Suture locking clamps for securing prostheses such as heart valves or annuloplasty rings with sutures and without using knots improve the ease of implantation. The clamps have opposed clamp halves separated by a slot opening to one side and surrounded by a biasing member such as one or more C-clip springs. Sutures pass laterally into the slot which is held open by a retention member positioned between the clamp halves. The locking clamp slides along the sutures into position, the tension of the sutures is adjusted, and the retention member removed to allow the biasing member to clamp the sutures between the clamp halves. A delivery tool used to deliver and deploy the locking clamps contains a number of clamps within a delivery tube in a stack and bonded together for safety and a common retention member. The tool has a longitudinal channel on one side for entry of sutures.

A constricting cord can be delivered to the vicinity of an annulus using an apparatus that includes a set of support arms, with a respective anchor launcher supported by each of the support arms. An inflatable first balloon is configured to push the support arms away from each other when the first balloon is inflated. An inflatable second balloon is mounted to a shaft and is configured for inflation when the second balloon is disposed distally beyond the first balloon. In some embodiments, the distal balloon is inflated while it is in a ventricle. In some embodiments, the distal balloon is inflated while it is in a pulmonary artery.

Surgical constructs, assemblies and methods of tissue fixation are disclosed. A surgical construct includes a spreadable web attached to a plurality of peripheral strands. The spreadable web may be tensionable and may include one or more flexible filaments or strands. At least one of the filaments is coupled to the peripheral strands. The filaments may extend from the peripheral strands in different directions and/or orientations. The spreadable web is expandable and can be adjusted to various widths. The spreadable web may be knotless. The spreadable web may be tensionable. The surgical construct may be attached to one or more knotted or knotless fixation devices.

This disclosure relates to the field of luminal surgery. Specifically, the present disclosure relates to medical devices that expand within a body lumen for accessing a target tissue. In an aspect, an expandable device for a body lumen may include a filament comprising a proximal end, a distal end, and a length. The device may include a plurality of segments. Each segment may comprise a middle portion comprising a longitudinal axis extending axially therethrough, a projection portion extending from an end of the middle portion along the longitudinal axis, and a receptive portion extending from an opposing end of the middle portion away from the longitudinal axis, the receptive portion configured to receive the projection portion of an adjacent one of the plurality of segments. An aperture may be disposed through the projection portion, the middle portion, and the receptive portion.

In one embodiment, the present disclosure may be a method for preparing a soft tissue graft, comprising: passing a suture material through the soft tissue graft adjacent to a graft support filament at a first longitudinal location along the filament and graft, such that the suture material passes through the graft on a first side of the filament; passing the suture material over the filament and back through the graft adjacent to the filament at a second longitudinal location spaced longitudinally along the filament and graft from the first longitudinal location, such that the suture material passes through the graft on the first side of the filament; and tensioning the suture material to secure the filament to the graft along a length of the suture material between the first longitudinal location and the second longitudinal location.

Dislodgment of a constricting cord from an annulus can be prevented by delivering the distal loop portion of the constricting cord to the annulus using a percutaneous delivery tool, and launching anchors into the annulus so as to affix the distal loop portion of the constricting cord to the annulus. The percutaneous delivery tool is withdrawn in a proximal direction after the anchors have been launched. A pushing member is pressed in a distal direction so that the pushing member holds a portion of the constricting cord against the annulus with enough pressure to prevent dislodgment of any of the anchors during the withdrawal of the percutaneous delivery tool.

A method and apparatus for coupling a soft tissue implant into a locking cavity formed within a bone is disclosed. A bone engaging fastener is coupled to bone. A second fastener is coupled to a suture construction. The second fastener is coupled to the first fastener. Soft tissue is coupled to the suture construction.

Devices and methods for gastrointestinal bypass are described. A gastrointestinal bypass device includes a gastrointestinal cuff and a gastrointestinal sleeve. The cuff may be configured to be attached in the esophagus, and may be sufficiently flexible to expand and collapse to conform with the inside of the esophagus to allow the esophagus to function substantially normally. The sleeve is configured to be coupled to the cuff, and may be made of a material that is floppy or flaccid but does not substantially expand radially.

A medical device includes a surgical needle attached to a mesh suture having anti-roping elements. The suture is constructed of a flat macroporous mesh wall that facilitates and allows tissue integration subsequent to introduction to the body, thereby preventing suture pull-through and improving biocompatibility. Advantageously, the anti-roping elements serve to maintain the desired construct of the flat mesh wall when undergoing axial tensile loads by resisting elongation and loss of outer mesh wall macroporosity.

The disclosure provides apparatus and methods of use pertaining to syndesmosis reinforcement. Embodiments include a clamp having two jaws that extend toward each other to clamp two bone portions therebetween. The clamp may include an angle gauge and an adjustment mechanism having a force gauge that combine to enable the compression of the two bone portions in an optimal direction or angle and at an optimal, measurable compression force. Embodiments also include a tension instrument configured to knotlessly lock a flexible strand construct between two anchors at the same optimal direction and tension applied by the clamp. Further embodiments include an exemplary syndesmosis reinforcement procedure that employs the clamp and the tension instrument to construct a ligament reinforcement construct that achieves optimal anatomic positioning in both directional alignment and the reduction force applied by the construct. Other embodiments are disclosed.