Apparatus includes an annuloplasty structure, including: (i) a tubular body portion that is configured to be disposed at an annulus of a valve of a heart, and is shaped to define a perimeter; (ii) a flexible member, disposed within the tubular body portion; (iii) a first adjustment mechanism, attached to the tubular body portion and to the flexible member such that reversible actuation of the first adjustment mechanism reversibly adjusts a first dimension of the body portion by adjusting tension of the flexible member; (iv) a second adjustment mechanism, coupled to the tubular body portion, and reversibly actuatable to reversibly adjust a second dimension of the body portion. The apparatus further includes one or more elongate tools, reversibly couplable to the first and second adjustment mechanisms, and configured to independently actuate the first and second adjustment mechanisms by applying force thereto while the heart is beating.

A catheter device (2) is provided for implanting an anchor (9) into body tissue to attach a line (14) to the body tissue. The catheter device (2) comprises: a housing section (4), (8) extending from a distal end of the catheter device (2) along the length of the catheter device (2) toward the proximal end of the catheter device, the housing section (4), (8) comprising a distal part (8) at the distal end of the catheter device (2) and a proximal part 4 located on the proximal side of the distal part (8). An anchor deployment mechanism (106), (110) is provided at the distal part (8) of the housing section (4), (8) for deployment of the anchor (9) for attachment of the anchor (9) to the body tissue. The anchor (9) is held in its stowed position by the anchor deployment mechanism (106, 110) in the distal part (8) prior to deployment, and the anchor (9) comprises a number of hooks (62) for engagement with the body tissue and having a folded position and an unfolded position, wherein the anchor (9) is made of an elastic material such that the hooks (62) can be elastically deformed into the folded position by application of a constraining force, and will return to the unfolded position when no constraining force is applied, and wherein the hooks (62) are held in the folded position whilst the anchor (9) is in the stowed position within the distal part (8). The distal part (8) of the housing (4), (8) has a non-circular shape (118), (117) for engagement with a corresponding non-circular form (28), (108) of the anchor (9) and/or the anchor deployment mechanism (106), (110), such that when the anchor (9) is held in the distal part (8) movement of the anchor (9) is restrained with respect to rotation of the anchor (9) about a longitudinal axis of the distal part (8) due to engagement between the non-circular shape (118), (117) and the non-circular form (28), (108).

An annuloplasty implant comprising an inner core of a shape memory material, an outer covering arranged radially outside said inner core material to cover at least part of said inner core, wherein said outer covering is resilient to conform to said inner core during movement of said shape memory material, wherein said outer covering comprises a material having surface properties to promote endothelialization. Two portions of the implant may be joined by a recess to be flexible with respect to each other by a bending motion at the recess. The two portions may also have a predefined breaking point at the recess.

Apparatus, comprising: (i) a catheter (64); (ii) an implant (100), comprising a flexible longitudinal member (102), and a linking member (104) that extends from a first linking site (106a) of the longitudinal member to a second linking site (106b) of the longitudinal member, the implant having: (a) a delivery state in which the longitudinal member is coaxial with the catheter, and at least a portion of the linking member is disposed alongside the longitudinal member, and (b) an implanted state in which a first distance between the first linking site and the second linking site, measured along the longitudinal member, is greater than a second distance between the first linking site and the second linking site, measured along the linking member; and (iii) a plurality of tissue anchors (46), slidable through the catheter and with respect to the longitudinal member. Other embodiments are also described.

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.

A valve prosthesis and methods for implanting the prosthesis are provided. The prosthesis generally includes a self-expanding frame and two or more engagement arms. A valve prosthesis is sutured to the self-expanding frame. Each engagement arm corresponds to a native mitral valve leaflet. At least one engagement arm immobilizes the native leaflets, and holds the native leaflets close to the main frame. The prosthetic mitral valve frame also includes two or more anchor attachment points. Each anchor attachment point is attached to one or more anchors that help attach the valve prosthesis to the heart.

An apparatus for partially supporting a leaflet of a regurgitant heart valve comprises at least one subvalvular device including a subvalvular supporting portion including a leaflet-contacting upper supporter surface longitudinally spaced from an oppositely facing lower supporter surface. A supporter perimeter wall extends longitudinally between the upper and lower supporter surfaces, with at least a portion contacting a subvalvular cardiac wall adjacent to the heart valve. An anchor portion is adjacent to, and longitudinally spaced from, the upper supporter surface. The anchor portion includes a leaflet-contacting lower anchor surface longitudinally spaced from an oppositely facing upper anchor surface. A connector neck is interposed longitudinally between, and is directly attached to both of, the upper supporter surface and the lower anchor surface. The connector neck penetrates longitudinally through at least one of a base of the leaflet and an annulus of the heart valve at a manufactured puncture site.

Methods, devices and systems for anchoring and/or sealing a heart valve prosthesis and, in particular, a mitral valve prosthesis (202). Inflatable elements (204, 206) are used to seal and anchor the mitral valve prosthesis (202) and/or other elements associated with repairing a native mitral valve.

A tricuspid valve prosthesis includes a stent body implanted at a tricuspid valve annulus for supporting a prosthetic valve leaflet, and an anchoring structure disposed above the stent body for anchoring the stent body at a native valve annulus for preventing the stent body from displacing, wherein the anchoring structure is configured to be partially attached to a fossa ovalis of an interatrial septum to form a retention force by being attached to the fossa ovalis so that an anchoring effect on the valve prosthesis is achieved.

An apparatus for partially supporting a leaflet of a regurgitant heart valve includes at least one subvalvular device including a subvalvular supporting portion and an anchor portion. The subvalvular supporting portion and anchor portion are each at least partially formed from at least one of braided mesh strands of a first configuration, braided mesh strands of a second configuration, a balloon, a plurality of longitudinally extending struts, and a plurality of laterally extending struts. A connector neck is interposed longitudinally between, and is attached to both of, the subvalvular supporting portion and the anchor portion. The connector neck penetrates longitudinally through at least one of a base of the leaflet and an annulus of the heart valve at a manufactured puncture site.