A coil fastener applier including a housing, a flexible elongated tubular member, a flexible drive member, a fastener assembly and a trigger is disclosed. The housing defines a longitudinal axis and includes a stationary handle affixed thereto. The flexible elongated tubular portion extends distally from the housing. The flexible drive member is rotatably mounted within the flexible elongated tubular portion. The fastener assembly is mounted adjacent a distal portion of the flexible drive member and is configured to releasably mount at least one coil fastener thereon. The trigger is movably mounted on the housing and movement of the trigger rotates the flexible drive member to drive a coil fastener into tissue. The flexible elongated tubular member and the flexible drive member enable off-axis delivery of a coil fastener.

Embodiments are described for creating and closing tissue access ports or defects, such as transapical access ports, which involve placement of an elongate prosthesis in a helical configuration across the tissue structure site to be crossed, and confirmation that such helical suture configuration is positioned appropriately, before further interventional steps. A plug member may be included to assist with closure of the ports of defects. The elongate prosthesis and plug member may comprise bioresorbable materials.

Apparatus for percutaneous access to a patient's body comprising a first steerable tube (12), shaped to define a first lumen, and a first coupling (152) at a longitudinal site of the first tube; and a second steerable tube (14), shaped to define a second lumen and a second coupling (154), the second coupling being intracorporeally couplable to the first coupling, the apparatus having (A) an unlocked state in which the second tube is rotatable within the first lumen, and (B) a locked state in which the second coupling is coupled to the first coupling, and rotation of the second tube is inhibited. The apparatus is configured such that when the second coupling becomes disposed at the longitudinal site in a given rotational orientation of the second tube, the apparatus moves into the locked state by the second coupling automatically coupling to the first coupling. Other embodiments are also described.

An implant 801 for closing an opening in tissue such as a fistula or a sinus comprises a coil having a substantially uniform outer diameter. The coil forms an internal passage having a diameter that tapers from a distal end to a proximal end. The implant 801 may be delivered using a non-tapered driver coil 820.

Apparatus is provided that includes first and second tissue-engaging elements, and first and second flexible longitudinal members, coupled at respective first end portions thereof to the first and the second tissue-engaging elements, respectively. The apparatus further includes a first flexible-longitudinal-member-coupling element coupled to a second end portion of the first flexible longitudinal member, a second flexible-longitudinal-member-coupling element coupled to a second end portion of the second flexible longitudinal member, and a flexible longitudinal guide member reversibly coupled to the first flexible-longitudinal-member-coupling element. The first and second flexible-longitudinal-member-coupling elements are configured to be couplable together to couple together the first and the second flexible longitudinal elements. Other applications are also described.

A surgical fastener is provided for various surgical fastening applications, including attaching an implantable prosthesis, such as a soft tissue repair fabric, to tissue and/or muscle. The surgical fastener may include a coil body and a head attached to the coil body. The head may include at least one external thread adapted to engage with a corresponding internal thread of a delivery device. The head may include a through hole adapted to receive a rod therethrough for guiding and/or driving the surgical fastener from the delivery device. The through hole may have a non-circular configuration that complements at least a portion of the shape of a non-circular rod. The coil body may also define a channel with a non-circular configuration. The non-circular through hole and/or channel may be engaged and rotated by the non-circular rod to rotate the surgical fastener for delivery and insertion of the fastener into the prosthesis and/or tissue.

In some embodiments, a method includes delivering to a native valve annulus (e.g., a native mitral valve annulus) of a heart a prosthetic heart valve having a body expandable from a collapsed, delivery configuration to an expanded, deployed configuration. The method can further include, after the delivering, causing the prosthetic heart valve to move from the delivery configuration to the deployed configuration. With the prosthetic heart valve in its deployed configuration, an anchor can be delivered and secured to at least one of a fibrous trigone of the heart or an anterior native leaflet of the native valve. With the prosthetic heart valve disposed in the native valve annulus and in its deployed configuration, an anchoring tether can extending from the anchor can be secured to a wall of the heart to urge the anterior native leaflet towards the body of the prosthetic heart valve.

An anchoring device for use within a cardiovascular structure includes an expandable ring having a central axis extending in a longitudinal direction. At least one leg extends from the ring in the longitudinal direction. The leg includes a first end connected to the ring and a free end, with at least one anchor connected to the leg. The anchoring device may be used to anchor a transcatheter heart valve within the cardiovascular structure.

An endoscopic treatment tool includes: a sheath in which a lumen is formed; a treatment part which is inserted into the lumen and is configured to protrude and retract from a distal end of the sheath; a main manipulation part which is connected to the proximal end side of the sheath and allows the treatment part to perform a first motion and a second motion; an auxiliary manipulation part which is disposed to be separate from the main manipulation part and is configured to perform the first motion of the treatment part and configured to put the second motion out of action; and a manipulation transmission member which is made of a flexible member, connects the auxiliary manipulation part to the main manipulation part, and transmits a manipulation input of the auxiliary manipulation part with respect to the main manipulation part.

Implants, implant systems, and methods for treatment of mitral valve regurgitation and other valve diseases generally include a coaptation assist body which remains within the blood flow path as the leaflets of the valve move, the valve bodies often being relatively thin, elongate (along the blood flow path), and/or conformable structures which extend laterally from commissure to commissure, allowing the native leaflets to engage and seal against the large, opposed surfaces on either side of the valve body during the heart cycle phase when the ventricle contracts to empty that chamber of blood, and allows blood to pass around the valve body so that blood flows from the atrium to the ventricle during the filling phase of the heart cycle. Separate deployment of independent anchors near each of the commissures may facilitate positioning and support of an exemplary triangular valve body, with a third anchor being deployed in the ventricle. An outer surface of the valve body may accommodate tissue ingrowth or endothelialization, while a fluid-absorbing matrix can swell after introduction into the heart. The valve body shape may be selected after an anchor has been deployed, and catheter-based deployment systems may have a desirable low profile.