Apparatus for coupling a prosthetic chorda to an atrioventricular valve leaflet, the apparatus comprising: a neochorda delivery system comprising a steerable and pushable catheter housing a neochorda attached to a neochorda puncture needle, the catheter operable to push the puncture needle to puncture and thread the neochorda through a papillary muscle of a ventricle; a retriever system comprising a catheter housing a grabber operable to capture the neochorda puncture needle after being threaded through the papillary muscle and withdraw the neochorda puncture needle and neochorda from the ventricle; and a tissue clamping system comprising a catheter housing distal and proximal tissue clamps deployable to clamp a region of an atrioventricular valve between them and hold the region so that it may be punctured by the puncture needle to deliver the neochorda through the leaflet and to the papillary muscle.

Knotless suture-based implant systems and related methods for joining bone and/or tissue portions is disclosed. The implant systems include a flexible anchor tube comprising an annular side wall defining an internal cavity, a first longitudinal end and a second longitudinal end. The implant systems also comprise a suture that extends through the side wall of the anchor tube a plurality of times and forms a free loop portion that extends from the side wall. The implant systems further comprise at least one suture passer extending through a portion of the loop portion of the suture configured to translate first and second end portions of the suture through the loop portion via translation of the at least one suture passer. The suture extends along a pattern that allows the suture to slide through the anchor tube when the first and second end portions of the suture are tensioned.

A sheath is transluminally introduced a sheath into an atrium of a heart of a subject. A guide member is advanced out of the sheath and to a chorda tendinea of the heart, the guide member having a proximal portion that includes a longitudinal element, and a distal portion that includes a helical chord-engaging element. The chord-engaging element is wrapped around the chorda tendinea. While the chord-engaging element remains wrapped around the chorda tendinea, (i) the chord-engaging element is slid over the chorda tendinea toward a papillary muscle that is coupled to the chorda tendinea; and (ii) subsequently, a tool is moved out of the sheath and toward the papillary muscle by sliding the tool along the longitudinal element. Other embodiments are also described.

Devices, systems and/or methods for repairing soft tissue adjacent a soft tissue repair site. In one embodiment, a repair device includes an anchor member, a capture member and one or more flexible members. The anchor member includes a base with at least four legs extending integrally from the base, the at least four legs configured to be moveable from a straight first position to a formed second position. The capture member is configured to be coupled to the anchor member such that the at least four legs of the anchor member move around structural portions of the capture member with the at least four legs of the anchor member in the formed second position. The one or more flexible members are coupled to the base of the anchor member, the one or more flexible members extending at least partially along the base of the anchor member.

Systems and methods for soft tissue to bone repairs, without knot tying. The soft tissue repair systems include self-cinching constructs with a fixation device, a flexible coupler and an optional shuttle/pull device attached to the flexible strand. An accordion-style weave region is formed by pulling on the shuttle/pull device subsequent to the fixation device being secured into the bone, to allow desired tensioning of soft tissue to be fixated or repaired relative to the bone and secured self-locking of the construct.

Surgical constructs and methods for soft tissue to bone repairs, without knot tying. The soft tissue repair constructs include a fixation device, a flexible strand, and a shuttle/pull device attached to the flexible strand and provided within the body of the fixation device. A splice is formed by pulling on the shuttle/pull device to allow desired tensioning of soft tissue to be fixated or repaired relative to the bone.

A deployment device, including a driver shaft; an implant attached to the distal end of the driver shaft; a handle assembly connected to the proximal end of the driver shaft including a handle and a knob positioned distally to the handle; a cleat configured to secure a proximal end of a suture received from the implant through an aperture of the driver shaft resulting in a first applied tension value when the implant is placed in a pilot hole, wherein each of the implant, proximal handle and cleat is connected to the driver shaft such that rotation of the proximal handle in a first direction results in the rotation of the implant in the first direction and the maintenance of at least 50% of the first applied tension value when the implant is rotated in the first direction and advanced in the distal direction within the pilot hole.

A delivery device includes an inner shaft, an outer sheath, a nosecone, and a tether component. The outer sheath is slidably disposed over the inner shaft. The nosecone is removably coupled to the inner shaft. The nosecone includes a delivery configuration for delivery to a treatment site, a radially compressed configuration in which a portion of the nosecone is configured to traverse through a heart wall, and a radially expanded configuration in which an outer surface of the nosecone contacts an outer surface of the heart wall. The tether component includes a first end coupled to the nosecone. The nosecone is configured to plug a piercing in the heart wall when in the radially expanded configuration.

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.