A tissue anchor is provided that includes a head connected to a shaft, and a tissue-coupling element extending from the shaft. The shaft includes a seal that is configured to form a blood-tight seal between the shaft and a heart wall, and to promote hemostasis. When the tissue anchor is unconstrained, the head is coaxial with an axis of the shaft, and the tissue-coupling element is generally orthogonal to the axis and is shaped such that if the tissue-coupling element were to be projected onto a plane that is perpendicular to the axis, at least 80% of an area of a projection of the tissue-coupling element on the plane would fall within a first angle of 180 degrees in the plane having a vertex at the axis. Other embodiments are also described.

The invention relates to a device for use in the transcatheter treatment of mitral valve regurgitation, specifically a coaptation enhancement element for implantation across the valve; a system including the coaptation enhancement element and anchors for implantation; a system including the coaptation enhancement element, catheter and driver; and a method for transcatheter implantation of a coaptation element across a heart valve.

Methods for reconstructing a joint include fixating at least one suture inside a joint space, retrieving the at least one suture from inside the joint space, passing the at least one suture through a graft at a location external to the joint space, shuttling the graft into the joint space, and fixating the graft to bone using the at least one suture.

Devices, systems, and methods are provided for mitral repair of a mitral valve within a heart of a subject that includes introducing a distal portion of a delivery device carrying an artificial chordae into the vasculature of the subject; advancing the distal portion into a right atrium of the heart and trans-septally from the right atrium into a left atrium of the heart; directing the distal portion through a mitral valve of the heart into a left ventricle of the heart; securing a distal end of the artificial chordae to a posterior ventricular wall of the heart adjacent the mitral valve; coupling a leaflet anchor end of the artificial chordae to a posterior leaflet of the mitral valve; adjusting a distance between the leaflet anchor and the distal end of the artificial chordae until coaptation of the mitral valve is improved and/or regurgitation is eliminated; and removing the delivery device from the subject's body.

A tissue anchor includes a shaft, a tissue-coupling element, and a flexible elongate tension member. The tissue-coupling element includes a wire, which is shaped as an open loop having more than one turn when the tissue anchor is unconstrained. The tension member includes a distal portion that is fixed to a site on the open loop, a proximal portion, which has a longitudinal segment that runs alongside at least a portion of the shaft, and a crossing portion, which (i) is disposed between the distal and the proximal portions along the tension member, and (ii) crosses at least a portion of the open loop when the tissue anchor is unconstrained. The tissue anchor is configured to allow relative axial motion between the at least a portion of the shaft and the longitudinal segment of the proximal portion of the tension member when the tissue anchor is unconstrained.

An implant comprises an anchor that comprises a helical tissue-coupling element. A tool is configured to advance the implant to a heart of a subject, and to position the anchor at tissue of the heart such that the implant extends from the anchor proximally away from the tissue. The tool comprises a tube having a distal end coupled to the implant, and a deployment manipulator. The deployment manipulator extends through the tube to the anchor disposed distally beyond the tube, and is configured to anchor the anchor to the tissue. Presence of the deployment manipulator through the distal end of the tube maintains the coupling between the distal end of the tube and the implant. Other embodiments are also described.

A method is described for use at a valve of a heart of a subject, the valve having an annulus, and the heart having an atrium upstream of the valve. A distal end of a manipulator is transluminally advanced into the atrium. A first part of an implant that includes an elongated contracting member is anchored to a first site on the annulus using the manipulator. The distal end of the manipulator is then pointed at a second site on the annulus such that a central longitudinal axis of the manipulator is disposed at an angle of 45-90 degrees with respect to a surface of the annulus. A second part of the implant is then anchored to the second site using the manipulator. Subsequently, the first site and the second site are drawn together by applying tension to the contracting member. Other embodiments are also described.

Anchor assemblies for endovascular introduction and implantation for tethering a replacement heart valve to a cardiac wall. An anchor delivery system introduces the assembly. The anchor may be either implanted with a tether connected thereto or implanted and then connected to a tether. If the latter, a tether assembly is mounted to the implanted anchor to connect the anchor to the valve. The anchors may be implanted into any cardiac wall including the interventricular septum or the epicardial space and the valve may replace the mitral or tricuspid valve.

An anchor assembly is configured to implant a cardiac anchor into a heart wall of a patient to anchor a suture configured to extend from a valve leaflet of the heart as an artificial chordae. The anchor assembly can include an anchor hub defining an open interior and a helical coil extending distally from the anchor hub and having a sharpened tip configured to embed the helical coil into the heart wall upon rotation of the helical coil. A spring can be disposed within the open interior of the anchor hub. Compressing the spring distally can create an open space within the open interior of the anchor hub for a suture extending through the anchor hub to slide freely and releasing compression on the spring can cause the spring to expand in a proximal direction to clamp the suture within the open interior of the anchor hub.

Methods and devices for transvascular prosthetic chordae tendinea implantation are disclosed. A catheter is advanced into the left atrium, through the mitral valve, and into the left ventricle. A ventricular anchor is deployed from the catheter and into a wall of the left ventricle, leaving a ventricular suture attached to the ventricular anchor and extending proximally through the catheter. A leaflet anchor is deployed to secure a mitral valve leaflet to a leaflet suture, with the leaflet suture extending proximally through the catheter. The leaflet suture is secured to the ventricular suture to limit a range of travel of the leaflet in the direction of the left atrium. Also disclosed is an assembled in situ mitral valve leaflet restraint, having a neo papillary muscle and a neo chordae tendinea.