Patent Application
20230200981
The present invention relates to a prosthetic valve device for treatment of heart valve diseases, in particular mitral valve insufficiencies, wherein the device comprises: a main body having a lumen and comprising a tubular flexible stent frame having an inner surface and an outer surface, and a prosthetic material covering the stent frame at least partially, and wherein the lumen contains a valve structure. The present invention also relates to methods for manufacturing such a device, and methods for treatment.
Diseases of the mitral valve are the second-most common clinically significant form of valvular defect in adults. Mitral valve regurgitation occurs with increasing frequency as part of degenerative changes in the aging process (primary or degenerative Mitral regurgitation) and as consequence of ventricular anatomic changes during myocardium dilatative process (secondary or functional).
The mammalian heart comprises four chambers, i.e., two atria, which are the filling chambers, and two ventricles, which are the pumping chambers. In a mammalian heart, there are four heart valves present which normally allow blood to flow in only one direction through the heart, whereby a heart valve opens or closes depending on the differential blood pressure on each side.
The four main valves in the heart are the mitral valve, representing a bicuspid valve, and the tricuspid valve, which are between the upper atria and the lower ventricles, respectively, and thus are called atrioventricular (AV) valves. Further, there are the aortic valve and the pulmonary valve which are in the arteries leaving the heart. The mitral valve and the aortic valve are in the left heart and the tricuspid valve and the pulmonary valve are in the right heart.
The valves incorporate leaflets or so-called cusps, wherein each valve has three cusps, except for the mitral valve, which only has two.
The mitral and the tricuspid valve are situated, respectively, between the atria and the ventricles and prevent backflow from the ventricles into the atria during systole. They are anchored to the walls of the ventricles by chordae tendineae which prevent the valves from inverting. The chordae tendineae are attached to papillary muscles that cause tension to better hold the valve. Together, the papillary muscles and the chordae tendineae are known as the subvalvular apparatus. While the function of the subvalvular apparatus is to keep the valves from prolapsing into the atria when they close, the subvalvular apparatus, however, has no effect on the opening and closure of the valves, which is caused entirely by the pressure gradient across the valve.
During diastole, a normally-functioning mitral valve opens as a result of increased pressure from the left atrium as it fills with blood (preloading). As atrial pressure increases above that of the left ventricle, the mitral valve opens. Opening facilitates the passive flow of blood into the left ventricle. Diastole ends with atrial contraction, which ejects the final 20% of blood that is transferred from the left atrium to the left ventricle, and the mitral valve closes at the end of atrial contraction to prevent a reversal of blood flow.
Several different kinds of valve disorders are known, such as stenosis, which occurs when a heart valve doesn't fully open due to stiff or fused leaflets preventing them from opening properly, or prolapse, where the valve flaps do not close smoothly or evenly but collapse backwards into the heart chamber they are supposed to be sealing off.
Valve regurgitation (backward flow) is also a common problem, and occurs when a heart valve doesn't close tightly, as a consequence of which the valve does not seal and blood leaks backwards across the valve. This condition—also called valvular insufficiency—reduces the heart's pumping efficiency: When the heart contracts blood is pumped forward in the proper direction but is also forced backwards through the damaged valve. As the leak worsens, the heart has to work harder to make up for the leaky valve and less blood may flow to the rest of the body. Depending on which valve is affected, the condition is called tricuspid regurgitation, pulmonary regurgitation, mitral regurgitation, or aortic regurgitation.
Mitral regurgitation, i.e., the abnormal leaking of blood from the left ventricle through the mitral valve and into the left atrium when the left ventricle contracts, is a common valvular abnormality, being present in 24% of adults with valvular heart disease and in 7% of the population 75 years of age. Surgical intervention is recommended for symptomatic severe mitral regurgitation or asymptomatic severe mitral regurgitation with left ventricular dysfunction or enlargement. Surgical treatment of severe degenerative mitral regurgitation has evolved from mitral valve replacement to mitral valve repair, since a mitral valve repair has proven to produce superior outcomes.
The annual incidence of degenerative Mitral valve disease (primary) in developed nations is estimated at around 2% to 3%. In addition to degenerative changes, secondary Mitral valve regurgitation include cardiac ischemia, infective endocarditis and rheumatic disease, occurs more frequently in less developed countries.
Mitral valve replacement was the highest risk adult cardiac procedure in most centers in the world, with operative mortalities up to 20-30%. Introduction of new techniques, refinement of reparative methods and Carpentier's unified approach bringing together the techniques of ring annuloplasty, leaflet reconstruction, and chordal shortening/transfer with excellent results lead the way to the establishment of mitral valve repair as the procedure of choice in mitral insufficiency.
At least 50% of patients with severe MR are not candidates for surgery due to their age or other co-morbidities.
More recently, transcatheter mitral valve repair has become an alternative way for replacing or supporting a diseased or malfunctioning mitral valve. Percutaneous mitral valve repair technology is currently available for patients with nonsurgical high-risk degenerative mitral regurgitation. Other transcatheter mitral regurgitation repair and replacement technology is at various levels of preclinical and clinical investigation, although the currently tested devices are proving to be more challenging compared to transcatheter aortic valve replacement due to the significantly more complex mitral anatomy and the greater heterogeneity of mitral disease requiring treatment.
Percutaneous mitral valve repair technology is generally based on the same principles as mitral valve surgery: neo-chordae placement, leaflet plication, annuloplasty, papillary modification, and left ventricle remodeling. A different approach not based in surgical experience was proposed some years ago, based on the idea of creating an artificial space between the native leaflets enhancing the coaptation between these leaflets. The device developed for this therapy, named “Spacer” was an endovascular balloon catheter, positioned trans-apically in between the Mitral leaflets with an insufflating port implanted sub-cutaneous allowing controlling the volume of the balloon.
This therapy, while having proven to be efficient in reducing the mitral regurgitation volume, nevertheless, presented unsolved complications, such as thrombogenicity of the balloon-material, which requires anticoagulation therapy to reduce the possibility of strokes; also, the space occupied by the balloon reduces the valve orifice area, which in turn leads to reduction of the perfusion between the atrium and ventricle creating an iatrogenic stenosis in the mitral valve.
In view of the above, there still is the need for a heart valve prosthesis by means of which heart valve regurgitation can be efficiently treated, while at the same time traumatic impact on the heart is minimized.
According to the invention, this and other objects is solved by a prosthetic valve device for treatment of mitral valve insufficiency, wherein the device comprises: a main body having a lumen and comprising a tubular flexible stent frame having an inner surface and an outer surface, and a prosthetic material covering the stent frame at least partially, and wherein the lumen contains a valve structure, wherein the flexible stent frame consists of a plurality of wire-elements, each of the plurality of wire-elements being formed of a single wire having a first wire end portion and a second wire end portion, wherein each of the wire-elements has a proximal wire-element portion and a distal wire-element portion, wherein at the proximal wire-element portion an elongated loop-structure is provided, and wherein the elongated loop-structure comprises a proximal curve section, a distal curve section, and a medium section between the proximal and the distal curve section, wherein the prosthetic material covers the proximal wire-element portion, and in that the prosthetic material is fixed to the proximal curve section from the inner surface of the stent frame, and fixed to the distal curve section from the outer surface of the stent frame.
With the prosthetic valve device of the invention, it is possible to create a spacer for enhancing the coaptation between the native mitral valve leaflets, while at the same time avoiding the related complication of the spacer devices of the prior art.
The prosthetic valve device of the invention can be easily introduced, released and positioned at the native mitral valve region and fixated at the left ventricle apex of the heart of the patient to be treated, without running danger of getting dislocated and injuring the heart tissue. The prosthetic valve device of the invention has the advantage of providing a flexible frame with a tubular segment in the ventricular cavity, leading to a better fatigue resistance. Also, a modular construction with appropriated fixation for the valve leaflets is effected. With the prosthetic valve device of the invention, it is possible to locate the valve of the device in the transition from the left atrium to the left ventricle of a patient's heart, allowing the pressure inside the coaptation cylinder balance to the pressure of native leaflets closure and reducing excessive compress. Also, it the specific attachment of the prosthetic material to the stent frame, a balloon effect of the coaptation cylinder during systolic cycle can be effected, improving coaptation additionally.
The “main body” of the prosthetic valve device comprises or consists of the stent frame, wherein the stent frame is covered by a prosthetic material at least partially. Herein, the expression “at least partially” in view of the prosthesis material means that the stent frame, over a substantial part along its length, is circumferentially covered by the prosthesis material, in particular in the region of the stent frame where the elongated loop-structure/element is provided. Preferably, only the portion of the stent frame carrying the elongated loop-structure/element is covered by the prosthesis material. The wire end portions extend further in the distal/outflow direction and are—over a certain length—not covered by the prosthesis material or contained in any element, so that perfusion inside the wire supported cylindrical body is allowed.
Further, a “valve structure” as herein used, means any element for controlling the passage of blood in one direction only, and in particular includes any artificial or mixed artificial/natural valves or valve tissue resembling a native heart valve of a mammal, in particular a human. In other words, according to the invention, a “valve structure” is a valve element fulfilling functions similar to healthy native heart valves, i.e., allowing blood flow in one direction only.
As used herein, a “wire-element” is an element formed by/through a/one single wire. A “wire”, as used and meant herein, as well as known in the prior art, includes any metal/alloy drawn out into the form of a thin flexible longish thread, that has two ends.
In this connection, a wire-element end portion designates a section or area of the end portion of the wire-element located either in the proximally or distally with respect to the inflow end (=proximal/proximally) and the outflow end (=distal/distally).
As used herein, an “elongated loop-structure” means and encompasses any curved shape made when a single wire is bent until one part of it crosses another part of it, thus forming a ring-like structure, wherein the shape of the ring is elongate, i.e., rather oval or substantially oval than circular. According to a preferred embodiment, the elongated loop-structure has a diameter taken in the proximal-distal direction that is larger than a diameter taken in the circumferential direction. The plurality of elongated loop-like elements preferably has the same diameter in proximal-distal direction.
A “curve section” shall designate a curved area/portion of the elongated loop-like element that lies, depending on the definition, proximally or distally, wherein the proximal curve section designates the curve bending in the proximal/inflow direction, and the distal curve section being towards the distal/outflow direction.
According to the invention, a “wire-element” has a loop at the proximal wire-element portion; preferably, the first and second ends, respectively, are comprised by end portions that are not bended or curved, but extend in a straight manner in the distal direction over a certain length. Preferably, the end portions are of the same length.
The expression “proximal”, as used herein, generally designates the direction of blood inflow of the prosthetic valve device, i.e., the direction—in relation of the prosthetic valve device—where blood enters to flow from the atrium into the lumen of the prosthetic valve device. Accordingly, the expression “distal” designates the blood outflow direction of the prosthetic valve device, i.e., the end where the blood exits the lumen into the ventricle. Accordingly, the expression “proximal” can also be used synonymously with “inflow” and “proximal” with “outflow”.
According to the invention, the prosthetic material is fixed to the stent frame, such, that it covers the proximal wire-element portion carrying the elongated loop-structure. The fixation can be performed/effected by any kind of suitable fixation or attachment means, in particular by sewing, preferably by means of a surgical thread made of PTFE or any other biocompatible material. Preferably, the prosthetic material wherein the prosthetic material does not cover the distal wire-element portion.
According to an embodiment of the prosthetic device of the invention, at the proximal wire-element portion an elongated loop-structure is provided and the first and second wire end portions both extend in the distal wire-element portion.
According to preferred embodiments of the invention, the loop-structure can be formed by either forming, in the length of a wire, a bend in about the middle of its length, thus generating a proximal bend/curve section and by bringing together, with a half-bend in each of the wire ends, the first and second wire end portions to form a distal wire curve section. Alternatively, according to another preferred embodiment, the proximal and distal curve sections are formed by guiding around a wire-element in a circle.
According to a preferred embodiment of the prosthetic valve device of the invention, the loop-structure can be provided as an open or closed loop-structure.
Preferably, when “open”, the loop is preferably formed such, that in the length of a wire a bend is formed in about the middle of its length, by generating a proximal bend/curve section and by bringing together the first and second wire end portions to form a distal wire curve section or bend, preferably with each wire forming a half of the distal curve section. In that way, the elongated loop-structure is formed in the proximal wire-element portion, and the first and second wire end portions both extend—as individual end portions—in/towards the distal wire-element portion, i.e., opposite the proximal bend/curve section.
Preferably, in case of a “closed” loop-structure, the first and second wire end portions of the wires opposite the bend/proximal curve are being held together, adjacent and distal to the distal curve section, at least over a certain distance, preferably by a crimp, a sleeve, or by twisting.
According to yet another preferred embodiment, when provided with a closed loop-structure, the first and second wire end portions can be held together by a sleeve substantially over their entire length adjacent to the distal curve section, whereby a joint distal wire-element portion is formed by a joined first and second wire end portion. As a consequence, a first and second wire end portion jointly/as a pair extends in/towards the distal wire-element portion as one unit, respectively.
According to yet another embodiment, the proximal curve section can comprise two layers of the single wire, and the distal curve section comprises one layer of the wire, or in other words, this embodiment is generated by guiding the wire in an oval circle. Also, in this case, the first and the second wire end portions can extend as individual end portions in the distal wire-element portions, or as a joint unit of two ends. In the latter case, the first and second wire end portions of the wires opposite the bend/proximal curve are being held together, adjacent and distal to the distal curve section, at least over a certain distance, preferably by a crimp, a sleeve, or by twisting.
According to an embodiment of the prosthetic device of the invention, the elongated loop-structure is designed such, that it has a proximal curve section, a distal curve section and a medium section extending between the proximal curve section and the distal curve section, wherein preferably, in the medium section, the wire extends substantially straight. More preferably, the wire extends from the proximal curve section to the medium section into left and right straight wire sections, and further to the distal curve section, wherein the left and right wire sections at the distal curve section each are bend towards each other such, that the distal curve is formed.
In a preferred embodiment, the proximal curve section, with reference to the proximal-distal length axis and/or the lumen, is bent outwardly.
According to another embodiment of the prosthetic device of the invention, the wire-elements are attached to one another, preferably via crimp-elements crimping together the wire-elements. In a refinement, the first and second wire ends of one wire element are additionally paired in a sleeve.
According to an refinement of this embodiment, at least one, two, three four, five or six, crimp-elements are provided, preferably adjacent to the proximal curve section, wherein further preferably one crimp-element connects a left and a right wire section of two different wire-elements.
With this embodiment, a more stable connection/assembly of the wire-elements as such can be provided. Accordingly, in case of three wire-elements, three crimp-elements are needed to attach the wire-elements to one another.
According to a refinement of the invention, the prosthetic valve device of the invention further comprises a tube-element, the tube-element comprising at least one lumen extending through the tube-element, the lumen being designed for accommodating the distal wire-element portion, and preferably for accommodating the first and/or second wire end portions singularly or in pairs.
With the tube-element, the free ends/end portions of the wire-elements can be guided/threaded or introduced into a lumen, thus avoiding that the free ends can contact/cause injury of the heart tissue. Also, by means of the tube-element, a stable and secure fixation of the wire-elements ends can be achieved, e.g., by apically or septally fixating the tube having “bundled” the wires therein. As such, the “tube”-element represents a shaft for accommodating the wire end portions via which the device can be fixated apically or septally.
According to the invention, the tube-element is spaced in a distance from the covered stent frame section; in other words, the tube element is spaced apart from the distal curved section, thus creating a bare stent frame section that contains wires which are not covered and not contained in the tube-element. As mentioned above, this allows perfusion inside the wire supported tubular structure.
According to a preferred embodiment, the plurality of wire-elements consists of at least or exactly three, four, five or six wire-elements. When using three wires, six wire end portions, i.e., two per wire, are extending towards the distal direction, with the loops being at the proximal end, respectively.
According to another refinement, the tube-element has multiple lumens, preferentially radial to the tube section, extending through the tube-element, such, that each of the first and second wire end portions of the single wires is guided through a single lumen of the multiple lumens of the tube-element. According to a preferred embodiment, the tube-element comprises at least or exactly three or six lumens. Three lumens are preferred for the tube-element in cases where there are three wire-elements provided, with the first and second ends of the three wire-elements, respectively, guided in pairs in one lumen, respectively. Six lumens are preferred for the tube-element in cases where there are three wire-elements provided, with the first and second ends of the three wire-elements, respectively, guided separately in a single lumen in the tube-element.
With this embodiment, the wire end portions of the wire-elements can be secured and guided separately or in pairs through the tube-element, thus avoiding friction of the wires against one another.
According to a preferred embodiment, the tube-element has a length that is shorter than the length of the free wire ends/uncovered end portions. Also, the wire ends/end portions, for fixation purposes, can be guided through the lumen(s) so that they exit the lumen(s) of the tube-element so that they can be used for fixating the prosthetic valve device in the heart of the patient to be treated.
According to a preferred embodiment, the tube-element consists of or comprises a material that is selected from any biocompatible polymer or plastic, such as polyether ether ketone (PEEK), polyoxymethylene (POM), polyether (PE), polyamide (PA), polytetrafluoroethylene (PTFE), ceramics, materials of animal or human origin or generally synthetic materials.
According to a preferred embodiment, the prosthetic material is a biocompatible flexible material, and more preferably selected from mammal tissue, PFTE, and is most preferably mammal pericardium.
According to another preferred embodiment, wires consist of a shape-memory alloy, preferably Nitinol.
By using nitinol wires, the elongated loop-structure of the wire-elements can be preformed according to individual or general needs/requirements. I.e., the diameter of the elongated loop-structure, taken in the proximal-distal direction, can be made larger or smaller, and, as a consequence, the tube or covered portion can be longer or shorter in view of the dimensions of the heart/valve to be treated/supported.
According to a preferred embodiment, in the prosthetic valve device of the invention the prosthetic material is fixed only to the proximal curve section and the distal curve section.
With this embodiment, the medium section of the prosthetic material is not attached to the stent frame, and as a consequence, can inflate in a balloon-like fashion and can coapt to the native mitral valve during systole.
According to a preferred embodiment of the device of the invention, the elongated loop-structure has a substantially oval form.
The present invention also concerns a method for manufacturing a prosthetic valve device, the method comprising the subsequent steps of:
With this method, a cost-effective and efficient way of manufacturing a prosthetic valve device, in particular one as detailed as invention above, can be achieved: By attaching the wire-elements via their elongated loop-structure to the outer surface of the tubular prosthetic material, and by inverting/folding the tubular prosthetic material “inside-out” over the elongated loop-structure, a valve-element is being generated within the lumen of the prosthetic valve device.
According to the method and the prosthetic valve device of the invention, the wire-elements, in the first step, are arranged on the outer surface of the tubular prosthetic material, such, that the elongated loop-structures are distributed in circumferential direction at the same heights.
According to a preferred embodiment, in step a), the wire elements are attached to one another by crimp-elements, thus forming the stent frame.
According to a refinement of the method and the prosthetic valve device of the invention it is preferred, if the tubular prosthesis material has a first prosthetic material end portion and a second prosthetic material end portion, and that the wire-elements are attached to the outer surface of the tubular prosthesis material, at the first prosthetic material end portion in step b), such, that the proximal curve sections of the wire-elements cover an the first prosthetic material end portion of the tubular prosthesis material, which portion is selected from about a half, a third, a quarter, a fifth of the outer surface of the prosthesis material in step b). While the tubular prosthetic material is attached in the proximal curve section of the elongated loop-structures, its first prosthetic material end portion is fixed in a certain desired distance X from the absolute proximal end of the elongated loop-structures.
According to a preferred embodiment, where three wire-elements are provided, the elongated loop-structures of the wire-elements are dimensioned such, that when arranged in the circumferential direction of the prosthesis material, they abut with each other. In this configuration, the wire-elements, or rather the elongated loop-structures are arranged in a quasi-triangle circumferentially surrounding the prosthetic material in step b).
According to a refinement of the invention, i.e. the method and/or the device of the invention, the wire-elements can additionally be fixed to one another, e.g. by sewing them together at the respective sites they abut with one another.
According to another refinement, the method further comprises step e): threading the respective first wire end portions and second wire end portions into a lumen of a tube-element, the tube-element comprising at least one lumen extending through the tube-element, the lumen being designed for accommodating the first and second wire ends/end portions.
In this refinement it is particularly preferred if the wire ends/end portions are introduced into the tube-element such, that the main body carrying the covered section of the stent frame is spaced apart from the tube-element at a certain distance, so that a bare stent frame section is created allowing perfusion.
As already detailed for the prosthetic valve device of the invention, and according to a preferred embodiment, the tube-element is a multi-lumen tube-element, comprising at least or exactly three or six lumen for accommodating the first and second wire end portions.
Also, in the method of the invention, it is preferred if the wires consist of or contain a shape-memory alloy, preferably Nitinol.
In a step preceding step a) of the method of the invention, a step a′) can be provided, comprising the generating of an elongated loop-structure in a wire, which can be performed by, e.g., guiding a wire with one end over one pin or two pins that are spaced apart from one another, and heating the wire, thus, generating the elongated loop-structure of the wire-elements.
According to another aspect of the invention, a prosthetic valve device is provided that comprises a main body having a cylindrical form and comprising a lumen extending from a main body proximal end to a main body distal end, and a valve at the main body distal end, and that is manufactured by the method as detailed above.
According to yet another aspect of the invention, a method for treating a mitral valve disease of a person, preferably a human, in need thereof, is disclosed, the method comprising the steps of providing a prosthetic valve device as detailed above, and implanting the prosthetic valve device in the region of the mitral valve to be treated. Accordingly, the present invention also concerns the use of the prosthetic device as described herein for treating a mitral valve disease of a person, preferably a human, in need thereof.
The prosthetic valve device according to the invention can be either surgically implanted or delivered by transcatheter methods. In the latter case, i.e., with a transcatheter method, the device according to the invention is loaded onto a suitable deployment catheter, there being compressed by a retractable sheath or tube or similar. The deployment catheter is inserted into the heart of a patient whose mitral valve needs replacement or support. The tube-element, in this process, is subsequently fixed to the apex in an apical anchor, which grabs and holds the tube in the desired position. The tube-element can be moved in the anchor to the respective best coaptation position and fixed, e.g., via hooks or a plug, in the apex tissue.
When treating the mitral valve trans-apically, the implantation is done with a small surgery to access the apex of the left ventricle, and the deployment catheter having the device according to the invention loaded thereon in a compressed state, is advanced trans-apically into the left ventricle crossing the mitral valve where it is deployed, with the valve-bearing section in the atrial side.
Alternatively, the compressed device can be introduced via the femoral vein or Jugular vein into the right atrium and trans-septally to the left atrium crossing the mitral valve until the catheter tip reaches the left ventricle apex from inside, when it is deployed in order to expand the valve-bearing section in the atrial side. Via a mechanism, the wires are pushed forward and locked out of the tip of the tube-element/catheter, hooking the wire ends into the myocardium. Additionally, the compressed device can be introduced via a small surgical thoracotomy into to the pulmonic vein (right, left, inferior or superior pulmonic vein) to the left atrium where it is deployed in order to expand valve-bearing section in the atrial side.
Upon correct placement, the sheath or the otherwise compressing means is retracted to release the prosthetic valve device of the invention in a stepwise fashion, upon which action the stent frame of the device can expand.
Further advantages and features of the invention are set forth in the following description and in the attached figures.
It will be understood that the aforementioned features and the features still to be explained below can be used not only in the respectively specified combination but also in other combinations or on their own, without departing from the scope of the present invention.
The aforementioned features of the invention and the features still to be explained below are shown in the figures, in which:
In
In more detail, the superior vena cava 52 returns the blood from the upper half of the body, and opens into the upper and back part of the right atrium 54, the direction of its orifice 52a being downward and forward. Its orifice 52a has no valve.
The inferior vena cava 53, which has a larger diameter than the superior vena cava 52, returns the blood from the lower half of the body, and opens into the lowest part of the right atrium 54, its orifice 53a being directed upward and backward, and guarded by a rudimentary valve, the valve of the inferior vena cava (Eustachian valve, not shown).
The right ventricle 55 has a triangular in form, and extends from the right atrium 54 to near the apex 59 of the heart 50.
The right atrioventricular orifice (not depicted in
The opening 61 of the pulmonary artery 62 is circular in form, and is placed above and to the left of the atrioventricular opening; it is guarded by the pulmonary valves 63.
As discussed above, the function of the tricuspid valve 60 is to prevent back flow of blood into the right atrium 54; arrows 70 and 71 indicate normal blood flow into the right atrium 54.
The left atrium 56 is smaller than the right atrium 54. The left ventricle 57 is longer and more conical in shape than the right ventricle 55. The left atrioventricular opening (mitral orifice, not depicted in
The aortic opening 65 is a circular aperture, in front and to the right of the atrioventricular opening, and its orifice is guarded by the three aortic valves 67. Reference number 68 designates the aorta.
Separating the left atrial chamber or left atrium 56 from the left ventricle 57, the mitral valve 66 is, as mentioned above, an atrio-ventricular valve, with the mitral annulus 70 constituting the anatomical junction between the ventricle 57 and the left atrium 56; the annulus 70 also serves as insertion site for the leaflet tissue (not shown).
The normal mitral valve 66 opens when the left ventricle 57 relaxes (diastole) allowing blood from the left atrium 56 to fill the decompressed left ventricle 57. During systole, i.e., when the left ventricle 57 contracts, the increase in pressure within the ventricle 57 causes the mitral valve 66 to close, preventing blood from leaking into the left atrium 56 and assuring that all of the blood leaving the left ventricle is ejected though the aortic valve 67 into the aorta 68 and to the body. Proper function of the mitral valve is dependent on a complex interplay between the annulus 70, leaflets and subvalvular apparatus (not depicted in
Mitral valve 66 regurgitation is present when the valve 66 does not close completely, causing blood to leak back into the left atrium 56.
In
The elongated loop-structure 107 has a proximal curve section 108 and a distal curve section 109, as well as a medium section 110 between the proximal curve section 108 and distal curve section 109.
As can be seen in
Herein, i.e. throughout the invention, with the term “wire ends” 103a, 104a the very ends of the wires 102 are designated, wherein with “wire end portions” 103, 104 a section of the respective wire 102 directly adjacent to the specific wire end 103, 104 is designated, although at some passages, when used alternatively, it will be obvious which of the two alternatives, i.e. the very end or an “end portion”/end section is meant.
When manufacturing a prosthetic valve device 100 of the invention, at least two, preferably three of the wire-elements 101 are provided, preferably made from nitinol, wherein the elongated loop-structure 107 is generated such, that each of the wire-elements 101 is winded around, e.g., two pins that are spaced from one another in a certain, desired distance, which distance regulates the diameter d1 of the elongated loop-structure 107. Upon heating the wire-elements, they retain the elongated loop-structure 107.
Next, and this can be seen in
In order to generate the valve structure 116, the tubular prosthetic material 113 is inverted, or folded over the proximal curve section 108 of the elongated loop-structures 107, as indicated by the arrows 117 in
In a next step, as can be seen in
With this step, i.e. inverting or folding the tubular prosthetic material 113 over the proximal curve section 108 of elongated loop-structures 107, a valve structure 116 is generated which is positioned at the attachment site of the first prosthetic material end portion 113a of the prosthetic material 113, which is generally located at the proximal curve section 108, but distanced from the very proximal end 111 of the elongated loop-structures 107 at a distance X (see
The first and second end portions 103, 104 of the wire-elements, extend the towards the wire-elements distal portion 106.
In providing the tube-element 130 accommodating the wire-elements 101, it can be advantageously avoided, that the ends/end portions 103, 104, 103a, 104a, cause injuries of the heart tissue. Also, friction of the wire end portions 103, 104, which outwears the wire-elements 101, can be avoided.
As can be seen in the embodiments 3E and 3F, the proximal curve sections 108 are bent outwardly, in respect to longitudinal axis A (see
In
In an alternative embodiment shown in
Turning now to
While the first and second wire end portions 103, 104, in the embodiment shown in
Alternatively, and this is shown in
In both embodiments, the first and second wire end portions 103, 104 can either be separately be guided into a tube-element 103, or in pairs.
In a preferred embodiment, the proximal curve section, with reference to the proximal-distal length axis and/or the lumen, is bent outwardly.
According to another embodiment of the prosthetic device of the invention, the wire-elements are attached to one another, preferably via crimp-elements crimping together the wire-elements.
According to an refinement of this embodiment, at least one, two, three four, five or six, crimp-elements are provided, preferably adjacent to the proximal curve section, wherein further preferably one crimp-element connects a left and a right wire section of two different wire-elements.
With this embodiment, a more stable connection/assembly of the wire-elements as such can be provided. Accordingly, in case of three wire-elements, three crimp-elements are needed to attach the wire-elements to one another.
According to a refinement of the invention, the prosthetic valve device of the invention further comprises a tube-element, the tube-element comprising at least one lumen extending through the tube-element, the lumen being designed for accommodating the distal wire-element portion, and preferably for accommodating the first and/or second wire end portions singularly or in pairs.
The trans-apical implantation is effected by a small surgery to access the apex of the left ventricle and the prosthetic valve device 100 is deployed using a trans-apical catheter (not shown). The tube-element 130 is fixed to the apex in an apical anchor 133 which can grab the tube-element 130 in the desired position. The tube-element 130 can be moved in the anchor 133 to the best coaptation position and fixed, e.g., in a plug-like fashion.
The trans-septal implantation requires a catheter (not shown) that delivers the prosthetic valve device 100 via the femoral vein, right atrium, cross septum, left atrium, crossing mitral valve, until the catheter tip reaches the left ventricle apex from inside. Using a mechanism to slide and lock the wires out of the tube-element the wire-elements can be hooked to the myocardium via hooks 135.
As can be seen, the proximal curve sections 108 are slightly bent outwardly, in respect to longitudinal axis A. Further, the stent frame 112 is generated such, that three wire-elements 101 are provided, which are connected to one another by crimp-elements 140a, 140b at two different positions, i.e., a more proximal one 140a and a more distal one 140b. The proximal crimp-elements 140a are provided adjacent to the proximal curve section 108, joining left and right wire portions 136, 137 of two different wire-elements 101 together, respectively. The distal crimp-elements 140b are provided proximal to the distal curve section 109, in a certain distance from the proximal crimp-element 104a.
In the embodiment shown in
| Number | Date | Country | Kind |
|---|---|---|---|
| 10 2020 122 386.2 | Aug 2020 | DE | national |
This application is a continuation of international patent application PCT/EP2021/073468, filed on Aug. 25, 2021, designating the U.S., which international patent application has been published in English language and claims priority from German patent application DE 10 2020 122 386.2, filed on Aug. 27, 2020. The entire contents of these priority applications are incorporated herein by reference.
| Number | Date | Country | |
|---|---|---|---|
| Parent | PCT/EP2021/073468 | Aug 2021 | US |
| Child | 18107670 | US |
