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    • 专利摘要:
    HEART VALVE REPLACEMENT APPARATUS AND METHODS. The present invention relates to systems and methods for replacing a native heart valve (16). An expandable helical anchor (12) is formed as multiple loops (22) adapted to support a heart valve prosthesis (60). At least one of the turns (22) is normally in a first diameter, and is expandable to a second, larger diameter when applying an outward radial force from within the helical anchor (12). A gap (91) is defined between adjacent turns (22) sufficient to prevent coupling by at least one of the adjacent turns (22) with the native heart valve (16). An expandable heart valve prosthesis (60) is provided and configured to be supplied within the helical anchor (12) and expanded within the multiple loops (22) in coupling with at least one loop (22). This moves at least this loop (22) from the first diameter to the second diameter while holding the helical anchor (12) and the heart valve prosthesis (60) together. The system also includes a seal (90) over the expandable heart valve prosthesis (60) configured to couple the helical anchor (12) and prevent blood leakage passing through the heart valve prosthesis (60) after implantation of the valve prosthesis (60) within the helical anchor (12). Gadgets (...).
    公开号:BR112016003044B1
    申请号:R112016003044-3
    申请日:2014-08-14
    公开日:2021-02-09
    发明作者:Paul A. Spence；Landon H. Tompkins；Mark Chau；Alex Siegel
    申请人:Mitral Valve Technologies Sarl；Landon H. TOMPKINS；
    IPC主号:
    专利说明:

    CROSS REFERENCE TO RELATED REQUESTS
    [001] This order claims priority for U.S. Interim Order Serial Number 61 / 865,657, filed on August 14, 2013 (pending); U.S. Interim Order Serial Number. 61 / 942,300, deposited on February 20, 2014 (pending); and U U.S. Provisional Order Serial Number 61 / 943,125, filed on 21, 2014 (pending), descriptions of which are hereby incorporated by reference. TECHNICAL FIELD
    [002] The present invention generally relates to medical procedures and devices relating to heart valves such as replacement device and techniques. More specifically, the invention relates to the replacement of heart valves that have various malformations and dysfunctions. BACKGROUND
    [003] Complications of the mitral valve, which controls the flow of blood from the left atrium into the left ventricle of the human heart, have been known to cause fatal heart failure. In the developed world, one of the most common forms of valvular heart disease is leakage of the mitral valve, also known as mitral regurgitation, which is characterized by the leakage of abnormal blood from the left ventricle through the mitral valve and back into the left atrium. . This most commonly occurs due to ischemic heart disease when mitral valve follicles are no longer found or closed properly after multiple infarctions, idiopathic and hypertensive cardiomyopathies where the left ventricle enlarges, and with follicle and cord abnormalities, such as those caused by a degenerative disease.
    [004] In addition to mitral regurgitation, mitral narrowing or stenosis is most often the result of rheumatic disease. Although this has been virtually eliminated in developed countries, it is still common where living standards are not so high.
    [005] Similar to complications of the mitral valve are complications of the aortic valve, which controls the flow of blood from the left ventricle into the aorta. For example, many older patients develop aortic valve stenosis. Historically, the traditional treatment has been to replace the valve with a large open-heart procedure. The procedure takes a considerable amount of time to recover since it is so highly invasive. Fortunately over the past decade, great strides have been made in replacing this open heart surgery procedure with a catheter procedure that can be performed quickly without surgical incisions or the need for a heart - lung machine to support circulation while the heart is stopped. Using catheters, the valves are mounted on stents or structures such as stents, which are compressed and delivered through blood vessels to the heart. The stents are then expanded and the valves begin to function. The diseased valve is not removed, but instead it is crushed or deformed by the stent which contains the new valve. The deformed tissue serves to help anchor the new prosthetic valve.
    [006] The supply of the valves can be carried out from arteries which can be easily accessed in a patient. Most commonly this is done from the groin where the femoral and iliac arteries can be cannulated. The shoulder region is also used, where the subclavian and axillary arteries can also be accessed. The recovery from this procedure is remarkably fast.
    [007] Not all patients can be served with a pure catheter procedure. In some cases the arteries are too small to allow catheters to pass into the heart, or the arteries are too sick or tortuous. In these cases, surgeons can make a small incision in the chest (thoracotomy) and then place these catheter-based devices directly into the heart. Typically, a pouch cord suture is made at the apex of the left ventricle and the delivery system is placed through the apex of the heart. The valve is then delivered to its final position. These delivery systems can also be used to access the aortic valve from the aorta itself. Some surgeons introduce the aortic valve delivery system directly into the aorta at the time of open surgery. The valves vary considerably. There is a mounting structure that is often a form of stent. Prosthetic follicles are loaded into the stent on the assembly and retention structure. Typically, these follicles are made from biological material that is used in traditional surgical valves. The valve may be of an actual animal valve tissue or more often the follicles are made of pericardial tissue from cows, pigs or horses. These follicles are treated to reduce their immunogenicity and improve their durability. Many fabric processing techniques have been developed for this purpose. In the future, biologically created tissues can be used or polymers or other non-biological materials can be used for valve follicles. All of these can be incorporated into the inventions described in this description.
    [008] There are, in fact, more patients with mitral valve disease than aortic valve disease. In the course of the past decade, many companies have succeeded in creating catheter implantable or minimally invasive aortic valves, but implantation of a mitral valve is more difficult and to date there has been no good solution. Patients would benefit from implanting a device through a surgical procedure that employs a small incision or by implanting a catheter such as the groin. From the patient's point of view, the catheter procedure is very attractive. There is currently no commercially available way to replace the mitral valve with a catheter procedure. Many patients who require mitral valve replacement are elderly and an open-heart procedure is painful, risky and takes time to recover. Some patients are not even candidates for surgery due to old age and frailty. Therefore, there is a specific need for a remotely placed mitral valve replacement device.
    [009] Although previously, it was thought that mitral valve replacement instead of valve repair was associated with a more negative long-term prognosis for patients with mitral valve disease, this belief came into question. It is now believed that the outcome for patients with mitral valve leak or regurgitation is almost the same if the valve is repaired or replaced. Furthermore, the durability of a surgical mitral valve repair is now under question. Many patients, who have undergone repair, nets involve a leak over several years. As many of these are elderly, repeated intervention on an older patient is not welcome by the patient or the doctors.
    [0010] The most prominent obstacle to replacing the mitral valve of the catheter is to hold the valve in position. The mitral valve is subject to a large cyclic load. The pressure inside the left ventricle is close to zero before contraction and then rises to systolic pressure (or higher if there is aortic stenosis) and it can be very high if the patient has systolic hypertension. Often the load on the valve is 150 mm Hg or more. As the heart is moving as it beats, the movement and thus the load can combine to dislodge a valve. Also, the movement and rhythmic load can fatigue the materials leading to fractures of the materials. Thus, there is a major problem associated with anchoring a valve.
    [0011] Another problem with creating a mitral valve replacement provided by a catheter is the size. The implant must have characteristics of strong retention and avoidance of leakage and it must contain a valve. Separate prostheses can contribute to solving this problem by placing an anchor or dock first and then implanting the valve second. However, in this situation, the patient must remain stable between the implantation of the anchor or dock and the implantation of the valve. If the patient's native mitral valve is rendered non-functional by the anchor or dock, then the patient can quickly become unstable and the operator may be forced to quickly deploy the new valve or possibly stabilize the patient by removing the anchor or dock and abandoning the procedure.
    [0012] Another problem with mitral replacement is the leak around the valve, or paravalvular leak. If a good seal is not established around the valve, blood can leak back into the left atrium. This places an extra burden on the heart and can damage the blood as it travels in jets through the leak sites. Hemolysis or rupture of red blood cells is a frequent complication if this occurs. Paravalvular leakage was one of the common problems encountered when the aortic valve was first implanted over a catheter. During surgical replacement, a surgeon has a great advantage when replacing the valve as he or she can see a gap outside the valve suture line and prevent or repair it. With catheter insertion, this is not possible. Furthermore, large leaks can reduce a patient's survival and can cause symptoms that restrict mobility and make the patient uncomfortable (for example, short, edematous, fatigued breathing). Therefore, devices, systems, and methods which refer to mitral valve replacement must also incorporate a means to prevent and repair leaks around the replacement valve.
    [0013] The annular space of a patient's mitral valve can also be quite large. When companies develop surgical replacement valves, this problem is solved by restricting the number of valve sizes produced and then adding more fabric sheath around the valve margin to increase the valve size. For example, a patient may have a 45 mm annular valve space. In this case, the actual prosthetic valve diameter can be 30 mm and the difference is made up by adding a larger band of fabric sheath material around the prosthetic valve. However, in catheter procedures, adding more material to a prosthetic valve is problematic since the material must be condensed and retained by small delivery systems. This method is often very difficult and impractical, so alternative solutions are needed.
    [0014] As numerous valves have been developed for the aortic position, it is desirable to avoid repeating valve development if taking advantage of existing valves. These valves were very expensive to develop and bring to the market, so that extending their application can save considerable amounts of time and money. It would then be useful to create an anchor or mitral dock station for such a valve. An existing valve developed for the aortic position, perhaps with some modification, could then be implanted at the dock station. Some previously developed valves can adjust well without any modification, such as the Edwards Sapien ™ valve. Others, such as Corevalve ™, can be implantable but require some modification for optimal coupling with the anchor and mount inside the heart.
    [0015] A number of additional complications can arise from a poorly retained or poorly positioned mitral valve replacement prosthesis. Namely, a valve can be dislodged into the atrium or ventricle, which could be fatal for a patient. Previous prosthetic anchors reduced the risk of dislodgement by drilling through the tissue to retain the prosthesis. However, this is a risky maneuver as the penetration must be performed by a sharp object from a long distance, leading to a risk of perforation of the heart and injury to the patient.
    [0016] The orientation of the mitral prosthesis is also important. The valve should allow blood to flow easily from the atrium to the ventricle. A prosthesis that enters at an angle can lead to poor flow, obstruction of flow through the heart wall or a follicle and a poor hemodynamic result. A repeated contraction against the ventricular wall can also lead to the rupture of the back wall of the heart and the sudden death of the patient.
    [0017] With surgical mitral valve replacement or repair, sometimes the anterior follicle of the mitral valve follicle is pushed into the area of the left ventricular outflow and this leads to poor left ventricular emptying. This syndrome is known as left ventricular outflow obstruction. The replacement valve itself can cause left ventricular outflow tract obstruction if it is located close to the aortic valve.
    [0018] Yet another obstacle encountered when implanting a replacement mitral valve is the need for the patient's native mitral valve to continue to function regularly during the placement of the prosthesis so that the patient can remain stable without the need for a heart machine - lung to support circulation.
    [0019] In addition, it is desirable to provide devices and methods that can be used in a variety of implantation proposals. Depending on the anatomy and clinical situation of a specific patient, a medical professional may wish to make a determination regarding the optimal implantation method, such as inserting a replacement valve directly into the heart in an open procedure (open heart surgery or minimally evasive surgery ) or insert a vein replacement valve through arteries in a closed procedure (such as a catheter-based implant). It is preferable to allow a medical professional a plurality of implantation options to choose from. For example, a medical professional may wish to insert a replacement valve either on the ventricle side or the atrial side of the mitral valve.
    [0020] Therefore, the present invention provides devices and methods that solve these and other challenges in the art. SUMMARY
    [0021] In an illustrative embodiment, the invention provides a system to replace a native heart valve that includes an expandable helical anchor formed as multiple turns adapted to support a heart valve prosthesis. At least one of the loops is normally in a first diameter, and is expandable to a second, larger diameter when applying an outward radial force from within the helical anchor. A gap is defined between adjacent turns sufficient to prevent coupling by at least one of the adjacent turns with the native heart valve. An expandable heart valve prosthesis is provided and configured to be supplied within the helical anchor and expanded within the multiple turns in coupling with at least one loop. This moves at least this loop from the first diameter to the second diameter while holding the helical anchor and the heart valve prosthesis together. The system also includes a seal over the expandable heart valve prosthesis configured to couple the helical anchor and prevent blood leakage through the heart valve prosthesis after implantation of the heart valve prosthesis in the helical anchor.
    [0022] The system may include one or more additional aspects. For example, the helical anchor may include another loop that moves from a larger diameter to a smaller diameter as the heart valve prosthesis is expanded within the multiple turns. The fence can take many alternative forms. For example, the seal may include portions that extend between adjacent turns to prevent blood leakage through the helical anchor and through the heart valve prosthesis. The seal can be comprised of many different alternative materials. The seal may also comprise a membrane or panel that extends between at least two helical anchor loops after implantation of the heart valve prosthesis in the helical anchor. For example, an example is a biological material. The helical anchor may further comprise a shape memory material. The heart valve prosthesis includes a blood flow inlet end and a blood flow outlet end, and at least one end may be non-enlarged and generally cylindrical in shape. In an illustrative embodiment, the blood flow outlet end is radially enlarged outward and includes a shoulder to prevent damage to the tissue structure within the heart after implantation. The clearance may be formed by a loop portion of the helical anchor that extends non-parallel to adjacent spiral portions of the helical anchor.
    [0023] In another illustrative embodiment, a system is provided as generally described above, except that the seal is alternatively or in addition loaded on the helical anchor instead of being loaded on the heart valve prosthesis. Any other features as described or incorporated herein may be included.
    [0024] In another illustrative embodiment, a system for coupling a heart valve prosthesis includes a helical anchor formed of multiple turns adapted to support a heart valve prosthesis with loop portions positioned above and / or below the annular space of the heart valve. An external, flexible and helical tube carries the helical anchor turns to form a set. A helical delivery tool carries the assembly and is adapted to be rotated into position via a native heart valve. Additional or optional features can be provided. For example, a heart valve prosthesis can be expanded into multiple turns. The outer tube can be formed from a low-friction material adapted to slide out of the multiple helical anchor turns after rotating into position through the native heart valve. The outer tube may be attached to the helical supply tool with suture or any other method. The helical supply tool can be formed with a plurality of turns, and the outer tube can also be attached at the far end. The furthest end may further comprise a sharpened tip or shape to assist with delivery. The furthest end may further comprise a resilient element, and the furthest ends of the outer tube and helical supply tube are attached to the resilient element.
    [0025] In another illustrative embodiment, a system to replace a native heart valve includes a helical anchor formed of multiple turns adapted to support a heart valve prosthesis in the native heart valve. An expandable heart valve prosthesis is provided in this system and is capable of being supplied into the helical anchor and expanded into the multiple loops in coupling with at least one loop to hold the helical anchor and the heart valve prosthesis together. A guide structure on the expandable heart valve prosthesis is configured to guide the helical anchor to the position as the helical anchor is extruded from a helical anchor delivery catheter.
    [0026] The guide structure may further comprise an opening within a portion of the expandable heart valve prosthesis, such as an opening in a loop, a tube or simply an opening in the stent structure of the expandable heart valve prosthesis, for example . The opening can be configured to receive a helical anchor supply catheter that loads the helical anchor during the implantation procedure. The opening may be located on an arm of the expandable heart valve prosthesis and the prosthesis may further comprise a plurality of arms configured to engage under the native heart valve. The guide structure may further comprise a tubular arm of the expandable heart valve prosthesis.
    [0027] In another illustrative embodiment, a system for coupling a mitral valve prosthesis and replacing a native mitral valve is provided and includes a loop guide catheter and a helical anchor adapted to be received inside and supplied from the loop guide catheter . The helical anchor is formed as multiple loops that have a spiral configuration after being supplied from the loop guide catheter and adapted to support the mitral valve prosthesis when fully supplied from the loop guide catheter and implanted in the native mitral valve. the system also includes a tissue accumulation catheter that includes a loop structure configured to be positioned to encircle and accumulate the native chordea tendinae to allow for an easier direction of the helical anchor within the left ventricle.
    [0028] In another illustrative embodiment, an anchor for coupling a heart valve prosthesis includes an upper helical loop portion, a lower helical loop portion, and a fastener that secures the upper helical loop portion to the lower helical loop portion.
    [0029] In another illustrative embodiment, a method for implanting a heart valve prosthesis in the heart of a patient includes holding a helical anchor in the form of multiple loops inside a flexible, external tube. The flexible, outer tube and helical anchor assembly is attached to a helical supply tool. The helical delivery tool is rotated adjacent to a patient's native heart valve to position the assembly on each or both sides of the native heart valve. The assembly is removed from the helical supply tool, and the outer tube is removed from the helical anchor. The heart valve prosthesis is then implanted into the helical anchor.
    [0030] Attaching the assembly may further comprise positioning the turns of the assembly generally along adjacent turns of the helical supply tool. Removing the outer tube may also comprise holding the helical anchor with a pusher element, and pulling the outer tube out of the helical anchor.
    [0031] In another illustrative embodiment, a method for implanting an expandable heart valve prosthesis in a patient's heart includes providing an expandable helical anchor in the form of multiple turns closest to the native heart valve. The expandable heart valve prosthesis is positioned within the multiple turns of the expandable helical anchor with the expandable heart valve prosthesis and the expandable helical anchor in unexpanded states. The expandable heart valve prosthesis is expanded against the expandable helical anchor thereby expanding the expandable heart valve prosthesis while attaching the expandable heart valve prosthesis to the expandable helical anchor. A seal is loaded onto the helical anchor and / or the heart valve prosthesis and extends between at least two adjacent loops to prevent blood leakage through the helical anchor and through the heart valve prosthesis.
    [0032] In another illustrative embodiment, a method for implanting an expandable heart valve prosthesis to replace a patient's native heart valve includes providing a helical anchor in the form of multiple turns closest to the native heart valve. The expandable heart valve prosthesis is supplied closest to the native heart valve. The helical anchor is generally guided around a periphery of the expandable heart valve prosthesis using a guide structure loaded over the expandable heart valve prosthesis. The expandable heart valve prosthesis is expanded against the helical anchor. As discussed above, the guide structure can take many different forms.
    [0033] In another illustrative embodiment, a method for implanting a helical anchor to attach a mitral heart valve prosthesis to a patient includes accumulating the chordea tendinae using a tissue accumulation catheter. A helical anchor is then provided in the form of multiple turns closest to the native heart valve and around the accumulated chordae tendinae.
    [0034] In another illustrative embodiment, a method for implanting a helical anchor to attach a heart valve prosthesis to a patient includes providing a portion of the upper helical anchor comprised of upper turns to a position above a native heart valve, and providing a lower helical anchor portion comprised of lower turns to a position below the native heart valve. The upper and lower helical anchor portions are attached together with a fastener either before or after the delivery of each helical anchor portion.
    [0035] In another illustrative embodiment, a system to replace a native heart valve is provided and includes an expandable helical anchor formed as multiple turns adapted to support a heart valve prosthesis. At least one of the loops is normally in a first diameter, and is expandable to a second, larger diameter when applying an outward radial force from within the helical anchor. A gap is defined between the adjacent turns sufficient to prevent coupling by at least one of the adjacent turns with the native heart valve. An expandable heart valve prosthesis is provided and is capable of being supplied into the helical anchor and expanded into the multiple turns in coupling with at least one loop. In this way, the expandable loop moves from the first diameter to the second diameter while holding the helical anchor and the heart valve prosthesis together. The expandable heart valve prosthesis includes a flow-in end and a flow-out end. The inlet end of the flow is not enlarged and generally cylindrical, while the outflow end of the flow is widened in an outward direction radially.
    [0036] Various advantages, methods, devices, systems and additional features will become more readily apparent to those skilled in the art when reviewing the next detailed description of the illustrative modalities taken in conjunction with the accompanying drawings. BRIEF DESCRIPTIONS OF THE DRAWINGS
    [0037] Figure 1 is a perspective view that schematically illustrates the introduction of a helical anchor for the position of the native mitral valve.
    [0038] Figure 2A is an enlarged cross-sectional view that illustrates an initial portion of the procedure shown in Figure 1, but with the use of a flexible catheter.
    [0039] Figure 2B is a cross-sectional view of the heart similar to Figure 2A, but illustrating the deflection of the delivery catheter and introduction of the helical anchor under the native mitral valve.
    [0040] Figures 3A and 3B are enlarged elevation views that illustrate the furthest end of the delivery catheter and its deflection capacity.
    [0041] Figures 4A and 4B are respective top view of Figures 3A and 3B.
    [0042] Figure 5A is a side elevation view similar to Figure 3B, but illustrating the use of a wire inside the delivery catheter used to deflect or direct the farthest end.
    [0043] Figure 5B is a cross-sectional top view of the supply catheter shown in Figure 5A.
    [0044] Figure 6A is a perspective view showing the combination of a helical anchor and an external tube used to assist with the provision of the helical anchor for the location of the native mitral valve.
    [0045] Figure 6B is a perspective view of the helical anchor inside the outer tube shown in Figure 6A.
    [0046] Figure 7A is an elevation view showing a helical supply tool used to supply the set of Figure 6B for the location of the native mitral valve.
    [0047] Figure 7B is a perspective view illustrating the attachment of the assembly shown in Figure 6B to the helical supply tool shown in Figure 7A.
    [0048] Figure 8A is a perspective view showing the heart in cross section and the helical supply tool being used to implant the set of Figure 6B.
    [0049] Figures 8B to 8E are seen in perspective showing additional steps in the implantation method.
    [0050] Figure 8F is a perspective view showing the implanted helical anchor.
    [0051] Figure 8G is a cross-sectional view showing a replacement heart valve, such as a stent-mounted valve, inside the implanted helical anchor.
    [0052] Figure 9 is a perspective view that illustrates another illustrative modality of a tool and set for implanting a helical anchor.
    [0053] Figure 10 is a top view in partial cross section showing the set of Figure 9.
    [0054] Figure 11A is a cross-sectional view of the farthest end of an alternative embodiment of a helical anchor and delivery catheter.
    [0055] Figure 11B is a perspective view of the farthest end of another modality of the helical anchor and delivery catheter.
    [0056] Figure 12 is a cross-sectional view of a valve mounted on an implanted replacement stent and helical anchor in a location of the native mitral valve according to another illustrative modality.
    [0057] Figure 13 is an enlarged cross-sectional view showing another illustrative modality of a stent-mounted replacement heart valve.
    [0058] Figure 13A is an enlarged cross-sectional view showing an unstretched embodiment of the flow outlet end of the replacement heart valve shown in Figure 13.
    [0059] Figure 14A is a cross-sectional view illustrating another illustrative embodiment of a replacement heart valve attached to a helical anchor.
    [0060] Figure 14B is an enlarged cross-sectional view of the replacement valve shown in Figure 14A.
    [0061] Figure 15A is a schematic view showing a heart in cross section and the initial introduction of a delivery catheter for the location of the mitral valve.
    [0062] Figure 15B is an enlarged cross-sectional view of the heart showing an additional step in the introduction of a stent-mounted replacement heart valve together with a helical anchor.
    [0063] Figures 15C through 15F are seen similar to Figure 15B, but progressively illustrating additional steps in the method for introducing the stent-mounted helical anchor and replacement heart valve at the location of the native mitral valve.
    [0064] Figures 16A and 16B are seen in schematic elevation showing the simultaneous positioning of a stent-mounted replacement heart valve and a helical anchor using an arm with a loop over the stent valve.
    [0065] Figures 17A and 17B are similar to Figures 16A and 16B, but illustrate another modality.
    [0066] Figures 18A, 18B and 18C are similar to Figures 16A and 16B, however, these views progressively illustrate another modality of a method for positioning a helical anchor and a stent-mounted replacement valve.
    [0067] Figure 19A is a side elevation view of a helical anchor constructed in accordance with another illustrative modality.
    [0068] Figure 19B is a cross-sectional view taken along the 19B-19B of Figure 19A.
    [0069] Figure 20 is a schematic perspective view illustrating another alternative system for providing a helical anchor.
    [0070] Figure 21A is a schematic perspective view illustrating the initial delivery of an alternative helical anchor.
    [0071] Figure 21B is a schematic perspective view of the helical anchor in Figure 21A fully supplied.
    [0072] Figure 22A is a cross-sectional view showing another illustrative embodiment of a helical anchor that includes a seal.
    [0073] Figure 22B is a cross-sectional view similar to Figure 22A, but showing the helical anchor implanted at the location of a native mitral valve and an expandable stent-mounted replacement valve attached within the helical anchor.
    [0074] Figure 23A is a schematic elevation view showing another illustrative embodiment of a helical anchor before expansion with a balloon catheter.
    [0075] Figure 23B is an elevation view similar to Figure 23A, but illustrating the helical anchor during expansion by the balloon catheter. DETAILED DESCRIPTION OF THE ILLUSTRATIVE MODALITIES
    [0076] It will be appreciated that equal reference numbers throughout this description and the drawings generally refer to equal elements of structure and function. The differences between the modalities will be apparent from the drawings and / or the description and / or the use of different reference numbers in different figures. For clarity and conciseness, the description of like elements will not be repeated throughout this description.
    [0077] Referring first to Figure 1 in conjunction with Figures 2A and 2B, as previously discussed in Applicant's PCT Application Serial Number PCT / US2013 / 024114, the description of which is fully incorporated by reference, a flexible catheter 10 makes implanting a helical anchor 12 much easier. The flexible tip 10a of catheter 10 assists with the helical anchor 12 coupling a junction 14 of the native mitral valve 16, as shown in Figure 1. The tip 10a of catheter 10 can be designed and configured so that it can bend downwards in the direction native follicles 18, 20 of the mitral valve 16. Since the tip 10a of catheter 10 is usually placed over junction 14 as shown in Figure 2A, the farthest tip or end 10a can be folded down and it is then relatively easy to push or extrude helical anchor 12 out of the farthest end 10a and down through the mitral valve 16 as shown in Figure 2B.
    [0078] Now referring to Figures 3A, 3B, 4A, 4B, 5A and 5B, the flexible catheter, or anchor delivery catheter 10, can be flexed at many different points or locations. Deflection of the catheter tip 10a outward to increase the radius of the delivery catheter tip 10a can be very useful, as shown in Figures 3A, 3B and 4A, 4B which show the "before" and "after" effects of deflecting the farthest end 10a. Deflection of the catheter 10 in this way will give the helical anchor 12 a larger diameter start loop or loop 22. As an example, this loop or loop 22 of the helical anchor 12 can normally be 25 mm but operating the farthest end 10a from the catheter 10 in this way can increase the diameter to 30 mm. Opening the first loop or loop 22 of the helical anchor 12 in this way would assist the helical anchor 12 in capturing all the chordae 24 and follicles 18, 20 as helical anchor 12 is introduced as above generally discussed in connection with Figure 1 and Figures 2A and 2B. As the helical anchor 12 advances, the farthest end 10a of the delivery catheter 10 could also deflect inward to assist the helical anchor 12 in capturing all the chordae 24 at the opposite junction. Moving the farthest end 10a of the delivery catheter 10 from side to side as the helical anchor 12 is essentially screwed or rotated inward and through the native mitral valve 16 is essentially like tracking the delivery catheter 10 with the loop or turn 22. In this case, however, the delivery catheter 10 is stationary since only the tip 10a is moving with the turns 22. The deflection of the farthest end 10a in any direction can be achieved by embedding a wire 26 that runs the length of the delivery catheter 10. When the wire 26 is pulled, the delivery catheter tip 10a deflects and deforms in various ways as desired or necessary in the procedure.
    [0079] A procedure will now be described for introducing or implanting a helical anchor 12 in connection with Figures 6A, 6B, 7A, 7B, and 8A through 8C. A helical supply tool 30 which includes turns 31 is used to supply the helical anchor 12 which is contained within an outer tube 32, for example, formed from a Goretex or other low friction material, such as PTFE. A suture 34 is used to hold the combination or assembly of the outer tube 32 and helical anchor 12 in place over the turns 31 of the helical supply tool 30. A groove (not shown) can be formed in the helical tool 30 so that it comes from a safe seat for the suture. An additional suture 36 is used to tie the front end of the outer tube 32 through a loop 38 at the end of the helical supply tool 30. The helical supply tool 30 and the outer tube / helical anchor combination 32, 12 is rotated in. from the heart 40, through the mitral valve 16 as shown and the suture 34 is cut, for example, with a scalpel 42 (Figure 8B). A pair of forceps 44 is used to rotate the tool 30 in through the native mitral valve 16 slightly more and this breaks suture 36 (Figure 8C). The helical tool 30 is then rotated in an opposite direction and removed from the heart 40, leaving the helical anchor 12 combined with the outer tube 32 within the heart 40, as shown. A push rod 50 with a cup end 52 is inserted at the rear end of the outer tube 32 (Figure 8D). The outer tube 32 is then pulled backwards or backwards leaving the helical anchor 12 in place while removing the outer tube 32. Due to the low friction material of the outer tube 32, it easily slides off the helical anchor 12. The Figures 8F and 8G, respectively, show a total implantation of this type of helical anchor 12 and a replacement heart valve 60 mounted inside and firmly against the helical anchor 12. The replacement valve 60 includes follicles 62, 64, and a body 66 which can be of any suitable design, such as an expandable stent design.
    [0080] In another embodiment shown in Figures 9 and 10, a tip-shaped head 70 is provided over the helical tool 30. There is a slot 72 over the tip-shaped head 70 that runs parallel to the wire or helically turns 22 adjacent the head 70. The pointed head 70 is formed of a resilient polymer, for example, and the slit 72 opens and closes by means of this resilience. Again, the outer tube 32 is attached to the helical delivery tool 30 with a suture (not shown). The front end 32a of the outer tube 32 is inserted into the tip-shaped head 70, for example, with forceps 44. In this embodiment, the tip-shaped head 70 provides easier insertion due to its tuned shape.
    [0081] Figures 11A and 11B show additional illustrative modalities of combining a delivery catheter 10 with a helical anchor 12 inside, prior to positioning. The furthest tip 10a of the delivery catheter 10 includes a thinning which can be gradually tapered as shown in Figure 11A, or more rounded as shown in Figure 11B. In each case, the configuration of the farthest tip 10a allows for a more uniform, easy delivery to a native mitral valve location and can maneuver through tissue structure, such as a native tissue, into the heart 40. For example, the end furthest 10a from the delivery catheter 10 can be directed through the mitral valve 16 and may need to surround the chordae 24 either partially or totally (Figure 1). As shown in Figure 11A, helical anchor 12 can be constructed with an inner wire loop 12a and an outer covering or coating 12b such as a fabric, and can include a soft tip 12c, as formed from a polymer, to avoid damaging cardiac tissue during delivery and to allow easier delivery.
    [0082] Figure 12 is a cross-sectional view showing a replacement heart valve mounted on an illustrative stent or prosthesis 60 at the location of a native mitral valve 16 coupled to a helical anchor 12. In this embodiment, a "shoulder" structure 80 has been added to the annular edge at the flow outlet end of valve 60. This shoulder structure 80 may be formed, for example, of foam 82 covered by a sealing material 84 such as a fabric or other suitable material or coating. This sealing layer 84 extends upward over an open stent structure 86 of the valve 60 to prevent blood leakage passing through the valve 60 and through the coils 22 of the helical anchor 12.
    [0083] Figure 13 is an enlarged view of a replacement heart valve 60 similar to the valve shown in Figure 12, but showing radially enlarged outflow inlet and outflow end.
    [0084] Figure 13A is an enlarged section view showing an outflow end generally cylindrical, without radially extending outwardly.
    [0085] Figures 14A and 14B illustrate another illustrative embodiment of the invention that includes a helical anchor 12 coupling or mounting a replacement stent valve 60 and including a biological tissue seal 90, such as a pericardial tissue or other animal tissue used both at the location of the shoulder 80 to cover the internal foam layer 82, and the seal and cover of the open stent structure 86 to the location of an existing tissue layer 92 that circumscribes the replacement heart valve 60. The combination of the existing tissue 92 over the stent valve 60 and the sealing layer 90 that circumscribes the lower or outflow portion of the valve 60 prevents blood flow from leaking through the valve 60 through the stent structure 86. Instead, the blood passes as it should through follicles 62, 64 of replacement valve 60. As additionally shown in Figure 14A, helical anchor 12 is preferably formed of a loop s spaced 22 creating a gap 91 as configured in any mode previously discussed in connection with PCT Order Serial Number PCT / US2014 / 050525 the description of which is hereby fully incorporated by reference, or spaced or formed as elsewhere desired mode. As additionally described in PCT / US2014 / 050525, helical anchor 12 is expandable by stent valve 60.
    [0086] Referring to Figures 15A-15C, an initial portion of a procedure according to another illustrative embodiment is shown. In this figure, a sheath 100 and a delivery catheter 101 have been advanced through a peripheral vein into the right atrium 102 of the heart 40, through the atrial septum 104, to the left atrium 106. A farther end 10a from the delivery catheter 101 is positioned inside the left ventricle 108 being directed through the native mitral valve 16. This delivery catheter 101 contains a replacement valve or stent-mounted mitral prosthesis 60 that must be implanted in the location of the native mitral valve 16. A material superelastic or shape memory type, such as Nitinol, is typically used to form the frame or body structure 66 of the self-expanding replacement valve 60, but other materials can be used instead. The frame or body 66 includes artificial valve follicles 18, 20 typically formed from tissue such as cow or pig pericardial tissue. Follicles 18, 20 could instead be formed from other materials, such as synthetics or other biomaterials, for example, materials derived from small intestinal mucosa. As additionally described above, the catheter supply 101 also contains a helical anchor 12 and a delivery system. Helical anchor 12 can generally take the forms described here or previously described, for example, in PCT Orders Serial Numbers PCT / US2014 / 050525 and PCT / IB2013 / 000593. The PCT / IB2013 / 000593 order description is also incorporated here by reference.
    [0087] Figure 15B illustrates the delivery catheter 101 inside the left ventricle 108 with the farthest tip 10a just below the native mitral valve follicles 18, 20. The procedure was initiated with the exposure of the content of the delivery system.
    [0088] Figure 15C illustrates another portion of the procedure subsequent to Figure 15B and illustrating that prosthetic or replacement mitral valve 60 was partially supplied through the farthest end 10a of catheter 101. The end of replacement valve 60 that is positioned inside the left ventricle 108 has arms 110 that wrap around native mitral follicles 18, 20 and serve to anchor replacement valve 60 firmly against the margins of native mitral valve follicles 18, 20. Arrows 112 show how arms 110 were wrapped around the lower margins of the native mitral follicles 18, 20 after the arms 110 have been extruded or positioned out of the delivery catheter 101. This replacement valve construction 60 was shown in the above incorporated PCT Order Serial Number PCT / IB2013 / 000593. These arms 110 will help prevent the replacement valve 60 from dislodging upward into the left atrium 106 when the replacement valve 60 is fully positioned, because the arms 110 hook around the edges of the native mitral follicles 18, 20. Multi-arms 110 are useful to provide a lower fixation plane of the mitral valve prosthesis 60 to the native mitral valve 16. The arms 110 can vary in length and in character and construction. It will be understood that a plurality of arms 110 is used with this embodiment, but only two arms 110 are shown in these figures for purposes of illustration and simplification. One of the arms 110 includes a loop 120 for directing or controlling the helical anchor delivery catheter 10 which contains a helical anchor 12. The anchor delivery catheter 10 was preloaded within loop 120 before the assembly was loaded into the supply sheath 100. The arm with loop 120 can be of heavier construction than the other arms 110 and does not need to resemble the other arms 110. The arms 110 have a memory property so that when they are extruded or positioned out of the anchor catheter 10 these wrap around the native mitral follicles 18, 20. The arm 110 with the loop 120 winds around the native mitral follicles 18, 20 and the attached helical anchor delivery catheter 10 is loaded with it so that the chordae 24 and native mitral valve follicles 18, 20 are positioned within the exposed end of the helical anchor 12.
    [0089] When helical anchor 12 is advanced or extruded as shown initially in Figure 15C, it will surround the chordae tendinae 24 so that the entire valve and chordae will be trapped inside the helical anchor 12. Loop 120 oscillates the catheter supplying helical anchor 10 around the native mitral follicles 18, 20 and above the chordae 24 to a preferred position under the annular space of the native mitral valve 126. The arm 110 with the loop 120 can have a dual function of fixing the valve 60 at the edge of the native follicle and for guidance during the delivery of the helical anchor 12. Loop 120 may be large enough to allow the helical anchor delivery catheter 10 to pivot or oscillate as the system is positioned. It is important that the helical anchor 12 is extruded in a plane close to parallel to the bottom side of the native mitral valve 16. The helical anchor delivery catheter 10 is also aimed at or oriented to this plane by loop 120. Loop 120 can , in fact, be composed of a short tube (not shown) instead of a wire as shown. A tube would force the helical anchor delivery catheter 10 into a favorable plane and orientation. Alternatively, the helical anchor delivery catheter 10 could be steerable in one of the known ways through the steerable catheter technology.
    [0090] Other mitral valve prostheses or replacement valves could be used and have a wide range of arms or fixation wings, or stent structure, which wrap around the native mitral valve follicles 18, 20. The arms or other structures similar in such prostheses could all be equipped with a loop 120, or tube or other similarly oriented structure, to perform similar functions as the loop 120 described immediately above. This function generally refers to directing the supply of helical anchor 12. Furthermore, it is not necessary for a loop 120 to direct the supply of helical anchor. For example, a cell or opening in the replacement valve stent structure 86 could also perform the same function as the loop 120 shown and described in these figures. A hook or tube can also be used in place of the illustrated loop 120. Any structure that can work to direct the helical anchor 12 around the native mitral valve follicles 18, 20 can be added to the prosthetic or replacement heart valve 60. The structure can be permanently manufactured as part of the replacement valve 60 or can be a temporary structure used only during the procedure. For example, a suture loop (not shown) can be used to guide the delivery of a helical anchor 12 including any helical anchor delivery catheter 10 associated with it. After using the suture, it can be removed from the patient.
    [0091] The arms 110 illustrated in these figures are quite narrow or elongated. In practice it may be more useful to have arms that are made up of pairs or triples of threads that are fused at the ends. The narrow terminal ends of the arms 110 facilitate the arms 110 to pass between the chordae tendinae 24 on their margins with the free edge of the native mitral follicles 18, 20 to allow the arms 110 to wrap around the native follicles 18, 20. The chordae 24 they are closely packed in some areas and the elongated arms 110 will allow the arms 110 to pass between the chordae tendinae 24. Once the elongated portion of the arms 110 pass, the thicker portions of the arms 110 can move between the chordae 24 spreading -at. Therefore, an arm 110 that is elongated or composed of a single wire or fusion of threads at the tip and that is more robust or thicker closer to the main body of the prosthetic or replacement valve 60, may be a desirable arrangement. The strands or arms 110 can also be much shorter than those shown in these illustrative figures. In the illustrated method, delivery of helical anchor 12 can be initiated at any desired location and not necessarily at junction 14 of native mitral valve 16. For example, delivery can start at the middle portion of a native mitral follicle 18 or 20. This would be advantageous for the surgeon who would not need to locate junction 14 precisely to initiate the procedure, thereby greatly simplifying the procedure.
    [0092] Figure 15D illustrates a helical anchor 12 being delivered over the native mitral follicles 18, 20. Arrow 130 indicates helical anchor 12 being extruded from the helical anchor delivery catheter 10 under the native mitral valve 16. Any number of turns or turns 22 of the helical anchor 12 can be extruded depending on the specific configuration of the helical anchor 12 being used in the procedure. The inner diameter of the helical anchor 12 would preferably be slightly smaller than the outer diameter of the fully expanded mitral valve prosthesis 60 to promote a firm coupling or anchoring of the mitral replacement valve 60. The helical anchor 12 can be made up of bare wire, or it may have coatings or coverings for various reasons such as those described in the PCT Orders incorporated above. The partially supplied mitral valve prosthesis 60 serves an important function to center the supply of the helical anchor 12. The mitral valve prosthesis or replacement valve 60 also provides a stable platform.
    [0093] Figure 15E illustrates that three loops 22 of helical anchor 12 were placed below the native mitral valve 16. These loops or turns 22 positioned those of native mitral valve follicles 18, 20 between the helical anchor 12 and the prosthetic mitral valve 60 which is shown in a configuration to be expanded. Once the replacement valve 60 is expanded, this securely positions the replacement valve 60 and prevents leaks around the replacement valve 60 by sealing the native mitral follicles 18, 20 in the prosthesis 60. The supply sheath 101 for the replacement valve replacement 60 is removed and when using a self-expanding valve, valve 60 would pop open when removing the supply sheath 101. Arrows 132 indicate this process before it occurs. In this figure, the replacement valve 60 is still in a closed position to allow a clear view of the turns or turns 22 of the helical anchor 12 under the native mitral valve 16. In this configuration, there are three helical anchor turns 22 below the native mitral valve 16, however, any number of turns 22 can be used instead. The loops 22 are positioned against the underside of the annular space of mitral valve 126 and follicles 18, 20 to provide solid support to hold helical anchor 12 in position and prevent movement into the left atrium 106 when the powerful ventricle left 108 contracts. When the arms 110 wrap around the helical anchor 12, the entire structure or assembly is stabilized in position. This modality provides a surgeon or interventionist with a considerable amount of choice due to the fact that anchor 12 can be provided at the same time as the replacement valve 60. Many prosthetic heart valves 60 of shape memory can be sheathed again. This means that during a procedure, the replacement valve 60 can be partially advanced from a catheter or sheath 101 and tested for its fit within the heart 40. If the surgeon or interventionist is satisfied with the placement of the replacement valve 60 before from the final release of replacement valve 60, valve 60 can be pulled back into sheath or catheter 101. Therefore, a prosthetic or replacement valve 60 can be positioned initially with no helical anchor 12 in place. If the subsequent anchorage appeared strong and stable and there was no evidence of movement or leakage, valve 60 can be released. On the other hand, if the surgeon or interventionist is not satisfied, valve 60 can be pulled back into sheath 101. Helical anchor 12 can be implanted first, and then valve 60 can be extruded from the supply sheath 101. This would allow the user to decide on the clinical need for additional anchorage under the native mitral valve 16.
    [0094] Figure 15F illustrates the fully deployable expandable replacement valve 60 shown in the appropriate position. The arms 110 wrapped around the native mitral valve follicles 18, 20 to prevent the replacement valve 60 from moving upward into the left atrium 106. The native mitral follicles 18, 20 are compressed under the arms 110 and a mechanical structure and a very solid anchor was created to prevent the replacement valve 60 from migrating to an undesirable position. The turns or turns 22 of the helical anchor 12 also compress against the body 66 of the prosthetic or replacement valve 60 to position, orient and prevent the movement of the replacement valve 60. Therefore, the helical anchor 12 provides a friction fixation of the replacement valve 60 and serves to anchor the arms 110 that wrap around the helical anchor 12. The upper portion of the native mitral valve 16 is shown with a wider area that rests within the left atrium 106 to promote attachment to the atrium wall left 106. However, the force that moves the replacement valve 60 from the left atrium 106 towards the left ventricle 108 is low and this portion of the replacement valve 60 may not be necessary and could be eliminated or reduced from a clinical prosthesis. The turns or turns 22 of the helical anchor 12 are important because they can overcome a wide variety of variations in the lengths of the native mitral follicles 18, 20 from patient to patient and the length of the chordae tendinae 24 and the attachment points of the chordae 24 in the ventricle left 108. When a replacement valve 60 with arms 110 wrapped around the native mitral follicles 18, 20 is used without any helical anchor 12 encircling under the native follicles 18, 20, the fixation depth of the prosthetic mitral valve 60 can vary over around the perimeter of the implanted replacement valve 60. For example, if the chordae tendinae 24 stuck in the middle part of the posterior follicle 20 were too elongated or ruptured, which is a common situation, the arms 110 may fail to wrap around and couple the native follicle 20 at this location. Alternatively, there may be very limited coupling along or on a much higher plane. This portion of the replacement valve 60 would be positioned higher, creating a slope in the replacement valve 60 so that the replacement valve 60 would be positioned at an angle to the plane of blood flowing inward through the replacement valve 60. As the heart 40 beats, there is a large load on the replacement valve 60 and it can start to swing and move. Heart 40 beats almost 100,000 times a day and after several days or weeks or months, valve 60 can displace, move and / or dislodge. Also, if follicles 18, 20 and / or chordae 24 were too elongated, there may be no contact with the arms 110. This could result in a large perivalvular leak due to the lack of coupling of the replacement valve 60 with the native mitral follicles 18 , 20. An anchor 12 under the native mitral valve follicles 18, 20 would compress the native follicle tissue against the replacement valve 60 and prevent this problem. Helical anchor 12 would be positioned on a plane and would prevent problems related to variations in the patient's anatomy.
    [0095] In clinical practice, there are virtually unlimited variations in the size of the native mitral follicles 18, 20, in the character of the native mitral follicles 18, 20, in the chordae lengths and in the fixation of the chordae 24 as well as the diameter of the mitral annular space 126. The use of a helical anchor 12 or other anchor structure under the native follicles 18, 20 neutralizes many of these variables since the attachment point of the arms 110 can be brought to the lower loop 22 of the helical anchor 12. This position it can also be determined in advance by selecting the number of turns 22 on the helical anchor 12 as well as the thickness of the turns 22 on the helical anchor 12 to match the turning point of the arms 110 on the lower portion of the replacement valve 60. Thus, an important feature of the helical anchor 12 provided under the native mitral annular space 126 is that it can create a common and pre-defined plane to anchor the arms 110 of the replacement valve 60. In the situation described above in which some of the chordae 24 are stretched, the fixation in this region of the replacement valve 60 could be the helical anchor 12. This would create a common plane for the lowest point on the replacement valve 60 To ensure that valve 60 anchors in a common lower plane across its entire perimeter, additional turns 22 can be added to helical anchor 12, or the diameter of turns 22 can be made larger. Additional options are, for example, waves or undulations can be added to the turns 22 of the helical anchor 12 to expand the total height of the helical anchor 12. The helical anchor 12 therefore improves the stability of the replacement valve 60 by providing an anchoring point or location for the replacement valve arms 60 to wrap around while, at the same time, helical anchor 12 can trap the perimeter of the replacement valve 60 along its length. The combination of these features provides increased stability for the replacement valve 60 and can also seal the replacement valve 60 against the native mitral valve 16 to prevent a perivalvular leakage of blood flow. As mentioned, the native mitral valve and the cardiac structure of patients come in many varieties and combinations. It is not practical for a manufacturer to make different lengths and depths of anchor arms 110 and for the user to provide these products optimally in position for each case. Instead, it is much more practical to adjust for these variations by placing a helical anchor 12 below the native mitral valve 16 and using this to create a lower plane for the arms 110 to anchor against. The delivery system for helical anchor 12 can be any delivery or positioning system, for example, described in the PCT orders incorporated above. It will be appreciated that such positioning methods and apparatus can be used to provide helical anchor 12 so that anchor 12 is positioned just below the native mitral valve 16 as shown here.
    [0096] Figures 16A and 16B illustrate another embodiment in which a loop 120 is provided at the end of an arm 110 over the replacement valve 60 that guides the helical anchor delivery catheter 10. This loop 120 allows the delivery catheter 10 oscillate as it is moved into position. In this embodiment, the helical anchor delivery catheter 10 passes through the replacement valve 60 or, in other words, into the replacement valve body 66, however, this can be directed in modes other than that shown, and the catheter helical anchor supply line 10 can be used for additional guidance along the path, such as being steerable after being directed through loop 120 further away than shown in Figures 16A and 16B for supplying helical anchor 12.
    [0097] Figures 17A and 17B illustrate another embodiment in which a helical anchor supply tube 140 has been incorporated into the replacement valve 60 instead of the helical anchor supply catheter 10 previously described. In this embodiment, a replacement valve arm 60 is, in fact, tube 140 that is loaded with and carries helical anchor 12. When tubular arm 140 winds around the native mitral valve follicle (not shown), the anchor helical 12 is loaded to the correct location and to the correct supply plane. Any structure on one of the arms 110 of the replacement valve 60 or any portion of the replacement valve 60 that can guide the helical anchor 12 for delivery can be used instead. In Figure 17B, the helical anchor 12 has been extruded from the tubular arm 140 by almost one rotation or full turn. As previously described, multiple turns or turns 22 of the helical anchor 12 can be positioned in this way to finally secure the replacement valve 60 at the location of the native mitral valve 16 generally as described above. The main difference with this modality is that a helical anchor delivery catheter 10 is not necessary.
    [0098] Figures 18A to 18C illustrate another modality for the replacement valve and positioning and implantation of helical anchor. In this respect, the helical anchor delivery catheter 10 and the replacement valve 60 are essentially supplied side by side. Figure 18A illustrates the helical anchor supply catheter 10 outside or extruded from the supply sheath 101 which also supplies the replacement valve 60. The helical anchor supply catheter 10 passes through a loop 120 on one of the valve arms 110 replacement arrow 60. Arrow 150 indicates that helical anchor 12 is to be extruded from the end of the helical anchor supply catheter 10. As shown in Figure 18B, with the end of the helical anchor supply catheter 10 still within loop 120 , almost a complete turn or turn 22 of helical anchor 12 was provided under the native mitral valve (not shown). Figure 18C illustrates an additional point during the implantation process in which approximately three loops or turns 22 of the helical anchor 12 were provided under the plane 152 of the native mitral valve 16. In this figure, the helical anchor delivery catheter 10 and the sheath 101 that supplies the replacement valve 60 has been removed. When the replacement valve 60 is formed with a self-expanding stent, the body 66 of the valve 60 will spring open when the supply sheath 101 is removed. For clarity and illustration purposes, valve 60 is still shown in a closed or unexpanded state simply for clarity. However, in general, the fully deployed system or assembly will be similar to that shown in Figure 15F.
    [0099] Figures 19A and 19B illustrate another embodiment of a helical anchor 12. In this embodiment, the configuration of helical anchor 12 in terms of the spacing and size of turns 22 may vary. The cross-sectional construction includes a fabric cover 160 which can, for example, be made of PET that has a thickness of 0.20 +/- 0.5 mm (0.008 +/- 0.002 inches), and a weight of 72 + / 6 grams / m2 (2.12 +/- 0.18 oz / yard2), a boss / inch of 40 +/- 5, strokes / inch of 90 +/- 10. A layer of foam 162 can, for example , be a 2 mm thick polyurethane sheet material. The foam can be attached to the fabric 160 using a PTFE suture with a slight straight seam. The fabric 160 and the foam 162 can then be folded around the central thread portion 22a of the coils 22 of the helical anchor 12 and cross-stitched to the thread portion 22a using a fiber suture.
    [00100] Figure 20 illustrates another system which may include the provision of a helical anchor 12 as shown above and / or in the PCT orders incorporated above. According to this embodiment, however, an additional tissue accumulation device 170 is included in the delivery system. Device 170 provides a temporary ring or loop 172 which can collect or surround the bundles of chordae tendinae 24 in a smaller area. This can facilitate easier placement of the helical anchor 12 without entanglement or obstruction with the chordae tendinae 24. Also shown in this figure is an introducer sheath 100, a delivery catheter 101 as well as a helical anchor delivery catheter 10 all generally as previously described.
    [00101] Figures 21A and 21B illustrate another helical anchor device or assembly 12. Assembly 12 is comprised of an upper or atrial helical anchor portion 180 as well as a lower or ventricular helical anchor portion 182. These helical anchor portions 180, 182 are supplied simultaneously by extruding from a helical anchor delivery catheter 10. The lower anchor vapor 182 is supplied through the mitral valve 16 between native follicles 18, 20. The upper and lower anchor portions 180, 182 can be coupled together, for example, by a crimp joint 184. The upper anchor portion 180 is positioned above the native mitral valve 16 within the left atrium 106 (Figure 20). The upper and lower anchor portions 180, 182 can be staggered so that the lower anchor portion 182 is initially directed into the junction 14 and through the native mitral valve 16. As shown, the upper and lower helical anchor portions 180, 182 roll or rotate in opposite directions and then can be crimped together, as shown, or can be pre-crimped or otherwise secured before loading on the catheter 10.
    [00102] Figures 22A and 22B illustrate another embodiment of a helical anchor and replacement valve system similar to those discussed in connection with PCT Order Serial Number PCT / US2014 / 050525 above. In this embodiment, however, the configuration of the helical anchor 12 is shown to have a gap 200 between at least the upper turns 22a and the native mitral valve 16. As in the PCT order incorporated above, the helical anchor 12 includes an annular seal 202 of any desired configuration extending lengthwise or otherwise along the length of anchor 12. In this embodiment, a panel or membrane seal 202 is shown extending down one of the turns 22a and covering the portion of the mounted replacement valve on stent 60 that would otherwise be opened due to stent structure 86. Seal 202 therefore prevents blood leakage through the replacement valve 60 through open stent structure 86. All other aspects of the assembly as shown in Figures 22A and 22B are as described herein and may include any of the options or features described herein or otherwise, for example, in PCT applications to incorporated above. The gap 200 is formed by a loop portion 22b that extends not parallel to the adjacent loop portions 22a, 22c.
    [00103] Figures 23A and 23B illustrate another modality of a helical anchor 12, again similar to the PCT Order Serial Number PCT / US2014 / 050525 incorporated above. The difference between this modality and the similar modality shown in the PCT order incorporated above is that a gap 200 was created between two of the intermediate turns 22a, 22c of the anchor 12. These two figures illustrate the characteristic of the helical anchor 12 in which the loops 22 will move or rotate as the expandable anchor 12 is expanded, for example, by a balloon catheter 210. As previously described, a gap 200 formed between adjacent loops 22a, 22c can be used to ensure that the native mitral tissue is not trapped or coupled by the adjacent turns 22a, 22c. The gap 200 is formed by a loop portion 22b that extends not parallel to the adjacent loop portions 22a, 22c.
    [00104] Although the present invention has been illustrated by a description of preferred modalities and although these modalities have been described in some detail, it is not the applicants' intention to restrict or in any way limit the scope of the claims attached to such details. Additional advantages and modifications will readily appear for those skilled in the art. The various features and concepts of the invention can be used alone or in any combination depending on the needs and preferences of the operator. This was a description of the present invention, along with preferred methods for practicing the present invention as currently known. However, the invention itself should only be defined by the appended claims.
    权利要求:
    Claims (20)
    [0001]
    1. System to replace a native heart valve (16), characterized by the fact that it comprises: an expandable helical anchor (12) formed as multiple turns (22) adapted to support a heart valve prosthesis (60), at least one of turns (22) normally being in a first diameter and being expandable to a second diameter larger than the first diameter when applying a radial force from the inside of the helical anchor (12), in which a clearance (200) is defined between the adjacent loops (22a, 22c), being configured to prevent the coupling of at least one of the adjacent loops (22a, 22c) with the native heart valve; an expandable heart valve prosthesis capable of being delivered into the helical anchor (12) and expanded into the multiple loops (22), configured to move at least one loop from the first diameter to the second diameter while securing the helical anchor (12 ) and the heart valve prosthesis on the native heart valve (16), where the expandable heart valve comprises a shoulder structure (80) at a blood flow outlet end of the heart valve prosthesis (60) configured to prevent damage the tissue structure within the heart after implantation; and a seal on the expandable heart valve, configured to couple the helical anchor (12) and prevent blood leakage through the heart valve prosthesis after an implantation of said heart valve prosthesis (60) in the helical anchor (12), in which the seal comprises a seal layer (84, 90) covering a flow outlet portion of the expandable heart valve prosthesis and the shoulder (80) comprises an inner layer (82) covered by the seal material (84, 90).
    [0002]
    2. System to replace a native heart valve (16), according to claim 1, characterized by the fact that the helical anchor (12) includes another loop that moves from a larger diameter to a smaller diameter according to the prosthesis of heart valve (60) is expanded into the multiple turns (22).
    [0003]
    3. System to replace a native heart valve (16), according to claim 2, characterized by the fact that the seal includes portions that extend between adjacent turns (22a, 22c), configured to prevent blood leakage through the anchor helical (12) and heart valve prosthesis (60).
    [0004]
    4. System for replacing a native heart valve (16), according to claim 1, characterized by the fact that the seal still comprises a biological material.
    [0005]
    5. System for replacing a native heart valve (16), according to claim 1, characterized by the fact that the helical anchor (12) further comprises a material with shape memory.
    [0006]
    6. System for replacing a native heart valve (16), according to claim 1, characterized by the fact that the seal still comprises a membrane or a panel (202), which extends between at least two helical anchor turns (12 ) after implantation of the heart valve prosthesis (60) on the helical anchor (12).
    [0007]
    7. System for replacing a native heart valve (16) according to claim 1, characterized in that the heart valve prosthesis (60) includes a blood flow inlet end and a blood flow outlet end. blood, in which at least one of the ends is cylindrical.
    [0008]
    System for replacing a native heart valve (16) according to claim 7, characterized in that the outflow end of the blood stream is radially enlarged outwardly.
    [0009]
    9. System for replacing a native heart valve (16) according to claim 1, characterized by the fact that the gap is formed by a loop portion of the helical anchor (12) that extends not parallel to adjacent loop portions of the helical anchor (12).
    [0010]
    10. System for replacing a native heart valve (16) according to claim 1, characterized in that the inner layer (82) of the shoulder structure (80) comprises a foam material.
    [0011]
    11. System for replacing a native heart valve (16) according to claim 10, characterized in that the sealing layer comprises a material different from the foam material.
    [0012]
    12. System for replacing a native heart valve (16) according to claim 1, characterized in that the shoulder structure (80) comprises a biological tissue configured to cover the blood flow outlet end of the prosthesis. heart valve (60).
    [0013]
    13. System for replacing a native heart valve (16) according to claim 12, characterized in that the biological tissue is configured to cover a foam layer.
    [0014]
    14. System for replacing a native heart valve (16) according to claim 12, characterized in that the heart valve prosthesis (60) includes an open stent structure (86) and the biological tissue is configured to cover a portion of the open stent structure (86).
    [0015]
    15. System for replacing a native heart valve (16), according to claim 12, characterized by the fact that the biological tissue is made of a pericardium tissue.
    [0016]
    16. System for replacing a native heart valve, according to claim 1, characterized by the fact that it also comprises a flexible tube to which the helical anchor (12) is attached prior to implantation in the native heart valve.
    [0017]
    17. System to replace a native heart valve (16), according to claim 1, characterized by the fact that it also comprises a helical supply tool (30), configured to load the helical anchor (12) and is adapted to be rotated in position through a native heart valve.
    [0018]
    18. System for replacing a native heart valve (16) according to claim 1, characterized by the fact that a layer of tissue (92) circumscribes the interior of a flow inlet portion of the expandable heart valve prosthesis and the sealing layer (90) circumscribes the interior of a flow outlet portion of the expandable heart valve prosthesis to the tissue layer (92).
    [0019]
    19. System for replacing a native heart valve (16) according to claim 18, characterized in that the sealing layer (90) comprises a biological material.
    [0020]
    20. System for replacing a native heart valve (16) according to claim 19, characterized in that the sealing layer (90) comprises pericardium tissue.
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    法律状态:
    2020-03-17| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|
    2020-11-24| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|
    2021-02-09| B16A| Patent or certificate of addition of invention granted [chapter 16.1 patent gazette]|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 14/08/2014, OBSERVADAS AS CONDICOES LEGAIS. |
    优先权:
    申请号 | 申请日 | 专利标题
    US201361865657P| true| 2013-08-14|2013-08-14|
    US61/865,657|2013-08-14|
    US201461942300P| true| 2014-02-20|2014-02-20|
    US61/942,300|2014-02-20|
    US201461943125P| true| 2014-02-21|2014-02-21|
    US61/943,125|2014-02-21|
    PCT/US2014/051095|WO2015023862A2|2013-08-14|2014-08-14|Replacement heart valve apparatus and methods|
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