 8,852,272); PCT patent application IL2012/000292 to Gross et al., filed Aug. 5, 2012, which published as WO/2013/021374; PCT patent application IL2012/000293 to Gross et al., filed Aug. 5, 2012, which published as WO/2013/021375; and U.S. patent application Ser. No. 14/161,921 to HaCohen et al., entitled “Anchoring of prosthetic valve supports”, filed on Jan. 23, 2014 (now U.S. Pat. No. 9,681,952), all of which are incorporated herein by reference.

US Referenced Citations (1890)
Number Name Date Kind
3604488 Wishart et al. Sep 1971 A
3656185 Carpentier Apr 1972 A
3840018 Heifetz Oct 1974 A
3874388 King et al. Apr 1975 A
3898701 La Russa Aug 1975 A
4042979 Angell Aug 1977 A
4118805 Reimels Oct 1978 A
4214349 Munch Jul 1980 A
4222126 Boretos et al. Sep 1980 A
4261342 Aranguren Apr 1981 A
4275469 Gabbay Jun 1981 A
4340091 Skelton et al. Jul 1982 A
4423525 Vallana et al. Jan 1984 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
4853986 Allen Aug 1989 A
4892541 Alonso Jan 1990 A
4917698 Carpenter et al. Apr 1990 A
4961738 Mackin Oct 1990 A
4972494 White et al. Nov 1990 A
4994077 Dobben Feb 1991 A
5061277 Carpentier et al. Oct 1991 A
5078739 Martin Jan 1992 A
5104407 Lam et al. Apr 1992 A
5108420 Marks Apr 1992 A
5201757 Heyn et al. Apr 1993 A
5201880 Wright Apr 1993 A
5258008 Wilk Nov 1993 A
5300034 Behnke Apr 1994 A
5306296 Wright et al. Apr 1994 A
5314473 Godin May 1994 A
5325845 Adair Jul 1994 A
5332402 Teitelbaum Jul 1994 A
5397351 Pavcnik et al. Mar 1995 A
5405378 Strecker Apr 1995 A
5443500 Sigwart Aug 1995 A
5450860 O'Connor Sep 1995 A
5473812 Morris et al. Dec 1995 A
5477856 Lundquist Dec 1995 A
5593424 Northrup, III Jan 1997 A
5601572 Middleman et al. Feb 1997 A
5607444 Lam Mar 1997 A
5607470 Milo Mar 1997 A
5626609 Zvenyatsky et al. May 1997 A
5647857 Anderson et al. Jul 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
5713948 Uflacker Feb 1998 A
5716370 Williamson et al. Feb 1998 A
5716397 Myers Feb 1998 A
5716417 Girard et al. Feb 1998 A
5728116 Rosenman Mar 1998 A
5730150 Peppel et al. Mar 1998 A
5741297 Simon Apr 1998 A
5749371 Zadini et al. May 1998 A
5765682 Bley et al. Jun 1998 A
5776140 Cottone Jul 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
5868777 Lam Feb 1999 A
5873906 Lau et al. Feb 1999 A
5876373 Giba et al. Mar 1999 A
5935098 Blaisdell et al. Aug 1999 A
5954766 Zadno-Azizi et al. Sep 1999 A
5957949 Leonhardt et al. Sep 1999 A
5957953 DiPoto et al. Sep 1999 A
5961440 Schweich et al. Oct 1999 A
5961539 Northrup, III et al. Oct 1999 A
5980565 Jayaraman Nov 1999 A
5984959 Robertson Nov 1999 A
6010530 Goicoechea Jan 2000 A
6019787 Richard et al. Feb 2000 A
6042554 Rosenman Mar 2000 A
6042607 Williamson, IV Mar 2000 A
6045497 Schweich et al. Apr 2000 A
6050936 Schweich et al. Apr 2000 A
6059715 Schweich et al. May 2000 A
6059827 Fenton 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
6113612 Swanson et al. Sep 2000 A
6120534 Ruiz Sep 2000 A
6126686 Badylak et al. Oct 2000 A
6143024 Campbell et al. Nov 2000 A
6152937 Peterson et al. Nov 2000 A
6159240 Sparer Dec 2000 A
6165119 Schweich et al. Dec 2000 A
6165183 Kuehn et al. Dec 2000 A
6165210 Lau et al. Dec 2000 A
6174332 Loch Jan 2001 B1
6183411 Mortier et al. Feb 2001 B1
6187020 Zegdi et al. Feb 2001 B1
6187040 Wright Feb 2001 B1
6193686 Estrada et al. Feb 2001 B1
6193745 Fogarty et al. Feb 2001 B1
6315784 Djurovic Feb 2001 B1
6217610 Carpentier et al. Apr 2001 B1
6231602 Carpentier et al. May 2001 B1
6251092 Qin et al. Jun 2001 B1
6254609 Vrba et al. Jul 2001 B1
6264700 Kilcoyne et al. Jul 2001 B1
6287339 Vasquez et al. Sep 2001 B1
6296656 Bodluc et al. Oct 2001 B1
6312465 Griffin et al. Nov 2001 B1
6319281 Patel Nov 2001 B1
6332893 Mortier et al. Dec 2001 B1
6334873 Lane et al. Jan 2002 B1
6346074 Roth Feb 2002 B1
6350278 Lenker et al. Feb 2002 B1
6352561 Leopold et al. Mar 2002 B1
6391036 Berg et al. May 2002 B1
6402780 Williamson, IV Jun 2002 B2
6406420 McCarthy et al. Jun 2002 B1
6406493 Tu et al. Jun 2002 B1
6409755 Vrba Jun 2002 B1
6419696 Ortiz et al. Jul 2002 B1
6428550 Vargas et al. Aug 2002 B1
6440164 Dimatteo et al. Aug 2002 B1
6451054 Stevens Sep 2002 B1
6454799 Schreck Sep 2002 B1
6458153 Bailey et al. Oct 2002 B1
6461366 Seguin Oct 2002 B1
6470892 Forsell Oct 2002 B1
6478807 Foreman et al. Nov 2002 B1
6482228 Norred Nov 2002 B1
6491711 Durcan Dec 2002 B1
6503274 Howanec et al. Jan 2003 B1
6511491 Grudem et al. Jan 2003 B2
6524338 Gundry Feb 2003 B1
6530952 Vesely Mar 2003 B2
6533772 Sherts et al. Mar 2003 B1
6537314 Langberg et al. Mar 2003 B2
6540782 Snyders Apr 2003 B1
6547801 Dargent et al. Apr 2003 B1
6551350 Thornton et al. Apr 2003 B1
6554845 Fleenor et al. Apr 2003 B1
6558396 Inoue May 2003 B1
6558418 Carpentier et al. May 2003 B2
6564805 Garrison et al. May 2003 B2
6565603 Cox May 2003 B2
6569196 Vesely May 2003 B1
6569198 Wilson et al. May 2003 B1
6579297 Bicek et al. Jun 2003 B2
6582464 Gabbay Jun 2003 B2
6589160 Schweich et al. Jul 2003 B2
6602263 Swanson et al. Aug 2003 B1
6602288 Cosgrove et al. Aug 2003 B1
6602289 Colvin et al. Aug 2003 B1
6613078 Barone Sep 2003 B1
6613079 Wolinsky et al. Sep 2003 B1
6616675 Evard et al. Sep 2003 B1
6619291 Hlavka et al. Sep 2003 B2
6626899 Houser et al. Sep 2003 B2
6626917 Craig Sep 2003 B1
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 et al. Nov 2003 B1
6669724 Park et al. Dec 2003 B2
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
6699256 Logan et al. Mar 2004 B1
6702826 Liddicoat et al. Mar 2004 B2
6702846 Mikus et al. Mar 2004 B2
6706065 Langberg et al. Mar 2004 B2
6709456 Langberg et al. Mar 2004 B2
6711444 Koblish Mar 2004 B2
6716244 Klaco Apr 2004 B2
6718985 Hlavka et al. Apr 2004 B2
6719781 Kim Apr 2004 B1
6719786 Ryan et al. Apr 2004 B2
6719788 Cox Apr 2004 B2
6723038 Schroeder et al. Apr 2004 B1
6726716 Marquez Apr 2004 B2
6726717 Alfieri et al. Apr 2004 B2
6730118 Spenser et al. May 2004 B2
6730121 Ortiz et al. May 2004 B2
6733525 Yang et al. May 2004 B2
6749630 McCarthy et al. Jun 2004 B2
6752813 Goldfarb et al. Jun 2004 B2
6764310 Ichihashi et al. Jul 2004 B1
6764510 Vidlund et al. Jul 2004 B2
6764514 Li et al. Jul 2004 B1
6764518 Godin Jul 2004 B2
6767362 Schreck Jul 2004 B2
6770083 Seguin Aug 2004 B2
6786924 Ryan et al. Sep 2004 B2
6786925 Schoon et al. Sep 2004 B1
6790231 Liddicoat et al. Sep 2004 B2
6797001 Mathis et al. 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
6821297 Snyders Nov 2004 B2
6830585 Artof et al. Dec 2004 B1
6830638 Boylan et al. Dec 2004 B2
6855126 Flinchbaugh Feb 2005 B2
6858039 McCarthy Feb 2005 B2
6884250 Monassevitch et al. Apr 2005 B2
6884257 Cox Apr 2005 B1
6893459 Macoviak May 2005 B1
6893460 Spenser et al. May 2005 B2
6908482 McCarthy et al. Jun 2005 B2
6918917 Nguyen et al. Jul 2005 B1
6926715 Hauck et al. Aug 2005 B1
6926730 Nguyen et al. Aug 2005 B1
6951571 Srivastava Oct 2005 B1
6960217 Bolduc Nov 2005 B2
6964684 Ortiz et al. Nov 2005 B2
6964686 Gordon Nov 2005 B2
6974476 McGuckin et al. Dec 2005 B2
6976995 Mathis et al. Dec 2005 B2
6986775 Morales et al. Jan 2006 B2
6989028 Lashinski et al. Jan 2006 B2
6997951 Solem et al. Feb 2006 B2
7004176 Lau Feb 2006 B2
7011669 Kimblad Mar 2006 B2
7011681 Vesely Mar 2006 B2
7011682 Lashinski et al. Mar 2006 B2
7018406 Seguin et al. Mar 2006 B2
7037334 Hlavka et al. May 2006 B1
7041132 Quijano et al. May 2006 B2
7074236 Rabkin et al. Jul 2006 B2
7077850 Kortenbach Jul 2006 B2
7077861 Spence Jul 2006 B2
7077862 Vidlund et al. Jul 2006 B2
7087064 Hyde Aug 2006 B1
7101336 Miller Sep 2006 B2
7101395 Tremulis et al. Sep 2006 B2
7101396 Artof et al. Sep 2006 B2
7112207 Allen et al. Sep 2006 B2
7118595 Ryan et al. Oct 2006 B2
7125421 Tremulis et al. Oct 2006 B2
7137184 Schreck Nov 2006 B2
7150737 Purdy et al. Dec 2006 B2
7159593 McCarthy et al. Jan 2007 B2
7166127 Spence et al. Jan 2007 B2
7169187 Datta et al. Jan 2007 B2
7172625 Shu et al. Feb 2007 B2
7175656 Khairkhahan Feb 2007 B2
7175660 Cartledge et al. Feb 2007 B2
7186262 Saadat Mar 2007 B2
7186264 Liddicoat et al. Mar 2007 B2
7189199 McCarthy et al. Mar 2007 B2
7192443 Solem et al. Mar 2007 B2
7198646 Figulla et al. Apr 2007 B2
7201772 Schwammenthal Apr 2007 B2
7220277 Arru 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
7261686 Couvillon, Jr. Aug 2007 B2
7288097 Seguin Oct 2007 B2
7288111 Holloway et al. Oct 2007 B1
7294148 McCarthy Nov 2007 B2
7297150 Cartledge et al. Nov 2007 B2
7311728 Solem et al. Dec 2007 B2
7311729 Mathis et al. Dec 2007 B2
7314485 Mathis Jan 2008 B2
7316710 Cheng et al. Jan 2008 B1
7316716 Egan Jan 2008 B2
7329279 Haug et al. Feb 2008 B2
7329280 Bolling et al. Feb 2008 B2
7335213 Hyde et al. Feb 2008 B1
7351256 Hojeibane et al. Apr 2008 B2
7361190 Shoulian et al. Apr 2008 B2
7364588 Mathis et al. Apr 2008 B2
7374571 Pease et al. May 2008 B2
7374573 Gabbay May 2008 B2
7377938 Sarac et al. May 2008 B2
7377941 Rhee et al. May 2008 B2
7381218 Schreck Jun 2008 B2
7381219 Salahieh et al. Jun 2008 B2
7390329 Westra et al. Jun 2008 B2
7404824 Webler et al. Jul 2008 B1
7422603 Lane Sep 2008 B2
7429269 Schwammenthal Sep 2008 B2
7431692 Zollinger et al. Oct 2008 B2
7442204 Schwammenthal Oct 2008 B2
7442207 Rafiee Oct 2008 B2
7445630 Lashinski et al. Nov 2008 B2
7452376 Lim et al. Nov 2008 B2
7455677 Vargas et al. Nov 2008 B2
7455688 Furst et al. Nov 2008 B2
7455690 Cartledge et al. Nov 2008 B2
7462162 Phan et al. Dec 2008 B2
7481838 Carpentier et al. Jan 2009 B2
7485142 Milo 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 et al. Mar 2009 B2
7513909 Lane et al. Apr 2009 B2
7524331 Birdsall Apr 2009 B2
7527646 Rahdert et al. May 2009 B2
7527647 Spence May 2009 B2
7530995 Quijano et al. May 2009 B2
7549983 Roue et al. Jun 2009 B2
7556632 Zadno Jul 2009 B2
7556646 Yang et al. Jul 2009 B2
7559936 Levine Jul 2009 B2
7562660 Saadat Jul 2009 B2
7563267 Goldfarb et al. Jul 2009 B2
7563273 Goldfarb et al. Jul 2009 B2
7569062 Kuehn et al. Aug 2009 B1
7582111 Krolik et al. Sep 2009 B2
7585321 Cribier Sep 2009 B2
7588582 Starksen et al. Sep 2009 B2
7591826 Alferness et al. Sep 2009 B2
7597711 Drews et al. Oct 2009 B2
7604646 Goldfarb et al. Oct 2009 B2
7608091 Goldfarb et al. Oct 2009 B2
7608103 McCarthy Oct 2009 B2
7611534 Kapadia et al. Nov 2009 B2
7618449 Tremulis et al. Nov 2009 B2
7621948 Hermann et al. Nov 2009 B2
7625403 Krivoruchko Dec 2009 B2
7632302 Vreeman et al. Dec 2009 B2
7632303 Stalker et al. Dec 2009 B1
7635329 Goldfarb et al. Dec 2009 B2
7635386 Gammie Dec 2009 B1
7648528 Styrc Jan 2010 B2
7655015 Goldfarb et al. Feb 2010 B2
7666204 Thornton et al. Feb 2010 B2
7682319 Martin Mar 2010 B2
7682369 Seguin Mar 2010 B2
7682380 Thornton et al. Mar 2010 B2
7686822 Shayani Mar 2010 B2
7699892 Rafiee et al. Apr 2010 B2
7704269 St. Goar et al. Apr 2010 B2
7704277 Zakay et al. Apr 2010 B2
7708775 Rowe et al. May 2010 B2
7717952 Case et al. May 2010 B2
7717955 Lane et al. May 2010 B2
7722666 Lafontaine May 2010 B2
7731741 Eidenschink Jun 2010 B2
7731742 Schlick et al. Jun 2010 B2
7736388 Goldfarb et al. Jun 2010 B2
7748389 Salahieh et al. Jul 2010 B2
7753922 Starksen Jul 2010 B2
7753924 Starksen et al. Jul 2010 B2
7753949 Lamphere et al. Jul 2010 B2
7758595 Allen et al. Jul 2010 B2
7758632 Hojeibane et al. Jul 2010 B2
7758640 Vesely Jul 2010 B2
7771467 Svensson Aug 2010 B2
7771469 Liddicoat Aug 2010 B2
7776080 Bei et al. Aug 2010 B2
7776083 Vesely Aug 2010 B2
7780726 Seguin Aug 2010 B2
7785341 Forster et al. Aug 2010 B2
7799069 Bailey et al. Sep 2010 B2
7803181 Furst et al. Sep 2010 B2
7811296 Goldfarb et al. Oct 2010 B2
7811316 Kalmann et al. Oct 2010 B2
7824442 Salahieh et al. Nov 2010 B2
7837645 Bessler et al. Nov 2010 B2
7837727 Goetz et al. Nov 2010 B2
7842081 Yadin Nov 2010 B2
7850725 Vardi et al. Dec 2010 B2
7871368 Zollinger et al. Jan 2011 B2
7871432 Bergin Jan 2011 B2
7871433 Lattouf Jan 2011 B2
7871436 Ryan et al. Jan 2011 B2
7887583 Macoviak Feb 2011 B2
7892281 Seguin et al. Feb 2011 B2
7896915 Guyenot et al. Mar 2011 B2
7914544 Nguyen et al. Mar 2011 B2
7914569 Nguyen et al. Mar 2011 B2
7927370 Webler et al. Apr 2011 B2
7927371 Navia et al. Apr 2011 B2
7942927 Kaye et al. May 2011 B2
7947072 Yang et al. May 2011 B2
7947075 Goetz et al. May 2011 B2
7951195 Antonsson et al. May 2011 B2
7955375 Agnew Jun 2011 B2
7955377 Melsheimer Jun 2011 B2
7955384 Rafiee et al. Jun 2011 B2
7959666 Salahieh et al. Jun 2011 B2
7959672 Salahieh et al. Jun 2011 B2
7967833 Sterman et al. Jun 2011 B2
7967857 Lane Jun 2011 B2
7981151 Rowe Jul 2011 B2
7981153 Fogarty et al. Jul 2011 B2
7988725 Gross et al. Aug 2011 B2
7992567 Hirotsuka et al. Aug 2011 B2
7993368 Gambale et al. Aug 2011 B2
7993393 Carpentier et al. Aug 2011 B2
7993397 Lashinski Aug 2011 B2
8002825 Letac et al. Aug 2011 B2
8002826 Seguin Aug 2011 B2
8012201 Lashinski et al. Sep 2011 B2
8016877 Seguin et al. Sep 2011 B2
8016882 Macoviak Sep 2011 B2
8021420 Dolan Sep 2011 B2
8021421 Fogarty et al. Sep 2011 B2
8025695 Fogarty et al. Sep 2011 B2
8029518 Goldfarb et al. Oct 2011 B2
8029557 Sobrino-Serrano et al. Oct 2011 B2
8029564 Johnson et al. Oct 2011 B2
8034103 Burriesci Oct 2011 B2
8034104 Carpentier et al. Oct 2011 B2
8038720 Wallace et al. Oct 2011 B2
8043360 McNamara et al. Oct 2011 B2
8048138 Sulivan et al. Nov 2011 B2
8048140 Purdy Nov 2011 B2
8048153 Salahieh et al. Nov 2011 B2
8052592 Goldfarb et al. Nov 2011 B2
8052741 Bruszewski et al. Nov 2011 B2
8052749 Salahieh et al. Nov 2011 B2
8057493 Goldfarb et al. Nov 2011 B2
8057532 Hoffman Nov 2011 B2
8057540 Letac et al. Nov 2011 B2
8062355 Figulla et al. Nov 2011 B2
8062359 Marquez et al. Nov 2011 B2
8070708 Rottenberg et al. Dec 2011 B2
8070800 Lock et al. Dec 2011 B2
8070802 Lamphere et al. Dec 2011 B2
8070804 Hyde Dec 2011 B2
8070805 Vidlund Dec 2011 B2
8075611 Milwee et al. Dec 2011 B2
8075616 Solem Dec 2011 B2
8080054 Rowe Dec 2011 B2
8083793 Lane et al. Dec 2011 B2
D652927 Braido et al. Jan 2012 S
D653341 Braido et al. Jan 2012 S
8092518 Schreck Jan 2012 B2
8092520 Quadri Jan 2012 B2
8092521 Figulla et al. Jan 2012 B2
8100964 Spence Jan 2012 B2
8105377 Liddicoat Jan 2012 B2
8109996 Stacchino et al. Feb 2012 B2
8118866 Herrmann et al. Feb 2012 B2
8123800 McCarthy Feb 2012 B2
8123801 Milo Feb 2012 B2
8323334 Deem et al. Feb 2012 B2
8133270 Kheradvar et al. Mar 2012 B2
8136218 Millwee et al. Mar 2012 B2
8137398 Tuval et al. Mar 2012 B2
8142492 Forster et al. Mar 2012 B2
8142493 Spence et al. Mar 2012 B2
8142494 Rahdert et al. Mar 2012 B2
8142495 Hasenkam et al. Mar 2012 B2
8142496 Berreklouw Mar 2012 B2
8142497 Friedman Mar 2012 B2
8147504 Ino et al. Apr 2012 B2
8147542 Maisano et al. Apr 2012 B2
8152844 Rao Apr 2012 B2
8157852 Bloom et al. Apr 2012 B2
8157853 Laske et al. Apr 2012 B2
8157860 McNamara et al. Apr 2012 B2
8163008 Wilson et al. Apr 2012 B2
8163013 Machold et al. Apr 2012 B2
8163014 Lane et al. Apr 2012 B2
D660433 Braido et al. May 2012 S
D660967 Braido et al. May 2012 S
8167894 Miles et al. May 2012 B2
8167932 Bourang et al. May 2012 B2
8167935 McGuckin, Jr. et al. May 2012 B2
8172896 McNamara et al. May 2012 B2
8172898 Alferness et al. May 2012 B2
8177836 Lee et al. May 2012 B2
8182528 Salahieh et al. May 2012 B2
8187299 Goldfarb et al. May 2012 B2
8187324 Webler et al. May 2012 B2
8202315 Hlavka et al. Jun 2012 B2
8206439 Gomez-Duran Jun 2012 B2
8211169 Lane et al. Jul 2012 B2
8216256 Raschdorf, Jr. et al. Jul 2012 B2
8216301 Bonhoeffer et al. Jul 2012 B2
8221492 Case et al. Jul 2012 B2
8221493 Boyle et al. Jul 2012 B2
8226710 Nguyen et al. Jul 2012 B2
8226711 Mortier et al. Jul 2012 B2
8231670 Salahieh et al. Jul 2012 B2
8231671 Kim Jul 2012 B2
8236045 Benichou et al. Aug 2012 B2
8236049 Rowe et al. Aug 2012 B2
8241351 Cabiri Aug 2012 B2
8252042 McNamara et al. Aug 2012 B2
8252050 Maisano et al. Aug 2012 B2
8252051 Chau et al. Aug 2012 B2
8252052 Salahieh et al. Aug 2012 B2
8257390 Carley et al. Sep 2012 B2
8262725 Subramanian Sep 2012 B2
8267988 Hamer et al. Sep 2012 B2
8277501 Chalekian et al. Oct 2012 B2
8277502 Miller et al. Oct 2012 B2
8287584 Salahieh et al. Oct 2012 B2
8287591 Keidar et al. Oct 2012 B2
8298280 Yadin et al. Oct 2012 B2
8303608 Goldfarb et al. Nov 2012 B2
8303653 Bonhoeffer et al. Nov 2012 B2
8308798 Pintor et al. Nov 2012 B2
8317853 Agnew Nov 2012 B2
8317855 Gregorich et al. Nov 2012 B2
8323335 Rowe et al. Dec 2012 B2
8328868 Paul et al. Dec 2012 B2
8333777 Schaller et al. Dec 2012 B2
8337541 Quadri et al. Dec 2012 B2
8343173 Starksen et al. Jan 2013 B2
8343174 Goldfarb et al. Jan 2013 B2
8343213 Salahieh et al. Jan 2013 B2
8348999 Kheradvar et al. Jan 2013 B2
8349002 Milo Jan 2013 B2
8353956 Miller et al. Jan 2013 B2
8357195 Kuehn Jan 2013 B2
8361144 Fish et al. Jan 2013 B2
8366767 Zhang Feb 2013 B2
8372140 Hoffman et al. Feb 2013 B2
8377119 Drews et al. Feb 2013 B2
8382829 Call et al. Feb 2013 B1
8388680 Starksen et al. Mar 2013 B2
8393517 Milo Mar 2013 B2
8398708 Meiri et al. Mar 2013 B2
8403981 Forster et al. Mar 2013 B2
8403983 Quadri et al. Mar 2013 B2
8408214 Spenser Apr 2013 B2
8414644 Quadri et al. Apr 2013 B2
8425593 Braido et al. Apr 2013 B2
8430926 Kirson Apr 2013 B2
8430934 Das Apr 2013 B2
8444689 Zhang May 2013 B2
8449599 Chau et al. May 2013 B2
8449625 Campbell et al. May 2013 B2
8454686 Alkhatib Jun 2013 B2
8460365 Haverkost et al. Jun 2013 B2
8460370 Zakay et al. Jun 2013 B2
8460371 Hlavka et al. Jun 2013 B2
8474460 Barrett et al. Jul 2013 B2
8475491 Milo Jul 2013 B2
8480732 Subramanian Jul 2013 B2
8500800 Maisano et al. Aug 2013 B2
8500821 Sobrino-Serrano et al. Aug 2013 B2
8512400 Tran et al. Aug 2013 B2
8518107 Tsukashima et al. Aug 2013 B2
8523881 Cabiri et al. Sep 2013 B2
8523940 Richardson et al. Sep 2013 B2
8529431 Baker et al. Sep 2013 B2
8539662 Stacchino et al. Sep 2013 B2
8540767 Zhang Sep 2013 B2
8545544 Spenser et al. Oct 2013 B2
8545553 Zipory et al. Oct 2013 B2
8551160 Figulla et al. Oct 2013 B2
8551161 Dolan Oct 2013 B2
8562672 Bonhoeffer et al. Oct 2013 B2
8568475 Nguyen et al. Oct 2013 B2
8579964 Lane et al. Nov 2013 B2
8579965 Bonhoeffer et al. Nov 2013 B2
8585755 Chau et al. Nov 2013 B2
8585756 Bonhoeffer et al. Nov 2013 B2
8591460 Wilson et al. Nov 2013 B2
8591570 Revuelta et al. Nov 2013 B2
8591576 Hasenkam et al. Nov 2013 B2
8608797 Gross et al. Dec 2013 B2
8623075 Murray et al. Jan 2014 B2
8623080 Fogarty et al. Jan 2014 B2
8628569 Benichou et al. Jan 2014 B2
8628570 Seguin 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
8652204 Quill et al. Feb 2014 B2
8657872 Seguin Feb 2014 B2
8663322 Keranen Mar 2014 B2
8673020 Sobrino-Serrano et al. Mar 2014 B2
8679174 Ottma et al. Mar 2014 B2
8685086 Navia et al. Apr 2014 B2
8690939 Miller et al. Apr 2014 B2
8696742 Pintor 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
8734507 Keranen May 2014 B2
8740920 Goldfarb et al. Jun 2014 B2
8747460 Tuval et al. Jun 2014 B2
8771345 Tuval et al. Jul 2014 B2
8778021 Cartledge Jul 2014 B2
8784472 Eidenschink Jul 2014 B2
8784479 Antonsson et al. 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 Aug 2014 B2
8795356 Quadri et al. Aug 2014 B2
8795357 Yohanan et al. Aug 2014 B2
8801776 House et al. Aug 2014 B2
8808366 Braido et al. Aug 2014 B2
8808368 Maisano et al. Aug 2014 B2
8808371 Cartledge Aug 2014 B2
8840663 Salahieh et al. Sep 2014 B2
8840664 Karapetian et al. Sep 2014 B2
8845717 Khairkhahan et al. Sep 2014 B2
8845722 Gabbay 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
8870950 Hacohen Oct 2014 B2
8876800 Behan Nov 2014 B2
8888843 Khairkhahan et al. Nov 2014 B2
8894702 Quadri et al. Nov 2014 B2
8900294 Paniagua et al. Dec 2014 B2
8900295 Migliazza et al. Dec 2014 B2
8906083 Obermiller et al. Dec 2014 B2
8911455 Quadri et al. Dec 2014 B2
8911461 Traynor et al. Dec 2014 B2
8911489 Ben-Muvhar Dec 2014 B2
8911493 Rowe 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
8945177 Dell et al. Feb 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
8979922 Jayasinghe et al. Mar 2015 B2
8986370 Annest Mar 2015 B2
8986373 Chau et al. Mar 2015 B2
8986375 Garde et al. Mar 2015 B2
8992599 Thubrikar et al. Mar 2015 B2
8992604 Gross et al. Mar 2015 B2
8992608 Haug et al. Mar 2015 B2
8998982 Richter et al. Apr 2015 B2
9005273 Salahieh et al. Apr 2015 B2
9011468 Ketai et al. Apr 2015 B2
9011520 Miller et al. Apr 2015 B2
9011527 Li et al. Apr 2015 B2
9011530 Reich et al. Apr 2015 B2
9017399 Gross et al. Apr 2015 B2
D730520 Braido et al. May 2015 S
D730521 Braido et al. May 2015 S
9023100 Quadri et al. May 2015 B2
9034032 McLean et al. May 2015 B2
9034033 McLean et al. May 2015 B2
9039757 McLean et al. May 2015 B2
D732666 Nguyen et al. Jun 2015 S
9050188 Schweich et al. Jun 2015 B2
9060858 Thornton et al. Jun 2015 B2
9072603 Tuval et al. Jul 2015 B2
9084676 Chau et al. Jul 2015 B2
9095434 Rowe Aug 2015 B2
9119719 Zipory et al. Sep 2015 B2
9125632 Loulmet et al. Sep 2015 B2
9125738 Figulla et al. Sep 2015 B2
9125740 Morriss et al. Sep 2015 B2
9132006 Spenser et al. Sep 2015 B2
9132009 Hacohen et al. Sep 2015 B2
9138312 Tuval et al. Sep 2015 B2
9155619 Liu et al. Oct 2015 B2
9173646 Fabro Nov 2015 B2
9173659 Bodewadt et al. Nov 2015 B2
9173738 Murray et al. Nov 2015 B2
9180005 Lashinski et al. Nov 2015 B1
9192472 Gross et al. Nov 2015 B2
9220594 Braido et al. Dec 2015 B2
9226820 Braido et al. Jan 2016 B2
9226825 Starksen et al. Jan 2016 B2
9226839 Kariniemi et al. Jan 2016 B1
9232995 Kovalsky et al. Jan 2016 B2
9241790 Lane et al. Jan 2016 B2
9241791 Braido et al. Jan 2016 B2
9241792 Benichou et al. Jan 2016 B2
9241794 Braido et al. Jan 2016 B2
9248014 Lane et al. Feb 2016 B2
9265608 Miller et al. Feb 2016 B2
9277994 Miller et al. Mar 2016 B2
9289290 Alkhatib et al. Mar 2016 B2
9289291 Gorman et al. Mar 2016 B2
9295550 Nguyen et al. Mar 2016 B2
9295551 Straubinger et al. Mar 2016 B2
9295552 McLean et al. Mar 2016 B2
9301836 Buchbinder et al. Apr 2016 B2
9308087 Lane et al. Apr 2016 B2
9320591 Bolduc Apr 2016 B2
D755384 Pesce et al. May 2016 S
9326852 Spenser May 2016 B2
9326876 Acosta et al. May 2016 B2
9345573 Nyuli et al. May 2016 B2
9351830 Gross et al. May 2016 B2
9387078 Gross et al. Jul 2016 B2
9393110 Levi et al. Jul 2016 B2
9421098 Gifford et al. Aug 2016 B2
9427303 Liddy et al. Aug 2016 B2
9427316 Schweich, Jr. et al. Aug 2016 B2
9439757 Wallace et al. Sep 2016 B2
9463102 Kelly Oct 2016 B2
9474599 Keränen Oct 2016 B2
9474638 Robinson et al. Oct 2016 B2
9480559 Vidlund et al. Nov 2016 B2
9492273 Wallace et al. Nov 2016 B2
9498314 Behan Nov 2016 B2
9498332 Hacohen et al. Nov 2016 B2
9510947 Straubinger et al. Dec 2016 B2
9532870 Cooper et al. Jan 2017 B2
9554897 Lane et al. Jan 2017 B2
9554899 Granada et al. Jan 2017 B2
9561103 Granada et al. Feb 2017 B2
9566152 Schweich et al. Feb 2017 B2
9597182 Straubinger et al. Mar 2017 B2
9629716 Seguin Apr 2017 B2
9662203 Sheahan et al. May 2017 B2
9681952 Hacohen et al. Jun 2017 B2
9717591 Chau et al. Aug 2017 B2
9743932 Amplatz et al. Aug 2017 B2
9763657 Hacohen et al. Sep 2017 B2
9763817 Roeder Sep 2017 B2
9770256 Cohen et al. Sep 2017 B2
D800908 Hariton et al. Oct 2017 S
9788941 Hacohen Oct 2017 B2
9895226 Harari et al. Feb 2018 B1
9974651 Hariton et al. May 2018 B2
9987132 Hariton et al. Jun 2018 B1
9993360 Shalev et al. Jun 2018 B2
10010414 Cooper et al. Jul 2018 B2
10045845 Hacohen et al. Aug 2018 B2
10076415 Metchik et al. Sep 2018 B1
10098732 Hariton et al. Oct 2018 B1
10105222 Metchik et al. Oct 2018 B1
10111751 Metchik et al. Oct 2018 B1
10123873 Metchik et al. Nov 2018 B1
10130475 Metchik et al. Nov 2018 B1
10136993 Metchik et al. Nov 2018 B1
10143552 Wallace et al. Dec 2018 B2
10149761 Granada et al. Dec 2018 B2
10154903 Albitov et al. Dec 2018 B2
10154906 Granada et al. Dec 2018 B2
10159570 Metchik et al. Dec 2018 B1
10182908 Tubishevitz et al. Jan 2019 B2
10206668 Mcgoldrick et al. Feb 2019 B2
10226341 Gross et al. Mar 2019 B2
10231831 Hacohen Mar 2019 B2
10231837 Metchik et al. Mar 2019 B1
10238493 Metchik et al. Mar 2019 B1
10245143 Gross et al. Apr 2019 B2
10245144 Metchik et al. Apr 2019 B1
10258471 Lutter et al. Apr 2019 B2
10292816 Raanani et al. May 2019 B2
10299927 McLean et al. May 2019 B2
10321995 Christianson et al. Jun 2019 B1
10322020 Lam et al. Jun 2019 B2
10327895 Lozonschi et al. Jun 2019 B2
10335278 McLean et al. Jul 2019 B2
10376361 Gross et al. Aug 2019 B2
10390952 Hariton et al. Aug 2019 B2
10426614 Hariton et al. Oct 2019 B2
10449047 Hariton et al. Oct 2019 B2
10456256 Braido et al. Oct 2019 B2
10492908 Hammer et al. Dec 2019 B2
10507108 Delgado et al. Dec 2019 B2
10507109 Metchik et al. Dec 2019 B2
10512456 Hacohen et al. Dec 2019 B2
10517719 Miller et al. Dec 2019 B2
10524792 Hernandez et al. Jan 2020 B2
10524910 Hammer et al. Jan 2020 B2
10531866 Hariton et al. Jan 2020 B2
10531872 Hacohen et al. Jan 2020 B2
10537426 Iamberger et al. Jan 2020 B2
10548726 Hacohen et al. Feb 2020 B2
10548731 Lashinski et al. Feb 2020 B2
10575948 Iamberger et al. Mar 2020 B2
10595992 Chambers Mar 2020 B2
10595997 Metchik et al. Mar 2020 B2
10610358 Vidlund et al. Apr 2020 B2
10610359 Hacohen Apr 2020 B2
10631871 Goldfarb et al. Apr 2020 B2
10631982 Hammer et al. Apr 2020 B2
10646342 Marr et al. May 2020 B1
10660751 Hacohen May 2020 B2
10667908 Hariton et al. Jun 2020 B2
10667912 Dixon et al. Jun 2020 B2
10682227 Hariton et al. Jun 2020 B2
10695173 Gross et al. Jun 2020 B2
10695177 Hariton et al. Jun 2020 B2
10702385 Hacohen Jul 2020 B2
10736742 Hariton et al. Aug 2020 B2
10758342 Chau et al. Sep 2020 B2
10779939 Hariton et al. Sep 2020 B2
10813760 Metchik et al. Oct 2020 B2
10820998 Marr et al. Nov 2020 B2
10835377 Hacohen et al. Nov 2020 B2
10842627 Delgado et al. Nov 2020 B2
10856972 Hariton et al. Dec 2020 B2
10856975 Hariton et al. Dec 2020 B2
10856978 Straubinger et al. Dec 2020 B2
10874514 Dixon et al. Dec 2020 B2
10888422 Hariton et al. Jan 2021 B2
10888425 Delgado et al. Jan 2021 B2
10888644 Ratz et al. Jan 2021 B2
10905552 Dixon et al. Feb 2021 B2
10905554 Cao Feb 2021 B2
10918481 Hariton et al. Feb 2021 B2
10918483 Metchik et al. Feb 2021 B2
10925732 Delgado et al. Feb 2021 B2
10945843 Delgado et al. Mar 2021 B2
10945844 McCann et al. Mar 2021 B2
10952850 Hariton et al. Mar 2021 B2
10959846 Marr et al. Mar 2021 B2
10993809 McCann et al. May 2021 B2
11065114 Raanani et al. Jul 2021 B2
11083582 McCann et al. Aug 2021 B2
11135059 Hammer et al. Oct 2021 B2
11147672 McCann et al. Oct 2021 B2
11179240 Delgado et al. Nov 2021 B2
11246704 Hariton et al. Feb 2022 B2
11291545 Hacohen Apr 2022 B2
11291546 Gross et al. Apr 2022 B2
11291547 Gross et al. Apr 2022 B2
11304806 Hariton et al. Apr 2022 B2
11389297 Franklin et al. Jul 2022 B2
20010002445 Vesely May 2001 A1
20010005787 Oz et al. Jun 2001 A1
20010021872 Bailey et al. Sep 2001 A1
20010021874 Carpentier et al. Sep 2001 A1
20010044656 Williamson et al. Nov 2001 A1
20010056295 Solem Dec 2001 A1
20020013571 Goldfarb et al. Jan 2002 A1
20020022862 Grafton et al. Feb 2002 A1
20020029080 Mortier et al. Mar 2002 A1
20020032481 Gabbay Mar 2002 A1
20020042621 Liddicoat et al. Apr 2002 A1
20020082525 Oslund et al. Jun 2002 A1
20020087048 Brock et al. Jul 2002 A1
20020099436 Thornton et al. Jul 2002 A1
20020103532 Langberg et al. Aug 2002 A1
20020151916 Muramatsu et al. Oct 2002 A1
20020151961 Lashinski et al. Oct 2002 A1
20020151970 Garrison et al. Oct 2002 A1
20020169358 Mortier et al. Nov 2002 A1
20020173841 Ortiz et al. Nov 2002 A1
20020177894 Acosta et al. Nov 2002 A1
20020177904 Huxel et al. Nov 2002 A1
20020198586 Inoue Dec 2002 A1
20030009236 Godin Jan 2003 A1
20030018358 Saadat Jan 2003 A1
20030036791 Philipp et al. Feb 2003 A1
20030050693 Quijano et al. Mar 2003 A1
20030050694 Yang et al. Mar 2003 A1
20030060846 Egnelov et al. Mar 2003 A1
20030060875 Wittens Mar 2003 A1
20030069635 Cartledge Apr 2003 A1
20030074052 Besselink Apr 2003 A1
20030078465 Pai et al. Apr 2003 A1
20030078653 Vesely et al. Apr 2003 A1
20030083742 Spence et al. 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 et al. Jul 2003 A1
20030158578 Pantages et al. Aug 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 et al. Oct 2003 A1
20030229350 Kay Dec 2003 A1
20030229395 Cox Dec 2003 A1
20030233142 Morales et al. Dec 2003 A1
20040010272 Manetakis et al. Jan 2004 A1
20040019377 Taylor et al. Jan 2004 A1
20040024451 Johnson et al. Feb 2004 A1
20040030382 St. Goar et al. Feb 2004 A1
20040039414 Carley et al. Feb 2004 A1
20040039436 Spenser 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
20040093060 Seguin et al. May 2004 A1
20040122448 Levine Jun 2004 A1
20040122503 Campbell et al. Jun 2004 A1
20040122514 Fogarty 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
20040133267 Lane Jul 2004 A1
20040133274 Webler et al. Jul 2004 A1
20040133374 Kattan Jul 2004 A1
20040138744 Lashinski et al. Jul 2004 A1
20040138745 Macoviak et al. Jul 2004 A1
20040143315 Bruun 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 et al. Sep 2004 A1
20040176788 Opolski Sep 2004 A1
20040176839 Huynh et al. Sep 2004 A1
20040181287 Gellman Sep 2004 A1
20040186558 Pavcnik et al. Sep 2004 A1
20040186565 Schreck Sep 2004 A1
20040186566 Hindrichs et al. Sep 2004 A1
20040210244 Vargas et al. Oct 2004 A1
20040210304 Seguin et al. Oct 2004 A1
20040220593 Greenhalgh Nov 2004 A1
20040225354 Allen et al. Nov 2004 A1
20040236354 Seguin Nov 2004 A1
20040236419 Milo Nov 2004 A1
20040249433 Freitag Dec 2004 A1
20040249453 Cartledge et al. Dec 2004 A1
20040260317 Bloom et al. Dec 2004 A1
20040260389 Case 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
20050021056 St. Goar et al. Jan 2005 A1
20050027305 Shiu et al. Feb 2005 A1
20050027348 Case et al. Feb 2005 A1
20050038494 Eidenschink Feb 2005 A1
20050055038 Kelleher et al. Mar 2005 A1
20050055086 Stobie 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
20050075726 Svanidze Apr 2005 A1
20050075727 Wheatley Apr 2005 A1
20050075731 Artof et al. Apr 2005 A1
20050080430 Wright et al. Apr 2005 A1
20050080474 Andreas et al. Apr 2005 A1
20050085900 Case et al. Apr 2005 A1
20050085903 Lau Apr 2005 A1
20050090827 Gedebou Apr 2005 A1
20050096740 Langberg et al. May 2005 A1
20050107871 Realyvasquez et al. May 2005 A1
20050119734 Spence et al. Jun 2005 A1
20050125002 Baran et al. Jun 2005 A1
20050125011 Spence et al. Jun 2005 A1
20050131533 Alfieri et al. Jun 2005 A1
20050137686 Salahieh et al. Jun 2005 A1
20050137688 Salahieh et al. Jun 2005 A1
20050137689 Salahieh et al. Jun 2005 A1
20050137690 Salahieh et al. Jun 2005 A1
20050137691 Salahieh et al. Jun 2005 A1
20050137692 Haug et al. Jun 2005 A1
20050137693 Haug et al. Jun 2005 A1
20050137695 Salahieh et al. Jun 2005 A1
20050137697 Salahieh et al. Jun 2005 A1
20050137699 Salahieh et al. Jun 2005 A1
20050143809 Salahieh et al. Jun 2005 A1
20050149160 McFerran Jul 2005 A1
20050154443 Linder et al. Jul 2005 A1
20050159728 Armour et al. Jul 2005 A1
20050171601 Cosgrove et al. Aug 2005 A1
20050177180 Kaganov et al. Aug 2005 A1
20050177228 Solem et al. Aug 2005 A1
20050182483 Osborne et al. Aug 2005 A1
20050182486 Gabbay Aug 2005 A1
20050187613 Bolduc et al. Aug 2005 A1
20050192596 Jugenheimer et al. Sep 2005 A1
20050197695 Stacchino et al. Sep 2005 A1
20050197696 Gomez Duran Sep 2005 A1
20050203549 Realyvasquez Sep 2005 A1
20050203606 VanCamp Sep 2005 A1
20050203618 Sharkawy et al. 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
20050234508 Cummins et al. Oct 2005 A1
20050240200 Bergheim Oct 2005 A1
20050251251 Cribier Nov 2005 A1
20050256532 Nayak et al. Nov 2005 A1
20050256566 Gabbay Nov 2005 A1
20050267478 Corradi et al. Dec 2005 A1
20050267573 Macoviak et al. Dec 2005 A9
20050273138 To et al. Dec 2005 A1
20050288776 Shaoulian et al. Dec 2005 A1
20050288778 Shaoulian et al. Dec 2005 A1
20050288781 Moaddeb et al. Dec 2005 A1
20060004439 Spenser et al. Jan 2006 A1
20060004442 Spenser et al. Jan 2006 A1
20060004443 Liddicoat et al. Jan 2006 A1
20060004469 Sokel Jan 2006 A1
20060015171 Armstrong Jan 2006 A1
20060020275 Goldfarb et al. Jan 2006 A1
20060020326 Bolduc et al. Jan 2006 A9
20060020327 Lashinski et al. Jan 2006 A1
20060020333 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
20060041189 Vancaillie Feb 2006 A1
20060041319 Taylor et al. Feb 2006 A1
20060052867 Revuelta et al. Mar 2006 A1
20060052868 Mortier Mar 2006 A1
20060058871 Zakay et al. Mar 2006 A1
20060069429 Spence et al. Mar 2006 A1
20060074486 Liddicoat et al. Apr 2006 A1
20060085012 Dolan Apr 2006 A1
20060089627 Burnett et al. Apr 2006 A1
20060095009 Lampropoulos et al. May 2006 A1
20060106423 Weisel et al. May 2006 A1
20060111773 Rittgers et al. May 2006 A1
20060116750 Herbert et al. Jun 2006 A1
20060116757 Lashinski et al. Jun 2006 A1
20060122692 Gilad et al. Jun 2006 A1
20060129166 Lavelle Jun 2006 A1
20060135964 Vesley Jun 2006 A1
20060149280 Harvine et al. Jul 2006 A1
20060149368 Spence Jul 2006 A1
20060155357 Melsheimer Jul 2006 A1
20060161250 Shaw Jul 2006 A1
20060161265 Levine et al. Jul 2006 A1
20060047297 Case Aug 2006 A1
20060178700 Quinn Aug 2006 A1
20060178740 Stacchino et al. Aug 2006 A1
20060184203 Martin et al. Aug 2006 A1
20060184240 Jimenez et al. Aug 2006 A1
20060184242 Lichtenstein Aug 2006 A1
20060190036 Wendel et al. Aug 2006 A1
20060190038 Carley et al. Aug 2006 A1
20060195134 Crittenden Aug 2006 A1
20060195183 Navia et al. Aug 2006 A1
20060195184 Lane et al. Aug 2006 A1
20060201519 Frazier et al. Sep 2006 A1
20060212111 Case et al. Sep 2006 A1
20060216404 Seyler et al. Sep 2006 A1
20060229708 Powell et al. Oct 2006 A1
20060241622 Zergiebel Oct 2006 A1
20060241656 Starksen et al. Oct 2006 A1
20060241745 Solem Oct 2006 A1
20060241748 Lee et al. Oct 2006 A1
20060247680 Amplatz et al. Nov 2006 A1
20060247763 Slater Nov 2006 A1
20060253191 Salahieh et al. Nov 2006 A1
20060259135 Navia et al. Nov 2006 A1
20060259136 Nguyen et al. Nov 2006 A1
20060259137 Artof et al. Nov 2006 A1
20060271166 Thill et al. Nov 2006 A1
20060271171 McQuinn et al. Nov 2006 A1
20060271175 Woolfson Nov 2006 A1
20060282150 Olson et al. Dec 2006 A1
20060282161 Huyn et al. Dec 2006 A1
20060287661 Bolduc et al. Dec 2006 A1
20060287716 Banbury et al. Dec 2006 A1
20060287719 Rowe et al. Dec 2006 A1
20070001627 Lin et al. Jan 2007 A1
20070008018 Nagashima et al. Jan 2007 A1
20070016286 Herrmann et al. Jan 2007 A1
20070016287 Cartledge et al. Jan 2007 A1
20070016288 Gurskis et al. Jan 2007 A1
20070021781 Jervis et al. Jan 2007 A1
20070027528 Agnew Feb 2007 A1
20070027533 Douk Feb 2007 A1
20070027536 Mihaljevic et al. Feb 2007 A1
20070027549 Godin Feb 2007 A1
20070038221 Fine et al. Feb 2007 A1
20070038293 St. Goar et al. Feb 2007 A1
20070038295 Case et al. Feb 2007 A1
20070043435 Seguin et al. 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
20070055340 Pryor Mar 2007 A1
20070056346 Spenser 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
20070078510 Ryan Apr 2007 A1
20070080188 Spence et al. Apr 2007 A1
20070083168 Whiting et al. Apr 2007 A1
20070106328 Wardle et al. May 2007 A1
20070112359 Kimura et al. 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 et al. Jun 2007 A1
20070162103 Case et al. Jul 2007 A1
20070162107 Haug et al. Jul 2007 A1
20070162111 Fukamachi et al. Jul 2007 A1
20070173932 Cali et al. Jul 2007 A1
20070197858 Goldfarb et al. Aug 2007 A1
20070198077 Cully et al. Aug 2007 A1
20070198082 Kapadia et al. Aug 2007 A1
20070198097 Zegdi Aug 2007 A1
20070208550 Cao Sep 2007 A1
20070213582 Zollinger et al. Sep 2007 A1
20070213810 Newhauser et al. Sep 2007 A1
20070213813 Von Segesser et al. Sep 2007 A1
20070219558 Deutsch Sep 2007 A1
20070219630 Chu Sep 2007 A1
20070225759 Thommen et al. Sep 2007 A1
20070225760 Moszner et al. Sep 2007 A1
20070233186 Meng Oct 2007 A1
20070233237 Krivoruchko Oct 2007 A1
20070233239 Navia et al. Oct 2007 A1
20070239208 Crawford Oct 2007 A1
20070239272 Navia et al. Oct 2007 A1
20070239273 Allen Oct 2007 A1
20070244546 Francis Oct 2007 A1
20070244555 Rafiee et al. Oct 2007 A1
20070244556 Rafiee 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 et al. 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
20080004688 Spenser et al. Jan 2008 A1
20080004697 Lichtenstein et al. Jan 2008 A1
20080027483 Cartledge et al. Jan 2008 A1
20080027555 Hawkins Jan 2008 A1
20080035160 Woodson 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 Mackoviak et al. Mar 2008 A1
20080071361 Tuval et al. Mar 2008 A1
20080071363 Tuval et al. Mar 2008 A1
20080071366 Tuval et al. Mar 2008 A1
20080071369 Tuval et al. Mar 2008 A1
20080077235 Kirson Mar 2008 A1
20080082083 Forde et al. Apr 2008 A1
20080082159 Tseng et al. Apr 2008 A1
20080082166 Styrc et al. Apr 2008 A1
20080086138 Stone et al. Apr 2008 A1
20080086164 Rowe et al. Apr 2008 A1
20080086203 Roberts Apr 2008 A1
20080086204 Rankin Apr 2008 A1
20080091257 Andreas et al. Apr 2008 A1
20080091261 Long et al. Apr 2008 A1
20080097523 Bolduc et al. Apr 2008 A1
20080097595 Gabbay Apr 2008 A1
20080132989 Snow et al. Jun 2008 A1
20080140003 Bei et al. Jun 2008 A1
20080140116 Bonutti Jun 2008 A1
20080147182 Righini et al. Jun 2008 A1
20080161910 Revuelta et al. Jul 2008 A1
20080167705 Agnew Jul 2008 A1
20080167714 St. Goar et al. Jul 2008 A1
20080188929 Schreck Aug 2008 A1
20080195126 Solem Aug 2008 A1
20080195200 Vidlund et al. Aug 2008 A1
20080200980 Robin et al. Aug 2008 A1
20080208265 Frazier et al. Aug 2008 A1
20080208328 Antocci et al. Aug 2008 A1
20080208330 Keranen Aug 2008 A1
20080208332 Lamphere et al. Aug 2008 A1
20080221672 Lamphere et al. Sep 2008 A1
20080234814 Salahieh et al. Sep 2008 A1
20080243245 Thambar et al. Oct 2008 A1
20080255580 Hoffman et al. Oct 2008 A1
20080262609 Gross et al. Oct 2008 A1
20080269879 Sathe et al. Oct 2008 A1
20080275300 Rothe et al. Nov 2008 A1
20080275469 Fanton et al. 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
20080294234 Hartley et al. Nov 2008 A1
20080300629 Surti Dec 2008 A1
20090005863 Goetz et al. Jan 2009 A1
20090036966 O'Connor et al. Feb 2009 A1
20090043153 Zollinger et al. Feb 2009 A1
20090043381 Macoviak et al. Feb 2009 A1
20090054969 Salahieh et al. Feb 2009 A1
20090062866 Jackson Mar 2009 A1
20090076586 Hauser et al. Mar 2009 A1
20090076600 Quinn Mar 2009 A1
20090082844 Zacharias et al. Mar 2009 A1
20090088836 Bishop et al. Apr 2009 A1
20090088837 Gillinov et al. Apr 2009 A1
20090099554 Forster et al. Apr 2009 A1
20090099650 Bolduc et al. Apr 2009 A1
20090105794 Ziarno et al. Apr 2009 A1
20090105816 Olsen et al. Apr 2009 A1
20090112159 Slattery et al. Apr 2009 A1
20090125098 Chuter May 2009 A1
20090125102 Cartledge May 2009 A1
20090149872 Gross et al. Jun 2009 A1
20090157175 Benichou Jun 2009 A1
20090163934 Raschdorf, Jr. et al. Jun 2009 A1
20090177274 Scorsin et al. Jun 2009 A1
20090171363 Chocron Jul 2009 A1
20090171439 Nissl Jul 2009 A1
20090177266 Powell et al. Jul 2009 A1
20090177277 Milo Jul 2009 A1
20090177278 Spence Jul 2009 A1
20090210052 Forster et al. Aug 2009 A1
20090222081 Linder et al. Sep 2009 A1
20090240320 Tuval et al. Sep 2009 A1
20090241656 Jacquemin Oct 2009 A1
20090248143 Laham Oct 2009 A1
20090248148 Shaolian et al. Oct 2009 A1
20090254103 Deustch Oct 2009 A1
20090259306 Rowe Oct 2009 A1
20090259307 Gross et al. Oct 2009 A1
20090264859 Mas Oct 2009 A1
20090264994 Saadat Oct 2009 A1
20090264995 Subramanian Oct 2009 A1
20090276040 Rowe et al. Nov 2009 A1
20090281619 Le et al. Nov 2009 A1
20090287299 Tabor Nov 2009 A1
20090287304 Dahlgren et al. Nov 2009 A1
20090299409 Coe et al. Dec 2009 A1
20090299449 Styrc Dec 2009 A1
20090306768 Quardi Dec 2009 A1
20090319037 Rowe et al. Dec 2009 A1
20090326648 Machold et al. Dec 2009 A1
20100001038 Levin et al. Jan 2010 A1
20100010538 Juravic et al. Jan 2010 A1
20100022823 Goldfarb et al. Jan 2010 A1
20100023117 Yoganathan et al. Jan 2010 A1
20100023118 Medlock et al. Jan 2010 A1
20100023120 Holecek et al. Jan 2010 A1
20100030014 Ferrazzi Feb 2010 A1
20100036479 Hill et al. Feb 2010 A1
20100036484 Hariton Feb 2010 A1
20100042147 Janovsky et al. Feb 2010 A1
20100049313 Alon et al. Feb 2010 A1
20100063542 Van der Burg et al. Mar 2010 A1
20100063550 Felix et al. Mar 2010 A1
20100063586 Hasenkam et al. Mar 2010 A1
20100069852 Kelley Mar 2010 A1
20100076499 McNamara et al. Mar 2010 A1
20100076548 Konno Mar 2010 A1
20100082094 Quadri Apr 2010 A1
20100094248 Nguyen et al. Apr 2010 A1
20100100167 Bortlein et al. Apr 2010 A1
20100114180 Rock May 2010 A1
20100114299 Ben-Muvhar et al. May 2010 A1
20100121349 Meier May 2010 A1
20100130992 Machold et al. May 2010 A1
20100131054 Tuval et al. May 2010 A1
20100137979 Tuval et al. Jun 2010 A1
20100152845 Bloom et al. Jun 2010 A1
20100160958 Clark Jun 2010 A1
20100161036 Pintor et al. 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
20100174363 Castro Jul 2010 A1
20100179574 Longoria et al. Jul 2010 A1
20100179643 Shalev Jul 2010 A1
20100179648 Richter et al. Jul 2010 A1
20100179649 Richter et al. Jul 2010 A1
20100185277 Braido Jul 2010 A1
20100198347 Zakay et al. Aug 2010 A1
20100217382 Chau et al. Aug 2010 A1
20100222810 DeBeer et al. Sep 2010 A1
20100228285 Miles et al. Sep 2010 A1
20100234935 Bashiri et al. Sep 2010 A1
20100234940 Dolan Sep 2010 A1
20100249908 Chau et al. Sep 2010 A1
20100249915 Zhang Sep 2010 A1
20100249917 Zhang Sep 2010 A1
20100249920 Bolling et al. Sep 2010 A1
20100256737 Pollock et al. Oct 2010 A1
20100262232 Annest Oct 2010 A1
20100262233 He Oct 2010 A1
20100280603 Maisano et al. Nov 2010 A1
20100280604 Zipory et al. Nov 2010 A1
20100280605 Hammer et al. Nov 2010 A1
20100280606 Naor Nov 2010 A1
20100286628 Gross Nov 2010 A1
20100286767 Zipory et al. Nov 2010 A1
20100305475 Hinchliffe et al. Dec 2010 A1
20100312333 Navia et al. Dec 2010 A1
20100324595 Linder et al. Dec 2010 A1
20100331971 Keränen et al. Dec 2010 A1
20110004210 Johnson et al. Jan 2011 A1
20110004227 Goldfarb et al. Jan 2011 A1
20110004296 Lutter et al. Jan 2011 A1
20110004298 Lee et al. Jan 2011 A1
20110004299 Navia et al. Jan 2011 A1
20110011917 Loulmet Jan 2011 A1
20110015729 Jimenez et al. Jan 2011 A1
20110015731 Carpentier et al. Jan 2011 A1
20110015739 Cheung et al. Jan 2011 A1
20110021985 Spargias Jan 2011 A1
20110022165 Oba et al. Jan 2011 A1
20110178597 Navia et al. Jan 2011 A9
20110026208 Otsuro et al. Feb 2011 A1
20110029066 Gilad et al. Feb 2011 A1
20110029067 Mcguckin, Jr. et al. Feb 2011 A1
20110029072 Gabbay Feb 2011 A1
20110035000 Nieminen et al. Feb 2011 A1
20110040374 Goetz et al. Feb 2011 A1
20110040375 Letac et al. Feb 2011 A1
20110046662 Moszner et al. Feb 2011 A1
20110054466 Rothstein et al. Mar 2011 A1
20110054596 Taylor Mar 2011 A1
20110054598 Johnson Mar 2011 A1
20110066231 Cartledge et al. Mar 2011 A1
20110066233 Thornton et al. Mar 2011 A1
20110067770 Pederson et al. Mar 2011 A1
20110071626 Wright et al. Mar 2011 A1
20110077730 Fentster Mar 2011 A1
20110082538 Dahlgren et al. Apr 2011 A1
20110087146 Ryan et al. Apr 2011 A1
20110087322 Letac et al. Apr 2011 A1
20110093002 Rucker et al. Apr 2011 A1
20110093063 Schreck Apr 2011 A1
20110098525 Kermode et al. Apr 2011 A1
20110106245 Miller et al. May 2011 A1
20110106247 Miller et al. May 2011 A1
20110112625 Ben-Muvhar et al. May 2011 A1
20110112632 Chau et al. May 2011 A1
20110113768 Bauer et al. May 2011 A1
20110118830 Liddicoat et al. May 2011 A1
20110118832 Punjabi May 2011 A1
20110125257 Seguin et al. May 2011 A1
20110125258 Centola May 2011 A1
20110137326 Bachman Jun 2011 A1
20110137397 Chau et al. Jun 2011 A1
20110137409 Yang et al. Jun 2011 A1
20110137410 Hacohen Jun 2011 A1
20110144703 Krause et al. Jun 2011 A1
20110144742 Madrid et al. Jun 2011 A1
20110166636 Rowe Jul 2011 A1
20110166649 Gross et al. Jul 2011 A1
20110172784 Richter Jul 2011 A1
20110184510 Maisano et al. Jul 2011 A1
20110190877 Lane et al. Aug 2011 A1
20110190879 Bobo et al. Aug 2011 A1
20110202076 Richter Aug 2011 A1
20110202130 Cartledge et al. Aug 2011 A1
20110208283 Rust Aug 2011 A1
20110208293 Tabor Aug 2011 A1
20110208298 Tuval et al. Aug 2011 A1
20110213459 Garrison et al. Sep 2011 A1
20110213461 Seguin et al. Sep 2011 A1
20110218619 Benichou et al. Sep 2011 A1
20110218620 Meiri et al. Sep 2011 A1
20110224785 Hacohen Sep 2011 A1
20110230941 Markus Sep 2011 A1
20110230961 Langer et al. Sep 2011 A1
20110238088 Bodluc et al. Sep 2011 A1
20110238094 Thomas et al. Sep 2011 A1
20110238159 Guyenot et al. Sep 2011 A1
20110245911 Quill et al. Oct 2011 A1
20110245917 Savage et al. Oct 2011 A1
20110251675 Dwork Oct 2011 A1
20110251676 Sweeney et al. Oct 2011 A1
20110251678 Eidenschink et al. Oct 2011 A1
20110251679 Weimeyer et al. Oct 2011 A1
20110251680 Tran et al. Oct 2011 A1
20110251682 Murray, III et al. Oct 2011 A1
20110251683 Tabor Oct 2011 A1
20110257433 Walker Oct 2011 A1
20110257633 Cartledge et al. Oct 2011 A1
20110257721 Tabor Oct 2011 A1
20110257728 Kuehn Oct 2011 A1
20110257729 Spenser et al. Oct 2011 A1
20110257736 Marquez et al. Oct 2011 A1
20110257737 Fogarty et al. Oct 2011 A1
20110264191 Rothstein Oct 2011 A1
20110264196 Savage et al. Oct 2011 A1
20110264198 Murray, III et al. Oct 2011 A1
20110264199 Tran et al. Oct 2011 A1
20110264200 Tran et al. Oct 2011 A1
20110264201 Yeung Oct 2011 A1
20110264202 Murray, III et al. Oct 2011 A1
20110264203 Dwork et al. Oct 2011 A1
20110264206 Tabor Oct 2011 A1
20110264208 Duffy Oct 2011 A1
20110270276 Rothstein et al. Nov 2011 A1
20110271967 Mortier et al. Nov 2011 A1
20110276062 Bolduc Nov 2011 A1
20110282361 Miller et al. Nov 2011 A1
20110282438 Drews et al. Nov 2011 A1
20110282439 Thill et al. Nov 2011 A1
20110282440 Cao Nov 2011 A1
20110283514 Fogarty et al. Nov 2011 A1
20110288435 Christy et al. Nov 2011 A1
20110288632 White Nov 2011 A1
20110288634 Tuval et al. Nov 2011 A1
20110288635 Miller et al. Nov 2011 A1
20110295354 Bueche et al. Dec 2011 A1
20110295363 Girard et al. Dec 2011 A1
20110301498 Maenhout et al. Dec 2011 A1
20110301688 Dolan Dec 2011 A1
20110301698 Miller et al. Dec 2011 A1
20110301701 Padala et al. Dec 2011 A1
20110301702 Rust et al. Dec 2011 A1
20110306916 Nitzan et al. Dec 2011 A1
20110307049 Kao Dec 2011 A1
20110313452 Carley et al. Dec 2011 A1
20110313515 Quadri et al. Dec 2011 A1
20110319989 Lane et al. Dec 2011 A1
20110319991 Hariton et al. Dec 2011 A1
20120010694 Lutter et al. Jan 2012 A1
20120016468 Robin et al. Jan 2012 A1
20120022557 Cabiri et al. Jan 2012 A1
20120022629 Perera et al. Jan 2012 A1
20120022633 Olson et al. Jan 2012 A1
20120022637 Ben-Movhar et al. Jan 2012 A1
20120022639 Hacohen et al. Jan 2012 A1
20120022640 Gross et al. Jan 2012 A1
20120022644 Reich et al. Jan 2012 A1
20120035703 Lutter et al. Feb 2012 A1
20120035712 Maisano et al. Feb 2012 A1
20120035713 Lutter et al. Feb 2012 A1
20120035722 Tuval et al. Feb 2012 A1
20120041547 Duffy et al. Feb 2012 A1
20120041551 Spenser et al. Feb 2012 A1
20120046738 Lau et al. Feb 2012 A1
20120046742 Tuval et al. Feb 2012 A1
20120053676 Ku et al. Mar 2012 A1
20120053680 Bolling et al. Mar 2012 A1
20120053682 Kovalsky et al. Mar 2012 A1
20120053688 Fogarty et al. Mar 2012 A1
20120059337 Eilat Mar 2012 A1
20120059454 Millwee et al. Mar 2012 A1
20120059458 Buchbinder et al. Mar 2012 A1
20120065464 Ellis et al. Mar 2012 A1
20120078237 Wang et al. Mar 2012 A1
20120078353 Quadri et al. Mar 2012 A1
20120078355 Zipory et al. Mar 2012 A1
20120078357 Conklin Mar 2012 A1
20120078359 Li et al. Mar 2012 A1
20120083832 Delaloye et al. Apr 2012 A1
20120083839 Letac et al. Apr 2012 A1
20120083879 Eberhardt et al. Apr 2012 A1
20120089022 House et al. Apr 2012 A1
20120089223 Nguyen et al. Apr 2012 A1
20120095552 Spence et al. Apr 2012 A1
20120101570 Tuval et al. Apr 2012 A1
20120101571 Thambar et al. Apr 2012 A1
20120101572 Kovalsky et al. Apr 2012 A1
20120109155 Robinson et al. May 2012 A1
20120123511 Brown May 2012 A1
20120123529 Levi May 2012 A1
20120123530 Carpentier et al. May 2012 A1
20120130473 Norris et al. May 2012 A1
20120130474 Buckley May 2012 A1
20120130475 Shaw May 2012 A1
20120136434 Carpentier et al. May 2012 A1
20120136436 Cabiri et al. May 2012 A1
20120143323 Hasenkam et al. Jun 2012 A1
20120150218 Sandgren et al. Jun 2012 A1
20120150290 Gabbay Jun 2012 A1
20120158021 Morrill Jun 2012 A1
20120165915 Melsheimer et al. Jun 2012 A1
20120165930 Gifford, III et al. Jun 2012 A1
20120179086 Shank et al. Jul 2012 A1
20120179244 Schankereli et al. Jul 2012 A1
20120191182 Hauser et al. Jul 2012 A1
20120197292 Chin-Chen et al. Aug 2012 A1
20120197388 Khairkhahan et al. Aug 2012 A1
20120215303 Quadri et al. Aug 2012 A1
20120239142 Liu et al. Sep 2012 A1
20120245604 Tegzes Sep 2012 A1
20120271198 Whittaker et al. Oct 2012 A1
20120277845 Bowe Nov 2012 A1
20120283757 Miller et al. Nov 2012 A1
20120283824 Lutter et al. Nov 2012 A1
20120290062 McNamara et al. Nov 2012 A1
20120296349 Smith et al. Nov 2012 A1
20120296360 Norris et al. Nov 2012 A1
20120296417 Hill et al. Nov 2012 A1
20120296418 Bonyuet et al. Nov 2012 A1
20120296419 Richardson Nov 2012 A1
20120300063 Majkrzak et al. Nov 2012 A1
20120123531 Tsukashima et al. Dec 2012 A1
20120310328 Olson et al. Dec 2012 A1
20120310330 Buchbinder et al. Dec 2012 A1
20120323313 Seguin Dec 2012 A1
20120323316 Chau et al. Dec 2012 A1
20120330408 Hillukka et al. Dec 2012 A1
20120330410 Hammer et al. Dec 2012 A1
20120330411 Gross et al. Dec 2012 A1
20130006347 McHugo Jan 2013 A1
20130018450 Hunt Jan 2013 A1
20130018458 Yohanan Jan 2013 A1
20130023758 Fabro Jan 2013 A1
20130030519 Tran et al. Jan 2013 A1
20130030522 Rowe et al. Jan 2013 A1
20130035759 Gross et al. Feb 2013 A1
20130041204 Heilman et al. Feb 2013 A1
20130041451 Patterson et al. Feb 2013 A1
20130046373 Cartledge et al. Feb 2013 A1
20130066341 Ketai et al. Mar 2013 A1
20130066342 Dell et al. Mar 2013 A1
20130079872 Gallagher Mar 2013 A1
20130079873 Migliazza et al. Mar 2013 A1
20130085529 Housman Apr 2013 A1
20130090724 Subramanian et al. Apr 2013 A1
20130096673 Hill et al. Apr 2013 A1
20130116776 Gross et al. May 2013 A1
20130116779 Weber May 2013 A1
20130116780 Miller et al. May 2013 A1
20130123896 Bloss et al. May 2013 A1
20130123900 Eblacas et al. May 2013 A1
20130123910 Cartledge et al. May 2013 A1
20130131791 Hlavka et al. May 2013 A1
20130131792 Miller et al. May 2013 A1
20130150945 Crawford et al. Jun 2013 A1
20130150956 Yohanan et al. Jun 2013 A1
20130158647 Norris et al. Jun 2013 A1
20130166017 Cartledge et al. Jun 2013 A1
20130166022 Conklin Jun 2013 A1
20130172978 Vidlund et al. Jul 2013 A1
20130172992 Gross et al. Jul 2013 A1
20130178930 Straubinger et al. Jul 2013 A1
20130190857 Mitra Jul 2013 A1
20130190861 Chau et al. Jul 2013 A1
20130190863 Call et al. Jul 2013 A1
20130190866 Zipory et al. Jul 2013 A1
20130197632 Kovach et al. Aug 2013 A1
20130204361 Adams et al. Aug 2013 A1
20130211501 Buckley et al. Aug 2013 A1
20130211508 Lane et al. Aug 2013 A1
20130226289 Shaolian et al. Aug 2013 A1
20130226290 Yellin et al. Aug 2013 A1
20130231735 Deem et al. Sep 2013 A1
20130245742 Norris Sep 2013 A1
20130253643 Rolando et al. Sep 2013 A1
20130261737 Costello Oct 2013 A1
20130261738 Clague et al. Oct 2013 A1
20130268069 Zakai et al. Oct 2013 A1
20130274870 Lombardi et al. Oct 2013 A1
20130282059 Ketai et al. Oct 2013 A1
20130289711 Liddy et al. Oct 2013 A1
20130289718 Tsukashima et al. Oct 2013 A1
20130289740 Liddy et al. Oct 2013 A1
20130297013 Klima et al. Nov 2013 A1
20130304093 Serina et al. Nov 2013 A1
20130304197 Buchbinder et al. Nov 2013 A1
20130304200 McLean Nov 2013 A1
20130310928 Morriss et al. Nov 2013 A1
20130325114 McLean et al. Dec 2013 A1
20130325118 Cartledge Dec 2013 A1
20130331929 Mitra et al. Dec 2013 A1
20140000112 Braido et al. Jan 2014 A1
20140005767 Glazier et al. Jan 2014 A1
20140005778 Buchbinder et al. Jan 2014 A1
20140018911 Zhou et al. Jan 2014 A1
20140018914 Zipory et al. Jan 2014 A1
20140018915 Biadillah et al. Jan 2014 A1
20140031928 Murphy et al. Jan 2014 A1
20140046430 Shaw Feb 2014 A1
20140052237 Lane et al. Feb 2014 A1
20140067050 Costello et al. Mar 2014 A1
20140067054 Chau et al. Mar 2014 A1
20140081376 Burkart et al. Mar 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
20140099726 Heller Apr 2014 A1
20140106951 Brandon Apr 2014 A1
20140120287 Jacoby et al. May 2014 A1
20140121749 Roeder May 2014 A1
20140121763 Duffy et al. May 2014 A1
20140135799 Henderson May 2014 A1
20140135894 Norris et al. May 2014 A1
20140135895 Andress et al. May 2014 A1
20140142619 Serina et al. May 2014 A1
20140142681 Norris May 2014 A1
20140142688 Duffy et al. May 2014 A1
20140142695 Gross et al. May 2014 A1
20140148849 Serina et al. May 2014 A1
20140148891 Johnson 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
20140172069 Roeder et al. Jun 2014 A1
20140172077 Bruchman et al. Jun 2014 A1
20140172082 Bruchman et al. Jun 2014 A1
20140188108 Goodine et al. Jul 2014 A1
20140188140 Meier et al. Jul 2014 A1
20140188210 Beard et al. Jul 2014 A1
20140188215 Hlavka et al. Jul 2014 A1
20140188221 Chung et al. Jul 2014 A1
20140194970 Chobotov Jul 2014 A1
20140194976 Starksen et al. Jul 2014 A1
20140194981 Menk et al. Jul 2014 A1
20140194983 Kovalsky et al. Jul 2014 A1
20140207231 Hacohen et al. Jul 2014 A1
20140214157 Börtlein et al. Jul 2014 A1
20140214159 Vidlund et al. Jul 2014 A1
20140222136 Geist et al. Aug 2014 A1
20140222137 Miller et al. Aug 2014 A1
20140222142 Kovalsky et al. Aug 2014 A1
20140236287 Clague et al. Aug 2014 A1
20140236289 Alkhatib Aug 2014 A1
20140243859 Robinson Aug 2014 A1
20140243894 Groothuis et al. Aug 2014 A1
20140243963 Sheps et al. Aug 2014 A1
20140249622 Carmi et al. Sep 2014 A1
20140257461 Robinson et al. Sep 2014 A1
20140257467 Lane et al. Sep 2014 A1
20140257475 Gross et al. Sep 2014 A1
20140257476 Montorfano et al. Sep 2014 A1
20140275757 Goodwin et al. Sep 2014 A1
20140276648 Hammer et al. Sep 2014 A1
20140277358 Slazas Sep 2014 A1
20140277409 Börtlein et al. Sep 2014 A1
20140277411 Börtlein et al. Sep 2014 A1
20140277412 Börtlein et al. Sep 2014 A1
20140277418 Miller Sep 2014 A1
20140277422 Ratz et al. Sep 2014 A1
20140277427 Ratz et al. Sep 2014 A1
20140296962 Cartledge et al. Oct 2014 A1
20140296969 Tegels 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 et al. Oct 2014 A1
20140324164 Gross et al. Oct 2014 A1
20140329225 Morin Nov 2014 A1
20140331475 Duffy et al. Nov 2014 A1
20140336744 Tani et al. Nov 2014 A1
20140343668 Zipory et al. Nov 2014 A1
20140343670 Bakis et al. Nov 2014 A1
20140350662 Vaturi Nov 2014 A1
20140350670 Keränen Nov 2014 A1
20140358222 Gorman, III et al. Dec 2014 A1
20140358224 Tegels et al. Dec 2014 A1
20140378331 Morin Dec 2014 A1
20140379006 Sutherland et al. Dec 2014 A1
20140379065 Johnson et al. Dec 2014 A1
20140379074 Spence et al. Dec 2014 A1
20140379076 Vidlund et al. Dec 2014 A1
20150012087 Miller et al. Jan 2015 A1
20150018940 Quill et al. Jan 2015 A1
20150018944 O'Connor et al. Jan 2015 A1
20150032205 Matheny Jan 2015 A1
20150045880 Hacohen Feb 2015 A1
20150045881 Lim Feb 2015 A1
20150051697 Spence et al. Feb 2015 A1
20150081014 Gross et al. Mar 2015 A1
20150094802 Buchbinder et al. Apr 2015 A1
20150105855 Cabiri et al. Apr 2015 A1
20150119970 Nakayama et al. Apr 2015 A1
20150127097 Neumann et al. May 2015 A1
20150142100 Morriss et al. May 2015 A1
20150142103 Vidlund May 2015 A1
20150148894 Damm et al. May 2015 A1
20150157457 Hacohen Jun 2015 A1
20150157458 Thambar et al. Jun 2015 A1
20150164640 McLean et al. Jun 2015 A1
20150173896 Richter et al. Jun 2015 A1
20150173897 Raanani et al. Jun 2015 A1
20150182336 Zipory et al. Jul 2015 A1
20150196390 Ma et al. Jul 2015 A1
20150196393 Vidlund et al. Jul 2015 A1
20150216661 Hacohen et al. Aug 2015 A1
20150230924 Miller et al. Aug 2015 A1
20150238313 Spence et al. Aug 2015 A1
20150245934 Lombardi et al. Sep 2015 A1
20150250588 Yang et al. Sep 2015 A1
20150272730 Melnick et al. Oct 2015 A1
20150272731 Racchini et al. Oct 2015 A1
20150272734 Sheps et al. Oct 2015 A1
20150282964 Beard et al. Oct 2015 A1
20150305903 Kitaoka Oct 2015 A1
20150320556 Levi et al. Nov 2015 A1
20150327994 Morriss et al. Nov 2015 A1
20150328000 Ratz et al. Nov 2015 A1
20150335429 Morriss et al. Nov 2015 A1
20150342736 Rabito et al. Dec 2015 A1
20150351903 Morriss et al. Dec 2015 A1
20150351904 Cooper et al. Dec 2015 A1
20150351906 Hammer et al. Dec 2015 A1
20150359629 Ganesan et al. Dec 2015 A1
20160030169 Shahriari Feb 2016 A1
20160030171 Quijano et al. Feb 2016 A1
20160089482 Siegenthaler Mar 2016 A1
20160095700 Righini Apr 2016 A1
20160100939 Armstrong et al. Apr 2016 A1
20160106539 Buchbinder et al. Apr 2016 A1
20160113766 Ganesan et al. Apr 2016 A1
20160113768 Ganesan et al. Apr 2016 A1
20160125160 Heneghan et al. May 2016 A1
20160157862 Hernandez et al. Jun 2016 A1
20160175095 Dienno et al. Jun 2016 A1
20160200773 Morin Jul 2016 A1
20160213473 Hacohen et al. Jul 2016 A1
20160220367 Barrett Aug 2016 A1
20160228247 Maimon et al. Aug 2016 A1
20160242902 Morriss et al. Aug 2016 A1
20160245802 Morin et al. Aug 2016 A1
20160258939 Morin et al. Sep 2016 A1
20160266089 Morin et al. Sep 2016 A1
20160270911 Ganesan et al. Sep 2016 A1
20160296330 Hacohen Oct 2016 A1
20160310268 Oba et al. Oct 2016 A1
20160310274 Gross et al. Oct 2016 A1
20160317301 Quadri et al. Nov 2016 A1
20160317305 Pelled et al. Nov 2016 A1
20160324633 Gross et al. Nov 2016 A1
20160324635 Vidlund et al. Nov 2016 A1
20160324640 Gifford et al. Nov 2016 A1
20160331526 Schweich et al. Nov 2016 A1
20160331527 Vidlund et al. Nov 2016 A1
20160338706 Rowe Nov 2016 A1
20160367360 Cartledge et al. Dec 2016 A1
20160367368 Vidlund et al. Dec 2016 A1
20160374801 Jimenez et al. Dec 2016 A1
20160374802 Levi et al. Dec 2016 A1
20170042678 Ganesan et al. Feb 2017 A1
20170049435 Sauer et al. Feb 2017 A1
20170056166 Ratz et al. Mar 2017 A1
20170056171 Cooper et al. Mar 2017 A1
20170065407 Hacohen et al. Mar 2017 A1
20170065411 Grundeman et al. Mar 2017 A1
20170074855 Morin et al. Mar 2017 A1
20170100236 Robertson et al. Apr 2017 A1
20170128205 Tamir et al. May 2017 A1
20170135816 Lashinski et al. May 2017 A1
20170189174 Braido et al. Jul 2017 A1
20170196688 Christianson et al. Jul 2017 A1
20170196692 Kirk et al. Jul 2017 A1
20170209264 Chau et al. Jul 2017 A1
20170216026 Quill et al. Aug 2017 A1
20170224323 Rowe et al. Aug 2017 A1
20170231757 Gassler Aug 2017 A1
20170231759 Geist et al. Aug 2017 A1
20170231760 Lane et al. Aug 2017 A1
20170231766 Hariton et al. Aug 2017 A1
20170234850 Morin Aug 2017 A1
20170239048 Goldfarb et al. Aug 2017 A1
20170252159 Hacohen et al. Sep 2017 A1
20170266003 Hammer et al. Sep 2017 A1
20170333183 Backus Nov 2017 A1
20170333187 Hariton et al. Nov 2017 A1
20170349940 Morin et al. Dec 2017 A1
20170360426 Hacohen et al. Dec 2017 A1
20170367823 Hariton et al. Dec 2017 A1
20180000580 Wallace et al. Jan 2018 A1
20180014930 Hariton et al. Jan 2018 A1
20180014932 Hammer et al. Jan 2018 A1
20180021129 Peterson et al. Jan 2018 A1
20180023114 Morin et al. Jan 2018 A1
20180023115 Morin et al. Jan 2018 A1
20180028215 Cohen Feb 2018 A1
20180028311 Hacohen Feb 2018 A1
20180049873 Manash et al. Feb 2018 A1
20180055628 Patel et al. Mar 2018 A1
20180055630 Patel et al. Mar 2018 A1
20180098850 Rafiee et al. Apr 2018 A1
20180116790 Ratz et al. May 2018 A1
20180116843 Schreck et al. May 2018 A1
20180125644 Conklin May 2018 A1
20180132999 Perouse May 2018 A1
20180147059 Hammer et al. May 2018 A1
20180153687 Hariton et al. Jun 2018 A1
20180153689 Maimon et al. Jun 2018 A1
20180153696 Albitov et al. Jun 2018 A1
20180161159 Lee et al. Jun 2018 A1
20180177593 Hariton et al. Jun 2018 A1
20180177594 Patel et al. Jun 2018 A1
20180185148 Hariton et al. Jul 2018 A1
20180206983 Noe et al. Jul 2018 A1
20180214263 Rolando et al. Aug 2018 A1
20180243086 Barbarino et al. Aug 2018 A1
20180250126 O'Connor et al. Sep 2018 A1
20180250147 Syed Sep 2018 A1
20180271654 Hariton et al. Sep 2018 A1
20180280136 Hariton et al. Oct 2018 A1
20180296333 Dixon et al. Oct 2018 A1
20180296336 Cooper et al. Oct 2018 A1
20180296341 Noe et al. Oct 2018 A1
20180325671 Abunassar et al. Nov 2018 A1
20180344457 Gross et al. Dec 2018 A1
20180344490 Fox et al. Dec 2018 A1
20180353294 Calomeni et al. Dec 2018 A1
20180360457 Ellis et al. Dec 2018 A1
20190000613 Delgado et al. Jan 2019 A1
20190015200 Delgado et al. Jan 2019 A1
20190021852 Delgado et al. Jan 2019 A1
20190021857 Hacohen et al. Jan 2019 A1
20190038404 Iamberger et al. Feb 2019 A1
20190038405 Iamberger et al. Feb 2019 A1
20190053896 Adamek-bowers et al. Feb 2019 A1
20190060060 Chau et al. Feb 2019 A1
20190060068 Cope et al. Feb 2019 A1
20190060070 Groothuis et al. Feb 2019 A1
20190069997 Ratz et al. Mar 2019 A1
20190069998 Hacohen Mar 2019 A1
20190083248 Hariton et al. Mar 2019 A1
20190083249 Hariton et al. Mar 2019 A1
20190083261 Perszyk et al. Mar 2019 A1
20190105153 Barash et al. Apr 2019 A1
20190117391 Humair Apr 2019 A1
20190167423 Hariton et al. Jun 2019 A1
20190175339 Vidlund Jun 2019 A1
20190175342 Hariton et al. Jun 2019 A1
20190183639 Moore Jun 2019 A1
20190183644 Hacohen Jun 2019 A1
20190192295 Spence et al. Jun 2019 A1
20190216602 Lozonschi Jul 2019 A1
20190231525 Hariton et al. Aug 2019 A1
20190240010 Hacohen Aug 2019 A1
20190321172 Gross et al. Oct 2019 A1
20190336280 Naor Nov 2019 A1
20190350701 Adamek-bowers et al. Nov 2019 A1
20190365530 Hoang et al. Dec 2019 A1
20190388218 Vidlund et al. Dec 2019 A1
20190388220 Vidlund et al. Dec 2019 A1
20200000449 Goldfarb et al. Jan 2020 A1
20200000579 Manash et al. Jan 2020 A1
20200000580 Hacohen Jan 2020 A1
20200015964 Noe et al. Jan 2020 A1
20200030098 Delgado et al. Jan 2020 A1
20200038181 Hariton et al. Feb 2020 A1
20200046496 Hammer et al. Feb 2020 A1
20200054335 Hernandez et al. Feb 2020 A1
20200060818 Geist et al. Feb 2020 A1
20200078002 Hacohen et al. Mar 2020 A1
20200113677 McCann et al. Apr 2020 A1
20200113689 McCann et al. Apr 2020 A1
20200113692 McCann et al. Apr 2020 A1
20200138567 Marr et al. May 2020 A1
20200146824 Hammer et al. May 2020 A1
20200163760 Hariton et al. May 2020 A1
20200163761 Hariton et al. May 2020 A1
20200205969 Hacohen Jul 2020 A1
20200214832 Metchik et al. Jul 2020 A1
20200237512 McCann et al. Jul 2020 A1
20200246136 Marr et al. Aug 2020 A1
20200246140 Hariton et al. Aug 2020 A1
20200253600 Darabian Aug 2020 A1
20200261094 Goldfarb et al. Aug 2020 A1
20200306037 Siegel Oct 2020 A1
20200315786 Metchik et al. Oct 2020 A1
20200330221 Hacohen Oct 2020 A1
20200330227 Hacohen Oct 2020 A1
20200337842 Metchik et al. Oct 2020 A1
20200360139 Hammer et al. Nov 2020 A1
20200390548 Hariton et al. Dec 2020 A1
20210093449 Hariton et al. Apr 2021 A1
20210106419 Abunassar Apr 2021 A1
20210113331 Quadri et al. Apr 2021 A1
20210137680 Kizuka et al. May 2021 A1
20210145578 Hariton et al. May 2021 A1
20210196461 Hariton et al. Jul 2021 A1
20210259835 Tyler, II et al. Aug 2021 A1
20210330456 Hacohen et al. Oct 2021 A1
20210361422 Gross et al. Nov 2021 A1
20210361426 Hacohen Nov 2021 A1
20210401573 Gross et al. Dec 2021 A1
20220000612 Hacohen Jan 2022 A1
Foreign Referenced Citations (194)
Number Date Country
2005107650 Nov 2005 AI
2822801 Aug 2006 CA
2671966 Jun 2008 CA
101653365 Feb 2010 CN
103974674 Aug 2014 CN
103997990 Aug 2014 CN
105324091 Feb 2016 CN
0170262 Feb 1986 EP
0614342 Sep 1994 EP
1006905 Jun 2000 EP
0954257 Aug 2000 EP
1258437 Nov 2002 EP
1264582 Dec 2002 EP
0871417 Oct 2003 EP
1266641 Oct 2004 EP
1034753 Feb 2005 EP
1258232 Jan 2006 EP
1637092 Mar 2006 EP
1990014 Nov 2008 EP
1562522 Dec 2008 EP
1420723 Jan 2009 EP
1903991 Sep 2009 EP
1418865 Oct 2009 EP
2119399 Nov 2009 EP
1531762 Apr 2010 EP
1450733 Feb 2011 EP
2 446 915 May 2012 EP
2088965 Nov 2012 EP
1768630 Jan 2015 EP
1861045 Mar 2015 EP
1465555 May 2015 EP
2349124 Oct 2018 EP
2739214 Oct 2018 EP
3417813 Dec 2018 EP
3583922 Dec 2019 EP
3270825 Apr 2020 EP
2485795 Sep 2020 EP
223448 Dec 2012 IL
S53152790 Dec 1978 JP
20010046894 Jun 2001 KR
9205093 Apr 1992 WO
9310714 Jun 1993 WO
9639963 Dec 1996 WO
9640344 Dec 1996 WO
9701369 Jan 1997 WO
9846149 Oct 1998 WO
1998043557 Oct 1998 WO
1999030647 Jun 1999 WO
0022981 Apr 2000 WO
2000-047139 Aug 2000 WO
0126586 Apr 2001 WO
0156457 Aug 2001 WO
2001-062189 Aug 2001 WO
0182832 Nov 2001 WO
02085250 Oct 2002 WO
02085251 Oct 2002 WO
02085252 Oct 2002 WO
2003020179 Mar 2003 WO
2003028558 Apr 2003 WO
03047467 Jun 2003 WO
2003049647 Jun 2003 WO
2003105667 Dec 2003 WO
2004028399 Apr 2004 WO
04103434 Dec 2004 WO
2004108191 Dec 2004 WO
05021063 Mar 2005 WO
05046488 May 2005 WO
2005062931 Jul 2005 WO
2006007389 Jan 2006 WO
2006007401 Jan 2006 WO
06012013 Feb 2006 WO
06012038 Feb 2006 WO
06054930 May 2006 WO
2006065212 Jun 2006 WO
2006070372 Jul 2006 WO
06086434 Aug 2006 WO
2006089236 Aug 2006 WO
2006091163 Aug 2006 WO
06097931 Sep 2006 WO
06105084 Oct 2006 WO
06116558 Nov 2006 WO
2006128193 Nov 2006 WO
07011799 Jan 2007 WO
2007030063 Mar 2007 WO
2007047488 Apr 2007 WO
2007059252 May 2007 WO
07121314 Oct 2007 WO
07136783 Nov 2007 WO
07136981 Nov 2007 WO
08013915 Jan 2008 WO
2008014144 Jan 2008 WO
2008029296 Mar 2008 WO
2008031103 Mar 2008 WO
2008058940 May 2008 WO
08068756 Jun 2008 WO
2008070797 Jun 2008 WO
2008103722 Aug 2008 WO
2009026563 Feb 2009 WO
09033469 Mar 2009 WO
09053497 Apr 2009 WO
2009080801 Jul 2009 WO
2009091509 Jul 2009 WO
2009160631 Oct 2009 WO
10004546 Jan 2010 WO
2010000454 Jan 2010 WO
2010005827 Jan 2010 WO
2010006627 Jan 2010 WO
2010006905 Jan 2010 WO
2010027485 Mar 2010 WO
2010037141 Apr 2010 WO
2010044851 Apr 2010 WO
2010045297 Apr 2010 WO
2010057262 May 2010 WO
2010073246 Jul 2010 WO
2010081033 Jul 2010 WO
2010085649 Jul 2010 WO
2010121076 Oct 2010 WO
2010128502 Nov 2010 WO
2010128503 Nov 2010 WO
2010150178 Dec 2010 WO
2011025972 Mar 2011 WO
2011051942 May 2011 WO
2011067770 Jun 2011 WO
2011069048 Jun 2011 WO
2011089401 Jul 2011 WO
2011089601 Jul 2011 WO
2011106137 Sep 2011 WO
2011111047 Sep 2011 WO
0187190 Nov 2011 WO
2011137531 Nov 2011 WO
2011-143263 Nov 2011 WO
2011144351 Nov 2011 WO
2011148374 Dec 2011 WO
2011154942 Dec 2011 WO
2012011108 Jan 2012 WO
2012014201 Feb 2012 WO
2012024428 Feb 2012 WO
2012036740 Mar 2012 WO
2012048035 Apr 2012 WO
2012068541 May 2012 WO
2012127309 Sep 2012 WO
2012176195 Dec 2012 WO
2012177942 Dec 2012 WO
2013021374 Feb 2013 WO
2013021375 Feb 2013 WO
2013021384 Feb 2013 WO
2013059747 Apr 2013 WO
2013069019 May 2013 WO
2013072496 May 2013 WO
2013078497 Jun 2013 WO
2013088327 Jun 2013 WO
2013114214 Aug 2013 WO
2013128436 Sep 2013 WO
2013175468 Nov 2013 WO
2014022124 Feb 2014 WO
2014064694 May 2014 WO
2014064695 May 2014 WO
2014076696 May 2014 WO
2014087402 Jun 2014 WO
2014115149 Jul 2014 WO
2014121280 Aug 2014 WO
2014144937 Sep 2014 WO
2014145338 Sep 2014 WO
2014164364 Oct 2014 WO
2014194178 Dec 2014 WO
2014195786 Dec 2014 WO
2015059699 Apr 2015 WO
2015173794 Nov 2015 WO
2015191923 Dec 2015 WO
2016016899 Feb 2016 WO
2016093877 Jun 2016 WO
2016125160 Aug 2016 WO
2017223486 Dec 2017 WO
2018025260 Feb 2018 WO
2018025263 Feb 2018 WO
2018029680 Feb 2018 WO
2018039631 Mar 2018 WO
2018106837 Jun 2018 WO
2018112429 Jun 2018 WO
2018118717 Jun 2018 WO
2018131042 Jul 2018 WO
2018131043 Jul 2018 WO
2019026059 Feb 2019 WO
2019027507 Feb 2019 WO
2019030753 Feb 2019 WO
2019077595 Apr 2019 WO
2019116369 Jun 2019 WO
2019138400 Jul 2019 WO
2019195860 Oct 2019 WO
2019202579 Oct 2019 WO
2020058972 Mar 2020 WO
2020167677 Aug 2020 WO
2021156866 Aug 2021 WO
2021186424 Sep 2021 WO
Non-Patent Literature Citations (597)
Entry
IPR2021-01051 Preliminary Guidance Patent Owner's Motion to Amend dated Jun. 24, 2022.
Ex Parte Quayle dated May 2, 2022, which issued during the prosecution of U.S. Appl. No. 16/879,952.
An International Search Report and a Written Opinion both dated May 3, 2022, which issued during the prosecution of Applicant's PCT/IL2021/051433.
An Office Action together with an English Summary dated May 7, 2022 which issued during the prosecution of Chinese Patent Application No. 201880058940.2.
Notice of Allowance dated May 4, 2022, which issued during the prosecution of U.S. Appl. No. 16/680,739.
An Office Action dated Jun. 28, 2022, which issued during the prosecution of U.S. Appl. No. 16/135,969.
An Office Action dated Jul. 8, 2022, which issued during the prosecution of U.S. Appl. No. 16/144,054.
IPR2021-00383 Final Written Decision dated Jul. 18, 2022.
An Office Action dated Apr. 11, 2022, which issued during the prosecution of U.S. Appl. No. 17/473,472.
IPR2021-00383 Preliminary Guidance dated Jan. 31, 2022.
An Office Action dated Mar. 18, 2022, which issued during the prosecution of U.S. Appl. No. 16/746,489.
Notice of Allowance dated Mar. 22, 2022, which issued during the prosecution of U.S. Appl. No. 17/366,711.
Notice of Allowance dated Mar. 4, 2022, which issued during the prosecution of U.S. Appl. No. 16/768,909.
An Office Action dated Dec. 9, 2021, which issued during the prosecution of U.S. Appl. No. 16/135,969.
An Office Action dated Jan. 24, 2022, which issued during the prosecution of U.S. Appl. No. 16/135,466.
An Office Action dated Sep. 29, 2022, which issued during the prosecution of U.S. Appl. No. 17/010,886.
An Office Action dated Sep. 29, 2022, which issued during the prosecution of U.S. Appl. No. 16/656,790.
An Office Action dated Nov. 2, 2022, which issued during the prosecution of U.S. Appl. No. 17/004,693.
An Office Action dated Nov. 28, 2022, which issued during the prosecution of U.S. Appl. No. 17/141,853.
An Office Action dated Oct. 19, 2022, which issued during the prosecution of U.S. Appl. No. 17/875,589.
An Office Action dated Oct. 26, 2022, which issued during the prosecution of U.S. Appl. No. 16/746,489.
An Office Action dated Nov. 23. 2012, which issued during the prosecution of U.S. Appl. No. 13/033,852.
An Office Action dated Dec. 31, 2012, which issued during the prosecution of U.S. Appl. No. 13/044,694.
An Office Action dated Feb. 6, 2013, which issued during the prosecution of U.S. Appl. No. 13/412,814.
Langer F et al., “RING plus STRING: Papillary muscle repositioning as an adjunctive repair technique for ischemic mitral regurgitation,” J Thorac Cardiovasc Surg 133:247-9, Jan. 2007.
Langer F et al., “RING+STRING: Successful repair technique for ischemic mitral regurgitation with severe leaflet tethering,” Circulation 120[suppl 1]: S85-S91, Sep. 2009.
“Transcatheter Valve-in-Valve Implantation for Failed Bioprosthetic Heart Valves”, J Webb et al., Circulation. Apr. 2010; 121: 1848-1857.
Jansen, J., Willeke, S., Reul, H. and Rum, G. (1992), Detachable Shape-Memory Sewing Ring for Heart Valves. Artificial Organs, 16:294-297. 1992 (an abstract).
Alexander S. Geha, et al., Replacement of degenerated mitral and aortic bioprostheses without explanation Ann Thorac Surg. Jun. 2001; 72:1509-1514.
An International Search Report and a Written Opinion both dated Oct. 13, 2011 which issued during the prosecution of Applicant's PCT/IL11/00231.
An Office Action dated Jul. 1, 2016, which issued during the prosecution of U.S. Appl. No. 14/161,921.
An International Search Report and a Written Opinion both dated Dec. 5, 2011, which issued during the prosecution of Applicant's PCT/IL11/00582.
An Office Action dated May 29, 2012, which issued during the prosecution of U.S. Appl. No. 12/840,463.
U.S. Appl. No. 61/555,160, filed Nov. 3, 2011.
U.S. Appl. No. 61/525,281, filed Aug. 19, 2011.
U.S. Appl. No. 61/537,276, filed Sep. 21, 2011.
U.S. Appl. No. 61/515,372, filed Aug. 5, 2011.
U.S. Appl. No. 61/492,449, filed Jun. 2, 2011.
U.S. Appl. No. 61/588,892, filed Jan. 20, 2012.
An International Search Report and a Written Opinion both dated Feb. 6, 2013, which issued during the prosecution of Applicant's PCT/IL12/00292.
An International Search Report and a Written Opinion both dated Feb. 6, 2013, which issued during the prosecution of Applicant's PCT/IL12/00293.
An Office Action dated Nov. 28, 2012, which issued during the prosecution of U.S. Appl. No. 12/961,721.
An Office Action dated Feb. 15, 2013, which issued during the prosecution of U.S. Appl. No. 12/840,463.
An Office Action dated Feb. 10, 2014, which issued during the prosecution of U.S. Appl. No. 13/031,852.
An Office Action dated Sep. 19, 2014, which issued during the prosecution of U.S. Appl. No. 13/044,694.
An Intemational Search Report and a Written Opinion both dated Sep. 4, 2014 which issued during the prosecution of Applicant's PCT/IL2014/050087.
Invitation to Pay Additional Fees dated Jun. 12, 2014 PCT/IL2014/050087.
An Office Action dated Jun. 17, 2014, which issued during the prosecution of U.S. Appl. No. 12/961,721.
An Office Action dated Jul. 3, 2014, which issued during the prosecution of U.S. Appl. No. 13/033,852.
An Office Action dated May 23, 2014, which issued during the prosecution of U.S. Appl. No. 13/411,814.
Dominique Himbert; Mitral Regurgitation and Stenosis from Bioprosthesis and Annuloplasty Failure: Transcatheter approaches and outcomes 24 pages Oct. 28, 2013.
An International Search Report and a Written Opinion both dated Mar. 17, 2014 which issued during the prosecution of Applicant's PCT/IL2013/050937.
An International Preliminary Report on patentabilty dated Dec. 2, 2013, which issued during the prosecution of Applicant's PCT/IL11/00582.
An Office Action dated Sep. 12, 2013, which issued during the prosecution of U.S. Appl. No. 13/411,814.
An Office Action dated Aug. 2, 2013, which issued during the prosecution of U.S. Appl. No. 13/033,852.
An International Preliminary Report on patentabilty dated Sep. 11, 2012, which issued during the prosecution of Applicant's PCT/IL2011/000231.
An Office Action dated Jul. 2, 2014, which issued during the prosecution of U.S. Appl. No. 13/811,308.
An Office Action dated Jan. 20, 2016, which issued during the prosecution of U.S. Appl. No. 14/161,921.
An Office Action dated Jul. 23, 2013, which issued during the prosecution of U.S. Appl. No. 12/961,721.
An Office Action dated Jul. 18, 2013, which issued during the prosecution of U.S. Appl. No. 13/044,694.
An Office Action dated Nov. 8, 2013, which issued during the prosecution of U.S. Appl. No. 12/840,463.
An Office Action dated Jun. 4, 2014, which issued during the prosecution of U.S. Appl. No. 12/840,463.
An Office Action dated Aug. 13, 2012, which issued during the prosecution of U.S. Appl. No. 13/044,694.
An Office Action dated Jul. 2, 2012, which issued during the prosecution of U.S. Appl. No. 13/033,852.
An Office Action dated Feb. 3, 2014, which issued during the prosecution of U.S. Appl. No. 13/811,308.
An International Preliminary Report on patentabilty dated Feb. 11, 2014, which issued during the prosecution of Applicant's PCT/IL12/00292.
An International Preliminary Report on patentabilty dated Feb. 11, 2014, which issued during the prosecution of Applicant's PCT/IL12/00293.
A Notice of Allowance dated Aug. 15, 2014, which issued during the prosecution of U.S. Appl. No. 13/411,814.
An Office Action dated Aug. 14. 2012, which issued during the prosecution of U.S. Appl. No. 12/961,721.
U.S. Appl. No. 61/283,819, filed Dec. 8, 2009.
Notice of Allowance dated Apr. 8, 2016, which issued during the prosecution of U.S. Appl. No. 14/237,258.
U.S. Appl. No. 61/756,034, filed Jan. 24, 2013.
U.S. Appl. No. 61/756,049, filed Jan. 24, 2013.
An International Preliminary Report on Patentability dated Jan. 31, 2017, which issued during the prosecution of Applicant's PCT/IL2015/050792.
U.S. Appl. No. 62/372,861, filed Aug. 10, 2016.
Notice of Allowance dated Aug. 13, 2018, which issued during the prosecution of U.S. Appl. No. 15/995,597.
Notice of Allowance dated Apr. 20, 2018, which issued during the prosecution of U.S. Appl. No. 15/878,206.
An Office Action dated Dec. 10, 2015, which issued during the prosecution of U.S. Appl. No. 14/237,258.
An International Preliminary Report on Patentability dated Jul. 28, 2015, which issued during the prosecution of Applicant's PCT/IL2014/050087.
An Office Action dated Nov. 27, 2015, which issued during the prosecution of U.S. Appl. No. 14/626,267.
An Office Action dated Jan. 21, 2016, which issued during the prosecution of U.S. Appl. No. 14/237,264.
An Office Action dated Jan. 30, 2015, which issued during the prosecution of UK Patent Application No. 1413474.6.
An International Search Report and a Written Opinion both dated May 30, 2016, which issued during the prosecution of Applicant's PCT/IL2016/050125.
An Office Action dated Sep. 26, 2016, which issued during the prosecution of U.S. Appl. No. 14/761,004.
An Office Action dated Jan. 18, 2017, which issued during the prosecution of U.S. Appl. No. 14/626,267.
An Office Action dated Feb. 7, 2017, which issued during the prosecution of U.S. Appl. No. 14/689,608.
An Office Action dated Feb. 8, 2017, which issued during the prosecution of UK Patent Application No. 1613219.3.
An Office Action together dated Feb. 10, 2017: which issued during the prosecution of European Patent Application No. 12821522.5.
An International Search Report and a Written Opinion both dated Oct. 27, 2015, which issued during the prosecution of Applicant's PCT/IL2015/050792.
European Search Report dated Feb. 18. 2015, which issued during the prosecution of Applicant's European App No. 12821522.5.
Saturn Project—a novel solution for transcatheter heart valve replacement specifically designed to address clinical therapeutic needs on mitral valve: Dec. 2016.
Righini presentation EuroPCR May 2015 (Saturn)—(downloaded from: https://www.pcronline.com/Cases-resourcesimages/Resources/Course-videos-slides/2015/Cardiovascularinnovation-pipeline-Mitral-and-tricuspid-valve-interventions).
An Advisory Action dated Apr. 2, 2018, which issued during the prosecution of U.S. Appl. No. 14/761,004.
An Office Action dated Jul. 26, 2018, which issued during the prosecution of U.S. Appl. No. 15/872.501.
An Office Action dated May 4, 2018, which issued during the prosecution of U.S. Appl. No. 15/872.501.
An Office Action dated Apr. 20, 2018, which issued during the prosecution of U.S. Appl. No. 15/886,517.
An Office Action dated Aug. 9, 2018, which issued during the prosecution of U.S. Appl. No. 15/899,858.
An Office Action dated Aug. 9, 2018, which issued during the prosecution of U.S. Appl. No. 15/902,403.
An Office Action dated Jun. 28, 2018, which issued during the prosecution of U.S. Appl. No. 29/635,658.
An Office Action dated Jun. 28, 2018, which issued during the prosecution of U.S. Appl. No. 29/635,661.
Georg Lutter, MD, et a1; “Percutaneous Valve Replacement: Current State and Future Prospects”, The Annals of Thoracic Surgery ; vol. 78, pp. 2199-2206, Dec. 2004.
An Office Action dated Jun. 6, 2018, which issued during the prosecution of UK Patent Application No. 1720803.4.
An International Search Report and a Written Opinion both dated Jun. 20, 2018, which issued during the prosecution of Applicant's PCT/IL2018/050024.
An Office Action dated Jun. 18, 2018, which issued during the prosecution of UK Patent Application No. 1800399.6.
An Office Action dated Oct. 23, 2017, which issued during the prosecution of U.S. Appl. No. 14/761,004.
An Office Action dated Dec. 7, 2017, which issued during the prosecution of U.S. Appl. No. 15/211,791.
Interview Summary dated Feb. 8, 2018, which issued during the prosecution of U.S. Appl. No. 15/213,791.
An Office Action dated Feb. 7, 2018, which issued during the prosecution of U.S. Appl. No. 15/197,069.
An International Search Report and a Written Opinion both dated Nov. 24, 2017, which issued during the prosecution of Applicant's PCT/IL2017/050873.
An Office Action dated Jan. 5, 2018, which issued during the prosecution of U.S. Appl. No. 15/541,783.
An Office Action dated Feb. 2, 2018, which issued during the prosecution of U.S. Appl. No. 15/329,920.
An Invitation to pay additional fees dated Jan. 2, 2018, which issued during the prosecution of Applicant's PCT/IL2017/050849.
An Invitation to pay additional fees dated Sep. 29, 2017, which issued during the prosecution of Applicant's PCT/IL2017/050873.
European Search Report dated Jun. 29, 2017, which issued during the prosecution of Applicant's European App No. 11809374.9.
An Invitation to pay additional fees dated Oct. 11, 2018, which issued during the prosecution of Applicant's PCT/IL2018/050725.
An Office Action dated Dec. 4, 2018, which issued during the prosecution of U.S. Appl. No. 16/041,059.
An Office Action together with the English translation dated Nov. 5, 2018 which issued during the prosecution of Chinese Patent Application No. 201680008328.5.
Notice of Allowance dated Sep. 25, 2018, which issued during the prosecution of U.S. Appl. No. 15/188,507.
European Search Report dated Sep. 26, 2018 which issued during the prosecution of Applicant's European App No. 18186784.7.
An Office Action dated Jun. 30, 2015, which issued during the prosecution of U.S. Appl. No. 14/522,987.
Notice of Allowance dated Dec. 13. 2013, which issued during the prosecution of U.S. Appl. No. 13/675,119.
An International Preliminary Report on Patentability dated Aug. 8, 2017, which issued during the prosecution of Applicant's PCT/IL2016/050125.
An Office Action dated Jan. 17, 2018, which issued during the prosecution of U.S. Appl. No. 14/763,004.
An Office Action dated Mar. 25, 2015, which issued during the prosecution of U.S. Appl. No. 12/840,463.
An Office Action dated Feb. 25, 2016, which issued during the prosecution of U.S. Appl. No. 14/522,987.
An Office Action dated Apr. 13, 2016, which issued during the prosecution of U.S. Appl. No. 14/626,267.
An Office Action dated Aug. 28, 2015, which issued during the prosecution of U.S. Appl. No. 14/237,264.
Maisano (2015) TCR presentation re Cardiovalve.
Notice of Allowance dated Sep. 29, 2016, which issued during the prosecution of U.S. Appl. No. 14/442,541.
Notice of Allowance dated May 10, 2016, which issued during the prosecution of U.S. Appl. No. 14/237,258.
Notice of Allowance dated May 20, 2016, which issued during the prosecution of U.S. Appl. No. 14/237,258.
An International Preliminary Report on Patentability dated May 19, 2015, which issued during the prosecution of Applicant's PCT/IL2013/050937.
Dusan Pavcnik, MD, PhD2, et al.; “Development and Initial Experimental Evaluation of a Prosthetic Aortic Valve for Transcatheter Placement”, Cardiovascular Radiology. Radiology Apr. 1992, vol. 183, pp. 151-154.
Notice of Allowance dated Oct. 16, 2013, which issued during the prosecution of U.S. Appl. No. 13/675,119.
Notice of Allowance dated Feb. 11. 2015, which issued during the prosecution of U.S. Appl. No. 13/033,852.
Notice of Allowance dated May 5, 2015, which issued during the prosecution of U.S. Appl. No. 12/840,463.
Notice of Allowance dated Mar. 10, 2015, which issued during the prosecution of U.S. Appl. No. 13/811,308.
Notice of Allowance dated Jul 1, 2016, which issued during the prosecution of U.S. Appl. No. 14/442,541.
An Office Action dated Mar. 25, 2019, which issued during the prosecution of European Patent Application No. 14710060.6.
An International Search Report and a Written Opinion both dated Nov. 9, 2018, which issued during the prosecution of Applicant's PCT/IL2018/050869.
An International Search Report and a Written Opinion both dated Dec. 5, 2018, which issued during the prosecution of Applicant's PCT/IL2018/050725.
An International Search Report and a Written Opinion both dated Apr. 25, 2019, which issued during the prosecution of Applicant's PCT/IL2019/050142.
An International Preliminary Report on Patentability dated Feb. 12, 2019, which issued during the prosecution of Applicant's PCT/IL2017/050873.
An Office Action dated Sep. 13, 2019, which issued during the prosecution of U.S. Appl. No. 16/460,313.
An Office Action dated Nov. 26, 2019, which issued during the prosecution of U.S. Appl. No. 16/532,945.
An Office Action dated Aug. 16, 2019, which issued during the prosecution of U.S. Appl. No. 15/668,659.
An Office Action dated Nov. 1, 2019, which issued during the prosecution of U.S. Appl. No. 15/872,501.
An Office Action dated Jun. 14, 2019, which issued during the prosecution of U.S. Appl. No. 15/703,385.
An Office Action dated Oct. 4, 2019, which issued during the prosecution of U.S. Appl. No. 16/183,140.
An Office Action dated Jun. 13, 2019, which issued during the prosecution of U.S. Appl. No. 16/388,038.
An International Preliminary Report on Patentability dated Feb. 4, 2020, which issued during the prosecution of Applicant's PCT/IL2018/050725.
An International Search Report and a Written Opinion both dated Jan. 25, 2019, which issued during the prosecution of Applicant's PCT/IL2018/051122.
An International Search Report and a Written Opinion both dated May 13, 2019, which issued during the prosecution of Applicant's PCT/IL2018/051350.
An International Preliminary Report on Patentability dated Feb. 5, 2019, which issued during the prosecution of Applicant's PCT/IL2017/050849.
An Office Action dated Oct. 25, 2018, which issued during the prosecution of U.S. Appl. No. 14/761,004.
An Office Action dated Mar. 4, 2019, which issued during the prosecution of U.S. Appl. No. 14/763,004.
An Office Action dated Jan. 9, 2019, which issued during the prosecution of U.S. Appl. No. 15/329,920.
An Office Action dated Jan. 30, 2019, which issued during the prosecution of U.S. Appl. No. 15/872,501.
An Office Action dated Feb. 5, 2019, which issued during the prosecution of U.S. Appl. No. 15/899,858.
An Office Action dated May 23, 2019, which issued during the prosecution of U.S. Appl. No. 15/668,659.
An Office Action dated May 1, 2019, which issued during the prosecution of U.S. Appl. No. 15/691,032.
An Office Action dated Aug. 1, 2019, which issued during the prosecution of U.S. Appl. No. 15/668,559.
An Office Action dated Jun. 19, 2019, which issued during the prosecution of U.S. Appl. No. 15/682,789.
Notice of Allowance dated Jan. 13, 2020, which issued during the prosecution of U.S. Appl. No. 15/956,956.
An Office Action dated Jun. 25, 2019, which issued during the prosecution of U.S. Appl. No. 15/329,920.
An Office Action dated May 16, 2019, which issued during the prosecution of U.S. Appl. No. 15/433,547.
U.S. Appl. No. 62/560,384, filed Sep. 19, 2017.
U.S. Appl. No. 62/112,343, filed Feb. 5, 2015.
An International Preliminary Report on Patentability dated Feb. 11, 2020, which issued during the prosecution of Applicant's PCT/IL2018/050869.
An International Preliminary Report on Patentability dated Oct. 20, 2020, which issued during the prosecution of Applicant's PCT/IL2019/050142.
An Office Action dated Jan. 6, 2020, which issued during the prosecution of U.S. Appl. No. 16/660,231.
An Office Action dated Dec. 31, 2019, which issued during the prosecution of U.S. Appl. No. 16/183,140.
Notice of Allowance dated Apr. 24, 2019, which issued during the prosecution of U.S. Appl. No. 16/045,059.
An Office Action dated Jan. 14, 2020, which issued during the prosecution of U.S. Appl. No. 16/284,331.
European Search Report dated Mar. 5, 2020 which issued during the prosecution of Applicant's European App No. 17752184.6.
European Search Report dated Mar. 4, 2020 which issued during the prosecution of Applicant's European App No. 16706913.7.
Notice of Allowance dated Mar. 12, 2020, which issued during the prosecution of U.S. Appl. No. 16/460,313.
An Office Action dated Jan. 9, 2020, which issued during the prosecution of U.S. Appl. No. 15/600,190.
An Office Action dated Jan. 3, 2020, which issued during the prosecution of U.S. Appl. No. 16/678,355.
An Office Action dated Feb. 6, 2020, which issued during the prosecution of U.S. Appl. No. 15/668,659.
Notice of Allowance dated Jan. 16, 2020, which issued during the prosecution of U.S. Appl. No. 16/532,945.
Notice of Allowance dated Aug. 19, 2020, which issued during the prosecution of U.S. Appl. No. 16/637,166.
Notice of Allowance dated Jul. 27, 2020, which issued during the prosecution of U.S. Appl. No. 16/637,166.
Notice of Allowance dated Jun. 23, 2020, which issued during the prosecution of U.S. Appl. No. 16/637,166.
Notice of Allowance dated May 7, 2020, which issued during the prosecution of U.S. Appl. No. 16/637,166.
Sündermann, Simon H., et al. “Feasibility of the Engager™ aortic transcatheter valve system using a flexible over-the-wire design.” European Journal of Cardio-Thoracic Surgery 42.4 (2012): e48-e52.
An Office Action summarized English translation and Search Report dated Jul. 3, 2020, which issued during the prosecution of Chinese Patent Application No. 201780061210.3.
Serruys, P. W., Piazza, N., Cribier, A., Webb, J., Laborde, J. C., & de Jaegere, P. (Eds.). (2009). Transcatheter aortic valve implantation: tips and tricks to avoid failure. CRC Press.—Screenshots from Google Books downloaded from: https://books.google.co.il/books?id=FLzLBQAAQBAJ&lpg=PA198&ots=soqWrDH-y_&dq=%20%22Edwards%20SAPIEN%22&lr&pg=PA20#v=onepage&q=%22Edwards%20SAPIEN%22&f=false ; Downloaded on Jun. 18, 2020.
An International Search Report and a Written Opinion both dated Jun. 24, 2020, which issued during the prosecution of Applicant's PCT/IL2019/051398.
An Office Action dated Jul. 14, 2020, which issued during the prosecution of U.S. Appl. No. 16/324,339.
Notice of Allowance dated Aug. 28, 2020, which issued during the prosecution of U.S. Appl. No. 16/324,339.
Notice of Allowance dated Jul. 29, 2020, which issued during the prosecution of U.S. Appl. No. 16/132,937.
An Office Action dated Jul. 29, 2020, which issued during the prosecution of U.S. Appl. No. 16/269,328.
Notice of Allowance dated Aug. 26, 2020, which issued during the prosecution of U.S. Appl. No. 16/269,328.
An Office Action dated Aug. 7, 2020, which issued during the prosecution of U.S. Appl. No. 15/668,659.
Tchetche, D. and Nicolas M. Van Mieghem: “New-generation TAVI devices: description and specifications” EuroIntervention, 2014, No. 10:U90-U100.
An Office Action dated Aug. 23, 2019, which issued during the prosecution of U.S. Appl. No. 15/600,190.
Symetis S.A.: “ACURATE neo ™ Aortic Bioprosthesis for Implantation using the ACURATE neo ™ TA Transapical Delivery System in Patients with Severe Aortic Stenosis,” Clinical Investigation Plan, Protocol No. 2015-01, Vs. No. 2, 2015:1-76.
Notice of Allowance dated Sep. 10, 2020, which issued during the prosecution of U.S. Appl. No. 15/600,190.
Notice of Allowance dated Sep. 10, 2020, which issued during the prosecution of U.S. Appl. No. 16/324,339.
Notice of Allowance dated Oct. 19, 2020, which issued during the prosecution of U.S. Appl. No. 16/324,339.
Notice of Allowance dated Sep. 21, 2020, which issued during the prosecution of U.S. Appl. No. 16/269,328.
Notice of Allowance dated Oct. 28, 2020, which issued during the prosecution of U.S. Appl. No. 16/269,328.
Notice of Allowance dated Jan. 16, 2020, which issued during the prosecution of U.S. Appl. No. 15/872,501.
An Office Action dated May 11, 2020, which issued during the prosecution of U.S. Appl. No. 16/811,732.
An Office Action dated Sep. 24, 2020, which issued during the prosecution of U.S. Appl. No. 16/811,732.
Notice of Allowance dated Mar. 29, 2017, which issued during the prosecution of U.S. Appl. No. 14/161,921.
Agarwal et al. International Cardiology Perspective Functional Tricuspid Regurgitation, Circ Cardiovasc Interv 2009;2;2;565-573 (2009).
Alfieri et al., “An effective technique to correct anterior mitral leaflet prolapse,” J Card 14(6):468-470 (1999).
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).
Alfieri, “The edge-to-edge repair of the mitral valve,” [Abstract] 6th Annual NewEra Cardiac Care: Innovation & Technology, Heart Surgery Forum pp. 103. (2000).
Alfieri et al. “Novel Suture Device for Beating-Heart Mitral Leaflet Approximation”, Ann Thorac Surg. 2002, 74:1488-1493.
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).
Amplatzer Cardiac Plug brochure (English pages), AGA Medical Corporation (Plymouth, MN) (copyright 2008-2010, downloaded Jan. 11, 2011).
AMPLATZER® Cribriform Occluder. A patient guide to Percutaneous, Transcatheter, Atrial Septal Defect Closuer, AGA Medical Corporation, Apr. 2008.
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.
Brennan, Jennifer, 510(k) Summary of safety and effectiveness, Jan. 2008.
Dictionary.com definition of “lock”, Jul. 29, 2013.
Dang NC et al. “Simplified Placement of Multiple Artificial Mitral Valve Chords,” The Heart Surgery Forum #2005-1005, 8 (3) (2005).
Maisano, The double-orifice technique as a standardized approach to treat mitral . . . , European Journal of Cardio-thoracic Surgery 17 (2000) 201-205.
“Two dimensional real-time ultrasonic imaging of the heart and great vessels”, Mayo Clin Proc. vol. 53:271-303, 1978.
Odell JA et al, “Early Results o4yf a Simplified Method of Mitral Valve Annuloplasty,” Circulation 92: 150-154 (1995).
O'Reilly S et al., “Heart valve surgery pushes the envelope,” Medtech Insight 8(3): 73, 99-108 (2006).
Swain CP et al., “An endoscopically deliverable tissue-transfixing device for securing biosensors in the gastrointestinal tract,” Gastrointestinal Endoscopy 40(6): 730-734 (1994).
An Invitation to pay additional fees dated Jan. 31, 2014, which issued during the prosecution of Applicant's PCT/IL2013/050860.
U.S. Appl. No. 62/030,715, filed Jul. 30, 2014.
U.S. Appl. No. 62/139,854, filed Mar. 30, 2015.
U.S. Appl. No. 61/312,412, filed Mar. 10, 2010.
An Invitation to pay additional fees dated Jan. 31, 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 International Preliminary Report on Patentability dated Sep. 18, 2007, which issued during the prosecution of Applicant's PCT/IL2006/000342.
An International Preliminary Report on Patentability dated Jun. 5, 2012, which issued during the prosecution of Applicant's PCT/IL2010/001024.
An International Preliminary Report on Patentability dated Apr. 28, 2015, which issued during the prosecution of Applicant's PCT/IL2013/050861.
An International Preliminary Report on Patentability dated Apr. 26, 2016, which issued during the prosecution of Applicant's PCT/IL2014/050914.
An International Preliminary Report on Patentability dated Jun. 10, 2009, which issued during the prosecution of Applicant's PCT/IL07/01503.
An International Preliminary Report on Patentability dated Dec. 18, 2010, which issued during the prosecution of Applicant's PCT/IL09/00593.
An International Preliminary Report on Patentability dated Jun. 29, 2011, which issued during the prosecution of Applicant's PCT/IL2009/001209.
Notice of Allowance dated Aug. 18, 2017, which issued during the prosecution of U.S. Appl. No. 14/682,608.
Notice of Allowance dated Jul. 6, 2017, which issued during the prosecution of U.S. Appl. No. 14/682,608.
Notice of Allowance dated May 22, 2017, which issued during the prosecution of U.S. Appl. No. 14/682,608.
An Office Action dated Apr. 21, 2017, which issued during the prosecution of U.S. Appl. No. 15/213,791.
An Office Action dated Sep. 29, 2017, which issued during the prosecution of U.S. Appl. No. 15/191,069.
An International Preliminary Report on Patentability dated Nov. 9, 2011, which issued during the prosecution of Applicant's PCT/IL2010/000357.
An International Preliminary Report on Patentability dated Nov. 9, 2011 which issued during the prosecution of Applicant's PCT/IL2010/000358.
An International Preliminary Report on Patentability dated Nov. 27, 2012, which issued during the prosecution of Applicant's PCT/IL2011/000404.
An International Preliminary Report on Patentability dated Feb. 4, 2014, which issued during the prosecution of Applicant's PCT/IL2011/000446.
An International Preliminary Report on Patentability dated Jan. 29, 2013, which issued during the prosecution of Applicant's PCT/IL2011/000600.
An International Preliminary Report on Patentability dated Dec. 23, 2014, which issued during the prosecution of Applicant's PCT/IL2012/050451.
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 Sep. 29, 2014, which issued during the prosecution of U.S. Appl. No. 13/504,870.
An Office Action dated Jan. 13, 2015, which issued during the prosecution of U.S. Appl. No. 13/707,013.
An Office Action dated Mar. 23, 2015, which issued during the prosecution of U.S. Appl. No. 13/707,013.
Notice of Allowance dated Mar. 25, 2015, which issued during the prosecution of U.S. Appl. No. 13/749,153.
An Office Action dated Oct. 3, 2014, which issued during the prosecution of U.S. Appl. No. 13/749,153.
Notice of Allowance dated May 22, 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.
An Office Action dated Dec. 19, 2013, which issued during the prosecution of U.S. Appl. No. 14/027,934.
An Office Action dated Jun. 11, 2014, which issued during the prosecution of U.S. Appl. No. 14/027,934.
An Office Action dated Aug. 22, 2014, which issued during the prosecution of U.S. Appl. No. 14/027,934.
An Office Action dated Apr. 2, 2015, which issued during the prosecution of U.S. Appl. No. 14/027,934.
An Office Action dated Jan. 5, 2016, which issued during the prosecution of U.S. Appl. No. 14/027,934.
An Office Action dated Jan. 5, 2016, which issued during the prosecution of U.S. Appl. No. 14/084,426.
An Office Action dated Mar. 16, 2015, which issued during the prosecution of U.S. Appl. No. 14/084,426.
An Office Action dated Jan. 6, 2016, which issued during the prosecution of U.S. Appl. No. 14/128,756.
An Office Action dated May 11, 2016, which issued during the prosecution of U.S. Appl. No. 14/128,756.
Notice of Allowance dated Oct. 20, 2015, which issued during the prosecution of U.S. Appl. No. 12/996,954.
Notice of Allowance dated Feb. 19, 2014, which issued during the prosecution of U.S. Appl. No. 12/795,192.
An Office Action dated Jul. 20, 2012, which issued during the prosecution of U.S. Appl. No. 12/843,412.
An Office Action dated Mar. 27, 2013, which issued during the prosecution of U.S. Appl. No. 12/843,412.
A Restriction Requirement dated May 1, 2012, which issued during the prosecution of U.S. Appl. No. 12/843,412.
A Notice of Allowance dated May 2, 2013, which issued during the prosecution of U.S. Appl. No. 12/843,412.
A Restriction Requirement dated Nov. 19, 2012, which issued during the prosecution of U.S. Appl. No. 12/926,673.
An Office Action dated Feb. 12, 2013, which issued during the prosecution of U.S. Appl. No. 12/926,673.
An Office Action dated Oct. 22, 2013, which issued during the prosecution of U.S. Appl. No. 12/926,673.
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 Oct. 9, 2013, which issued during the prosecution of U.S. Appl. No. 12/996,954.
An Office Action dated Mar. 24, 2015, which issued during the prosecution of U.S. Appl. No. 12/996,954.
An Office Action dated Oct. 5, 2012, which issued during the prosecution of U.S. Appl. No. 12/996,954.
Notice of Allowance dated Jul. 7, 2015, which issued during the prosecution of U.S. Appl. No. 12/996,954.
An Office Action dated Nov. 16, 2018, which issued during the prosecution of U.S. Appl. No. 16/042,028.
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 Search Report together with Written Opinion both dated Mar. 30, 2011, which issued during the prosecution of Applicant's PCT/IL2010/001024.
An International Search Report and a Written Opinion both dated Feb. 10, 2011, which issued during the prosecution of Applicant's PCT/IL10/00890.
An Office Action dated May 28, 2015, which issued during the prosecution of U.S. Appl. No. 14/128,756.
An Office Action dated Sep. 6, 2018, which issued during the prosecution of U.S. Appl. No. 15/994,022.
An Office Action dated Sep. 7, 2018, which issued during the prosecution of U.S. Appl. No. 15/991,725.
An Office Action dated Nov. 26, 2018, which issued during the prosecution of U.S. Appl. No. 16/040,831.
An Office Action dated Jul. 11, 2018, which issued during the prosecution of U.S. Appl. No. 15/978,494.
An Office Action dated Nov. 23, 2018, which issued during the prosecution of U.S. Appl. No. 16/041,208.
An Office Action dated Jun. 15, 2018, which issued during the prosecution of U.S. Appl. No. 15/970,314.
An Office Action dated Oct. 12, 2018, which issued during the prosecution of U.S. Appl. No. 15/970,314.
An Office Action dated Jul. 26, 2018, which issued during the prosecution of U.S. Appl. No. 15/979,686.
An Office Action dated Sep. 10, 2018, which issued during the prosecution of U.S. Appl. No. 16/008,618.
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 Apr. 22, 2019, which issued during the prosecution of U.S. Appl. No. 15/668,559.
Notice of Allowance dated Aug. 30, 2019, which issued during the prosecution of U.S. Appl. No. 15/682,789.
Notice of Allowance dated Mar. 29, 2019, which issued during the prosecution of U.S. Appl. No. 15/541,783.
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).
An Advisory Action dated Dec. 13, 2013, which issued during the prosecution of U.S. Appl. No. 12/961,721.
An Office Action dated Aug. 7, 2015, which issued during the prosecution of U.S. Appl. No. 14/128,756.
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 May 30, 2012, which issued during the prosecution of U.S. Appl. No. 12/706,868.
A Notice of Allowance dated Sep. 18, 2012, which issued during the prosecution of U.S. Appl. No. 12/706,868.
Restriction Requirement dated May 5, 2011, which issued during the prosecution of U.S. Appl. No. 12/706,868.
A Restriction Requirement dated Mar. 30, 2012, which issued during the prosecution of U.S. Appl. No. 12/785,717.
An Office Action dated Oct. 5, 2020, which issued during the prosecution of Canadian Patent Application No. 2,973,940.
An Office Action dated Nov. 30, 2020, which issued during the prosecution of U.S. Appl. No. 16/138,129.
An Office Action summarized English translation and Search Report dated Nov. 25, 2020, which issued during the prosecution of Chinese Patent Application No. 201910449820.1.
Notice of Allowance dated Nov. 19, 2020, which issued during the prosecution of U.S. Appl. No. 16/318,025.
An Office Action dated Aug. 2, 2011, which issued during the prosecution of U.S. Appl. No. 12/435,291.
Notice of Allowance dated Dec. 7, 2011, which issued during the prosecution of U.S. Appl. No. 12/435,291.
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 Oct. 6, 2010, which issued during the prosecution of Applicant's U.S. Appl. No. 12/484,512.
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.
An Office Action dated Jan. 27, 2012, which issued during the prosecution of U.S. Appl. No. 12/548,991.
An Office Action dated Aug. 6, 2012, which issued during the prosecution of U.S. Appl. No. 12/548,991.
An Advisory Action dated Sep. 6, 2012 which issued during the prosecution of U.S. Appl. No. 12/548,991.
Notice of Allowance dated Jun. 23, 2014, which issued during the prosecution of U.S. Appl. No. 12/548,991.
A Restriction Requirement dated Nov. 14, 2011 which issued during the prosecution of U.S. Appl. No. 12/548,991.
Amendment, Terminal Disclaimer and Extension dated Jun. 27, 2012, which issued during the prosecution of U.S. Appl. No. 12/548,991.
A Restriction Requirement dated Jul. 5, 2012, which issued during the prosecution of 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 Office Action dated Dec. 27, 2013, which issued during the prosecution of U.S. Appl. No. 12/781,717.
An Office Action dated Nov. 5, 2012, which issued during the prosecution of U.S. Appl. No. 12/791,026.
An Office Action dated May 10, 2012, which issued during the prosecution of U.S. Appl. No. 12/795,026.
Notice of Allowance dated Nov. 13, 2014, which issued during the prosecution of U.S. Appl. No. 12/791,026.
Notice of Allowance dated Dec. 24, 2014, which issued during the prosecution of U.S. Appl. No. 12/791,026.
A Restriction Requirement dated Jan. 6, 2012, which issued during the prosecution of U.S. Appl. No. 12/791,026.
A Restriction Requirement dated Sep. 14, 2012, which issued during the prosecution of U.S. Appl. No. 12/795,192.
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.
Notice of Allowance dated Nov. 19, 2013, which issued during the prosecution of U.S. Appl. No. 12/795,192.
A Notice of Allowance dated Jun. 26, 2012, which issued during the prosecution of U.S. Appl. No. 12/608,316.
An Office Action dated Nov. 14, 2011, which issued during the prosecution of U.S. Appl. No. 12/608,316.
A Restriction Requirement dated Apr. 1, 2011, which issued during the prosecution of U.S. Appl. No. 12/608,316.
An Office Action dated Jul. 6, 2012, which issued during the prosecution of U.S. Appl. No. 12/692,061.
An Office Action dated Jan. 23, 2012, which issued during the prosecution of U.S. Appl. No. 12/692,061.
An Office Action dated Mar. 9, 2012, which issued during the prosecution of U.S. Appl. No. 12/689,635.
An Office Action dated Nov. 30, 2012, which issued during the prosecution of U.S. Appl. No. 12/689,635.
A Notice of Allowance dated May 22, 2013, which issued during the prosecution of U.S. Appl. No. 12/689,635.
Restriction Requirement dated Nov. 14, 2011, which issued during the prosecution of U.S. Appl. No. 12/689,635.
An Office Action dated May 6, 2013, which issued during the prosecution of U.S. Appl. No. 12/689,693.
An Office Action dated Feb. 3, 2014, which issued during the prosecution of U.S. Appl. No. 12/689,693.
Notice of Allowance dated Jun. 11, 2014, which issued during the prosecution of U.S. Appl. No. 12/689,693.
A Restriction Requirement dated Sep. 17, 2012, which issued during the prosecution of U.S. Appl. No. 12/689,693.
A Notice of Allowance dated Sep. 3, 2014, which issued during the prosecution of U.S. Appl. No. 12/689,693.
European Search Report dated Jul. 8, 2016, which issued during the prosecution of Applicant's European App No. 13849843.1.
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.
Search Report in European Patent Application 10772090.6 dated Jan. 17, 2014.
Supplementary European Search Report dated Oct. 23, 2014 which issued during the prosecution of Applicant's European App No. 10826224.7.
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.
An Office Action dated Jun. 7, 2013 which issued during the prosecution of U.S. Appl. No. 13/141,606.
An Office Action dated Jun. 13, 2014, which issued during the prosecution of U.S. Appl. No. 13/141,606.
Notice of Allowance dated Sep. 29, 2014, which issued during the prosecution of U.S. Appl. No. 13/141,606.
An Office Action dated Feb. 4, 2013 which issued during the prosecution of U.S. Appl. No. 13/141,606.
An English translation of an Office Action dated Apr. 23, 2014 which issued during the prosecution of Chinese Patent Application No. 201080059948.4.
Communication dated Jul. 25, 2014, issued by the State Intellectual Property Office of the P.R. of China in counterpart Application No. 200980157331.3.
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 International Search Report dated May 19, 2011, which issued during the prosecution of Applicant's PCT/IL2011/00064.
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 International Search Report & Written Opinion both dated Mar. 21, 2014, which issued during the prosecution of Applicant's PCT/IL13/50992.
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 and a Written Opinion both dated Apr. 15, 2014, which issued during the prosecution of Applicant's PCT/IL2013/050861.
An International Search Report & Written Opinion both dated May 12, 2015, which issued during the prosecution of Applicant's PCT/IL2014/050914.
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 International Search Report and a Written Opinion both dated Jun. 10, 2010, which issued during the prosecution of Applicant's PCT/IL09/01209.
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 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 a Written Opinion both dated Sep. 12, 2008, which issued during the prosecution of Applicant's PCT/IL07/01503.
An International Search Report and Written Opinion dated Nov. 8, 2010, which issued during the prosecution of Applicant's PCT/IL2010/000358.
An International Search Report and a Written Opinion both dated Nov. 23, 2011, which issued during the prosecution of Applicant's PCT/IL2011/000446.
Supplementary European Search Report dated Sep. 25, 2015, which issued during the prosecution of Applicant's European App No. 09794095.1.
A Supplementary European Search Report dated Feb. 1, 2011, which issued during the prosecution of European Patent Application No. EP 07849540.
An English translation of an Office Action dated Dec. 12, 2013 which issued during the prosecution of Chinese Patent Application No. 200980157331.3.
Communication regarding amended claims filed dated Dec. 27, 2012, regarding European App No. 11792047.0.
An Office Action dated Mar. 23, 2015, which issued during the prosecution of European Patent Application No. EP 09834225.6.
An English translation of an Office Action dated Jul. 17, 2015 which issued during the prosecution of Chinese Patent Application No. 201080059948.4.
An English translation of an Office Action dated Dec. 16, 2015 which issued during the prosecution of Chinese Patent Application No. 201080059948.4.
Communication from the European Patent Office dated Jun. 11, 2015, which issued during the prosecution of European U.S. Appl. No. 11/811,934.
A communication from the European Patent Office dated Sep. 28, 2011 which issued during the prosecution of European Application No. 09834225.6.
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. 23, 2012, which issued during the prosecution of Japanese Patent Application No. 2009-539871.
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. 17, 2015, which issued during the prosecution of U.S. Appl. No. 14/486,226.
Notice of Allowance dated Jan. 29, 2016, which issued during the prosecution of U.S. Appl. No. 14/551,951.
An Office Action dated Jun. 18, 2015, which issued during the prosecution of U.S. Appl. No. 14/551,951.
An Office Action dated Jan. 4, 2016, which issued during the prosecution of U.S. Appl. No. 14/589,100.
An Office Action dated May 4, 2016, which issued during the prosecution of U.S. Appl. No. 14/589,100.
An International Search Report and a Written Opinion both dated Nov. 14, 2011, which issued during the prosecution of Applicant's PCT/IL2011/000404.
An International Search Report and a Written Opinion both dated Dec. 6, 2012 which issued during the prosecution of Applicant's PCT/IL2012/000250.
A Notice of Allowance dated Apr. 3, 2013, which issued during the prosecution of U.S. Appl. No. 12/563,930.
An Office Action dated Aug. 24, 2012, which issued during the prosecution of U.S. Appl. No. 12/563,930.
An Office Action dated Dec. 29, 2011, which issued during the prosecution of U.S. Appl. No. 12/563,952.
A Restriction Requirement 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 Apr. 1, 2013 which issued during the prosecution of U.S. Appl. No. 13/161,476.
An Office Action dated Nov. 21, 2013, which issued during the prosecution of U.S. Appl. No. 13/161,476.
An Advisory Action dated Feb. 4, 2014, which issued during the prosecution of U.S. Appl. No. 13/167,476.
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.
An Office Action dated Aug. 26, 2014 which issued during the prosecution of U.S. Appl. No. 13/167,444.
An Office Action dated Aug. 23, 2013 which issued during the prosecution of U.S. Appl. No. 13/167,444.
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.
An Office Action dated Oct. 2, 2013, which issued during the prosecution of U.S. Appl. No. 13/167,492.
A Restriction Requirement dated Nov. 2, 2012, which issued during the prosecution of U.S. Appl. No. 13/167,492.
An Office Action dated Feb. 14, 2013 which issued during the prosecution of U.S. Appl. No. 13/167,492.
Notice of Allowance dated Nov. 7, 2014, which issued during the prosecution of U.S. Appl. No. 13/167,492.
An Office Action dated Jun. 10, 2014, which issued during the prosecution of U.S. Appl. No. 13/167,492.
Notice of Allowance dated Dec. 9, 2014, which issued during the prosecution of U.S. Appl. No. 13/167,476.
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 May 1, 2012, which issued during the prosecution of Applicant's PCT/IL2010/000890.
An International Preliminary Report on Patentability dated Jun. 9, 2015, which issued during the prosecution of Applicant's PCT/IL2013/050992.
U.S. Appl. No. 60/873,075, filed Dec. 5, 2006.
U.S. Appl. No. 60/902,146, filed Feb. 16, 2007.
An Office Action dated Mar. 29, 2018, which issued during the prosecution of U.S. Appl. No. 15/188,507.
Notice of Allowance dated Sep. 17, 2014, which issued during the prosecution of U.S. Appl. No. 12/961,721.
An Office Action dated Oct. 1, 2015, which issued during the prosecution of U.S. Appl. No. 14/141,228.
A Restriction Requirement dated Jun. 2, 2014, which issued during the prosecution of U.S. Appl. No. 13/319,030.
An Office Action dated Oct. 14, 2014, which issued during the prosecution of US Appl. No. 13/319,030.
An Office Action dated Jun. 18, 2015, which issued during the prosecution of U.S. Appl. No. 13/319,030.
An Office Action dated May 3, 2016, which issued during the prosecution of U.S. Appl. No. 13/319,030.
Notice of Allowance dated Dec. 30, 2016, which issued during the prosecution of U.S. Appl. No. 13/319,030.
An Office Action dated Apr. 7, 2015, which issued during the prosecution of U.S. Appl. No. 13/319,007.
An Office Action dated Apr. 8, 2016, which issued during the prosecution of U.S. Appl. No. 14/141,228.
An Office Action dated Oct. 5, 2015, which issued during the prosecution of U.S. Appl. No. 14/246,417.
An Office Action dated Apr. 7, 2016, which issued during the prosecution of U.S. Appl. No. 14/242,151.
An Office Action dated May 23, 2016, which issued during the prosecution of U.S. Appl. No. 14/209,171.
An Office Action dated Jul. 20, 2016, which issued during the prosecution of U.S. Appl. No. 14/246,417.
An Office Action dated Jun. 14, 2016, which issued during the prosecution of U.S. Appl. No. 14/273,155.
An Office Action dated Jun. 17, 2016, which issued during the prosecution of U.S. Appl. No. 14/357,040.
An Office Action dated Mar. 24, 2015, which issued during the prosecution of U.S. Appl. No. 14/486,226.
U.S. Appl. No. 61/001,013, filed Oct. 29, 2007.
U.S. Appl. No. 61/132,295, filed Jun. 16, 2008.
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.
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.
U.S. Appl. No. 61/555,570, filed Nov. 4, 2011.
U.S. Appl. No. 61/557,082, filed Nov. 8, 2011.
U.S. Appl. No. 60/662,616, filed Mar. 17, 2005.
U.S. Appl. No. 60/700,542, filed Jul. 18, 2005.
U.S. Appl. No. 61/782,121, filed Mar. 14, 2013.
European Search Report dated Jul. 15, 2016, which issued during the prosecution of Applicant's European App No. 13849947.0.
European Search Report dated Nov. 4, 2015, which issued during the prosecution of European Patent Application No. EP 1077 2091.4.
Search Report in European Patent Application 10826224.7 dated Nov. 16, 2015.
Supplementary European Search Report dated Dec. 23, 2014 which issued during the prosecution of Applicant's European App No. 10834311.
Supplementary European Search Report dated Jan. 21, 2014 which issued during the prosecution of Applicant's European App No. 11 78 6226.
A Supplementary European Search Report dated Jan. 20, 2015, which issued during the prosecution of European Patent Application No. 12803037.6.
Supplementary European Search Report dated Aug. 4, 2014 which issued during the prosecution of Applicant's European App No. 11 81 1934.6.
European Search Report dated Jun. 24, 2016, which issued during the prosecution of European Patent Application No. EP 12847363.
Supplementary European Search Report dated Apr. 29, 2015, which issued during the prosecution of Applicant's European App No. 14200202.
An Office Action dated Dec. 16, 2013, which issued during the prosecution of U.S. Appl. No. 13/666,262.
An Office Action dated Dec. 18, 2013, which issued during the prosecution of U.S. Appl. No. 13/666,141.
Notice of Allowance dated Jun. 25, 2014, which issued during the prosecution of U.S. Appl. No. 13/666,262.
A Notice of Allowance dated Feb. 2, 2015, which issued during the prosecution of U.S. Appl. No. 13/504,870.
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, 2013, which issued during the prosecution of U.S. Appl. No. 11/908,906.
A Restriction Requirement dated Aug. 5, 2011, which issued during the prosecution of U.S. Appl. No. 11/908,906.
An Office Action dated Sep. 16, 2009 which issued during the prosecution of U.S. Appl. No. 11/950,930.
Notice of Allowance dated Sep. 12, 2014, which issued during the prosecution of U.S. Appl. No. 11/950,930.
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.
A Restriction Requirement dated Apr. 19, 2010 which issued during the prosecution of U.S. Appl. No. 12/341,960.
An Office Action dated Sep. 28, 2011, which issued during the prosecution of U.S. Appl. No. 12/437,103.
An Office Action dated Jun. 13, 2012, which issued during the prosecution of U.S. Appl. No. 12/437,103.
A Restriction Requirement dated Jul. 12, 2011, which issued during the prosecution of U.S. Appl. No. 12/437,103.
Notice of Allowance dated Mar. 6, 2014, which issued during the prosecution of U.S. Appl. No. 12/437,103.
Notice of Allowance dated Dec. 20, 2013, which issued during the prosecution of U.S. Appl. No. 12/437,103.
Notice of Allowance dated Apr. 27, 2012, which issued during the prosecution of U.S. Appl. No. 12/341,960.
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. 4, 2010, which issued during the prosecution of U.S. Appl. No. 12/341,960.
An Interview Summary dated Jul. 27, 2011, which issued during the prosecution of U.S. Appl. No. 12/341,960.
Notice of Allowance dated Aug. 21, 2019, which issued during the prosecution of U.S. Appl. No. 15/703,385.
Notice of Allowance dated Oct. 16, 2019, which issued during the prosecution of U.S. Appl. No. 15/703,385.
Notice of Allowance dated Dec. 24, 2020, which issued during the prosecution of U.S. Appl. No. 15/668,659.
Notice of Allowance dated Oct. 21, 2020, which issued during the prosecution of U.S. Appl. No. 15/668,659.
Declaration of Ivan Vesely, Ph.D., in Support of Petition for Inter Partesreview of U.S. Pat. No. 7,563,267—dated May 29, 2019.
U.S. Appl. No. 60/128,690, filed Apr. 9, 1999.
U.S. Appl. No. 60/613,867, filed Sep. 27, 2004.
An Office Action dated Dec. 24, 2020, which issued during the prosecution of U.S. Appl. No. 16/144,054.
An Office Action dated Feb. 2, 2021, which issued during the prosecution of U.S. Appl. No. 16/811,732.
An Office Action dated Jan. 13, 2021, which issued during the prosecution of European Patent Application No. 15751089.2.
An Office Action together with an English summary dated Mar. 3, 2021, which issued during the prosecution of Chinese Patent Application No. 201780047391.4.
Declaration of Dr. Ivan Vesely, Ph.D. in Support of Petition for Inter Partes Review of U.S. Pat. No. 10,226,341—dated Dec. 17, 2020.
Petition for Inter Partes Review of U.S. Pat. No. 10,226,341 and EXHIBITS 1001-1013—dated Dec. 29, 2020.
Batista, Randas JV, et al. “Partial left ventriculectomy to treat end-stage heart disease.” The Annals of thoracic surgery 64.3 (1997): 634-638.
Beall Jr, Arthur C., et al. “Clinical experience with a dacron velour-covered teflon-disc mitral-valve prosthesis.” The Annals of thoracic surgery 5.5 (1968): 402-410.
Kalbacher, D., et al. “1000 MitraClip™ procedures: Lessons learnt from the largest single-centre experience worldwide.” (2019): 3137-3139.
Maisano, F., et al. “The edge-to-edge technique: a simplified method to correct mitral insufficiency.” European joumal of cardio-thoracic surgery 13.3 (1998): 240-246.
Fucci, C., et al. “Improved results with mitral valve repair using new surgical techniques.” European journal of cardio-thoracic surgery 9.11 (1995): 621-627.
Notice of Allowance dated Nov. 19, 2019, which issued during the prosecution of U.S. Appl. No. 15/668,559.
Mitral Valve Academic Research Consortium. “Clinical Trial Design Principles and Endpoint Definitions for Transcatheter Mitral Valve Repair and Replacement: Part 1: Clinical Trial Design Principles a Consensus Document from the Mitral Valve Academic Research Consortium.” Journal of the American College of Cardiology 66.3 (2015): 278-307.
An Office Action dated Aug. 29, 2018, which issued during the prosecution of U.S. Appl. No. 15/329,920.
An Office Action dated May 8, 2018, which issued during the prosecution of U.S. Appl. No. 15/902,403.
An Office Action dated May 11, 2018, which issued during the prosecution of U.S. Appl. No. 15/899,858.
Notice of Allowance dated Oct. 5, 2018, which issued during the prosecution of U.S. Appl. No. 15/886,517.
Notice of Allowance dated Jul. 19, 2019, which issued during the prosecution of U.S. Appl. No. 15/899,858.
Notice of Allowance dated Nov. 16, 2020, which issued during the prosecution of U.S. Appl. No. 16/324,339.
Notice of Allowance dated Apr. 27, 2020, which issued during the prosecution of U.S. Appl. No. 16/591,330.
An Advisory Action dated Jan. 2, 2020, which issued during the prosecution of U.S. Appl. No. 15/668,659.
Notice of Allowance dated Oct. 17, 2019, which issued during the prosecution of U.S. Appl. No. 15/329,920.
An Office Action dated Dec. 31, 2019, which issued during the prosecution of U.S. Appl. No. 16/591,330.
Notice of Allowance dated Feb. 9, 2021, which issued during the prosecution of U.S. Appl. No. 16/937,216.
An Advisory Action dated Nov. 18, 2020, which issued during the prosecution of U.S. Appl. No. 16/811,732.
An International Search Report and a Written Opinion both dated Mar. 27, 2018, which issued during the prosecution of Applicant's PCT/IL2017/050849.
Notice of Allowance dated Jun. 11, 2021, which issued during the prosecution of U.S. Appl. No. 16/811,732.
Notice of Allowance dated Jul. 16, 2021, which issued during the prosecution of U.S. Appl. No. 16/811,732.
Patent Trial and Appeal Board Decision Granting Institution in U.S. Pat. No. 10,226,341—Dated Jul. 20, 2021.
European Search Report dated Jun. 10, 2021 which issued during the prosecution of Applicant's European App No. 21157988.3.
Notice of Allowance dated Nov. 19, 2018, which issued during the prosecution of U.S. Appl. No. 15/197,069.
Poirier, Nancy C., et al. “A novel repair for patients with atrioventricular septal defect requiring reoperation for left atrioventricular valve regurgitation.” European journal of cardio-thoracic surgery 18.1 (2000): 54-61.
An Office Action dated Mar. 29, 2021, which issued during the prosecution of U.S. Appl. No. 16/738,516.
Ando, Tomo, et al. “Iatrogenic ventricular septal defect following transcatheter aortic valve replacement: a systematic review.” Heart, Lung and Circulation 25.10 (2016): 968-974.
Urena, Marina, et al. “Transseptal transcatheter mitral valve replacement using balloon-expandable transcatheter heart valves: a step-by-step approach.” JACC: Cardiovascular Interventions 10.19 (2017): 1905-1919.
An English summary of an Official Action dated Mar. 29, 2021, which issued during the prosecution of Chinese Patent Application No. 201780061210.3.
An International Search Report and a Written Opinion both dated Jan. 28, 2020, which issued during the prosecution of Applicant's PCT/IL2019/051031.
An International Preliminary Report on Patentability dated Mar. 9, 2021, which issued during the prosecution of Applicant's PCT/IL2019/051031.
An Office Action dated May 4, 2021, which issued during the prosecution of U.S. Appl. No. 16/636,204.
Notice of Allowance dated May 17, 2021, which issued during the prosecution of U.S. Appl. No. 16/138,129.
Notice of Allowance dated Jun. 4, 2021, which issued during the prosecution of U.S. Appl. No. 16/802,353.
An Office Action dated May 12, 2021, which issued during the prosecution of Canadian Patent Application No. 2,973,940.
Petition for Inter Partes Review of U.S. Pat. No. 10,702,385—dated Jun. 4, 2021.
Declaration of Ivan Vesely, Ph.D. In Support of Petition for Inter Partes Review of U.S. Pat. No. 10,702,385—dated Jun. 4, 2021.
Notice of Allowance dated Oct. 30, 2018, which issued during the prosecution of U.S. Appl. No. 15/197,069.
An International Search Report and a Written Opinion both dated Jul. 12, 2021, which issued during the prosecution of Applicant's PCT/IL2021/050132.
Notice of Allowance dated Oct. 3, 2019, which issued during the prosecution of U.S. Appl. No. 15/691,032.
An Office Action dated Sep. 6, 2018, which issued during the prosecution of U.S. Appl. No. 15/213,791.
Condado, José Antonio, et al. “Percutaneous edge-to-edge mitral valve repair: 2-year follow-up in the first human case.” Catheterization and cardiovascular interventions 67.2 (2006): 323-325.
Notice of Allowance dated Mar. 18, 2020, which issued during the prosecution of U.S. Appl. No. 16/284,331.
Feldman, Ted, et al. “Percutaneous mitral repair with the MitraClip system: safety and midterm durability in the initial EVEREST (Endovascular Valve Edge-to-Edge REpair Study) cohort.” Journal of the American College of Cardiology 54.8 (2009): 686-694.
Notice of Allowance dated Nov. 21, 2018, which issued during the prosecution of U.S. Appl. No. 15/213,791.
Notice of Allowance dated Jul. 3, 2019, which issued during the prosecution of U.S. Appl. No. 15/691,032.
IPR2021-00383 Petitioners' Authorized Reply to Patent Owner's Preliminary Response dated May 27, 2021.
Exhibit 1014—Transcript of proceedings held May 20, 2021 (Edwards Lifesciences vs. Cardiovalve).
Exhibit 1015—Facilitate, Meriam-Webster.com, https://www.merriamwebster.com/dictionary/facilitate (visited May 26, 2021).
Patent Owner's Authorized Surreply to Petitioner's Reply to Patent Owner's Preliminary Response dated Jun. 4, 2021(Edwards Lifesciences vs. Cardiovalve).
An Invitation to pay additional fees dated May 19, 2021, which issued during the prosecution of Applicant's PCT/IL2021/050132.
An Office Action dated Aug. 18, 2021, which issued during the prosecution of U.S. Appl. No. 17/210,183.
An Office Action dated Sep. 9, 2021, which issued during the prosecution of U.S. Appl. No. 16/768,909.
An Office Action dated Sep. 15, 2021, which issued during the prosecution of U.S. Appl. No. 16/135,599.
Notice of Allowance dated Oct. 14, 2021, which issued during the prosecution of U.S. Appl. No. 16/680,739.
An Office Action dated Oct. 21, 2021, which issued during the prosecution of U.S. Appl. No. 17/331,845.
European Search Report dated Oct. 11, 2021 which issued during the prosecution of Applicant's European App No. 21176010.3.
Fann, James I., et al. “Beating heart catheter-based edge-to-edge mitral valve procedure in a porcine model: efficacy and healing response.” Circulation 110.8 (2004): 988-993.
IPR2021-00383 Patent Owner'S Contingent Motion to Amend Under 37 C.F.R. §42.121 dated Oct. 13, 2021.
IPR2021-00383 Patent Owner's Response Pursuant to 37 C.F.R. §42.120 dated Oct. 13, 2021.
IPR2021-00383 Second Declaration of Dr. Michael Sacks dated Oct. 13, 2021.
An Office Action dated Oct. 21, 2021, which issued during the prosecution of U.S. Appl. No. 17/306,231.
Maisano, Francesco, et al. “The evolution from surgery to percutaneous mitral valve interventions: the role of the edge-to-edge technique.” Journal of the American College of Cardiology 58.21 (2011): 2174-2182.
An Office Action dated Nov. 6, 2015, which issued during the prosecution of U.S. Appl. No. 14/626,267.
An Office Action dated Jan. 26, 2022, which issued during the prosecution of U.S. Appl. No. 16/888,210.
IPR2021-00383 Deposition of Dr. Ivan Vesely, dated Sep. 22, 2021.
Cardiovalve Exhibit 2009—Percutaneous Mitral Leaflet Repair: MitraClip® Therapy for Mitral Regurgitation (2012).
Feldman, Ted, et al. “Percutaneous mitral valve repair using the edge-to-edge technique: six-month results of the EVEREST Phase I Clinical Trial.” Journal of the American College of Cardiology 46.11 (2005): 2134-2140.
An Office Action summarized English translation and Search Report dated Oct. 8, 2021, which issued during the prosecution of Chinese Patent Application No. 201780061210.3.
An Office Action dated Nov. 4, 2021, which issued during the prosecution of U.S. Appl. No. 17/366,711.
An Office Action summarized English translation and Search Report dated Aug. 12, 2021, which issued during the prosecution of Chinese Patent Application No. 201880058940.2.
An Office Action dated Nov. 25, 2021, which issued during the prosecution of European Patent Application No. 18826823.9.
IPR2021-01051 Institution decision dated Dec. 10, 2021
Notice of Allowance dated Dec. 7, 2021, which issued during the prosecution of U.S. Appl. No. 17/394,307.
Notice of Allowance dated Dec. 6, 2021, which issued during the prosecution of U.S. Appl. No. 16/738,516.
Notice of Allowance dated Dec. 29: 2021, which issued during the prosecution of U.S. Appl. No. 17/210,183.
IPR2021-00383 Petitioners' Reply to Patent Owner's Response dated Jan. 5, 2022.
IPR2021-00383 Petitioners' Opposition to Patent Owner's Contingent Motion to Amend dated Jan. 5, 2022.
An Office Action dated Sep. 22, 2021, which issued during the prosecution of European Patent Application No. 20714289.4.
Summary of Examination Notice dated Jan. 6, 2022, which issued during the prosecution of Chinese Patent Application No. 201880064313.X.
An Office Action dated Jan. 12, 2022, which issued during the prosecution of U.S. Appl. No. 17/101,787.
Notice of Allowance dated Jun. 20, 2017, which issued during the prosecution of U.S. Appl. No. 14/626,267.
Notice of Allowance dated Oct. 20, 2021, which issued during the prosecution of U.S. Appl. No. 16/636,204.
Notice of Allowance dated Jan. 31, 2022, which issued during the prosecution of U.S. Appl. No. 17/479,418.
An Office Action dated Jan. 13, 2022, which issued during the prosecution of U.S. Appl. No. 17/473,472.
An Office Action dated Jul. 27, 2022, which issued during the prosecution of U.S. Appl. No. 16/881,350.
An Office Action dated Sep. 21, 2022, which issued during the prosecution of U.S. Appl. No. 16/776,581.
An Office Action dated Jul. 20, 2022, which issued during the prosecution of U.S. Appl. No. 17/101,787.
An Office Action dated Sep. 16, 2022, which issued during the prosecution of U.S. Appl. No. 16/135,466.
An Office Action dated Aug. 1, 2022, which issued during the prosecution of European Patent Application No. 18826823.9.
European Search Report dated Sep. 6, 2022 which issued during the prosecution of Applicant's European App No. 22161862.2.
IPR2021-01051 Petitioners' Reply to Preliminary Guidance dated Aug. 2, 2022.
IPR2021-01051 Patent Owner's Sur-Reply To Petitioners' Reply to Preliminary Guidance dated Aug. 23, 2022.
An Office Action dated Aug. 5, 2022, which issued during the prosecution of U.S. Appl. No. 16/760,147.
An Office Action dated Sep. 8, 2022, which issued during the prosecution of U.S. Appl. No. 16/896,858.
European Search Report dated Mar. 20, 2023 which issued during the prosecution of Applicant's European App No. 22204764.9.
An Office Action dated Apr. 14, 2023, which issued during the prosecution of U.S. Appl. No. 16/144,054.
An Office Action dated May 15, 2023, which issued during the prosecution of U.S. Appl. No. 16/656,790.
An Office Action dated May 16, 2023, which issued during the prosecution of U.S. Appl. No. 17/114,771.
An Office Action dated May 25, 2023, which issued during the prosecution of U.S. Appl. No. 17/397,235.
An Office Action dated Mar. 3, 2023, which issued during the prosecution of European Patent Application No. 17 751 143.3.
An Office Action dated Mar. 20, 2023, which issued during the prosecution of U.S. Appl. No. 17/181,722.
Related Publications (1)
Number Date Country
20210393402 A1 Dec 2021 US
Provisional Applications (2)
Number Date Country
61756034 Jan 2013 US
61756049 Jan 2013 US
Continuations (3)
Number Date Country
Parent 16802353 Feb 2020 US
Child 17466785 US
Parent 15872501 Jan 2018 US
Child 16802353 US
Parent 14763004 US
Child 15872501 US