A method is described, for use with a native valve of a heart of a subject, the valve being disposed between an atrium and a ventricle of the heart. A first radiopaque marker and a second radiopaque marker are percutaneously advanced to the heart. The first radiopaque marker is placed against a tissue site in the ventricle. The second radiopaque marker is placed against a leaflet of the valve. A distance is measured between the first radiopaque marker at the tissue site, and the second radiopaque marker at the leaflet. Responsively to the measured distance, a chord-length is determined. An artificial chord, selected based on the chord-length, is implanted in the heart. Other embodiments are also described.

A surgical suture system, tissue restraint/suture capture and tissue anchor for tissue repair and reattachment of torn tissue to a tissue substrate, medical, veterinary or dental prosthesis or medical implant. The system includes a plurality of tissue restraints/suture captures which each include a central locking aperture sized and configured to receive a beaded suture member passed therethrough which minimizes longitudinal tensioning and/or restraining movement, the “GO” force, of a beaded suture member in the forwardly direction through the locking apertures for suture tightening and which maximizes “NO-GO” force to pull the suture in the reverse direction. Uniquely configured tissue anchors and other medically implantable devices securely receive one of the tissue restraints/suture captures for tensioning of a suture member between tissue and the tissue anchor.

Devices, systems, and methods for implanting radially expandable prostheses in the body lumens rely on tacking or anchoring the prostheses with separately introduced fasteners. The prostheses may be self-expanding or balloon expandable, and may include a single lumen or more than one lumen. After initial placement, a fastener applier system is introduced within the expanded prostheses to deploy a plurality of fasteners to at least one prosthesis end. The fasteners are usually helical fasteners which are releasably restrained on the fastener driver, and are delivered by rotation of the fastener driver. The fasteners may be applied singly, typically in circumferentially spaced-apart patterns about the interior of at least one end of the prosthesis. A lumen extension or lumens may be coupled to the prosthesis to extend the reach of the prosthesis within the implantation site. Fasteners may also be applied to the lumen extensions.

A medical apparatus positionable in a cavity of a bodily organ (e.g., a heart) may constrict a bodily orifice (e.g., a mitral valve). The medical apparatus may include tissue anchors that are implanted in the annulus of the orifice. The tissue anchors may be guided into position by an intravascularly or percutaneously deployed anchor guiding frame. Constriction of the orifice may be accomplished by cinching a flexible cable attached to implanted tissue anchors. The medical device may be used to approximate the septal and lateral (clinically referred to as anterior and posterior) annulus of the mitral valve in order to move the posterior leaflet anteriorly and the anterior leaflet posteriorly and thereby improve leaflet coaptation and eliminate mitral regurgitation.

Apparatus and methods are provided for use with a mitral valve of a heart of a subject. The apparatus includes a P1-anchor, a P2-anchor, and a P3-anchor, that are anchored to tissue in a vicinity of, respectively, P1, P2 and P3 segments of a posterior leaflet of the mitral valve, a tether being fixedly coupled to the P2-anchor, and slidably coupled to the P1 and P3 anchors. A cardiac-site anchor anchors the tether to an anchoring location that is at a cardiac site that is anterior and inferior to the posterior leaflet. Other embodiments are also described.

A transluminal sheath is advanced into a femoral vein of a subject, through an inferior vena cava of the subject, into a right atrium of a heart of the subject, and transseptally into a left atrium of the heart. A surrounding-sheath is advanced out of a distal end of the transluminal sheath, into the left atrium, and toward a commissure of a mitral valve of the heart. A commissural helix is implanted at the commissure by advancing the commissural helix out of the surrounding-sheath and through the commissure into a left ventricle of the heart, such that the commissural helix wraps around at least some chordae tendineae at the commissure and facilitates sealing of the commissure. Subsequently to the implantation of the commissural helix, the surrounding-sheath is extracted from the heart. Other embodiments are also described.

Apparatus comprises: (A) a housing (248), percutaneously deliverable to a heart of a subject, slidable along a guidewire (242), and shaped to define at least one opening (249); (B) a guide member (250), percutaneously deliverable to the heart, percutaneously removable from the subject, couplable to the housing, and having: (i) a distal portion, comprising a chord-engaging element (252), configured to be percutaneously slidably coupled to and decouplable from at least one chordae tendineae (244), and (ii) a proximal portion, comprising a longitudinal element (251); and (C) a deployment tool, configured (i) to be reversibly coupled to a tissue anchor (50,280), (ii) to be slidably coupled to the longitudinal element of the guide member, and (iii) to anchor the tissue anchor to a papillary muscle (254) of the subject. Other embodiments are also described.

An anchor device and system for coupling soft tissue to osseous tissue includes a stopper member that supports a loop of suture material. A fixing member includes features that allow it to be rigidly coupled to surrounding bone and thus hold the stopper member in a cavity within the bone. The loop of suture material, in turn, supports a second suture device, which is coupled to, and thus retains, the soft tissue. In certain embodiments, the stopper member includes a mechanical linkage for coupling it to the fixing member, and surface features that resist withdrawal of the fixing member from the bone.

The present disclosure relates to a delivery device and screw combination. The combination includes a delivery device comprising a handle and a shaft coupled to the handle, the shaft including a proximal end, a distal end, a non-circular cannulation, and markings along a length of the shaft; an interference screw coupled to the delivery device comprising a proximal end and a distal end, the screw including threads extending in an open helical form from the proximal end to the distal end, a suture bridge located at a distal end of the screw and housed within a slot of the delivery device shaft, and a plurality of runners extending longitudinally along an interior of the screw, the runners housed within grooves of the delivery device shaft; and a suture disposed around the suture bridge, ends of the suture extending through the cannulation of the delivery device shaft.

The disclosure provides apparatus and methods of use pertaining to syndesmosis reinforcement. Embodiments include a clamp having two jaws that extend toward each other to clamp two bone portions therebetween. The clamp may include an angle gauge and an adjustment mechanism having a force gauge that combine to enable the compression of the two bone portions in an optimal direction or angle and at an optimal, measurable compression force. Embodiments also include a tension instrument configured to knotlessly lock a flexible strand construct between two anchors at the same optimal direction and tension applied by the clamp. Further embodiments include an exemplary syndesmosis reinforcement procedure that employs the clamp and the tension instrument to construct a ligament reinforcement construct that achieves optimal anatomic positioning in both directional alignment and the reduction force applied by the construct. Other embodiments are disclosed.