An assembly includes a flexible fixation member, a suture, and a delivery device. The fixation member includes a body with two terminal ends. A suture passes through the flexible fixation member at various points along a length of the body such that portions of the fixation member are slidable relative to the suture and configurable to form a cluster within a surgical site. The delivery device includes a tubular member, an elongated inserter, and a trigger. The elongated inserter is slidably disposed within the tubular member. The inserter has a forked distal end configured to receive a portion of the flexible fixation member and the suture. The trigger is finger-engagable and fixedly coupled to the proximal end of the inserter. It is configured to advance and retract the inserter relative to the tubular member. The trigger includes a retention member for retaining a proximal end portion of the suture.

A method for delivery and deployment of a prosthetic mitral valve into a heart includes inserting an introducer sheath having a prosthetic mitral valve disposed therein in a collapsed configuration into the left atrium of a patient's heart, through a gap between the native mitral valve leaflets, the left ventricle and apex of the heart. An epicardial pad device coupled to the prosthetic valve via a tether is moved distally out of the sheath. The introducer sheath is withdrawn into the left atrium of the heart. An inner delivery sheath is extended distally from within the introducer sheath and disposed within the left atrium. The prosthetic mitral valve is moved distally out of the inner delivery sheath and assumes a biased expanded configuration. The valve is positioned within the mitral annulus of the heart, and secured in place via the tether and epicardial pad device.

Surgical constructs and methods are provided for securing soft tissue to bone. One exemplary embodiment of a construct is formed from a suture filament and includes two terminal ends of filament and an intermediate portion disposed along at least a portion of a length extending between the terminal ends. The construct can have a first terminal end that is the first terminal end of the filament, and a second terminal end that includes a loop. The loop can be formed by disposing the second terminal end of the filament within a volume of a portion of the intermediate portion of the filament. In some disclosed methods, both terminal ends of the filament can be passed through tissue when performing soft tissue repairs. Various other embodiments of constructs and methods are provided, including constructs having two or more filaments associated with an anchor and methods of using such constructs.

A catheter device is described. The device is for implanting a leaflet anchor (10) into the heart as part of a procedure for implanting an artificial chordae line (14). The catheter device comprises: a leaflet anchor (10) for attachment to the leaflet (12) of the heart; and a leaflet anchor deployment mechanism (6), (30), (38) for deploying the leaflet anchor (10). The leaflet anchor deployment mechanism (6), (30), (38) allows for retraction and repositioning of the leaflet anchor (10) after deployment of the anchor (10) into the leaflet (12) via an ejector unit (36) having a grasping device (50) with a first configuration arranged to permit deployment of the leaflet anchor (10) into the leaflet (12) without disengagement of the leaflet anchor (10) from the ejector unit (34), and a second configuration in which the leaflet anchor (10) is reversibly released from the ejector unit (36). In the first configuration the grasping device (50) of the ejector unit (36) grasps a proximal end of the leaflet anchor (10), whilst a distal end of the leaflet anchor (10) is unimpeded by the grasping device (50) to enable it to be implanted in the leaflet (12). In the second configuration the grasping device (50) is disengaged from the leaflet anchor (10).

A catheter device is described. The device is for implanting an artificial chordae line (14) in the heart. The catheter device comprises: a leaflet anchor (10) for placement in a leaflet (12) of a heart valve, wherein the leaflet anchor (10) is arranged to be coupled to the artificial chordae line (14); and a leaflet anchor deployment mechanism (6, 30, 38) for deploying the leaflet anchor (10), wherein the leaflet anchor deployment mechanism (6, 30, 38) comprises a mechanical gripper device (30, 32, 32′), for grasping the leaflet (12), wherein the gripper device (30, 32, 32′) comprises a leaflet anchor tube 38 for housing the leaflet anchor (10) in a folded configuration. The gripper device (6, 30, 38) and the leaflet anchor (10) are arranged such that when, in use, the gripper device (6, 30, 38) grasps the leaflet (12), the leaflet anchor (10) can be pushed out of the leaflet anchor tube (38) to pierce the leaflet (12) and form the leaflet anchor (10) into an unfolded configuration so that hooked formations of the leaflet anchor (10) can, in use, secure the leaflet anchor (10) in the leaflet (12). The mechanical gripper device (6, 30, 38) includes a first gripper arm (30) rotatably coupled to a main body (4) of the catheter device so that the gripper arm (30) can rotate relative to the catheter device to move an outer end (42) of the first gripper arm (30) away from the main body (4) of the catheter device and a second gripper arm (32, 32′) rotatably and/or slideably coupled to the main body (4) of the catheter device so that the second gripper arm (32, 32′) can rotate and/or slide relative to the main body (4) of the catheter device to move an outer end 46 of the second gripper arm (32, 32′) away from the main body (4). The first and second gripper arms (30, 32, 32′) are arranged so that they can move to come into contact with one another at a point spaced apart from the main body (4) of the catheter device.

A simple, threaded suture anchor is pre-loaded with suture in a configuration that allows a surgeon to compress tissue against the bone without tying a knot. The knot-tying step is replaced by a simple suture looping step which requires less time and is not prone to errors in knot tying technique. The suture anchor is a screw-in style anchor body. The suture is loaded into the anchor in a configuration that allows it to create a loop on top of the tissue after it has been passed through the tissue from bottom to top. The suture limbs are then loaded into a knotless anchor which is implanted off the lateral edge of the tissue. Tensioning of the suture limbs in the knotless anchor tightens the loop on top of the tissue, providing a fulcrum point of fixation over the pre-loaded suture anchor without the otherwise need for requisite knot tying.

Disclosed herein are various embodiments of suture adjustment mechanisms for anchors configured to be inserted into a heart wall of a patient to anchor a suture as an artificial chordae under an appropriate tension for proper valve function. Suture adjustment mechanisms can be configured to retain suture ends extending from the leaflet to the anchor with sufficient force to prevent natural movement of the leaflet from adjusting a length of the suture between the anchor and the leaflet. Free ends of the suture can extend from the anchor external to the body as tensioning strands. A surgeon can supply sufficient force on the tensioning strands from external the body to adjust a length and tension of the suture between the anchor and the leaflet.

Methods of tissue repair. At least one example method includes: pulling a tissue in place over a bone location; abutting a distal end of a guide tool against the tissue at a first location, and driving a first bone anchor through a delivery tube of the guide tool, through the tissue, and into the bone at the first location, the first bone anchor coupled to a first suture line; abutting the distal end of the guide tool against the tissue at a second location displaced from the first location, and then driving a second bone anchor through the delivery tube, through the tissue, and into the bone at the second location, the second bone anchor associated with the first suture line; withdrawing the guide tool away from the tissue; and tightening the first suture line to create a first suture over the tissue.

An adjustable fixation system for coupling a tissue or graft to bone is disclosed including a suture construct including a first limb, a second limb and a body therebetween. The body is continuously braided with the first and second limbs and has a longitudinal passage therethrough. The first and second limbs define a braided portion including a braided core. The suture construct is configured to form at least one adjustable loop formed by passing the first limb between braids of the suture construct, along the longitudinal passage and back out between braids of the adjustable suture construct. Tension on at least one of the first or second limbs reduces a diameter of the longitudinal passage around a length of the first limb and thereby the braided core disposed along the body longitudinal passage and knotlessly locks the adjustable loop.

Disclose herein are suture anchor constructs. The suture anchor constructs can include an anchor, a first suture, and a second suture. The anchor can include a post and a body. The body can define a central hole extending from a trailing end of the body along a central axis towards a leading end of the body. The first suture can have a first tail, a second tail, and a first intermediate potion located proximate the post. The second suture can have a third tail, a fourth tail, and a second intermediate portion secured to the post. The first, second, third, and fourth, tails can pass through the central hole.