A patient's stomach may be secured to the patient's diaphragm. A method to accomplish this includes visualizing a wall of a patient's stomach adjacent the patient's diaphragm from within the patient's stomach, inserting a fastener deployment apparatus down the patient's esophagus and into the mammalian's stomach, and fastening the patient's stomach to the patient's diaphragm with the fastener deployment apparatus and from within the stomach. The procedure may be employed to advantage to treat a hiatal hernia, for example, either alone or in conjunction with the restoration of the patient's gastroesophageal flap valve.

A method can include engaging the pericardium of a patient at two engagement positions of the pericardium. The method can further include moving the two engagement positions of the pericardium away from each other to tension a portion of the pericardium. The method can further include advancing an access device through the tensioned portion of the pericardium to introduce the access device into the pericardial space of the patient. Other and further methods are also disclosed.

A sleeve can be adapted to reinforce a bone anchor, and can include a body, a lock, and an actuator. The body can include a first sleeve arm and a second sleeve arm, where each can extend longitudinally along opposing sides of a longitudinal bore open at a distal end of the sleeve. The lock can be coupled to the body and releasably securable to a channel of a head of the bone anchor to secure the sleeve to the anchor.

An interventional device for cutting tissue at a targeted cardiac valve, such as a mitral valve. The interventional device includes a catheter having a proximal end and a distal end. A cutting mechanism is positionable at the distal end, such as by routing the cutting mechanism through the catheter to position it at the distal end. The cutting mechanism includes one or more cutting elements configured for cutting valve tissue when engaged against the tissue. A handle is coupled to the proximal end of the catheter and includes one or more controls for actuating the cutting mechanism.

A medical instrument having integrated arms extending from a proximal end to a distal end, and a handpiece with actuators to control movement of the arms. The instrument includes an insertion tube having arm channel(s) for receiving an arm therethrough. Each arm includes an engagement member at the distal end of resilient material with a natural non-linear configuration when deployed but deforming when retracted into the arm channel when retracted. Arm channels may be located at different radial distances from one another in the insertion tube so the engagement members may be at radial angles relative to one another when deployed. Arms and engagement members are movable between at least a first position and second position relative to one another by rotation and/or translational motion of the corresponding actuator, to contact tissue or deflect a tool extended through the working channel of the endoscope.

The present disclosure provides a heart valve repair method, comprising: advancing a distal end of a suture implanting apparatus from an outside of a body through a transapical approach into a left ventricle or a right ventricle of a heart; holding each leaflet of a heart valve with the distal end of the suture implanting apparatus; implanting at least one suture into the leaflet; withdrawing the suture implanting apparatus from the body; advancing a distal end of a suture locking apparatus from the outside of a body through a transapical approach into the corresponding left ventricle or the corresponding right ventricle; using the suture locking apparatus to lock the plurality of sutures; and withdrawing the suture locking apparatus from the body. The heart valve repair method has a simple surgical procedure, a low degree of patient trauma, and a high success rate of surgery.

Mechanical thrombectomy apparatuses including an inverting, rolling conveyor region (“tractor”) at the distal end that are configured to grab and remove thrombus material. In particular, described herein are mechanical thrombectomy apparatuses that are adapted to prevent premature deployment of the tractor, e.g., by including a tractor hold (e.g., a housing, a lock, a clamp, etc.) or the like to secure the outer end of the tractor against and/or relative to the elongate inversion support.

Methods and tools for implanting prosthetic heart valves and modifying leaflets of an existing valvular structure in a subject are disclosed herein. Prior to or during implantation of the prosthetic heart valve within the existing valvular structure, each tool can be provided in the ascending aorta (or equivalent thereof) of a subject and can be used to pierce, lacerate, slice, tear, cut or otherwise modify a leaflet or commissure of the existing valvular structure. The existing valvular structure can be a native aortic valve or other native heart valve, or a previously-implanted prosthetic heart valve. The modification can avoid, or at least reduce the likelihood of, issues that leaflets of the existing valvular structure might otherwise cause once the prosthetic heart valve has been fully installed, for example, obstruction of blood flow to the coronary arteries and/or improper valve mounting due to a non-circular cross-section.

The present disclosure relates generally to devices and methods for treating a tissue defect, for example, by suturing. In some embodiments, a suturing device may include an elongate member having a working channel, a suture channel, and a suture arm extending from the elongate member. The suturing device may further include a needle passer located within the working channel, the needle passer operable to deliver a needle between the elongate member and a distal end of the suture arm for suturing a target tissue, and a suture extending through the suture channel, wherein the suture is coupled to the needle. The suturing device may further include a plurality of imaging devices, wherein a first imaging device is positioned along a distal face of the elongate member, and wherein a second imaging device is positioned along the suture arm.

A salvage device for localizing a tissue marker clip includes an elongate handle having a metal ball connected to its distal end, and a probe connected to a distal end of the radiopaque fiducial element. A lumen extends through at least a portion of the elongate handle, the metal ball and the probe, terminating at a distal tip of the probe. A deployable tissue engagement member is housed at least partially within the lumen and connected to a proximal switch.