A distal end of a guide catheter is transvascularly advanced into a left ventricle of a heart of a subject. While the distal end of the guide catheter remains disposed in the left ventricle, a first tissue anchor of an implant is deployed from the distal end of the guide catheter. Subsequently, the guide catheter is retracted while progressively exposing the implant. Subsequently, a second tissue anchor of the implant is anchored to a posterior annulus of a mitral valve of the heart by deploying at least part of the second anchor within a left atrium of the heart, such that the implant extends from the first tissue anchor, over an atrial side of a posterior leaflet of the mitral valve, and to the second tissue anchor. Other embodiments are also described.

Systems, devices and methods for securing tissue including the annulus of a mitral valve. The systems, devices and methods may employ catheter based techniques and devices to plicate tissue and perform an annuloplasty.

Methods for sealing a percutaneous puncture in a wall of a body passageway are disclosed herein. The methods include inserting a deployment instrument into the puncture via a toggle along the guidewire, and actuating the deployment instrument to move the first component and the second component relative to each other such that the toggle abuts the wall of the artery proximate the puncture to seal the puncture.

A suture instrument comprising an elongated outer sleeve (3) and a cannula (9) terminating in a distal piercing tip (12) is slideable within a cannula bore (7) extending through the outer sleeve (3). A plurality of sutures (15), are located in a suture bore (14) extending longitudinally through the cannula (9). Each suture (15) comprises a suture thread extending between a pair of anchor bars (20), and a cinch clip (24), which is located on a loop (22) of the suture thread (7) formed between the anchor bars (20), and is slideable along the loop (22) for reducing the effective length of the suture thread (17) between the anchor bars (20). The anchor bars (20) and the cinch clips (24) of the sutures (15) are aligned end-to-end sequentially along the suture bore (14) of the cannula (9) with the cinch clip (24) of each suture (15) located between the anchor bars (20) thereof. A pusher rod (35) slideable in the suture bore (14) is operable by a linear actuator for sequentially urging the anchor bars (20) and the cinch clip (24) of each suture (15) from the suture bore (14) through the distal piercing tip (12) of the cannula (9).

Integratable treatment devices, assemblies including a treatment device, at least one anchor, and a tether coupled thereto, and various methods and devices for inserting such devices and assemblies are disclosed herein. The treatment devices can be made of an integratable material that is not fully bioresorbable but promotes native tissue growth in and around the material. Certain methods involve first inserting at least one anchor and then advancing a treatment device via a tether coupled to the at least one anchor. Further various insertion devices that can be used to implant any of the treatment devices herein using any of the methods herein are disclosed.

A sternal tie assembly having a pair of hook-shaped needles, a length of sternal tie extending from a proximal end of each of the needles, and a pair of posterior plugs, each of the posterior plugs being slidably mounted on the tie and tethered, via suture material, to the proximal end of a respective one of the needles. A method of use of the sternal tie assembly includes creation of a hole or channel in sternum, manubrium, rib, rib cartilage, intercostal muscle, or other tissue, drawing a portion of the tie and the suture material through the channel formed in the tissue by the needle, severing the needle from the tie and suture material, continuing to advance the suture material until a post of each of the posterior plugs is pulled into the respective channel in the tissue, or at least until a head of the plug is disposed against the channel in the tissue, then threading an anterior plug onto each exposed end of the sternal tie, securing the anterior plugs into respective anterior openings in the tissue, then crossing and twisting the sternal tie ends together until the tissue ends are closed together.

Various embodiments of a cartridge are disclosed, for loading a suture onto a suturing instrument and, in some embodiments, for loading a pre-tied knot formed from the suture onto the suturing instrument. The suturing instrument is typically of the type having a suture passing member defining a suture receiving passage therein. The cartridge may be operable to load the suture and/or the knot onto the suturing instrument at a point of use. In some embodiments, the cartridge defines a path for insertion thereto and withdrawal therefrom of the suturing instrument. The cartridge further comprises a seat for releasably holding a portion of a suture and a mechanism for transferring the suture from seat to the suturing instrument, various features of which are described herein.

A prosthetic heart valve may include a valve portion, a tether connected to the valve portion, and an anchor for connecting the tether to the wall of the heart. The anchor may include a flexible first disc biased toward a first shape that is convex in a first direction and a neck extending from the first disc in a second direction opposite the first direction. The neck has a first end connected to the first disc and a second end. The anchor may further include a flexible second disc connected to the second end of the neck and biased toward a second shape that is convex in the first direction. When deployed, the first and second discs sandwich the wall of the heart.

A system and associated method for manipulating tissues and anatomical or other structures in medical applications for the purpose of treating diseases or disorders or other purposes. In one aspect, the system includes a delivery device including a flexible portion that is suited to access target anatomy. The flexibility of an elongate portion of the delivery device can be varied. Additionally, the delivery device can include structure that maintains the positioning of the delivery device in patient anatomy.

An example medical system includes a medical device configured to join the edges of the leaflets together, an elongate body configured to be navigated through vasculature to a heart valve of patient, and a plurality of tissue engagement devices extending from a distal end of the elongate body, each tissue engagement device comprising at least one clamp configured to capture leaflets of the heart valve.