Mitral Valve Repair

• US 20120226349A1
• Filed: 03/01/2011
• Published: 09/06/2012
• Est. Priority Date: 03/01/2011
• Status: Active Grant

• Current Assignee: Medtronic Ventor Technologies LTD. (Medtronic Plc)
• Original Assignee: Medtronic Ventor Technologies LTD. (Medtronic Plc)
• Inventors: Tuval, Yosi, Hariton, Ilia
• Granted Patent: US 9,445,898 B2
• Time in Patent Office: Days
• US Class Current: 623/2.37
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00292 mounted on or guided by flexible, e.g. catheter-like, means
• CPC Class Codes: A61B 2017/00783 Valvuloplasty
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0441 the shaft being a rigid coil or spiral
• CPC Class Codes: A61B 2017/0443 the shaft being resilient and having a coiled or helical shape in the released state
• CPC Class Codes: A61B 2017/06095 pliable
• CPC Class Codes: A61B 2017/0649 Coils or spirals
• CPC Class Codes: A61B 2017/22038 with a guide wire
• CPC Class Codes: A61F 2/2409 Support rings therefor, e.g. for connecting valves to tissue annuloplasty rings A61F2/2442
• CPC Class Codes: A61F 2/2445 Annuloplasty rings in direct contact with the valve annulus
• CPC Class Codes: A61F 2/2457 Chordae tendineae prostheses

Abstract

Apparatus and methods are provided for use with a mitral valve of a heart of a subject. The apparatus includes a P1-anchor, a P2-anchor, and a P3-anchor, that are anchored to tissue in a vicinity of, respectively, P1, P2 and P3 segments of a posterior leaflet of the mitral valve, a tether being fixedly coupled to the P2-anchor, and slidably coupled to the P1 and P3 anchors. A cardiac-site anchor anchors the tether to an anchoring location that is at a cardiac site that is anterior and inferior to the posterior leaflet. Other embodiments are also described.

Claims

1. Apparatus for use with a mitral valve of a heart of a subject, the apparatus comprising:

a P1-anchor, a P2-anchor, and a P3-anchor, configured to become anchored to tissue in a vicinity of, respectively, P1, P2 and P3 segments of a posterior leaflet of the mitral valve, a tether being fixedly coupled to the P2-anchor, and slidably coupled to the P1 and P3 anchors; and

a cardiac-site anchor configured to anchor the tether to an anchoring location that is at a cardiac site that is anterior and inferior to the posterior leaflet.

2. The apparatus according to claim 1, wherein the cardiac-site anchor comprises a clip.

3. The apparatus according to claim 1, wherein the P1-anchor, the P2-anchor, and the P3-anchor comprise clips.

4. The apparatus according to claim 3, wherein the clips are shaped to define openings therethrough, wherein the apparatus further comprises a mandrel configured to be reversibly disposed through the openings, and wherein, in response to removing the mandrel from the openings, the clips are configured to automatically become anchored to the tissue.

5. The apparatus according to claim 4, wherein the apparatus further comprises a mitral ring configured to become coupled to the tissue by the anchors.

6. The apparatus according to claim 5, wherein the mitral ring comprises compressible portion thereof, the compressible portions being disposed between adjacent anchors of the anchors.

7. A method of treating a mitral valve of a heart of a subject, the method comprising:

reducing a circumference of a mitral annulus and restoring a saddle-shape of the mitral annulus, by;

anchoring a P1-anchor, a P2-anchor, and a P3-anchor to tissue in a vicinity of, respectively, P1, P2 and P3 segments of a posterior leaflet of the mitral valve, a tether being fixedly coupled to the P2-anchor, and slidably coupled to the P1 and P3 anchors;

subsequently, pulling the tether; and

anchoring the tether to an anchoring location that is at a cardiac site that is anterior and inferior to the posterior leaflet.

8. The method according to claim 7, wherein anchoring the anchor to the anchoring location comprises anchoring the anchor to an inner surface of the heart at a vicinity of an apex of the heart.

9. The method according to claim 7, wherein anchoring the anchor to the anchoring location comprises anchoring the anchor to an outer surface of the heart at a vicinity of an apex of the heart.

10. The method according to claim 7, wherein anchoring the P1-anchor, the P2-anchor, and the P3-anchor comprises inserting the anchors transmyocardially into a left atrium of the subject, and anchoring the anchors to a left atrial side of the posterior leaflet of the mitral valve.

11. The method according to claim 7, wherein the P1-anchor, the P2-anchor, and the P3-anchor include a P1-clip, a P2-clip, and a P3-clip, and wherein anchoring the P1-anchor, the P2-anchor, and the P3-anchor comprises inserting the clips into a left ventricle of the subject and clipping the clips to a left ventricular side of the posterior leaflet of the mitral valve, such that the clips penetrate tissue of the posterior leaflet.

12. The method according to claim 7, wherein anchoring the tether to the anchoring location comprises decreasing a ratio of an anteroposterior diameter of the mitral annulus to a lateral diameter of the mitral annulus.

13. The method according to claim 7, wherein anchoring the tether to the anchoring location comprises reshaping a left ventricle of the subject.

14. The method according to claim 7, wherein the anchors are shaped to define openings therethrough, and wherein anchoring the anchors comprises causing the anchors to become anchored automatically, by removing a mandrel from inside the openings defined by the anchors.

15. The method according to claim 14, wherein the anchors are coupled to a ring, and wherein anchoring the anchors to the tissue comprises coupling the ring to the tissue.

16. A method of treating a mitral valve of a heart of a subject, the method comprising:

reducing a circumference of a mitral annulus and reshaping a left ventricle, by;

anchoring a P1-anchor, a P2-anchor, and a P3-anchor to tissue in a vicinity of, respectively, P1, P2 and P3 segments of a posterior leaflet of the mitral valve;

subsequently, pulling a tether that passes through the anchors; and

anchoring the tether to an anchoring location that is at a cardiac site that is anterior and inferior to the posterior leaflet.

17. The method according to claim 16, wherein anchoring the anchor to the anchoring location comprises anchoring the anchor to an inner surface of the heart at a vicinity of an apex of the heart.

18. The method according to claim 16, wherein anchoring the anchor to the anchoring location comprises anchoring the anchor to an outer surface of the heart at a vicinity of an apex of the heart.

19. The method according to claim 16, wherein anchoring the P1-anchor, the P2-anchor, and the P3-anchor comprises inserting the anchors transmyocardially into a left atrium of the subject, and anchoring the anchors to a left atrial side of the posterior leaflet of the mitral valve.

20. The method according to claim 16, wherein the P1-anchor, the P2-anchor, and the P3-anchor include a P1-clip, a P2-clip, and a P3-clip, and wherein anchoring the P1-anchor, the P2-anchor, and the P3-anchor comprises inserting the clips into a left ventricle of the subject and clipping the clips to a left ventricular side of the posterior leaflet of the mitral valve, such that the clips penetrate tissue of the posterior leaflet.

21. The method according to claim 16, wherein anchoring the tether to the anchoring location comprises decreasing a ratio of an anteroposterior diameter of the mitral annulus to a lateral diameter of the mitral annulus.

22. The method according to claim 16, wherein anchoring the tether to the anchoring location comprises restoring a saddle-shape of the mitral annulus.

23. The method according to claim 16, wherein anchoring the P1-anchor, the P2-anchor, and the P3-anchor comprises anchoring the anchors to the tissue, the tether being fixedly coupled to the P2-anchor, and slidably coupled to the P1 and P3 anchors.

24. The method according to claim 16, wherein the anchors are shaped to define openings therethrough, and wherein anchoring the anchors comprises causing the anchors to become anchored automatically, by removing a mandrel from inside the openings defined by the anchors.

25. The method according to claim 24, wherein the anchors are coupled to a ring, and wherein anchoring the anchors to the tissue comprises coupling the ring to the tissue.

26. A method of treating a mitral valve of a heart of a subject, the method comprising:

reducing a circumference of a mitral annulus and decreasing a ratio of an anteroposterior diameter of the mitral annulus to a lateral diameter of the mitral annulus, by;

anchoring a P1-anchor, a P2-anchor, and a P3-anchor to tissue in a vicinity of, respectively, P1, P2 and P3 segments of a posterior leaflet of the mitral valve;

subsequently, pulling a tether that passes through the anchors; and

anchoring the tether to an anchoring location that is at a cardiac site that is anterior and inferior to the posterior leaflet.

27. The method according to claim 26, wherein anchoring the anchor to the anchoring location comprises anchoring the anchor to an inner surface of the heart at a vicinity of an apex of the heart.

28. The method according to claim 26, wherein anchoring the anchor to the anchoring location comprises anchoring the anchor to an outer surface of the heart at a vicinity of an apex of the heart.

29. The method according to claim 26, wherein anchoring the P1-anchor, the P2-anchor, and the P3-anchor comprises inserting the anchors transmyocardially into a left atrium of the subject, and anchoring the anchors to a left atrial side of the posterior leaflet of the mitral valve.

30. The method according to claim 26, wherein the P1-anchor, the P2-anchor, and the P3-anchor include a P1-clip, a P2-clip, and a P3-clip, and wherein anchoring the P1-anchor, the P2-anchor, and the P3-anchor comprises inserting the clips into a left ventricle of the subject and clipping the clips to a left ventricular side of the posterior leaflet of the mitral valve, such that the clips penetrate tissue of the posterior leaflet.

31. The method according to claim 26, wherein anchoring the tether to the anchoring location comprises reshaping a left ventricle of the subject.

32. The method according to claim 26, wherein anchoring the tether to the anchoring location comprises restoring a saddle-shape of the mitral annulus.

33. The method according to claim 26, wherein anchoring the P1-anchor, the P2-anchor, and the P3-anchor comprises anchoring the anchors to the tissue, the tether being fixedly coupled to the P2-anchor, and slidably coupled to the P1 and P3 anchors.

34. The method according to claim 26, wherein the anchors are shaped to define openings therethrough, and wherein anchoring the anchors comprises causing the anchors to become anchored automatically, by removing a mandrel from inside the openings defined by the anchors.

35. The method according to claim 34, wherein the anchors are coupled to a ring, and wherein anchoring the anchors to the tissue comprises coupling the ring to the tissue.