Tissue Anchor with Tether Stop

Abstract

An expandable tissue anchor is provided that includes an elongate tissue-coupling portion configured to be delivered through a cardiac tissue wall, and a flexible elongate tension member, which is coupled to a portion of the tissue-coupling portion such that a tensile force can be applied to the tissue-coupling portion after it has been expanded. A portion of the tension member is slidably disposed through a passage defined by the anchor. A sleeve encloses a portion of the tension member between the tissue-coupling portion and a distal opening of the passage. The sleeve and the passage are sized and shaped such that the size and shape of the passage prevent proximal movement of the sleeve past the passage upon application of the tensile force to the tension member, thereby limiting compression and deformation of the expanded tissue-coupling portion by the tension member. Other embodiments are also described.

Claims

1. An expandable tissue anchor configured to be delivered to a cardiac chamber using a deployment tool, and to be anchored to a cardiac tissue wall at a target site such that a tensile force can be applied to the expandable tissue anchor and thus to the cardiac tissue wall, once the expandable tissue anchor is deployed, so as to move the cardiac tissue wall at the target site relative to adjacent cardiac tissue, the expandable tissue anchor comprising: an elongate tissue-coupling portion configured to be delivered in an unexpanded generally elongate configuration through the cardiac tissue wall from a first side of the cardiac tissue wall to a second side of the cardiac tissue wall, the tissue-coupling portion further configured to expand on the second side of the cardiac tissue wall; a flexible elongate tension member, which is coupled to a portion of the tissue-coupling portion of the expandable tissue anchor such that the tensile force can be applied to the tissue-coupling portion after it has been expanded, wherein a portion of the flexible elongate tension member is slidably disposed through a passage defined by the expandable tissue anchor; and a sleeve that encloses a portion of the flexible elongate tension member between (a) the tissue-coupling portion of the expandable tissue anchor and (b) a distal opening of the passage, wherein the sleeve and the passage are sized and shaped such that the size and shape of the passage prevent proximal movement of the sleeve past the passage upon application of the tensile force to the flexible elongate tension member, thereby limiting compression and deformation of the expanded tissue-coupling portion by the flexible elongate tension member.

2. The expandable tissue anchor according to claim 1, wherein the sleeve is axially slidable along the flexible elongate tension member.

3. The expandable tissue anchor according to claim 1, wherein the sleeve is configured such that the expanded tissue-coupling portion and the sleeve can be drawn tightly against the second side of the cardiac tissue wall at the target site when the tensile force is applied to the tissue-coupling portion.

4. The expandable tissue anchor according to claim 1, wherein the expandable tissue anchor is configured such that when the cardiac tissue wall is a myocardial tissue wall, the tissue-coupling portion of the expandable tissue anchor can be advanced into the pericardial cavity between visceral pericardium and parietal pericardium, generally alongside and against the parietal pericardium, without penetrating the parietal pericardium.

5. The expandable tissue anchor according to claim 1, further comprising an anchor head that supports the tissue-coupling portion at a proximal end of the tissue-coupling portion.

6. The expandable tissue anchor according to claim 5, wherein the anchor head is shaped so as to define the passage.

7. The expandable tissue anchor according to claim 6, wherein a lateral surface of the anchor head is shaped so as to define at least a portion of the distal opening of the passage.

8. The expandable tissue anchor according to claim 6, wherein the anchor head comprises a collar, which is shaped so as to define the distal opening of the passage.

9. The expandable tissue anchor according to claim 8, wherein a distal end of the collar is shaped so as to define the distal opening of the passage.

10. The expandable tissue anchor according to claim 8, wherein a lateral surface of the collar is shaped so as to define at least a portion of the distal opening of the passage.

11. The expandable tissue anchor according to claim 5, wherein the tissue-coupling portion of the expandable tissue anchor, once expanded on the second side of the cardiac tissue wall, assumes a shape generally orthogonal to the anchor head.

12. An anchor system comprising the expandable tissue anchor according to claim 1, wherein the anchor system further comprises a tether affixed to the flexible elongate tension member such that the tensile force can be applied to the expandable tissue anchor via the tether and the flexible elongate tension member.

13. A method for moving a cardiac tissue wall at a target site relative to adjacent cardiac tissue, the method comprising: delivering, to a cardiac chamber, an expandable tissue anchor in an unexpanded generally elongate configuration within a deployment tool, the expandable tissue anchor comprising (a) an elongate tissue-coupling portion, (b) a flexible elongate tension member coupled to a portion of the tissue-coupling portion, and (c) a sleeve that encloses a portion of the flexible elongate tension member between (i) the tissue-coupling portion of the expandable tissue anchor and (ii) a distal opening of a passage defined by the expandable tissue anchor, wherein a portion of the flexible elongate tension member is slidably disposed through the passage defined by the expandable tissue anchor; delivering the tissue-coupling portion in an unexpanded generally elongate configuration through the cardiac tissue wall from a first side of the wall to a second side of the wall, such that the tissue-coupling portion expands on the second side of the cardiac tissue wall, thereby anchoring the expandable tissue anchor to the cardiac tissue wall at the target site; partially compressing the expanded tissue-coupling portion by applying a tensile force to the flexible elongate tension member, until the passage prevents proximal movement of the sleeve past the passage, thereby limiting compression and deformation of the expanded tissue-coupling portion by the flexible elongate tension member; and after the passage prevents proximal movement of the sleeve past the passage, applying, to the flexible elongate tension member, additional tensile force that does not further compress or deform the expanded tissue-coupling portion, and thus is applied to the cardiac tissue wall, so as to move the cardiac tissue wall at the target site relative to the adjacent cardiac tissue.

14. The method according to claim 13, wherein the expandable tissue anchor further comprises an anchor head that supports the tissue-coupling portion at a proximal end of the tissue-coupling portion.

15. The method according to claim 13, wherein the anchor head is shaped so as to define the passage.

16. The method according to claim 15, wherein a lateral surface of the anchor head is shaped so as to define at least a portion of the distal opening of the passage.

17. The method according to claim 15, wherein the anchor head comprises a collar, which is shaped so as to define the distal opening of the passage.

18. The method according to claim 17, wherein a distal end of the collar is shaped so as to define the distal opening of the passage.

19. The method according to claim 17, wherein a lateral surface of the collar is shaped so as to define at least a portion of the distal opening of the passage.

20. The method according to claim 13, wherein the tissue-coupling portion and the expandable tissue anchor, once expanded on the second side of the cardiac tissue wall, comprises a configuration generally orthogonal to the anchor head.

21. The method according to claim 13, wherein the sleeve is axially slidable along the flexible elongate tension member.

22. The method according to claim 13, wherein applying the tensile force to the flexible elongate tension member comprises tightly drawing the expanded tissue-coupling portion and the sleeve against the second side of the cardiac tissue wall at the target site.

23. The method according to claim 13, wherein the cardiac tissue is a myocardial tissue wall, and wherein delivering the tissue-coupling portion in the unexpanded generally elongate configuration through the cardiac tissue wall comprises delivering the tissue-coupling portion through the cardiac tissue wall into the pericardial cavity between visceral pericardium and parietal pericardium, generally alongside and against the parietal pericardium, without penetrating the parietal pericardium.

24. The method according to claim 13, wherein applying the tensile force to the flexible elongate tension member comprises applying the tensile force to a tether affixed to the flexible elongate tension member.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0039] FIG. 1 is a schematic illustration of an expandable tissue anchor that is configured to be anchored to a cardiac tissue wall at a target site, in accordance with an application of the present invention;

[0040] FIGS. 2A-C are schematic illustrations of a method of deploying the expandable tissue anchor of FIG. 1 through a myocardial tissue wall, in accordance with an application of the present invention;

[0041] FIG. 3 is a schematic illustration of another expandable tissue anchor, in accordance with an application of the present invention; and

[0042] FIG. 4 is a schematic illustration of yet another expandable tissue anchor, in accordance with an application of the present invention.

DETAILED DESCRIPTION OF APPLICATIONS

[0043] FIG. 1 is a schematic illustration of an expandable tissue anchor 120 that is configured to be anchored to a cardiac tissue wall at a target site such that a tensile force can be applied to expandable tissue anchor 120 and thus to the cardiac tissue wall, so as to move the cardiac tissue wall at the target site relative to adjacent cardiac tissue, in accordance with an application of the present invention. Expandable tissue anchor 120 comprises an elongate tissue-coupling portion 130, which optionally is supported by an anchor head 196 at a proximal end 134 of tissue-coupling portion 130. Tissue-coupling portion 130 is configured to be delivered in an unexpanded generally elongate configuration, such as described hereinbelow with reference to FIG. 2A, through the cardiac tissue wall from a first side of the wall to a second side of the wall, such as described hereinbelow with reference to FIGS. 2A-C. Tissue-coupling portion 130 is further configured, upon deployment, to expand on the second side of the cardiac tissue wall, such as described hereinbelow with reference to FIG. 2B. FIGS. 1 and 2B show tissue-coupling portion 130 expanded. For some applications, expanded tissue-coupling portion 130 has less than one turn, as shown in the figures, while for other applications, expanded tissue-coupling portion 130 has one turn (configuration not shown) or more than one turn (configuration not shown, but, for example, may be as shown in FIGS. 5B-D, 6A-B, 7A-B, 9A-G, and/or 91 of above-mentioned PCT Publication WO 2016/087934).

[0044] Expandable tissue anchor 120 further comprises a flexible elongate tension member 146 coupled to a portion of tissue-coupling portion 130 of expandable tissue anchor 120. Through flexible elongate tension member 146, or components equivalent thereto, the tensile force can be applied to tissue-coupling portion 130 after it has been expanded. When applied in vivo, the tensile force may have the benefit of bringing the anchor close to the tissue wall to which it is applied. For some applications, an anchor system 150 is provided that comprises expandable tissue anchor 120 and a tether 152 affixed to flexible elongate tension member 146 such that the tensile force can be applied to expandable tissue anchor 120 via tether 152 and flexible elongate tension member 146. Optionally, expandable tissue anchor 120 further comprises a tube 154 that surrounds a proximal portion of flexible elongate tension member 146. For some applications, anchor system 150 further comprises a second tissue anchor, separate and distinct from expandable tissue anchor 120, such as is shown in above-mentioned PCT Publication WO 2016/087934. For some applications, the second tissue anchor, and additional anchors if so desired, is couplable or coupled to expandable tissue anchor 120 by one or more tethers that include tether 152.

[0045] Expandable tissue anchor 120 further comprises a sleeve 190 that encloses a portion of flexible elongate tension member 146 between (a) tissue-coupling portion 130 of expandable tissue anchor 120 and (b) a distal opening 194 of a passage 191 through expandable tissue anchor 120, such that expanded tissue-coupling portion 130 (and, optionally, sleeve 190) can be drawn tightly against the second side of the cardiac tissue wall at the target site when the tensile force is applied to tissue-coupling portion 130.

[0046] Distal opening 194 of passage 191 is typically located near (e.g., at) a distal end 192 of anchor head 196. A portion of flexible elongate tension member 146 is slidably disposed through passage 191. For some applications, passage 191 is defined by anchor head 196 (as shown). For example, distal opening 194 may be defined by a tubular anchor shaft 132 that anchor head 196 comprises; anchor head 196 may optionally implement techniques described in above-mentioned PCT Publication WO 2016/087934. For some applications, in addition to or instead of tubular anchor shaft 132, anchor head 196 comprises one or more collars 197, such as distal and proximal collars 197A and 197B, as shown, or exactly one collar 197 (configuration not shown). For some of these applications, distal opening 194 is defined by a distal end of distal collar 197A (as shown in FIGS. 1 and 2A-C) or a distal end of the exactly one collar 197 (configuration not shown). For other applications, distal opening 194 is defined by a lateral surface of the distal collar, such as described hereinbelow with reference to FIG. 3. For some applications, passage 191 includes more than one passage 191, as shown. For some applications, passage 191 is alternatively or additionally defined by another portion of expandable tissue anchor 120, such as both tissue-coupling portion 130 of expandable tissue anchor 120 and anchor head 196 of expandable tissue anchor 120, such as shown in FIG. 4, described hereinbelow. Passage 191 is typically a channel, but may also be a groove (e.g., a U-shaped groove).

[0047] Sleeve 190 and passage 191 are sized and shaped such that the size and shape of passage 191 prevent proximal movement of sleeve 190 past passage 191 (e.g., prevent proximal movement of sleeve 190 into distal opening 194). Sleeve 190 and passage 191 thus limit movement of tissue-coupling portion 130 toward distal end 192 of anchor head 196 upon application of the tensile force to flexible elongate tension member 146. This is the case because sleeve 190 has sufficient axial stiffness and too large an outer diameter to pass through passage 191 (e.g., including distal opening 194), and a distal (far) end 193 of sleeve 190 contacts tissue-coupling portion 130 near a junction 195 between flexible elongate tension member 146 and tissue-coupling portion 130, such as shown in FIG. 2C. Sleeve 190, because of its axial stiffness, thus limits compression and deformation of expanded tissue-coupling portion 130 by flexible elongate tension member 146. A portion of the load (tension) applied by flexible elongate tension member 146 brings sleeve 190 into contact with expandable tissue anchor 120 near or at distal opening 194. Additional load (tension) applied by flexible elongate tension member 146 (a) increases the total load on expanded tissue-coupling portion 130 (without further compressing or deforming expanded tissue-coupling portion 130), (b) optionally is diverted to elastic or plastic deformation of sleeve 190, and (c) pulls on the entire expandable tissue anchor 120.

[0048] Attachment of sleeve 190 to flexible elongate tension member 146 is relatively simple during manufacture of expandable tissue anchor 120, as sleeve 190 need not be, and indeed typically is not, axially fixed to flexible elongate tension member 146. Even though sleeve 190 is typically axially slidable along flexible elongate tension member 146, the sleeve nevertheless serves its compression-limiting function, as described hereinabove.

[0049] In addition, sleeve 190 may generally increase the contact area between flexible elongate tension member 146 and the second site of the cardiac tissue wall. As a result, sleeve 190 may generally reduce the likelihood of flexible elongate tension member 146 cutting the cardiac tissue wall, particularly if the tissue is diseased.

[0050] For some applications, sleeve 190 has an outer diameter of at least 0.5 mm, no more than 1 mm, and/or between 0.5 and 1 mm, such as 0.75 mm. For some applications, sleeve 190 has a length of at least 2 mm, no more than 6 mm, and/or between 2 and 6 mm, such as between 3 and 5 mm, e.g., 4 mm. For some applications, sleeve 190 comprises PET, PEEK, a closely wound metal coil spring, porous ePTFE, or woven PET fiber.

[0051] For some applications, tissue-coupling portion 130, once expanded on the second side of the cardiac tissue wall, such as described hereinbelow with reference to FIG. 2B, assumes a shape generally orthogonal to anchor head 196, as shown in FIG. 1, although it need not be orthogonal.

[0052] For some applications, as shown in FIG. 1, anchor head 196 further comprises a sealing element 174, which is sized and shaped to be inserted with anchor head 196 into an incision through the cardiac tissue wall. Sealing element 174, along with at least a portion of anchor head 196, remains in the incision upon completion of the implantation of expandable tissue anchor 120. Sealing element 174 promotes hemostasis to provide sealing of the incision. For some applications, sealing element 174 comprises a mesh, which may comprise Nitinol, covered with a membrane. The membrane may comprise a bioabsorbable polymer, which breaks down after healing and hemostasis occur.

[0053] Reference is now made to FIGS. 2A-C, which are schematic illustrations of a method of deploying expandable tissue anchor 120 through a myocardial tissue wall 160, in accordance with an application of the present invention. Although in FIGS. 2A-C expandable tissue anchor 120 is shown deployed through a myocardial tissue wall, expandable tissue anchor 120 may also be deployed through other cardiac tissue walls, such as the interatrial septum, either at or not at the fossa ovalis, or through other non-cardiac tissue walls. Indeed, the tissue anchors described herein may be deployed in any number of bodily locations where it is desired to anchor into or behind tissue for purposes of moving such tissue relative to adjacent tissue.

[0054] As shown in FIG. 2A, expandable tissue anchor 120 is delivered to a target site, such as a cardiac chamber, in an unexpanded generally elongate configuration within a deployment tool 170, which may comprise a hollow needle 172. The cardiac chamber may be a right atrium 164 (as shown), a right ventricle 166 (configuration not shown), a left atrium (configuration not shown), or a left ventricle (configuration not shown). In one application, hollow needle 172 is used to puncture through a first side of a myocardial tissue wall 160 and visceral pericardium 182 (which is part of the epicardium), avoiding vasculature such as the right coronary artery

[0055] (RCA) 178. For some applications, deployment tool 170 is then further directed into the pericardial cavity 180 between visceral pericardium 182 and parietal pericardium 184, carefully avoiding puncturing parietal pericardium 184 and fibrous pericardium 186.

[0056] As shown in FIG. 2B, tissue-coupling portion 130 expands on the second side of myocardial tissue wall 160, thereby anchoring expandable tissue anchor 120 to myocardial tissue wall 160.

[0057] As shown in FIG. 2C, once expandable tissue anchor 120 has been anchored to myocardial tissue wall 160 at the target site, expanded tissue-coupling portion 130 (and, optionally, sleeve 190) is tightly drawn against the second side of myocardial tissue wall 160 at the target site by applying a tensile force, using tether 152, to tissue-coupling portion 130 and thus to myocardial tissue wall 160. Application of the tensile force partially compresses expanded tissue-coupling portion 130, until passage 191 prevents proximal movement of sleeve 190 past passage 191, thereby limiting movement of tissue-coupling portion 130 toward distal end 192 of anchor head 196 and thus further compression and deformation of expanded tissue-coupling portion 130. Typically, after passage 191 prevents the proximal movement of the sleeve 190 past the passage, addition tensile force is applied to flexible elongate tension member 146 that does not further compress or deform the expanded tissue-coupling portion 130. As a result, the additional tensile force is applied to myocardial tissue wall 160 and myocardial tissue wall 160 at the target site is moved relative to adjacent cardiac tissue. For some applications, such motion can have the benefit of altering the geometry of a nearby cardiac valve, such as the tricuspid valve or the mitral valve.

[0058] For some applications, after application of the tensile force, all or a portion of sleeve 190 rests against the second side of myocardial tissue wall 160, generally helping prevent possible inadvertent cutting of myocardial tissue wall 160 by flexible elongate tension member 146. For some applications, such as shown in FIG. 2B, tissue-coupling portion 130 (and sleeve 190) is delivered through myocardial tissue wall 160, into pericardial cavity 180, generally alongside and against parietal pericardium 184, without penetrating the parietal pericardium 184. For some applications, a second tissue anchor is implanted, separate and distinct from expandable tissue anchor 120.

[0059] Reference is made to FIGS. 1 and 2A-C. For some applications, tissue-coupling portion 130 comprises a tip 188, which is fixed to a distal end of a wire 189 of tissue-coupling portion 130. Tip 188, at a widest longitudinal site along tip 188, has a greatest outer cross-sectional area that equals at least 150% (e.g., at least 200%, or at least 300%) of an average cross-sectional area of wire 189. (The cross-sectional area of tip 188 is measured perpendicular to a central longitudinal axis of tip 188. Similarly, the cross-sectional area of wire 189 is measured perpendicular to a central longitudinal axis of the wire, and is not a cross-sectional area of tissue-coupling portion 130.) Tip 188 temporarily serves as an atraumatic distal end of hollow needle 172 of deployment tool 170 when the tip is removably coupled to a distal end of hollow needle 172, as shown in FIG. 2A. For some applications, hollow needle 172 of deployment tool 170 has an outer cross-sectional area which equals between 90% and 110% (e.g., 100%) of the greatest outer cross-sectional area of tip 188, and tip 188 is shaped so as to removably engage the distal end of hollow needle 172, such as shown in FIG. 2A. Alternatively, tip 188 is smaller than the internal diameter of hollow needle 172, allowing tip 188 to be retracted into the needle. Wire 189 may be solid or hollow (i.e., tubular).

[0060] For some applications, wire 189 comprises a shape-memory alloy, which is configured to automatically transition to a predetermined shape upon deployment of tissue-coupling portion 130 on the second side of the cardiac tissue wall. For some of these applications, tissue-coupling portion 130 comprises tip 188, while for others of these applications, tissue-coupling portion 130 does not comprise tip 188.

[0061] Reference is still made to FIGS. 1 and 2A-C. For some applications, expandable tissue anchor 120 further comprises a second sleeve 198, which encloses a portion of wire 189 of tissue-coupling portion 130. Second sleeve 198 serves to increase the contact area between tissue-coupling portion 130 and the second site of the cardiac tissue wall. As a result, second sleeve 198 may generally reduce the likelihood of wire 189 cutting the cardiac tissue wall, particularly if the tissue is diseased. For some applications, second sleeve 198 has an inner diameter of 0.5 mm and an outer diameter of 1.0 mm, and/or may comprise, for example, porous ePTFE or woven PET fiber. The combined profile of sleeve 190 and second sleeve 198 is less than the inner diameter of hollow needle 172.

[0062] Reference is now made to FIG. 3, which is a schematic illustration of an expandable tissue anchor 220, in accordance with an application of the present invention. Except as described below, expandable tissue anchor 220 is generally similar to expandable tissue anchor 120, described hereinabove with reference to FIGS. 1 and 2A-C, and like reference numerals refer to like parts. Expandable tissue anchor 220 may implement any of the techniques described hereinabove for expandable tissue anchor 120, including, for example, sealing element 174, even though the sealing element is not shown in FIG. 3. For some applications, an anchor system 250 is provided that comprises expandable tissue anchor 220 and tether 152 affixed to flexible elongate tension member 146 such that the tensile force can be applied to expandable tissue anchor 220 via tether 152 and flexible elongate tension member 146.

[0063] An anchor head 296 of expandable tissue anchor 220 supports elongate tissue-coupling portion 130 at a proximal end of the tissue-coupling portion. A lateral surface 299 of anchor head 296, typically near a distal end 292 of anchor head 296, is shaped so as to define at least a portion of a distal opening 294 of a passage 291 through expandable tissue anchor 220. For some applications, anchor head 296 comprises one or more collars 297, such as distal and proximal collars 297A and 297B, as shown. Lateral surface 299 may be defined by distal collar 297A, typically near distal end 292 of anchor head 296. Alternatively, anchor head 296 comprises exactly one collar 297, and distal opening 294 is defined by a lateral surface of the exactly one collar (configuration not shown). Further alternatively, anchor head 296 does not comprise any collars 297, and distal opening 294 of passage 291 is defined by a lateral wall of another portion of anchor head 296, such as of a tubular anchor shaft 232 that anchor head 296 comprises (configuration not shown). For some applications, passage 291 includes more than one passage 291, as shown. Passage 291 is typically a channel, but may also be a groove (e.g., a U-shaped groove).

[0064] A portion of flexible elongate tension member 146 is slidably disposed through passage 291. Sleeve 190 and passage 291 are sized and shaped such that the size and shape of passage 291 prevent proximal movement of sleeve 190 past passage 291 (e.g., prevent proximal movement of sleeve 190 into distal opening 294). Sleeve 190 and passage 291 thus limit movement of tissue-coupling portion 130 toward distal end 192 of anchor head 196 upon application of the tensile force to flexible elongate tension member 146. This is the case because sleeve 190 has sufficient axial stiffness and too large an outer diameter to pass through passage 291 (e.g., including distal opening 294), and a distal (far) end of sleeve 190 contacts tissue-coupling portion 130 near a junction between flexible elongate tension member 146 and tissue-coupling portion 130, such as shown in FIG. 2C for expandable tissue anchor 120. Sleeve 190, because of its axial stiffness, thus limits compression and deformation of expanded tissue-coupling portion 130 by flexible elongate tension member 146. A portion of the load (tension) applied by flexible elongate tension member 146 brings sleeve 190 into contact with lateral surface 299 of distal collar 297A near or at distal opening 194. Additional load (tension) applied by flexible elongate tension member 146 (a) increases the total load on expanded tissue-coupling portion 130 (without further compressing or deforming expanded tissue-coupling portion 130), (b) optionally is diverted to elastic or plastic deformation of sleeve 190, and (c) pulls on the entire expandable tissue anchor 120.

[0065] Locating distal opening 294 of passage 291 at least partially through lateral surface 299 of distal collar 297A may reduce the load on the curved portion of flexible elongate tension member 146 in the vicinity of distal opening 294. In addition, any damage to the proximal end of sleeve 190 is reduced or avoided because the proximal end of sleeve 190 is oriented perpendicularly with distal opening 294 at the point of contact with the distal opening. Further, in this arrangement, flexible elongate tension member 146 is not subject to shear between sleeve 190 and the edge of distal opening 294.

[0066] Reference is now made to FIG. 4, which is a schematic illustration of an expandable tissue anchor 320, in accordance with an application of the present invention. Except as described below, expandable tissue anchor 320 is generally similar to expandable tissue anchor 120, described hereinabove with reference to FIGS. 1 and 2A-C, and like reference numerals refer to like parts. Expandable tissue anchor 220 may implement any of the techniques described hereinabove for expandable tissue anchor 120. For some applications, an anchor system 350 is provided that comprises expandable tissue anchor 320 and tether 152 affixed to flexible elongate tension member 146 such that the tensile force can be applied to expandable tissue anchor 320 via tether 152 and flexible elongate tension member 146.

[0067] In this configuration, a passage 391 through expandable tissue anchor 320 is defined at least in part by tissue-coupling portion 130 of expandable tissue anchor 320. A distal opening 394 of passage 391 may be defined by wire 189 of tissue-coupling portion 130, which, in this configuration, includes at least a portion that is hollow (i.e., tubular), through which a portion of flexible elongate tension member 146 passes. Optionally, passage 391 is also defined by (a) an anchor head 396 of expandable tissue anchor 120 that supports elongate tissue-coupling portion 130 at a proximal end of the tissue-coupling portion. For some applications, anchor head 396 comprises one or more collars 397, such as distal and proximal collars 397A and 397B, as shown, or exactly one collar 397, and passage 391 passes through the one or more collars 397. For some applications, passage 391 includes more than one passage 391, as shown. Passage 391 is typically a channel, but may also be a groove (e.g., a U-shaped groove).

[0068] The scope of the present invention includes embodiments described in the following applications, which are assigned to the assignee of the present application and are incorporated herein by reference. For some applications, techniques and apparatus described in one or more of the following applications are combined with techniques and apparatus described herein: [0069] U.S. Pat. No. 8,475,525 to Maisano et al.; [0070] U.S. Pat. No. 8,961,596 to Maisano et al.; [0071] U.S. Pat. No. 8,961,594 to Maisano et al.; [0072] PCT Publication WO 2011/089601; [0073] U.S. Pat. No. 9,241,702 to Maisano et al.; [0074] U.S. Provisional Application 61/750,427, filed Jan. 9, 2013; [0075] U.S. Provisional Application 61/783,224, filed Mar. 14, 2013; [0076] U.S. Provisional Application 61/897,491, filed Oct. 30, 2013; [0077] U.S. Provisional Application 61/897,509, filed Oct. 30, 2013; [0078] U.S. Pat. No. 9,307,980 to Gilmore et al.; [0079] PCT Publication WO 2014/108903; [0080] PCT Publication WO 2014/141239; [0081] U.S. Provisional Application 62/014,397, filed Jun. 19, 2014; [0082] PCT Publication WO 2015/063580; [0083] US Patent Application Publication 2015/0119936; [0084] U.S. Provisional Application 62/086,269, filed Dec. 2, 2014; [0085] U.S. Provisional Application 62/131,636, filed Mar. 11, 2015; [0086] U.S. Provisional Application 62/167,660, filed May 28, 2015; [0087] PCT Publication WO 2015/193728; [0088] PCT Publication WO 2016/087934; [0089] US Patent Application Publication 2016/0235533; [0090] US Patent Application Publication 2016/0242762; [0091] PCT Publication WO 2016/189391; [0092] US Patent Application Publication 2016/0262741; [0093] U.S. Provisional Application 62/376,685, filed Aug. 18, 2016; [0094] U.S. Provisional Application 62/456,206, filed Feb. 8, 2017; [0095] U.S. Provisional Application 62/456,202, filed Feb. 8, 2017; [0096] U.S. Provisional Application 62/465,410, filed Mar. 1, 2017; and [0097] U.S. Provisional Application 62/465,400, filed Mar. 1, 2017.

[0098] Patents and patent application publications incorporated by reference in the present patent application are to be considered an integral part of the application except that to the extent any terms are defined in these incorporated patents and patent application publications in a manner that conflicts with the definitions made explicitly or implicitly in the present specification, only the definitions in the present specification should be considered.

[0099] It will be appreciated by persons skilled in the art that the present invention is not limited to what has been particularly shown and described hereinabove. Rather, the scope of the present invention includes both combinations and subcombinations of the various features described hereinabove, as well as variations and modifications thereof that are not in the prior art, which would occur to persons skilled in the art upon reading the foregoing description.