Apparatuses and techniques to access the right ventricle via transfemoral vein threading a catheter or catheters to the apex or bottom of the right ventricle. Piercing through the venous or right side of the heart in the interventricular septal wall to access the left ventricle a catheter can be passed to turn upward pointing to the mitral valve. From this access point in the left ventricle the flail mitral leaflet can be sutured and tethered pulling it back into position and reattached with a grounding anchor in the right ventricle or imbedding the anchor into the septal wall. The interventricular septal wall crossing technique could include the passing of a coaxial catheter through the first access catheter where the first access catheter could act as a guide to direct the internal or second coaxial catheter toward the flail mitral leaflet.

Disclosed herein are minimally invasive systems and methods for performing an edge to edge repair of a heart valve on a beating heart of a patient. One or more sutures are inserted into a plurality of leaflets of the heart valve while the heart is beating through a minimally invasive access. The sutures can be threaded through a suture crimp that is advanced to the leaflets. A movable gate on the suture crimp can be actuated to secure the sutures at an appropriate tension to maintain the leaflets in a coapted position.

A stent system is provided that includes a first radially-expandable stent, which includes mechanical structural elements arranged so as to form a first tubular structure having a lumen; and a second radially-expandable stent, which includes mechanical structural elements, which are arranged so as to form a second tubular structure, and which are shaped so as to provide tissue-engaging structures that protrude radially outward from the second tubular structure. The second stent is shaped so as to be concentrically disposed within the lumen of the first stent such that the tissue-engaging structures extend between the mechanical structural elements of the first stent in order to engage and be anchored to tissue of a blood vessel, thereby facilitating anchoring of the first stent in the blood vessel. A tissue anchor is coupled to the first stent by a flexible band. Other embodiments are also described.

Disclosed herein are minimally invasive systems and methods for performing an edge to edge repair of a heart valve on a beating heart of a patient. One or more sutures are inserted into a plurality of leaflets of the heart valve while the heart is beating through a minimally invasive access. The sutures can be threaded through a suture crimp that is advanced to the leaflets. A movable gate on the suture crimp can be actuated to secure the sutures at an appropriate tension to maintain the leaflets in a coapted position.