A tissue anchor is provided that includes a metal wire shaped so as to define a straight anchor-shaft portion and a tissue-coupling portion extending therefrom. The tissue anchor is configured such that when the tissue-coupling portion is in an unconstrained state: (a) the tissue-coupling portion crosses itself at first and second loop-end longitudinal portions along the wire, so as to define a looped portion, which generally defines a looped-portion plane, (b) the first loop-end longitudinal portion is closer to a first proximal wire end along the wire than the second loop-end longitudinal portion is to the first proximal wire end along the wire, and (c) a greatest absolute distance between the first loop-end longitudinal portion and the first proximal wire end is greater than a greatest absolute distance between the second loop-end longitudinal portion and the first proximal wire end. Other embodiments are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A tissue anchor (200, 258, 300) includes a shaft (122), a tissue-coupling element (128), and a flexible elongate tension member (202). The tissue-coupling element (128) includes a wire (150), which is shaped as an open loop (154) having more than one turn when the tissue anchor (200, 258, 300) is unconstrained. The tension member (202) includes a distal portion (204) that is fixed to a site (206) on the open loop (154), a proximal portion (208), which has a longitudinal segment (209) that runs alongside at least a portion (210) of the shaft (122), and a crossing portion (212), which (i) is disposed between the distal and the proximal portions (204, 208) along the tension member (202), and (ii) crosses at least a portion of the open loop (154) when the tissue anchor (200, 258, 300) is unconstrained. The tissue anchor (200, 258, 300) is configured to allow relative axial motion between the at least a portion (210) of the shaft (122) and the longitudinal segment (209) of the proximal portion (208) of the tension member (202) when the tissue anchor (200, 258, 300) is unconstrained.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A61B 17/00 - Surgical instruments, devices or methods
A61B 17/10 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for applying or removing wound clampsWound clamp magazines
A61F 2/82 - Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
A61F 2/915 - Stents in a form characterised by wire-like elementsStents in a form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
A method is provided that includes implanting a first tissue-engaging element in a first portion of tissue in a vicinity of a heart valve. A second tissue-engaging element, which is connected to a third tissue-engaging element by a longitudinal sub-member, is implanted in a second portion of tissue of an annulus, and the third tissue-engaging element is implanted in a third portion of tissue of the annulus. A fourth tissue-engaging element is implanted in a portion of a blood vessel that is in contact with an atrium. While the longitudinal sub-member engages the longitudinal member at a junction therebetween, at least a first leaflet of the heart valve is drawn toward at least a second leaflet of the heart valve by adjusting a distance between the portion of the blood vessel and the first portion of tissue in the vicinity of the heart valve. Other embodiments are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A61F 2/915 - Stents in a form characterised by wire-like elementsStents in a form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
A61F 2/848 - Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents having means for fixation to the vessel wall, e.g. barbs
A tissue anchor system is provided that includes a first tissue anchor, a second tissue anchor that is separate and distinct from the first tissue anchor, and one or more tethers, which are configured to couple the first tissue anchor to the second tissue anchor. When the first tissue anchor is unconstrained, a head thereof is coaxial with an axis of a shaft thereof, and a tissue-coupling element thereof extends from a distal end of the shaft, is generally orthogonal to the axis, and is shaped such that if the tissue-coupling element were to be projected onto a plane that is perpendicular to the axis, at least 80% of an area of a projection of the tissue-coupling element on the plane would fall within a first angle of 180 degrees in the plane having a vertex at the axis. Other embodiments are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A61B 17/00 - Surgical instruments, devices or methods
A61B 17/10 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for applying or removing wound clampsWound clamp magazines
A61F 2/82 - Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
A61F 2/915 - Stents in a form characterised by wire-like elementsStents in a form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
A tissue anchor is provided that includes a metal wire shaped so as to define a straight anchor-shaft portion and a tissue-coupling portion extending therefrom. The tissue anchor is configured such that when the tissue-coupling portion is in an unconstrained state: (a) the tissue-coupling portion crosses itself at first and second loop-end longitudinal portions along the wire, so as to define a looped portion, which generally defines a looped-portion plane, (b) the first loop-end longitudinal portion is closer to a first proximal wire end along the wire than the second loop-end longitudinal portion is to the first proximal wire end along the wire, and (c) a greatest absolute distance between the first loop-end longitudinal portion and the first proximal wire end is greater than a greatest absolute distance between the second loop-end longitudinal portion and the first proximal wire end. Other embodiments are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A stent system is provided that includes a first radially-expandable stent, which includes mechanical structural elements arranged so as to form a first tubular structure having a lumen; and a second radially-expandable stent, which includes mechanical structural elements, which are arranged so as to form a second tubular structure, and which are shaped so as to provide tissue-engaging structures that protrude radially outward from the second tubular structure. The second stent is shaped so as to be concentrically disposed within the lumen of the first stent such that the tissue-engaging structures extend between the mechanical structural elements of the first stent in order to engage and be anchored to tissue of a blood vessel, thereby facilitating anchoring of the first stent in the blood vessel. A tissue anchor is coupled to the first stent by a flexible band. Other embodiments are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A61B 17/06 - NeedlesHolders or packages for needles or suture materials
A61F 2/848 - Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents having means for fixation to the vessel wall, e.g. barbs
A61F 2/852 - Two or more distinct overlapping stents
A61F 2/915 - Stents in a form characterised by wire-like elementsStents in a form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
A61F 2/95 - Instruments specially adapted for placement or removal of stents or stent-grafts
A61B 17/00 - Surgical instruments, devices or methods
A tissue anchor is provided that includes a head connected to a shaft, and a tissue-coupling element extending from the shaft. The shaft includes a seal that is configured to form a blood-tight seal between the shaft and a heart wall, and to promote hemostasis. When the tissue anchor is unconstrained, the head is coaxial with an axis of the shaft, and the tissue-coupling element is generally orthogonal to the axis and is shaped such that if the tissue-coupling element were to be projected onto a plane that is perpendicular to the axis, at least 80% of an area of a projection of the tissue-coupling element on the plane would fall within a first angle of 180 degrees in the plane having a vertex at the axis. Other embodiments are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A61B 17/10 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for applying or removing wound clampsWound clamp magazines
A61F 2/82 - Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
A61B 17/00 - Surgical instruments, devices or methods
A61F 2/915 - Stents in a form characterised by wire-like elementsStents in a form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
A tissue anchor is provided for delivery by a deployment tool in a constrained state, the tissue anchor including a shaft; a tissue-coupling element, which includes a wire including a shape-memory alloy; and a flexible elongate tension member, which is distinct from the wire. The flexible elongate tension member includes a distal portion that is fixed to a site on the wire such that, when the tissue anchor is not constrained by the deployment tool, the flexible elongate tension member applies, to the tissue-coupling element, tension that constrains lateral expansion of the tissue-coupling element away from a central longitudinal axis of the shaft, by preventing the tissue-coupling element from automatically assuming a predetermined shape provided by the shape-memory alloy of the wire. Other embodiments are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A61B 17/10 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for applying or removing wound clampsWound clamp magazines
A61F 2/82 - Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
A61B 17/00 - Surgical instruments, devices or methods
A61F 2/915 - Stents in a form characterised by wire-like elementsStents in a form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
A tissue anchor (20, 70, 120, 220, 270, 320, 420, 520A, 520B, 620) is provided that includes a metal wire (22, 122, 222, 322, 422, 622) shaped so as to define a straight anchor-shaft portion (26, 276) and a tissue-coupling portion (31, 131, 231, 331, 431, 631) extending therefrom. The tissue anchor is configured such that when the tissue-coupling portion is in an unconstrained state: (a) the tissue-coupling portion crosses itself at first (40A, 340A, 640A) and second (40B, 340B, 640B) loop-end longitudinal portions along the wire, so as to define a looped portion (44, 344, 644), which generally defines a looped-portion plane (46, 346), (b) the first loop-end longitudinal portion (40A, 340 A, 640 A) is closer to a first proximal wire end (24A) along the wire than the second loop-end longitudinal portion (40B, 340B, 640B) is to the first proximal wire end (24A) along the wire, and (c) a greatest absolute distance (Dl) between the first loop-end longitudinal portion (40 A, 340 A, 640A) and the first proximal wire end (24A) is greater than a greatest absolute distance (D2) between the second loop-end longitudinal portion (40B, 340B, 640B) and the first proximal wire end (24A). Other embodiments are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
Apparatus is provided that includes an implantable tissue anchor for delivery in a constrained state within a deployment tool. The implantable tissue anchor includes an anchor shaft and a tissue-coupling element, which extends from a distal end of the anchor shaft. The tissue-coupling element includes a wire and a tip, which is fixed to a distal end of the wire, and has, at a widest longitudinal site along the tip, a greatest tip outer cross-sectional area that equals at least 150% of an average wire cross-sectional area of the wire. The tissue-coupling element is shaped as an open shape that is generally orthogonal to the anchor shaft when the tissue anchor is unconstrained by the deployment tool. Other embodiments are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A61B 17/10 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for applying or removing wound clampsWound clamp magazines
A61F 2/82 - Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
A61B 17/00 - Surgical instruments, devices or methods
A61F 2/915 - Stents in a form characterised by wire-like elementsStents in a form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
A method is provided including introducing, during a transcatheter procedure, a tissue anchor into a cardiac chamber of a heart of a subject, while a tissue-coupling element of the tissue anchor is constrained by a deployment tool. The tissue-coupling element is delivered distally through a cardiac wall. The tissue anchor is at least partially released from the deployment tool such that the tissue-coupling element is unconstrained by the deployment tool. After the tissue-coupling element is delivered through the cardiac wall and the tissue anchor is at least partially released from the deployment tool, whether the tissue-coupling element overlies a coronary blood vessel is ascertained, and, if the tissue-coupling element overlies the coronary blood vessel, the tissue anchor is rotated until the tissue-coupling element no longer overlies the coronary blood vessel. Thereafter, the tissue-coupling element is proximally pulled by applying tension to the tissue anchor. Other embodiments are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A61B 17/10 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for applying or removing wound clampsWound clamp magazines
A61F 2/82 - Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
A61B 17/00 - Surgical instruments, devices or methods
A61F 2/915 - Stents in a form characterised by wire-like elementsStents in a form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
A heart-treatment system (100) includes a first tissue anchor (30) and a second tissue anchor (140), which includes a stent (158), which includes (a) a plurality of struts (160) arranged as a tubular stent body (161) and (b) a locking frame (184). One or more tethers (32) couple together the first and the second tissue anchors (30, 140). A longitudinal portion (180) of the one or more tethers (32) passes through one or more openings (182) of the locking frame (184) so as to form a tether loop (186). The system (100) is arranged such that enlargement of the tether loop (186) by pulling on the tether loop (186) applies tension between the first and the second tissue anchors (30, 140). Other embodiments are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A61F 2/915 - Stents in a form characterised by wire-like elementsStents in a form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
A61B 17/00 - Surgical instruments, devices or methods
A tissue anchor is provided that includes a head connected to a shaft, and a tissue-coupling element extending from the shaft. When the tissue anchor is unconstrained, the head is coaxial with an axis of the shaft, and the tissue-coupling element is generally orthogonal to the axis and is shaped such that if the tissue-coupling element were to be projected onto a plane that is perpendicular to the axis, (a) at least 80% of an area of a projection of the tissue-coupling element on the plane would fall within a first angle of 180 degrees in the plane having a vertex at the axis, and (b) the area would partially overlap, at least 3 mm from the vertex, both rays of a second angle of between 45 and 180 degrees in the plane having the vertex at the axis. Other embodiments are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A61B 17/10 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for applying or removing wound clampsWound clamp magazines
A61F 2/82 - Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
A61B 17/00 - Surgical instruments, devices or methods
A61F 2/915 - Stents in a form characterised by wire-like elementsStents in a form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
A method of reducing tricuspid valve regurgitation is provided, including implanting first, second, and third tissue anchors at respective different first, second, and third implantation sites in cardiac tissue in the vicinity of the tricuspid valve of the patient. The geometry of the tricuspid valve is altered by drawing the leaflets of the tricuspid valve toward one another by applying tension between the first, the second, and the third tissue anchors by rotating a spool that (a) winds therewithin respective portions of first, second, and third longitudinal members coupled to the first, the second, and the third tissue anchors, respectively, and (b) is suspended along the first, the second, and the third longitudinal members hovering over the tricuspid valve away from the annulus of the tricuspid valve. Other embodiments are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A61F 2/915 - Stents in a form characterised by wire-like elementsStents in a form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
A61F 2/848 - Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents having means for fixation to the vessel wall, e.g. barbs
A61B 17/00 - Surgical instruments, devices or methods
A61F 2/90 - Stents in a form characterised by wire-like elementsStents in a form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure
A hemostatic tissue anchor (120) is provided that includes an anchor portion (130) supported at a distal end (192) of a generally elongate anchor shaft (132). A hemostatic sealing element (122) is coupled to and surrounds at least an axial portion of the anchor shaft (132), is configured to be disposed at least partially within a cardiac tissue wall (160) at a target site, and includes a self-expanding frame (124) attached to a sealing membrane (126). The hemostatic sealing element (122) includes an expandable portion (128) that assumes an expanded frustoconical configuration (138) that is defined by the self-expanding frame (124) and the sealing membrane (126), and acts as a hemostatic seal of an opening through the cardiac tissue wall (160), through which opening the anchor shaft (132) is disposed. Other embodiments are also described.
A61B 17/00 - Surgical instruments, devices or methods
A61N 1/05 - Electrodes for implantation or insertion into the body, e.g. heart electrode
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A suture-securing device includes a first tubular element, shaped to define a first lumen therethrough, and having first and second ends; and a second tubular element, shaped to define a second lumen therethrough, and having first and second ends. The suture-securing device is configured to have (a) an unlocked configuration in which the first end of the second tubular element is disposed closer to the first end of first tubular element than is the second end of the second tubular element, and the sutures are disposable within and slidable through the first and second lumens, and (b) a locking configuration in which the second end of the second tubular element is disposed closer to the first end of first tubular element than is the first end of the second tubular element, and the sutures are inhibited from sliding through the first and second lumens. Other embodiments are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A hemostatic tissue anchor (120, 220, 320, 420, 520) is provided which is configured to be anchored to a cardiac tissue wall. The hemostatic tissue anchor (120, 220, 320, 420, 520) includes an anchor portion (130) supported by releasably positioned at a distal end of a generally elongate anchor shaft (132). The anchor portion (130) is expandable from a first generally elongate configuration to a second expanded configuration such that in the second expanded configuration it can be drawn tightly against the cardiac tissue wall when a tensile force is applied to the anchor portion (130). One or more discs (126, 226, 326) surround the anchor shaft (132). Once the one or more discs (126, 226, 326) are implanted entirely within the cardiac tissue wall, the one or more discs (126, 226, 326) act as a hemostatic seal of an opening through the cardiac tissue wall, through which opening the elongate anchor shaft (132) is disposed. Other applications are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A61F 2/82 - Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
A tension system (10) includes first, second, and third tissue anchors (20A, 20B, 20C) configured to be anchored to first, second, and third sites in a patient's body, respectively. The first tissue anchor (20A) is coupled to the third tissue anchor (20C) via a first superelastic force modulator (30A), and the second tissue anchor (20B) is coupled to the third tissue anchor (20C) via a second superelastic force modulator (30B). The first and the second superelastic force modulators (30A, 30B) are configured, in response to a force being applied to the third tissue anchor (20C) by tissue at the third site, to distribute the force in a predetermined ratio between the first and the second tissue anchors (20A, 20B), when the first, the second, and the third tissue anchors (20A, 20B, 20C) are anchored to the first, the second, and the third sites, respectively. Other embodiments are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
Apparatus for use with a deployment tool is provided. The apparatus includes a tissue anchor configured to be delivered in a constrained state within the deployment tool. The tissue anchor includes a shaft and a tissue-coupling element, which extends from a distal end of the shaft and is configured to be advanced through an incision in a wall of a cardiac chamber and be coupled to a far outer side of the wall. A spring is disposed proximal to a sealing element, and is configured to distally push the sealing element against an inner side of the wall to seal the incision. Other embodiments are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A61B 17/10 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for applying or removing wound clampsWound clamp magazines
A61F 2/82 - Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
A61B 17/00 - Surgical instruments, devices or methods
A61F 2/915 - Stents in a form characterised by wire-like elementsStents in a form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
A tissue anchor is provided that is configured to be delivered in a constrained state within a deployment tool. The tissue anchor includes a shaft and a tissue-coupling element, which (a) extends from a distal end of the shaft, and (b) is configured to be advanced through a heart wall and be coupled to a far side of the heart wall. The tissue anchor further includes a sealing element, which is (a) disposed around the shaft, (b) sized and shaped to be disposed entirely within the heart wall, and (c) configured to promote hemostasis. Other embodiments are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A61B 17/10 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for applying or removing wound clampsWound clamp magazines
A61F 2/82 - Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
A61B 17/00 - Surgical instruments, devices or methods
A61F 2/915 - Stents in a form characterised by wire-like elementsStents in a form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
An expandable tissue anchor (20, 220) is provided that includes an elongate tissue-coupling portion (30) configured to be delivered in an unexpanded generally elongate configuration through a 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 (30) further configured to expand on the second side of the cardiac tissue wall. A flexible membrane (40, 240) is coupled to the expandable tissue anchor (20, 220), and configured to expand to a generally planar configuration, such that the expanded tissue-coupling portion (30) and the expanded flexible membrane (40, 240) can be drawn tightly against the second side of the cardiac tissue wall at the target site when a tensile force is applied to the tissue-coupling portion (30). Other embodiments are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
An expandable tissue anchor (120, 220, 320) is provided that includes an elongate tissue-coupling portion (130) and a flexible elongate tension member (146). A portion of the tension member (146) is slidably disposed through a passage (191, 291, 391) defined by the anchor (120, 220, 320). A sleeve (190) encloses a portion of the tension member (146) between the tissue-coupling portion (130) and a distal opening (194, 294, 394) of the passage (191, 291, 391). The sleeve (190) and the passage (191, 291, 391) are sized and shaped such that the size and shape of the passage (191, 291, 391) prevent proximal movement of the sleeve (190) past the passage (191, 291, 391) upon application of the tensile force to the tension member (146), thereby limiting compression and deformation of the expanded tissue-coupling portion (130) by the tension member (146). Other embodiments are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A heart-treatment system is provided that includes a first cardiac tissue anchor (30), a coupling element (34), and one or more tethers (32), which are attached to the first tissue anchor (30) and are fixed to the coupling element (34). A second tissue anchor (40) includes a stent (70) that includes a plurality of struts (72), which define first and second radially-inwardly-extending coupling sites (50, 52) to which the coupling element (34) is configured to be coupled from within the stent (70), so as to couple the first tissue anchor (30) to the second tissue anchor (40) via the one or more tethers (32). The coupling element (34) is coupleable to the first coupling site (50), and thereafter decouplable from the first coupling site (50) and couplable to the second coupling site (52) so as to increase tension between the first and the second tissue anchors (30, 40).
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A tension system (10) is provided, including first and second tissue anchors (20A, 20B) configured to be anchored to two target sites, respectively; and first and second tethers (24A, 24B), coupled to the first and the second tissue anchors (20A, 20B), respectively. An implantable force gauge (30) includes first and second components (31A, 31B), which are fixed to the first and the second tethers (24A, 24B), respectively, and which are non-integral with each other and are configured to be coupled together in situ so as to couple the first and the second tissue anchors (20A, 20B) together via the first and the second tethers (24A, 24B), for applying variable tension between the two target sites. The implantable force gauge (30) is configured to provide a radiographically-discernible indication of a magnitude of the variable tension between the two target sites, enabling radiographically monitoring of changes in the magnitude of the tension.
A61B 17/00 - Surgical instruments, devices or methods
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A61B 90/00 - Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups , e.g. for luxation treatment or for protecting wound edges
A system (78) is provided for treating a heart of a patient. The system (78) includes a first tissue anchor (30) configured to be implanted in cardiac tissue of the patient, and a second tissue anchor (40) configured to be implanted in the patient. The system (78) further includes one or more first tethers (32) that couple together the first and the second tissue anchors (30, 40), and a second tether (50) configured to be coupled to a coupling site (52) along the one or more first tethers (32), so as to apply tension between the first and the second tissue anchors (30, 40) using (a) the second tether (50) and (b) a longitudinal portion (54) of the one or more first tethers (32). Other embodiments are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
An expandable tissue anchor (20, 120, 190, 220, 320, 420) includes an elongate tissue-coupling portion (30, 130, 192, 230, 330, 430) supported by an anchor shaft (32) at a first end (34) of the tissue-coupling portion (30, 130, 192, 230, 330, 430). The tissue-coupling portion (30, 130, 192, 230, 330, 430) is configured to be delivered in an unexpanded generally elongate configuration through a cardiac tissue wall from a first side to a second side, and to expand, on the second side of the cardiac tissue wall, to an open shape configuration, such that the tissue-coupling portion (30, 130, 192, 230, 330, 430) can be drawn tightly against the second side of the cardiac tissue wall when a tensile force is applied to the tissue-coupling portion (30, 130, 192, 230, 330, 430). The anchor (20, 120, 190, 220, 320, 420) also includes an elongate tip portion (38, 138, 238, 338, 438) supported at a second end (40, 240, 340, 440) of the tissue-coupling portion (30, 130, 192, 230, 330, 430) and configured to be delivered through the cardiac tissue wall ahead of the tissue-coupling portion (30, 130, 192, 230, 330, 430), the tip portion (38, 138, 238, 338, 438) including material having a stiffness less than a stiffness of the tissue-coupling portion (30, 130, 192, 230, 330, 430).
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A tissue anchor is provided for delivery in a constrained state within a deployment tool. The tissue anchor includes a tissue-coupling element; a flexible elongate tension member, which includes (a) a distal portion that is fixed to a site on the tissue-coupling element, and (b) a proximal portion, which is slidably disposed through a passage defined by the tissue anchor; and a load-limiting element, which is attached to the flexible elongate tension member. The load-limiting element and the passage are sized and shaped such that the size and shape of the passage prevent proximal movement of the load-limiting element past the passage, such that the load-limiting element limits a total load that can be applied to the tissue-coupling element by the flexible elongate tension member.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A61B 17/10 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for applying or removing wound clampsWound clamp magazines
A61F 2/82 - Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
A61B 17/00 - Surgical instruments, devices or methods
A61F 2/915 - Stents in a form characterised by wire-like elementsStents in a form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
A tissue anchor (200, 258, 300) includes a shaft (122), a tissue-coupling element (128), and a flexible elongate tension member (202). The tissue-coupling element (128) includes a wire (150), which is shaped as an open loop (154) having more than one turn when the tissue anchor (200, 258, 300) is unconstrained. The tension member (202) includes a distal portion (204) that is fixed to a site (206) on the open loop (154), a proximal portion (208), which has a longitudinal segment (209) that runs alongside at least a portion (210) of the shaft (122), and a crossing portion (212), which (i) is disposed between the distal and the proximal N portions (204, 208) along the tension member (202), and (ii) crosses at least a portion of the open loop (154) when the tissue anchor (200, 258, 300) is unconstrained. The tissue anchor (200, 258, 300) is configured to allow relative axial motion between the at least a portion (210) of the shaft (122) and the longitudinal segment (209) of the proximal portion (208) of the tension member (202) when the tissue anchor (200, 258, 300) is unconstrained.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A61B 17/10 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for applying or removing wound clampsWound clamp magazines
A61F 2/82 - Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
A61F 2/915 - Stents in a form characterised by wire-like elementsStents in a form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
A61B 17/00 - Surgical instruments, devices or methods
A method is provided including making an opening (300) through an atrial septum (302) at a septal site (304) at least 5 mm from a fossa ovalis (330). A first tissue anchor (204) is endovascularly advanced to a left-atrial site (306) on an annulus of a mitral valve (310) or a wall of a left atrium (308) above the annulus. The first tissue anchor (204) is implanted at the left-atrial site (306). A second tissue anchor (24) is endovascularly advanced to a right-atrial site (320) on an annulus of a tricuspid valve (207) or a wall of a right atrium (200) above the annulus. The second tissue (24) anchor is implanted at the right-atrial site (320). The left-atrial site (306) and the right-atrial site (320) are approximated by tensioning a tether (22) that passes through the opening (300) of the atrial septum (302) and connects the first and the second tissue anchors (204, 24). Other embodiments are also described.
A61B 17/00 - Surgical instruments, devices or methods
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A method is provided for repairing the tricuspid valve of a patient using tension. A radially-expandable stent is implanted in a coronary sinus of the patient. A tissue anchor is implanted in tissue in the vicinity of the tricuspid valve. The tricuspid valve is repaired by applying tension between the radially-expandable stent and the tissue anchor using a flexible longitudinal member that connects the radially-expandable stent and the tissue anchor.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A61F 2/915 - Stents in a form characterised by wire-like elementsStents in a form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
A61F 2/95 - Instruments specially adapted for placement or removal of stents or stent-grafts
A61B 17/06 - NeedlesHolders or packages for needles or suture materials
A61B 17/00 - Surgical instruments, devices or methods
Apparatus is provided that includes a tissue anchor, which (a) includes a helical tissue-coupling element which has a distal tissue-penetrating tip at a distal end of the tissue anchor, and is configured to be advanced into soft tissue, and (b) is shaped so as to define a longitudinal channel extending to the distal end of the tissue anchor. The apparatus further includes (a) a depth-finding tool, which includes a radiopaque bead, which is shaped so as to define a hole therethrough, and which is positioned within and axially moveable along the channel so as to serve as a marker indicating a depth of penetration of the tissue-coupling element into the soft tissue, and (b) and a shaft that is removably positioned within the channel, such that the shaft passes through the hole of the bead, and such that the bead is axially moveable along the shaft and along the channel.
A61N 1/05 - Electrodes for implantation or insertion into the body, e.g. heart electrode
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A61B 90/00 - Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups , e.g. for luxation treatment or for protecting wound edges
A method is provided of reducing tricuspid valve regurgitation of a patient. A first tissue anchor is implanted at a first implantation site in cardiac tissue in the vicinity of the tricuspid valve of the patient. A second tissue anchor is implanted at a second implantation site of the patient, different from the first implantation site. After the first and the second tissue anchors have been implanted, a longitudinal member that couples the first and the second tissue anchors together is longitudinally deflected.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A61F 2/915 - Stents in a form characterised by wire-like elementsStents in a form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
A61F 2/848 - Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents having means for fixation to the vessel wall, e.g. barbs
A61B 17/00 - Surgical instruments, devices or methods
A61F 2/90 - Stents in a form characterised by wire-like elementsStents in a form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure
A tissue anchor (290, 420, 450, 470, 490) is provided including an anchor shaft (122); a tissue-coupling element (128), which (a) extends from a distal end (130) of the anchor shaft (122), (b) comprises a wire (150), and (c) is shaped as an open shape (291) when the tissue anchor (290, 420, 450, 470, 490) is unconstrained by a deployment tool (30); and a flexible elongate tension member (202), which (a) extends from a distal site (380) on the open shape (291), the distal site (380) located within 7 mm of a distal end (294) of the open shape (291), and (b) includes a proximal portion (208), which has a longitudinal segment (209) that runs alongside at least a portion (210) of the anchor shaft (122) when the tissue anchor (290, 420, 450, 470, 490) is unconstrained by the deployment tool (30). The tissue anchor (290, 420, 450, 470, 490) is configured to allow relative axial motion between the at least a portion (210) of the anchor shaft (122) and the longitudinal segment (209) of the proximal portion (208) of the flexible elongate tension member (202) when the tissue anchor (290, 420, 450, 470, 490) is unconstrained by the deployment tool (30).
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A tissue anchor includes a shaft, a tissue-coupling element, and a flexible elongate tension member. The tissue-coupling element includes a wire, which is shaped as an open loop having more than one turn when the tissue anchor is unconstrained. The tension member includes a distal portion that is fixed to a site on the open loop, a proximal portion, which has a longitudinal segment that runs alongside at least a portion of the shaft, and a crossing portion, which (i) is disposed between the distal and the proximal portions along the tension member, and (ii) crosses at least a portion of the open loop when the tissue anchor is unconstrained. The tissue anchor is configured to allow relative axial motion between the at least a portion of the shaft and the longitudinal segment of the proximal portion of the tension member when the tissue anchor is unconstrained.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A61B 17/10 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for applying or removing wound clampsWound clamp magazines
A61F 2/82 - Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
A61B 17/00 - Surgical instruments, devices or methods
A61F 2/915 - Stents in a form characterised by wire-like elementsStents in a form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheets or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
A tissue anchor (200, 258, 300) includes a shaft (122), a tissue-coupling element (128), and a flexible elongate tension member (202). The tissue-coupling element (128) includes a wire (150), which is shaped as an open loop (154) having more than one turn when the tissue anchor (200, 258, 300) is unconstrained. The tension member (202) includes a distal portion (204) that is fixed to a site (206) on the open loop (154), a proximal portion (208), which has a longitudinal segment (209) that runs alongside at least a portion (210) of the shaft (122), and a crossing portion (212), which (i) is disposed between the distal and the proximal portions (204, 208) along the tension member (202), and (ii) crosses at least a portion of the open loop (154) when the tissue anchor (200, 258, 300) is unconstrained. The tissue anchor (200, 258, 300) is configured to allow relative axial motion between the at least a portion (210) of the shaft (122) and the longitudinal segment (209) of the proximal portion (208) of the tension member (202) when the tissue anchor (200, 258, 300) is unconstrained.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A61B 17/00 - Surgical instruments, devices or methods
A method is provided including making an opening (300) through an atrial septum (302) at a septal site (304) at least 5 mm from a fossa ovalis (330). A first tissue anchor (204) is endovascularly advanced to a left-atrial site (306) on an annulus of a mitral valve (310) or a wall of a left atrium (308) above the annulus. The first tissue anchor (204) is implanted at the left-atrial site (306). A second tissue anchor (24) is endovascularly advanced to a right-atrial site (320) on an annulus of a tricuspid valve (207) or a wall of a right atrium (200) above the annulus. The second tissue (24) anchor is implanted at the right-atrial site (320). The left-atrial site (306) and the right-atrial site (320) are approximated by tensioning a tether (22) that passes through the opening (300) of the atrial septum (302) and connects the first and the second tissue anchors (204, 24). Other embodiments are also described.
A valve-tensioning implant includes a first venous tissue anchor (30), which is configured to be implanted in a vein selected from the group of veins consisting of: a superior vena cava (110), an inferior vena cava (80), and a coronary sinus (115); exactly two atrial tissue anchors, which consist of second and third atrial tissue anchors (40, 42); and a pulley system (44). The pulley system (44) includes a pulley (50), which is connected to the second atrial tissue anchor (40); and a tether (54), which (a) is connected to the first venous tissue anchor (30) and the third atrial tissue anchor (42), (b) is moveable through the pulley (50), and (c) has a length, measured between the first venous and the third atrial tissue anchors (30, 42), of at least 30 mm. Other embodiments are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A radially-expandable stent (20) is shaped so as to define one or more tether interfaces (50), a lower-securement portion (56), and a higher-securement portion (64). The lower-securement portion (56) extends (a) along at least a contiguous lower- securement axial segment (58) of the stent (20) and (b) circumferentially around a contiguous lower-securement circumferential portion (60) of the stent (20), which lower- securement axial segment (58) and lower-securement circumferential portion (60) include the one or more tether interfaces (50). The higher-securement portion (64) extends (a) along at least a contiguous higher-securement axial segment (65) of the stent (20) and (b) circumferentially around between 215 and 330 degrees of a circumference (C), at all circumferential locations other than those of the lower-securement circumferential portion (60). The stent (20) is shaped so as to define a plurality of outward protrusions (70) at respective circumferential locations (72) around the higher-securement portion (64), and not around the lower-securement portion (56). One or more tethers (34) are coupled to the one or more tether interfaces (50), respectively, and to one or more tissue anchors (30), respectively.
A61F 2/848 - Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents having means for fixation to the vessel wall, e.g. barbs
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
A tissue anchor (20) comprises a helical tissue-coupling element (30) disposed about a longitudinal axis (32) thereof and having a distal tissue-penetrating tip (34). The helical tissue-coupling element (30) has: a first axial stiffness along a first axial portion (60) of the helical tissue-coupling element (30); a second axial stiffness along a second axial portion (62) of the helical tissue-coupling element (30) more distal than the first axial portion (60), which second axial stiffness is greater than the first axial stiffness; and a third axial stiffness along a third axial portion (64) more distal than the second axial portion (62), which third axial stiffness is less than the second axial stiffness. Other embodiments are also described.
A61B 17/06 - NeedlesHolders or packages for needles or suture materials
A61N 1/05 - Electrodes for implantation or insertion into the body, e.g. heart electrode
A61B 19/00 - Instruments, implements or accessories for surgery or diagnosis not covered by any of the groups A61B 1/00-A61B 18/00, e.g. for stereotaxis, sterile operation, luxation treatment, wound edge protectors(protective face masks A41D 13/11; surgeons' or patients' gowns or dresses A41D 13/12; devices for carrying-off, for treatment of, or for carrying-over, body liquids A61M 1/00)
Apparatus (20) is described including first and second tubular elements (24, 26) shaped to define respective first and second lumens (L1, L2) therethrough. In an unlocked configuration, the first end (12) of the second tubular element (26) is disposed closer to the first end (10) of the first tubular element (24) than is the second end (13) of the second tubular element (26), and sutures (34a, 34b) are slidable through the first and second lumens (L1, L2). In a locking configuration, the second end (13) of the second tubular element (26) is disposed closer to the first end (10) of the first tubular element (24) than is the first end (12) of the second tubular element (26), and the sutures (34a, 34b) are inhibited from sliding through the first and second lumens (L1, L2). Other embodiments are also described.
A61B 17/04 - Surgical instruments, devices or methods for closing wounds or holding wounds closedAccessories for use therewith for suturing woundsHolders or packages for needles or suture materials
43.
METHOD AND APPARATUS FOR TRICUSPID VALVE REPAIR USING TENSION
Apparatus is provided including a first tissue-engaging element (60a), a first flexible longitudinal member (2612) coupled at a first end portion (2613) thereof to at least a portion of the first tissue-engaging element (60a), and a first flexible-longitudinal-member-coupling element (2614) coupled to the first flexible longitudinal member (2612) at a second end portion (2615) of the first flexible longitudinal member (2612). Apparatus includes a second tissue-engaging element (60b), a second flexible longitudinal member (2660) coupled at a first end portion thereof to at least a portion of the second tissue-engaging element (60b), and a second flexible-longitudinal-member-coupling element (2650) coupled to the second flexible longitudinal member (2660) at a second end portion (2662) of the second flexible longitudinal member (2660), the first and second flexible-longitudinal-member-coupling elements (2614, 2650) being couplable to couple together the first and second flexible longitudinal elements (2612, 2660). Other applications are also described.
A method is provided, including implanting at least a first tissue-engaging element (60a) in a first portion of tissue in a vicinity of a heart valve (4) of a patient, implanting at least a second tissue-engaging element (60b) in a portion of a blood vessel (8, 10) that is in contact with an atrium (6) of a heart (2) of the patient, and drawing at least a first leaflet of the valve (4) toward at least a second leaflet of the valve (4) by adjusting a distance between the portion of the blood vessel (8, 10) and the first portion of tissue in the vicinity of the heart valve (4) of the patient. Other applications are also described.
A61F 2/90 - Stents in a form characterised by wire-like elementsStents in a form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure
A method is provided, including implanting at least a first tissue-engaging element in a first portion of tissue in a vicinity of a heart valve of a patient, implanting at least a second tissue-engaging element in a portion of a blood vessel that is in contact with an atrium of a heart of the patient, and drawing at least a first leaflet of the valve toward at least a second leaflet of the valve by adjusting a distance between the portion of the blood vessel and the first portion of tissue in the vicinity of the heart valve of the patient. Other applications are also described.
