A surgical pad can comprise a flexible pad portion configured to be positioned over an opening in a target tissue. A plurality of elongate ribs can be distributed across a surface of the flexible pad portion oriented away from the target tissue and can be coupled to the flexible pad portion. A surgical pad can comprise a central opening configured to be aligned with an opening in a target tissue, and a plurality of edge openings distributed around an outer edge portion. A method can comprise positioning a spacer between a target tissue and a surgical pad to adjust the tension of surgical cords secured to surgical pad. A method can comprise positioning a spacer between a surface of a surgical pad oriented away from a target tissue and portions of surgical cords secured over the surface of the surgical pad, to adjust the tension of the surgical cords.

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.

Disclosed is a self-expandable atrioventricular valve prosthesis device, including a main body portion of a frame structure, wherein the main body portion is implanted at a primary annulus of a heart and the main body portion includes an inflow segment, an outflow segment and a transition segment, wherein the inflow segment is located at an atrium end, the outflow segment is located at a ventricle end, and the transition segment is located between the inflow segment and the outflow segment. The device further includes at least one prosthetic valve leaflet fixed to the transition segment of the main body portion, and the prosthetic valve leaflet is configured with a connecting portion. The device further includes a chordae tendineae portion with one end fixed and the other end connected to the prosthetic valve leaflet via the connecting portion. In the present invention, by limiting the movement range of the prosthetic valve leaflet via the chordae tendineae portion, and by preventing the shear stress and the stress concentration on the valve leaflets exerted by the chordae tendineae portion via the connecting portion, the endurance of the prosthetic valve leaflet is increased.

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.

A method is provided, including treating a heart valve of a patient by implanting at the heart valve an implant including an elongate element including at least in part a tension element, by placing the implant at the heart valve of the patient, and subsequently to the placing, increasing tension of the elongate element at least in part. The tension element is configured to undergo conformational changes, subsequently to the placing, responsively to a cardiac cycle of the patient. Implanting the implant includes implanting the implant such that the tension element undergoes the conformational changes responsively to the cardiac cycle of the patient in a manner in which the tension element cyclically increases and decreases pressure applied to at least one leaflet of the heart valve by the elongate element.

A delivery device includes an inner shaft, an outer sheath, a nosecone, and a tether component. The outer sheath is slidably disposed over the inner shaft. The nosecone is removably coupled to the inner shaft. The nosecone includes a delivery configuration for delivery to a treatment site, a radially compressed configuration in which a portion of the nosecone is configured to traverse through a heart wall, and a radially expanded configuration in which an outer surface of the nosecone contacts an outer surface of the heart wall. The tether component includes a first end coupled to the nosecone. The nosecone is configured to plug a piercing in the heart wall when in the radially expanded configuration.

A sutureless implant for replacing damaged natural chordae tendineae of a human or possibly animal heart, the implant including a distal implant part, a proximal implant part, and an artificial chord. The distal implant part is configured to fit in a lumen of an implant delivery device and includes a self-spreading portion spreading radially outside when the distal implant part is released from the lumen, the self-spreading portion being capable of anchoring the distal implant part in human muscle tissue. The proximal implant part is configured to fit in the lumen of the implant delivery device and comprises a self-spreading portion spreading radially outside when the proximal implant part is released from the lumen, the self-spreading portion being capable of bearing on a tissue portion of leaflet tissue. The distal implant part and the proximal implant part are connected by the chord.

A medical device for cutting a suture during a minimally invasive procedure may include an elongate shaft having a proximal end, a distal end, and a central longitudinal axis, a handle disposed at the proximal end of the elongate shaft, the handle including an actuation mechanism, and a cutting blade disposed proximate the distal end of the elongate shaft. The cutting blade is axially translatable within the elongate shaft in response to operation of the actuation mechanism. The elongate shaft includes a distal port to receive a suture. The elongate shaft includes a transverse slot extending inward from an outer surface of the elongate shaft generally perpendicular to the central longitudinal axis. The elongate shaft includes a suture lumen extending from the distal port axially within the elongate shaft to the transverse slot. The cutting blade intersects the transverse slot adjacent the suture lumen.

Apparatus and methods are described herein for anchoring a prosthetic heart valve. In some embodiments, an apparatus includes a tether attachment member that includes a base member that defines at least a portion of a tether passageway through which a portion of a tether extending from a prosthetic heart valve can be received therethrough. The base member defines a locking pin channel that intersects the tether passageway. A locking pin is disposable within the locking pin channel and movable between a first position in which the locking pin is at a spaced distance from the tether passageway, and a second position in which the locking pin intersects the tether passageway and can engage the portion of a tether disposed therein to secure the tether to the tether attachment member.

In one embodiment, a suture attachment catheter configured to repair a heart valve by inserting a suture in a valve leaflet of a beating heart of a patient includes a handle control, a flexible catheter body, and a suture attachment assembly at a distal end of the catheter body. The suture attachment assembly can include a rail between a distal clamping jaw hingedly attached to the rail, and a proximal clamping jaw. One of the proximal clamping jaw or distal clamping jaw can be selectively slideable with respect to the other on the rail using a jaw actuator of the control handle to adjust a distance between the proximal clamping jaw and the distal clamping jaw. A needle can be selectively slideable within the catheter body by using a needle actuator of the proximal handle control to penetrate a valve leaflet and insert a suture through the valve leaflet when the valve leaflet is captured between the proximal clamping jaw and the distal clamping jaw.