Methods and devices for transvascular prosthetic chordae tendinea implantation are disclosed. A catheter is advanced into the left atrium. From an atrium side, a leaflet connector carried by a distal end of the catheter can be anchored to a superior surface of a mitral valve leaflet. A needle is axially advanceable through the leaflet connector and through the leaflet. A leaflet anchor having a leaflet suture can be advanced out of the needle to secure the mitral valve leaflet to the leaflet suture. A ventricular anchor is anchored to the wall of the ventricle to secure the ventricular wall to a ventricle suture. The leaflet suture and the ventricle suture may be tensioned and connected by a suture lock to form an artificial chordae.

The present teachings provide methods for resizing, reducing, and/or closing an atrial appendage. A delivery catheter is percutaneously advanced to the atrial appendage. At least two tissue anchors are implanted in tissue of the heart. Both tissue anchors are pulled together so that the atrial appendage is resized, reduced, and/or closed. This closure method and system could be used alone in closing the atrial appendage. This closure method and system could also be used in addition to other treatment mechanisms.

A method for coupling tissue with a flexible member including a tail and a self-locking construct coupled to the tail. The self-locking construct includes an adjustable first loop and an adjustable second loop coupled thereto. The method includes implanting an anchor in bone, the anchor slidably mounted to the tail. The tail is positioned relative to the tissue. An end of the tail is inserted through the first loop. The tail is passed through the first loop, the second loop is pulled into the anchor, and the self-locking construct is positioned relative to the tissue. The self-locking construct is tightened against the tissue by pulling on an end of the self-locking construct. The first loop is tightened onto the second loop.

A tissue repair construct having first and second implants coupled via a flexible element is provided. The flexible element forms an adjustable loop closed with a sliding knot, and has first and second free ends extending from the knot formed by wrapping the second end around the first end. The second implant can have a changeable configuration. The construct can be placed within a surgical site in a patient's body such that the first implant is passed into a bone adjacent to soft tissue and the second implant is disposed on an opposed side of the soft tissue. The first free end of the flexible element is configured to be tensioned to decrease a size of the loop and thereby change the configuration of the second implant and to thereby cause at least the second implant to move towards the first implant.

Systems and methods for building a landing zone for an endovascular procedure are described. This procedure is “hybrid” in that it involves both direct access (e.g., sternotomy or partial sternotomy) to the site for installation of the landing zone, as well as endovascular installation of a TAVR or TEVAR device (e.g., stent graft) once the landing zone is installed. The landing zone is installed by wrapping a landing band around a portion of a vessel. The landing band may be selected to be fixed at a diameter so that it inhibits any expansion of the vessel, and also supports a later-installed TAVR or TEVAR device. The TAVR or TEVAR device is then endovascularly delivered to the vessel and deployed therein. The device expands until it contacts the vessel, which is supported from the outside by the landing band, which thus constrains and supports the device from outside.

Methods and devices for the treatment of cardiac valve dysfunction through the placement of lines and anchors. The lines and anchors can form artificial chordae between valve leaflets and the ventricular wall or papillary muscles or connect the two valve leaflets together. The methods and devices offer a mechanism for performing this technique with the heart still beating, and allows for the placement of multiple lines with a single device.

A method is presented for tricuspid valve commissural annuloplasty for secondary tricuspid insufficiency. The method comprises suturing through a valve annulus, and bringing the valve annulus to its normal size while eliminating its regurgitation. The suturing comprises applying individual sutures on pledgets through the tricuspid valve annulus from a right ventricle side along anteroposterior and posteroseptal commissures on both sides of each of said commissures, spaced-apart from them; taking out needles of said sutures from a right atrium side and tying knots along the commissures between them.

A suture construct having a soft button, defining a multiplicity of first apertures and a set of second apertures. Also, a suture loop assembly has a suture defining a lumen and forming a double loop, formed by a double trap having a first end and a second end, formed in a trap region of the suture, and in which a first portion of the suture is threaded through the trap region lumen from the first end to the second end and the first portion extends out from the second end, and a second portion of the suture is threaded through the trap region lumen from the second end to the first end, and the second portion extends out from the first end. Finally, the double loop passes through the set of second apertures of the soft button.

Described herein are devices for approximating targeted tissue by intertwining two or more sutures together. The sutures are attached to the targeted tissue and routed to a twister device. The twister device secures end portions of the sutures and twists them to intertwine the sutures. Controlling the number of twists provides control over the forces applied to the targeted tissue. In conjunction with visualization feedback, real-time adjustments can be made to achieved targeted results, such as elimination of mitral regurgitation when the disclosed methods and apparatus are applied to mitral valve repair.

A knotless instability anchor having an anchor having a first side and a second side with a suture material passing therethrough from the first side to the second side. The suture material has an adjustable loop extending from the first side of the anchor and a first limb and a second limb extending from the second side of the anchor. A splice is formed in the first limb between a first end of the first limb and the anchor. A self-collapsing loop is formed in the first limb between the first end and the splice. The second limb extends through the splice in the first limb.