Patent Grant
11872130
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.
Dilation of the annulus of a heart valve, such as that caused by ischemic heart disease, 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.
For some applications, prosthetic heart valve implants are described that comprise an upstream frame, a downstream frame that is distinct from the upstream frame, and a flexible sheet that connects and provides fluid communication between the upstream and downstream frames. For some applications, snares are alternatively or additionally coupled to the valve frame by a flexible sheet.
The implants described are typically secured to tissue of a native heart valve by sandwiching the tissue between elements of the implant, such as between frames or frame components. The sandwiching is typically facilitated by elastic coupling between the frames or frame components. The elastic coupling may be provided by the flexible sheet, or may be provided by other means, such as by one or more of the frames, or by an additional elastic member.
There are therefore provided, in accordance with some applications of the invention, the following inventive concepts:
The present invention will be more fully understood from the following detailed description of applications thereof, taken together with the drawings, in which:
Reference is made to
Frame 22 has a generally toroid shape, having an upstream end 32, a downstream end 34, and a mid portion 36 therebetween. Mid portion 36 has a width d1 that is greater than a width d2 of downstream end 34 or a width d3 of upstream end 32. That is, frame 22 is typically wider at mid portion 36 than at upstream end 32 or downstream end 34. Upstream and downstream portions of frame 22 curve radially inward to provide frame 22 with this shape. It is to be noted that, although d2 and d3 are shown as being generally equal, for some applications of the invention these widths are different. For some applications, width d1 is greater than 35 mm and/or less than 75 mm (e.g., 35-75 mm, such as 50-65 mm). For some applications, width d2 and/or width d3 is greater than 35 mm and/or less than 60 mm (e.g., 35-60 mm, such as 40-50 mm). Frame 22 (e.g., downstream end 34 thereof) defines an opening 28 therethrough.
Typically, and as shown, frame 22 is wider at mid portion 36 than at upstream end 32 or downstream end 34, both with respect to an outer surface of the upstream frame, and with respect to an inner surface of the upstream frame. Therefore, the inner surface of the frame typically defines a ring-shaped concavity 52 upstream of downstream end 34 (see
For some applications, when viewed from the side, frame 22 appears generally stadium-shaped, and/or as a rectangle with rounded corners.
It is to be noted that, in its expanded state, frame 22 defines at least two layers. That is, a line parallel with and lateral to axis ax1 (i.e., closer to the outer edge of frame 22) will pass through the frame at least twice. For example, in the configuration of frame 22 shown in the figures, upstream end 32 defines a first layer and downstream end 34 defines a second layer. It is hypothesized that such a configuration increases stiffness of frame 22 in its expanded state, in a manner similar to that of a structural channel (known in the construction art), mutatis mutandis. It is to be noted that the scope of the invention includes other configurations (e.g., structures) of frame 22 that define at least two layers.
Frame 24 defines a generally tubular valve body 40 and a lumen 30 therethrough. Frame 24 (e.g., body 40) has an upstream portion 42 (including an upstream end) and a downstream portion 44 (including a downstream end). A plurality of snares (e.g., protrusions) 46 protrude radially outward from tubular body 40, thereby defining a diameter d11 that is greater than a diameter d12 of body 40.
Typically, snares 46 protrude outward in an upstream direction (i.e., toward upstream frame 22), e.g., at an angle alpha_1 greater than 10 degrees (e.g., greater than 15 degrees, e.g., greater than 25 degrees) and/or less than 90 degrees (e.g., less than 80 degrees, e.g., less than 55 degrees), such as 10-90 degrees (e.g., 15-80 degrees, e.g., 25-55 degrees), such as about 40 degrees. For some applications, and as shown, snares 46 are disposed at upstream portion 42. Typically, each snare 46 is defined by a cell of frame 24 that is bent out of plane to body 40. Alternatively, snares 46 may be disposed elsewhere on tubular body 40, such as at downstream portion 44 (e.g., as described hereinbelow with reference to
Frame 24 (and lumen 30) has a height that is typically greater than 8 mm and/or less than 40 mm, such as between 8 and 40 mm (e.g., between 12 and 25 mm, such as between 15 and 20 mm). For some applications this height is defined by a height of tubular body 40; this height is represented in
Frames 22 and 24 are typically thin-walled (e.g., having a thickness d14 (
Sheet 26 is shaped to define a conduit 48, and is coupled to frames 22 and 24 in a manner that provides closed fluid communication between opening 28 and lumen 30. Diameter d2 is typically greater than diameter d12, and the diameter of opening 28 is typically greater than the diameter of the lumen 30. Therefore an upstream portion of conduit 48 (i.e., a portion closer to upstream frame 22) is typically wider than a downstream portion of the conduit (i.e., a portion closer to downstream frame 24). For some applications, sheet 26 assumes a frustoconical or funnel shape, and may in fact serve as a funnel. The shape assumed by sheet 26 is typically at least partly guided by the expansion of frames 22 and 24.
Sheet 26 (i.e., a material thereof) 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, sheet 26 is coupled to frame 22 at a level that is upstream of opening 28, and for some applications the sheet is coupled to frame 24 at a level that is downstream of upstream portion 42. For example, portions of sheet 26 may line and/or cover at least part of (e.g., all of) frame 24, and at least part of frame 22. For example, and as shown, the sheet may line most of frame 22 and at least a downstream portion of frame 22 (including downstream end 34). The flexibility of such portions of the sheet is in effect reduced by being attached to the respective frame. Therefore, throughout this patent application, including the specification and the claims, unless specified otherwise, the term “flexible sheet” refers to portions of the sheet disposed between the frames (e.g., longitudinally between the frames), and typically not to portions of the sheet that line and/or cover the frames. It is to be noted that sheet 26 is not attached to snares 46.
Implant 20 comprises a valve member (e.g., a plurality of prosthetic leaflets) 50, configured to facilitate downstream movement of liquid (e.g., blood) through the apparatus (e.g., through opening 28, conduit 48, and lumen 30), and to inhibit upstream movement of the liquid through the apparatus. Leaflets 50 are shown in
For some applications, at least part of the immobilized edge of each leaflet is attached (e.g., sutured) to sheet 26 (i.e., within conduit 48).
Implant 20 is configured to be placed at a native heart valve of a subject, such as the mitral valve or tricuspid valve. Upstream frame 22 is shaped and dimensioned to be placed in an atrium of the heart that is upstream of the native valve, such as the left atrium, with downstream end 34 disposed against tissue of the native valve, such as against an annulus of the native valve. Typically, frame 22 is shaped and dimensioned to be placed in this position, with upstream end 32 not in contact with the roof of the atrium (i.e., the superior wall of the atrium). That is, frame 22 typically has a height d4 between upstream end 32 and downstream end 34 that is smaller than the height of the atrium between the annulus and the atrial roof. For some applications, height d4 is greater than 2 mm (e.g., greater than 7 mm) and/or less than 30 mm, e.g., between 2 and 30 mm (e.g., between 7 and 30 mm, such as between 10 and 20 mm). Examples of the positioning described in this paragraph are described in more detail hereinbelow, e.g., with reference to
Upstream frame 22 is typically elastically-coupled to downstream frame 24, such that a distance between the two frames is increasable to a distance d6 by applying a force, and in response to subsequent removal of that force, the distance automatically becomes reduced to a distance d7 (see
For some applications, distance d6 is greater than 0 mm and/or less than 35 mm (e.g., 0-35 mm, such as 5-18 mm). For some applications, distance d7 is greater than 0 mm and/or less than 25 mm (e.g., 0-25 mm, such as 0-10 mm). For some applications, in the absence of tissue disposed between frames 22 and 24, upstream portion 42 of frame 24 may actually be disposed within a space defined by frame 22 (e.g., may be disposed more than 1 mm and/or less than 10 mm (e.g., 1-10 mm, such as 1-5 mm) upstream of opening 28 of frame 22). For such applications, this distance upstream may be considered a negative value of distance d7, such that, overall, distance d7 may be greater than −10 mm and/or less than 25 mm (e.g., between −10 and 25 mm, such as between −5 and 10 mm).
For implant 20, the elastic coupling is provided by sheet 26. For example, sheet 26 may be a sheet of an elastic material, and/or may comprise one or more elastic threads embedded within, threaded through, and/or attached to the material of the sheet. For other systems similar to implant 20, other elements provide the elastic coupling, such as, but not limited to, those described with reference to
Reference is made to
Downstream frame 24 is shaped and dimensioned to be placed in ventricle 8, typically with upstream portion 42 and/or snares 46 in contact with tissue of the mitral valve, such as leaflets 12.
As described hereinbelow (e.g., with reference to
It is to be noted that throughout this application, including the specification and the claims, sandwiching of tissue between apparatus components means reducing a distance between the components while the tissue is disposed between the components (thereby typically increasing coupling to the tissue). Sandwiching does not necessarily require that the components move directly toward each other (e.g., having opposite but collinear vectors). For example, for applications in which diameter d11 is equal to or slightly larger than diameter d12, sandwiching may in fact occur as a result of snares 46 and downstream end 34 of frame 22 moving directly toward each other. However, for applications in which diameter d11 is smaller than diameter d12 (as shown), snares 46 and end 34 may not move directly toward each other, but may instead move as though they would eventually pass each other, nonetheless reducing the distance between these two components.
Inter alia,
Reference is now made to
A trocar 60 is transapically (e.g., intercostally) advanced into ventricle 8, and implant 20, in its compressed delivery state within a sheath 62, is delivered via the trocar (
Sheath 62 is subsequently partially withdrawn (i.e., moved downstream) such that upstream frame 22, sheet 26, and at least upstream portion 42 and/or snares 46 of downstream frame 24 are exposed from the sheath (
Due to the above-described position of implant 20, the leaflets coapt against upstream portion 42, and because of the expansion of this portion, during ventricular systole, a distance d9 between the leaflets at the point of this coaptation (e.g., between scallops a2 and p2) is greater than the distance when they previously coapted against sheath 62. This increased distance is observable by the operating physician using imaging techniques, e.g., as described hereinabove. For some applications, distance d9 is greater than 8 mm and/or less than 18 mm (e.g., 8-18 mm, such as 10-15 mm).
Subsequently, implant 20 and sheath 62 are withdrawn slightly proximally (i.e., downstream), until leaflets 12 coapt above upstream portion 42 and/or snares 46 (e.g., against sheet 26 and/or upstream frame 22). Because frame 22 has not expanded, a distance d10 between the leaflets during systole is now smaller than distance d9. This reduced distance is observable by the operating physician using imaging techniques, e.g., as described hereinabove. For some applications, distance d10 is greater than 5 mm and/or less than 12 mm (e.g., 5-12 mm, such as 6-8 mm). Typically, the withdrawal of implant 20 and sheath 62 is performed slowly, while observing leaflets 12, and withdrawal is stopped as soon as the physician observes a reduction in the systolic distance between them. It is hypothesized that this facilitates identification of a position of implant 20 in which upstream portion 42 of downstream frame 24 is close to, but downstream of, the level of coaptation of leaflets 12.
For some applications, at this stage, sheath 62 is further withdrawn with respect to implant 20, exposing more of downstream frame 24 (e.g., including some of downstream portion 44 thereof), and thereby facilitating further automatic expansion of the downstream frame (
It is to be noted that, for some applications, a longitudinal portion of implant 20 other than an end of the implant (e.g., a generally middle portion of the implant—upstream portion 42 and/or snares 46) is expanded prior to expansion of either end of the implant.
Typically, movement of downstream frame 24 with respect to sheath 62 is controlled via a mount 72, which is slidable though the sheath. Mount 72 comprises a body portion 76, and one or more flanges 74 via which it is reversibly coupled to frame 24. Mount 72 is dimensioned such that, while flanges 74 are disposed close to (e.g., touching) the inner wall of sheath 62, a gap 78 having a width d13 exists between body portion 76 and the inner wall of the sheath. Width d13 is greater than thickness d14 of frame 24, e.g., more than twice as great and/or less than 20 times as great, e.g., 2-20 times as great, such as 2-6 times as great. Thus, flanges 74 typically protrude radially outward from body portion 76 by a distance that is greater than thickness d14 (e.g., more than twice as great and/or less than 20 times as great, e.g., 2-20 times as great, such as 2-6 times as great).
Frame 24 is thereby movable radially inward and outward within gap 78, such that when the upstream part of the frame expands radially outward, the downstream end of the frame moves radially inward, frame 24 thereby pivoting about flanges 74. It is hypothesized that this configuration thereby proximal portion 42 and/or snares 46 of frame 24 expanding radially outward further than they would in a similar configuration in which width d13 is generally the same as thickness d14, i.e., in a configuration in which frame 24 fits snugly between body portion 76 and sheath 62.
Implant 20 and sheath 62 are subsequently moved distally (i.e., upstream), such that upstream portion 42 and/or snares 46 contact and apply an upstream force to tissue of the native valve, such as leaflets 12 (
Subsequently, sheath 62 is withdrawn further thereby exposing downstream portion 44 of downstream frame 24, and frame 24 automatically expands fully into its expanded state (
Upstream frame 22 is subsequently allowed to expand by releasing restraining element 64 while maintaining contact between upstream portion 42 (and/or snares 46) and the tissue of the native valve (
Restraining element 64 may alternatively or additionally comprise any restraining element configured to reversibly restrain upstream frame 22 in its compressed state. For example, (1) element 64 may comprise a wrapper (e.g., comprising a fabric) that circumscribes upstream frame 22, and retaining member 66 comprises a ripcord that opens the wrapper when pulled, or (2) element 64 may comprise a capsule that is slid off of frame 22.
For some applications, when upstream frame 22 expands, it applies a radially-outward force against the atrial walls, but does not apply a radially-outward force against the annulus (e.g., due to the position of the upstream frame with respect to the native valve). For some applications, when upstream frame 22 expands it does not apply a radially-outward force against the atrial walls (e.g., width d1 may be less than a width of the atrium).
Before release and expansion of upstream frame 22, the upstream frame is disposed around and held immobile with respect to a central rod 68, which provides a separating force that maintains a given distance between frames 22 and 24. Typically, downstream frame 24 is also disposed around and held immobile with respect to rod 68 while in its compressed state within sheath 62. Rod 68 therefore serves as a delivery tool, and/or a component thereof. For some applications, implant 20 is delivered to the heart with frames 22 and 24 separated by that given distance. For some applications, implant 20 is delivered to the heart with frames 22 and 24 closer than that given distance, and prior to release of frame 22 (e.g., subsequently to placement of snares 46 against the tissue of the native valve), the distance is increased by moving frame 22 away from frame 24. For some applications, rod 68 is slidable with respect to (e.g., through) mount 72 (described hereinabove with reference to
When frame 22 is released, the elastic coupling of frame 22 to frame 24 reduces the distance between the frames generally at the same time that frame 22 expands. The arrows in
Due to the coupling of frame 22 to the upstream portion of sheet 26, expansion of frame 22 pulls the upstream portion of sheet 26 radially outward, typically tensioning the sheet. For some applications, this sandwiches a portion of one or more leaflets 12 between sheet 26 and frame 24 and/or snares 46. For some applications, sheet 26 comprises one or more elastically-deformable wire braces (not shown; e.g., disposed circumferentially around conduit 48) that facilitate the radially-outward movement of the sheet.
For some applications, and as shown, a plurality of control wires 70 are coupled to upstream frame 22 and pass through rod 68 to outside of the body of the subject. For some applications, the operating physician may, by controlling tension on control wires 70, control expansion of frame 22. Alternatively or additionally, the operating physician may adjust positioning of frame 22 subsequently to its expansion, e.g., as shown in
As described hereinabove, positioning of frame 22 with respect to frame 24, while maintaining fluid communication therethrough, is facilitated by sheet 26. For example, and as shown in
As described hereinabove, securing of implant 20 at mitral valve 10 is facilitated by the elastic coupling of frame 22 to frame 24 which sandwiches valve tissue between the two frames. It is to be noted that this “sandwiching” is typically possible even when diameter d11 is smaller than width d2 (see
Reference is again made to
It is to be noted that for some applications snares 46 are disposed at a longitudinal portion of downstream frame 24 other than upstream portion 42. For example, snares 46 may be disposed at downstream portion 44 (e.g., as described for implant 140 with reference to
Reference is made to
In the contracted state of implant 140, at least upstream portion 42 (e.g., an upstream end) of downstream frame 144 is disposed upstream of second opening 150′ (e.g., within a space 154 defined by upstream frame 22). Typically, in the extended state, less (e.g., none) of frame 144 is disposed upstream of opening 150′ (e.g., within space 154). During implantation of implant 140, tissue of the native valve becomes sandwiched between snares 148 and upstream frame 22, e.g., using one or more of the mechanisms described herein.
It is hypothesized that the coupling of sheet 146 to upstream end 32 of frame 22 provides improved blood flow compared to a similar device in which the sheet is coupled to downstream end 34 of frame 22, because in the latter a zone 152 may be defined in the vicinity of downstream end 34 in which blood flow is reduced, increasing the likelihood of thrombosis formation. For example, zone 152 may be within space 154, downstream of upstream portion 42 of frame 144, and upstream of downstream end 34 of frame 22. It is to be noted that the scope of the invention includes coupling of sheet 146 to other regions of frame 22, such as slightly downstream of upstream end 32 (e.g., a quarter, a third, halfway, two-thirds, or three-quarters of the way toward downstream end 34).
Reference is now made to
Reference is now made to
Each snare typically extends more than 20 degrees around body 40 (e.g., more than 40 degrees, such as more than 60 degrees). Purely for illustrative purposes,
For some applications, snares 206 are used in combination with snares 46, described hereinabove. For example, an implant may comprise one snare 206 and a plurality of snares 46. Typically, when the implant comprises one or more snares 206 (as opposed to solely snares 46), the implant is placed in a particular rotational orientation with respect to the native valve, e.g., before deployment. For example, snares 206 may be aligned with the a2 and/or p2 scallops of leaflets 12 e.g., so as to reduce interaction with chordae tendineae. Typically, for the example in which the implant comprises one snare 206 and a plurality of snares 46, the snare 206 is aligned with the a2 scallop of the anterior leaflet.
Reference is made to
A catheter 220 (e.g., a sheath) is advanced transfemorally and via the inferior vena cava into right atrium 7 of the heart, and then into left atrium 6 via transseptal puncture, as is known in the art. Compared to the techniques described with reference to
The step shown in
Reference is again made to
For some applications, the upstream frame (e.g., the upstream frame of implant 140, or another upstream frame described herein) may be covered or lined (e.g., partially or entirely) with a covering, such as a fabric. For some applications, the covering may comprise the same material as the flexible sheet. For some such applications, a continuous piece of material may define the covering and the flexible sheet.
For some applications, in addition to or in place of elastic coupling of frame 22 to frame 24, sandwiching may be achieved by the operating physician actively reducing the distance between the frames, such as by tensioning one or more tethers. For some such applications, this may be achieved using apparatus and/or methods described in International Patent Application PCT/IL2014/050087, filed Jan. 23, 2014, which published as PCT Publication WO 2014/115149 to Hammer et al. and is incorporated herein by reference.
Reference is made to
In the expanded state of implant 240, upstream portion (e.g., an upstream end) 42 of downstream frame 244 is disposed longitudinally upstream of opening 150′ of upstream frame 22. That is, implant 240 has a central longitudinal axis, and upstream portion 42 is disposed further upstream along the longitudinal axis than is opening 150′. This typically occurs because expansion of upstream frame 22 toward its expanded state pulls valve frame 244 longitudinally in an upstream direction, by pulling sheet 246 radially outward. Typically, in the expanded state of implant 240, a diameter d15 of frame 244 is smaller than diameter d2 of frame 22, and sheet 246 is annular, extending radially inward from frame 22 to frame 244, and is circumferentially attached to frame 244 at a longitudinal site 254 of frame 244. Typically, sheet 246 provides fluid sealing between frames 22 and 244.
Implant 240 is percutaneously advanced, in its compressed state, to the native valve, and is deployed such that snares 248 are disposed downstream of the native valve (i.e., in the ventricle) and upstream frame 22 is disposed upstream of the native valve (i.e., in the atrium), e.g., sandwiching tissue of the native valve between the snares and the upstream frame (and/or between the snares and sheet 246).
Upstream frame 262 is similar to upstream frame 22 described hereinabove, except that frame 262 is not necessarily widest at a mid-portion thereof (compare to
It is to be noted that for some applications, frame 22 of implant 240 and frame 262 of implant 260 may be substituted for each other.
In the expanded state of implant 260, upstream portion (e.g., an upstream end) 42 of downstream frame 264 is disposed longitudinally upstream of opening 150′ of upstream frame 262. That is, implant 260 has a central longitudinal axis, and upstream portion 42 is disposed further upstream along the longitudinal axis than is opening 150′. This typically occurs because expansion of upstream frame 262 toward its expanded state pulls valve frame 264 longitudinally in an upstream direction, by pulling sheet 266a and/or sheet 266b radially outward. Typically, in the expanded state of implant 260, a diameter of frame 264 is smaller than a diameter d2 of frame 262, e.g., as described for implant 240, mutatis mutandis. That is, the diameter of frame 264 is smaller than the opening defined by the downstream end of frame 262. Sheet 266a extends radially inward from frame 262 to frame 264, and is circumferentially attached to frame 264 at a first longitudinal site 274a of frame 264. For some applications, sheet 266a is identical to sheet 246 described hereinabove, mutatis mutandis.
Sheet 266b also extends radially inward from frame 262 (e.g., from the same or a different point of frame 262), and is circumferentially attached to frame 264 at a second longitudinal site 274b of frame 264. Typically, longitudinal site 274b is closer to upstream portion 42 than is longitudinal site 274b. For example, longitudinal site 274b may be at least 2 mm and/or less than 8 mm closer to upstream portion 42 than is longitudinal site 274b (e.g., 2-12 mm closer, or at least 3 mm closer, such as 3-10 mm closer). Further typically, longitudinal site 274b is at upstream portion 42.
A chamber 276 (e.g., a closed chamber) that circumscribes frame 264 is defined between sheets 266a and 266b (shown in cross-section in
Reference is made to
Implant 280 comprises an upstream support 282, a valve frame 284, a snare frame 288, and at least one flexible sheet 286. Sheet 286 couples snare frame 288 to valve frame 284, and as shown, typically further couples upstream support 282 to the valve frame. For some applications, the coupling of upstream support 282 to valve frame 284 via sheet 286 is similar to that of the coupling provided by sheet 266b of implant 260, mutatis mutandis. Sheet 286 typically provides fluid sealing between support 282 (e.g., the frame thereof) and frame 284, and further typically provides fluid sealing between frames 284 and 288. For some applications, a single sheet 286 extends from snare frame 288, along valve frame 284, and to upstream support 282, thereby coupling the three frames together in the configuration shown. The coupling of the frames via sheet 286 advantageously provides some limited movement (e.g., articulation) between the frames, at least in some states of the implant. For example, as described hereinbelow, this coupling facilitates expansion of snare frame 288 while valve frame 284 remains at least in part compressed.
Snare frame 288 typically comprises an annular portion 290 and a plurality of snares 292 that extend from the annular portion.
Valve frame 284 is a tubular frame that defines a lumen therethrough, e.g., as described herein for other valve frames. For some applications, valve frame 284 is identical to other valve frames described herein.
Upstream support 282 is annular, and defines two annular portions: an upper annular portion 294 and a lower annular portion 296 that is circumferentially coupled to the upper annular portion (e.g., at a perimeter of upstream support 282). Upper annular portion 294 may be considered to be a first layer of support 282, and downstream annular portion 296 may be considered to be a second layer of the support. For some applications, upstream support 282 is cut from a single piece of metal (typically Nitinol), and in a compressed state of the upstream support, struts that form lower annular portion 296 intercalate with struts that form upper annular portion 294. For some applications, and as shown, the struts that define upper annular portion 294 are arranged as chevrons that repeat in a circumferential pattern (e.g., a zigzag pattern). For some applications, and as shown, the struts that define lower annular portion 296 are arranged as chevrons that repeat in a circumferential pattern. For some applications, and as shown, each chevron of upper annular portion 294 is coupled to a chevron of lower annular portion 296 at the perimeter of support 282, and is slightly differently sized to that chevron of the lower annular portion.
As shown in
For some applications, upstream support 282 is coupled to valve frame 284 such that upper annular portion 294 extends, from first longitudinal site 298, radially outward in a downstream direction (e.g., as shown). For some applications, upstream support 282 is coupled to valve frame 284 such that lower annular portion 296 extends, from the upper annular portion, radially inward in a downstream direction (e.g., as shown).
Lower annular portion 296 is deflectable with respect to upper annular portion 294, and is typically more movable with respect to valve frame 284 than is upper annular portion 296. For example, lower annular portion 296 may be articulatably coupled to upper annular portion 294, and/or may be more flexible than the upper annular portion (e.g., struts that form the lower annular portion may be thinner than those that form the upper annular portion, as shown). As described in more detail hereinbelow, it is hypothesized that this configuration facilitates sealing of support 282 against the upstream surface of mitral valve 10 (e.g., the mitral annulus) by maintaining contact between lower annular portion 296 and the upstream surface of the mitral valve, irrespective of an angle that upper annular portion 294 is disposed with respect to valve frame 284.
For some applications, the struts of upper annular portion 294 have a transverse cross-sectional area 295 of 0.25-1 mm{circumflex over ( )}2. For some applications, the struts of lower annular portion 296 have a transverse cross-sectional area 297 of 0.04-0.2 mm{circumflex over ( )}2. For some applications, support 282 has a diameter (defined by its perimeter) of 50-70 mm.
For some applications, sheet 286 extends over an upper surface of upper annular portion 294, around perimeter 300, and over a lower surface of lower annular portion 296 (thereby serving as a covering of portions 294 & 296). While implant 280 is implanted at mitral valve 10, the above-described configuration of upstream support 282 thereby holds the covering against the upstream surface of the mitral valve, thereby facilitating sealing.
The bubble of
At a connection point 310, portion 286c (i) is connected (e.g., sutured) to portion 286a or 286b (whichever does not extend to the upper end of valve frame 284), and (ii) is typically also connected to the valve frame. (Typically, portion 286a is also connected to valve frame 284 at point 310.) At a connection point 312, portion 286a or 286b (whichever extends to support 282) (i) is connected (e.g., sutured) to portion 286c, and (ii) is typically also connected to support 282. (Typically, portion 286c is also connected to support 282 at point 312.) It is to be noted that such an arrangement results in valve frame 284 being coupled to support 282 via two flexible sheets 286 (each of the sheets being defined by one of the sheet portions).
It is hypothesized that such an arrangement of sheet portions, and such attachment of the sheet portions to the frames and to each other, provides strong and durable coupling of valve frame 284 to support 282 via a flexible sheet.
A technique for implanting implant 280 is now described with reference to
Once snare frame 288 is fully exposed from delivery tube 302, the snare frame automatically expands toward its expanded state, e.g., by re-inverting, such that snares 292 are upstream of annular portion 290 (
These increased angles facilitate engagement of tissue of mitral valve 10 (e.g., leaflets 12) when implant 280 is subsequently moved upstream (
Following the upstream movement of implant 280, upstream support 282, in its compressed state within delivery tube 302, is upstream of mitral valve 10 (i.e., in atrium 6). For some applications, the coupling of upstream support 282 to valve frame 284 via sheet 286 facilitates expansion of the valve frame while the upstream support 282 remains compressed.
It is to be noted that therefore, for some applications, when implanting implant 280 (or another implant in which snares are coupled to the valve frame in the manner described for implant 280), the following steps are performed: (i) The implant is percutaneously delivered via delivery tube 302. (ii) While at least a portion (e.g., an upstream portion) of the valve frame remains disposed within the delivery tube, the snares are deployed from the distal end of the delivery tube such that the snares protrude radially outward and form angle alpha_3 with the axis, and angle alpha_4 with the valve frame. (iii) Subsequently, tissue of the native valve is engaged using the snares (e.g., by moving the implant in an upstream direction). (iv) Subsequently, by deploying more of the valve frame (e.g., the remainder of the valve frame) from the catheter, angle alpha_4 is reduced by at least 30 percent (e.g., by at least 50 percent), while angle alpha_3 is not changed by more than 10 percent (e.g., angle alpha_3 is changed by less than 8 percent, e.g., by less than 5 percent), such as while angle alpha_3 remains constant.
For some applications, in the absence of lower annular portion 296, upstream support 282 would contact the upstream valve surface only at perimeter 300. Lower annular portion 296 increases the contact surface area between upstream support 282 and the upstream valve surface.
Upper annular portion 294 is resilient (e.g., has shape memory) and is thus biased to assume a particular shape. For example, and as shown, upper annular portion 294 may be frustoconical, with its wider base lower than (e.g., downstream of) its narrower base. This characteristic facilitates upstream annular portion 294 serving as a spring that is tensioned by sandwiching of tissue between the upstream annular portion and snare frame 288 during implantation, and thereby facilitates secure anchoring of the implant at the mitral valve. Upstream annular portion facilitates this anchoring via tension on sheet 286.
Tensioning of upper annular portion 294 typically results in deflection of upper annular portion 294 with respect to valve frame 284 (e.g., perimeter 300 becomes more upstream with respect to site 298). This may also occur during the cardiac cycle. The deflectability of lower annular portion 296 with respect to upper annular portion 294 facilitates the lower annular portion remaining in contact with the upstream valve surface despite the deflection of the upper annular portion with respect to the upstream valve surface. Thus, for some applications, an angle alpha_5 between upper annular portion 294 and lower annular portion 296 when the implant is in a rest state (e.g., an unconstrained shape, such as when the implant is on a table-top) (
It is to be noted that for some applications snares 292 (e.g., snare frame 288) may be coupled via a flexible sheet to other prosthetic valves (e.g., to other valve frames described herein), including those comprising a valve frame that is rigidly coupled to an upstream support, and those comprising a valve frame that is not coupled to an upstream support (e.g., prosthetic valves that are configured to be intracorporeally coupled to an upstream support, and prosthetic valves that are configured to be implanted without an upstream support).
It is to be noted that for some applications upstream support 282 may be used in combination with other prosthetic valves (e.g., with other valve frames described herein), including those comprising a valve frame that is rigidly coupled to snares or tissue-engaging elements. It is to be noted that for some applications upstream support 282 may be rigidly coupled to valve frame 284 (or to another valve frame).
Reference is now made to
For some applications, articulation zone 289a separates snare frame 288 from valve frame 284 by at least 1.5 mm (e.g., 1.5-10 mm, e.g., 1.5-5 mm, such as 2-5 mm). For some applications, articulation zone 289a separates valve frame 284 from upstream support 282 by at least 1.5 mm (e.g., at least 3 mm, e.g., 3-10 mm, e.g., 3-8 mm, such as 3-5 mm).
For some applications this articulation is hypothesized to facilitate percutaneous (e.g., transluminal) delivery of implant 280, by allowing the compressed implant to articulate as it passes bends in the percutaneous path to the heart.
For some applications, in its compressed state, implant 280 has a length of at least 25 mm (e.g., 25-50 mm), such as at least 30 mm. For some applications, in its compressed state, implant 280 has a greatest width that is at least 50 percent (e.g., 50-90 percent), such as at least 75 percent (e.g., 75-98 percent, such as 75-90 percent) of the internal diameter of delivery tube 302. For some applications, in the compressed state of implant 280, upstream support 282, valve frame 284, and snare frame 288, each have a respective width d21 that is at least 50 percent (e.g., 50-90 percent), such as at least 75 percent (e.g., 75-98 percent, such as 75-90 percent) of the internal diameter of delivery tube 302. It is hypothesized that an implant having the same length and width, but not having articulatable coupled segments, would not be advanceable through bend 291.
For some applications, in the compressed state of implant 280, no individual rigid segment has a length (measured along the longitudinal axis of the implant) that is greater than 22 mm. For some applications, in the compressed state of implant 280, a sum of (i) a length d20′ of the rigid segment defined by support 282, (ii) a length d20″ of the rigid segment defined by frame 284, and a length d20′″ of the rigid segment defined by frame 288, is at least 35 mm.
Typically, a delivery tool 304, reversibly couplable to implant 280, is used to advance the implant to the heart (e.g., via delivery tube 302). Typically, implant 280 is delivered with snare frame 288 disposed distally to valve frame 284, and upstream support 282 disposed proximally to the valve frame, e.g., such that snare frame 288 emerges from tube 302 first.
For some applications, implant 280 is delivered with frame 288 inverted and folded up against the outside of frame 284. For such applications, it is hypothesized that the coupling of these two frames via sheet 286 facilitates this folding. For example, for some applications frame 288 (e.g., the entire length of frame 288) may be disposed flat against frame 284, thereby resulting in a small maximum width of the implant in its compressed state. In contrast, a different sort of coupling might result in the fold between the frames having a radius of curvature that increases the width of the implant, at least in the area of coupling between frames 288 and 284.
It is to be noted that for some applications the apparatus and techniques described with reference to
Reference is made to
Upstream support 642 is typically identical to upstream support 282 except where noted otherwise. Upstream support 642 is annular, and defines two annular portions: an upper annular portion 654 and a lower annular portion 656 that is circumferentially coupled to the upper annular portion (e.g., at a perimeter of upstream support 642). As described for support 282, for some applications struts 655 that form upper annular portion 654 of support 642 are arranged as chevrons that repeat in a circumferential pattern (e.g., a zigzag pattern). In contrast to support 282, struts 657 that form lower annular portion 656 of support 642 are typically individual rods 658 that protrude radially inward from the point at which they are coupled to upper annular portion 654 (e.g., from the perimeter of the frame). It is to be noted that the frame of support 642 (e.g., the struts of its upper and lower annular portions) is typically covered with a covering (e.g., described for support 282), such that the support generally resembles support 282 (e.g., as shown in
Support 442 generally functions as described for support 282. It is hypothesized that, for some applications, the different configuration of the lower annular portion of support 642 compared to that of support 282 facilitates independent movement of different regions of lower annular portion 656, thereby improving its conformation to the anatomy and/or sealing against the anatomy. For some applications, this is further facilitated by each rod 658 being shaped as a spring (as shown), thereby increasing flexibility of the rod.
Upstream support 662 is typically identical to upstream support 642 except where noted otherwise. Upstream support 662 is annular, and defines two annular portions: an upper annular portion 674 and a lower annular portion 676 that is circumferentially coupled to the upper annular portion (e.g., at a perimeter of upstream support 662). As described for support 282 and 642, for some applications struts 675 and 679 that form upper annular portion 674 of support 662 are arranged as chevrons that repeat in a circumferential pattern (e.g., a zigzag pattern). For some applications, and as shown, struts 677 that form lower annular portion 676 of support 662 are individual rods 678 that protrude radially inward from the point at which they are coupled to upper annular portion 664 (e.g., as described for support 642). For some applications (not shown), the struts that form lower annular portion 676 are arranged as chevrons that repeat in a circumferential pattern (e.g., as described for support 282). It is to be noted that the frame of support 662 (e.g., the struts of its upper and lower annular portions) is typically covered with a covering (e.g., described for support 282), such that the support generally resembles support 282 (e.g., as shown in
Upstream annular portion 674 of support 662 has a flexible sector 663 that is more flexible than other portions of the upstream annular portion. For example, struts 679 that form sector 663 may be more flexible (e.g., by being thinner) than struts 675 that form other portions of upstream annular portion 674. As shown in
Reference is made to
A valve member (e.g., a plurality of prosthetic leaflets) is disposed within the lumen defined by valve frame 384, so as to facilitate one-way downstream movement of blood through the lumen, e.g., as described herein for other valve members. For clarity, the valve member is not shown in
Implant 380 has a compressed state for percutaneous (e.g., transluminal) delivery to the heart, and is intracorporeally expandable into an expanded state. In the compressed state of implant 380, frames 382 and 384 are in respective compressed states thereof.
Support frame 382 has a generally toroid shape, defining an opening 390 through the support frame, and dimensioned to be placed against an upstream surface of the native heart valve such that the support frame circumscribes the valve orifice. Typically, support frame 382 is dimensioned to be placed on the annulus of the native valve. It is to be noted that the term toroid (including the specification and the claims) is describable as the result of revolving a plane geometric figure about a central longitudinal axis. The generally toroid shape of support frame 382 is describable as the result of revolving a plane geometric figure about a central longitudinal axis ax3 of the support frame (and/or of implant 380 as a whole). That is, an axis of revolution ax4 of the toroid shape circumscribes axis ax3, and the toroid shape is describable as the result of moving the plane geometric figure along the axis of revolution. It is to be noted that the position of axis of revolution ax4 is merely an illustrative example, and may pass through another part of the plane geometric figure.
For some applications, and as shown, the plane geometric figure is U-shaped or V-shaped (e.g., as shown in the cross-sections of
When valve frame 384 is moved in a downstream direction, a force is applied to support frame 382 via sheet 386, and the support frame 382 responsively rolls inward (e.g., about axis of revolution ax4) such that an orientation of the plane geometric figure with respect to opening 390 changes (e.g., the plane geometric figure deflects and/or rotates). For example, in
Support frame 382 is biased to assume its relaxed state, such that removal of the force (e.g., releasing of valve frame 384) results in implant 380 returning to the state shown in
For some applications support frame 382 defines an inner ring 394 and an outer ring 396, each ring defined by a circumferential arrangement of cells, each cell of the inner ring coupled to adjacent cells of the inner ring, and to a corresponding cell of the outer ring. The inner ring defines one arm of the U-shape, the outer ring defines the other arm of the U-shape, and the inner ring cells are coupled to the outer ring cells at a trough 398 of the U-shape. The rolling of frame 382 in response to the applied force compresses the inner ring cells and outer ring cells, at least in part, i.e., reducing a width d17 of the inner ring cells and a width d18 of the outer ring cells. Upon removal of the force, the cells re-widen, thereby causing support frame 382 to roll back toward its relaxed state.
The mechanics described in the above paragraph may be alternatively described as follows: The rolling of the frame moves at least part of inner ring 394 and at least part of outer ring 396 radially inward, such that a diameter of each ring becomes smaller. Upon removal of the force each ring re-expands toward its original diameter, thereby causing support frame 382 to roll back toward its relaxed state. That is, support frame 382 defines at least one ring that is compressed as the frame rolls inward, and expands as the frame rolls outward. This is illustrated in the cross-sections of
The biasing of support frame 382 to assume its relaxed state is typically achieved by forming the support frame from a shape-memory material such as Nitinol.
For some applications, and as shown, sheet 386 extends over the lip of inner ring 394, and covers at least part of the inner ring. For some such applications, sheet 386 is circumferentially attached to support frame 382 at least at trough 398.
The rolling inward of support frame 382 typically involves a most-radially-inward point of contact between the support frame and sheet 386 moving in a downstream direction, and further typically involves the most-radially-inward point of contact moving radially inward. For example, and as shown in the cross-sections of
Reference is made to
Prior to implantation, implant 402 is coupled to a delivery tool 410, which typically comprises a central rod (e.g., as described elsewhere herein, mulatis mutandis). For some applications, implant 402 is provided pre-coupled to the delivery tool (e.g., by being compressed, or “crimped”, onto the delivery tool, as is known in the art, mutatis mutandis). For some applications, part or all of implant 402 is coupled to delivery tool 410 soon before implantation (e.g., by the operating physician, or by a technician at the operating institution). For example, for applications in which one of the frames (e.g., frame 408) comprises a prosthetic valve frame that comprises prosthetic leaflets, it may be desirable that the prosthetic valve frame not remain compressed for an extended period, and so at least that frame is compressed against the delivery tool soon before implantation.
Once frames 404 and 408 are coupled to the delivery tool (e.g., to respective connectors of the delivery tool), the elastic coupling between the frames is stretched by increasing a distance between the frames, such as by increasing a distance between the connectors to which the frames are coupled (
Reference is now made to
Implant 460 comprises an upstream frame 462, a downstream frame 464, and at least one flexible sheet 466 that couples the upstream frame to the downstream frame. Typically, implant 460 comprises two flexible sheets 466, such as a flexible sheet 466a and a flexible sheet 466b, which each couple upstream frame 462 to downstream frame 464. Downstream frame 464 comprises a tubular body that defines a lumen therethrough (e.g., as described hereinabove for other downstream frames), and a plurality of snares 468. As shown, snares 468 typically meet the valve body defined by frame 464 toward a downstream end of the valve body, and do not extend in an upstream direction as far as the upstream end of frame 464. Implant 460 comprises a valve member (e.g., a plurality of prosthetic leaflets) 50 disposed within the lumen defined by downstream frame 464, e.g., as described hereinabove, mutatis mutandis.
As described for upstream frame 22, mutatis mutandis, upstream frame 462 (and other upstream frames described herein, such as upstream frame 262) may be considered to define an upstream opening 150 (i.e., an opening defined by an upstream end of the upstream frame) and a downstream opening 150′ (i.e., an opening defined by a downstream end of the upstream frame). An upstream end 492 of frame 462 defines upstream opening 150 of frame 462, and a downstream end 494 of frame 462 defines downstream opening 150′ of frame 462. It is to be noted that throughout this application (including the specification and the claims), in the absence of further definition, the “opening” of any of the upstream frames typically refers to the downstream opening of the upstream frame.
As described for implant 260, mutatis mutandis, in the expanded state of implant 460, a diameter of frame 464 is smaller than a diameter of opening 150′ defined by downstream end 494 of frame 462. Sheet 466a extends radially inward from frame 462 to frame 464, and is circumferentially attached to frame 464 at a first longitudinal site 474a of frame 464. For some applications, sheet 466a is identical to sheet 266a described hereinabove, mutatis mutandis. Sheet 466b also extends radially inward from frame 462, and is circumferentially attached to frame 464 at a second longitudinal site 474b of frame 464.
Typically, longitudinal site 474b is closer to upstream portion 42 than is longitudinal site 474b. For example, longitudinal site 474b may be at least 4 mm and/or less than 10 mm closer to an upstream end of frame 464 than is longitudinal site 474b (e.g., 4-10 mm closer, or at least 3 mm closer, such as 3-10 mm closer, e.g., about 6 mm closer). For some applications, longitudinal site 474b is at the upstream end of frame 464, although is shown in
Typically, sheet 466b is attached to upstream frame 462 further upstream than is sheet 466a. For example, and as shown, sheet 466a may be attached to (i.e., may extend from) downstream end 494 of frame 462, whereas sheet 466b may be attached to (i.e., may extend from) upstream end 492 of frame 462. The sites of attachment of sheets 466 to frames 462 and 464 (i) facilitates the longitudinal pulling of frame 464 into frame 462 (e.g., via opening 150′) by the radial expansion of frame 462, (ii) facilitate smooth bloodflow from opening 150 into the lumen of downstream frame 464, and/or (iii) defines, between sheets 466a and 466b, a chamber 476 (e.g., a closed chamber) that circumscribes frame 464. Chamber 476 is typically toroidal. Subsequently to implantation of implant 460, tissue formation typically occurs within chamber 476, e.g., due to blood entering the chamber 476 by passing through the flexible sheets (e.g., at least one of the sheets is at least partially blood-permeable). For some applications this tissue formation is hypothesized to gradually increase rigidity of implant 460.
Therefore, as described with reference to implants 260 and 460, percutaneously-implantable apparatus is provided, comprising (i) a first frame; (ii) a second frame; and (iii) a plurality of flexible sheets comprising at least a first flexible sheet and a second flexible sheet, at least the first sheet coupling the first frame to the second frame, and the plurality of flexible sheets being coupled to the first frame and the second frame such that a closed chamber is disposed between the first sheet and the second sheet, and at least one of the sheets being at least partially blood-permeable.
As described hereinabove for other implants, mulatis mutandis, frames 462 and 464 (or at least portions thereof) are typically covered and/or lined, and flexible sheets 466a and 466b may extend over portions of the frames so as to perform this function. For example, and as shown, sheet 466a typically extends from longitudinal site 474a of frame 464, to downstream end 494 of frame 462, and over an outer surface of frame 462. Sheet 466a may continue to extend around upstream end 492 of frame 462 and line part of an inner surface of frame 462, as shown. Frame 464 is typically at least partly lined, e.g., with a fabric, which may be the same material as sheet(s) 466. For some applications, and as shown, frame 464 has unlined zones, e.g., positioned where leaflets 50 deflect outward to allow fluid flow.
There is therefore provided, in accordance with some applications of the invention, apparatus comprising: (i) a first catheter (e.g., catheter 504), dimensioned for transfemoral and transseptal advancement into a left atrium of a heart of a subject, and having a lumen that has an internal diameter; (ii) a second catheter (e.g., catheter 506), having an external diameter that is smaller than the internal diameter, the second catheter being sufficiently long to extend through the first catheter such that a steerable distal portion (e.g., portion 507) of the second catheter extends out of a distal end of the first catheter, and (iii) an implant (e.g., implant 460), having a compressed state in which the implant is transfemorally and transseptally advanceable into the left atrium by the first catheter and the second catheter, and in which a width of the implant is greater than the internal diameter of the first catheter.
It is to be noted that the term “steerable” (including the specification and the claims) means actively steerable, e.g., by using an extracorporeal controller to effect bending. (This is in contrast to a flexible but non-steerable element, which may bend in response to encountering forces during advancement through the body of the subject.) Bending of portion 505 of catheter 504 is performed by actuating a controller 565 (e.g., on a handle 555 at a proximal end of catheter 504) that is operably coupled (e.g., via pull-wires) to portion 505. Bending of portion 507 of catheter 506 is performed by actuating a controller 567 (e.g., on a handle 557 at a proximal end of catheter 506) that is operably coupled (e.g., via pull-wires) to portion 507. Bending of portion 509 of rod 508 is performed by actuating a controller 569 (e.g., on a handle 559 at a proximal end of rod 508) that is operably coupled (e.g., via pull-wires) to portion 509. Typically, a bending plane of portion 507 is orthogonal to a bending plane of portion 505. Thereby together catheters 504 and 506 provide movement in two dimensions. Portion 509 of rod 508 may be steerable on one or more bending planes (e.g., on two bending planes). As well as being steerable, rod 508 is typically slidable longitudinally with respect to the catheters (e.g., by sliding handle 559, such as along a track 558).
As shown in sub-views C and B, implant 460, in its compressed state, is disposed around steerable distal portion 509 of rod 508, with frames 464 and 462 in tandem with each other. Sub-view C shows implant 460 including sheets 466 (which also serve as coverings for the frames of implant 460, e.g., as described elsewhere hereinabove, mulatis mutandis), and sub-view B shows the implant in the absence of sheets 466, thereby more clearly showing the positions of frames 462 and 464. Frame 462 is disposed around rod 508 (e.g., around distal portion 509 thereof) at a first longitudinal site 560a, sheet 466 is disposed around rod 508 at a second longitudinal site 560b, and frame 464 is disposed around rod 508 at a third longitudinal site 560c. Distal portion 509 is bendable at least at second longitudinal site 560b, which serves as an articulation zone.
As shown in sub-view A (as well as the primary view), a sheath 510 is disposed over at least implant 460 (and typically over at least portions 507 and 509 of catheters 506 and 508). Sheath 510 is thin (e.g., greater than 100 microns and/or less than 300 microns, e.g., 100-300 microns, such as about 200 microns thick), typically has insignificant compressive, torsional, or deflective strength, and is sufficiently flexible to passively bend in response to the bending of rod 508 and the articulation between frames 462 and 464. Sheath 510 comprises a low-friction material (e.g., is formed from the low-friction material, or is coated in the low-friction material) such as polytetrafluoroethylene (PTFE).
A second cross-section (
A third cross-section (
It is to be noted that in this context, the term “layer” (including in the specification and in the claims) may refer to a continuous layer (such as that defined by sheath 510) or an interrupted layer (such as that which might defined by the struts of frames 462 and 464, when viewed in cross-section).
It is to be noted that no guide catheter is advanced to the heart prior to advancing implant 460. Rather, system 500 is advanced as-is, through the vasculature. Rather, sheath 510 slides through the vasculature simultaneously with implant 460, and reduces friction between implant 460 and the vasculature.
It is to be further noted, that implant 460 is not disposed within a steerable (i.e., actively bendable) catheter for any part of the implantation process. Rather, and as can be understood from
System 500 is advanced transseptally into left atrium 6 (
System 500 is then advanced between leaflets 12 of mitral valve 10, typically such that (within sheath 510) at least part of frame 464 is disposed in left ventricle 8, and at least part of frame 462 is disposed within left atrium 6 (
There is therefore provided, in accordance with some applications of the invention, a method comprising (i) using a delivery tool, percutaneously advancing toward a heart of a subject a prosthetic valve implant coupled to a distal portion of the delivery tool, the implant comprising a first frame coupled to a second frame; (ii) subsequently, articulating the first frame with respect to the second frame by bending the distal portion of the delivery tool; (iii) subsequently, reducing the articulation of the first frame with respect to the second frame by reducing the bending of the distal portion of the delivery tool; and (iv) subsequently, implanting the implant in the heart of the subject. For some applications, between the step of articulating the first frame and the step of implanting, another portion of the delivery tool, proximal to the distal portion, is bent.
There is therefore also provided, in accordance with some applications of the invention, apparatus, comprising: (i) a delivery tool (e.g., tool 502) comprising: (a) a first catheter (e.g., catheter 504), (b) a second catheter (e.g., catheter 506) extending through the first catheter, and (c) one or more extracorporeal controllers (e.g., controllers 565, 567, and 569), coupled to a proximal end of at least one of the first catheter and the second catheter; and (ii) an implant (e.g., implant 460), comprising a first frame (e.g., frame 462) articulatably coupled to a second frame (e.g., frame 464), and coupled to a distal portion of the delivery tool, distal to a distal end of the first catheter and to a distal end of the second catheter, and the one or more extracorporeal controllers are actuatable to transition the apparatus between: (i) a first state in which the first catheter and the second catheter are straight, and the first frame is articulated with respect to the second frame, and (ii) a second state in which a distal portion of at least one of the first catheter and the second catheter is bent, and the first frame is collinear with the second frame.
Subsequently, implant 460 is unsheathed (
As shown in
First restraint 530a, which restrains snares 468 in their compressed state, is disengaged, thereby allowing the snares to extend radially away from frame 464 (e.g., from the valve body thereof) (
Second restraint 530b remains in place, restraining frame 464 (e.g., the valve body thereof) in its compressed state, and third restraint 530c remains in place, restraining frame 462 in its compressed state. Typically, at this stage, one or more imaging techniques (e.g., fluoroscopy) are used to determine, and optionally adjust, the position of implant 460, and in particular of snares 468 thereof.
There is therefore provided (e.g., as described with reference to
As shown in
There is therefore provided, in accordance with some applications of the invention, a method, comprising: (i) transluminally advancing an implant to a heart of a subject, the implant including (a) a valve frame at a downstream portion of the implant, (b) a valve member disposed within the valve frame, (c) a flexible sheet, and (d) a support frame at an upstream portion of the implant, coupled to the valve frame via the flexible sheet, wherein the valve frame and the support frame are constrained in respective compressed states during the advancing; and (ii) within the heart, (a) releasing the valve frame such that the valve frame automatically expands from its compressed state, while (b) maintaining the support frame in its compressed state such that the support frame limits expansion of an upstream portion of the valve frame via tension on the sheet.
Tissue of the native valve (e.g., leaflet tissue) is engaged using snares 468 by moving implant 460 upstream (e.g., by withdrawing rod 508 into catheter 506) (
Subsequently, restraint 530c is disengaged (e.g., using restraint controller 532c), thereby allowing upstream frame 462 to expand toward its expanded state (
Subsequently, delivery tool 502 is withdrawn from the subject, leaving implant 460 implanted at the native valve, and serving as a prosthetic valve (
There is therefore provided, in accordance with some applications of the invention, a method comprising (i) transfemorally advancing to the heart a rod (e.g., rod 508) and an implant (e.g., implant 460) compressed around a distal portion of the rod, the implant including a first frame (e.g., frame 462), a second frame (e.g., frame 464), a valve member (e.g., leaflets 50) disposed within the second frame, and a flexible sheet (e.g., sheet 466a) coupling the first frame to the second frame, wherein the first frame and the second frame are in tandem; (ii) subsequently, articulating the second frame with respect to the first frame by bending the distal portion of the rod by operating an extracorporeal controller (e.g., controller 569); and (iii) subsequently, implanting the implant at the valve such that at least part of the first frame is disposed on a first side of the valve and at least part of the second frame is disposed on a second side of the valve.
As described for implant 460, and for other implants, there is also provided, in accordance with some applications of the invention, a method, comprising (i) percutaneously delivering into the body an implant in a compressed state, the implant (a) having a longitudinal axis, and (b) including a first frame, a flexible sheet, and a second frame coupled, via the flexible sheet, to the first frame in tandem along the longitudinal axis; and (ii) subsequently, radially expanding the first frame such that the first frame pulls the second frame longitudinally into the first frame by pulling the sheet radially outward.
There is also provided, in accordance with some applications of the invention, apparatus comprising (i) a first frame having a compressed state in which the frame is transluminally advanceable into the subject, and having a tendency to radially expand from the compressed state toward an expanded state; and (ii) a second frame distinct from the first frame, and coupled to the first frame in tandem with the first frame along a longitudinal axis of the implant, and the coupling of the second frame to the first frame is such that a radially outward force of the first frame during its expansion is converted into a longitudinal force that pulls the second frame into the first frame.
Although transfemoral and transseptal delivery is described, for some applications a retrograde approach (i.e., via the aortic valve) is used, mulatis mutandis. For such applications, as well as other differences, implant 460 is disposed on delivery tool 502 in the inverse orientation (i.e., with frame 464 disposed proximally to frame 462).
It is to be noted that delivery tool 502 may be used to deliver prosthetic heart valves other than implant 460. For some applications, tool 502 is used to deliver a prosthetic valve that, in its delivery state, does not have an articulation zone between two frames. For some applications, tool 502 is used to deliver a prosthetic valve that, in its delivery state, is rigid. For such applications, rod 508 is typically used to orient the compressed prosthetic valve with respect to the native valve.
Reference is again made to
Therefore apparatus is provided, in accordance with some applications of the invention, comprising (i) a support frame, having a compressed state, and an expanded state in which the support frame defines an opening therethrough, and is dimensioned to be placed against an upstream surface of the native valve such that the opening is disposed over an orifice defined by the native valve; (ii) a flexible sheet; and (i) a valve frame that (a) has a compressed state, and an expanded state in which the valve frame defines a lumen therethrough, (b) comprises a valve member disposed within the lumen, and (c) is coupled to the support frame via the flexible sheet such that when the support frame is in its expanded state, and the valve frame is in its expanded state, at least part of the lumen is disposed within the opening, and the valve frame is not in contact with the support frame.
Reference is again made to
Reference is again made to
Reference is again made to
For some applications, the apparatus and techniques described herein may be used in combination with apparatus and techniques described in one or more of the following references, which are incorporated herein by reference:
It will be appreciated by persons skilled in the art that the present invention is not limited to what has been particularly shown and described hereinabove. Rather, the scope of the present invention includes both combinations and subcombinations of the various features described hereinabove, as well as variations and modifications thereof that are not in the prior art, which would occur to persons skilled in the art upon reading the foregoing description.
The present application is a Continuation of U.S. patent application 15/703,385 to Hammer et al., filed Sep. 13, 2017, now U.S. Pat. No. 10,492,908, which published as US 2018/0014932, and which is a Continuation of U.S. patent application 15/329,920 to Hammer et al., filed Jan. 27, 2017, now U.S. Pat. No. 10,524,910, which published as US 2017/0266003, and which is the US National Phase of PCT application IL2015/050792 to Hammer et al., filed Jul 30, 2015, and entitled “Articulatable prosthetic valve,” which published as WO 2016/016899, and which claims priority from: (i) U.S. Provisional Patent Application 62/030,715 to Hammer et al., filed Jul. 30, 2014, and entitled “Prosthetic valve with crown”; and (ii) U.S. Provisional Patent Application 62/139,854 to Hammer et al., filed Mar. 30, 2015, and entitled “Prosthetic valve with crown.” The present application is related to (i) PCT patent application IL2014/050087 to Hammer et al., filed Jan. 23, 2014, entitled “Ventricularly-anchored prosthetic valves”, which published as WO 2014/115149, and (ii) U.S. patent application 14/763,004 to Hammer et al., entitled “Ventricularly-anchored prosthetic valves”, now abandoned, which published as US 2015/0351906, and which is a US National Phase of PCT IL2014/050087. All of the above are incorporated herein by reference.
| Number | Name | Date | Kind |
|---|---|---|---|
| 3874388 | King et al. | Apr 1975 | A |
| 4222126 | Boretos et al. | Sep 1980 | A |
| 4340091 | Skelton et al. | Jul 1982 | A |
| 4972494 | White et al. | Nov 1990 | A |
| 5201757 | Heyn et al. | Apr 1993 | A |
| 5314473 | Godin | May 1994 | A |
| 5473812 | Morris et al. | Dec 1995 | A |
| 5702397 | Goble et al. | Dec 1997 | A |
| 5713948 | Uflacker | Feb 1998 | A |
| 5716417 | Girard et al. | Feb 1998 | A |
| 5741297 | Simon | Apr 1998 | A |
| 5776140 | Cottone | Jul 1998 | A |
| 5954766 | Zadno-Azizi et al. | Sep 1999 | A |
| 5957949 | Leonhardt et al. | Sep 1999 | A |
| 6010530 | Goicoechea | Jan 2000 | A |
| 6126686 | Badylak et al. | Oct 2000 | A |
| 6165183 | Kuehn et al. | Dec 2000 | A |
| 6254609 | Vrba et al. | Jul 2001 | B1 |
| 6264700 | Kilcoyne et al. | Jul 2001 | B1 |
| 6312465 | Griffin et al. | Nov 2001 | B1 |
| 6334873 | Lane et al. | Jan 2002 | B1 |
| 6346074 | Roth | Feb 2002 | B1 |
| 6402780 | Williamson, IV et al. | Jun 2002 | B2 |
| 6454799 | Schreck | Sep 2002 | B1 |
| 6569196 | Vesely | May 2003 | B1 |
| 6669724 | Park | Dec 2003 | B2 |
| 6682558 | Tu et al. | Jan 2004 | B2 |
| 6730121 | Ortiz et al. | May 2004 | B2 |
| 6733525 | Yang et al. | May 2004 | B2 |
| 6752813 | Goldfarb et al. | Jun 2004 | B2 |
| 6764518 | Godin | Jul 2004 | B2 |
| 6821297 | Snyders | Nov 2004 | B2 |
| 6893460 | Spenser et al. | May 2005 | B2 |
| 6926715 | Hauck et al. | Aug 2005 | B1 |
| 6951571 | Srivastava et al. | Oct 2005 | B1 |
| 6974476 | McGuckin, Jr. et al. | Dec 2005 | B2 |
| 6997918 | Soltesz | Feb 2006 | B2 |
| 7018406 | Seguin et al. | Mar 2006 | B2 |
| 7074236 | Rabkin et al. | Jul 2006 | B2 |
| 7137184 | Schreck | Nov 2006 | B2 |
| 7175656 | Khairkhahan | Feb 2007 | B2 |
| 7226467 | Lucatero et al. | Jun 2007 | B2 |
| 7226477 | Cox | Jun 2007 | B2 |
| 7252682 | Seguin | Aug 2007 | B2 |
| 7261686 | Couvillon, Jr. | Aug 2007 | B2 |
| 7288097 | Séguin | Oct 2007 | B2 |
| 7316716 | Egan | Jan 2008 | B2 |
| 7377938 | Sarac et al. | May 2008 | B2 |
| 7381218 | Schreck | Jun 2008 | B2 |
| 7381219 | Salahieh et al. | Jun 2008 | B2 |
| 7524331 | Birdsall | Apr 2009 | B2 |
| 7556632 | Zadno | Jul 2009 | B2 |
| 7556646 | Yang et al. | Jul 2009 | B2 |
| 7563267 | Goldfarb et al. | Jul 2009 | B2 |
| 7563273 | Goldfarb et al. | Jul 2009 | B2 |
| 7585321 | Cribier | Sep 2009 | B2 |
| 7597711 | Drews et al. | Oct 2009 | B2 |
| 7608091 | Goldfarb et al. | Oct 2009 | B2 |
| 7611534 | Kapadia et al. | Nov 2009 | B2 |
| 7635329 | Goldfarb et al. | Dec 2009 | B2 |
| 7655015 | Goldfarb et al. | Feb 2010 | B2 |
| 7717952 | Case et al. | May 2010 | B2 |
| 7731742 | Schlick | Jun 2010 | B2 |
| 7736388 | Goldfarb et al. | Jun 2010 | B2 |
| 7753949 | Lamphere et al. | Jul 2010 | B2 |
| 7758640 | Vesely | Jul 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 |
| 7951195 | Antonsson et al. | May 2011 | B2 |
| 7959666 | Salahieh et al. | Jun 2011 | B2 |
| 7959672 | Salahleh et al. | Jun 2011 | B2 |
| 8002826 | Seguin | Aug 2011 | B2 |
| 8025695 | Fogarty et al. | Sep 2011 | B2 |
| 8029557 | Sobino-Serrano et al. | Oct 2011 | B2 |
| 8038720 | Wallace et al. | Oct 2011 | B2 |
| 8052592 | Goldfarb et al. | Nov 2011 | B2 |
| 8052749 | Salahieh et al. | Nov 2011 | B2 |
| 8057493 | Goldfarb et al. | Nov 2011 | B2 |
| 8070802 | Lamphere et al. | Dec 2011 | B2 |
| 8080054 | Rowe | Dec 2011 | B2 |
| D652927 | Braido et al. | Jan 2012 | S |
| D653341 | Braido et al. | Jan 2012 | S |
| 8109996 | Stacchino et al. | Feb 2012 | B2 |
| 8133270 | Kheradvar et al. | Mar 2012 | B2 |
| 8163008 | Wilson et al. | Apr 2012 | B2 |
| D660433 | Braido et al. | May 2012 | S |
| D660967 | Braido et al. | May 2012 | S |
| 8172898 | Alferness et al. | May 2012 | B2 |
| 8216256 | Raschdorf, Jr. et al. | Jul 2012 | B2 |
| 8337541 | Quadri et al. | Dec 2012 | B2 |
| 8348999 | Kheradvar et al. | Jan 2013 | B2 |
| 8366767 | Zhang | Feb 2013 | B2 |
| 8372140 | Hoffman et al. | Feb 2013 | B2 |
| 8377119 | Drews et al. | Feb 2013 | B2 |
| 8398708 | Meiri et al. | Mar 2013 | B2 |
| 8403981 | Forster et al. | Mar 2013 | B2 |
| 8403983 | Quadri et al. | Mar 2013 | B2 |
| 8414644 | Quadri et al. | Apr 2013 | B2 |
| 8425593 | Braido et al. | Apr 2013 | B2 |
| 8444689 | Zhang | May 2013 | B2 |
| 8449599 | Chau et al. | May 2013 | B2 |
| 8460365 | Haverkost et al. | Jun 2013 | B2 |
| 8474460 | Barrett et al. | Jul 2013 | B2 |
| 8500821 | Sobrino-Serrano et al. | Aug 2013 | B2 |
| 8512400 | Tran et al. | Aug 2013 | B2 |
| 8539662 | Stacchino et al. | Sep 2013 | B2 |
| 8540767 | Zhang | Sep 2013 | B2 |
| 8551160 | Figulla et al. | 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 |
| 8623075 | Murray et al. | Jan 2014 | B2 |
| 8623080 | Fogarty et al. | Jan 2014 | B2 |
| 8628570 | Seguin | Jan 2014 | B2 |
| 8628571 | Hacohen et al. | Jan 2014 | B1 |
| 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 |
| 8728155 | Montorfano et al. | May 2014 | B2 |
| 8734507 | Keranen | May 2014 | B2 |
| 8747460 | Tuval et al. | Jun 2014 | B2 |
| 8771345 | Tuval et al. | Jul 2014 | B2 |
| 8784479 | Antonsson et al. | Jul 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 |
| 8840663 | Salahieh et al. | Sep 2014 | B2 |
| 8840664 | Karapetian et al. | Sep 2014 | B2 |
| 8845722 | Gabbay | Sep 2014 | B2 |
| 8852261 | White | Oct 2014 | B2 |
| 8852272 | Gross 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 |
| 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 |
| 8911489 | Ben-Muvhar | Dec 2014 | B2 |
| 8911493 | Rowe et al. | Dec 2014 | B2 |
| 8932343 | Alkhatib et al. | Jan 2015 | B2 |
| 8945177 | Dell et al. | Feb 2015 | B2 |
| 8961595 | Alkhatib | Feb 2015 | B2 |
| 8979922 | Jayasinhe 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 |
| 9011527 | Li 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 |
| 9039757 | McLean et al. | May 2015 | B2 |
| D732666 | Nguyen et al. | Jun 2015 | S |
| 9050188 | Schweich, Jr. 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 |
| 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 |
| 9173659 | Bodewadt et al. | Nov 2015 | B2 |
| 9173738 | Murray, III et al. | Nov 2015 | B2 |
| 9220594 | Braido et al. | Dec 2015 | B2 |
| 9226820 | Braido et al. | Jan 2016 | B2 |
| 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 |
| 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 |
| 9320591 | Bolduc | Apr 2016 | B2 |
| D755384 | Pesce et al. | May 2016 | S |
| 9326876 | Acosta et al. | May 2016 | B2 |
| 9345573 | Nyuli et al. | May 2016 | B2 |
| 9387078 | Gross et al. | Jul 2016 | B2 |
| 9393110 | Levi et al. | Jul 2016 | B2 |
| 9421098 | Gifford, III et al. | Aug 2016 | B2 |
| 9427303 | Liddy et al. | Aug 2016 | B2 |
| 9439757 | Wallace et al. | Sep 2016 | B2 |
| 9463102 | Kelly | Oct 2016 | B2 |
| 9474599 | Keranen | Oct 2016 | B2 |
| 9474638 | Robinson et al. | Oct 2016 | B2 |
| 9492273 | Wallace et al. | Nov 2016 | B2 |
| 9498314 | Behan | Nov 2016 | B2 |
| 9498332 | Hacohen et al. | Nov 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, Jr. 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 |
| 9987132 | Hariton et al. | Jun 2018 | B1 |
| 10010414 | Cooper et al. | Jul 2018 | B2 |
| 10016271 | Morriss | Jul 2018 | B2 |
| 10076415 | Metchik et al. | Sep 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 |
| 10154906 | Granada et al. | Dec 2018 | B2 |
| 10159570 | Metchik et al. | Dec 2018 | B1 |
| 10182908 | Tubishevitz et al. | Jan 2019 | B2 |
| 10226341 | Gross et al. | Mar 2019 | B2 |
| 10231837 | Metchik et al. | Mar 2019 | B1 |
| 10238493 | Metchik et al. | Mar 2019 | B1 |
| 10245143 | Gross | 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 | Aug 2019 | B2 |
| 10390952 | Hariton et al. | Aug 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 |
| 10531866 | Hariton et al. | Jan 2020 | B2 |
| 10531872 | Hacohen et al. | Jan 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 |
| 10631871 | Goldfarb et al. | Apr 2020 | B2 |
| 10631982 | Hammer | Apr 2020 | B2 |
| 10646342 | Marr et al. | May 2020 | B1 |
| 10667912 | Dixon et al. | Jun 2020 | B2 |
| 10702385 | Hacohen et al. | Jul 2020 | B2 |
| 10758342 | Chau et al. | Sep 2020 | B2 |
| 10813760 | Metchik et al. | Oct 2020 | B2 |
| 10820998 | Marr 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 |
| 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 |
| 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 |
| 11147672 | McCann et al. | Oct 2021 | B2 |
| 11179240 | Delgado et al. | Nov 2021 | B2 |
| 11291545 | Hacohen | Apr 2022 | B2 |
| 11291546 | Gross et al. | Apr 2022 | B2 |
| 11291547 | Gross et al. | Apr 2022 | B2 |
| 11291844 | Gross | Apr 2022 | B2 |
| 11304806 | Hariton et al. | Apr 2022 | B2 |
| 11389297 | Franklin et al. | Jul 2022 | B2 |
| 11426155 | Hacohen et al. | Aug 2022 | B2 |
| 11517429 | Gross et al. | Dec 2022 | B2 |
| 11517436 | Hacohen | Dec 2022 | B2 |
| 20010002445 | Vesely | May 2001 | A1 |
| 20010005787 | Oz et al. | Jun 2001 | A1 |
| 20010021872 | Bailey et al. | Sep 2001 | A1 |
| 20020013571 | Goldfarb et al. | Jan 2002 | A1 |
| 20020032481 | Gabbay | Mar 2002 | A1 |
| 20020151970 | Garrison et al. | Oct 2002 | A1 |
| 20020177894 | Acosta et al. | Nov 2002 | A1 |
| 20030050694 | Yang et al. | Mar 2003 | A1 |
| 20030060875 | Wittens | Mar 2003 | A1 |
| 20030069635 | Cartledge et al. | Apr 2003 | A1 |
| 20040030382 | St. Goar et al. | Feb 2004 | A1 |
| 20040133267 | Lane | Jul 2004 | A1 |
| 20040186558 | Pavcnik et al. | Sep 2004 | A1 |
| 20040210304 | Seguin | Oct 2004 | A1 |
| 20040236354 | Seguin | Nov 2004 | A1 |
| 20040249433 | Freitag | Dec 2004 | A1 |
| 20050027305 | Shiu et al. | Feb 2005 | A1 |
| 20050027348 | Case et al. | Feb 2005 | A1 |
| 20050080474 | Andreas et al. | Apr 2005 | A1 |
| 20050085900 | Case | Apr 2005 | A1 |
| 20050137690 | Salahieh | Jun 2005 | A1 |
| 20050137691 | Salahieh et al. | Jun 2005 | A1 |
| 20050137692 | Haug et al. | Jun 2005 | A1 |
| 20050137693 | Haug et al. | Jun 2005 | A1 |
| 20050137699 | Salahieh et al. | Jun 2005 | A1 |
| 20050149160 | McFerran | Jul 2005 | A1 |
| 20050203618 | Sharkawy et al. | Sep 2005 | A1 |
| 20050240200 | Bergheim | Oct 2005 | A1 |
| 20050251251 | Cribier | Nov 2005 | A1 |
| 20050256566 | Gabbay | Nov 2005 | A1 |
| 20060004439 | Spenser et al. | Jan 2006 | A1 |
| 20060004469 | Sokel | Jan 2006 | A1 |
| 20060020275 | Goldfarb et al. | Jan 2006 | A1 |
| 20060020327 | Lashinski et al. | Jan 2006 | A1 |
| 20060041189 | Vancaillie | Feb 2006 | A1 |
| 20060052867 | Revuelta et al. | Mar 2006 | A1 |
| 20060111773 | Rittgers et al. | May 2006 | A1 |
| 20060116750 | Hebert et al. | Jun 2006 | A1 |
| 20060122692 | Gilad | Jun 2006 | A1 |
| 20060149360 | Schwammenthal | Jul 2006 | A1 |
| 20060155357 | Melsheimer | Jul 2006 | A1 |
| 20060184203 | Martin et al. | Aug 2006 | A1 |
| 20060195183 | Navia et al. | Aug 2006 | A1 |
| 20060216404 | Seyler et al. | Sep 2006 | A1 |
| 20060229708 | Powell et al. | Oct 2006 | A1 |
| 20060241745 | Solem | Oct 2006 | A1 |
| 20060259137 | Artof et al. | Nov 2006 | A1 |
| 20060282150 | Olson et al. | Dec 2006 | A1 |
| 20060287719 | Rowe | Dec 2006 | A1 |
| 20070016286 | Herrmann et al. | Jan 2007 | A1 |
| 20070027528 | Agnew | Feb 2007 | A1 |
| 20070038293 | St. Goar et al. | Feb 2007 | A1 |
| 20070056346 | Spenser et al. | Mar 2007 | A1 |
| 20070078510 | Ryan | Apr 2007 | A1 |
| 20070142907 | Moaddeb | Jun 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 |
| 20070198097 | Zegdi | Aug 2007 | A1 |
| 20070213810 | Newhauser et al. | Sep 2007 | A1 |
| 20070213813 | Von Segesser et al. | 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 |
| 20070239272 | Navia et al. | Oct 2007 | A1 |
| 20070239273 | Allen | Oct 2007 | A1 |
| 20070244546 | Francis | Oct 2007 | A1 |
| 20070255400 | Parravicini et al. | Nov 2007 | A1 |
| 20080004688 | Spenser et al. | Jan 2008 | A1 |
| 20080004697 | Lichtenstein et al. | Jan 2008 | A1 |
| 20080051703 | Thornton et al. | Feb 2008 | A1 |
| 20080065204 | Macoviak 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 |
| 20080086164 | Rowe | Apr 2008 | A1 |
| 20080086204 | Rankin | Apr 2008 | A1 |
| 20080091261 | Long et al. | Apr 2008 | A1 |
| 20080097595 | Gabbay | Apr 2008 | A1 |
| 20080132989 | Snow et al. | Jun 2008 | A1 |
| 20080140003 | Bei et al. | Jun 2008 | A1 |
| 20080140189 | Nguyen | 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 |
| 20080195200 | Vidlund et al. | Aug 2008 | A1 |
| 20080200980 | Robin et al. | Aug 2008 | A1 |
| 20080208328 | Antocci et al. | Aug 2008 | A1 |
| 20080208332 | Lamphere et al. | Aug 2008 | A1 |
| 20080221672 | Lamphere et al. | Sep 2008 | A1 |
| 20080234813 | Heuser | 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 |
| 20080281411 | Berreklouw | Nov 2008 | A1 |
| 20080294234 | Hartley et al. | Nov 2008 | A1 |
| 20090005863 | Goetz et al. | Jan 2009 | A1 |
| 20090036966 | O'Connor et al. | Feb 2009 | A1 |
| 20090054969 | Salahieh et al. | Feb 2009 | A1 |
| 20090082844 | Zacharias et al. | Mar 2009 | A1 |
| 20090088836 | Bishop et al. | Apr 2009 | A1 |
| 20090099554 | Forster et al. | Apr 2009 | A1 |
| 20090099650 | Bolduc et al. | Apr 2009 | A1 |
| 20090112159 | Slattery et al. | Apr 2009 | A1 |
| 20090125098 | Chuter | May 2009 | A1 |
| 20090157175 | Benichou | Jun 2009 | A1 |
| 20090163934 | Raschdorf, Jr. et al. | Jun 2009 | A1 |
| 20090171363 | Chocron | Jul 2009 | A1 |
| 20090177278 | Spence | Jul 2009 | A1 |
| 20090192601 | Rafiee et al. | 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 |
| 20090259306 | Rowe | Oct 2009 | A1 |
| 20090264859 | Mas | Oct 2009 | A1 |
| 20090264994 | Saadat | Oct 2009 | A1 |
| 20090276040 | Rowe et al. | Nov 2009 | A1 |
| 20090281619 | Le et al. | Nov 2009 | A1 |
| 20090287299 | Tabor et al. | Nov 2009 | A1 |
| 20090287304 | Dahlgren et al. | Nov 2009 | A1 |
| 20090299449 | Styrc | Dec 2009 | A1 |
| 20090306768 | Quadri et al. | Dec 2009 | A1 |
| 20090319037 | Rowe et al. | Dec 2009 | A1 |
| 20100022823 | Goldfarb et al. | Jan 2010 | A1 |
| 20100023117 | Yoganathan et al. | Jan 2010 | A1 |
| 20100023120 | Holecek et al. | Jan 2010 | A1 |
| 20100036479 | Hill et al. | Feb 2010 | A1 |
| 20100049306 | House et al. | Feb 2010 | A1 |
| 20100049313 | Alon et al. | Feb 2010 | A1 |
| 20100069852 | Kelley | Mar 2010 | A1 |
| 20100076548 | Konno | Mar 2010 | A1 |
| 20100100167 | Bortlein et al. | Apr 2010 | A1 |
| 20100114299 | Ben Muvhar et al. | May 2010 | A1 |
| 20100131054 | Tuval et al. | May 2010 | A1 |
| 20100137979 | Tuval et al. | Jun 2010 | A1 |
| 20100160958 | Clark | Jun 2010 | A1 |
| 20100161036 | Pintor et al. | Jun 2010 | A1 |
| 20100161042 | Maisano et al. | Jun 2010 | A1 |
| 20100174363 | Castro | Jul 2010 | A1 |
| 20100179643 | Shalev | Jul 2010 | A1 |
| 20100179648 | Richter et al. | Jul 2010 | A1 |
| 20100179649 | Richter et al. | Jul 2010 | A1 |
| 20100185277 | Braido et al. | Jul 2010 | A1 |
| 20100217382 | Chau et al. | Aug 2010 | A1 |
| 20100222810 | DeBeer et al. | Sep 2010 | A1 |
| 20100228285 | Miles et al. | Sep 2010 | A1 |
| 20100234940 | Dolan | Sep 2010 | A1 |
| 20100249908 | Chau et al. | Sep 2010 | A1 |
| 20100249917 | Zhang | Sep 2010 | A1 |
| 20100256737 | Pollock et al. | Oct 2010 | A1 |
| 20100262232 | Annest | Oct 2010 | A1 |
| 20100280603 | Maisano et al. | Nov 2010 | A1 |
| 20100280606 | Naor | Nov 2010 | A1 |
| 20100312333 | Navia et al. | Dec 2010 | A1 |
| 20100324595 | Linder et al. | Dec 2010 | A1 |
| 20100331971 | Keranen et al. | Dec 2010 | A1 |
| 20110004227 | Goldfarb et al. | Jan 2011 | A1 |
| 20110004296 | Lutter et al. | Jan 2011 | A1 |
| 20110004299 | Navia et al. | Jan 2011 | A1 |
| 20110015729 | Jimenez et al. | Jan 2011 | A1 |
| 20110015731 | Carpentier et al. | Jan 2011 | A1 |
| 20110021985 | Spargias | Jan 2011 | A1 |
| 20110022165 | Oba et al. | Jan 2011 | A1 |
| 20110029072 | Gabbay | 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 |
| 20110066233 | Thornton et al. | Mar 2011 | A1 |
| 20110071626 | Wright et al. | Mar 2011 | A1 |
| 20110077730 | Fenster | Mar 2011 | A1 |
| 20110082538 | Dahlgren et al. | Apr 2011 | A1 |
| 20110087322 | Letac et al. | Apr 2011 | A1 |
| 20110093063 | Schreck | Apr 2011 | A1 |
| 20110098525 | Kermode et al. | Apr 2011 | A1 |
| 20110098802 | Braido et al. | Apr 2011 | A1 |
| 20110106247 | Miller et al. | May 2011 | A1 |
| 20110112625 | Ben-Muvhar et al. | May 2011 | A1 |
| 20110112632 | Chau et al. | May 2011 | A1 |
| 20110118830 | Liddicoat et al. | 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 |
| 20110144742 | Madrid et al. | Jun 2011 | A1 |
| 20110166636 | Rowe | Jul 2011 | A1 |
| 20110172784 | Richter et al. | Jul 2011 | A1 |
| 20110178597 | Navia et al. | Jul 2011 | A9 |
| 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 |
| 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 |
| 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 | Wiemeyer 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 |
| 20110257721 | Tabor | 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 et al. | 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 et al. | Oct 2011 | A1 |
| 20110270276 | Rothstein et al. | Nov 2011 | A1 |
| 20110271967 | Mortier et al. | Nov 2011 | A1 |
| 20110282438 | Drews et al. | Nov 2011 | A1 |
| 20110282439 | Thill et al. | Nov 2011 | A1 |
| 20110282440 | Cao et al. | Nov 2011 | A1 |
| 20110283514 | Fogarty et al. | Nov 2011 | A1 |
| 20110288632 | White | Nov 2011 | A1 |
| 20110288634 | Tuval et al. | Nov 2011 | A1 |
| 20110295354 | Bueche et al. | Dec 2011 | A1 |
| 20110295363 | Girard 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 |
| 20110319988 | Schankereli 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 |
| 20120022629 | Perera et al. | Jan 2012 | A1 |
| 20120022633 | Olson et al. | Jan 2012 | A1 |
| 20120022637 | Ben-Muvhar | Jan 2012 | A1 |
| 20120022639 | Hacohen et al. | Jan 2012 | A1 |
| 20120022640 | Gross et al. | Jan 2012 | A1 |
| 20120035703 | Lutter et al. | Feb 2012 | A1 |
| 20120035713 | Lutter et al. | Feb 2012 | A1 |
| 20120035722 | Tuval | 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 |
| 20120053682 | Kovalsky et al. | Mar 2012 | A1 |
| 20120053688 | Fogarty et al. | 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 |
| 20120078357 | Conklin | Mar 2012 | A1 |
| 20120083832 | Delaloye et al. | Apr 2012 | A1 |
| 20120083839 | Letac et al. | Apr 2012 | A1 |
| 20120083879 | Eberhardt et al. | Apr 2012 | A1 |
| 20120089223 | Nguyen 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 |
| 20120123511 | Brown | May 2012 | A1 |
| 20120123529 | Levi et al. | 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 |
| 20120150218 | Sandgren et al. | Jun 2012 | A1 |
| 20120165915 | Melsheimer et al. | Jun 2012 | A1 |
| 20120165930 | Gifford, III et al. | Jun 2012 | A1 |
| 20120179244 | Schankereli et al. | Jul 2012 | A1 |
| 20120197292 | Chin-Chen et al. | Aug 2012 | A1 |
| 20120277845 | Bowe | Nov 2012 | A1 |
| 20120283824 | Lutter et al. | Nov 2012 | A1 |
| 20120290062 | McNamara et al. | Nov 2012 | A1 |
| 20120296360 | Norris et al. | Nov 2012 | A1 |
| 20120296418 | Bonyuet et al. | Nov 2012 | A1 |
| 20120300063 | Majkrzak et al. | Nov 2012 | A1 |
| 20120310328 | Olson et al. | Dec 2012 | A1 |
| 20120323316 | Chau et al. | Dec 2012 | A1 |
| 20120330408 | Hillukkla et al. | Dec 2012 | A1 |
| 20130006347 | McHugo | Jan 2013 | A1 |
| 20130018450 | Hunt | Jan 2013 | A1 |
| 20130018458 | Yohanan et al. | Jan 2013 | A1 |
| 20130030519 | Tran et al. | Jan 2013 | A1 |
| 20130035759 | Gross 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 |
| 20130116780 | Miller et al. | May 2013 | A1 |
| 20130123896 | Bloss et al. | May 2013 | A1 |
| 20130123900 | Eblacas et al. | May 2013 | A1 |
| 20130150945 | Crawford et al. | Jun 2013 | A1 |
| 20130150956 | Yohanan | 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 |
| 20130190861 | Chau et al. | Jul 2013 | A1 |
| 20130211501 | Buckley et al. | Aug 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 |
| 20130274870 | Lombardi et al. | Oct 2013 | A1 |
| 20130282059 | Ketai et al. | Oct 2013 | A1 |
| 20130289711 | Liddy et al. | Oct 2013 | A1 |
| 20130289740 | Liddy et al. | Oct 2013 | A1 |
| 20130297013 | Klima 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 |
| 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 |
| 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 |
| 20140106951 | Brandon | Apr 2014 | A1 |
| 20140120287 | Jacoby et al. | May 2014 | A1 |
| 20140121749 | Roeder | May 2014 | A1 |
| 20140121763 | Duffy et al. | May 2014 | A1 |
| 20140135894 | Norris et al. | May 2014 | A1 |
| 20140135895 | Andress et al. | May 2014 | A1 |
| 20140142681 | Norris | May 2014 | A1 |
| 20140142688 | Duffy et al. | May 2014 | A1 |
| 20140148891 | Johnson | May 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 |
| 20140188210 | Beard et al. | Jul 2014 | A1 |
| 20140188221 | Chung et al. | Jul 2014 | A1 |
| 20140194981 | Menk et al. | Jul 2014 | A1 |
| 20140194983 | Kovalsky et al. | Jul 2014 | A1 |
| 20140200649 | Essinger | 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 |
| 20140222142 | Kovalsky et al. | Aug 2014 | A1 |
| 20140236287 | Clague et al. | Aug 2014 | A1 |
| 20140236289 | Alkhatib | 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 |
| 20140277358 | Slazas | Sep 2014 | A1 |
| 20140277409 | Bortlein 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 |
| 20140324164 | Gross et al. | Oct 2014 | A1 |
| 20140331475 | Duffy et al. | Nov 2014 | A1 |
| 20140336744 | Tani et al. | Nov 2014 | A1 |
| 20140343670 | Bakis et al. | Nov 2014 | A1 |
| 20140358222 | Gorman, III et al. | Dec 2014 | A1 |
| 20140358224 | Tegels 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 |
| 20150018944 | O'Connell et al. | Jan 2015 | A1 |
| 20150032205 | Matheny | Jan 2015 | A1 |
| 20150045880 | Hacohen | Feb 2015 | A1 |
| 20150045881 | Lim | Feb 2015 | A1 |
| 20150094802 | Buchbinder 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 |
| 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 | Jun 2015 | A1 |
| 20150196390 | Ma | Jul 2015 | A1 |
| 20150196393 | Vidlund et al. | Jul 2015 | A1 |
| 20150216661 | Hacohen 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 | 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 |
| 20160175095 | Dienno et al. | Jun 2016 | A1 |
| 20160213473 | Hacohen | Jul 2016 | A1 |
| 20160220367 | Barrett | Aug 2016 | A1 |
| 20160228247 | Maimon et al. | Aug 2016 | A1 |
| 20160242902 | Morriss et al. | Aug 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, III et al. | Nov 2016 | A1 |
| 20160331526 | Schweich, Jr. 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 |
| 20170100236 | Robertson et al. | Apr 2017 | A1 |
| 20170128205 | Tamir et al. | May 2017 | A1 |
| 20170135816 | Lashinski et al. | May 2017 | A1 |
| 20170165054 | Benson et al. | Jun 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 |
| 20170239048 | Goldfarb et al. | Aug 2017 | A1 |
| 20170266003 | Hammer et al. | Sep 2017 | A1 |
| 20170333183 | Backus | Nov 2017 | A1 |
| 20170333187 | Hariton et al. | Nov 2017 | A1 |
| 20180000580 | Wallace et al. | Jan 2018 | A1 |
| 20180014930 | Hariton et al. | Jan 2018 | A1 |
| 20180021129 | Peterson et al. | Jan 2018 | A1 |
| 20180028215 | Cohen | Feb 2018 | A1 |
| 20180049873 | Manash et al. | Feb 2018 | A1 |
| 20180055628 | Patel et al. | Mar 2018 | A1 |
| 20180055629 | Oba 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 |
| 20180153689 | Maimon et al. | Jun 2018 | A1 |
| 20180161159 | Lee et al. | Jun 2018 | A1 |
| 20180177594 | Patel et al. | Jun 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 |
| 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 |
| 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 |
| 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 |
| 20190183639 | Moore | Jun 2019 | A1 |
| 20190192295 | Spence et al. | Jun 2019 | A1 |
| 20190216602 | Lozonschi | Jul 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 |
| 20200015964 | Noe et al. | Jan 2020 | A1 |
| 20200030098 | Delgado et al. | Jan 2020 | A1 |
| 20200054335 | Hernandez et al. | Feb 2020 | A1 |
| 20200060818 | Geist et al. | Feb 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 |
| 20200163761 | Hariton et al. | May 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 et al. | Oct 2020 | A1 |
| 20200315786 | Metchik et al. | Oct 2020 | A1 |
| 20200337842 | Metchik et al. | Oct 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 |
| 20210259835 | Tyler, II et al. | Aug 2021 | A1 |
| 20220000612 | Hacohen | Jan 2022 | A1 |
| Number | Date | Country |
|---|---|---|
| 2822801 | Aug 2006 | CA |
| 103974674 | Aug 2014 | CN |
| 1264582 | Nov 2002 | EP |
| 1637092 | Mar 2006 | EP |
| 2446915 | May 2012 | EP |
| 2641569 | Sep 2013 | EP |
| 1768630 | Jan 2015 | EP |
| 2349124 | Oct 2018 | EP |
| 3583922 | Dec 2019 | EP |
| 3270825 | Apr 2020 | EP |
| 2485795 | Sep 2020 | EP |
| S53152790 | Dec 1978 | JP |
| 20010046894 | Jun 2001 | KR |
| 9843557 | Oct 1998 | WO |
| 9930647 | Jun 1999 | WO |
| 0047139 | Aug 2000 | WO |
| 0162189 | Aug 2001 | WO |
| 0182832 | Nov 2001 | WO |
| 0187190 | Nov 2001 | WO |
| 2003020179 | Mar 2003 | WO |
| 03028558 | Apr 2003 | WO |
| 2004028399 | Apr 2004 | WO |
| 2004108191 | Dec 2004 | WO |
| 2005107650 | Nov 2005 | WO |
| 2006007389 | Jan 2006 | WO |
| 2006007401 | Jan 2006 | WO |
| 2006054930 | May 2006 | WO |
| 2006070372 | Jul 2006 | WO |
| 2006086434 | Aug 2006 | WO |
| 2006089236 | Aug 2006 | WO |
| 2006113906 | Oct 2006 | WO |
| 2006116558 | Nov 2006 | WO |
| 2006128193 | Nov 2006 | WO |
| 2007047488 | Apr 2007 | WO |
| 2007059252 | May 2007 | WO |
| 2008013915 | Jan 2008 | WO |
| 2008029296 | Mar 2008 | WO |
| 2008070797 | Jun 2008 | WO |
| 2008103722 | Aug 2008 | WO |
| 2009033469 | Mar 2009 | WO |
| 2009053497 | Apr 2009 | WO |
| 2009091509 | Jul 2009 | WO |
| 2010006627 | Jan 2010 | WO |
| 2010006627 | Jan 2010 | WO |
| 2010027485 | Mar 2010 | WO |
| 2010037141 | Apr 2010 | WO |
| 2010045297 | Apr 2010 | WO |
| 2010057262 | May 2010 | WO |
| 2010057262 | May 2010 | WO |
| 2010073246 | Jul 2010 | WO |
| 2010081033 | Jul 2010 | WO |
| 2010121076 | Oct 2010 | WO |
| 2011025972 | Mar 2011 | WO |
| 2011057087 | May 2011 | WO |
| 2011069048 | Jun 2011 | WO |
| 2011072084 | Jun 2011 | WO |
| 2011089601 | Jul 2011 | WO |
| 2011106137 | Sep 2011 | WO |
| 2011111047 | Sep 2011 | WO |
| 2011137531 | Nov 2011 | WO |
| 2011143263 | Nov 2011 | WO |
| 2011144351 | Nov 2011 | WO |
| 2011154942 | Dec 2011 | WO |
| 2012011108 | Jan 2012 | WO |
| 2012024428 | Feb 2012 | WO |
| WO-2012024428 | Feb 2012 | WO |
| 2012036740 | Mar 2012 | WO |
| 2012048035 | Apr 2012 | WO |
| 2012127309 | Sep 2012 | WO |
| 2012177942 | Dec 2012 | WO |
| 2012178115 | Dec 2012 | WO |
| 2013021374 | Feb 2013 | WO |
| 2013021374 | Feb 2013 | WO |
| 2013021375 | Feb 2013 | WO |
| 2013021375 | Feb 2013 | WO |
| 2013021384 | Feb 2013 | WO |
| 2013028387 | Feb 2013 | WO |
| 2013059743 | Apr 2013 | WO |
| 2013059747 | Apr 2013 | WO |
| 2013072496 | May 2013 | WO |
| 2013078497 | Jun 2013 | WO |
| 2013078497 | Jun 2013 | WO |
| 2013128436 | Jun 2013 | WO |
| 2013114214 | Aug 2013 | WO |
| 2013175468 | Nov 2013 | WO |
| 2014022124 | Feb 2014 | WO |
| 2014076696 | May 2014 | WO |
| 2014076696 | May 2014 | WO |
| 2014115149 | Jul 2014 | WO |
| 2014115149 | Jul 2014 | WO |
| 2014121275 | Aug 2014 | WO |
| 2014121280 | Aug 2014 | WO |
| 2014144937 | Sep 2014 | WO |
| 2014145338 | Sep 2014 | WO |
| 2014164364 | Oct 2014 | WO |
| 2014194178 | Dec 2014 | WO |
| 2016173794 | Nov 2015 | WO |
| 2016016899 | Feb 2016 | WO |
| 2016016899 | Feb 2016 | WO |
| 2016093877 | Jun 2016 | WO |
| 2016125160 | Aug 2016 | WO |
| 2016183526 | Nov 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 |
| 2019086958 | May 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 |
| 2022046568 | Mar 2022 | WO |
| 2022061017 | Mar 2022 | WO |
| Entry |
|---|
| 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 Oct. 5, 2020, which issued during the prosecution of Canadian Patent Application No. 2,973,940. |
| Notice of Allowance dated Nov. 19, 2020, which issued during the prosecution of U.S. Appl. No. 16/318,025. |
| An Office Action dated Sep. 24, 2020, which issued during the prosecution of U.S. Appl. No. 16/811,732. |
| 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. |
| An Office Action dated Nov. 30, 2020, which issued during the prosecution of U.S. Appl. No. 16/138,129. |
| An International Search Report and a Written Opinion both dated Apr. 25, 2019, which issued during the prosecution of Applicants PCT/IL2019/050142. |
| IPR2021-01051 Preliminary Guidance Patent Owner's Motion to Amend dated Jun. 24, 2022. |
| 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 Decision Final Written Decision dated Jul. 18, 2022. |
| An Office Action dated Jun. 6, 2018, which issued during the prosecution of UK Patent Application No. 1720803.4. |
| An Office Action dated Jun. 18, 2018, which issued during the prosecution of UK Patent Application No. 1800399.6. |
| An International Search Report and a Written Opinion both dated Jun. 20, 2018, which issued during the prosecution of Applicant's PCT/IL2018/050024. |
| USPTO AA dated Apr. 2, 2018 in connection with U.S. Appl. No. 14/763,004. |
| USPTO RR dated May 4, 2018 in connection with U.S. Appl. No. 15/872,501. |
| USPTO NFOA dated Jul. 26, 2018 in connection with U.S. Appl. No. 15/872,501. |
| USPTO NOA maled Apr. 20, 2018 in connection with U.S. Appl. No. 15/878,206. |
| USPTO NFOA dated Apr. 20, 2018 in connection with U.S. Appl. No. 15/886,517. |
| USPTO NFOA dated Aug. 9, 2018 in connection with U.S. Appl. No. 15/899,858. |
| USPTO NFOA dated Aug. 9, 2018 in connection with U.S. Appl. No. 15/002,403. |
| USPTO NFOA dated Jun. 28, 2018 in connection with U.S. Appl. No. 29/635,658. |
| USPTO NFOA dated Jun. 28, 2018 in connection with U.S. Appl. No. 29/635,661. |
| An Office Action dated Jan. 26, 2022, which issued during the prosecution of U.S. Appl. No. 16/888,210. |
| Notice of Allowance dated Jan. 31, 2022, which issued during the prosecution of U.S. Appl. No. 17/479,418. |
| 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 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 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. |
| An Office Action dated Jan. 14, 2020, which issued during the prosecution of U.S. Appl. No. 16/284,331. |
| Notice of Allowance dated Jan. 13, 2020, which issued during the prosecution of U.S. Appl. No. 15/956,956. |
| 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. |
| 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. |
| Great Britain Office Action dated Jan. 30, 2015; Appln. 1413474.6. |
| IPRP issued Jan. 31, 2017; PCT/IL2015/050792. |
| IPRP issued Jul. 28, 2015; PCT/IL2014/050087. |
| U.S. Appl. No. 61/312,412. |
| U.S. Appl. No. 61/756,034. |
| U.S. Appl. No. 61/756,049. |
| U.S. Appl. No. 62/030,715. |
| U.S. Appl. No. 62/139,854. |
| Notice of Allowance dated May 7, 2020, which issued during the prosecution of U.S. Appl. No. 16/637,166. |
| Sundermann, 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&Ir&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. |
| 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. |
| USPTO FOA dated Feb. 10, 2014; U.S. Appl. No. 13/033,852. |
| USPTO FOA dated Feb. 15, 2013; U.S. Appl. No. 12/840,463. |
| USPTO FOA dated Feb. 25, 2016; U.S. Appl. No. 14/522,987. |
| USPTO FOA dated Mar. 25, 2015; U.S. Appl. No. 12/840,463. |
| USPTO FOA dated Apr. 13, 2016; U.S. Appl. No. 14/626,267. |
| USPTO FOA dated May 23, 2014; U.S. Appl. No. 13/412,814. |
| USPTO FOA dated Jul. 18, 2013; U.S. Appl. No. 13/044,694. |
| USPTO FOA dated Jul. 23, 2013; U.S. Appl. No. 12/961,721. |
| USPTO FOA dated Sep. 12, 2013; U.S. Appl. No. 13/412,814. |
| USPTO NFOA dated Jan. 18, 2017; U.S. Appl. No. 14/626,267. |
| USPTO NFOA dated Jan. 21, 2016; U.S. Appl. No. 14/237,264. |
| USPTO NFOA dated Feb. 6, 2013; U.S. Appl. No. 13/412,814. |
| USPTO NFOA dated Feb. 7, 2017; U.S. Appl. No. 14/689,608. |
| USPTO NFOA dated Jun. 4, 2014; U.S. Appl. No. 12/840,463. |
| USPTO NFOA dated Jun. 17, 2014; U.S. Appl. No. 12/961,721. |
| USPTO NFOA dated Jun. 30, 2015; U.S. Appl. No. 14/522,987. |
| USPTO NFOA dated Jul. 2, 2014; U.S. Appl. No. 13/811,308. |
| USPTO NFOA dated Jul. 3, 2014; U.S. Appl. No. 13/033,852. |
| USPTO NFOA dated Aug. 2, 2013; U.S. Appl. No. 13/033,852. |
| USPTO NFOA dated Sep. 19, 2014; U.S. Appl. No. 13/044,694. |
| USPTO NFOA dated Nov. 8, 2013; U.S. Appl. No. 12/840,463. |
| USPTO NFOA dated Nov. 23, 2012; U.S. Appl. No. 13/033,852. |
| USPTO NFOA dated Nov. 27, 2015; U.S. Appl. No. 14/626,267. |
| USPTO NFOA dated Nov. 28, 2012; U.S. Appl. No. 12/961,721. |
| USPTO NFOA dated Dec. 10, 2015; U.S. Appl. No. 14/237,258. |
| USPTO NFOA dated Dec. 31, 2012; U.S. Appl. No. 13/044,694. |
| USPTO NFOA dated May 29, 2012; U.S. Appl. No. 12/840,463. |
| USPTO NOA dated May 20, 2016; U.S. Appl. No. 14/237,258. |
| USPTO NOA dated Jul. 6, 2017; U.S. Appl. No. 14/689,608. |
| USPTO NOA dated Aug. 18, 2017; U.S. Appl. No. 14/689,608. |
| USPTO NOA malled Feb. 11, 2015; U.S. Appl. No. 13/033,852. |
| USPTO NOA mailed Mar. 10, 2015; U.S. Appl. No. 13/811,308. |
| USPTO NOA mailed Apr. 8, 2016; U.S. Appl. No. 14/237,258. |
| USPTO NOA mailed May 5, 2015; U.S. Appl. No. 12/840,463. |
| USPTO NOA dated May 10, 2016; U.S. Appl. No. 14/237,258. |
| USPTO NOA mailed May 22, 2017; U.S. Appl. No. 14/689,608. |
| USPTO NOA mailed Aug. 15, 2014; U.S. Appl. No. 13/412,814. |
| USPTO RR dated Jan. 20, 2016; U.S. Appl. No. 14/161,921. |
| USPTO RR dated Feb. 3, 2014; U.S. Appl. No. 13/811,308. |
| USPTO RR dated Apr. 21, 2017; U.S. Appl. No. 15/213,791. |
| USPTO RR dated Jul. 2, 2012; U.S. Appl. No. 13/033,852. |
| USPTO RR dated Aug. 13, 2012; U.S. Appl. No. 13/044,694. |
| USPTO RR dated Aug. 14, 2012; U.S. Appl. No. 12/961,721. |
| USPTO RR dated Aug. 28, 2015; U.S. Appl. No. 14/237,264. |
| USPTO RR dated Sep. 26, 2016; U.S. Appl. No. 14/763,004. |
| USPTO RR dated Sep. 29, 2017; U.S. Appl. No. 16/197,069. |
| USPTO NFOA dated Oct. 23, 2017; U.S. Appl. No. 14/763,004. |
| USPTO NFOA dated Jul. 1, 2016; U.S. Appl. No. 14/161,921. |
| Extended European Search Report dated Sep. 26, 2018; Appln. No. 18186784.7. |
| The First Chinese Office Action dated Nov. 5, 2018; Appln. No. 201680008328.5. |
| Invitation to pay additional fees dated Oct. 11, 2018; PCT/IL2018/050725. |
| USPTO NFOA dated Dec. 4, 2018 in connection with U.S. Appl. No. 16/045,059. |
| USPTO NOA mailed Sep. 25, 2018 in connection with U.S. Appl. No. 15/188,507. |
| 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. |
| Maisano, F., et al. “The edge-to-edge technique: a simplified method to correct mitral insufficiency.” European journal of cardio-thoracic surgery 13.3 (1998): 240-246. |
| 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. |
| An Office Action together with an English summary dated Mar. 3, 2021, which issued during the prosecution of Chinese Patent Application No. 201780047391.4. |
| 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. |
| U.S. Appl. No. 60/128,690, filed Apr. 9, 1999. |
| 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. 60/613,867, filed Sep. 27, 2004. |
| Batista, Randas JV, et al. “Partial left ventriculectomy to treat end-stage heart disease.” The Annals of thoracic surgery 64.3 (1997): 634-638. |
| 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. |
| Kalbacher, D., et al. “1000 MitraClip™ procedures: Lessons learnt from the largest single-centre experience worldwide.” (2019): 3137-3139. |
| 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. |
| 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. |
| An Office Action 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. 17/335,845. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| USPTO FOA dated Jan. 17, 2018 in connection with U.S. Appl. No. 14/763,004. |
| USPTO NFOA dated Feb. 7, 2018 in connection with U.S. Appl. No. 15/197,069. |
| USPTO NFOA dated Dec. 7, 2017 in connection with U.S. Appl. No. 15/213,791. |
| Interview Summary dated Feb. 8, 2018 in connection with U.S. Appl. No. 15/213,791. |
| USPTO NFOA dated Jan. 5, 2018 in connection with U.S. Appl. No. 15/541,783. |
| USPTO NFOA dated Feb. 2, 2018 in connection with U.S. Appl. No. 15/329,920. |
| Invitation to pay additional fees dated Jan. 2, 2018; PCT/IL2017/050849. |
| European Search Report dated Jun. 10, 2021 which issued during the prosecution of Applicants European App No. 21157988.3. |
| An Invitation to pay additional fees dated May 19, 2021, which issued during the prosecution of Applicants PCT/IL2021/050132. |
| An International Search Report and a Written Opinion both dated Jul. 12, 2021, which issued during the prosecution of Applicants PCT/IL2021/050132. |
| 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 Owners Authorized Surreply to Petitioners Reply to Patent Owners Preliminary Response dated Jun. 4, 2021 (Edwards Lifesciences vs. Cardiovalve). |
| An Office Action dated Aug. 18, 2021, which issued during the prosecution of U.S. Appl. No. 17/210,183. |
| Institution decision dated Jul. 20, 2021(Edwards Lifesciences vs. Cardiovalve). |
| 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. 17/394,807. |
| 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. |
| An International Search Report and a Written Opinion both dated Nov. 9, 2018, which issued during the prosecution history of Applicant's PCT/IL2018/050869. |
| An International Search Report and a Written Opinion both dated May 13, 2019, which issued during the prosecution history of Applicant's PCT/IL2018/051350. |
| An International Search Report and a Written Opinion both dated Apr. 5, 2019, which issued during the prosecution history of Applicant's PCT/IL2019/050142. |
| An International Search Report and a Written Opinion both dated Jan. 25, 2019, which issued during the prosecution history of Applicant's PCT/IL2018/0051122. |
| An International Search Report and a Written Opinion both dated Dec. 5, 2018, which issued during the prosecution history of Applicant's PCT/IL2018/050725. |
| An International Search Report and a Written Opinion both dated Feb. 12, 2019, which issued during the prosecution history of Applicant's PCT/IL2017/050873. |
| 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 Mar. 25, 2019, which issued during the prosecution of European Patent Application No. 14710060.6. |
| An Office Action dated Oct. 25, 2018, which issued during the prosecution of U.S. Appl. No. 14/763,004. |
| 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. 6, 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 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. |
| An Office Action dated Aug. 1, 2019, which issued during the prosecution of U.S. Appl. No. 15/668,559. |
| An Office Action dated Aug. 16, 2019, which issued during the prosecution of U.S. Appl. No. 15/668,659. |
| An Office Action dated Jun. 19, 2019, which issued during the prosecution of U.S. Appl. No. 15/682,789. |
| 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 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 Nov. 1, 2019, which issued during the prosecution of U.S. Appl. No. 15/872,501. |
| An Office Action dated Mar. 3, 2023, which issued during the prosecution of European Patent Application No. 17751143.3. |
| An Office Action dated Mar. 20, 2023, which issued during the prosecution of U.S. Appl. No. 17/181,722. |
| An Office Action dated Nov. 28, 2022, which issued during the prosecution of U.S. Appl. No. 17/141,853. |
| U.S. Appl. No. 15/703,385, filed Sep. 13, 2017, published as 2018/0014932, issued as U.S. Pat. No. 10,492,908. |
| U.S. Appl. No. 15/329,920, filed Jan. 27, 2017, published as 2017/0266003, issued as U.S. Pat. No. 10,524,910. |
| U.S. Appl. No. 62/030,715, filed Jul. 30, 2014. |
| U.S. Appl. No. 62/139,854, filed Mar. 30, 2015. |
| 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. |
| An Office Action dated Aug. 3, 2023, which issued during the prosecution of U.S. Appl. No. 17/683,875. |
| Grounds of Opposition to European Patent No. EP 2 948 103, filed Sep. 6, 2023. |
| Opposition to European Patent No. EP 2 948 103, filed Sep. 6, 2023. |
| An Office Action dated Sep. 8, 2023, which issued during the prosecution of U.S. Appl. No. 18/216,391. |
| An Office Action dated Sep. 8, 2023, which issued during the prosecution of U.S. Appl. No. 18/218,419. |
| An International Search Report and a Written Opinion both dated Sep. 13, 2023, which issued during the prosecution of Applicant's PCT/IL2023/050587. |
| Number | Date | Country | |
|---|---|---|---|
| 20200046496 A1 | Feb 2020 | US |
| Number | Date | Country | |
|---|---|---|---|
| 62030715 | Jul 2014 | US | |
| 62139854 | Mar 2015 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 15703385 | Sep 2017 | US |
| Child | 16656790 | US | |
| Parent | 15329920 | US | |
| Child | 15703385 | US |
