A system for forming a suture connector in situ includes a suture connector placement device having a handle, an outer shaft, an intermediate shaft, and a push rod, and a suture connector having a sleeve and a plug. The intermediate shaft is slidingly disposed through a lumen of the outer shaft, and the push rod is slidingly disposed through a lumen of the intermediate shaft. When the suture connector is in a loaded configuration within the suture connector placement device, the sleeve is radially disposed over the intermediate shaft and the plug is positioned proximal to the sleeve within the lumen of the intermediate shaft. Distal advancement of the push rod moves the plug into the sleeve and proximal retraction of the intermediate shaft releases the resilient sleeve onto the plug, thereby securing two suture portions between the sleeve and the plug. The system is then utilized to trim the suture portions.

A plication lock delivery system that enables a suture lock assembly to be delivered percutaneously. The plication lock delivery system comprises a lock assembly that secures sutures in place, a control assembly that allows a clinician to engage a suture to a suture lock assembly, apply tension to the sutures to cause tissue plication, and deploy the lock assembly, and a catheter assembly. This plication lock delivery system can be used to repair mitral regurgitation percutaneously or in an open-heart surgery.

Described herein are systems and methods for securing sutures that obviate the need for tying knots. Disclosed suture clips can comprise a first part and a second part that are attachable together to secure one or more sutures in a suture engagement region between the first and second parts. The first and second parts can include locking projections and slots at opposing ends of the suture engagement region to align the two parts, contain sutures, and/or secure the clip onto sutures. When the first and second parts are attached together, first engagement features of the first part inter-engage with second engagement features of the second part to grip and secure sutures within suture engagement region. An exemplary delivery device holds a plurality of such suture clips in an elongated shaft portion and deploys the clips successively to sutures via actuation of a handle portion.

A device for suture management and tensioning is disclosed. The device for suture tensioning may include a housing having multiple suture channels, a cleat array, several indicator biasing elements, and an actuator movable between an unlocked position, a tensioned position, and a locked position. The cleat array in the device for suture tensioning may also include at least one first cleat movable relative to the housing and colinear with a second cleat fixedly attached to the housing. The device for suture tensioning may also include an indicator biasing element which is colinear with each cleat pair.

A delivery system for delivering a plurality of helical tissue anchors to repair a wall defect. Coaxially contained within the outer sheath are inner tubular members. The first inner tubular member designed to deploy a first helical tissue anchor, a second inner tubular member designed to deploy a second helical tissue anchor, and a centered inner tubular member contains a cinching mechanism. The two helical tissue anchors are connected to a suture or strap that pull the two helical tissue anchors together to close a tissue defect. A cinching mechanism holds the anchors and tissue defect together and cut the suture or strap.

A surgical fastener instrument (30) includes an outer delivery tube (36); an inner delivery shaft (42), disposed at least partially in the outer delivery tube (36); and a handle (44) coupled to a proximal portion (46) of the outer delivery tube (36), and including a user control element (48) arranged to rotate the inner delivery shaft (42) with respect to the outer delivery tube (36). A suture fastener (32) is removably disposed in the outer delivery tube (36) in an unlocked conical helical configuration. Distal advancement of the inner delivery shaft (42), when one or more portions of one or more sutures (22) pass through respective portions of the suture fastener (32), transitions the suture fastener (32) from the unlocked configuration to a locked planar spiral configuration, in which the one or more sutures (22) are fixedly coupled to the suture fastener (32). Other embodiments are also described.

A suture clip applier for applying a suture around a tubular tissue adjacent to an open lumen. The suture clip applier includes an elongated body having a tissue clinching mechanism at one end of the body. The tissue clinching mechanism comprises two arms that are movable between open and clinched positions. The suture clip applier includes a plurality of deformable suture clips mounted along a longitudinal length of the elongated body, wherein each suture clip is configured to be detachably positioned within an interior of the two arms and to be deformed between open and clinched positions in response to the two arms being moved between the open and clinched positions. The suture clip applier further includes a length of suture comprising a pre-formed adjustable fastening and a loop extending from the pre-formed adjustable fastening, the loop extending between the two arms.

Knot placement devices and methods can improve the ease for a user and/or success of ejecting a knot having a knot body and a plug, cutting suture and/or releasing the cut suture. The knot placement device can have an incremental rotational feature to cut the suture. The knot placement device can include first and second actuators configured for forming and ejecting a knot. The second actuator can be reversed in its position to release suture(s) caught within the device.

Systems and methods for closing a tissue defect are disclosed. The systems may include a subcutaneous guide that is placed transcutaneously between two skin access sites and a self-locking strap that may be advanced into the body through a first access site via a first needle and then passed to a second needle. The strap may be withdrawn with the second needle through a second access site to the outside of the body. The strap may be withdrawn from the first needle, leaving the strap placed through both access sites and across the defect. As the subcutaneous guide is withdrawn from the body it pulls the captured strap such that both ends of the strap protrude from the first access site, allowing the strap to be tightened around the defect. Devices for closure of a tissue defect are also disclosed.

A gastrointestinal tissue approximation clip (“GI TAC”) system for approximating tissue defects, the GI TAC system including an applicator that is sized to travel through an instrument channel of an endoscope; a plurality of tissue approximation clips that are transported to a plurality of locations about a tissue defect by the applicator; a suture coupled to at least one of the tissue approximation clips; and a clip approximation means for approximating the tissue approximation clips. The clip approximation means and the tissue approximation clips are sized respectively to travel through the instrument channel, and the tissue approximation clips are adapted to be detachably coupled to the applicator.