A method of treating a heart of a patient is provided, including implanting a first tissue anchor in cardiac tissue of the patient, the first tissue anchor attached to one or more tethers that are fixed to a coupling element. A second tissue anchor is implanted in the patient. The coupling element is coupled to a first coupling site of the second tissue anchor, thereby coupling the first tissue anchor to the second tissue anchor via the one or more tethers. Thereafter, after allowing at least 24 hours for tissue growth on the first tissue anchor to strengthen anchoring of the first tissue anchor in the cardiac tissue, tension is increased between the first and the second tissue anchors by decoupling the coupling element from the first coupling site and coupling the coupling element to a second coupling site of the second tissue anchor. Other embodiments are also described.

Devices, systems and methods for compressing, cutting, incising, reconfiguring, remodeling, attaching, repositioning, supporting, dislocating or altering the composition of tissues or anatomical structures to alter their positional or force relationship to other tissues or anatomical structures. In some applications, the invention may be used to used to improve patency or fluid flow through a body lumen or cavity (e.g., to limit constriction of the urethra by an enlarged prostate gland).

Devices for easily and quickly tying complex suture knots are disclosed. The knot tying accessories described herein provide a means for introducing a complex knot pattern into a bight of suture using a device body and a guide thread. The device body includes system for maintaining the guide thread and suture in a convoluted pathway, either with the use of channels, protrusions, or a combination of both within its interior, on its exterior, or both. The guide thread may include a coupler at one end for holding a suture end while the guide thread leads the suture through the convoluted path defined within the guide body. Pull tabs may also be included to aid with exchanging the guide thread for the suture ends.

Methods and devices are disclosed for manipulating the tongue. An implant is positioned within at least a portion of the tongue and may be secured to other surrounding structures such as the mandible and/or hyoid bone. In general, the implant is manipulated to displace at least a portion of the posterior tongue in an anterior or lateral direction, or to alter the tissue tension or compliance of the tongue. Methods and devices for adjusting a glossopexy system are also disclosed. Adjusting a distance between two body-engaging structures can be performed without disengaging a tether from either of the body-engaging structures in some embodiments.

Embodiments of invention are directed to tissue approximation instruments that may be delivered to the body of a patient during minimally invasive or other surgical procedures. In one group of embodiments, the instrument has an elongated configuration with two sets of expandable wings that each have spreadable wings that can be made to expand when located on opposite sides of a distal tissue region and a proximal tissue region and can then be made to move toward one another to bring the two tissue regions into a more proximate position. The instrument is delivered through a needle or catheter and is controlled by relative movement of a push tube and control wire wherein the control wire can be released from the instrument via rotation in a first direction and can cause release of the approximation device from tissue that it is holding by rotation in the opposite direction.

The technology includes an anchor assembly for tissue repair having an open helical coil sleeve and a tip structure. The tip structure includes an aperture for passing a suture and a suture capture member for capturing a suture. The technology also includes an anchor driver for installing an anchor into bone. The anchor driver includes an outer shaft and a sleeve advancement member for advancing the sleeve as well as an inner shaft and a suture capture advancement member for advancing the suture capture member. The technology also includes a system for tissue repair having an anchor assembly and an anchor driver for installing the anchor assembly into bone.

An implantable device for shaping an intracorporeal wall includes: an elongate element which has a first end, a second end and a central filiform region between the first end and the second end; and a blocking member. The elongate element is mobile in relation to the blocking member between an unlocked position away from the blocking member and a locked position on the blocking member, in which the elongate element is connected to the blocking member. The blocking member includes a mechanism for selective adjustment of the length of the central region protruding towards the second end from the blocking member.

A surgical bone sheath staple device, anchor, and/or scaffold enables low impact installation of distal end members in bones to secure soft tissue and the like via a deployment system. The bone sheath staples, anchors, and scaffolds secure soft tissue to bone to ensure tailored fixation of soft tissue to bone. The bone staples, anchors, and scaffolds integrate sheath and suture tightening members to secure soft tissue to bone and tailor compression of soft tissue to bone to encourage healing. The bone staples, anchors, and scaffolds integrate sheaths and suture to define attachment mechanisms and other features that secure the staples, anchors, and/or scaffolds to bone.

Apparatus and methods for occluding hollow body structures, such as blood vessels, and for attaching tissue layers together by providing implantable elements on opposite sides of the structure or tissue layers and drawing the implants together to occlude the body structure and/or bring the tissue layers together. The implants are deliverable in a low-profile configuration and self-expand to an enlarged configuration. The implantable elements are delivered by transfixing the body structure, then releasing the implants on opposite sides of the body structure and drawing the implants together to effect an occlusion or attachment. The implants are configured to apply oppositely directed forces to opposite surfaces of the tissue layers at alternate, circumferentially spaced locations and may constrain the tissue in a serpentine pattern or in a direct clamping pattern. The implants grip the tissue in a manner that defines a pressure zone about the transfixion aperture that prevents leakage from the aperture. The implants have a low profile in that they have a relatively short axial dimension relative to their deployed diameter.

An assembly includes a flexible fixation member, a suture, and a delivery device. The fixation member includes a body with two terminal ends. A suture passes through the flexible fixation member at various points along a length of the body such that portions of the fixation member are slidable relative to the suture and configurable to form a cluster within a surgical site. The delivery device includes a tubular member, an elongated inserter, and a trigger. The elongated inserter is slidably disposed within the tubular member. The inserter has a forked distal end configured to receive a portion of the flexible fixation member and the suture. The trigger is finger-engagable and fixedly coupled to the proximal end of the inserter. It is configured to advance and retract the inserter relative to the tubular member. The trigger includes a retention member for retaining a proximal end portion of the suture.