MINIMALLY INVASIVE FIXATION DEVICES FOR FIXATING A FELTABLE TEXTILE, SETS COMPRISING A FIXATION DEVICE AND A METHOD FOR FIXATING A FELTABLE TEXTILE AT A TARGET SITE IN A PATIENT

Abstract

Disclosed is a less or minimally invasive fixation device for fixating a feltable textile (108) at a target site that includes an elongate tubular member, a needle and a drive assembly. The elongate tubular member has a proximal end and a distal end and an interior lumen extending between the proximal end and the distal end. The needle assembly comprises at least one felting needle, which is arranged or arrangeable at the distal end of the elongate tubular member and is movable relatively to the elongate tubular member with a reciprocal motion. The drive assembly is arranged in the interior lumen of the tubular member and operably connected to the needle assembly for moving the at least one felting needle with the reciprocal motion when the at least one needle is located at the distal end such that the feltable textile can be fixated at the target site.

Claims

1. A Less invasive fixation device for fixating a feltable textile at a target site in a human or animal, the fixation device comprising: an elongate tubular member having a proximal end and a distal end, an interior lumen extending between the proximal end and the distal end, wherein the elongate tubular member is at least partially flexible; a needle assembly comprising at least one felting needle arranged or arrangeable at the distal end of the elongate tubular member, wherein the at least one felting needle is movable relatively to the elongate tubular member, and wherein the at least one felting needle is movable with a reciprocal motion; and a drive assembly arranged in the interior lumen of the tubular member, wherein the drive assembly is operably connected to the needle assembly for moving the at least one felting needle with the reciprocal motion when the at least one felting needle is located at the distal end such that the feltable textile can be fixated at the target site.

2. (canceled)

3. The fixation on device according to claim 1, wherein the drive assembly is adapted to drive the reciprocal motion with an amplitude of in a range of 2 to 25 mm.

4. The fixation device according to claim 1, wherein the fixation device additionally comprises the feltable textile and wherein the feltable textile is arranged or arrangeable such that at least one felting needle penetrates the feltable textile with the reciprocal motion.

5. The fixation device according to claim 1, wherein the at least one felting needle points in a distal direction of the elongate tubular member.

6. The fixation device according to claim 1, wherein the reciprocal motion of the at least one felting needle is linear or rotational.

7. The fixation device according to claim 1, wherein the drive assembly comprises an elongate driving wire or tube that extends from a proximal side of the elongate tubular member to the needle assembly, and wherein the elongate driving wire or tube is operably connected to the needle assembly such that the driving elongate wire or tube causes the reciprocal motion of the at least one felting needle.

8-10. (canceled)

11. The fixation device according to claim 1, wherein the elongate tubular member comprises at least one guiding element for the drive assembly in the interior lumen.

12. (canceled)

13. The fixation device according to claim 1, comprising the textile, wherein the textile has an annular shape and/or forms an annuloplasty ring.

14. The fixation device according to claim 1, wherein the fixation device additionally comprises: a holding assembly for the feltable textile, wherein the holding assembly comprises at least one holder for securing the textile to the holding assembly, wherein the textile is in a folded position.

15-18. (canceled)

19. A set comprising the fixation device according to claim 1, and an implant comprising the feltable textile.

20-45. (canceled)

46. The set according to claim 19, wherein the feltable textile has an annular shape.

47. The fixation device according to claim 11, wherein the at least one guiding element comprises at least one ring-shaped concentric lead element.

48. A fixation device for fixating a feltable textile at a target site in a human or animal, the fixation device comprising: an elongate tubular member having a proximal end and a distal end, an interior lumen extending between the proximal end and the distal end, wherein the elongate tubular member is at least partially flexible; a needle assembly comprising at least one felting needle arranged or arrangeable at the distal end of the elongate tubular member, wherein the at least one felting needle is movable relatively to the elongate tubular member, and wherein the at least one felting needle is movable with a reciprocal motion; and a drive assembly arranged in the interior lumen of the tubular member and operably connected to the needle assembly, the drive assembly configured to move the at least one felting needle with the reciprocal motion when the at least one felting needle is located at the distal end such that the feltable textile can be fixated at the target site, wherein the drive assembly includes an elongate driving wire or tube and a spring operably connected between the elongate tubular member and the driving wire or tube.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0068] FIG. 1A: is a schematic view of an end portion of a first fixation device in a first stage of fixation.

[0069] FIG. 1B: is a schematic view of an end portion of the fixation device of FIG. 1A in a second stage of fixation.

[0070] FIG. 2A: is a schematic view of an end portion of the fixation device of FIG. 1A in a third stage of fixation.

[0071] FIG. 2B: is a schematic view of an end portion of the fixation device of FIG. 1A in a fourth stage of fixation.

[0072] FIG. 3: shows a schematic view of a cross-section of a second fixation device FIG. 4A to 4C: show a schematic view of the third fixation device with a textile patch and an outer sheath.

[0073] FIG. 5A to 5C: show a schematic view of the third fixation device with a textile patch in the form of an annuloplasty ring and an outer sheath.

[0074] FIG. 6: shows a schematic view of the third fixation device with the textile patch after implantation.

[0075] FIG. 7: is a schematic view of an end portion of a fourth fixation device.

[0076] FIGS. 8A to 8B: are schematic view of the fourth fixation device during fixation.

[0077] FIGS. 9A to 9C: are cross-sectional views of a portion of fixation device showing example embodiments of needle assemblies.

[0078] FIG. 10A to 10B: show a schematic view and a cross-section of a fifth fixation device.

[0079] FIGS. 11A to 11D: are schematic views of an end portion of a sixth fixation device in four stages of fixation.

[0080] FIG. 12: is a schematic view of a cross-section of a human heart after fixation of a of an end portion of the fixation device of FIG. 1 in a fourth stage of fixation.

[0081] While the above-identified figures set forth one or more embodiments of the present invention, other embodiments are also contemplated, as noted in the discussion. In all cases, this disclosure presents the invention by way of representation and not limitation. It should be understood that numerous other modifications and embodiments can be devised by those skilled in the art, which fall within the scope and spirit of the principles of the invention. The figures may not be drawn to scale, and applications and embodiments of the present invention may include features, steps, and/or components not specifically shown in the drawings.

DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS

[0082] FIGS. 1A to 2B show an end portion of the first embodiment 100 of a fixation device. The fixation device 100 includes an elongate tubular member that is realized as a catheter 102. The catheter 102 may be inserted into the body of a human or animal, for example through a short sheath with a valve (i.e. a portal). One example of the insertion of such a short sheath to gain access to a blood vessel and other hollow organs is the Seldinger technique. Before the catheter 102 is inserted, a guidewire 101 is inserted. The guidewire 101 navigates the vessels to reach a target site, such as particular vessel segments, e.g. heart valves or lesions. Then, the catheter 102 is pushed over the guidewire 101 to the target site.

[0083] The situation, where the catheter 102 has reached the target site is shown in FIG. 1A. Thereafter, hooks 104 and 105 are deployed (see FIG. 1B). The hooks 104, and 105 may include a sharp tip to anchor the device in soft tissue to retain a location of the fixation device at the target site. The hooks 104, 105 may penetrate the tissue or may reach behind the tissue and pull the tissue towards the catheter 102. Alternatively, the guidewire 101 is retracted after the catheter 102 has reached the target site, and a second catheter 103 is introduced which includes the hooks 104, and 105.

[0084] In the next step, a pusher 106 is advanced through the catheter 102 over the guidewire 101 or over the second catheter 103. On its distal end, the pusher 106 includes a flat surface. On the flat surface, a folded patch 108 made of a feltable textile is arranged and pushed through an inner lumen of the catheter 102. When the folded patch is expelled from a distal end of the catheter 102 as shown in FIG. 2A, it unfolds as shown in FIG. 2B. The flat side of the distal end of the pusher 106 is used to push the patch 108 against the tissue of the human or animal. In order to prevent the patch 108 from moving, the pusher includes two barbed needles 110, 111 that are deployed, i.e. moved in a distal direction through the patch and into the tissue of the human or animal to keep the patch in place. Then, a felting needle 109 is moved through the patch 108 and into the soft tissue of the human or animal. Then, the felting needle 109 is retracted again by moving the needle in the proximal direction. The advancement and retraction are repeated with a frequency of 60 Hz. By repeatedly advancing a needle 109 through the patch 108 the fibers of the patch 108 are pushed or pulled through patch 108 into the soft tissue 3 by means of the needle 109 to produce a firm connection between the feltable textile of the patch and the soft tissue. This process may be supported by the needle additionally comprising felting barbs as described in PCT/CH2019/000015. Thereafter, the patch 108 is fixated at the target site.

[0085] The needle can be moved over the surface of patch 108 by rotating the catheter 102 around the second catheter 103. To cover a greater area this can be repeated by navigating to a new target site on the patch with catheter 102.

[0086] FIG. 3 shows a schematic view of a cross-section of a second fixation device. FIG. 3 illustrates how a felting needle, for example felting needle 109, may be actuated. Patches of feltable materials such as patch 108 may be attached to target sites in the cardiovascular, urological, gastrointestinal, or neurovascular regions. Oftentimes this requires following the path of the respective hollow organ, e.g. blood vessels, along their bent paths. Therefore, catheters that are flexible, and sometimes soft, are used to allow the catheter to follow the shape of the hollow organ. However, this poses a challenge for actuating the felting needle with the reciprocal motion. In particular in case the fixation device comprises a motor to actuate the felting needle, the motion needs to be transmitted to the felting needle via a driving assembly (or drive assembly). One example of such a driving assembly including a spring coil 205, a washer 205, and driving wire 210 is shown with reference to FIG. 3. FIG. 3 shows a fixation device 200 with a felting needle 209. An actuator (not shown) generates the reciprocal motion and is directly connected to a driving wire 210. The driving wire 210 is pulled by the motor in the proximal direction. Similarly to the fixation device too, the fixation device 200 comprises an elongate tubular member that is realized as a catheter 202. As can be seen from FIG. 3, the catheter 202 is flexible along its entire length and bends around curves. The driving wire 210 is held and guided within the catheter 202 by a guiding element. The guiding element may be a concentric lead element 201 as shown in FIG. 3. The concentric lead elements 201 are circular, ring-shaped and extend from an inner side of the catheter. Those elements 201 have preferably also a low friction index to allow optimal guidance and force transmission. This feature reduces bending forces and ultimately reduces vibration during application. The concentric lead elements 201 center the driving wire in the catheter 210, thereby preventing a bending or buckling of the driving wire in the tube beyond the bending of the catheter 202. The concentric lead elements are covered by a PTFE coating to lower a friction between the driving wire 210 and the lead elements. Additionally or alternatively, the driving wire may also include a similar or different friction reducing (low friction) coating.

[0087] The catheter 202 comprises a linear bearing 203 at its distal end. Further, the catheter 202 includes a spring coil 204 and a felting needle 209 at its distal end. The driving wire 210 is rigidly connected to the felting needle 209 or forms the felting needle 209 and is connected to a distal end of the spring coil 204 with a washer 205. On the other hand, the spring coil contacts the linear bearing 203. When the wire 210 is pulled, the needle 209 is retracted and the spring 204 is compressed between the linear bearing 203 and the washer 205. Upon releasing the wire 210, the spring coil presses the felting needle forward. The amplitude (penetration depth) and frequency of the motion of the felting needle can be modulated and the suitable springs with resonance frequencies in the desired range may be chosen as is known in the art.

[0088] If a sufficiently stiff driving wire is used (e.g. steel cable) which is able to transport compressive and tensile forces from one end to the other end of the catheter, the spring 204 can be avoided. Alternatively to the above described driving assembly comprising an elastic element (spring 204) and a driving wire, the needling mechanism can be driven by a pneumatic or hydraulic force or by an electro-magnetic actuator.

[0089] FIGS. 4A to 4C show a schematic view of the third fixation device 300 with a textile patch 308 and an outer sheath 302. In particular, FIGS. 4A to 4C show one embodiment of how a patch of a feltable textile 308 may attached to a target site of soft tissue. In the embodiment of FIGS. 4A to 4C the feltable textile 308 is advanced with a guidewire 301. In first step of the operation the guidewire 301 is guided towards the target site as is known in the art. The tip of the guidewire is for example angled e.g. by having a J shape, allowing a navigation through hollow organs, such as blood vessels.

[0090] Once, the guidewire 301 is at the target site, an outer sheath 302 is advanced over the guidewire into the body of the human or animal. The outer sheath 302 comprises an inner lumen, through which a further outer catheter 303 is advanced. The outer catheter 303 includes an inner catheter 305. The inner catheter 305 may be a catheter such as catheter 200 as described with reference to FIG. 3. The patch 308 can be provided with a small hole or simply be penetrated by the guidewire. Then the patch can be advanced over the guidewire 301 with a separate pusher (not shown). Otherwise the patch 308 can be advanced with the guidewire 301 when the guidewire is inserted or by being pushed with the outer sheath 302 or with the outer or inner catheter 303, 305 over the guidewire 301.

[0091] In addition, the inner catheter 305 comprises a joint 304. The joint may comprise an elastic element such as a coil or an elastic material and a bearing, e.g. a pivot bearing. The elastic element is prestressed and forces the inner catheter to bend at the joint 304 around the bearing. For example, the elastic material maybe compressed which would bend the inner catheter to an opposing side or the elastic material may be stretched, which would bend the inner catheter to the side of the elastic material. The angle of the joint may in one example be controlled by a user with a wire pulling the elastic element.

[0092] Additionally or alternatively, the joint 304 is made of a shape memory alloy. Further, upon being expelled from the outer catheter 303, the joint bends the inner catheter 305 at a predetermined angle. The angle may be controlled by the axial position of the inner catheter 305 relative to the outer catheter. This allows the needle to cover a bigger felting area on the patch.

[0093] The predetermined angle may be less than 90, preferably less than 60, preferably less than 45 and particularly preferred about 30. Due to the bending at the joint, a rotation of the inner catheter 305 around its own axis steers the distal tip of the inner catheter 305 similarly to a guidewire with a J-shaped end. Thereby, the end portion of the inner catheter with the felting needle can be guided to a desired position. As shown in particular in FIGS. 4B and 4C (see arrows 309, 310), the steerable inner catheter is rotated around its own axis and thereby the circumference of the patch 308 is attached to the target site with the felting needle. The relative position of the inner catheter 305 and the outer catheter 303 may be adjustable. For example, at a first relative position, the joint may be end at an angle of 15 at a first relative position while the angle may be 30 at a second position. Thereby, an inner radius can be fixated. For example, the further the outer catheter 303 is withdrawn, the further the inner catheter 305 bent. Thereby, the entire surface of the eligible material can be attached to the target site by rotating the inner catheter and changing the angle of the joint 304.

[0094] A particular application of the above technique is shown with respect to FIGS. 5A to 6. In this application, the feltable textile forms an annuloplasty ring 408. An annuloplasty is a procedure to tighten or reinforce the ring (annulus) around a valve in the heart. The annuloplasty ring reshapes, reinforces and/or tightens the ring around a heart valve thereby preventing for example regurgitation through the valve. An outer catheter 403 includes a holder 409 for the feltable textile 408 that is ring-shaped. The holder has a mesh structure and is made of a shape memory alloy that expands upon being expelled from an outer sheath 402. The holder 409 includes releasable anchors that may clamp the feltable textile. When the holder is expelled from the distal end, it spans the feltable textile 408. Then, similarly to the inner catheter 305 of FIGS. 4A to 4C, an inner catheter 405 is advanced through the outer catheter 403. Similarly to the inner catheter 305 of FIGS. 4A to 4C, the inner catheter 405 includes a bendable joint. Through a rotation around the axis of the inner catheter, the annuloplasty ring 408 is attached to an annulus of a heart valve. The annuloplasty ring is pressed against the tissue by pushing the catheter 400 in the proximal direction. The result of the procedure is shown in FIG. 6. Here the annuloplasty ring 408 is attached to the mitral valve of a human heart on the side of the left atrium.

[0095] A further embodiment 500 of a fixation device is shown in FIG. 7 to 8B. The fixation device 500 includes an elongate tubular member formed as catheter 502. In this fixation device, the eligible textile is provided as an elongate feltable textile strip 508 (e.g. an elongate patch or a braided suture). The feltable textile strip 508 extends along the surface of the tip of the catheter 500 and to goes into two slots 509 provided at the tip of the catheter 500. FIGS. 8A and 8B show a view, in which the catheter 502 is removed. As can be seen from FIGS. 8A and 8B, the fixation device includes similar as elements as the catheter of FIG. 3. In particular, the device comprises a spring coil, a linear bearing, a driving wire, a washer and a felting needle that can be advanced and retracted with the driving wire.

[0096] In addition, the device comprises two holders 510, 511 for the strip 508. A first holder 510 clamps an end of the strip 508. The second holder 511 also clamps the strip 508. On the side of the second holder, the strip 508 extends further along the length of the catheter 502 in the proximal direction. In some embodiments the strip may go along half or the entire catheter from the catheter tip. The catheter 502 also provides an inner lumen for a guidewire and a steering wire for positioning.

[0097] Strip 508 enters the catheter on one side and is stretched by the felt holders 510, 511 to the opposite side, where it is attached. In another embodiment a felt holder only holds the textile over the tissue wall and a fixation device as previously described with reference to FIG. 3 starts fixating it. The holder 511 can release the strip after it is felted to a soft tissue by being rotated (for example with a release cable), and the catheter tip can be moved along a surface to which the strip 508 is to be attached. The catheter tip can be moved along a desired route, which pulls out the strip 508 continuously. Once the strip is felted to the soft tissue over a desired length, the felt strip is cut by rotating the holder 511 further. The holder 511 includes a cutting edge. By rotating the holder 511 further, the strip is cut. Then, or beforehand the first holder is released as well. Thereby, a strip of feltable textile is applied similarly to a correction roller. The feltable textile strip can be advanced for example by manual or electrical means.

[0098] In the previous embodiments, the felting needle was moved linearly along the elongate direction of the respective catheters. However, the needle may also rotate or move in a direction orthogonal to the catheter. An example of such a needle is shown with respect to FIGS. 9A to 9C. FIG. 9A shows a cross-section of a catheter 605 of a fixation device 600. In the cross-section, a felting needle 602 that is connected with a rod 601 is shown. In the position shown in FIG. 9A and on the left side of FIG. 9C, the needle maybe advanced through the catheter 605. As can be seen from FIGS. 9A to 9C, the needle may either be angled or curved, in particular curved along an arc, e.g. a circular circumference. Further as can also be seen from FIGS. 9A to 9C, the rod 601 is arranged eccentrically in the catheter 605. Once the needle exits a distal end of the catheter 605, the rod 601 may be rotated around its axis as indicated by arrow 606. Then, the needle 602 can be used to felt a strip of felt of the material 603 to a tissue 604 as shown in FIG. 9B. Since the rod 601 and thus the needle 602 are arranged eccentrically, tissue 604 and feltable textile 603 can be attached to each other. Similarly 5 to the previous embodiments, the needle is moved back and forth with a reciprocal motion to felt tissue 604 and textile 603. In this way, tissue laying in radial position relative to the catheter can be reached, e.g. in blood vessels.

[0099] Additionally, the eccentric position of the rod 601 may be changed by moving the rod 601 relatively to the catheter to another eccentric position. For example, as shown to the right in FIG. 10C, the rod 601 is movable along a circular path within the cross-section of the catheter 605 as indicated by arrow 607. The rod 601 can be moved to different circumferential positions of the catheter 605. The positions maybe defined by an inner wall, e.g. inner catheter 608, and a core 609. The core 609 may be a tube for the guidewire and is arranged within the lumen of the inner catheter. Thereby, a space 610 is formed between the inner catheter 608 and the core 609 that extends along the length of the inner catheter 608 and the core 609. In the example of FIG. 10C the space has the shape of a hollow cylinder.

[0100] FIGS. 10A to 10B show a schematic view and a cross-section of a fifth fixation device. The fifth fixation device 700 includes an outer sheath 701 and a catheter 702. The catheter 702 additionally comprises a distal tip portion 706 with a slot 707 for receiving a feltable textile 702 and tissue 703. On an opposing side of a felting needle 704, a distal counter surface 708 of the slot 707 is arranged. The distal tip portion and the counter surface 708 hold the feltable textile and the tissue in place during fixation by generating resistance and keeping feltable textile 702 and tissue 703 in place.

[0101] A further embodiment of a fixation device 800 is shown with reference to FIGS. 11A to 12. FIGS. 11A to 11B show the fixation device 800 in isolation while FIG. 12 illustrates an example implantation of the fixation device 800 in the annulus of the aortic valve of a human. The fixation device 800 includes an outer sheath 801 and an inner sheath 802. A holder 803 for an implant comprising a feltable textile is arranged at the distal end portion of the inner sheath 802. The holder includes a plurality of arms 804 as can be seen in FIG. 11A. These arms 804 hold the feltable textile that forms an annuloplasty ring 805 for the aortic valve in the shown embodiment as can be seen from FIGS. 11B to 12. The arms 804 may clamp, grasp, be laced through the feltable textile or otherwise fixate the annuloplasty ring to hold the annuloplasty ring. Similarly to the holder 409, the arms 804 may be made of a shape memory alloy or comprise one or more joints made of a shape memory alloy. Thus, when the arms are expelled from the outer sheath 802, they fold out radially and bring the annuloplasty ring in a position in which the annuloplasty ring 805 can be attached to a soft tissue.

[0102] The embodiment shown in FIGS. 11A to 12D additionally includes two felting needles 806 with a driving assembly comprising two aims 807. The driving assembly is moved past the annuloplasty ring (i.e. through the hole of the ring) in the distal direction. Upon being expelled from the inner sheath 802, the arms unfold or are unfolded, such that the felting needles at their end point in a distal direction. Then, the two felting needles are actuated such that the felting needles stitch the annuloplasty ring proximally from a distal direction and felt the annuloplasty ring to a soft tissue proximally behind the annuloplasty ring. The shown arrangement allows a user to control the pressure on the tissue by pulling at the inner sheath 802. This is particularly of interest where the target zone (area in which surgical felting is performed) is behind anatomical structures such as e.g. valves. Alternatively, the needles themselves might be curved or angled such that their tips point in a distal direction.

[0103] One application of the above described fixation devices and feltable textile is a mitral valve repair, optionally with replacement/enhancement of the chordae tendineae. During diastole, the opening of the mitral valve lets blood flow from the left atrium to the left ventricle. During systole, the mitral valve closes, so that blood gets pumped through the aorta to the body. Patients suffering from mitral regurgitation have a mitral valve that does not close Lightly, which allows blood to flow from the left ventricle back to the left atrium. Depending on cause and severity of the case, one approach is to replace or enhance the chordae tendineae; the cords that transmit the contraction and relaxation of the papillary muscles to the mitral valve. Access to the mitral valve may be gained percutaneously through the femoral vein and puncture of the septum. The catheter enters the mitral valve and fixates the first end of a textile patch to the papillary muscle. A second end is fixated at the leaflet and gets released by the catheter. Thereby, the chordae tendineae are supported by the feltable textile that are fixated strongly and durably. In particular, the device shown with respect to FIGS. 7 to 8B might be used for this purpose.

[0104] Another application of the above described fixation devices and feltable textiles is an Atrial Septal Defect (ASD). ASD is a congenital heart defect that occurs, when the septum between the two atria is not developed properly and a hole remains. Depending on the size and location of the defect, the hole needs to be closed. The majority of cases can be treated by a transcatheter approach shown above. Access to the defect of the septum is gained percutaneously through the femoral vein into the right atrium. The elongate tubular member in the form of a catheter contains a central rod with a folded disk at the tip, which is guided through the hole into the left atrium. There, the feltable textile can be unfolded and expanded. A holder as described above may fixate the feltable textile. The pusher may also push the folded textile that will occlude the hole. It gets pushed through the catheter, unfolds once it exits the catheter and is pressed onto the septum. Two hollow tubes, each equipped with a barbed needle next to the central rod are guided to the patch. They fixate the edge of the patch by rotating (in this case 90) in both directions (clockwise and counterclockwise) and thereby occluding the hole as shown in FIGS. 4A to 4C. Alternatively, this surgery could also be performed with a continuous deployed feltable textile as shown with respect to FIG. 7 to 8B.

[0105] In a further example of a surgical procedure, the feltable textile is advanced through the septal defect, such that the main section is positioned in the septal defect, the first connecting section is arranged in the left atrium and the second connecting section is arranged in the right atrium, or vice versa. An upper portion of the first connecting section may then be connected to the upper part of the atrial septum adjacent the atrial septal defect, and an upper portion of the second connecting section may be connected to the upper part of the atrial septum by advancing a surgical felting needle repeatedly through the respective portion of the respective connecting section and into the atrial septum. In this manner, the fibers of the respective connecting section are inserted into the atrial septum to tightly connect the medical implant to the heart tissue. Subsequently, a mechanical force (e.g. an upward force on the lower part of the heart and hence the lower part of the atrial septum or a downward force on the upper part of the heart and hence the upper part of the atrial septum) may be applied to transiently close the septal defect, and the lower portion of the first connecting section and the lower portion of the second connecting section may then be connected to the heart tissue of the lower part of the atrial septum by advancing a surgical felting needle repeatedly through the respective portion of the respective connecting section and into the tissue of the lower part of the atrial septum. The described procedure is preferably performed using minimal invasive surgery, i.e. by advancing one or several catheters into the left atrium and or the right atrium of the heart via the vascular system of the patient.

[0106] Although the present invention has been described with reference to preferred embodiments, workers skilled in the art will recognize that changes may be made in form and detail without departing from the spirit and scope of the invention.