Devices, systems, and methods for delivering various implantable devices, such as heart valve implants, with the use of a steerable imaging element are described. An imaging element is positioned adjacent the implantable device and implant site, a relationship between the implantable device and the implant site is visualized and/or imaged, and the implantable device is anchored and/or adjusted with reference to the visualization and/or imaging thereof.

A prosthetic heart valve is provided with a cuff having features which promote sealing with the native tissues even where the native tissues are irregular. The cuff may include a portion adapted to bear on the LVOT when the valve is implanted in a native aortic valve. The valve may include elements for biasing the cuff outwardly with respect to the stent body when the stent body is in an expanded condition. The cuff may have portions of different thickness distributed around the circumference of the valve in a pattern matching the shape of the opening defined by the native tissue. All or part of the cuff may be movable relative to the stent during implantation.

The present disclosure relates to an arrangement, a loop-shaped support, a prosthetic heart valve and a method of repairing or replacing a native heart valve. With the method or the arrangement, leakage or regurgitation between a prosthetic heart valve and the surrounding valve tissue is prevented. In one embodiment, an arrangement for replacement or repair of a native heart valve is provided, which comprises a loop-shaped support 41 and a prosthetic heart valve 70 and wherein an outer segment 32 of the loop-shaped support 41 is positionable towards surrounding valve tissue of a native heart valve and wherein an outer surface 74 of the prosthetic heart valve 70 is positionable towards an inner segment 34 of the loop-shaped support 41 so as to prevent paravalvular leakage or regurgitation between the prosthetic heart valve 70 and the surrounding valve tissue of the native heart valve.

Systems, devices and methods for resizing a valve annulus are described. An implant is delivered proximate a mitral valve, the implant comprising a tubular body and a plurality of piercing helical anchors, the tubular body comprising an proximal diameter and a distal diameter. Tissue proximate the mitral valve is engaged by rotating the plurality of anchors with corresponding rotational drivers. The tubular body may be transitioned from a first structural configuration having the proximal diameter smaller than the distal diameter to a second structural configuration having the proximal diameter larger than the distal diameter.

The present disclosure relates to delivery devices and interventional devices configured to enable monitoring of pressure and other hemodynamic properties before, during, and/or after a cardiac procedure. A guide catheter includes a routing lumen or a routing groove for routing a sensor wire to a desired location during a cardiac procedure. A guide catheter includes one or more pressure sensors positioned to provide desired pressure measurements when the guide catheter is deploying an interventional device. An interventional device may also include one or more associated sensors for providing hemodynamic information before, during, and/or after deployment.

A delivery system for an interventional device includes an elongate catheter body, a catheter shaft extending within the elongate catheter body and configured to releasably attach to the interventional device, and at least one flexible element attached to a distal portion of the catheter shaft. The at least one flexible element has an expanded configuration in which the at least one flexible element extends beyond an outer circumference of the elongate catheter body and a collapsed configuration in which the at least one flexible element collapses within an inner circumference of the elongate catheter body. The at least one flexible element is configured to act as a tactile stop when pulled proximally against the elongate catheter body and/or to fold over the interventional device to act as a retraction aid.

A method for accessing a mitral valve that includes forming an incision and inserting a first catheter comprising a lumen. The first catheter is adapted to be directed towards a left atrium and the first catheter has a working length of approximately 15 cm to approximately 52 cm. The method further includes utilizing a trocar in the first catheter to penetrate a pericardium and utilizing the trocar to penetrate the left atrium. The method further includes accessing the mitral valve from an antegrade direction.

A heart valve repair system includes a delivery sheath and an implant that includes a frame having a surface configured to contact an upstream surface of a native heart valve. First and second gripping members are coupled to the frame and each (1) includes first and second arms and (2) is configured to clamp a respective native leaflet. The implant is disposed in the sheath in a delivery state in which the frame defines a wall fully surrounding a central longitudinal axis of the implant. The distal end of the wall defines a distal opening of the frame. The distal end of the wall is disposed proximally to the entire first tissue-engaging surface of each of the gripping members and proximally to the entire second tissue-engaging surface of each of the gripping members. Other embodiments are also described.

Apparatus for coupling a prosthetic chorda to an atrioventricular valve leaflet, the apparatus comprising: a neochorda delivery system comprising a steerable and pushable catheter housing a neochorda attached to a neochorda puncture needle, the catheter operable to push the puncture needle to puncture and thread the neochorda through a papillary muscle of a ventricle; a retriever system comprising a catheter housing a grabber operable to capture the neochorda puncture needle after being threaded through the papillary muscle and withdraw the neochorda puncture needle and neochorda from the ventricle; and a tissue clamping system comprising a catheter housing distal and proximal tissue clamps deployable to clamp a region of an atrioventricular valve between them and hold the region so that it may be punctured by the puncture needle to deliver the neochorda through the leaflet and to the papillary muscle.

A sheath is transluminally introduced a sheath into an atrium of a heart of a subject. A guide member is advanced out of the sheath and to a chorda tendinea of the heart, the guide member having a proximal portion that includes a longitudinal element, and a distal portion that includes a helical chord-engaging element. The chord-engaging element is wrapped around the chorda tendinea. While the chord-engaging element remains wrapped around the chorda tendinea, (i) the chord-engaging element is slid over the chorda tendinea toward a papillary muscle that is coupled to the chorda tendinea; and (ii) subsequently, a tool is moved out of the sheath and toward the papillary muscle by sliding the tool along the longitudinal element. Other embodiments are also described.