Systems, devices and methods for repairing a native heart valve. In one embodiment, a repair device for repairing a native mitral valve having an anterior leaflet and a posterior leaflet between a left atrium and a left ventricle comprises a support having a contracted configuration and an extended configuration, and an appendage, such as a flap or apron extending from the support. In the contracted configuration, the support is sized to be inserted under the posterior leaflet between a wall of the left ventricle and chordae tendineae. In the extended configuration, the support is configured to project anteriorly with respect to a posterior wall of the left ventricle by a distance sufficient to position at least a portion of the posterior leaflet toward the anterior leaflet, and the appendage is configured to extend beyond an edge of the posterior leaflet toward the anterior leaflet.

An articulated prosthesis, left in the patient's heart for repairing a tricuspid or mitral valve, is conceived so as to grip simultaneously all the three leaflets of the tricuspid valve, or the two of the mitral valve, so as to make them lay distended fully in the valve plane and assume a final configuration as in the common surgical procedure. It is also disclosed a related catching device and a device for repairing a tricuspid or mitral valve.

This application relates to methods, systems, and apparatus for replacing native heart valves with prosthetic heart valves and treating valvular insufficiency. In a representative embodiment, a support frame configured to be implanted in a heart valve comprises a main body formed by formed by a plurality of inner members forming an inner clover and a plurality of outer members forming an outer clover. The support frame can include gaps located between inner members of the plurality of inner members and outer members of the plurality of outer members. The inner clover can be radially inside the outer clover, and the outer clover can have larger dimensions than the inner clover. The support frames herein can be radially expandable and collapsible.

A mechanism for adjusting the chordae connecting the leaflets of a mitral valve to the papillary muscles in order to restore normal functioning of the mitral valve. The devices or mechanisms can correct problems associated with both prolapsed leaflets and restricted leaflets to allow the leaflets to properly coapt, thereby preventing or minimizing regurgitation. In accordance with the invention, the mechanisms or devices used for adjusting the chordae can be delivered and implanted in a minimally invasive and/or percutaneous manner, such as via transapical methods, transfermoral methods, or trans-septal methods.

Systems for mitral valve repair are disclosed where one or more mitral valve interventional devices may be advanced intravascularly into the heart of a patient and deployed upon or along the mitral valve to stabilize the valve leaflets. The interventional device may also facilitate the placement or anchoring of a prosthetic mitral valve implant. The interventional device may generally comprise a distal set of arms pivotably and/or rotating coupled to a proximal set of arms which are also pivotably and/or rotating coupled. The distal set of arms may be advanced past the catheter opening to a subannular position (e.g., below the mitral valve) and reconfigured from a low-profile delivery configuration to a deployed securement configuration. The proximal arm members may then be deployed such that the distal and proximal arm members may grip the leaflets between the two sets of arms to stabilize the leaflets.

A method is provided that includes implanting a first tissue-engaging element in a first portion of tissue in a vicinity of a heart valve. A second tissue-engaging element, which is connected to a third tissue-engaging element by a longitudinal sub-member, is implanted in a second portion of tissue of an annulus, and the third tissue-engaging element is implanted in a third portion of tissue of the annulus. A fourth tissue-engaging element is implanted in a portion of a blood vessel that is in contact with an atrium. While the longitudinal sub-member engages the longitudinal member at a junction therebetween, at least a first leaflet of the heart valve is drawn toward at least a second leaflet of the heart valve by adjusting a distance between the portion of the blood vessel and the first portion of tissue in the vicinity of the heart valve. Other embodiments are also described.

A method comprises inserting a needle into a ventricle of a heart. The needle is configured to deliver a first anchoring element, a second anchoring element, and a tethering suture to the ventricle. The tethering suture is tethered between the first anchoring element and the second anchoring element. The method further comprises penetrating a first leaflet of a heart valve with the needle, penetrating a second leaflet of the heart valve with the needle, deploying the first anchoring element at a distal side of the second leaflet, retracting the needle from the first leaflet and the second leaflet, deploying the second anchoring element at a proximal side of the first leaflet, cinching the tethering suture to cause a desired amount of valve coaptation, and locking the tethering suture.

An implant includes a clip and a clip-controller interface. The clip is disposed laterally from a central longitudinal axis of the implant, includes first and second arms articulatably coupled to each other, and sandwiches a leaflet of a heart valve between the first and second arms by articulation between the first and second arms, such that the second arm is disposed laterally from the first arm. The clip-controller interface is reversibly coupled to a clip controller of a delivery tool, and includes first and second portions. The first portion is linearly slidable by the clip controller. The second portion is articulatably coupled to the first portion and to the second arm, such that linear sliding of the first portion causes the second portion to (i) articulate with respect to the first portion, and (ii) push the second arm to articulate toward the axis. Other embodiments are also described.

A method of reducing tricuspid valve regurgitation is provided, including implanting first, second, and third tissue anchors at respective different first, second, and third implantation sites in cardiac tissue in the vicinity of the tricuspid valve of the patient. The geometry of the tricuspid valve is altered by drawing the leaflets of the tricuspid valve toward one another by applying tension between the first, the second, and the third tissue anchors by rotating a spool that (a) winds therewithin respective portions of first, second, and third longitudinal members coupled to the first, the second, and the third tissue anchors, respectively, and (b) is suspended along the first, the second, and the third longitudinal members hovering over the tricuspid valve away from the annulus of the tricuspid valve. Other embodiments are also described.

A system for treating valvular regurgitation in a heart valve includes a flexible canopy and an elongated tether including an elastic portion and an inelastic portion. When the system is in a deployed configuration, a proximal end of the flexible canopy is coupled to an annulus of the heart valve and a distal end of the elongated tether is coupled to a ventricle. The flexible canopy is configured to overlay a first native leaflet of the heart valve, and tension on the elongated tether is applied and/or adjusted to prevent the first leaflet from prolapsing, to maximize coaptation of the flexible canopy with a second native leaflet of the heart valve, and to minimize regurgitation of the heart valve.