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.

Apparatus for attaching a first object to a second object, the apparatus comprising a distal anchor comprising a generally cylindrical body and a vertical bore extending through the generally cylindrical body; a proximal anchor comprising a generally cylindrical body, a first vertical bore extending through the generally cylindrical body, a second vertical bore spaced distally from the first vertical bore parallel to the first vertical bore, a third vertical bore spaced distally from the second vertical bore parallel to the first vertical bore, and a fourth vertical bore spaced distally from the third vertical bore parallel to the first vertical bore; and a suture having a proximal end and a distal end, with an enlargement formed at the distal end, wherein the suture extends through the vertical bore, through the fourth vertical bore, through the third vertical bore, through the second vertical bore and through the first vertical bore.

In some embodiments, an apparatus includes a handle, an actuator, a pusher device, and a puncture member. A distal anchor is disposed at a distal end portion of an artificial chorda, or suture, and is in a delivery configuration. The artificial chorda, or suture, is coupled to the actuator and extends through a lumen of the puncture member. The actuator can be actuated to move the puncture member distally a preset distance, and to move the pusher device distally such that at least a portion of the distal anchor is moved distal to the distal end of the puncture member and the distal anchor is moved from its delivery configuration to a deployed configuration.

An adjustable artificial chordae tendineae fixing assembly includes an occlusion device and an adjusting rod which are both a hollow structure allowing the artificial chordae tendineae to pass through. The occlusion device is configured to be clamped on the interventricular septum. The occlusion device is provided with a switch adjusting device which controls the artificial chordae tendineae to move and to be fixed. The adjusting rod is connected to the occlusion device, and is capable of repeatedly adjusting the switch adjusting device on the occlusion device. The artificial chordae tendineae fixing assembly can fix the artificial chordae tendineae on the interventricular septum, and can also overcome the problem of unsuitable length of the artificial chordae tendineae in most of patients after the procedure due to cardiac changes. The artificial chordae tendineae is retained at the skin puncture point for a short time.

A soft anchor surgical fixation device includes two soft anchoring implants. The implants have a first elongate state where the implants may slide easily through a bone hole or tunnel, and a second axially compressed state where the implants are prevented from sliding through the bone hole or tunnel. The device also includes a suture pathway extending at least partially along and through the sidewalls of the implants. Tension on the suture transitions the implants from the first elongate state to the second compressed state.

An apparatus enables concurrent restoration of a gastroesophageal valve and tightening of the lower esophageal sphincter. The apparatus comprises a longitudinal member having a distal end arranged to be received within a stomach, a tissue shaper at the distal end of the longitudinal member that forms a gastroesophageal valve from stomach tissue, and a tissue gatherer that gathers fundus tissue at or aboral to the gastroesophageal junction to reduce an esophageal opening into the stomach and tighten the lower esophageal sphincter. A fastener deployer then deploys at least one fastener pair to maintain both the restored gastroesophageal valve and the tightened lower esophageal sphincter.

System for fixation of leaflets of a heart valve including a delivery catheter having an elongated shaft, a proximal end portion and a distal end portion configured to be positioned proximate native leaflets of a heart valve from a remote vascular access point, the delivery catheter further includes a rotatable actuator rod having a threaded fastener at a distal end thereof, and a fixation device releasably coupled by a threaded connection to the threaded fastener of the actuator rod. The fixation device includes a first arm moveable between a closed position and an open position, a second arm moveable between a closed position and an open position. The fixation device further includes a first gripping element movable relative to the first arm in the open position, the first gripping element biased toward the first arm to capture a first leaflet of the heart valve therebetween, and a second gripping element movable relative to the second arm in the open position, the second gripping element biased toward the second arm to capture a second leaflet of the heart valve therebetween. The first gripping element and the second gripping element each includes a plurality of barbs extending therefrom, the plurality of barbs of each of the first gripping element and the second gripping element being aligned transversely in at least one row. The fixation device further includes a covering disposed on each of the first gripping element and the second gripping element, wherein the plurality of barbs of the first gripping element and the second gripping element, respectively, protrude through the covering.

A heart valve therapeutic device (1) has an elongate anchor (7) wherein the anchor has a stiffness to hold its shape and location to support the valve element. The anchor may have a stylet or a shaped or stiff collar (70) arranged to provide a desired shape to the anchor (7) and it may be lockable. A prosthetic valve element (15) has leaflets (17) and is supported on the anchor by coupler (16, 50) at a desired location. There is an actuator for changing relative axial position of the proximal and distal couplers (16, 50) on the anchor. The anchor stiffness may be sufficient to provide sufficient support to resist axial forces from the ventricle in use without necessarily having a fixing element engaging heart tissue. The prosthetic leaflets (240) may extend proximally and radially outwardly, so that there is excellent co-apting of the native leaflets (NL) against the prosthetic leaflets (240).

Methods and devices for transvascular prosthetic chordae tendinea implantation are disclosed. A catheter is advanced into the left atrium, through the mitral valve, and into the left ventricle. A ventricular anchor is deployed from the catheter and into a wall of the left ventricle, leaving a ventricular suture attached to the ventricular anchor and extending proximally through the catheter. A leaflet anchor is deployed to secure a mitral valve leaflet to a leaflet suture, with the leaflet suture extending proximally through the catheter. The leaflet suture is secured to the ventricular suture to limit a range of travel of the leaflet in the direction of the left atrium. Also disclosed is an assembled in situ mitral valve leaflet restraint, having a neo papillary muscle and a neo chordae tendinea.

An insertion instrument is configured to eject one or more of anchor bodies across an anatomical gap so as to approximate the gap. The insertion instrument can include a single cannula that retains the pair of anchor bodies in a stacked relationship, or a pair of adjacent cannulas that each retains respective anchor bodies. The insertion instrument can be actuated so as to eject the anchor bodies into respective target anatomical locations.