US 8,778,017 B2Grant
Safety for mitral valve implant
Issue Date:2014-07-15
•11 Claims
•11 Drawing Sheets
Abstract
A heart valve implant may include a shaft extending generally along a longitudinal axis of the heart valve implant. A spacer may be coupled to the shaft between a first and a second end region of the shaft. The spacer may be configured to interact with at least a portion of at least one cusp of a heart valve to at least partially restrict a flow of blood through the heart valve in a closed position and at least one anchor may be configured to be coupled to the first end region of the shaft. At least one safety stop may extend generally radially outwardly from the longitudinal axis of the heart valve implant beyond at least a portion of an outer perimeter of the spacer. The safety stop may include a cross-section which is greater than a cross-section of the heart valve in at least one dimension. The safety stop may also be configured to at least partially restrict a movement of the heart valve implant with respect to the heart valve in at least one direction.
Metadata
Assignee
- Cardiosolutions, Inc.
Inventors
- Kenneth Arden Eliasen
- Steven J. Tallarida
- Christopher W. Maurer
- Jonathan E. Wilson
Application Information
Application Number:US 11/748,147
Filing Date:2007-05-14
Priority Date:2005-10-26
Art Unit:3773
Classifications
IPC:
A61F2/24
Patent Drawings (11 sheets)
Description
Cross-Reference to Related Application
[0001] The subject application is a continuation-in-part of co-pending U.S. patent application Ser. No. 11/258,828, entitled “Heart Valve Implant” filed on Oct. 26, 2005, which is hereby incorporated by reference.
Field
[0002] The present disclosure relates to the repair and/or correction of dysfunctional heart valves, and more particularly pertains to heart valve implants and systems and methods for delivery and implementation of the same.
Background
[0003] A human heart has four chambers, the left and right atrium and the left and right ventricles. The chambers of the heart alternately expand and contract to pump blood through the vessels of the body. The cycle of the heart includes the simultaneous contraction of the left and right atria, passing blood from the atria to the left and right ventricles. The left and right ventricles then simultaneously contract forcing blood from the heart and through the vessels of the body. In addition to the four chambers, the heart also includes a check valve at the upstream end of each chamber to ensure that blood flows in the correct direction through the body as the heart chambers expand and contract. These valves may become damaged, or otherwise fail to function properly, resulting in their inability to properly close when the downstream chamber contracts. Failure of the valves to properly close may allow blood to flow backward through the valve resulting in decreased blood flow and lower blood pressure.
[0004] Mitral regurgitation is a common variety of heart valve dysfunction or insufficiency. Mitral regurgitation occurs when the mitral valve separating the left coronary atrium and the left ventricle fails to properly close. As a result, upon contraction of the left ventricle blood may leak or flow from the left ventricle back into the left atrium, rather than being forced through the aorta. Any disorder that weakens or damages the mitral valve can prevent it from closing properly, thereby causing leakage or regurgitation. Mitral regurgitation is considered to be chronic when the condition persists rather than occurring for only a short period of time.
[0005] Regardless of the cause, mitral regurgitation may result in a decrease in blood flow through the body (cardiac output). Correction of mitral regurgitation typically requires surgical intervention. Surgical valve repair or replacement is carried out as an open heart procedure. The repair or replacement surgery may last in the range of about three to five hours, and is carried out with the patient under general anesthesia. The nature of the surgical procedure requires the patient to be placed on a heart-lung machine. Because of the severity/complexity/danger associated with open heart surgical procedures, corrective surgery for mitral regurgitation is typically not recommended until the patient's ejection fraction drops below 60% and/or the left ventricle is larger than 45 mm at rest.
Brief Description of the Drawings
[0006] Features and advantage of the claimed subject matter will be apparent from the following description of embodiments consistent therewith, which description should be considered in conjunction with the accompanying drawings, wherein:
[0007] FIG. 1 is a perspective view of an embodiment of a mitral valve implant consistent with the present disclosure;
[0008] FIG. 2 a depicts an embodiment mitral valve implant consistent with the present disclosure implanted within a heart in an open position;
[0009] FIG. 2 b depicts an embodiment mitral valve implant consistent with the present disclosure implanted within a heart in a closed position;
[0010] FIG. 3 is a perspective view of another embodiment of a mitral valve implant consistent with the present disclosure;
[0011] FIG. 4 depicts the mitral valve implant consistent with FIG. 3 implanted within a heart in an open position according to the present disclosure;
[0012] FIG. 5 depicts a further embodiment of a mitral valve implant consistent with the present disclosure;
[0013] FIG. 6 depicts yet another embodiment of a mitral valve implant consistent with the present disclosure;
[0014] FIGS. 7-9 depict additionally embodiments of a mitral valve implant consistent with the present disclosure; and
[0015] FIG. 10 depicts a mitral valve implant without a spacer consistent with the present disclosure.
Description
[0016] Referring to FIG. 1 , a perspective view of one embodiment of a mitral valve implant 10 is depicted. As shown, mitral valve implant 10 may generally include a spacer or valve body portion 12 which may be coupled to a shaft 14. The shaft 14 may be coupled to at least one anchor portion 16 configured to couple, attach, and/or otherwise secure the mitral valve implant 10 to native coronary tissue. In general, at least a portion of the spacer 12 may be configured to be disposed proximate a mitral valve such that the mitral valve implant 10 may interact and/or cooperate with at least a portion of the native mitral valve 18 to reduce and/or eliminate excessive regurgitation as illustrated in FIG. 2 .
[0017] The mitral valve implant 10, FIG. 1 , may also include one or more safety stops 20. The safety stops 20 may at least partially reduce, restrict and/or prevent the mitral valve implant 10 from moving away from the mitral valve 18 area in at least one direction should the anchor portion 16 become dislodged or allows excessive movement of the mitral valve implant 10. The safety stops 20 may be configured to extend generally radially outwardly from the longitudinal axis L of mitral valve implant 10 beyond at least a portion of an outer perimeter of the spacer 12 such that the safety stops 20 may at least partially reduce, restrict and/or prevent the mitral valve implant 10 from moving away from the mitral valve 18 area in at least one direction. According to one aspect, the safety stops 20 may define an outer perimeter and/or cross-section that is larger in at least one direction than the mitral valve 18. For example, the safety stops 20 may define an outer perimeter and/or cross-section that is larger in at least one direction than the perimeter and/or cross-section of the spacer 14.
[0018] For example, the safety stops 20 may be configured to reduce and/or prevent the mitral valve implant 10 from moving through the mitral valve 18 in at least one direction. According to this embodiment, the safety stop 20 may allow a portion of the mitral valve implant 10 to move with respect to the mitral valve 18; however, the safety stop 20 may prevent, restrict and/or reduce the ability of the entire mitral valve implant 10 from passing through the mitral valve 18. It should be noted that the safety stops 20 need only prevent, restrict and/or reduce the mitral valve implant 10 from passing through the mitral valve 18. The safety stop 20 does not necessarily have to restrict the movement of the mitral valve implant 10 sufficiently to allow the mitral valve implant may to continue to interact and/or cooperate with the mitral valve leaflets 19 and reduce and/or eliminate excessive regurgitation. In other words, the safety stop 20 may allow the mitral valve implant 10 to move such that the mitral valve implant 10 no longer interacts and/or cooperates with the mitral valve leaflets 19 and no longer reduces and/or eliminates excessive regurgitation. The safety stop 20 according to this aspect need only prevent, restrict and/or reduce the mitral valve implant 10 from passing through the mitral valve 18.
[0019] Additionally (or alternatively), the safety stops 20 may be configured to sufficiently reduce, restrict and/or prevent the movement of the mitral valve implant 10 (and in particular, the spacer 12) such that the spacer 12 may continue to interact and/or cooperate with at least a portion of the mitral valve 18 to reduce and/or eliminate excessive regurgitation. It should be noted that the safety stops 20 do not necessarily have to be configured to prevent the mitral valve implant 10 from moving at all or from moving away from an original, preferred, or optimized position with respect to the mitral valve 18. As such, the safety stops 20 may allow the mitral valve implant 10 to move with respect to the mitral valve 18 as long as a minimum degree of interaction and/or cooperation exists between the mitral valve implant 10 and at least a portion of the mitral valve leaflets 19. The minimum degree of interaction and/or cooperation between the mitral valve implant 10 and at least a portion of the mitral valve leaflets 19 may vary and may be determined experimentally.
[0020] As shown in FIG. 1 , the mitral valve implant 10 may include at least one safety stop 20 disposed generally above the spacer 12. For example, the mitral valve implant 10 may include a safety stop 20a extending generally radially outwardly from the longitudinal axis L of mitral valve implant 10 along at least a portion of the shaft 14. As used herein, the term “above” the spacer 12 refers to a portion of the mitral valve implant 10 between spacer 12 and a first end 23 of the mitral valve implant 10 which is intended to be disposed proximate the atrium (e.g., the left atrium 22). The safety stop 20a may be disposed proximate the distal portion of the first end 23 of the shaft 14 as shown, however, the safety stop 20a may be disposed anywhere along the portion of the mitral valve implant 10 between spacer 12 and the distal portion of the first end 23 of the shaft 14. For example, the safety stop 20a may be disposed proximate the spacer 12. As shown in FIG. 2 , the safety stop 20a may be configured to be disposed generally within the left ventricle 24.
[0021] Referring to FIG. 3 , the mitral valve implant 10 may include at least one safety stop 20 disposed generally below the spacer 12. As used herein, the term “below” the spacer 12 refers to a portion of the mitral valve implant 10 between spacer 12 and a second end 24 of the mitral valve implant 10 which is intended to be disposed proximate the ventricle (e.g., the left ventricle 24). For example, the mitral valve implant 10 may include a safety stop 20b extending generally radially outwardly from the longitudinal axis L of mitral valve implant 10 along at least a portion of the shaft 14. As shown in FIG. 4 , the safety stop 20b may be configured to be disposed generally within the left atrium 22. While the mitral valve implant 10 is shown having safety stops 20a, 20b disposed above and below the spacer 12, the mitral valve implant 10 may include only the safety stop 20b.
[0022] Alternatively (or in addition), the mitral valve implant 10 may include a safety stop 20c, FIG. 5 , extending generally radially outwardly from the longitudinal axis L of mitral valve implant 10 about the anchor portion 16. The safety stop 20c may be disposed proximate the shaft 14, however, one or more safety stops 20c may be disposed along other positions of the anchor portion 16. Again, while the mitral valve implant 10 is shown having safety stops 20a, 20b disposed above and below the spacer 12, the mitral valve implant 10 may include only the safety stop 20c.
[0023] Referring to FIG. 6 , the mitral valve implant 10 may include at least one safety stop 20d extending generally radially outwardly from the longitudinal axis L of mitral valve implant 10 along the spacer 12. According to one embodiment, the safety stop 20d may be disposed proximate either the first or the second ends 23, 24 of the mitral valve implant 10. Placing the safety stop 20d proximate either the first or second ends 23, 24 of the mitral valve implant 10 may increase the surface available to the spacer 12 to interact and/or cooperate with the mitral valve leaflets 19 to reduce and/or eliminate excessive regurgitation and may reduce the likelihood of the safety stop 20d from preventing the spacer 12 from interacting and/or cooperating with the mitral valve leaflets 19 to reduce and/or eliminate excessive regurgitation.
[0024] Those skilled in the art will recognize that while the mitral valve implant 10 in FIGS. 2-6 are shown in combination with the safety stop 20a disposed above the spacer 12, the mitral valve implant 10 does not necessarily have to include the safety stop 20a. The mitral valve implant 10 may include one or more or a combination of two or more of the safety stops 20a-20d.
[0025] As discussed above, the safety stops 20 may reduce and/or prevent the mitral valve implant 10 from moving away from the mitral valve 18 area should the anchor portion 16 become dislodged or allows excessive movement of the mitral valve implant 10. For example, the safety stops 20 may define an outer perimeter and/or cross-section that is larger in at least one direction than the mitral valve 18. As such, the safety stop 20 may include a variety a configurations and/or geometries depending on the intended application. The safety stop 20 may be shaped to facilitate the flow of blood from the left atrium 22 to the left ventricle 24 when the mitral valve 18 is open. The safety stop 20 may have a generally streamlined shape, allowing the smooth flow of blood around the safety stop 20. Other embodiments of the mitral valve implant 10 may provide less consideration for the flow characteristics of blood flowing around the safety stop 20.
[0026] According to one aspect, the safety stop 20 may have a generally annular, ring-like shape and may define an outer perimeter extending approximately 360 degrees around the radius of the mitral valve implant 10. For example, the safety stop 20 may include a generally circular, oval, or elliptical outer perimeter as generally shown in FIGS. 1-6 . In any event, the outer perimeter of the safety stop 20 may be configured to restrict the movement of the mitral valve implant 10 through the mitral valve 18. The safety stop 20 may be configured to be mounted, attached, coupled, or otherwise secured to the mitral valve implant 10 using one or more spokes, ribs, stringers, or supports 26. As such, the safety stop 20 may form a generally open, frame-like structure. Alternatively (or in addition), the safety stop 20 may be configured as a substantially solid geometry or shape. According to one embodiment, the safety stop 20 may include a generally solid, disc-like structure. The substantially solid geometry safety stop 20 may optionally include one or more apertures or openings that allow fluid to pass through the safety stop 20.
[0027] The safety stop 20 may also include one or more segments or components 30 extending generally radially outwardly from the mitral valve implant 10 as shown in FIGS. 7-9 . Each segment 30 may extend generally outwardly less than 360 degrees along the radius of the mitral valve implant 10. For example, the safety stop 20 may include a single segment 30a as shown in FIG. 7 . The single segment 30a may extend generally radially outwardly less than 360 degrees along the radius of the mitral valve implant 10. The single segment 30a may extend outwardly from mitral valve implant 10 in at least one direction such that an outer perimeter and/or cross-section of the mitral valve implant 10 is larger in at least one direction than the cross-section of the mitral valve 18. Alternatively, the safety stop 20 may include a plurality of segments 30a-30n as shown in FIGS. 8 and 9 . The plurality of segments 30a-30n may be spaced evenly and/or unevenly about the radial direction of the mitral valve implant 10. While each segment 30a-30n may extend less than 360 degrees along the radius of the mitral valve implant 10, the sum of the segments 30a-30n may be equal, less than, or greater than 360 degrees. Again, the plurality of segments 30a-30n may extend outwardly from mitral valve implant 10 in at least one direction such that an outer perimeter and/or cross-section of the mitral valve implant 10 is larger in at least one direction than the cross-section of the mitral valve 18.
[0028] According to one embodiment, the segments 30 may have a generally tear-drop like shape. However, the segments 30 may include other shapes such as, but not limited to, circles, ovals, rectangles, triangles, and the like. The segments 30 may form a generally wire-like frame as shown in FIGS. 7 and 8 . The wire-like frame may facilitate the flow of fluid past the safety stop 20.
[0029] The segments 30 may also have a generally solid geometry or shape as shown in FIG. 9 . The solid segments 30 may optionally include one or more openings, apertures, or passageways 32 configured to allow fluid to pass through the solid segment 30. As used herein, the phrases “generally solid geometry”, “substantially solid geometry”, or the like are intended to mean a geometry having an outer surface that defines a substantially fixed or constant volume. That is, a volume of the segments 30 does not substantially change before and after implantation of the mitral valve implant 10. A “generally solid geometry” may include, without limitation, a solid, semi-solid, or porous (e.g., micro- or nano-scale pores) material.
[0030] At least a portion of the safety stop 20 may be collapsible and/or reducible in volume to facilitate percutaneous and/or transluminal delivery of the mitral valve implant 10. In such a manner, the safety stop 20 of the mitral valve implant 10 may be a collapsible member, which can be reduced in volume and/or reduced in maximum diameter during delivery to the heart and/or during placement and/or attachment of the anchor to native coronary tissue. After delivery to the heart, the safety stop 20 may be expanded, inflated, and/or otherwise increased in volume or size. Accordingly, the mitral valve implant 10 may be delivered to an implantation site via a smaller diameter catheter, and/or via smaller vessels, than would otherwise be required.
[0031] The at least partially deformable safety stop 20 may be collapsed to a reduced size, which may, for example, allow the mitral valve implant 10 to be loaded into a catheter delivery system. Such a catheter delivery system may be suitable for transluminal delivery of a mitral valve implant 10, including the safety stop 20, to the heart. In addition to being collapsed, the safety stop 20 may be deformed to facilitate loading into a catheter delivery system. For example, the safety stop 20 may be collapsed and may be rolled and/or folded to a generally cylindrical shape, allowing the safety stop 20 to be loaded in a catheter having a circular lumen.
[0032] A collapsed and/or rolled or folded safety stop 20 may be inflated, restoring the safety stop 20 to expanded configuration. For example, a collapsed and/or rolled or folded safety stop 20 may be inflated and restored to an expanded configuration once the mitral valve implant 10 has been delivered to the heart and deployed from a catheter delivery system. Inflating the safety stop 20 may be carried out by introducing a fluid, such as saline, into the at least one cavity of the safety stop 20. In addition to a liquid, such as saline, the safety stop 20 may be inflated with a setting or curable fluid. The setting or curable fluid may set and/or be cured to a solid and/or semi-solid state within the cavity of the safety stop 20. An example of such a material may be a thermoset polymer resin, a gel material, such as silicone gel, etc.
[0033] At least a portion of the safety stop 20 may also be constructed from a shape-memory material. For example, at least a portion of the safety stop 20 may include a shape-memory alloy such as, but not limited to, copper-zinc-aluminum, copper-aluminum-nickel, and nickel-titanium (NiTi) alloys. The shape-memory alloy may include either one-way or two-way shape memory and may be introduced in to the delivery catheter lumen having a shape which does not exceed the interior dimensions of the delivery catheter lumen. For example, the safety stop 20 may have a generally elongated or generally helical shape. Upon delivery to proximate the mitral valve, the shape-memory safety stop 20 may be heated to cause the safety stop 20 to deform into the desired shape for installation.
[0034] According to another embodiment, the safety stop 20 may be formed from one or more separate segments 30 which are each no larger than the interior, radial dimensions of the delivery catheter lumen in at least one direction. The segments 30 do not need to be expanded/inflated, but rather may be configured to be mounted, coupled, attached, or otherwise secured to the mitral valve implant 10 once delivered proximate the mitral valve. The size and shape of the segments 30 may be varied by design and quantity such that the constructed safety stop 20 accommodates the patient's anatomy, etiology of valve regurgitation, as well as the physical limitations of the implant delivery system.
[0035] At least a portion of the safety stop 20 may also be coated or encapsulated with various compliant materials such as, but not limited to, porous synthetic materials (for example, polyesters) that promote cell growth to improve biocompatibility and improve attachment between the safety stop 20 and the native coronary tissue. Other coating materials include non-reactive synthetics (for example, silicone/urethane composites) and xenograft (animal pericardium or collagen) materials.
[0036] While the safety stop 20 has been shown extending generally 90 degrees radially outwardly from the mitral valve implant 10, one or more of the safety stops 20 may extend generally radially outwardly at one or more angles greater than or less than 90 degrees from the longitudinal axis L of the mitral valve implant 10. Additionally, the safety stops 20 may be located at a fixed position along the mitral valve implant 10 or may be movable along the longitudinal axis L of the mitral valve implant 10. Accordingly, the safety stop 20 may be positioned along the longitudinal axis L of the mitral valve implant 10 to minimize possible movement of the mitral valve insert 10 and/or to position the safety stop 20 to minimize potential interference with the surrounding tissue. For example, the safety stop 20 may include a ratchet-like mechanism. The safety stops 20 may also be located about a common, radial plane of the mitral valve implant 10 and/or may be located about two or more radial planes of the mitral valve implant 10.
[0037] It should be noted that while the mitral valve implant 10 has been described in combination with a spacer 12, the mitral valve implant 10 may optionally include only the shaft 14, the anchor portion 16, and one or more safety stops 20 as generally shown in FIG. 10 . Additionally, at least a portion of the shaft 14 may include a substantially rigid shaft which is configured to be substantially self-supporting. Alternatively (or in addition), at least a portion of the shaft 14 may include a wire-like shaft. According to this aspect, the first and second ends 23, 24 of the shaft 14 may each include anchor portions 16.
[0038] The spacer 12 of the mitral valve implant 10 shown in FIGS. 1-9 may have any shape known to those skilled in the art. For example, as shown in FIG. 1 , the spacer 12 may have a generally tapered shape, including a sidewall 17 tapering outwardly from a narrow portion 40 adjacent to one or more of the ends of the spacer 12 to an enlarged portion 42. The taper of the sidewall 17 may have a flared or belled shape, providing an at least partially concave geometry. In various other embodiments, the spacer 12 may include a sidewall 17 having a generally uniform taper, providing a straight profile. In still other embodiments, the sidewall 17 of the spacer 12 may exhibit a convex taper, producing an at least somewhat bulging tapered profile.
[0039] The enlarged portion 42 of the spacer 12 may have an arcuate profile around the circumference of the proximal region of the enlarged portion 42. The bottom 44 of the enlarged portion 42 may be provided having a flat and/or arcuate shape. Furthermore, the bottom 44 of the proximal region may include convex and/or concave contours.
[0040] According to an embodiment, the spacer 12 may be slidably coupled to the shaft 14. The spacer 12 may include an opening 46 extending from the bottom 44 of the enlarged portion 42, through the spacer 12, and to the narrow portion 40. In one such embodiment, the opening 46 may extend generally axially through the spacer 12. The opening 46 may be sized to slidably receive at least a portion of the shaft 14 therethrough. The shaft 14 may include one or more stops 48, 50. The stops 48, 50 may be sized and/or shaped to control and/or restrict translation of the spacer 12 along the shaft 14 beyond the respective stops 48, 50. In this manner, in the illustrated embodiment, translation of the spacer 12 along the shaft 14 may be restricted to the expanse of the shaft 14 between the stops 48, 50.
[0041] One or more of the stops 48, 50 may be integrally formed with the shaft 14. Furthermore, one or more of the stops 48, 50 may be provided as a separate member coupled to and/or formed on the shaft 14. In an embodiment in which one or more of the stops 48, 50 are integrally formed with the shaft 14, the spacer 12 may be slidably coupled to the shaft 14 by pressing the spacer 12 over at least one of the stops 48, 50, which may at least partially elastically deform the opening 46 to permit passage of at least one of the stops 48, 50. Once the one or more of the stops 48, 50 have been pressed through the opening 46, the opening 46 may at least partially elastically recover, thereby resisting passage of the one or more stops 48, 50 back through the opening 46. Various other arrangements may be employed for providing stops on the shaft and/or for controlling and/or limiting translation of the spacer along the shaft.
[0042] The anchor portion 16 may include a helical member 52 coupled to the shaft 14. As shown, the helical member 52 may be loosely wound such that adjacent turns of the helical member 52 do not contact one another, for example resembling a corkscrew-type configuration. The anchor portion 16 may be engaged with tissue by rotating the anchor portion 16 about the axis of the helical member 52, thereby advancing the anchor portion 16 into tissue. Consistent with such an embodiment, the anchor portion 16 may resist pulling out from the tissue. The anchor portion 16 may be provided as an extension of the shaft 14 wound in a helical configuration. Consistent with related embodiments, the anchor portion 16 may be formed as a separate feature and may be coupled to the shaft 14, e.g., using mechanical fasteners, welding, adhesive, etc.
[0043] According to various alternative embodiments, the anchor portion 16 may include various configurations capable of being coupled to and/or otherwise attached to native coronary tissue. For example, the anchor portion 16 may include one or more prongs adapted to pierce coronary tissue and to alone, or in conjunction with other features, resist removal of the anchor portion 16 from tissue. For example, the anchor portion 16 may include a plurality of prongs which may engage native coronary tissue. According to various other embodiments, the anchor portion 16 may include features that may facilitate attachment by suturing. Exemplary features to facilitate suturing may include rings or openings, suture penetrable tabs, etc. Various other anchor portions 16 that may allow attachment or coupling to native coronary tissue may also suitably be employed in connection with the present disclosure.
[0044] Turning to FIGS. 2 and 4 , the mitral valve implant 10 is shown implanted within a heart 102. The mitral valve implant 10 may be disposed at least partially within the left ventricle 24 of the heart 102. As shown, the anchor portion 16 may be engaged with native coronary tissue within and/or adjacent to the left ventricle 24. The shaft 14, coupled to the anchor portion 16, may extend into the left ventricle 24. The shaft 14 may further extend at least partially within the mitral valve 18, i.e., the shaft 14 may extend at least partially between the cusps or leaflets 19 of the mitral valve 18, and may also extend at least partially into the left atrium 22. The spacer 12 of the mitral valve implant 10 may be positioned at least partially within the left ventricle 24 with the enlarged portion 42 within the left ventricle 24 and with the narrow portion 48 positioned at least partially within and/or pointed towards the left atrium 22.
[0045] FIGS. 2 a and 4 depict the heart 102 in a condition in which the pressure of blood within the left atrium 22 is at equal to, or higher than, the pressure of blood within the left ventricle 24, e.g., during contraction of the left atrium 22. As shown, when the pressure of blood within the left atrium 22 is greater than or equal to the pressure of blood within the left ventricle 24, blood may flow from the left atrium 22 into the left ventricle 24. The pressure differential and/or the flow of blood from the left atrium 22 to the left ventricle 24 may slidably translate the spacer 12 along the shaft 14 toward the left ventricle 24, in the direction of blood flow between the chambers.
[0046] Sliding translation of the spacer 12 along the shaft 14 may at least partially withdraw the spacer 12 from the mitral valve 18 to an open position, as shown. When the spacer 12 is at least partially withdrawn from the mitral valve 18, a passage may be opened between the spacer 12 and the mitral valve 18, allowing blood to flow from the left atrium 22 to the left ventricle 24. Translation of the spacer 12 away from the mitral valve 18 may be controlled and/or limited by the stop 50. In the open position, the stop 50 may maintain the spacer 12 in general proximity to the mitral valve 18 while still permitting sufficient clearance between the mitral valve 18 and the spacer 12 to permit adequate blood flow from the left atrium 22 to the left ventricle 24. Additionally, the flow of blood from left atrium 22 to the left ventricle 24 may cause the mitral valve 18 to flare and/or expand outwardly away from the mitral valve implant 10, permitting blood flow between the implant 10 and the cusps 19 of the mitral valve 19.
[0047] As the left ventricle 24 contracts, the pressure of blood in the left ventricle 24 may increase such that the blood pressure in the left ventricle 24 is greater than the blood pressure in the left atrium 22. Additionally, as the pressure of the blood in the left ventricle 24 initially increases above the pressure of the blood in the left atrium 22, blood may begin to flow towards and/or back into the left atrium 22. The pressure differential and/or initial flow of blood from the left ventricle 24 into the left atrium 22 may act against the spacer 12 and may translate the spacer 12 toward the left atrium 104. For example, pressurized blood within the left ventricle 24 may act against the bottom 24 of the spacer 12 inducing sliding translation of the spacer 12 along the shaft 14 toward the left atrium 22.
[0048] In the closed position as shown in FIG. 2 b, the spacer 12 may be translated toward and/or at least partially into the left atrium 22. At least a portion of the spacer 12 may interact with, engage, and/or be positioned adjacent to at least a portion of the mitral valve 18. For example, at least a portion of at least one cusp 19 of the mitral valve 18 may contact at least a portion of the spacer 12. Engagement between the spacer 12 and the mitral valve 18 may restrict and/or prevent the flow of blood from the left ventricle 24 back into the left atrium 22.
[0049] In addition to the translation of the spacer 12, the mitral valve 18 may also at least partially close around the spacer 12, thereby also restricting and/or preventing the flow of blood from the left ventricle 24 to the left atrium 22. For example, as mentioned above, at least a portion of one or both of the cusps 19 of the mitral valve 18 may contact at least a portion of the spacer 12. In some embodiments, as the pressure of the blood in the left ventricle 24 increases, the pressure against the bottom 44 of the spacer 12 may increase. The increase in pressure against the bottom 44 of the spacer 12 may, in turn, increase the engagement between the spacer 12 and the mitral valve 18.
[0050] Sliding translation of the spacer 12 toward the left atrium 22 may at least partially be controlled and/or limited by the stop 48 coupled to the shaft 14. Additionally, translation of the spacer 12 toward the left atrium 22 may be at least partially limited and/or controlled by engagement between the spacer 12 and the mitral valve 18. One or both of these restrictions on the translation of the spacer 12 may, in some embodiments, prevent the spacer 12 from passing fully into the left atrium 22. Furthermore, the diameter of the enlarged portion 20 of the spacer 12 may limit and/or restrict the movement of the spacer 12 into the left atrium 22.
[0051] The preceding embodiment may, therefore, provide a mitral valve implant that is slidably translatable relative to the mitral valve to reduce and/or eliminate regurgitation. Additional embodiments of a mitral valve implant are described in co-pending U.S. patent application Ser. No. 11/258,828, entitled “Heart Valve Implant” filed on Oct. 26, 2005, which is fully incorporated herein by reference. For example, the mitral valve implant may include a generally stationary spacer and may include more than one anchoring portions.
[0052] The implant herein has been disclosed above in the context of a mitral valve implant. An implant consistent with the present disclosure may also suitably be employed in other applications, e.g., as an implant associated with one of the other valves of the heart, etc. The present invention should not, therefore, be construed as being limited to use for reducing and/or preventing regurgitation of the mitral valve.
[0053] According to one aspect, the present disclosure features a heart valve implant comprising a shaft extending generally along a longitudinal axis of the heart valve implant and a spacer coupled to the shaft between a first and a second end region of the shaft. The spacer may be configured to interact with at least a portion of at least one cusp of a heart valve to at least partially restrict a flow of blood through the heart valve in a closed position. At least one anchor may be configured to be coupled to the first end region of the shaft and at least one safety stop may extend generally radially outwardly from the longitudinal axis of the heart valve implant beyond at least a portion of an outer perimeter of the spacer. The safety stop may be configured to at least partially restrict a movement of the heart valve implant with respect to the heart valve in at least one direction.
[0054] According to another aspect, the present disclosure features a method of restricting movement of a heart valve implant with respect to a heart valve. The method may comprise providing a heart valve implant comprising a shaft, a spacer coupled to the shaft between a first and a second end region of the shaft, at least one anchor configured to be coupled to the first end region of the shaft, and at least one safety stop extending generally radially outwardly from the heart valve implant beyond at least a portion of an outer perimeter of the spacer. The heart valve implant may be at least partially collapsed and may be percutaneously inserted into a heart where it may be secured. At least a portion of the collapsed heart valve implant may be expanded and the safety stop may be configured to at least partially restrict a movement of the heart valve implant with respect to the heart valve in at least one direction.
[0055] According to yet another aspect, the present disclosure features a method of restricting the movement of a heart valve implant. The method may comprise engaging an anchor into coronary tissue, providing a shaft coupled to the anchor and a spacer coupled to the shaft. The spacer may be configured to interact with at least a portion of at least one cusp of a heart valve to at least partially restrict a flow of blood through the heart valve in a closed position. At least one safety stop may be provided that extends generally radially outwardly from the heart valve implant beyond at least a portion of an outer perimeter of the spacer. The safety stop may be configured to at least partially restrict a movement of the heart valve implant with respect to the heart valve in at least one direction.
[0056] While the depicted embodiments including expandable and/or recoverably deformable as well as solid safety stops have generally been shown configured as a safety stop consistent with a translating spacer, an expandable and/or recoverably or solid safety stop may be configured for use as part of a valve implant including a stationary spacer. Similarly, while the valve implant embodiments including an expandable spacer and/or safety stops have been discussed in connection with transluminal and/or percutaneous delivery systems and/or procedures, such embodiments may also suitably be employed in connection with surgical delivery systems and/or methods. Additionally, other features and aspects of the various embodiments may also suitably be combined and/or modified consistent with the present disclosure. The present disclosure herein should not, therefore, be limited to any particular disclosed embodiment, and should be given full scope of the appended claims.
Claims
What is claimed is:
1. A heart valve implant comprising:
a shaft extending generally along a longitudinal axis of said heart valve implant;
a spacer coupled to said shaft between a first and a second end region of said shaft, said spacer configured to interact with at least a portion of at least one cusp of a heart valve to at least partially restrict a flow of blood through said heart valve in a closed position;
at least one anchor configured to be coupled to said first end region of said shaft; and
at least one safety stop disposed between said spacer and said at least one anchor and extending generally radially outwardly from said longitudinal axis of said heart valve implant, said at least one safety stop having an outer perimeter that is larger in at least one direction than a largest outer perimeter of said spacer when said at least one safety stop and said spacer are both deployed in a heart, said at least one safety stop configured to restrict a movement of said heart valve implant through said heart valve in at least one direction, and said at least one safety stop has a cross-section that is greater than a cross-section of said heart valve in at least one dimension when said at least one safety stop and said spacer are both deployed within said heart.
2. A heart valve implant according to claim 1, further comprising a second safety stop extending generally radially outwardly from said shaft between said spacer and said second end region of said shaft.
3. A heart valve implant according to claim 2, wherein said second safety stop is disposed proximate a distal most portion of said second end region of said shaft.
4. A heart valve implant according to claim 1, further comprising an additional safety stop extending generally radially outwardly from said shaft between said spacer and said first end region of said shaft.
5. A heart valve implant according to claim 1, wherein said at least one safety stop extends generally radially outwardly from said at least one anchor.
6. A heart valve implant according to claim 1, further comprising a second safety stop extending generally radially outwardly from said shaft between said spacer and said second end region of said shaft and wherein said at least one safety stop extends generally radially outwardly from said at least one anchor.
7. A heart valve implant according to claim 1, wherein said outer perimeter is generally circular.
8. A heart valve implant according to claim 7, wherein said at least one safety stop includes at least one spoke extending generally radially outwardly from said heart valve implant to said generally circular outer perimeter.
9. A heart valve implant according to claim 1, wherein at least a portion of said at least one safety stop includes a coating material configured to promote cell growth between said at least one safety stop and at least a portion of tissue adjacent said heart valve implant.
10. A heart valve implant comprising:
a shaft;
a spacer coupled to said shaft between a first and a second end region of said shaft, said spacer configured to interact with at least a portion of at least one cusp of a heart valve to at least partially restrict a flow of blood through said heart valve in a closed position;
at least one anchor configured to be coupled to said first end region of said shaft; and
at least one safety stop disposed between said spacer and said at least one anchor and extending generally radially outwardly from a longitudinal axis of said heart valve implant, said at least one safety stop configured to restrict a movement of said heart valve implant through said heart valve in at least one direction wherein said at least one safety stop is configured to have a cross-section greater than a largest cross-section of said heart valve in at least one dimension when said at least one safety stop and said spacer are both deployed within a heart.
11. A heart valve implant according to claim 10 wherein said at least one safety stop is configured to at least partially restrict a movement of said heart valve implant with respect to said heart valve in at least one direction.
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