US 8,888,844 B2Grant
Heart valve implant
Issue Date:2014-11-18
•7 Claims
•16 Drawing Sheets
Abstract
A method according to one embodiment may include providing a heart valve implant including an anchor capable of engaging coronary tissue, a shaft coupled to said anchor, and a valve body coupled to said shaft. The method may further include at least partially collapsing the heart valve implant and percutaneously inserting the heart valve implant into a heart. The percutaneously inserted implant may be secured within the heart and may then be expanded. Of course, many alternatives, variations, and modifications are possible without departing from this embodiment.
Metadata
Assignee
- Cardiosolutions, Inc.
Inventors
- Kenneth Arden Eliasen
- Steven J. Tallarida
- Adrian Ebner
Application Information
Application Number:US 13/347,522
Filing Date:2012-01-10
Priority Date:2005-10-26
Art Unit:3738
Classifications
IPC:
A61F2/24A61B17/00
Patent Drawings (16 sheets)
Description
Cross Reference to Related Application
[0001] This application is a continuation of U.S. patent application Ser. No. 11/258,828 (now U.S. Pat. No. 8,092,525) filed Oct. 26, 2005, all of which is incorporated herein 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 depicts an embodiment mitral valve implant consistent with the present disclosure implanted within a heart in an open position;
[0009] FIG. 3 depicts an embodiment of a mitral valve implant consistent with the present disclosure implanted within a heart in a closed position;
[0010] FIG. 4 depicts another embodiment of a mitral valve implant consistent with the present disclosure;
[0011] FIG. 5 depicts the mitral valve implant of FIG. 4 implanted within a heart in an open position;
[0012] FIG. 6 depicts the mitral valve implant of FIG. 4 implanted within a heart in a closed position;
[0013] FIG. 7 shows another embodiment of a mitral valve implant consistent with the present disclosure;
[0014] FIG. 8 shows an embodiment of a mitral valve implant including a barb anchor portion consistent with the present disclosure;
[0015] FIG. 9 depicts another embodiment of a translating mitral valve implant consistent with the present disclosure;
[0016] FIG. 10 schematically shows and embodiment of a percutaneous mitral valve implant delivery system consistent with the present disclosure;
[0017] FIG. 11 is a cross-sectional view of an embodiment of an inflatable valve body consistent with the present disclosure;
[0018] FIG. 12 is a cross-sectional view of an embodiment of an expandable valve body consistent with the present disclosure;
[0019] FIG. 13 is a cross-sectional view of an embodiment of an expandable valve body consistent with the present disclosure including a recoverably deformable rib;
[0020] FIG. 14 is a cross-sectional view of another embodiment of an expandable valve body consistent with the present disclosure including recoverably deformable stringers; and
[0021] FIG. 15 is perspective view of a valve body of yet another embodiment of a mitral valve implant consistent with the present disclosure.
Description
[0022] The present disclosure relates to a heart valve implant. A heart valve implant herein may suitably be used in connection with the treatment and/or correction of a dysfunctional or inoperative heart valve. One suitable implementation for a heart valve implant consistent with the present disclosure is the treatment of mitral valve regurgitation. For the ease of explanation, the heart valve implant herein is described in terms of a mitral valve implant, such as may be used in treating mitral valve regurgitation. However, a heart valve implant consistent with the present disclosure may be employed for treating and/or correcting other dysfunctional or inoperative heart valves. The present disclosure should not, therefore, be construed as being limited to use as a mitral valve implant.
[0023] Generally, a heart valve implant consistent with the present invention may interact with at least a portion of an existing heart valve to prevent and/or reduce regurgitation. For example, at least a portion of one or more cusps of the heart valve may interact with, engage, and/or seal against at least a portion of the heart valve implant when the heart valve is in a closed condition. The interaction, engagement and/or sealing between at least a portion of at least one cusp and at least a portion of the heart valve implant may reduce and/or eliminate regurgitation in a heart valve, for example, providing insufficient sealing, including only a single cusp, e.g., following removal of a diseased and/or damaged cusp, and/or having a ruptured cordae. A heart valve implant consistent with the present disclosure may be used in connection with various additional and/or alternative defects and/or deficiencies.
[0024] Referring to FIG. 1 , a perspective view of an embodiment of a mitral valve implant 10 is depicted. In general, the mitral valve implant 10 may be capable of increasing the sealing and/or closure of the passage between the left ventricle and the left atrium during contraction of the left ventricle relative to damaged and/or leaking native valve. Accordingly, in some embodiments the mitral valve implant 10 may be capable of operating in combination with a partially operable and/or damaged mitral valve. That is, the mitral valve implant may interact and/or cooperate with at least a portion of the native mitral valve to reduce and/or eliminate excessive regurgitation. As shown, mitral valve implant may generally include a valve body portion 12 which may be coupled to a shaft 14. The shaft 14 may be coupled to an anchor portion 16.
[0025] The valve body portion 12 of the mitral valve implant 10 shown in FIG. 1 may have a generally tapered shape, including a sidewall 17 tapering outwardly from a narrow portion 18 adjacent to one end of the valve body 12 to an enlarged portion 20 adjacent to the other end of the valve body 12. The taper of the sidewall 17 may have a flared or belled shape, providing an at least partially concave geometry, as depicted in FIG. 1 . In various other embodiments the valve body may include a sidewall having a generally uniform taper, providing a straight profile. In still other embodiments, the sidewall of the valve body may exhibit a convex taper, producing an at least somewhat bulging tapered profile.
[0026] The enlarged portion 20 of the valve body 12 may have an arcuate profile around the circumference 22 of the proximal region of the enlarged portion 20. The bottom 24 of the enlarged portion 20 may be provided having a flat and/or arcuate shape. Furthermore, the bottom 24 of the proximal region may include convex and/or concave contours.
[0027] According to an embodiment, the valve body 12 may be slidably coupled to the shaft 14. The valve body 12 may include an opening 26 extending from the bottom 24 of the enlarged portion 20, through the valve body 12, and to the narrow portion 18. In one such embodiment, the opening 26 may extend generally axially through the valve body 12. The opening 26 may be sized to slidably receive at least a portion of the shaft 14 therethrough. The shaft 14 may include one or more stops 28, 30. The stops 28, 30 may be sized and/or shaped to control and/or restrict translation of the valve body 12 along the shaft 14 beyond the respective stops 28, 30. In this manner, in the illustrated embodiment, translation of the valve body 12 along the shaft 14 may be restricted to the expanse of the shaft 14 between the stops 28, 30.
[0028] One or more of the stops 28, 30 may be integrally formed with the shaft 14. Furthermore, one or more of the stops 28, 30 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 28, 30 are integrally formed with the shaft 14, the valve body 12 may be slidably coupled to the shaft 14 by pressing the valve body 12 over at least one of the stops 28, 30, which may at least partially elastically deform the opening 26 to permit passage of at least one of the stops 28, 30. Once the one or more of the stops 28, 30 have been pressed through the opening 26, the opening 26 may at least partially elastically recover, thereby resisting passage of the one or more stops 28, 30 back through the opening 26. Various other arrangements may be employed for providing stops on the shaft and/or for controlling and/or limiting translation of the valve body along the shaft.
[0029] The anchor portion 16 may include a helical member 32 coupled to the shaft 14. As shown, the helical member 32 may be loosely wound such that adjacent turns of the helical member 32 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 32, 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.
[0030] According to various alternative embodiments, the anchor portion may include various configurations capable of being coupled to and/or otherwise attached to native coronary tissue. For example, the anchor portion 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 from tissue. For example, the anchor portion may include a plurality of prongs which may engage native coronary tissue. According to various other embodiments, the anchor portion 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 that may allow attachment or coupling to native coronary tissue may also suitably be employed in connection with the present disclosure.
[0031] Turning to FIGS. 2 and 3 , 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 104 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 104. The shaft 14, coupled to the anchor portion 16, may extend into the left ventricle 104. The shaft 14 may further extend at least partially within the mitral valve 108, i.e., the shaft may extend at least partially between the cusps of the mitral valve, and may also extend at least partially into the left atrium 106. The valve body 12 of the mitral valve implant 10 may be positioned at least partially within the left ventricle 104 with the enlarged portion 20 within the left ventricle 104 and with the narrow portion 18 positioned at least partially within and/or pointed towards the left atrium 106.
[0032] FIG. 2 depicts the heart 102 in a condition in which the pressure of blood within the left atrium 106 is at equal to, or higher than, the pressure of blood within the left ventricle 104, e.g., during contraction of the left atrium 106. As shown, when the pressure of blood within the left atrium 106 is greater than or equal to the pressure of blood within the left ventricle 104, blood may flow from the left atrium 106 into the left ventricle 104. The pressure differential and/or the flow of blood from the left atrium 106 to the left ventricle 104 may slidably translate the valve body 12 along the shaft 14 toward the left ventricle 104, in the direction of blood flow between the chambers.
[0033] Sliding translation of the valve body 12 along the shaft 14 may at least partially withdraw the valve body 12 from the mitral valve 108 to an open position, as shown. When the valve body is at least partially withdrawn from the mitral valve 108, a passage may be opened between the valve body 12 and the mitral valve 108, allowing blood to flow from the left atrium 106 to the left ventricle 104. Translation of the valve body 12 away from the mitral valve 108 may be controlled and/or limited by the stop 30. In the open position, the stop 30 may maintain the valve body 12 in general proximity to the mitral valve 108 while still permitting sufficient clearance between the mitral valve 108 and the valve body 12 to permit adequate blood flow from the left atrium 106 to the left ventricle 104. Additionally, the flow of blood from left atrium to the left ventricle may cause the mitral valve to flare and/or expand outwardly away from the mitral valve implant, permitting blood flow between the implant and the cusps of the mitral valve.
[0034] As the left ventricle 104 contracts, the pressure of blood in the left ventricle 104 may increase such that the blood pressure in the left ventricle 104 is greater than the blood pressure in the left atrium 106. Additionally, as the pressure of the blood in the left ventricle 104 initially increases above the pressure of the blood in the left atrium 106, blood may begin to flow towards and/or back into the left atrium 106. The pressure differential and/or initial flow of blood from the left ventricle 104 into the left atrium 106 may act against the valve body 12 and may translate the valve body 12 toward the left atrium 104. For example, pressurized blood within the left ventricle 104 may act against the bottom 24 of the valve body 12 inducing sliding translation of the valve body 12 along the shaft 14 toward the left atrium 106.
[0035] Turning to FIG. 3 , the mitral valve implant 10 is shown in a closed position. In the closed position the valve body 12 may be translated toward and/or at least partially into the left atrium 106. At least a portion of the valve body 12 may interact with, engage, and/or be positioned adjacent to at least a portion of the mitral valve 108. For example, at least a portion of at least one cusp of the mitral valve 108 may contact at least a portion of the valve body 12. Engagement between the valve body 12 and the mitral valve 108 may restrict and/or prevent the flow of blood from the left ventricle 104 back into the left atrium 106.
[0036] In addition to the translation of the valve body 12, the mitral valve 108 may also at least partially close around the valve body 12, thereby also restricting and/or preventing the flow of blood from the left ventricle 104 to the left atrium 106. For example, as mentioned above, at least a portion of one or both of the cusps of the mitral valve may contact at least a portion of the valve body. In some embodiments, as the pressure of the blood in the left ventricle 104 increases, the pressure against the bottom 24 of the valve body 12 may increase. The increase in pressure against the bottom 24 of the valve body 12 may, in turn, increase the engagement between the valve body 12 and the mitral valve 108.
[0037] Sliding translation of the valve body 12 toward the left atrium 106 may at least partially be controlled and/or limited by the stop 28 coupled to the shaft 14. Additionally, translation of the valve body 12 toward the left atrium 106 may be at least partially limited and/or controlled by engagement between the valve body 12 and the mitral valve 108. One or both of these restrictions on the translation of the valve body 12 may, in some embodiments, prevent the valve body 12 from passing fully into the left atrium 106. Furthermore, the diameter of the enlarged portion 20 of the valve body 12 may limit and/or restrict the movement of the valve body 12 into the left atrium 106.
[0038] 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. Further embodiments of a mitral valve implant having a translating valve body may be provided including various alternative valve body configurations. For example, in one embodiment a valve body may be provided generally configured as a disc including generally planar or arcuate top and bottom surfaces. In the same manner as the illustrated embodiment of FIGS. 1-3 , the disc may translate along a shaft between an open position spaced from the mitral valve of the heart and closed position at least partially engaging the mitral valve and/or at least partially obstructing a flow of blood from the left ventricle to the left atrium. Implants employing a valve body having various other geometries, such as spherical, oblong, etc., may also suitably be employed. Furthermore, in addition to the slidably translatable valve body depicted in FIGS. 1-3 , embodiments may be provided in which the valve body is rotatably and/or pivotally translatable to engage and/or interact with at least a portion of the mitral valve.
[0039] The illustrated mitral valve implant is shown including only a single anchor portion coupled to a proximal end of the shaft. A mitral valve implant consistent with the present invention may include more than one anchor portion for securing the mitral valve implant to native coronary tissue. Additional anchor portions may be employed to provide more secure coupling of the valve implant to coronary tissue. Furthermore, more than one anchor portion may be employed to achieve more precise positioning of the valve implant and/or the valve body portion of the valve implant within the heart. For example, a replacement valve may include an anchor portion coupled to the proximal end of the shaft and to the distal end of the shaft. In such an embodiment, each end of the shaft may be coupled to native coronary tissue. The orientation of the shaft, and thereby the path of translation of the valve body, may be controlled by coupling each end of the shaft to native coronary tissue. In a similar embodiment, the valve implant may include an anchor portion coupled to one end of the shaft and may include another anchor portion coupled to the shaft between the ends thereof.
[0040] A valve implant may be produced from a variety of suitable materials. Generally, such materials maybe be biocompatible. Suitable materials may include biocompatible polymers, such as silicone, polyurethane, etc. Various metals may additionally be used in connection with a valve implant, such as titanium, stainless steel, etc. Additionally, biological materials and/or materials which may promote cellular ingrowth may also be used in connection with a valve implant herein. Furthermore, various combinations of materials may be used herein, e.g., providing composite features and/or portions made from different materials. For example, the shaft may be formed from a metal and the valve body may be formed from a polymeric material. Various additional and/or alternative combinations may also be employed herein.
[0041] Turning to FIG. 4 , another embodiment of a mitral valve implant 200 is depicted. The mitral valve implant 200 generally includes a valve body portion 202 coupled to a shaft 204. The shaft 204 may be coupled to an anchor 206. The valve body 202 may be coupled to the shaft 204 in a stationary fashion, e.g., the valve body may be coupled to the shaft in a non-slidable manner. Generally, the valve body 202 may be maintained at a generally fixed position on the shaft 204. The mitral valve implant 200 may be implanted in a heart such that the anchor 206 and the shaft 204 may maintain the valve body 202 in a position relative to various aspects of the coronary anatomy. According to one aspect, the anchor 206 and the shaft 204 may maintain the valve body 202 positioned extending at least partially within the mitral valve.
[0042] The valve body 202 may be maintained in a stationary position on the shaft 204 in various ways. For example, valve body 202 may be formed directly on the shaft 205. Additionally and/or alternatively, the valve body 202 may be adhesively bonded, welded, staked, and/or mechanically fastened to the shaft 204. Consistent with other embodiments, the shaft may include one or more stops or features which may prevent and/or limit translation of the valve body along the shaft. For example, the shaft may include a stop closely positioned on either end of the valve body, thereby restricting movement of the valve body. The stops may be fixed and/or may be adjustable along the shaft 204. Various other configurations and/or arrangements may be employed for coupling the valve body 202 in a stationary manner with respect to the shaft 204.
[0043] Similar to previous embodiments, the anchor 206 may be provided having a helical or corkscrew shape. The helical anchor 206 may be engaged with coronary tissue by rotating the anchor 206 about the axis of the helix, thereby driving the anchor 206 into native coronary tissue. Once the anchor has been engaged with native coronary tissue, the anchor 206 may resist axial pull-out from the tissue. The anchor may additionally and/or alternatively be provided having various features and/or configurations. For example, the anchor may be provided having one or more prongs which may pierce and or be embedded in coronary tissue. In one embodiment, the anchor may include a barbed prong which may resist removal of the anchor from the coronary tissue. The anchor may also be provided having suturing features. For example, the anchor may include a tab and/or ring, etc., through which a suture may pass to secure the anchor coronary tissue.
[0044] Turning to FIG. 5 , the mitral valve implant 200 is shown implanted within a heart 102. The mitral valve implant 200 may be positioned extending at least partially into and/or through the mitral valve 108 between the left ventricle 104 and the left atrium 106. As shown, when the pressure of blood in the left atrium 106 is higher than the pressure of blood in the left ventricle 104, for example during contraction of the left atrium 106, the mitral valve 108 may be in an open condition. In an open condition, blood may flow from the left atrium 106 through the mitral valve 108 and around the valve body 202 and into the left atrium 104.
[0045] The anchor 206 may be engaged in native coronary tissue surrounding and/or defining at least a portion of the left ventricle 104. The valve body 202 may be positioned extending at least partially into and/or through the mitral valve 108 by the shaft 204 extending between the anchor 206 and the valve body 202. In a related embodiment, the anchor may be engaged in tissue surrounding and/or defining at least a portion of the left atrium. Similar to the preceding embodiment, the valve body 202 may be positioned extending at least partially into and/or through the mitral valve 108 by the shaft 204 extending between the anchor 206 and the valve body 202.
[0046] Consistent with a further embodiment, the mitral valve implant may include more than one anchor for positioning the valve body relative to the mitral valve. For example, the shaft may include an anchor coupled to each end of the shaft. The shaft may be provided extending through the mitral valve, with one anchor being engaged with coronary tissue on the ventricle side of the mitral valve. The other anchor may be engaged with coronary tissue on the atrium side of the mitral valve. As with the previous embodiments, the valve body may be coupled in a stationary position on the shaft, such that the valve body is positioned extending at least partially into and/or at least partially through the mitral valve.
[0047] FIG. 6 depicts the mitral valve implant 200 implanted in a heart 102 with the mitral valve 108 in a closed condition. The closed condition of the mitral valve 108 may occur when the pressure of blood in the left ventricle 104 is higher than the pressure of blood in the left atrium 106. As shown, when the mitral valve 108 is in a closed condition at least a portion of the mitral valve 108 may interact with, engage, and/or seal against the valve body 202 of the mitral valve implant 200. The presence of the mitral valve implant 200 may reduce the amount of closure of the mitral valve 108 that is necessary to achieve an adequate seal to permit ejection of blood from the ventricle 104 through the aorta 208, i.e., to prevent and/or reduce mitral regurgitation.
[0048] The valve body 202 may be shaped to facilitate the flow of blood from the left atrium 106 to the left ventricle 104 when the mitral valve 108 is open. The valve body 202 may have a generally streamlined shape, allowing the smooth flow of blood around the valve body 202. Other embodiments of the mitral valve implant may provide less consideration for the flow characteristics of blood flowing around the valve body. The valve body may have a generally cylindrical, prismatic, etc. shape, without limitation.
[0049] The performance of the mitral valve implant 200 for reducing and/or eliminating mitral valve regurgitation may be, at least in part, related to the positioning of valve body 202 relative to the mitral valve 108. In an embodiment consistent with this aspect, during implantation of the mitral valve implant, the valve body 202 may be slidably positionable along the shaft 204. Once the anchor 206 is engaged with native coronary tissue the valve body 202 may be translated along the shaft 204 and may be positioned relative to the mitral valve 108, e.g., such that the valve body 202 extends at least partially within the mitral valve 108. Slidable positioning of the valve body 202 along the shaft 204 after the mitral valve implant 200 has been delivered to the heart 102 may allow the performance of the mitral valve implant 200 to be adjusted. Furthermore, the adjustability of the position of the valve body 202 may accommodate any errors in the position of the anchor 206 in the heart 102, and/or may render the successful implantation of the mitral valve implant 200 less dependent upon accurate placement of the anchor 206. Once the valve body 202 has been positioned, the position of the valve body 202 on the shaft 204 may be fixed, e.g. by frictional engagement between the valve body 202 and the shaft 204, etc.
[0050] The illustrated and described embodiments of the mitral valve implant have utilized an implant body coupled to a shaft. The shaft, as used herein, may be a rigid, semi-rigid. In further embodiments, the shaft may be a flexible member. Consistent with such embodiments, the shaft may be a flexible wire or filament, etc. In some embodiments, the flexible wire or filament may be coupled to at least two anchor portions. For example, the flexible wire or filament may extend through the valve body. An anchor may be coupled to the flexible wire or filament on each side of the valve body. For example, the flexible wire or filament may position the valve body relative to the mitral valve and may be coupled to the left ventricle and to the left atrium, on either side of the valve body.
[0051] An embodiment of a mitral valve implant including a flexible wire and/or filament may suitably be employed in embodiments including a translating valve body, in which the valve body may slidably translate along the flexible wire or filament. In a related embodiment, the valve body may be non-slidably coupled to the flexible wire or filament. The flexible wire or filament may be provided having a length which may permit the valve body to move toward and away from the mitral valve utilizing the flexibility of the flexible wire or filament.
[0052] Furthermore, an embodiment of a mitral valve implant including a flexible wire or filament may also suitably be employed in an embodiment including a generally stationary implant body. According to such an embodiment, the implant body may be generally non-slidably coupled to the flexible wire or filament. The flexible wire or filament may be coupled to native coronary tissue, e.g., via anchor portions, etc., on either side of the valve body. Coupling the flexible wire or filament on either side of the valve body may generally maintain the valve body in a position within and/or relative to the mitral valve.
[0053] Turning to FIG. 7 , another embodiment of a mitral valve implant 200a is shown. Similar to the previously described embodiment, the mitral valve implant 200a may generally include a valve body 202 configured to reduce and/or eliminate mitral valve regurgitation. In contrast to the preceding embodiment, an anchor 206 may be coupled to the valve body 202. As shown, the anchor 206 may be directly coupled to the valve body 202 without a shaft extending between the anchor 206 and the valve body 202.
[0054] As mentioned above, various different features and/or arrangements may be used for attaching and/or securing the mitral valve implant relative to coronary anatomy. FIG. 8 depicts another embodiment of a mitral valve implant 200b according to the present disclosure including an alternative anchor 206a. As shown, the mitral valve implant 200b may include a valve body 202 coupled directly to the anchor 206a. Alternatively, the valve body may be indirectly coupled to the anchor, e.g., by a shaft. The anchor 206a may generally include one or more prongs, stems, etc. 205. The prong 205 may include one or more barbs 207. The mitral valve implant 200b may be attached and/or secured to native coronary tissue by piercing the anchor 206a at least partially into native coronary tissue. The one or more barbs 207 may engage the coronary tissue and resist removal of the anchor 206a from the coronary tissue.
[0055] In a related embodiment, an anchor including one or more barbs may be employed in connection with a translating mitral valve implant configuration, as shown and described herein. In such and embodiment, the valve body may be translatable relative to the native mitral valve. For example, the valve body may be coupled to the anchor by a shaft extending therebetween. The valve body may be slidable along the shaft, permitting the valve body the translate relative to the mitral valve. Various alternative and/or additional related embodiments may also be provided consistent with this aspect of the present disclosure.
[0056] Turning to FIG. 9 , another embodiment of a movable and/or translatable mitral valve implant 10a is depicted. Similar to the previously described embodiment, the mitral valve implant 10 may generally include a valve body 12 slidably coupled to a shaft 14. The mitral valve 10a may further include an anchor 16 coupled to the shaft 14 and configured to secure and/or attach the mitral valve implant 10a to native coronary tissue. As shown in broken line, the mitral valve implant 10a may include a single stop 29 configured to restrict and/or control the range of movement of the valve body 12 along the shaft 14. As shown, the stop 29 may be disposed at least partially within the valve body 12 and the range of movement of the valve body 12 may be restricted by an interaction between the stop 29 and an inner wall and/or portion of the valve body 12.
[0057] As shown, the shaft 14 may extend at least partially though the valve body 12, e.g., through respective openings 26 and 27 at opposed ends of the valve body 12. The stop 29 may be an enlarged region of the shaft 14, and/or a bead or other member disposed on the shaft 14. The stop 29 may be dimensioned to prevent and/or restrict passage of the stop 29 through one or both of the openings 26, 27 in the valve body 12. The valve body 12 may, therefore, translate along the shaft 14 with the range of movement being controlled and/or restricted by the interaction of the stop 29 and the openings 26, 27 and/or with an interior wall of the valve body 12.
[0058] According to one embodiment of a mitral valve implant 10a including a single stop 29 for controlling the range of movement of the valve body 12, the stop 29 may be installed inside of the valve body by elastically deforming one of the openings 26, 27 over the stop 29. One of the openings 26, 27 may be elastically deformed by pushing the stop against the opening 26, 27 causing the valve body 12 to deform and the opening 26, 27 to expand to permit entrance of the stop 29 into the valve body 12. The valve body 12 may subsequently at least partially elastically recover to resist subsequent removal of the stop 29 from the valve body 12. Deformation and/or elastic recovery of the valve body 12 may be aided by heating the valve body and/or the stop. In a related embodiment, the stop may also and/or alternatively elastically deform to permit assembly of the mitral valve implant. Various additional and/or alternative methods may also be employed for forming a mitral valve implant including a single stop for restricting and/or controlling the range of movement of the valve body.
[0059] A mitral valve implant according to the present disclosure may be implanted using a variety of surgical an/or non-surgical procedures and/or minimally invasive surgical procedures. A surgical implantation procedure may include, for example, an open heart procedure in which the implant may be directly placed into the heart and manually positioned relative to the mitral valve.
[0060] A mitral valve implant consistent with the present disclosure may also advantageously be implanted using less invasive procedures. For example, the mitral valve implant may be implanted using a percutaneous procedure. A suitable percutaneous implantation procedure may include a catheterization procedure. Generally, in a percutaneous catheterization procedure the mitral valve implant may be delivered to the heart using a catheter inserted into a vein or artery, depending upon the desired delivery sight, and into the left atrium or the left ventricle. In one such embodiment, the mitral valve implant may be delivered via a transceptal approach, in which the catheter is inserted, e.g., via a vein, into the right atrium. The catheter may then pass through a puncture between the right atrium to the left atrium and further through the mitral valve to the left ventricle, if desired. Generally, according to a catheterization procedure, the vein or artery may be accessed through a percutaneous incision or puncture. A catheter carrying the mitral valve implant may be introduced into the vein or artery through the incision or puncture. The catheter and mitral valve implant may be passed through the vein or artery into the heart. Once in the heart, the mitral valve implant may be deployed from the catheter and positioned within and/or between the left ventricle and the left atrium.
[0061] Turning next to FIG. 10 , an embodiment of a percutaneous delivery system 300 for a mitral valve implant 301 is shown. As previously described, the mitral valve implant 301 may generally include a valve body 302 and an anchor 306. According to some embodiments, the mitral valve 301 may further include a shaft 304 which is coupled between the valve body 302 and the anchor 306. As depicted, the mitral valve implant 301 may be loaded into a catheter 308. According to a further embodiment, the mitral valve implant may be carried by a conveyance feature, such as an enlarged region of a catheter and/or a chamber or pod couple to the catheter.
[0062] As generally outlined above, with the mitral valve implant 301 loaded in the catheter 308 and/or within a conveyance feature associated with the catheter, at least a portion of the catheter 308 may be inserted into a vein or artery and passed through the vessels, i.e., veins and/or arteries, to the heart. Conveyance of the catheter 308 and/or of the mitral valve implant 301 to the heart may be directed and/or assisted by monitoring the travel of the catheter 308, e.g., via radiographic and/or other imaging techniques, etc. For example, at least a portion of the catheter 308 and/or at least a portion of the mitral valve implant 301 may include a radio-opaque material, allowing the position of the catheter 308 and/or of the mitral valve implant 301 to be radiographically monitored or determined.
[0063] Once the mitral valve implant 301 has been delivered to the heart, the mitral valve implant 301 may be implanted by positioning and securing the implant 301 within the heart and deploying the implant 301 from the catheter 308. The implant 301 may be secured within the heart by engaging the anchor 306 with native coronary tissue. Utilizing a helical anchor 306, as shown, the mitral valve implant 301 may be secured by pressing the anchor 306 into coronary tissue and rotationally advancing the anchor 306 into coronary tissue. Rotationally advancing the anchor 306 may be achieved by rotating the entire catheter 308, and or at least a portion of the catheter 308, and thereby also rotating the anchor 306 relative to the coronary tissue. Alternatively, the anchor and/or the entire mitral valve implant may be rotated independently of the catheter, e.g., by a drive lead, such as a flexible drive shaft, extending through at least a portion of the catheter and coupled to the mitral valve implant and/or coupled to the anchor. According to various other embodiments, the anchor of the mitral valve implant may include suturing features, barbs and/or prongs, etc. Suitable corresponding operations may be employed for engaging such anchor features with native coronary tissue.
[0064] The mitral valve implant 301 may be deployed from the catheter 308, or other conveyance feature by pushing the mitral valve implant 301 from the catheter. For example, a pushrod 310, etc., may extend through at least a portion of the catheter 308. The pushrod 310 may be axially advanced through the catheter 308 to force the mitral valve implant 301 from the lumen of the catheter 308. In a related embodiment, the mitral valve implant may be deployed from the catheter via hydraulic force. For example, a fluid may be forced through the catheter. The fluid may bear on, and may hydraulically eject the mitral valve implant from the catheter. In still a further embodiment, the mitral valve implant may be pulled from the catheter. The anchor may be engaged with coronary tissue, and the catheter may be withdrawn from the anchor site, leaving the mitral valve implant engaged with the coronary tissue. Combinations of the foregoing deployment techniques, as well as other known deployment techniques, may also suitable be employed.
[0065] The mitral valve implant 301 may be positioned relative to the coronary anatomy before, during or after deployment of the mitral valve implant 301 from the catheter 308. For example, the anchor portion 306 of the mitral valve implant 301 may be engaged with coronary tissue. The valve body 302 and shaft 304 may then be positioned relative to coronary anatomy by manipulation of the catheter 308, etc. Once the mitral valve implant 301 has been arranged relative to coronary anatomy, the mitral valve implant 301 may be fully deployed from the catheter 308. Alternatively, the mitral valve implant 301 may be fully deployed from the catheter 308. Following deployment, the mitral valve implant 301 may be manipulated to achieve a position and/or arrangement relative to coronary anatomy. Consistent with such an embodiment, the anchor 306 of the mitral valve implant 301 may be engaged with coronary tissue before, during, or after complete deployment of the mitral valve implant 301. Various other techniques and methods may also suitably be employed.
[0066] At least a portion of the mitral valve implant 301 may be collapsible and/or reducible in volume to facilitate percutaneous and/or transluminal delivery. In such a manner, the valve body 302 of the mitral valve implant 301 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 valve body 302 may be expanded, inflated, and/or otherwise increased in volume or size. Accordingly, the mitral valve implant 301 may be delivered to an implantation site via a smaller diameter catheter, and/or via smaller vessels, than would otherwise be required.
[0067] With reference to FIG. 11 , according to one embodiment, the mitral valve implant may include an inflatable valve body 402. An inflatable valve body 402 may include an at least partially deformable body 404 defining at least one cavity 406. The body 404 may further define an opening 408 capable of receiving at least a portion of a shaft 410 therein. Additionally or alternatively, the body may include one or more features for coupling the body to a shaft.
[0068] The at least partially deformable valve body 404 may be collapsed to a reduced size, which may, for example, allow the valve body 404 to be loaded into a catheter delivery system. Such a catheter delivery system may be suitable for transluminal delivery of a mitral valve implant, including the inflatable valve body 402, to the heart. In addition to being collapsed, the valve body 402 may be deformed to facilitate loading into a catheter delivery system. For example, the valve body 402 may be collapsed and may be rolled and/or folded to a generally cylindrical shape, allowing the valve body 402 to be loaded in a catheter having a circular lumen.
[0069] A collapsed and/or rolled or folded valve body 402 may be inflated, restoring the valve body 402 to expanded configuration. For example, a collapsed and/or rolled or folded valve body 402 may be inflated and restored to an expanded configuration once the mitral valve implant has been delivered to the heart and deployed from a catheter delivery system. Inflating the valve body 402 may be carried out by introducing a fluid, such as saline, into the at least one cavity 406. In addition to a liquid, such as saline, the valve body 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 valve body. An example of such a material may be a thermoset polymer resin, a gel material, such as silicone gel, etc.
[0070] According to one embodiment, after delivery to the heart and deployment from the catheter delivery system, the at least one cavity may be filled with a fluid by injecting the fluid into the cavity via a filling tube extending through and/or with the catheter delivery system. Other filling methods and systems may also suitably be employed herein. In an inflated state, the valve body may be shaped and/or configured for use in connection with a translating and/or a stationary mitral valve implant, as described previously.
[0071] According to another embodiment, shown in FIG. 12 , the valve body 502 may be expandable. An embodiment of an expandable valve body 502 suitable for use in connection with a mitral valve implant herein may include a recoverably deformable shell 504 defining the shape of the valve body 502. Similar to previous embodiments, the valve body 502 may include an opening 506 for receiving a shaft 508 of a mitral valve implant at least partially therein. According to one embodiment, the opening 506 may provide a passage extending through the valve body 502. Additionally and/or alternatively, the valve body may include features for coupling the valve body to the shaft.
[0072] The recoverably deformable shell 504 may be deformable, for example, to permit the valve body 502 to be collapsed, folded, rolled, etc., for loading into a catheter delivery system, and/or to facilitate delivery of a mitral valve implant including the valve body 502 to an implantation site, e.g., within the heart. The recoverably deformable shell 504 may further be recoverable, allowing the valve body 502 to return to the expanded configuration from a deformed configuration.
[0073] Consistent with one aspect, the deformable shell 504 may include a resiliently deformable material, such as an elastomer, which may be elastically deformed under stress. The deformable shell 504 may elastically recover when the stress is removed. In such an embodiment, the deformable shell 504 may, for example, be deformed from an expanded configuration to a collapsed condition and loaded into a catheter delivery system. After delivery to an implant site, the deformable shell 504 may be deployed from the catheter delivery system, thereby removing the deforming stress from the valve body 502. Once the deforming stress is removed, the deformable shell 504 may resiliently recover back to the expanded configuration.
[0074] In a related embodiment, the deformable shell may include a shape memory material, such as Nitinol, etc. The deformable shell may be collapsed and/or deformed to facilitate delivery of the implant to the desired site, e.g., via a transluminal and/or a surgical procedure. The deformable shell may subsequently be recovered to an expanded configuration. In an embodiment using a thermally activated shape memory material, recovery of the shape memory deformable shell may be accomplished by heating the deformable shell to, or above, an activation temperature. Heat for activating the shape memory material may be provided by the body temperature of the subject receiving the mitral valve implant, and/or from an external source, e.g., via the catheter, etc.
[0075] An embodiment of mitral valve implant may include an expandable/recoverable valve body including a cellular material. The cellular material may be, for example, a deformable and/or compressible expanded material, such as a polymeric foam material. The valve body may be deformed, compressed, and/or collapsed to a reduced volume configuration, at least in part, by compressing or deforming the cellular material. The mitral valve implant may be transported to an implant site as disclosed. When the implant is deployed from the delivery system the valve body may recover to a generally original volume and/or configuration. Recovery of the valve body may include recovery and/or expansion of the cellular material.
[0076] In another related embodiment, depicted in FIG. 13 , an expandable valve body 602 may include deformable and/or flexible outer shell 604. The outer shell 604 may be supported in an expanded configuration by one or more recoverably deformable supports. In the embodiment of FIG. 13 , the recoverably deformable support may be provided as a resiliently deformable rib 606. The deformable shell 604 may be a resiliently deformable material and/or may be a flexible material. The resiliently deformable rib 606 and/or the deformable shell 604 may be deformed, e.g., to collapse the valve body 602 from an expanded configuration, under a deforming stress. As discussed with reference to other embodiments, collapsing the valve body 602 may facilitate transport to an mitral valve implant, for example, using a catheter delivery system. When the deforming stress is released, e.g., by deploying the valve body 602 from a delivery system, the recoverably deformable rib 606 and/or the deformable outer shell 604 may resiliently recover to restore the valve body 602 to an expanded condition. While only a single rib is depicted in the illustrated embodiment, the valve body may alternatively include a plurality of recoverably deformable ribs.
[0077] In various embodiments, the recoverably deformable supports may be configured as ribs, generally having a transverse orientation relative to the axis of the valve body, such as depicted in FIG. 13 . In additional and/or alternative embodiments, a valve body 702 may include a deformable and/or flexible outer shell (not shown) covering and/or supported by recoverably deformable supports in the form of resiliently deformable stringers 704. As depicted in FIG. 14 , the recoverably deformable stringers 704 may be generally oriented along the longitudinal axis of the valve body 702. In a further embodiment, the recoverably deformable supports may be configured as a lattice, scaffolding, etc. supporting a deformable and/or flexible outer shell of the valve body. Further embodiments may include combinations ribs and stringers. Various other configurations of recoverably deformable supports may also suitably be employed.
[0078] In addition to resiliently recoverable shell, supports, etc., a mitral valve implant may include a valve body having an outer shell and/or having supports which may be controllably recoverable. For example, an outer shell and/or one or more supports of a mitral valve implant valve body may be formed from a shape memory material. Such materials may include shape memory metal alloys, shape memory polymers, etc. Consistent with such embodiments, the valve body may be collapsed and/or otherwise deformed from an expanded configuration. The collapsed and/or deformed valve body may maintain the collapsed and/or deformed configuration after the initial deforming stress is released. The valve body may subsequently be returned to the expanded and/or operable configuration, for example, by heating the valve body above an activation temperature of the shape memory material, which may induce recovery of the shape memory material to a pre-deformed shape. The activation temperature inducing recovery of the deformed valve body may be provided by the body temperature of the patient receiving the mitral valve implant. Alternatively, heat for activating recovery of the shape memory material may be provided by a heating element coupled to the valve body and/or a heating element delivered through a catheter. In other embodiments, activating heat may be provided by irradiating the shape memory material, e.g., with microwaves, IR light, etc.
[0079] Another embodiment of a valve body 800, suitable for use in a mitral valve implant, is shown in FIG. 15 . The valve body 800 may include first and second enlarged portions 802, 804 joined by a narrow region 806. In one such embodiment, the valve body may have a generally hourglass shape, as shown. The valve body 800 may be positioned relative to a mitral valve such that the first enlarged portion 802 may be disposed at least partially within the left atrium and the second enlarged portion may be disposed at least partially within the left ventricle. The valve body may be maintained in position relative to the coronary anatomy by an anchor and/or a shaft consistent with any preceding embodiment. Additionally, the valve body 800 may be a collapsible and/or expandable member consistent with any previously discussed embodiment.
[0080] 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.
[0081] While the depicted embodiments including expandable and/or recoverably deformable valve bodies have generally been shown configured as a valve body consistent with a stationary valve implant, an expandable and/or recoverably deformable valve body may be configured for use as part of a valve implant including a translating valve body. Similarly, while the valve implant embodiments including an expandable valve body 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 invention 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 linearly along a longitudinal axis of said heart valve implant, said shaft having a first and a second end disposed generally opposite each other;
an anchor coupled to said first end of said shaft, said anchor configured to engage native coronary tissue; and
an inflatable valve body fixably coupled to said second end of said shaft in a stationary position with respect to said second end of said shaft, said valve body configured to be disposed between at least two cusps of a heart valve and to engage against at least a portion of at least one cusp of said heart valve to at least partially restrict a flow of blood through said heart valve in a closed position;
wherein said heart valve implant is coupled only to native coronary tissue of a heart chamber; and
wherein said valve body comprises a tapered portion and an enlarged portion.
2. A heart valve implant according to claim 1, wherein said enlarged portion is capable of at least partially sealingly engaging said heart valve in said closed position.
3. A heart valve implant comprising:
a substantially linear shaft having a first and a second end;
an anchor coupled to said first end of said shaft, said anchor configured to engage only native coronary tissue; and
an inflatable valve body coupled to said second end of said shaft defining a cavity configured to receive an inflation medium, said valve body configured to be disposed between at least two cusps of a heart valve and to engage against at least a portion of at least one cusp of said heart valve to at least partially restrict a flow of blood through said heart valve in a closed position; wherein said valve body further comprises a plurality of support ribs.
4. A heart valve implant according to claim 3, wherein said plurality of support ribs includes a shape memory material capable of recoverable deformation.
5. A heart valve implant according to claim 3, wherein said valve body comprises a tapered portion and an enlarged portion.
6. A heart valve implant according to claim 5, wherein said enlarged position is capable of at least partially sealingly engaging said heart valve in said closed position.
7. A heart valve implant comprising:
a substantially linear shaft having a first and a second end;
an anchor coupled to said first end of said shaft, said anchor configured to be coupled to only native coronary tissue; and
an inflatable valve body defining a cavity configured to receive an inflation medium, said valve body configured to be securely coupled to said second end of said shaft such that said inflatable valve body is disposed between at least two cusps of a heart valve to engage against at least a portion of at least one cusp of said heart valve to at least partially restrict a flow of blood through said heart valve in a closed position when said heart valve implant is coupled to said native coronary tissue.
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