Atrioventricular valve repair

Patent metadata

Field	Value
Publication number	US-2022015905-A1
Application number	US-201917292987-A
Country	US
Kind code	A1
Filing date	Nov 13, 2019
Priority date	Nov 14, 2018
Publication date	Jan 20, 2022
Grant date	—

Abstract

Apparatus and methods are described for use with an annuloplasty ring (20), and an atrioventricular valve of a heart of a mammalian subject, the atrioventricular valve including a valve annulus, valve leaflets, chords, and papillary muscles. A plurality of chord-manipulation arms (26) are configured to be deployed among the chords of the atrioventricular valve, and to cause a size of the valve annulus to decrease, by the chord-manipulation arms (26) being rotated such as to twist the native atrioventricular valve and pull the native atrioventricular valve radially inwards, by the chord-manipulation arms (26) deflecting the chords. The chord-manipulation arms (26) are configured to subsequently provide a counterforce against which the annuloplasty ring (20) is pushed, during implantation of the annuloplasty ring (20). Other applications are also described.

First claim

1 . Apparatus for use with an annuloplasty ring, and an atrioventricular valve of a heart of a mammalian subject, the atrioventricular valve including a valve annulus, valve leaflets, chords, and papillary muscles, the apparatus comprising:
a plurality of chord-manipulation arms configured:
to be deployed among the chords of the atrioventricular valve;
subsequently cause a size of the valve annulus to decrease, by the chord-manipulation arms being rotated such as to twist the native atrioventricular valve and pull the native atrioventricular valve radially inwards, by the chord-manipulation arms deflecting the chords; and
subsequently to provide a counterforce against which the annuloplasty ring is pushed, during implantation of the annuloplasty ring.

2 . The apparatus according to claim 1 , wherein the chord-manipulation arms are configured, subsequent to the annuloplasty ring having been implanted, to allow the native atrioventricular valve to become untwisted by the chord-manipulation arms being rotated in an opposite direction to the direction of the rotation of the chord-manipulation arms that caused the native atrioventricular valve to become twisted.

3 . (canceled)

4 . The apparatus according to claim 1 , wherein the atrioventricular valve includes a mitral valve, and the chord-manipulation arms are configured to be deployed among chords of the mitral valve.

5 . The apparatus according to claim 1 , wherein the atrioventricular valve includes a tricuspid valve, and the chord-manipulation arms are configured to be deployed among chords of the tricuspid valve.

6 . (canceled)

7 . The apparatus according to claim 1 , wherein the chord-manipulation arms are sized such that, when disposed in radially-non-constrained configurations, the chord-manipulation arms span a diameter that is at least equal to an inner diameter of the annuloplasty ring, such that the chord-manipulation arms are configured to provide a counterforce against which the annuloplasty ring may be pushed, during implantation of the annuloplasty ring.

8 . The apparatus according to claim 1 , wherein the chord-manipulation arms are sized such that, when disposed in radially-non-constrained configurations, the chord-manipulation arms are configured to overlap radially with the annuloplasty ring, such that the chord-manipulation arms are configured to provide a counterforce against which the annuloplasty ring may be pushed, during implantation of the annuloplasty ring.

9 . The apparatus according to claim 1 , wherein at least a portion of an inner edge of each of the chord-manipulation arms is concavely curved in a given circumferential direction, and wherein the chord-manipulation arms are configured to pull the native atrioventricular valve radially inwards, by being rotated in the given circumferential direction.

10 - 11 . (canceled)

12 . The apparatus according to claim 1 , wherein the chord-manipulation arms, portions thereof, and/or extensions from the chord-manipulation arms are configured to be left under the atrioventricular valve leaflets and the annuloplasty ring is configured to become anchored to the chord-manipulation arms, portions thereof, and/or extensions from the chord-manipulation arms.

13 . The apparatus according to claim 12 , wherein the chord-manipulation arms comprise first and second portions, wherein the annuloplasty ring is configured to become anchored to the first portions of the chord-manipulation arms, and wherein the first portions of the chord-manipulation arms are configured to be detachable from the second portions of the chord-manipulation arms, and are configured to be left under the atrioventricular valve leaflets, even after the second portions of the chord-manipulation arms are removed from the subject's ventricle.

14 . The apparatus according to claim 12 , wherein the annuloplasty ring is configured to become anchored to extensions from the chord-manipulation arms, and wherein the extensions from the chord-manipulation arms are configured to be detachable and to be left under the atrioventricular valve leaflets, even after the chord-manipulation arms are removed from the subject's ventricle.

15 . The apparatus according to claim 12 , wherein plates are disposed at the ends of at least some of the chord-manipulation arms, the plates being configured to be left under the atrioventricular valve leaflets, and wherein the annuloplasty ring is configured to become anchored to the plates.

16 . The apparatus according to claim 12 , wherein the annuloplasty ring comprises a plurality of anchoring elements, and wherein at least some of the anchoring elements are configured to become embedded in the chord-manipulation arms, portions thereof, and/or extensions from the chord-manipulation arms.

17 . The apparatus according to claim 1 , further comprising a frame configured to extend from below the atrioventricular valve leaflets into an atrium of the subject's heart, the frame defining holes which are sized such as to allow blood to flow from the atrium to a ventricle of the subject's heart via the frame, and wherein the chord-manipulation arms are coupled to a portion of the frame that is configured to be disposed within the ventricle.

18 . (canceled)

19 . The apparatus according to claim 1 ,
further comprising a support rod and a hollow tube that define holes, wherein the chord-manipulation arms are coupled to the support rod and the support rod is configured to be disposed inside the hollow tube, and wherein the holes within the hollow tube are sized such as to allow blood to flow from an atrium of the subject's heart to a ventricle of the subject's heart via the hollow tube.

20 . The apparatus according to claim 19 , further comprising a unidirectional valve disposed within the hollow tube, and configured to allow blood flow from the atrium to the ventricle, but to block blood flow in the opposite direction.

21 . The apparatus according to claim 1 , further comprising a delivery device configured to deliver the chord-manipulation arms to a ventricle of the subject's heart, wherein the arms are disposed at an angle of between 45 degrees and 135 degrees with respect to a longitudinal axis of a distal-most portion of the delivery device.

22 - 24 . (canceled)

25 . The apparatus according to claim 1 , further comprising a plurality of support elements, wherein each of the chord-manipulation arms is coupled to a respective one of the support elements, wherein during delivery of the arms to a ventricle of the subject's heart, the support elements are configured to be held together with each other, and wherein, during deployment of the arms inside the ventricle, the support elements are configured to be separated from each other.

26 . The apparatus according to claim 25 , further comprising a separation element, wherein the support elements are configured to be separated from each other by retracting the separation element such that it is disposed between the support elements.

27 . (canceled)

28 . Apparatus for use an atrioventricular valve of a heart of a mammalian subject, the atrioventricular valve including a valve annulus, valve leaflets, chords, and papillary muscles, the apparatus comprising:
an annuloplasty ring that defines an inner diameter; and a plurality of arms that are sized such that, when disposed in radially-non-constrained configurations, the arms span a diameter that is at least equal

Assignees

• Tel Hashomer Medical Res Infrastructure & Services Ltd

Inventors

• Raanani Ehud
• Orlov Boris

Classifications

• A61F2/2412

  with soft flexible valve members, e.g. tissue valves shaped like natural valves · CPC title

• A61F2/2466 Primary

  Delivery devices therefor · CPC title

• A61F2/2445 Primary

  Annuloplasty rings in direct contact with the valve annulus · CPC title

• A61F2250/006

  modular · CPC title

• A61F2/2457

  Chordae tendineae prostheses · CPC title