Safe and effective devices, systems, techniques, and methods, for the correction of valvular regurgitation, including mitral regurgitation are desirable. Attempting to address valvular regurgitation only at a central location in the valve, may not properly address regurgitation that occurs at the edges or commissural positions of a valve.
This summary is meant to provide examples and is not intended to be limiting of the scope of the invention in any way. For example, any feature included in an example of this summary is not required by the claims, unless the claims explicitly recite the feature. Also, the features described can be combined in a variety of ways. Various features and steps as described elsewhere in this disclosure can be included in the examples summarized here.
In some implementations, an occluding device for preventing regurgitation or prolapse at a native heart valve includes a plug. In some implementations, the plug includes a generally conical shape. In some implementations, the generally conical shape defines a proximal side defining a base of the generally conical shape and a distal side defining a narrow end of the generally conical shape and opposite the base, and a central axis running between the distal and proximal sides, and a coil possessing at least one turn extending along the central axis; wherein the coil is sized to encircle native chordae tendineae of a heart valve and provide a retention force against the central plug.
In some implementations, the coil is joined to the central plug at the distal side.
In some implementations, the coil is joined to the central plug at an outer diameter of the proximal side.
In some implementations, the central plug further comprises a flange extending from the distal tip.
In some implementations, the central plug traverses a native annulus, such that the proximal side resides on the inflow side of a native annulus, and the distal side resides on the outflow side of the native annulus.
In some implementations, the coil possesses at least two turns.
In some implementations, the coil is constructed of a memory material.
In some implementations, the central plug is constructed of a memory material.
In some implementations, the memory material is nitinol.
In some implementations, the central plug comprises a covering.
In some implementations, the covering comprises a biocompatible or atraumatic material.
In some implementations, the covering is constructed of ePTFE, bovine pericardium, porcine pericardium, equine pericardium, woven PTFE, knitted PTFE, braided PTFE, polyurethane, electrospun ePTFE, dipped thermoplastic, sprayed thermoplastic, other organic tissues, other non-organic tissues, and combinations thereof.
In some implementations, the covering comprises a material or compound to encourage tissue ingrowth.
In some implementations again, the coil and the central plug possess a braided weave.
In some implementations, the occluding device further includes a lubricous outer surface.
In some implementations, the lubricous outer surface is disposed on the coil.
In some implementations, the lubricous outer surface is disposed on the central plug.
In some implementations, the lubricous outer surface is constructed of a bioabsorbable material.
In some implementations, an occluding device for preventing regurgitation at a native heart valve includes a central plug having a generally conical shape, wherein the generally conical shape defines a proximal side being the base of the conical shape and a distal side defining the narrow end opposite the base and a central axis running between the distal and proximal sides, and a plurality of tissue anchors extending radially from the distal side and sized to capture valvular leaflets against the central plug.
In some implementations, the plurality of tissue anchors possess a contoured shape.
In some implementations, the contoured shape is comprised of a covering disposed upon the plurality of tissue anchors.
In some implementations, the central plug is formed of a memory material.
In some implementations, the central plug further comprises a biocompatible or atraumatic material.
In some implementations, the biocompatible or atraumatic material or covering is selected from: ePTFE, bovine pericardium, porcine pericardium, equine pericardium, woven PTFE, knitted PTFE, braided PTFE, polyurethane, electrospun ePTFE, dipped thermoplastic, sprayed thermoplastic, other organic tissues, other non-organic tissues, and combinations thereof.
In some implementations, the plurality of tissue anchors are formed of a memory material.
In some implementations, the memory material is nitinol.
In some implementations, a lasso-type device for preventing regurgitation at a native heart valve includes an encircling element capable of encircling native chordae tendineae, and a clip affixed to the encircling element capable of permanently securing the encircling element.
In some implementations, a constriction device for preventing regurgitation at a native heart valve includes a plurality of tissue anchors capable of being secured into native heart tissue, and a constriction element joining the plurality of tissue anchors.
In some implementations, the plurality of tissue anchors and the constriction element are constructed of a biocompatible material.
In some implementations, the biocompatible material is selected from stainless steel, nitinol, and titanium.
In some implementations, the tissue anchors comprise a corkscrew-like element connected to a screw head.
In some implementations, the lasso-type device further includes a ratcheting mechanism, a spool, or a winch for tightening the constriction element.
In some implementations, the constriction element is selected from a cable, a strut, or a suture.
The methods of treatment herein can be performed on a living animal or on a non-living cadaver, cadaver heart, simulator (e.g., with the body parts, tissue, etc. being simulated), anthropomorphic ghost, etc.
The foregoing and other objects, features, and advantages of the disclosed technology will become more apparent from the following detailed description, which proceeds with reference to the accompanying figures.
Disclosed herein are various systems, apparatuses, methods, etc., including occluding or obstructing devices, which can be used to prevent valvular regurgitation at commissures or clefts of native heart valves. Additional implementations can be used in conjunction with expandable prosthetic valves (e.g., transcatheter heart valves (THV)) at a native valve annulus (e.g., mitral or tricuspid valve annulus), in order to prevent paravalvular leakage that may continue to exist after placement of a prosthetic valve and/or docking device for a prosthetic valve.
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When the left ventricle contracts, the blood pressure in the left ventricle increases substantially, which serves to urge the mitral valve closed. Due to the large pressure differential between the left ventricle and the left atrium during this time, a large amount of pressure is placed on the mitral valve, leading to a possibility of prolapse, or eversion of the leaflets of the mitral valve back into the atrium. A series of chordae tendineae 22 therefore connect the leaflets of the mitral valve to papillary muscles located on the walls of the left ventricle, where both the chordae tendineae and the papillary muscles are tensioned during ventricular contraction to hold the leaflets in the closed position and to prevent them from extending back towards the left atrium. This helps prevent backflow of oxygenated blood back into the left atrium. The chordae tendineae 22 are schematically illustrated in both the heart cross-section of
A general shape of the mitral valve and its leaflets as viewed from the left atrium is shown in
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In some implementations, coil 104 possesses at least one turn encircling central plug 102. In some implementations, the at least one turn extends around the central axis of central plug 102. In some implementations, the at least one turn is at least 2 turns (e.g., at least 720° of rotation), at least 3 turns (e.g., at least 1080° of rotation), or as many turns to provide sufficient retention force of the central plug against native anatomy (e.g., chordae tendineae and/or leaflets). In some implementations coil 104 is sized to encircle central plug 102 and at least some of the native chordae tendineae near the commissure of a native heart valve.
In some implementations, the central plug 102 possess a generally conical shape to arrest valvular prolapse. In some implementations, central plug 102 traverses a native valvular annulus. Further, these examples possess a proximal side 106, which refers to a portion of the occluding device 100 at the inflow side of a valve (e.g., atrial side for a mitral valve), and a distal side 108, which refers to a portion of the occluding device 100 at the outflow side of a valve (e.g., ventricular side for a mitral valve). In some implementations, proximal side 106 defines a larger or broader end, or “base,” of a generally conical shape, and distal side 108 defines a narrow end, or “tip,” opposite the base or proximal side 106. In some implementations, the central plug 102 defines a central axis running longitudinally through central plug 102 between the proximal side 106 (or base) and distal side 108 (or tip).
In some implementations, such as in
Some implementations incorporate a biocompatible and/or atraumatic material as a covering on a central plug 102 to prevent damage to native tissue, including ePTFE, bovine pericardium, porcine pericardium, equine pericardium, woven PTFE, knitted PTFE, braided PTFE, polyurethane, electrospun ePTFE, dipped thermoplastic, sprayed thermoplastic, other organic tissues, other non-organic tissues, and combinations thereof. Furthermore, semipermeable or impermeable material can be disposed on a central plug 102 to prevent flow and/or encourage thrombosis such to prevent flow because of valvular regurgitation and/or prolapse. Some implementations utilize materials and/or compounds to encourage tissue ingrowth into a central plug 102.
In some implementations, occluding device 100 possesses a lubricous outer surface. In some implementations, the lubricous outer surface is a hydrophilic coating or a slick jacket to reduce friction between an occluding device 100 and native tissue (e.g., chordae). In some implementations, the lubricous outer surface is disposed on the coil 104, while some examples dispose the lubricous outer surface on the central plug 102. Some implementations dispose the lubricous outer surface on both the coil 104 and the central plug 102. In some implementations, this is accomplished with a temporary lubricous sleeve or sheath that can be placed over occluding device 100 during delivery, and which is retractable from off of occluding device 100 after occluding device 100 is in a desired position/location. In some implementations, the lubricous coating is constructed of a temporary and/or bioabsorbable material, such that after a period of time the coating will disappear, preventing slippage, repositioning, or other movement of an occluding device after deployment or installation. Such temporary materials can dissipate as a factor or function of time when exposed to body temperatures and/or fluids, while some examples allow for a dissolution via introduction of a biocompatible solvent or other agent to increase the dissolution rate of the lubricous coating. In some implementations, a lubricous or low-friction sleeve/sheath is incorporated into a transvascular and transcatheter delivery system.
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In some implementations an occluding device 700 is constructed of a memory metal, such as described above in relation to
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To install some examples, tissue anchors 1002 can comprise corkscrew like elements 1006 which can be installed into an annulus 1008 near a commissure 1010. Alternatively, some embodiments install tissue anchors 1002 into an atrial or a ventricular wall. In corkscrew-like elements 1006, the anchors can be installed via a suitable tool that mates with a screw head 1012 (e.g., hex or star). In some embodiments, screws allow for removal or replacement of a constriction device 1000. However, some embodiments may be a permanent solution via barbs or some other mechanism that prevents the removal of a constriction device 1000. Upon installation of tissue anchors 1002, constriction element 1004 can be tightened via a ratcheting mechanism, spool, or winch that allows for tissue anchors 1002 to be drawn closer to each other, thus bringing valvular leaflets in closer proximity to each other. However, some implementations can have a static length on the constriction element 1004, such that installation of a second tissue anchor is the action that brings leaflets in closer proximity to each other, and no additional action is necessary to tighten or constrict constriction element 1004.
Any of the various systems, devices, apparatuses, etc. in this disclosure can be sterilized (e.g., with heat, radiation, ethylene oxide, hydrogen peroxide, etc.) to ensure they are safe for use with patients, and the methods herein can comprise sterilization of the associated system, device, apparatus, etc. (e.g., with heat, radiation, ethylene oxide, hydrogen peroxide, etc.).
For purposes of this description, certain aspects, advantages, and novel features of the embodiments of this disclosure are described herein. The disclosed methods, apparatus, and systems should not be construed as being limiting in any way. Instead, the present disclosure is directed toward all novel and nonobvious features and aspects of the various disclosed embodiments, alone and in various combinations and sub-combinations with one another. The methods, apparatus, and systems are not limited to any specific aspect or feature or combination thereof, nor do the disclosed embodiments require that any one or more specific advantages be present or problems be solved.
Although the operations of some of the disclosed embodiments are described in a particular, sequential order for convenient presentation, it should be understood that this manner of description encompasses rearrangement, unless a particular ordering is required by specific language set forth below. For example, operations described sequentially can in some cases be rearranged or performed concurrently. Moreover, for the sake of simplicity, the attached figures may not show the various ways in which the disclosed methods can be used in conjunction with other methods. Additionally, the description sometimes uses terms like “provide” or “achieve” to describe the disclosed methods. These terms are high-level abstractions of the actual operations that are performed. The actual operations that correspond to these terms may vary depending on the particular implementation and are readily discernible by one of ordinary skill in the art.
Further, the methods of treatment herein can be performed on a living animal or on a non-living cadaver, cadaver heart, simulator (e.g., with the body parts, tissue, etc. being simulated), anthropomorphic ghost, etc.
As used in this application and in the claims, the singular forms “a,” “an,” and “the” include the plural forms unless the context clearly dictates otherwise. Additionally, the term “includes” means “comprises.” Further, the terms “coupled” and “associated” generally mean electrically, electromagnetically, and/or physically (e.g., mechanically or chemically) coupled or linked and does not exclude the presence of intermediate elements between the coupled or associated items absent specific contrary language.
In the context of the present application, the terms “lower” and “upper” are used interchangeably with the terms “inflow” and “outflow”, respectively. Thus, for example, the lower end of the valve is its inflow end and the upper end of the valve is its outflow end.
As used herein, the term “proximal” refers to a position, direction, or portion of a device that is closer to the user and further away from the implantation site. As used herein, the term “distal” refers to a position, direction, or portion of a device that is further away from the user and closer to the implantation site. Thus, for example, proximal motion of a device is motion of the device toward the user, while distal motion of the device is motion of the device away from the user. The terms “longitudinal” and “axial” refer to an axis extending in the proximal and distal directions, unless otherwise expressly defined.
In view of the many possible embodiments to which the principles of the disclosed technology can be applied, it should be recognized that the illustrated embodiments are only preferred examples and should not be taken as limiting the scope of the disclosure. Rather, the scope of the disclosure is at least as broad as the following claims.
This application is a continuation of International Patent Application No. PCT/US2022/042201, filed Aug. 31, 2022, which claims the benefit of U.S. Patent Application No. 63/248,210, filed Sep. 24, 2021, the entire disclosures all of which are incorporated by reference for all purposes.
Number | Date | Country | |
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63248210 | Sep 2021 | US |
Number | Date | Country | |
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Parent | PCT/US2022/042201 | Aug 2022 | WO |
Child | 18590740 | US |