Replacement heart valves, delivery devices and methods

Description

BACKGROUND
Field of the Invention

Certain embodiments disclosed herein relate generally to replacement valves for a vascular system, delivery devices for the replacement valves, and related delivery methods, among other things. In particular, the valves relate to replacement heart valves, such as for the mitral valve.

Description of the Related Art

Human heart valves, which include the aortic, pulmonary, mitral and tricuspid valves, function essentially as one-way valves operating in synchronization with the pumping heart. The valves allow blood to flow downstream, but block blood from flowing upstream. Diseased heart valves exhibit impairments such as narrowing of the valve or regurgitation, which inhibit the valves' ability to control blood flow. Such impairments reduce the heart's blood-pumping efficiency and can be a debilitating and life threatening condition. For example, valve insufficiency can lead to conditions such as heart hypertrophy and dilation of the ventricle. Thus, extensive efforts have been made to develop methods and apparatus to repair or replace impaired heart valves.

Prostheses exist to correct problems associated with impaired heart valves. For example, mechanical and tissue-based heart valve prostheses can be used to replace impaired native heart valves. More recently, substantial effort has been dedicated to developing replacement heart valves, particularly tissue-based replacement heart valves, that can be delivered with less trauma to the patient than through open heart surgery. Replacement valves are being designed to be delivered through minimally invasive procedures and even percutaneous procedures. Such replacement valves often include a tissue-based valve body that is connected to an expandable frame that is then delivered to the native valve's annulus.

Development of replacement heart valves that can be compacted for delivery and then controllably expanded for controlled placement, and the related delivery devices have proven to be particularly challenging.

SUMMARY OF THE INVENTION

Accordingly, there is in the need of the art for improved replacement heart valves, delivery devices, and delivery methods, among other things.

In some embodiments a replacement heart valve can comprise an expandable frame, and a valve body. The expandable frame can be configured to engage a native valve annulus, wherein the frame extends longitudinally between an upstream end and a downstream end, the frame having a foreshortening portion at or adjacent the downstream end, the foreshortening portion comprising foreshortening cells that are longitudinally expanded when the frame is in a radially compacted state and longitudinally contracted when the frame is in a radially expanded state. The valve body can be coupled to the frame, the valve body coupled to the frame in the foreshortening portion in a manner so that the frame foreshortening portion can move longitudinally relative to the valve body. Upon radial compaction of the implant, the frame foreshortening portion can longitudinally expand but moves relative to the valve body so that the valve body substantially retains its longitudinal length.

According to some embodiments, the valve body can have a downstream end that is generally aligned with a downstream end of the frame foreshortening portion, but is not connected to the downstream end of the frame foreshortening portion. A first longitudinal distance can exist between the downstream end of the frame foreshortening portion downstream end and the downstream end of the valve body when the frame is in a radially expanded configuration, and a second longitudinal distance exists between the downstream end of the frame foreshortening portion downstream end and the downstream end of the valve body when the frame is in a radially compacted configuration, the second longitudinal distance being greater than the first longitudinal distance.

In some embodiments, the valve body can be slidably coupled to a downstream portion of the frame and substantially non-slidably coupled to an upstream portion of the frame. The expandable frame may further comprise a non-foreshortening portion at or adjacent the upstream end, the non-foreshortening portion comprising longitudinal struts. The non-foreshortening portion can be configured to substantially maintain its longitudinal length as between the radially compacted state and the radially expanded state. The longitudinal struts can extend upstream from the foreshortening cells. The valve body can be slidably coupled to a downstream portion of the frame and substantially non-slidably coupled to an upstream portion of the frame. The valve may also further comprise a substantially inelastic band at the upstream end of the expandable frame.

In some embodiments, replacement heart valve can comprise an expandable frame configured to engage a native valve annulus, wherein the frame extends longitudinally between an upstream end and a downstream end, the frame having a foreshortening portion at or adjacent the downstream end, the foreshortening portion comprising foreshortening cells that are longitudinally expanded when the frame is in a radially compacted state and longitudinally contracted when the frame is in a radially expanded state, a valve body coupled to the frame, and a support band positioned within the frame at the upstream end.

A delivery device for delivering a replacement heart valve according to some embodiments can comprise an inner support for receiving a replacement heart valve, an inner retainer ring on the inner support, and an outer retainer ring to slidably engage the inner retainer ring to secure a proximal end of the replacement heart valve on the delivery device.

Some embodiments of delivery device can further include a floating sheath to slidably cover a central region of the replacement heart valve between the proximal end and a distal end while the replacement heart valve is in a radially compacted state and/or an outer sheath to slidably cover the replacement heart valve in the radially compacted state, as well as the outer retainer ring, the inner retainer ring, and floating sheath, wherein the floating sheath is connected to the outer sheath with one or more tension members such that withdrawal of the outer sheath from covering the replacement heart valve can also cause the floating sheath to withdraw from covering the replacement heart valve. The outer sheath may have a first withdrawal position where at least the distal end of the replacement heart valve is uncovered and the floating sheath remains covering the central region. The outer sheath may have a second withdrawal position where the floating sheath does not cover the central region.

A method of treating valve insufficiency of a mitral valve of a patient by delivering a replacement valve can comprise one or more of the following steps. Providing a replacement valve mounted on a delivery device, the replacement valve comprising a radially expandable frame having an upstream end and a downstream end, the frame further comprising a plurality of first anchors directed toward the upstream end. Delivering the replacement valve to a native mitral valve annulus while the replacement valve is in a radially compacted state, the native mitral valve annulus having two or more native valve leaflets. Positioning the replacement valve so that tips of the plurality of first anchors are downstream of the native valve leaflets. Exposing a portion of the downstream end of the replacement valve so that the plurality of first anchors extend radially from the delivery device and the anchor tips are positioned to an outer side of the native leaflets. Moving the replacement valve in an upstream direction so that tips of the plurality of first anchors engage a downstream side of the native mitral valve annulus. After the plurality of first anchors engage the native mitral valve annulus, releasing the replacement valve from the delivery device and allowing the frame to expand to a radially expanded state.

In some embodiments, a method may also include one or more of the following steps. Wherein the downstream end of the frame has a foreshortening portion configured to longitudinally expand when in the radially compacted state and longitudinally contract when the foreshortening portion is in the radially expanded state and the upstream end maintains a substantially constant longitudinal length in the expanded state and in the compacted state. Wherein a downstream portion of the frame foreshortens and flares radially outward as the frame expands to the expanded state. Wherein moving the replacement valve in an upstream direction comprises engaging and compacting or folding the native valve leaflets with the plurality of first anchors. Wherein moving the replacement valve in an upstream direction so that tips of the plurality of first anchors engage a downstream side of the native valve annulus comprises engaging a posterior leaflet. After engaging the posterior leaflet repositioning the replacement valve, and engaging an anterior leaflet with the plurality of first anchors. Engaging an upstream side of the native mitral valve annulus with a plurality of second anchors. Exposing a portion of the downstream end of the replacement valve so that the plurality of first anchors extend radially from the delivery device further comprises expanding the frame to a first expanded state. Expanding the frame to a second expanded state and moving the replacement valve in an upstream direction so that tips of the plurality of first anchors engage another part of the downstream side of the native mitral valve annulus. Wherein releasing the replacement valve from the delivery device and allowing the frame to expand to a radially expanded state comprising expanding the frame to a third expanded state.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features, aspects and advantages are described below with reference to the drawings, which are intended to illustrate but not to limit the invention. In the drawings, like reference characters denote corresponding features consistently throughout similar embodiments.

FIG. 1 is a perspective view of one embodiment of a replacement heart valve.

FIG. 2 is a view looking upstream through the replacement heart valve of FIG. 1.

FIG. 3 is a schematic detail side view of the replacement heart valve of FIG. 1.

FIG. 4 shows a schematic detail side view of another embodiment of a replacement heart valve.

FIG. 5A is a perspective view of a replacement heart valve in an expanded state in accordance with an embodiment.

FIG. 5B is a side view of the replacement heart valve of FIG. 5A in a compacted state.

FIG. 5C is a side view of a portion of the cells of the compacted-state replacement heart valve of FIG. 5B.

FIG. 5D is a side view of a portion of the cells of the expanded-state replacement heart valve of FIG. 5A.

FIG. 6A is a perspective view of a replacement heart valve in an expanded state in accordance with an embodiment.

FIG. 6B is a side view of the replacement heart valve of FIG. 6A in a compacted state.

FIG. 7A is a perspective view of a replacement heart valve in an expanded state in accordance with another embodiment.

FIG. 7B is a side view of the replacement heart valve of FIG. 7A in a compacted state.

FIG. 7C is a cross-section side view of a portion of the expanded-state replacement heart valve of FIG. 7A.

FIG. 8 schematically shows a replacement heart valve as in FIGS. 1-2 deployed in a native mitral annulus of a human heart.

FIG. 9A shows an embodiment of a delivery device for delivering a replacement heart valve in accordance with one embodiment.

FIG. 9B shows a distal portion of the delivery device of FIG. 9A with a schematic representation of a valve frame.

FIGS. 10A-C schematically show a replacement heart valve and steps of a method of deploying the replacement heart valve according to one embodiment.

FIG. 11 shows a distal portion of another embodiment of delivery device with a schematic representation of a valve frame.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

The present specification and drawings provide aspects and features of the disclosure in the context of several embodiments of replacement heart valves, delivery devices and methods that are configured for use in the vasculature of a patient, such as for replacement of natural heart valves in a patient. These embodiments may be discussed in connection with replacing specific valves such as the patient's aortic or mitral valve. However, it is to be understood that the features and concepts discussed herein can be applied to products other than heart valve implants. For example, the controlled positioning, deployment, and securing features described herein can be applied to medical implants for use elsewhere in the body, such as within a vein, or the like. In addition, particular features of a valve, delivery device, etc. should not be taken as limiting, and features of any one embodiment discussed herein can be combined with features of other embodiments as desired and when appropriate.

With initial reference to FIGS. 1 and 2, an embodiment of a replacement heart valve 10 is shown. The illustrated replacement heart valve 10 is designed to replace a damaged or diseased native heart valve such as a mitral valve. The replacement heart valve 10 includes a self-expanding frame 20 to which a plurality of valve leaflets 12 are attached.

The plurality of valve leaflets 12 can function in a manner similar to the natural mitral valve, or to other valves in the vascular system. The plurality of valve leaflets 12 can open in a first position and then engage one another to close the valve in a second position. The plurality of valve leaflets 12 can be made to function as a one way valve such that flow in one direction opens the valve and flow in a second direction opposite the first direction closes the valve. The replacement heart valve 10 can be constructed so as to open naturally with the beating of the heart. For example, the plurality of valve leaflets 12 can be open during diastole and closed during systole. The valve can include many different components as will be discussed in detail below.

To aid in the description of the replacement heart valve 10, certain directional or relative terms may be used herein. The illustrated replacement heart valve 10 is a one-way valve, thus the term “upstream” refers to the end or section closest to the inflow of blood or other fluid into the valve and “downstream” refers to the end or section closest to the outflow of blood or other fluid from the valve. As will be described, the replacement heart valve 10 is generally implanted by moving the replacement heart valve 10 within a vessel towards the diseased or damaged native valve with the flow of fluid. Thus, the term “proximal” coincides with upstream and “distal” coincides with downstream. It should be understood that the valve can also be implanted by moving the replacement heart valve in the opposite direction. The term “longitudinal” refers to a direction, length or a location between the proximal end 14 and the distal end 16 of the replacement heart valve 10. The term “lateral” refers to a direction, length or location perpendicular to the longitudinal direction, length or location.

Still referring to FIG. 1, the shape of the illustrated replacement heart valve 10 can be generally referred to as having an upstream portion 38, a transition portion 40 and a downstream portion 42. The replacement heart valve 10 can be generally cylindrical in the longitudinal direction with the same or a varying diameter or outer perimeter. In the illustrated embodiment, the upstream portion 38 has an inflow diameter at the proximal end 14 and the downstream portion 42 preferably has an outflow diameter at the distal end 16. The upstream portion 38 and downstream portion 42 are generally cylindrical based on either the inflow diameter or the outflow diameter. As the outflow diameter is greater than the inflow diameter, a generally conical transition portion 40 is positioned between the proximal 14 and distal 16 ends. It will be understood that, in some embodiments, the replacement heart valve 10 may not have a transition portion 40, or that the transition portion 40 may be very abrupt and short. In addition, in some embodiments the transition portion 40 may be coextensive with either or both of the upstream portion 38 and the downstream portion 42. Some embodiments have a larger inflow dimension than the outflow dimension. In addition, in some embodiments the geometry of the replacement heart valve 10 can include one or more portions that are conical, spherical, parabolic, oval, convex, concave, or the like, or any combination thereof.

Finally, a non-foreshortening portion 52 and a foreshortening portion 54 are also referenced with the illustrated replacement heart valve 10. As will be described in more detail below, foreshortening refers to the idea that as the replacement heart valve 10 changes from the compacted or collapsed position to the expanded position the longitudinal length of the replacement heart valve 10 decreases in the foreshortening portion 54 but not in the non-foreshortening portion 52.

Replacement Heart Valve Frame

As has been mentioned, the replacement heart valve 10 includes a self-expanding frame 20 to which a plurality of valve leaflets 12 are attached. Other components of the valve may also be attached to the frame 20. It is to be understood that some embodiments may not employ a self expanding frame but may, for example, employ a balloon or the like to expand and deploy the frame.

The frame 20 can serve one or more different and unique purposes. For example, the frame 20 can serve as structural support for the valve, an anchoring mechanism to attach the valve to the vasculature, an attachment device to attach valve components to, a device to facilitate delivery of the valve and a device to maintain position of the valve after delivery.

The frame 20 can be made of many different materials, but is preferably made from metal. For example, the frame 20 can be a wireframe or a metal tube that has been cut or etched to remove all but a metal skeleton. The frame 20 can be constructed from a metal tube, such as a nitinol tube. In some embodiments, the frame 20 can be made from a shape memory material. The frame 20 can further be expanded and/or compressed and/or otherwise worked to have the desired introduction and implantation configurations.

As can be seen with particular reference to FIG. 1, the frame 20 includes a number of struts or members that collectively make up the frame 20. These struts can include longitudinal struts 56 and undulating struts, such as undulating struts forming one or more rings 58, 60, 62, 64, and 66. It will be understood that the frame 20 can include any number of longitudinal struts, undulating struts, and rings. The upstream 38, transition 40 and downstream 42 portions may all include more or less longitudinal struts, undulating struts, and rings than those shown herein, as well as, other configurations of the same.

As mentioned previously, the replacement heart valve 10 has a non-foreshortening portion 52 and a foreshortening portion 54. These portions can be defined by the frame 20 and the positioning of various types of struts along the frame 20. Referring now to FIGS. 1 and 3, it can be seen that the longitudinal struts 56 span the length of the non-foreshortening portion 52. Distal or downstream portions of the longitudinal struts 56 make up the transition portion 40, in which the struts 56 bend at bending stage 30 so as to flare radially outwardly and then bend again at bending stage 32 so as to stop expanding in radius and attach to the foreshortening portion 54 of the frame 20. As such, the frame 20 is generally divided into the upstream portion 38 made up of the first diameter, the transition portion 40 at which the diameter is expanding, and the downstream portion 42 with the larger second diameter. The downstream portion 42 also includes the foreshortening portion 54.

First 58, second 60, and third 62 rings made up of undulating struts are connected to the longitudinal struts 56 in the non-foreshortening portion 52. The illustrated first 58 and second 60 rings are of generally the same size, however, the struts in the third ring 62 are substantially larger and longer than the struts in the first 58 and second 60 rings. For example, the struts of the first 58 and second 60 rings can be about half as long as the struts of the third ring 62, or shorter. Additionally, upstream anchors 22 extend from the free apices of the struts in the third ring 62. As best shown in FIG. 3, the struts in the third ring 62 preferably are flared radially out at a more dramatic angle than is the longitudinal strut 56 at the transition portion 40. In the illustrated embodiment, the third ring struts 62 can be considered part of the upstream anchors 22.

Referring to FIGS. 1 and 3, a fourth ring 64 is attached to the distal end of the longitudinal struts 56 at an apex of the fourth ring 64. A fifth ring 66 attaches to the fourth ring 66 on the side opposite the longitudinal struts 56. The fifth ring 66 can be a mirror image of the fourth ring 64. In some embodiments, additional rings of undulating struts can be included in any part of the frame. For example, sixth and/or seventh rings can be positioned downstream of the fifth ring.

The fourth 64 and fifth 66 rings are made up of undulating struts and can make up the foreshortening portion 54. Expansion of the replacement heart valve 10 causes the struts of the fourth ring 64 to move farther apart such that they are at a greater angle relative to one another. Thus, they move from a relatively vertical orientation to a more horizontal orientation. This also causes the ring to shrink in vertical height. The fifth ring exhibits similar behavior when the valve 10 expands. This movement of the fourth 64 and fifth 66 rings results in foreshortening of the frame 20.

Opposing anchors 22, 24 can be constructed on the frame 20 so that preferably their tips 26, 28 move closer together as the frame foreshortens. This can allow the anchors 22, 24 to grasp opposite sides of the native mitral annulus or any other tissue that is perpendicular to the axis of the frame.

The anchors 22, 24 and anchor tips 26, 28 can be located anywhere along the frame 20 just so long as at least one of the anchors is connected to the foreshortening portion 54 to thereby move with the foreshortening portion 54. As shown, both of the anchor tips 26, 28 are located in the foreshortening portion 54. The foreshortening portion can also be positioned anywhere along the frame.

Preferably, each of the anchors 22, 24 also extends generally radially outwardly from the frame 20 so that the anchor tips 26, 28 are generally spaced away from the rest of the frame 20. In some embodiments, all or part of the structure connected to the anchor tip and extending radially from the frame, including one or more rings and/or struts, can be considered part of the anchor. The anchors can include a base located on the anchor on a side opposite the tip. The base can be for example where the anchor begins to extend from or away from the frame 20.

In some embodiments, each of the anchors can extend radially outwardly from the frame at an anchor base and terminate at an anchor tip. The anchors can be connected to the frame at one of many different locations including apices, junctions, other parts of struts, etc. The anchors can comprise first, second, third, or more spaced apart bending stages along the length of each anchor. The anchors can also extend either upstream or downstream before and/or after one or more of the bending stages. A portion of the anchor may extend with the frame before any bending stages. An example anchor can include first and second bending stages with a portion between the second bending stage and the anchor tip being generally parallel to an axis of the frame. Another example, can include first, second and third spaced apart bending stages, and wherein in the first bending stage the anchor is bent radially inwardly, in the second bending stage the anchor is bent radially outwardly, and in the third bending stage the anchor is bent radially inwardly. In the second bending stage the anchor can be bent about 180 degrees.

In preferred embodiments, the replacement heart valve 10 may be deployed into a heart valve annulus, and positioned when compacted so that the anchor tips 26, 28 of the opposing anchors 22, 24 are disposed on opposite sides of the native annulus. As the replacement heart valve 10 is expanded, the opposing anchors are drawn closer together so as to grasp opposite sides of the native annulus with the anchor tips 26, 28 and securely hold the replacement heart valve 10 in position. As such, the replacement heart valve 10 can be held securely in position without requiring a substantial radial force against the native annulus. The foreshortening portion 54 can be used to move the anchor tips 26, 28 closer together as the replacement heart valve 10 moves to the expanded position to thereby engage the native valve annulus.

Notably, in this embodiment the native annulus which is intended to be gripped between the anchor tips 26, 28 will be engaged by the foreshortening portion 54 of the frame 20, and will not engage the transition portion 40 of the frame 20. Rather, in a mitral placement, the upstream 38 and transition 40 portions of the replacement valve 10 will not necessarily be disposed within the annulus but mostly or entirely in the atrium.

Applicant's U.S. patent application Ser. No. 12/084,586, which was published on Aug. 27, 2009 as U.S. Publication No. 2009/0216314, discusses embodiments of foreshortening stents with anchors, and can be referred to for further discussion of certain aspects of the illustrated embodiments. Applicant's U.S. patent application Ser. No. 13/165,721, filed on Jun. 21, 2011, discusses embodiments of foreshortening frames with anchors, and can be referred to for further discussion of certain aspects of the illustrated embodiments. The above applications are incorporated in their entirety by reference herein with particular reference to the discussion concerning structure and operation of embodiments of foreshortening structures, particularly foreshortening structures having anchors.

Replacement Heart Valve Body

The replacement heart valve can include a valve body that is made up of one or more components. In some embodiments, the valve body only includes a plurality of valve leaflets. In other embodiments, the valve body may also include one or more of an outer valve skirt, a connection skirt, and a support band.

As has been mentioned, a plurality of valve leaflets 12 are attached to the self-expanding frame 20 (FIGS. 2 and 3). The plurality of valve leaflets 12 can function in a manner similar to the natural mitral valve to open and close as appropriate and thereby control blood flow.

The leaflets 12 can be one of many different shapes and configurations. There can be two, three or more leaflets 12. The leaflets 12 can be cut from a flat, tissue material such as pericardium. Preferably, upstream portions of the leaflets are generally curved. The curvature and size of the pattern cuts, and particularly the curvature of the side edges, can be chosen so that the valve fits within the particular shape defined by the frame 20.

The leaflets 12 can also be positioned in any portion of the frame. The leaflets 12 can be positioned solely within any one of the upstream portion 38, the transition portion 40, and the downstream portion 42. The leaflets can also extend between different diameter sections of the frame 20. Looking to FIG. 3, it can be seen that in some embodiments, the leaflets 12 extend from the upstream portion 38 to the end of the transition portion 40. The 12 leaflets 12 can alternatively extend from any part of one of the upstream portion 38, the transition portion 40, and the downstream portion 42 to any part of one of the upstream portion 38, the transition portion 40, and the downstream portion 42.

In some embodiments, the leaflets 12 can be coupled to the outwardly flaring portion of the valve skirt 18 in the transition portion 40. In this position, the leaflets can be at least partially within the native mitral valve annulus upon deployment, closer to the left ventricle, and closer to a native leaflet position.

The replacement heart valve 10 can further include an outer valve skirt 18. The outer valve skirt 18 can be configured to direct fluid to the valve leaflets 12. The outer valve skirt 18 can also be used at partially to control how fluid flows through and/or around the replacement heart valve 10. The outer valve skirt 18 can surround at least a portion of the valve and be connected to the valve leaflets 12. In some embodiments, the outer valve skirt 18 can form an inner wall connected to and positioned within the frame 20.

The outer valve skirt 18 can extend the length of the frame 20 or it can extend along only part of the length of the frame 20. In some embodiments, the ends 14, 16 of the replacement heart valve 10 can coincide with the inflow 34 and outflow 36 ends of the outer valve skirt 18. In the illustrated embodiment of FIGS. 1-3, the inflow end 34 substantially coincides with one end 14 of the replacement heart valve 10 while the other end 16 of the replacement heart valve 10 extends past the outflow end 36 of the valve body.

The shape of the outer valve skirt 18 can substantially correspond to that of the frame 20, with for example, different diameter sections and a transition between them. Other shapes and configurations can also be used.

The valve leaflets 12 can extend along all or part of the length of the outer valve skirt 18, and including all or part of the reduced and increasing diameter portions, i.e., the upstream 38 and transition 40 portions, as shown. In some embodiments, the leaflets 12 can also span all or part of the length of the downstream portion 42, together with or separate from the outer valve skirt 18.

In the illustrated embodiments, the outer valve skirt 18 is attached to the frame 20 and the leaflets 12 are attached to the outer valve skirt 18. Preferably, the outer valve skirt 18 is also formed of a pericardium tissue similar to the leaflets 12.

The outer valve skirt 18 can be constructed in multiple different ways. For example, the outer valve skirt 18 can be made by cutting out one or more pieces from flat tissue material and sewing the tissue together to form the outer valve skirt with a flared transition portion. Preferably, the outer valve skirt 18 is constructed of a tissue that is flexible, but not particularly expansive and stretchy.

As best shown in FIGS. 1-3, the replacement heart valve 10 can also include a connection skirt 50. The connection skirt 50 can be attached to one or both of the frame 20 and the outer valve skirt 18. The connection skirt 50 can function and/or provide benefits similar to the outer valve skirt 18. For example, the connection skirt 50 can be used to direct fluid flow into, out of, and/or around the replacement heart valve 10. The connection skirt 50 can also be made to move with the foreshortening portion 54 of the frame 20.

The connection skirt 50 can be made of knit polyester or another stretchable or flexible fabric. In some embodiments, the connection skirt 50 is made from a material that is more flexible than the outer valve skirt material and/or the valve leaflet material.

As shown, the connection skirt 50 is sewn to the outflow end 36 of the outer valve skirt 18 and is also attached to the frame 20 in the foreshortening portion. The upstream edge of the connection skirt 50 is generally straight so as to correspond to the downstream edge or outflow end 36 of the outer valve skirt 18 and contribute to an advantageous seam structure. The downstream end of the connection skirt 50 can be straight, curved, or have any other desired configuration. For example, the connection skirt 50 is shown with undulations patterned to generally correspond to the undulations at the end 16 of the frame 20. It is to be understood that other configurations of the connection skirt 50 can also be employed.

The replacement heart valve 10 can also include a support band 44. FIG. 4 illustrates a detail view of another embodiment of a replacement heart valve 10′ including a support band 44. Numerical reference to components is the same as previously described, except that a prime symbol (′) has been added to the reference. Where such references occur, it is to be understood that the components are the same or substantially similar to previously-described components.

The support band 44 may be placed or positioned around or within the frame 20′ at the proximal end. The support band 44 can be used to reinforce and/or constrain the frame 20′. The support band 44 can help to control the expansion of the frame 20′ from the compacted to the expanded state. The support band 44 can also be used to reduce the amount of motion that occurs at the upstream portion 38′ and/or at the proximal end 14′ after the replacement heart valve 10′ has been implanted within the mitral heart valve or other location.

In some embodiments, the support band 44 may comprise a polyester fabric band. The support band 44 may comprise a no-stretch or limited stretch material. Preferably the support band 44 is not made of an elastic material or a material known to have high elasticity. In some embodiments, the support band 44 is made from a material that is less flexible than the outer valve skirt material and/or the valve leaflet material. The distal and proximal ends of the support band 44 can be straight, curved, undulating with the undulations of frame, or any other desired configuration.

The support band 44 can be connected to the valve frame with a plurality of stitches, loops, knots, staples, or other types of connections. In some embodiments, the frame 20′ can be sandwiched between two sides or layers of the support band 44. Preferably, the support band 44 is a single layer positioned within and attached to the frame 20′ with a plurality of stitches around one or more of the longitudinal and/or undulating struts.

Viewing FIG. 4 in comparison to FIG. 3, it can be seen that the leaflets 12′, 12 are positioned lower in the valve, or closer to the proximal end 14′, 14 in FIG. 4. The support band 44 can reduce the movement and the moment at the proximal end 14′ allowing the valve to function more smoothly.

Still referring to FIG. 4, it can also be seen that this embodiment does not include a connection skirt so that the distal end 36′ of the outer valve skirt 18′ extends to the distal end 16′ of the valve.

The replacement heart valve 10′ may include a first ring of undulating struts in the upstream portion 38′, and a second ring of undulating struts in the transition portion 40′, including part of the anchor 22′. Third, fourth, and fifth rings are preferably located in the downstream portion 42′ forming two rows of adjacent diamond- or oval-shaped cells. In some embodiments, the downstream anchors 24′ extend from the junction of the fourth and fifth rings.

Additional example replacement heart valves with valve bodies are discussed in detail in U.S. application Ser. No. 12/569,856, filed Sep. 29, 2009 and Ser. No. 13/165,721, filed Jun. 21, 2011, both of which are incorporated by reference herein in their entirety and are to be considered a part of this specification.

Expansion and Compaction of Replacement Heart Valve

FIGS. 5A-D illustrate another embodiment of a replacement heart valve 10″. The illustrated replacement heart valve 10″ is designed to replace a diseased native mitral valve. The replacement heart valve includes a self-expanding frame 20″ to which a valve body is attached. The valve body includes an outer valve skirt 18″ and flexible leaflets that open and close, as discussed above. The replacement heart valve 10″ also includes a plurality of fasteners, which connect the valve body to the frame 20, as will be described in more detail below.

The replacement heart valve 10″ generally has two configurations, an expanded state shown in FIG. 5A and a compacted state shown in FIG. 5B. The replacement heart valve 10″ is typically stored in the compacted state prior to usage. In addition, the replacement heart valve 10″ is generally mounted onto a delivery device to assume the compacted state. The compacted state is preferably sufficiently small in diameter to fit into a catheter that will be used to advance the replacement heart valve 10″ through the vasculature and access the heart for deployment.

The replacement heart valve 10″ is generally deployed to assume the expanded state at a diseased or damage heart valve. Preferably the replacement heart valve 10″ transitions from the compacted state to the expanded state by self-expansion of the frame 20″. In some embodiments, the replacement heart valve 10″ transitions from a compacted to an expanded state by expansion of the frame 20″ by a dilator, such as a balloon, or the like. The transition may also be performed by the combination of a self-expanding frame and a dilator.

Expansion of the frame 20″ is controlled, at least in part, by the longitudinal 56″ and undulating struts that make up the frame. As mentioned previously, the replacement heart valve 10″ has a non-foreshortening portion 52″ and a foreshortening portion 54″. These portions can be defined at least in part by the frame 20″ and the positioning of various types of struts along the frame 20″.

The illustrated upstream portion 38″ of the frame 20″ is also part of the non-foreshortening portion 52″. Longitudinal struts 56″ substantially confine or restrict the upstream portion 38″ from changing length upon the radial expansion or compaction of the frame 20″. The upstream portion 38″ expands and compacts only in the radial direction. At least one ring 58″ of undulating struts can be positioned in the upstream portion 38″. Second and third rings 60″, 62″ are also shown. The at least one ring 58″ of undulating struts can extend circumferentially in a zigzag formation around the frame. Each ring can have two or more struts positioned between adjacent longitudinal struts 56″. This allows the struts of the ring, as well as the longitudinal struts 56″ to move closer together, or farther apart, as the replacement heart valve 10″ is respectively compacted, or expanded.

The longitudinal struts 56″ can also extend into the transition portion 40″ between the upstream portion 38″ and the downstream portion 42″. The transition portion 40″ defines a transition from the smaller upstream diameter to the larger downstream diameter of the replacement heart valve 10″ when in the expanded state. In the illustrated embodiment the longitudinal struts 56″ flare radially outwardly in the transition portion 40″. As such, the frame 20″ is generally divided into the upstream portion 38″ made up of the first diameter, the transition portion 40″ at which the diameter is expanding, and the downstream portion 42″ with the larger second diameter.

The downstream portion 42″ can also include at least one ring 64″ of undulating struts. As shown in FIGS. 5A and 5B, the frame 20″ has two rings 64″ and 66″ that form substantially diamond- or oval-shaped cells. FIG. 5A illustrates nine cells disposed circumferentially about the frame 20″; however, any quantity of cells can be implemented in the frame.

Each illustrated cell has two downstream struts 46, 48 and two upstream struts 68, 70. The individual cells are coupled to one another at junctions 72 located where one downstream strut 48 and one upstream strut 70 of one cell meet with one downstream strut 46 and one upstream strut 68 of another adjoining cell. The downstream undulating struts 46, 48 join to form downstream apex 74. The upstream undulating struts 68, 70 join to form upstream apex 76.

These diamond- or oval-shaped cells formed by the fourth 64″ and fifth 66″ rings in the downstream portion 42″ longitudinally expand when the frame is radially compacted and longitudinally shorten when the frame is radially expanded as can be seen in FIGS. 5C-5D. In the compacted state of FIG. 5C, the junctions 72 are closer together than when in the expanded state shown in FIG. 5D. The longitudinally opposing apices 74, 76 are closest in the expanded state.

Thus, the fourth 64″ and fifth 66″ rings can make up the foreshortening zone 54″. Expansion of the replacement heart valve 10″ causes the struts of the fourth ring 64″ to move angularly farther apart such that they are at a greater angle relative to one another. Thus, they move from a relatively vertical orientation to a more horizontal orientation. This also causes the ring 64″ to shrink in vertical height. The fifth ring exhibits similar behavior when the valve 10″ expands. This movement of the fourth 64″ and fifth 66″ rings results in foreshortening of the frame 20″. It is to be understood that foreshortening can also be achieved with more or less rings of undulating struts, as well as with other configurations of the frame.

The positioning of the outer valve skirt 18″, plurality of leaflets 12″ and/or other components of the valve body within and along the frame 20″, as well as the materials of the different parts of the replacement heart valve 10″ can also affect how much expansion, compression, and/or foreshortening the replacement heart valve 10″ can experience. In addition, the frame, the components of the valve body, and/or the connection(s) between the components of the valve body and the frame can be configured to deal with differences in material properties such as elasticity, and stretchability between the frame and the components of the valve body. It should be clear that some of these differences can be considerations for dealing with the foreshortening, non-foreshortening, expansion, and compaction of the replacement heart valve 10″.

The outer valve skirt and leaflets are preferably made from tissue, such as pericardium. Pericardium, like some other suitable valve skirt materials, is flexible but not particularly stretchable or otherwise elastic. At the same time, the outer valve skirt and leaflets can be made to accommodate and substantially correspond to the shape of the frame in the expanded configuration.

In some embodiments of replacement heart valve 10, such as that shown in FIGS. 1-3, a connection skirt 50 can be connected to the downstream end 36 of the outer valve skirt 18. The connection skirt 50 can be made of an elastic fabric and can typically be placed to correspond to the foreshortening portion 52 of the frame 20. In this way, the connecting skirt 50 can stretch or compact with the longitudinal lengthening and shortening incident to radially compacting and expanding the valve 10. In such embodiments, the downstream end 36 of the pericardium valve skirt 18 can be connected to the connection skirt 50 at a circumferentially-extending seam.

Applicants have found that a circumferential seam can bunch up when the replacement heart valve 10 is compacted, thus limiting compaction of the valve. FIGS. 5A-5D illustrate an embodiment of replacement heart valve 10″ without any circumferential seams. This enables the replacement heart valve 10″ to be able to radially compact to a smaller diameter.

In the illustrated embodiment the outer valve skirt 18″ is fabricated from one, two, three, or more longitudinally oriented pieces of tissue material, e.g., pericardium, or the like, that longitudinally span the frame length from the upstream end 14″ to the downstream end 16″. Preferably such longitudinal strips are stitched together by longitudinally-extending seams. Such construction lends itself to making the outer valve skirt 18″ out of a single material and eliminates a circumferential stitch or seam joining sections of different materials. Thus, as mentioned, in the illustrated embodiment, there is no circumferential stitch or other such connections to the valve skirt.

In the illustrated embodiment, the outer valve skirt 18″ is constructed of pericardium, which, like some other suitable valve skirt materials, is flexible but not particularly stretchable or otherwise elastic. Also, preferably the outer valve skirt 18″ is stitched to the expanded-configuration frame 20″ so that the downstream end 36″ of the outer valve skirt 18″ is generally or nearly coextensive with the downstream end 16″ of the frame 20″.

However, as noted above, when the implant is radially compacted, the longitudinal length of the frame 20″ increases. As such, preferably the downstream portion of the outer valve skirt 18″ is attached to the frame 20″ in a manner that enables the frame 20″ to move relative to the outer valve skirt 18″. In this manner, when the foreshortening portion 54″ increases in length, the outer valve skirt 18″ can remain substantially the same length, but the struts of the foreshortening cells can move relative to the outer valve skirt 18″. In this way, the outer valve skirt material is not substantially stretched or damaged.

In a preferred embodiment, the outer valve skirt 18″ is attached to the non-foreshortening portion 52″ of the frame 20″ in a manner so that there is little to no relative longitudinal movement between the frame 20″ and the outer valve skirt 18″. The outer valve skirt 18″ can be attached to the frame with a number of fasteners. The fasteners can be any device that can secure two objects together and can include two or more different types or different styles of device. Some example fasteners include stitches, staples, rivets, etc. Generally in the embodiments shown herein, stitches are used to attach the outer valve skirt to the frame, as well as to attach other components to one another. It will be understood that these are simply example fasteners and other devices could also be used.

FIGS. 5A-5D illustrate a stitching arrangement in which the outer valve skirt 18″ is mounted to the frame 20″ at the downstream portion so as to allow some relative movement. The downstream portion of the outer valve skirt 18″ is mounted to the frame in the foreshortening portion 54″ with loose or semi-loose stitching 78, 80 that allows the outer valve skirt 18″ to slide relative to the frame struts 46, 48, 68, 70. At the other end, on the upstream portion the outer valve skirt 18″ can be mounted to the frame 20″ with tight stitches 82, which are stitches or other fasteners that are configured to substantially prevent longitudinal movement of the outer valve skirt 18″ relative to the frame 20″ in the non-foreshortening portion 52″.

The tight stitches 82 can be tightly looped and/or cross-stitched around the struts 56″ and through the outer valve skirt 18″. The tight stitches 82 can be disposed about the longitudinal struts 56″ at selective locations. As shown in FIGS. 5A and 5B, tight stitches 82 are positioned on the longitudinal struts 56″ adjacent the apices of the first ring 58″ on the downstream side of the connected apices. This prevents the tight stitches 82 from migrating off of the upstream end of the frame 20″. Tight stitches 82 are also positioned adjacent the second 60″ and third 62″ rings on the upstream side of the connected apices, preventing the tight stitches 82 from migrating toward the downstream end of the replacement heart valve 10″.

Other arrangements are also contemplated. For example, in some embodiments, tight stitches 82 can be located on both the upstream and downstream sides of the connected apices to prevent longitudinal migration of the outer valve skirt 18″. In some embodiments, the tight stitches 82 can be looped through eyelets coupled to the upstream end of the longitudinal struts 56″ and/or selectively located along the longitudinal struts. In still further embodiments, the tight stitches 82 can extend along, or span, a portion and/or the full length of one or more of the longitudinal struts 56″.

Loose stitches 78, 80 can be used to allow some relative movement between the outer valve skirt 18″ and the frame 20″ as best seen in FIGS. 5C and 5D. The loose stitches can come in two types, those 80 that connect the outer valve skirt 18″ to one strut and those 78 that connect the outer valve skirt 18″ to two struts. A single strut stitch 80 loops around a single strut to couple the outer valve skirt 18″ to the frame 20″. A double-strut stitch 78 loosely loops around a pair of struts near the junction 72 when in the expanded state. The double-strut stitch 78 passes through the center of radially adjacent cells and the outer valve skirt tissue material.

The loose stitches 78, 80 have a greater distance between their respective points of entry into the outer valve skirt 18″ tissue material than the tight stitches 82. The loose stitches 78, 80 also provide more room or space for strut movement relative to the outer valve skirt 18″. The loose stitches 78, 80 readily allow the outer valve skirt 18″ downstream end to float, or slide, relative to the frame 20″, yet also sufficiently and durably mount the outer valve skirt 18″ to the frame 20″. In some embodiments, stitches that may not be physically loose-fitting may be placed so as to allow the outer valve skirt downstream end to float, or slide, relative to the frame. Such stitches, as well as physically loose stitches, can also be referred to as floating stitches or sliding stitches.

The loose stitches 78, 80 can allow the outer valve skirt 18″ that is longitudinally shorter than the compacted frame to slide on the cell struts as the cells foreshorten during radial expansion, as illustrated in the detail views of FIGS. 5C and 5D. Four struts 46, 48, 68, 70 joined at each junction 72 radially expand from a compacted configuration in which the apices 74, 76 are relatively close to one another to an expanded configuration in which the apices 74, 76 are relatively farther apart. The loose stitches 78, 80 are urged downstream as the cells radially expand positioning the junctions 72 farther apart.

The double-strut stitch 78 is urged downstream because the distance between the apices 74, 76 and the upstream portions of the struts becomes wider than the stitch width and the stitch is urged toward the narrower portion of the V- or X-shaped configuration. This can be seen by comparing the position of the double-strut stitch 78 in FIG. 5D with that of FIG. 5C. The loose stitches “ride” the struts downstream to their final longitudinal position, as indicated by the arrows. The single stitch 80 also moves along the strut because of the movement of the double-strut stitch 78 and the outer valve skirt.

The positions of the loose stitches 78, 80 can be limited by the position of either or both of the junction 72 and the apices 74, 76. For example, in FIG. 5C, the stitches 78, 80 cannot pass any lower than the junction 72 and/or apices 74 of which they are positioned next to. To position the loose stitches 78, 80 lower than the junction 72 and/or apices 74, with the loose stitches 78, 80 still being around a strut would overload the stitch upon expansion because the lengthening of the frame would force the stitch downstream into the junction or apex.

With reference now to FIGS. 6A and 6B, in another embodiment of replacement heart valve 10″′, the downstream end of the outer valve skirt 18″′ is connected to the struts in the downstream portion 42″′ by multiple stitches 80′. In this embodiment, the downstream end 36″′ of the outer valve skirt 18″′ is shaped to correspond to the undulating pattern of ring 66″′ when in the expanded state. However, as shown in FIG. 6A, the skirt is not attached to the downstream apices 76′ and is spaced therefrom. As such, when the replacement heart valve 10″′ is compacted, the outer valve skirt 18″′ and stitches 80′ will slide upstream relative to the downstream struts, resulting in a longitudinal space between the outer valve skirt distal end 36″′ and the distal apices 76′. When the foreshortening cell is compacted, the cell longitudinal length increases but the outer valve skirt length does not, resulting in a longitudinal space between the downstream apex 76′ and the downstream end 36″′ of the outer valve skirt 18″′. The frame 20″′ thus longitudinally expands while the outer valve skirt 18″′ maintains its length.

FIGS. 7A-C illustrate still another embodiment of replacement heart valve 10″″, in which the longitudinal length of the outer valve skirt 18″″ skirt is generally the same, or substantially the same, as the longitudinal length of the frame 20″″ in the radially-compacted configuration. In this embodiment, tight stitches 82″ can be used in the both the non-foreshortening portion 52″″ and the foreshortening portion 54″″. The long outer valve skirt 18″″ configuration preferably extends from the compacted frame upstream end to the compacted frame downstream end. The outer valve skirt 18″″ downstream end 36″″ can be securely coupled, or stitched, to the frame downstream end 16″″ in a manner that the outer valve skirt 18″″ will substantially move with the frame 20″″ as the frame longitudinally expands and contracts.

The outer valve skirt 18″″ can be greater in length than the length of the expanded-state frame and substantially the same length as the compact frame. This can result in excess outer valve skirt material when the replacement heart valve is in the expanded configuration. The excess length of the outer valve skirt 18″″ can create circumferential folds 84, or material bunching, in the foreshortening portion of the frame, as depicted in FIGS. 7A and 7C.

FIG. 7C illustrates a cross-section side view of the implant tissue material in this embodiment positioned in the frame downstream end after the frame expands radially outward. Preferably the folding or bunching pattern can be selectively controlled by placement of stitches such as stitches at the junction 72″. It should be understood that, in other embodiments, the valve skirt can be shorter, longer, or any length therebetween, than the illustrated long configuration. A longer skirt than the long configuration skirt of FIG. 7C creates a greater number and/or size of circumferential folds.

Also illustrated in FIGS. 7A-7C are eyelets 73. The eyelets 73 can be used to attach to the outer valve skirt to the frame. In some embodiments, the downstream anchors 24″″ can be passed through the eyelets 73 when assembling the replacement heart valve 10″″. Stitching can also pass through the eyelets 73. The eyelets 73 can also reinforce the skirt material.

With continued reference to FIG. 7C, when the replacement heart valve 10″″ is installed in the body, the folds 84 in the valve skirt material preferably are positioned at or adjacent the native valve annulus. Thus, over time the folds can support tissue ingrowth, further securing the replacement heart valve 10″″ to the mitral valve native annulus and preventing leakage past the outer valve skirt 18″″.

Delivery Device and Method

With reference next to FIG. 8, a schematic representation of the replacement heart valve 10 as discussed above in connection with FIGS. 1 and 2 is depicted installed in a human heart 90. The heart is shown in cross-section, and represents typical anatomy, including a left atrium 86 and left ventricle 88. The left ventricle 88 is defined by a muscular wall 98. The left atrium 86 and left ventricle 88 communicate with one another through a mitral annulus 92. Also shown schematically in FIG. 8 is a native anterior mitral leaflet 94 having chordae tendineae 96 that connect a downstream end of the anterior mitral leaflet 94 to the muscle wall 98 of the left ventricle 88. A left ventricle outflow tract 99 extends toward the top of the left ventricle 88.

As shown, the replacement heart valve 10 is disposed so that the mitral annulus 92 is grasped between the upstream anchors 22 and the downstream anchors 24. As such, all or most of the replacement heart valve 10 extends into the left atrium 86. The portion of the replacement heart valve 10 disposed upstream of the annulus 92 can be referred to as being positioned supra-annularly. The portion generally within the annulus 92 is referred to as positioned intra-annularly. The portion downstream of the annulus is referred to as being positioned sub-annularly. In the illustrated embodiment, only a part of the foreshortening portion is positioned intra-annularly or sub-annularly, and the rest of the replacement heart valve 10 is supra-annular.

The following is an example of how the replacement heart valve 10 can be deployed at a patient's native mitral valve annulus with reference to FIG. 8. A radially-compacted replacement heart valve 10 is advanced on a delivery device through and past the mitral valve annulus 92 so that the downstream anchors 24 are positioned downstream of the native mitral valve leaflets 94. The heart valve 10 can be partially deployed so that the downstream portion of the replacement heart valve 10 can be allowed to self-expand, thus urging the downstream anchors 24 between the chordae tendineae 96 and radially outboard of the native mitral valve leaflets 94. The delivery device and replacement heart valve 10 can then be proximally retracted or moved upstream to engage the downstream anchors 24 with the downstream side of the native mitral valve annulus 92. In this motion, preferably the downstream anchors 24 engage and capture the native leaflets 94. Once the native leaflets are engaged and captured by the anchors 24, the remainder of the replacement heart valve 10 can then be deployed to allow self-expansion of the replacement heart valve 10 so that the upstream anchors 22 engage the upstream side of the native annulus 92, and the replacement heart valve 10 is deployed in operational condition. In some embodiments the replacement heart valve may not be self expanding, and the partial and full deployment may be accomplished by one or more inflatable balloons or the like.

Replacement heart valves can be delivered to a patient's heart mitral valve annulus in various ways, such as by open surgery, minimally-invasive surgery, and percutaneous or transcatheter delivery through the patient's vasculature.

With reference to FIGS. 9A-B, an embodiment of a delivery device 100 is shown in connection with a replacement heart valve 10. The illustrated embodiment comprises an elongate, delivery catheter configured to be advanced through a patient's vasculature in a percutaneous delivery approach. The delivery device 100 can be a spring or a cut metal hypotube that imparts rigidity to the device and yet allows flexibility to be able to pass through the curvosities of the vasculature. The delivery device 100 can also be covered with a polymer outer sheath.

The illustrated delivery device 100 comprises an elongate inner tube 102 that is attached at its distal end to a nose cone 104. The inner tube 102 has a lumen sized and configured to slidably accommodate a guidewire 106 so that the delivery device 100 can be advanced over the guidewire through the vasculature. The delivery device 100 may also be a steerable catheter which may or may not use a guidewire.

As can best be seen in FIG. 9B, an inner retention ring 112 can be positioned on the inner tube 102. A support tube or outer retention ring 108 concentrically encircles the inner tube 102 and is sized to be slidable over the inner tube and the inner retention ring. In the illustrated embodiment the support tube is elongate. An outer sheath 110 is disposed so as to be slidable over the support tube 108.

In the illustrated embodiment, and preferably, in a manner as discussed in embodiments presented below, the support tube or outer retention ring 108 and outer sheath 110 cooperate to grasp onto the replacement heart valve 10. FIG. 9B schematically shows a valve frame 20 within and secured by the outer sheath 110 and other components of the delivery device 100. The inner retention ring 112 is also shown engaging the proximal end 14 of the valve frame 20. For example, teeth 116 on the inner retention ring 112 can engage tabs 15 on the proximal end 14 of the valve frame 20. The outer retention ring 108 can be positioned over the inner retention ring 112 so that the proximal end of the replacement heart valve 10 is trapped therebetween, securely attaching it to the delivery device 100.

The outer sheath 110 can also be positioned over the distal end of the delivery device 100 and over the replacement heart valve 10. As shown, the outer sheath 110 is advanced over a portion of the nose cone 104 of the delivery device 100. Optionally, a retainer member 114, e.g., an o-ring, a clamp, a cover, or the like, can be used to retain the outer sheath 110 in place. As shown, an o-ring 114 is placed over the outer sheath 110 at a groove or slot 118 disposed circumferentially around the nose cone 104. In some embodiments, the nose cone can include a flange that encompasses and secures the outer sheath, so that the outer sheath fits into the nose cone under the flange. This flange may also cover all or part of the replacement heart valve. In some embodiments, the delivery device may include one or more additional sheaths or other features that can be advanced over all or part of the replacement heart valve.

The delivery device 100 is configured to retain and restrict the valve frame 20 and the replacement heart valve 10 from expanding. The delivery device 100 restrains the replacement heart valve 10 until the replacement heart valve 10 is deployed from the delivery device 100 at, or adjacent, the native mitral valve annulus 92.

With reference next to FIGS. 10A-10C and FIG. 8, an embodiment of a method and apparatus for deploying a replacement heart valve 10 is depicted. Referring to FIG. 10A, it can be seen that the replacement heart valve 10, mounted in a radially-compacted configuration on the distal end of the delivery device 100, is introduced into the left atrium 86 of the heart 90. As shown, the native mitral leaflets 94 (posterior leaflet shown) extend downstream of the native annulus 94, and chordae tendineae 96 extend downstream from the mitral valve to the ventricle wall.

With reference next to FIG. 10B, the delivery device 100 is advanced so that the replacement heart valve 10 is positioned slightly downstream of its final mounting point. More specifically, it is positioned so that the downstream anchors 24 are positioned downstream of where the chordae tendineae 96 connect to the free end of the native mitral valve leaflets 94.

The outer sheath 110 is then at least partially retracted to expose at least part of the downstream end of the replacement heart valve 10, including the downstream anchors 24 as shown in FIG. 10C. The downstream end of the replacement heart valve 10 radially expands to approximately the full extent, or slightly less than the full extent. At the same time, the upstream end of the replacement heart valve 10 is still retained by the delivery device and is at least partially radially compacted. During expansion of the downstream end of the replacement heart valve 10 the downstream anchors 24 pass between chordae tendineae 96 so that the upstream-directed downstream anchor tips 28 substantially face the downstream side of the native mitral valve annulus 92. As the upstream portion of the replacement heart valve 10 is still retained by the delivery device 100 in a partially radially-compacted state, the position of the replacement heart valve 10 can still be readily adjusted.

After the downstream anchors 24 are expanded to be positioned downstream of and radially outside of the native leaflets 94, the delivery device 100 and replacement heart valve 10 are moved in an upstream direction. This causes the downstream anchors 24 and anchor tips 28 to engage with the downstream side of the native annulus 92, and the native leaflets 94. The native leaflets 94 are engaged and possibly retracted by the anchors. In some embodiments, the anchors pull the native leaflets 94 proximally, resulting in the native leaflets 94 being bunched up, and the chordae tendineae 96 being stretched and/or tightened. In other embodiments the native leaflets 94 may not be bunched up or may be only partially bunched up, but are contained by the anchors so as to prevent movement of the leaflets 94 into, for example, the left ventricle outflow tract 99.

Once the downstream anchors 24 are properly placed, the delivery device 100 can release the upstream anchors 22 and the remaining upstream end 14 of the replacement heart valve 10. This can be done by retracting the outer retention ring 108. In some embodiments this can be done by fully retracting the outer sheath 110, as well as, the outer retention ring 108.

As discussed previously, the upstream anchors 22 flare radially outward under the self-expansion force of the frame 20 and advance toward the upstream side of the native mitral valve annulus 92 under the foreshortening force of the cells. The downstream 24 and upstream 22 anchors can thus securely grasp the native mitral valve annulus 92 between their opposingly directed anchor tips, and the replacement heart valve 10 is fully and securely installed as can be seen in FIG. 8. The anchor placement can preferably prevent or reduce the prevalence of any up and/or down motion of the frame. The anchor placement can also help ensure that the replacement heart valve is perpendicular to the annulus and prevents any “rocking” and/or tilting of the frame. By engaging both the native annulus 92 and the native leaflets 94 by the frame 20 and anchors 22, 24 the load can be more evenly distributed to achieve equilibrium. Such a configuration can also provide a more robust implantation.

The independent nature of each anchor can allows the frame to conform to a number of different shapes. For example, the three dimensional annular shape of the mitral valve may not be entirely flat, and in fact, as is the case with most mitral anatomy, may be more saddle shaped. Thus, the independent anchors can stretch and bend to be able to engage these different shapes.

In embodiments in which the native leaflets 94 are compacted and urged against both the outer surface of the replacement heart valve 10 and the native annulus 92, the bunched up leaflets advantageously provides additional leak prevention between the native tissue and the replacement heart valve 10, or between the anchors and the valve frame.

Referring now FIG. 11, another embodiment of delivery device 100′ is shown. Numerical reference to components is the same as previously described, except that a prime symbol (′) has been added to the reference. Where such references occur, it is to be understood that the components are the same or substantially similar to previously-described components. The illustrated embodiment comprises an elongate, delivery catheter configured to be advanced through a patient's vasculature in a percutaneous delivery approach. In addition to an outer sheath 110′ and an outer retention ring 108′, the delivery device 100′ can also include a secondary sheath 120.

The secondary sheath 120 can be slidable over the outer retention ring 108′ which is slidable over the inner tube 102′ and the inner retention ring 112′. The outer sheath 110′ is disposed so as to be slidable over both the support tube 108′ and the secondary sheath 120. The outer retention ring 108′, secondary sheath 120 and outer sheath 110′ all cooperate to grasp onto the replacement heart valve 10. FIG. 11 schematically shows a valve frame 20 within and secured by these three components.

The secondary sheath 120 can be advanced over all or a part of the replacement heart valve 10. As such, the secondary sheath 120 can be used to further control the expansion of the replacement heart valve 10 during the delivery process. For example, the secondary sheath 120 can be positioned so that the distal end is right next to but not covering the downstream anchors 24. Thus, when the outer sheath 110′ is withdrawn, the secondary sheath 120 can limit the expansion of the replacement heart valve 10. In some embodiments, the secondary sheath 120 can limit the expansion of the replacement heart valve 10 to just the downstream anchors 24 or just the downstream anchors and a small amount of radial expansion of the foreshortening cells.

In some embodiments, the secondary sheath 120 can be positioned at the base of the downstream anchors 24 such that the secondary sheath 120 is between the downstream anchors 24 and the rest of the frame 20. Thus, the secondary sheath 120 can cover the frame 20 essentially to the distal end 16, with primarily only the downstream anchors 24 exposed. Again, this can limit the expansion of the replacement heart valve 10 upon withdrawal of the outer sheath 110′.

The delivery methods described above with reference to delivery device 100 and FIGS. 10A-C can be considered a two stage delivery method; the first stage being withdrawal of the outer sheath 110, and the second stage being withdrawal of the outer retention ring 108. The delivery device 100′ can use a three stage delivery method as will be described below. It should be understood that both delivery devices 100, 100′ can also be used in other delivery methods that may be considered single stage, two stage, three stage, etc.

The delivery device 100′ can be used in a delivery procedure similar to that described above. The delivery device 100′ can have a replacement heart valve 10 mounted in a radially-compacted configuration on the distal end and be introduced into the left atrium 86 of the heart 90. The delivery device 100′ can be advanced to position the replacement heart valve 10 slightly downstream of its final mounting point. More specifically, the replacement heart valve 10 can be positioned so that the downstream anchors 24 are positioned downstream of where the chordae tendineae 96 connect to the free end of the native mitral valve leaflets 94.

The outer sheath 110′ can then be at least partially retracted to expose at least the downstream anchors 24. The secondary sheath 120 and outer retention ring 108′ can still be positioned over the replacement heart valve 10 to limit expansion of the replacement heart valve 10 after withdrawal of the outer sheath 110.

With the downstream anchors 24 exposed and little to no other expansion experienced, the delivery device 100′ can easily position the downstream anchors 24 in an initial desired position. The secondary sheath 120 can then be retracted allowing the replacement heart valve 10 to further expand while still being attached at the proximal end 14 to the delivery device 100′ at the inner 112 and the outer 108 retention rings. The replacement heart valve 10 can then be adjusted again prior to completely releasing the replacement heart valve 10 from the delivery device 100′.

In some embodiments, the downstream anchors 24 can be positioned first next to one part of the native valve annulus before the secondary sheath 120 is withdrawn. As the mitral valve is a bicuspid valve, the delivery device 100′ can be used to attach the downstream anchors 24 to one of the leaflets, such as the posterior leaflet and then to the other of the leaflets, such as the anterior leaflet. This second part can be done after the replacement heart valve 10 is expanded or further expanded by moving the secondary sheath 120. In some embodiments, staged deployment can also be achieved without the use of a secondary sheath. For example, a primary sheath with sufficient column strength and/or resistance to collapsing/corrugating/compression along the axis can be used to achieve staged deployment.

In some embodiments, the entrance route of the delivery device 100′ into the left atrium 86 can bias the delivery device 100′ towards one side of the mitral valve 92. For example, the delivery device 100′ may be biased towards the posterior leaflet of the mitral valve 92. Also, an axis of the delivery device may be angled relative to an axis of the native annulus. This can facilitate securing the downstream anchors 24 to the posterior side or the posterior leaflet first, prior to expanding or further expanding the replacement heart valve 10. The downstream anchors 24 can then be secured to the anterior side of the mitral valve 92 or to the anterior leaflet.

For example, the downstream anchors 24 can be positioned initially past the mitral valve annulus 92 and then moved upstream to engage one side and/or one leaflet. The delivery device 100′ can then be repositioned, or first the secondary sheath 120 removed then the delivery device 100′ repositioned. The delivery device 100′ can again be moved upstream, this time so that the downstream anchors 24 on the other side will also engage the other side of the mitral valve 92 and/or the other leaflet.

After the downstream anchors 24 are released the delivery device 100′ and replacement heart valve 10 are moved in an upstream direction. This causes the downstream anchors 24 and anchor tips 28 to engage with the downstream side of the native annulus 92, and the native leaflets 94. The native leaflets 94 are engaged and possibly retracted by the anchors. As mentioned, this can occur first on one side or to one leaflet and then to the other side or to the other leaflet.

Once the downstream anchors 24 are properly placed, the delivery device 100′ can then release the upstream anchors 22 and the remaining upstream end 14 of the replacement heart valve 10. This can be done by retracting the outer retention ring 108′. In some embodiments this can be done by retracting the outer retention ring 108′ as well as fully retracting one or more of the outer sheath 110′ and the secondary sheath 120.

As discussed previously, the upstream anchors 22 flare radially outward under the self-expansion force of the frame 20 and advance toward the upstream side of the native mitral valve annulus 92 under the foreshortening force of the cells as the cells complete their radial expansion. The downstream 24 and upstream 22 anchors thus securely grasp the native mitral valve annulus 92 between their opposingly directed anchor tips, and the replacement heart valve 10 is fully and securely installed as can be seen in FIG. 8.

Multi-stage release of the replacement heart valve 10 by the delivery device 100, 100′ can facilitate better control and positioning of the replacement heart valve 10 at the native annulus 92. As explained above, three stage release by the delivery device 100′ can allow for a quicker and more reliable securement of the replacement heart valve 10 to the mitral valve 92.

A delivery device 100, 100′ with one or more of an outer sheath, a secondary sheath and/or an outer retention ring can control their movement in different ways. For example, each or some of the outer sheath, secondary sheath and outer retention ring can move separately and independently from the others. Alternatively, or in addition, some can be moved together, such as being attached to move in a coordinated fashion.

For example, the secondary sheath can be attached to the outer sheath through sutures, stitches, wire, string, cable, band, ribbon, etc. This can allow the outer sheath to be withdrawn initially without affecting the positioning of the secondary sheath. The outer sheath can then be further removed, causing tension on the secondary sheath through whichever device has been used to attach the two. Thus, the secondary sheath can be a floating sheath. In some embodiments, internal wires or outer coverings may extend the length or substantially the length of the delivery device and can be actuated at the proximal end.

In another embodiment, the outer sheath can be folded over itself in one or more positions to take the place of a secondary sheath and/or an outer retention ring. For example, the distal end of the outer sheath can be positioned over the inner retention member and then the outer sheath can be folded over itself to cover the replacement heart valve. Initial movement of the outer sheath can uncover a part of the replacement heart valve without uncovering the inner retention member.

In still another embodiment, the nose cone can be used to cover a portion of the replacement heart valve such as the downstream anchors. The nose cone can include a flange that encompasses and secures the outer sheath, so that the outer sheath fits into the nose cone under the flange. This flange may cover all or part of the replacement heart valve. The nose cone can be advanced exposing and expanding the anchors. The outer sheath can cover the rest of the device and can then be later withdrawn similar to the secondary sheath.

Although this invention has been disclosed in the context of certain preferred embodiments and examples, it will be understood by those skilled in the art that the present invention extends beyond the specifically disclosed embodiments to other alternative embodiments and/or uses of the invention and obvious modifications and equivalents thereof. In addition, while a number of variations of the invention have been shown and described in detail, other modifications, which are within the scope of this invention, will be readily apparent to those of skill in the art based upon this disclosure. For example, the support band can be used with the replacement heart valves shown in FIGS. 1-3, 5A-7C. Also, connection skirt can be used with the replacement heart valve shown in FIG. 4. Further, additional embodiments of valve delivery devices, whether or not disclosed herein, may employ, for example, the two and three-stage delivery methods discussed herein. It is also contemplated that various combinations or sub-combinations of the specific features and aspects of the embodiments may be made and still fall within the scope of the invention. Accordingly, it should be understood that various features and aspects of the disclosed embodiments can be combined with or substituted for one another in order to form varying modes of the disclosed invention. Thus, it is intended that the scope of the present invention herein disclosed should not be limited by the particular disclosed embodiments described above, but should be determined only by a fair reading of the claims that follow.

Similarly, this method of disclosure, is not to be interpreted as reflecting an intention that any claim require more features than are expressly recited in that claim. Rather, as the following claims reflect, inventive aspects lie in a combination of fewer than all features of any single foregoing disclosed embodiment. Thus, the claims following the Detailed Description are hereby expressly incorporated into this Detailed Description, with each claim standing on its own as a separate embodiment.

Claims

1. An implantable prosthetic valve comprising: an annular frame comprising an upstream portion and a downstream portion and being radially collapsible and expandable between a radially collapsed configuration and a radially expanded configuration, wherein the frame comprises a plurality of struts;a leaflet structure positioned within the frame and secured thereto; andan outer skirt comprising a first portion that is tightly connected to the frame with first stitches such that the first portion is prevented from moving axially with respect to the frame when the frame radially expands and collapses and a second portion that is loosely connected to the frame with second stitches such that the second portion can move axially with respect to the frame when the frame radially expands and collapses, and wherein at least one of the second stitches is connected to two struts of the frame.
2. The prosthetic valve of claim 1, wherein the at least one of the second stitches is configured such that it slides along the two struts of the frame when the frame is radially expanded and collapsed.
3. The prosthetic valve of claim 1, wherein the frame comprises a plurality of undulating struts arranged in rings positioned along the length of the frame, and wherein the at least one of the second stitches is looped around two adjacent undulating struts of the same ring.
4. The prosthetic valve of claim 1, wherein the frame comprises a plurality of longitudinal struts and a plurality of undulating struts, and wherein at least one of the first stitches is connected to a longitudinal strut.
5. The prosthetic valve of claim 1, wherein at least one of the second stitches is connected to a single strut of the frame.
6. The prosthetic valve of claim 1, wherein at least one of the first stitches is connected to a single strut of the frame.
7. The prosthetic valve of claim 1, wherein the outer skirt comprises a non-stretchable material.
8. The prosthetic valve of claim 1, wherein the second stitches are configured such that they are forced to move in an axial direction relative to the frame when the frame radially expands.
9. The prosthetic valve of claim 1, wherein the first portion of the outer skirt comprises an upstream portion and the second portion of the outer skirt comprises a downstream portion.
10. An implantable prosthetic valve comprising: an annular frame comprising an inflow end and an outflow end and being radially collapsible and expandable between a radially collapsed configuration and a radially expanded configuration;a plurality of valve leaflets positioned within the frame and secured thereto; andan outer skirt comprising a first portion that is secured to the frame such that the first portion is prevented from moving axially relative to the frame when the frame radially expands and collapses, the outer skirt further comprising a second portion axially spaced from the first portion along a length of the outer skirt, the second portion being loosely connected to the frame with stitches such that the second portion can move relative to the frame when the frame radially expands and collapses, and wherein at least one of the stitches is connected to two struts of the frame.
11. The prosthetic valve of claim 10, wherein the at least one of the stitches is configured to slide with the second portion of the outer skirt along the two struts of the frame when the frame is radially expanded and collapsed.
12. The prosthetic valve of claim 10, wherein the frame comprises a plurality of circumferentially extending rows of undulating struts, wherein the at least one of the stitches is looped around the two struts, wherein the two struts comprise two adjacent undulating struts of the same row.
13. The prosthetic valve of claim 10, wherein the first portion of the outer skirt is secured to the frame by tight stitches.
14. The prosthetic valve of claim 10, wherein another one of the stitches is connected to a single strut.
15. The prosthetic valve of claim 14, wherein the another one of the stitches forms multiple loops extending around the single strut and through the first portion of the outer skirt.
16. The prosthetic valve of claim 10, wherein the outer skirt comprises a non-stretchable material.
17. The prosthetic valve of claim 10, wherein the first portion of the outer skirt comprises an inflow end portion of the skirt and the second portion of the outer skirt comprises an outflow end portion.
18. An implantable prosthetic valve comprising: an annular frame comprising an upstream portion and a downstream portion and being radially collapsible and expandable between a radially collapsed configuration and a radially expanded configuration, wherein the frame comprises a plurality of struts;a leaflet structure positioned within the frame and secured thereto; andan outer skirt comprising an upstream portion and a downstream portion, wherein the upstream portion is connected to the frame with first stitches such that the upstream portion of the outer skirt is prevented from moving axially with respect to the frame when the frame radially expands and collapses and the downstream portion is connected to a foreshortening portion of the frame with second stitches such that the downstream portion of the outer skirt can move axially with respect to the frame when the frame radially expands and collapses, and wherein at least one of the second stitches is connected to two struts of the frame that can slide axially relative to the two struts when the frame radially expands and collapses.
19. The prosthetic valve of claim 18, wherein the at least one of the second stitches loosely wraps around the two struts adjacent a junction between the two struts.
20. The prosthetic valve of claim 18, wherein at least one of the first stitches is connected to a single strut of the frame.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No. 14/702,233, filed May 1, 2015, now U.S. Pat. No. 9,949,827, which is a continuation of U.S. application Ser. No. 13/756,424, filed Jan. 31, 2013, now U.S. Pat. No. 9,023,100, which is a continuation of U.S. application Ser. No. 13/244,080, filed Sep. 23, 2011, now U.S. Pat. No. 8,652,203, which claims priority to U.S. Provisional Appl. No. 61/385,651, filed Sep. 23, 2010. This application is also related to U.S. application Ser. No. 12/569,856, filed Sep. 29, 2009, Ser. No. 12/761,349, filed Apr. 15, 2010, and Ser. No. 13/165,721, filed Jun. 21, 2011. The entirety of each of the above applications is incorporated by reference herein and is to be considered a part of this specification.

US Referenced Citations (415)

Number	Name	Date	Kind
3657744	Ersek	Apr 1972	A
3671979	Moulopoulos	Jun 1972	A
3739402	Cooley et al.	Jun 1973	A
4056854	Boretos et al.	Nov 1977	A
4079468	Liotta et al.	Mar 1978	A
4204283	Bellhouse et al.	May 1980	A
4222126	Boretos et al.	Sep 1980	A
4339831	Johnson	Jul 1982	A
4340977	Brownlee et al.	Jul 1982	A
4470157	Love	Sep 1984	A
4477930	Totten et al.	Oct 1984	A
4490859	Black et al.	Jan 1985	A
4553545	Maass et al.	Nov 1985	A
4655771	Wallsten	Apr 1987	A
4733665	Palmaz	Mar 1988	A
4776337	Palmaz	Oct 1988	A
4777951	Cribier et al.	Oct 1988	A
4865600	Carpentier et al.	Sep 1989	A
4994077	Dobben	Feb 1991	A
5197978	Hess	Mar 1993	A
5326371	Love et al.	Jul 1994	A
5332402	Teitelbaum	Jul 1994	A
5370685	Stevens	Dec 1994	A
5397355	Marin et al.	Mar 1995	A
5411552	Andersen et al.	May 1995	A
5415667	Frater	May 1995	A
5439446	Barry	Aug 1995	A
5474563	Myler et al.	Dec 1995	A
5554185	Block et al.	Sep 1996	A
5575818	Pinchuk	Nov 1996	A
5607444	Lam	Mar 1997	A
5669919	Sanders et al.	Sep 1997	A
5693061	Pierce et al.	Dec 1997	A
5697382	Love et al.	Dec 1997	A
D390957	Fontaine	Feb 1998	S
5725519	Penner et al.	Mar 1998	A
5769812	Stevens et al.	Jun 1998	A
5807398	Shaknovich	Sep 1998	A
5810873	Morales	Sep 1998	A
5855601	Bessler et al.	Jan 1999	A
5868782	Frantzen	Feb 1999	A
5879381	Moriuchi et al.	Mar 1999	A
5902334	Dwyer et al.	May 1999	A
5935108	Katoh et al.	Aug 1999	A
5957949	Leonhardt et al.	Sep 1999	A
5992000	Humphrey et al.	Nov 1999	A
6004328	Solar	Dec 1999	A
6015431	Thornton et al.	Jan 2000	A
6042606	Frantzen	Mar 2000	A
6053940	Wijay	Apr 2000	A
6113612	Swanson et al.	Sep 2000	A
6113631	Jansen	Sep 2000	A
6123722	Fogarty	Sep 2000	A
6132458	Staehle et al.	Oct 2000	A
6152937	Peterson et al.	Nov 2000	A
6159237	Alt et al.	Dec 2000	A
6168616	Brown, III	Jan 2001	B1
6251093	Valley et al.	Jun 2001	B1
6280466	Kugler et al.	Aug 2001	B1
6306141	Jervis	Oct 2001	B1
6312465	Griffin et al.	Nov 2001	B1
6336938	Kavteladze et al.	Jan 2002	B1
6352543	Cole	Mar 2002	B1
6358277	Duran	Mar 2002	B1
6440164	DiMatteo et al.	Aug 2002	B1
6458153	Bailey et al.	Oct 2002	B1
6475237	Drasler et al.	Nov 2002	B2
6482228	Norred	Nov 2002	B1
6511491	Grudem et al.	Jan 2003	B2
6527800	McGuckin, Jr. et al.	Mar 2003	B1
6602281	Klein	Aug 2003	B1
6610088	Gabbay	Aug 2003	B1
6623518	Thompson et al.	Sep 2003	B2
6629534	St. Goar et al.	Oct 2003	B1
6641606	Ouriel et al.	Nov 2003	B2
D484979	Fontaine	Jan 2004	S
6676698	McGuckin, Jr. et al.	Jan 2004	B2
6682537	Ouriel et al.	Jan 2004	B2
6695878	McGuckin, Jr. et al.	Feb 2004	B2
6712836	Berg et al.	Mar 2004	B1
6716207	Farnholtz	Apr 2004	B2
6729356	Baker et al.	May 2004	B1
6730118	Spenser et al.	May 2004	B2
6746422	Noriega et al.	Jun 2004	B1
6749560	Konstorum et al.	Jun 2004	B1
6764505	Hossainy et al.	Jul 2004	B1
6767362	Schreck	Jul 2004	B2
6780200	Jansen	Aug 2004	B2
6790229	Berreklouw	Sep 2004	B1
6790230	Beyersdorf et al.	Sep 2004	B2
6814746	Thompson et al.	Nov 2004	B2
6858034	Hijlkema et al.	Feb 2005	B1
6875231	Anduiza et al.	Apr 2005	B2
6893460	Spenser et al.	May 2005	B2
6908481	Cribier	Jun 2005	B2
6926732	Derus et al.	Aug 2005	B2
6929660	Ainsworth et al.	Aug 2005	B1
6936058	Forde et al.	Aug 2005	B2
7018401	Hyodoh et al.	Mar 2006	B1
7018406	Seguin et al.	Mar 2006	B2
7044962	Elliott	May 2006	B2
7087088	Berg et al.	Aug 2006	B2
7147660	Chobotov et al.	Dec 2006	B2
7147661	Chobotov et al.	Dec 2006	B2
7186265	Sharkawy et al.	Mar 2007	B2
7192440	Andreas et al.	Mar 2007	B2
7198646	Figulla et al.	Apr 2007	B2
7201772	Schwammenthal et al.	Apr 2007	B2
D553747	Fliedner	Oct 2007	S
7276078	Spenser et al.	Oct 2007	B2
7329278	Seguin et al.	Feb 2008	B2
7381219	Salahieh et al.	Jun 2008	B2
7445631	Salahieh et al.	Nov 2008	B2
7462191	Spenser et al.	Dec 2008	B2
7510575	Spenser et al.	Mar 2009	B2
7553324	Andreas et al.	Jun 2009	B2
7569071	Haverkost et al.	Aug 2009	B2
7585321	Cribier	Sep 2009	B2
7608114	Levine et al.	Oct 2009	B2
7615072	Rust et al.	Nov 2009	B2
7621948	Herrmann et al.	Nov 2009	B2
7748389	Salahieh et al.	Jul 2010	B2
7753949	Lamphere et al.	Jul 2010	B2
D622387	Igaki	Aug 2010	S
D622388	Igaki	Aug 2010	S
7771463	Ton et al.	Aug 2010	B2
7785360	Freitag	Aug 2010	B2
7803185	Gabbay	Sep 2010	B2
7806917	Xiao	Oct 2010	B2
7806919	Bloom et al.	Oct 2010	B2
7815589	Meade et al.	Oct 2010	B2
7815673	Bloom et al.	Oct 2010	B2
7824443	Salahieh et al.	Nov 2010	B2
7892281	Seguin et al.	Feb 2011	B2
D635261	Rossi	Mar 2011	S
D635262	Rossi	Mar 2011	S
7905830	Stefanchik et al.	Mar 2011	B2
7914569	Nguyen et al.	Mar 2011	B2
7981151	Rowe	Jul 2011	B2
7993392	Righini et al.	Aug 2011	B2
8016877	Seguin et al.	Sep 2011	B2
8052750	Tuval et al.	Nov 2011	B2
8070800	Lock et al.	Dec 2011	B2
8070802	Lamphere et al.	Dec 2011	B2
8075615	Eberhardt et al.	Dec 2011	B2
8080054	Rowe	Dec 2011	B2
8109996	Stacchino et al.	Feb 2012	B2
8136218	Millwee et al.	Mar 2012	B2
8137398	Tuval et al.	Mar 2012	B2
8157852	Bloom et al.	Apr 2012	B2
8167926	Hartley et al.	May 2012	B2
8167934	Styrc et al.	May 2012	B2
8177799	Orban, III	May 2012	B2
8182528	Salahieh et al.	May 2012	B2
8182530	Huber	May 2012	B2
8197528	Colgan et al.	Jun 2012	B2
8216261	Solem	Jul 2012	B2
8216301	Bonhoeffer et al.	Jul 2012	B2
8219229	Cao et al.	Jul 2012	B2
8220121	Hendriksen et al.	Jul 2012	B2
8221482	Cottone et al.	Jul 2012	B2
D665079	Zago	Aug 2012	S
D665080	Zago	Aug 2012	S
8236045	Benichou et al.	Aug 2012	B2
8246675	Zegdi	Aug 2012	B2
8246678	Salahieh et al.	Aug 2012	B2
8252052	Salahieh et al.	Aug 2012	B2
8303653	Bonhoeffer et al.	Nov 2012	B2
8313525	Tuval et al.	Nov 2012	B2
8317854	Ryan et al.	Nov 2012	B1
8323335	Rowe et al.	Dec 2012	B2
8353953	Giannetti et al.	Jan 2013	B2
8361137	Perouse	Jan 2013	B2
8403983	Quadri et al.	Mar 2013	B2
8414645	Dwork et al.	Apr 2013	B2
8444689	Zhang	May 2013	B2
8449599	Chau et al.	May 2013	B2
8449625	Campbell et al.	May 2013	B2
8454685	Hariton et al.	Jun 2013	B2
8460368	Taylor et al.	Jun 2013	B2
8470023	Eidenschink et al.	Jun 2013	B2
8475521	Suri et al.	Jul 2013	B2
8475523	Duffy	Jul 2013	B2
8479380	Malewicz et al.	Jul 2013	B2
8486137	Suri et al.	Jul 2013	B2
8491650	Wiemeyer et al.	Jul 2013	B2
8500733	Watson	Aug 2013	B2
8500798	Rowe et al.	Aug 2013	B2
8511244	Holecek et al.	Aug 2013	B2
8512401	Murray, III et al.	Aug 2013	B2
8518096	Nelson	Aug 2013	B2
8518106	Duffy et al.	Aug 2013	B2
8535368	Headley, Jr. et al.	Sep 2013	B2
8562663	Mearns et al.	Oct 2013	B2
8579963	Tabor	Nov 2013	B2
8579964	Lane et al.	Nov 2013	B2
8584849	McCaffrey	Nov 2013	B2
8585749	Shelso	Nov 2013	B2
8617236	Paul et al.	Dec 2013	B2
8640521	Righini et al.	Feb 2014	B2
8652201	Oberti et al.	Feb 2014	B2
8652202	Alon et al.	Feb 2014	B2
8672992	Orr	Mar 2014	B2
8679174	Ottma et al.	Mar 2014	B2
8679404	Liburd et al.	Mar 2014	B2
8707957	Callister et al.	Apr 2014	B2
8721707	Boucher et al.	May 2014	B2
8721708	Seguin et al.	May 2014	B2
8721714	Kelley	May 2014	B2
8728154	Alkhatib	May 2014	B2
8740974	Lambrecht et al.	Jun 2014	B2
8740976	Tran et al.	Jun 2014	B2
8747458	Tuval et al.	Jun 2014	B2
8747459	Nguyen et al.	Jun 2014	B2
8753384	Leanna	Jun 2014	B2
8771344	Tran et al.	Jul 2014	B2
8784337	Voeller et al.	Jul 2014	B2
8784478	Tuval et al.	Jul 2014	B2
8784481	Alkhatib et al.	Jul 2014	B2
8790387	Nguyen et al.	Jul 2014	B2
8828078	Salahieh et al.	Sep 2014	B2
8828079	Thielen et al.	Sep 2014	B2
8834564	Tuval et al.	Sep 2014	B2
8852267	Cattaneo	Oct 2014	B2
8858620	Salahieh et al.	Oct 2014	B2
8870950	Hacohen	Oct 2014	B2
8876883	Rust	Nov 2014	B2
8876893	Dwork et al.	Nov 2014	B2
8876894	Tuval et al.	Nov 2014	B2
8876895	Tuval et al.	Nov 2014	B2
8911455	Quadri et al.	Dec 2014	B2
8926693	Duffy et al.	Jan 2015	B2
8939960	Rosenman et al.	Jan 2015	B2
8961583	Hojeibane et al.	Feb 2015	B2
8961593	Bonhoeffer et al.	Feb 2015	B2
8974524	Yeung et al.	Mar 2015	B2
8998979	Seguin et al.	Apr 2015	B2
8998980	Shipley et al.	Apr 2015	B2
9005273	Salahieh et al.	Apr 2015	B2
9011521	Haug et al.	Apr 2015	B2
9011524	Eberhardt	Apr 2015	B2
9028545	Taylor	May 2015	B2
9029418	Dove et al.	May 2015	B2
9078751	Naor	Jul 2015	B2
9173737	Hill et al.	Nov 2015	B2
9180004	Alkhatib	Nov 2015	B2
9277990	Klima et al.	Mar 2016	B2
9277993	Gamarra et al.	Mar 2016	B2
9295551	Straubinger et al.	Mar 2016	B2
9326815	Watson	May 2016	B2
9445897	Bishop et al.	Sep 2016	B2
9456877	Weitzner et al.	Oct 2016	B2
9681968	Goetz et al.	Jun 2017	B2
9700329	Metzger et al.	Jul 2017	B2
9700411	Klima et al.	Jul 2017	B2
9795479	Lim et al.	Oct 2017	B2
9833313	Board et al.	Dec 2017	B2
9861473	Lafontaine	Jan 2018	B2
9861476	Salahieh et al.	Jan 2018	B2
9861477	Backus et al.	Jan 2018	B2
9867698	Kovalsky et al.	Jan 2018	B2
9877830	Lim et al.	Jan 2018	B2
9889029	Li et al.	Feb 2018	B2
9895225	Rolando et al.	Feb 2018	B2
9925045	Creaven et al.	Mar 2018	B2
20010007956	Letac et al.	Jul 2001	A1
20010047200	White et al.	Nov 2001	A1
20020016623	Kula et al.	Feb 2002	A1
20020032481	Gabbay	Mar 2002	A1
20020045929	Diaz	Apr 2002	A1
20020052644	Shaolian et al.	May 2002	A1
20020111619	Keast et al.	Aug 2002	A1
20030105517	White et al.	Jun 2003	A1
20030120333	Ouriel et al.	Jun 2003	A1
20030130729	Paniagua et al.	Jul 2003	A1
20030176914	Rabkin et al.	Sep 2003	A1
20030199971	Tower et al.	Oct 2003	A1
20030220683	Minasian et al.	Nov 2003	A1
20040117009	Cali et al.	Jun 2004	A1
20040133273	Cox	Jul 2004	A1
20040210304	Seguin et al.	Oct 2004	A1
20040210307	Khairkhahan	Oct 2004	A1
20040215325	Penn et al.	Oct 2004	A1
20040225353	McGuckin et al.	Nov 2004	A1
20040236411	Sarac et al.	Nov 2004	A1
20040243230	Navia et al.	Dec 2004	A1
20050033398	Seguin	Feb 2005	A1
20050075727	Wheatley	Apr 2005	A1
20050090887	Pryor	Apr 2005	A1
20050096738	Cali et al.	May 2005	A1
20050107872	Mensah et al.	May 2005	A1
20050137682	Justino	Jun 2005	A1
20050137686	Salahieh et al.	Jun 2005	A1
20050137687	Salahieh et al.	Jun 2005	A1
20050137691	Salahieh et al.	Jun 2005	A1
20050137693	Haug et al.	Jun 2005	A1
20050159811	Lane	Jul 2005	A1
20050182486	Gabbay	Aug 2005	A1
20050216079	MaCoviak	Sep 2005	A1
20050234546	Nugent et al.	Oct 2005	A1
20060020247	Kagan et al.	Jan 2006	A1
20060020327	Lashinski et al.	Jan 2006	A1
20060052867	Revuelta et al.	Mar 2006	A1
20060058872	Salahieh et al.	Mar 2006	A1
20060095115	Bladillah et al.	May 2006	A1
20060116625	Renati et al.	Jun 2006	A1
20060173537	Yang et al.	Aug 2006	A1
20060195183	Navia et al.	Aug 2006	A1
20060212110	Osborne et al.	Sep 2006	A1
20060224232	Chobotov	Oct 2006	A1
20060241745	Solem	Oct 2006	A1
20060259135	Navia et al.	Nov 2006	A1
20060265056	Nguyen et al.	Nov 2006	A1
20060287717	Rowe et al.	Dec 2006	A1
20060293745	Carpentier et al.	Dec 2006	A1
20070043435	Seguin et al.	Feb 2007	A1
20070050021	Johnson	Mar 2007	A1
20070100432	Case et al.	May 2007	A1
20070129794	Realyvasquez	Jun 2007	A1
20070142906	Figulla et al.	Jun 2007	A1
20070213813	Von Segesser et al.	Sep 2007	A1
20070219620	Eells et al.	Sep 2007	A1
20070250151	Pereira	Oct 2007	A1
20070255394	Ryan	Nov 2007	A1
20070293940	Schaeffer et al.	Dec 2007	A1
20080009934	Schneider et al.	Jan 2008	A1
20080021546	Patz et al.	Jan 2008	A1
20080071366	Tuval et al.	Mar 2008	A1
20080082164	Friedman	Apr 2008	A1
20080082165	Wilson et al.	Apr 2008	A1
20080097571	Denison et al.	Apr 2008	A1
20080097581	Shanley	Apr 2008	A1
20080147179	Cai et al.	Jun 2008	A1
20080147183	Styrc	Jun 2008	A1
20080177381	Navia et al.	Jul 2008	A1
20080183273	Mesana et al.	Jul 2008	A1
20080208328	Antocci et al.	Aug 2008	A1
20080228254	Ryan	Sep 2008	A1
20080262590	Murray	Oct 2008	A1
20090005863	Goetz et al.	Jan 2009	A1
20090082844	Zacharias et al.	Mar 2009	A1
20090082847	Zacharias et al.	Mar 2009	A1
20090088832	Chew et al.	Apr 2009	A1
20090125096	Chu et al.	May 2009	A1
20090138079	Tuval et al.	May 2009	A1
20090149946	Dixon	Jun 2009	A1
20090171438	Chuter et al.	Jul 2009	A1
20090171456	Kveen et al.	Jul 2009	A1
20090182407	Leanna et al.	Jul 2009	A1
20090182413	Burkart et al.	Jul 2009	A1
20090188964	Orlov	Jul 2009	A1
20090216314	Quadri	Aug 2009	A1
20090270972	Lane	Oct 2009	A1
20090276027	Glynn	Nov 2009	A1
20090276040	Rowe et al.	Nov 2009	A1
20090281618	Hill et al.	Nov 2009	A1
20090287290	Macaulay et al.	Nov 2009	A1
20090287296	Manasse	Nov 2009	A1
20100004740	Seguin et al.	Jan 2010	A1
20100114299	Ben Muvhar et al.	May 2010	A1
20100114305	Kang et al.	May 2010	A1
20100121076	Taillefer et al.	May 2010	A1
20100191326	Alkhatib	Jul 2010	A1
20100217382	Chau et al.	Aug 2010	A1
20100249894	Oba et al.	Sep 2010	A1
20100249911	Alkhatib	Sep 2010	A1
20100256723	Murray	Oct 2010	A1
20100305685	Millwee et al.	Dec 2010	A1
20110029067	McGuckin, Jr. et al.	Feb 2011	A1
20110208297	Tuval et al.	Aug 2011	A1
20110208298	Tuval et al.	Aug 2011	A1
20110224785	Hacohen	Sep 2011	A1
20110264196	Savage et al.	Oct 2011	A1
20120022639	Hacohen et al.	Jan 2012	A1
20120041550	Salahieh et al.	Feb 2012	A1
20120078360	Rafiee	Mar 2012	A1
20120101572	Kovalsky et al.	Apr 2012	A1
20120123529	Levi et al.	May 2012	A1
20120271398	Essinger et al.	Oct 2012	A1
20120290062	McNamara et al.	Nov 2012	A1
20130006294	Kashkarov et al.	Jan 2013	A1
20130144375	Giasolli et al.	Jun 2013	A1
20130253635	Straubinger et al.	Sep 2013	A1
20130345786	Behan	Dec 2013	A1
20140163668	Rafiee	Jun 2014	A1
20140222139	Nguyen et al.	Aug 2014	A1
20140296973	Bergheim et al.	Oct 2014	A1
20140309728	Dehdashtian et al.	Oct 2014	A1
20140324160	Benichou et al.	Oct 2014	A1
20140336754	Gurskis et al.	Nov 2014	A1
20140350666	Righini	Nov 2014	A1
20140364943	Conklin	Dec 2014	A1
20140371847	Madrid et al.	Dec 2014	A1
20140371848	Murray, III et al.	Dec 2014	A1
20140379067	Nguyen et al.	Dec 2014	A1
20140379077	Tuval et al.	Dec 2014	A1
20150012085	Salahieh et al.	Jan 2015	A1
20150018938	Von Segesser et al.	Jan 2015	A1
20150148731	McNamara et al.	May 2015	A1
20150297346	Duffy et al.	Oct 2015	A1
20160158010	Lim et al.	Jun 2016	A1
20160166383	Lim et al.	Jun 2016	A1
20160184097	Lim et al.	Jun 2016	A1
20160199206	Lim et al.	Jul 2016	A1
20160279386	Dale et al.	Sep 2016	A1
20170128209	Morriss et al.	May 2017	A1
20170216023	Lane et al.	Aug 2017	A1
20170216575	Asleson et al.	Aug 2017	A1
20170258614	Griffin	Sep 2017	A1
20170325954	Perszyk	Nov 2017	A1
20170348096	Anderson	Dec 2017	A1
20170367823	Hariton et al.	Dec 2017	A1
20180055636	Valencia et al.	Mar 2018	A1
20180085218	Eidenschink	Mar 2018	A1
20180110534	Gavala et al.	Apr 2018	A1

Foreign Referenced Citations (75)

Number	Date	Country
2304325	Oct 2000	CA
102006052564	Dec 2007	DE
1171059	Jan 2002	EP
1255510	Nov 2002	EP
1259194	Nov 2002	EP
1281375	Feb 2003	EP
1369098	Dec 2003	EP
1472996	Nov 2004	EP
1734903	Dec 2006	EP
1827558	Sep 2007	EP
1239901	Oct 2007	EP
2124826	Dec 2009	EP
1935377	Mar 2010	EP
2238947	Oct 2010	EP
2308425	Apr 2011	EP
2319458	May 2011	EP
2398543	Dec 2011	EP
2496182	Sep 2012	EP
2750630	Jul 2014	EP
2815723	Dec 2014	EP
2815725	Dec 2014	EP
2967858	Jan 2016	EP
2168536	Apr 2016	EP
2262451	May 2017	EP
3184083	Jun 2017	EP
2446915	Jan 2018	EP
3057541	Jan 2018	EP
3037064	Mar 2018	EP
3046511	Mar 2018	EP
3142603	Mar 2018	EP
3294220	Mar 2018	EP
1264471	Feb 1972	GB
1315844	May 1973	GB
2245495	Jan 1992	GB
2398245	Aug 2004	GB
2002540889	Dec 2002	JP
1997049355	Dec 1997	WO
0053104	Sep 2000	WO
0061034	Oct 2000	WO
0135861	May 2001	WO
0172239	Oct 2001	WO
03092554	Nov 2003	WO
2004030569	Apr 2004	WO
2005011534	Feb 2005	WO
2005041810	May 2005	WO
2006085304	Aug 2006	WO
2006089236	Aug 2006	WO
2007025028	Mar 2007	WO
2007034488	Mar 2007	WO
2007058857	May 2007	WO
2007123658	Nov 2007	WO
2007134290	Nov 2007	WO
2008005535	Jan 2008	WO
2008013915	Jan 2008	WO
2008070797	Jun 2008	WO
2008125153	Oct 2008	WO
2008150529	Dec 2008	WO
2009026563	Feb 2009	WO
2009033469	Mar 2009	WO
2009045331	Apr 2009	WO
2009053497	Apr 2009	WO
2009091509	Jul 2009	WO
2009094500	Jul 2009	WO
2010004009	Jan 2010	WO
2010005524	Jan 2010	WO
2010008549	Jan 2010	WO
2010022138	Feb 2010	WO
2010037141	Apr 2010	WO
2010040009	Apr 2010	WO
2010057262	May 2010	WO
2010121076	Oct 2010	WO
2011025945	Mar 2011	WO
2011057087	May 2011	WO
2011111047	Sep 2011	WO
2012035279	Mar 2012	WO

Non-Patent Literature Citations (34)

Entry
Bavaria, Joseph E. M.D. et al.: “Transcatheter Mitral Valve Implantation: The Future Gold Standard for MR?,” Applicant requests the Examiner to consider this reference to be prior art as of Dec. 2010.
Bavaria, Joseph E. M.D.: “CardiAQ Valve Technologies: Transcatheter Mitral Valve Implantation,” Sep. 21, 2009.
Berreklouw, Eric, MD, PhD, et al., “Sutureless Mitral Valve Replacement With Bioprostheses and Nitinol Attachment Rings: Feasibility in Acute Pig Experiments,” The Journal of Thoracic and Cardiovascular Surgery, vol. 142, No. 2, Aug. 2011 in 7pages, Applicant believes this may have been available online as early as Feb. 4, 2011.
Boudjemline, Younes, et al., “Steps Toward the Percutaneous Replacement of Atrioventricular Valves,” JACC, vol. 46, No. 2, Jul. 19, 2005:360-5.
CardiAQ Valve Technologies, “Innovations in Heart Valve Therapy,” In3 San Francisco, Jun. 18, 2008, PowerPoint presentation in 19 slides.
Chiam, Paul T.L., et al., “Percutaneous Transcatheter Aortic Valve Implantation: Assessing Results, Judging Outcomes, and Planning Trials,” JACC: Cardiovascular Interventions, The American College of Cardiology Foundation, vol. 1, No. 4, Aug. 2008:341-50.
Condado, Jose Antonio, et al., “Percutaneous Treatment of Heart Valves,” Rev Esp Cardio. 2006;59(12):1225-31, Applicant believes this may have been available as early as Dec. 2006.
Feldman, Ted, MD. “Prospects for Percutaneous Valve Therapies,” Circulation 2007;116:2866-2877. Applicant believes that this may be available as early as Dec. 11, 2007.
Fitzgerald, Peter J. M.D., “Tomorrow's Technology: Percutaneous Mitral Valve Replacement, Chordal Shortening, and Beyond,” Transcatheter Valve Therapies (TVT) Conference. Seattle, WA. Applicant believes this may have been available as early as Jun. 7, 2010.
Grube, E. et al, “Percutaneous aortic valve replacement for severe aortic stenosis in high-risk patients using the second- and current third-generation self-expanding CoreValve prosthesis: device success and 30-day clinical outcome.” J Am Coll Cardiol. Jul. 3, 2007;50(1):69-76. Epub Jun. 6, 2007.
Horvath et al.: “Transapical Aortic Valve Replacement under Real-time Magnetic Resonance Imaging Guidance: Experimental Results with Balloon—Expandable and Self-Expanding Stents,” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038190/. Jun. 2011.
Karimi, Houshang, et al., “Percutaneous Valve Therapies,” SIS 2007 Yearbook, Chapter 11, pp. 1-11.
Kronemyer, Bob, “CardiAQ Valve Technologies: Percutaneous Mitral Valve Replacement,” Start Up—Windhover Review of Emerging Medical Ventures, vol. 14, Issue No. 6, Jun. 2009, pp. 48-49.
Leon, Martin B., et al., “Transcatheter Aortic Valve Replacement in Patients with Critical Aortic Stenosis: Rationale, Device Descriptions, Early Clinical Experiences, and Perspectives,” Semin. Thorac. Cardiovasc. Surg. 18:165-174, 2006 in 10 pages, Applicant believes this may have been available as early as the Summer of 2006.
Lutter, Georg, et al., “Off-Pump Transapical Mitral Valve Replacement,” European Journal of Cardio-thoracic Surgery 36 (2009) 124-128, Applicant believes this may have been available as early as Apr. 25, 2009.
Ma, Liang, et al., “Double-Crowned Valved Stents for Off-Pump Mitral Valve Replacement,” European Journal of Cardio-thoracic Surgery 28 (2005) 194-199, Applicant believes this may have been available as early as Aug. of 2005.
Mack, Michael M.D., “Advantages and Limitations of Surgical Mitral Valve Replacement; Lessons for the Transcatheter Approach,” Applicant believes this may have been available as early as Jun. 7, 2010. Applicant believes this may have been presented at the Texas Cardiovascular Innovative Ventures (TCIV) Conference in Dallas, TX on Dec. 8, 2010.
Mack, Michael, M.D., “Antegrade Transcatheter Mitral valve Implantation: A Short-term Experience in Swine Model,” Applicant believes this may have been presented on May 2011 at TVT.
Mack, Michael, M.D., “Antegrade Transcatheter Mitral valve Implantation: On-Going Experience in Swine Model,” Applicant believes this may have been presented on Nov. 2011 at TCT.
Masson, Jean-Bernard, et al., “Percutaneous Treatment of Mitral Regurgitation,” Circulation: Cardiovascular Interventions, 2:140-146, Applicant believes this may have been available as early as Apr. 14, 2009.
Neovasc corporate presentation, Oct. 2009, available at http://www.neovasc.com/investors/documents/Neovasc-Corporate-Presentation- -October-2009.pdf.
Ostrovsky, Gene, “Transcatheter Mitral Valve Implantation Technology from CardiAQ,” medGadget, Jan. 15, 2010, available at: http://www.medgadget.com/2010/01/transcatheter_mitral_valve_implantation_technology_from_cardiaq.html.
Piazza, Nicoló, MD, et al., “Anatomy of the Aortic Valvar Complex and Its Implications for Transcatheter Implantation of the Aortic Valve,” Contemporary Reviews in Interventional Cardiology, Circ. Cardiovasc. Intervent., 2008;1:74-81, Applicant believes this may have been available as early as Aug. 2008.
Pluth, James R., M.D., et al., “Aortic and Mitral Valve Replacement with Cloth-Covered Braunwald-Cutter Prosthesis, A Three-Year Follow-up,” The Annals of Thoracic Surgery, vol. 20, No. 3, Sep. 1975, pp. 239-248.
Quadri, Arshad M.D., “Transcatheter Mitral Valve Implantation (TMVI) (An Acute In Vivo Study),” Applicant believes his may have been presented on Sep. 22, 2010 at TCT.
Raiz, J. Brent et al., “Any experiences making an expandable stent frame?” Arch-Pub.com, Architecture Forums: Modeling, Multiple forum postings from Feb. 3, 2009 to Feb. 4, 2009, http://www.arch-pub.com.
Ratz, J. Brent, “In3 Company Overview,” Jun. 24, 2009.
Ratz, J. Brent, “LSI EMT Spotlight,” May 15, 2009.
Ruiz, Carlos E., “Overview of Novel Transcatheter Valve Technologies,” Applicant believes this may have been presented on May 27, 2010 at EuroPCR.
Seidel, Wolfgang, et al., “A Mitral Valve Prosthesis and a Study of Thrombosis on Heart Valves in Dogs,” JSR—vol. II, No. 3—May, 1962, submitted for publication Oct. 9, 1961.
Spillner, J. et al., “New Sutureless ‘Atrial- Mitral-Valve Prosthesis’ for Minimally Invasive Mitral Valve Therapy,” Textile Research Journal, 2010, in 7 pages, Applicant believes this may have been available as early as Aug. 9, 2010.
Van Mieghem, et al., “Anatomy of the Mitral Valvular Complez and Its Implications for Transcatheter Interventions for Mitral Regurgitation,” J. Am. Coll. Cardiol., 56:617-626 (Aug. 17, 2010).
“Company Overview,” at TVT on Jun. 25, 2009.
“Update,” Applicant believes this may have been presented on Jun. 6, 2010 at TVT.

Related Publications (1)

	Number	Date	Country
	20180235756 A1	Aug 2018	US

Provisional Applications (1)

	Number	Date	Country
	61385651	Sep 2010	US

Continuations (3)

	Number	Date	Country
Parent	14702233	May 2015	US
Child	15961353		US
Parent	13756424	Jan 2013	US
Child	14702233		US
Parent	13244080	Sep 2011	US
Child	13756424		US

Replacement heart valves, delivery devices and methods

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