A system for treating tissue includes a first fastener including a first anchoring element at a distal end thereof for anchoring the first fastener in a first target portion of tissue extending about a periphery of a tissue defect to be treated and a first suture extending from a proximal end thereof. The system also includes a second fastener including a second anchoring element at a distal end thereof for anchoring the second fastener in a second target portion of tissue extending about a periphery of a tissue defect to be treated and a second suture extending from a proximal end thereof. Furthermore, the system includes a cinch element disposed about both of the first and second sutures and slidable therealong such that a tension applied to the first and second sutures draws the first and second fasteners toward one another to close the tissue defect.

A handle assembly for actuating an end effector includes a feedback mechanism for providing an audible and/or tactical response to indicate to the user that the handle assembly is fully actuated. The feedback mechanism may include a hammer member configured to strike a surface of the handle assembly to create the audible and/or tactical response.

An apparatus for implantation at an annulus (75) of an intracardiac valve includes an annuloplasty ring (110) comprising a plurality of rotatably adjoining segments (112). The ring is configured to pass over multiple threads (58), respective distal ends of which are distributed over the annulus, and, while passing over the threads, expand from a collapsed state to an expanded state by virtue of the segments rotating with respect to each other. The apparatus further comprises a lock (114), configured to lock the ring in the expanded state at the valve by inhibiting rotation of the segments with respect to each another. Other embodiments are also described.

The invention generally relates to devices and methods for suturing tissue. The invention provides methods and devices for suturing by pushing two ends of a suture through tissue from a proximal side of the tissue and fastening the two ends together on a distal side of the tissue through one operation of a trigger.

A knotter, including: a driving structure; a punching and shearing clip, a clip mouth of the punching and shearing clip having a first position in an open state, and a second position in a punching state when driven by the driving structure; and scissor having a first position in an open state when driven by the driving structure, and a second position in a shearing state when driven by the driving structure. The second position of the scissor is synchronized with the second position of the punching and shearing clip. The disclosure effectively solves the problem that the shearing knife of the knotter in the related art is unstable when cutting the suture line.

An apparatus for application of surgical clips to body tissue is provided and includes a handle assembly; a shaft assembly including a housing extending distally from the handle assembly and defining a longitudinal axis; a plurality of surgical clips disposed within the shaft assembly; a jaw mounted adjacent a distal end portion of the shaft assembly, the jaw being movable between an open spaced-apart condition and a closed approximated condition; and a pusher bar reciprocally disposed within the housing of the shaft assembly and being detachably connectable to the housing of the shaft assembly, the pusher bar being configured to load a distal-most surgical clip into the jaws during distal movement and remain connected to the housing of the shaft assembly and in a distally advanced position during an approximation of the jaws.

Apparatus is provided that includes first and second tissue-engaging elements, and first and second flexible longitudinal members, coupled at respective first end portions thereof to the first and the second tissue-engaging elements, respectively. The apparatus further includes a first flexible-longitudinal-member-coupling element coupled to a second end portion of the first flexible longitudinal member, a second flexible-longitudinal-member-coupling element coupled to a second end portion of the second flexible longitudinal member, and a flexible longitudinal guide member reversibly coupled to the first flexible-longitudinal-member-coupling element. The first and second flexible-longitudinal-member-coupling elements are configured to be couplable together to couple together the first and the second flexible longitudinal elements. Other applications are also described.

A suture clip is comprised of a length of suture material with a male clip on one side and a female clip on the other side. The male clip may contain ratchets that, when engaged with the female clip, hold it in place and allow the male clip to adjustably lit within the female clip or even through it to “tighten” the suture when the male and female clips are engaged. The suture clips are configured to be used in a suture clip applicator that contains paired and opposing needles configured to hold the male clip on one side and the female clip on the other side and to cause the engagement of male and female clips and form a continuous loop through the suture material to enable the closure of fascia or other body tissues.

An apparatus for deployment of multiple hemostatic clips, comprises a shaft connected to a handle and a control linkage operatively connected to the handle in combination with a magazine disposed at a distal end of the shaft, the magazine containing a plurality of clips arranged in a chain rotatable within the magazine, wherein a proximal-most one of the clips is coupled to the control linkage, a distal portion of the magazine being contoured to permit opening of a distal-most one of the clips during a distal stroke of the control linkage, and to assist closing and locking of the distal-most clip during a proximal stroke of the control linkage, the magazine including an expanded chamber sized to allow opening in any rotational orientation of a next clip located immediately proximal to the distal-most clip to a degree sufficient to disengage the distal-most clip. A method for deploying multiple hemostatic clips, comprises positioning a distal end of a magazine containing a clip chain over selected target tissue and actuating a control link of the magazine in a distal stroke to open and distally translate a distal-most clip of the clip chain in combination with orienting the open distal-most clip in a desired orientation to grasp the target tissue and actuating the control link in a proximal stroke to close and lock the distal-most clip over the target tissue. The control link is further actuated in the proximal stroke to move a next clip immediately proximal to the distal-most clip into an expanded portion of the magazine sized to allow the next clip to open to a degree sufficient to release the distal-most clip regardless of a circumferential orientation of the next clip.

In one embodiment, a method of repairing a heart valve accesses an interior of a patient's beating heart minimally invasively and inserts one or more sutures into each of a plurality of heart valve leaflets with a suturing instrument. The suture ends of the sutures are divided into suture pairs, with each pair including one suture end from a suture inserted into a first valve leaflet and one suture end from a suture inserted into a second valve leaflet. One or more tourniquet tubes is advanced over the suture pairs to the leaflets to draw the sutures together to coapt the leaflets and then the sutures are secured in that position.