Abstract: The present invention comprises a novel and safer mechanism of deployment using a self-positioning, self-centering, and self-anchoring method. To embody the present invention, a disk-based valve apparatus allowing the repositioning and retrieval of the implantable valve while working on a dysfunctional valve structure is disclosed. The disk-based valve apparatus may comprise one or more disks, either proximal or distal, a valve-housing component and a valve component. The one or more disks may be either proximal or distal, may be either connected to each other or disconnected from each other and may either be symmetrical or have different shapes and dimensions. The disk-based valve apparatus may be self anchoring, such as anchored by pressure from the one or more disk, or may be anchored using any anchoring.

Abstract: A mitral cerclage annuloplasty apparatus comprises a tissue protective device and a cap device having a cerclage suture disposed within a first protective tube and a second protective tube, the proximal portions of the two tubes being attached side-by-side longitudinally to define a stem portion, the distal portions of the two tubes being separated thereafter, and a cap device that covers the stem portion wherein the stem portion and the cap device interlock, so that once the cerclage suture is knotted on the outer surface of the cap device, cap device can be pulled outwardly to enhance and maintain tension applied to the mitral annulus thus successfully treating the mitral regurgitation.

Abstract: Cardiac valve supports and their methods of use.

Abstract: An implantable device system for controlling the dimensions of internal anatomic passages corrects physiologic dysfunctions resulting from a structural lumen which is either too large or too small. Implantable devices are disclosed which employ various mechanisms for adjusting and maintaining the size of an orifice to which they are attached. Systems permit he implants to be implanted using minimally invasive procedures and permit final adjustments to the dimensions of the implants after the resumption of normal flow of anatomic fluids in situ.

Abstract: Apparatus (20) is provided for treating mitral valve regurgitation, including a band (30) having distal and proximal ends, the band (30) adapted to be placed: around between 90 and 270 degrees of a mitral valve (58), including around at least a portion of a posterior cusp (56) of the valve (58), in a space defined by (a) a ventricular wall (70), (b) a ventricular surface of the posterior cusp (56) in a vicinity of an annulus (60) of the mitral valve (58), and (c) a plurality of third-order chordae tendineae (74).

Abstract: A frame structure for a collapsible and re-expandable prosthetic heart valve. The frame structure includes an annular annulus portion that is configured for implanting in or near a patient's native heart valve annulus. This annulus portion of the frame structure may include a plurality of annularly spaced commissure post structures interconnected by connecting structures. The commissure post structures may be more resistant to annular collapse than the connecting structures. In the case of a prosthetic aortic valve, the frame structure may also include an annular aortic portion. The aortic portion may include a plurality of attachment points (for tethers) closest to the annulus portion. Such attachment points and tethers can facilitate re-collapse of a partly deployed valve in the event of a need to reposition or remove the valve.

Abstract: A system (1) for altering the geometry of a heart (100), comprising an annuloplasty ring; a set of elongate annulus-papillary tension members (21, 22, 23, 24), adapted for forming a link between said ring (10) and a papillary muscle, and a first set of papillary anchors (30) for connecting each of the tension members (21, 22, 23, 24) to the papillary muscle; and where said annuloplasty ring (10) has at least one aperture (12, 13); where each of said annulus-papillary tension members (21, 22, 23, 24) are extendable through said ring (10) through said apertures (11, 12, 13), and through an atrium to an exterior side of said atrium, such that the distance of each link between the annulus and the muscles is adjustable from a position exterior to the heart while the heart is beating.

Abstract: A device, a kit and a method is presented for permanently augmenting the pump function of the left heart. The mitral valve plane is assisted in a movement along the left ventricular long axis during each heart cycle. The very close relationship between the coronary sinus and the mitral valve is used by various embodiments of a medical device providing this assisted movement. By means of catheter technique an implant is inserted into the coronary sinus, the device is augmenting the up and down movement of the mitral valve and thereby increasing the left ventricular diastolic filling when moving upwards and the piston effect of the closed mitral valve when moving downwards.

Abstract: An annuloplasty ring for repairing a cardiac valve includes an expandable support member having oppositely disposed proximal and distal end portions and a main body portion between the end portions. The proximal end portion of the support member includes a plurality of wing members that extend from the main body portion. Each of the wing members includes at least one hook member for embedding into a cardiac wall and the valve annulus to secure the annuloplasty ring in the valve annulus. The annuloplasty ring may be expanded into full contact engagement with the annulus of the cardiac valve by an inflatable balloon. Methods for repairing a cardiac valve using the annuloplasty ring are also provided.

Abstract: Annuloplasty rings reduce or eliminate tricuspid regurgitation and/or tricuspid annulus dilation. An adjustable annuloplasty device includes a ring body having a first free end and a second free end. The ring body includes a shape memory material to provide a shape change to the adjustable annuloplasty device upon activation. The ring body includes a first segment including the first free end and following a curved path corresponding to an anterior leaflet region of a tricuspid annulus, a second segment following a curved path corresponding to a posterior leaflet region of the tricuspid annulus, and a third segment including the second free end and at least partially following a linear path corresponding to a portion of a septal leaflet region of the tricuspid annulus. Activation of the shape memory material changes a dimension of the adjustable annuloplasty device.

Abstract: An active bodily ring having a housing adapted to be sutured to a bodily component and a loop disposed in the housing, the loop capable of actively expanding and compressing during the bodily components normal function. The housing defines a first chamber and a second chamber, the first chamber containing the loop and the second chamber providing a region capable of being sutured to the bodily component. In one embodiment, the housing can be a crimped-fabric housing. In another embodiment, the housing can be a woven-fabric housing having elastic properties. The housing can be made from polyester.

Abstract: A holder for an annuloplasty ring having a template defining a proximal face opposite the distal face, and a peripheral edge about which the annuloplasty ring conforms. The annuloplasty ring anchors to the template using one or more flexible filaments. The template includes a single cutting well on its proximal face over which the flexible filament is suspended. Desirably, the single cutting well is located adjacent the peripheral edge so as to be away from any handle connections for ease of access. The flexible filament emerges above the proximal face of the template at only one location at the cutting well, thus presenting a one cut quick-release structure that is highly visible to the surgeon.

Abstract: An annuloplasty ring comprising an elongate tube of suturable material formed into a ring. A stiffener configured to prevent axial compression and radial deformation of the ring is received in the tube in a first circumferential segment of the ring. An axial support configured to prevent axial compression of the ring and to permit radial deformation of the ring is received in the tube in a second circumferential segment of the ring. The first circumferential segment of the ring may correspond to a posterior portion of a mitral valve annulus with the first circumferential portion configured to extend between the right and the left fibrous trigones of the mitral valve annulus upon installation. The second circumferential segment of the ring may correspond to an anterior portion of a mitral valve annulus and the second circumferential segment is configured to extend between the right and left fibrous trigones of the mitral valve annulus upon installation.

Abstract: Heart valve prostheses are provided having a self-expanding frame that supports a valve body comprising a skirt and a plurality of coapting leaflets. The leaflets are constructed with four commissure points to reduce the stress and strain applied to the commissure points and to efficiently distribute and transmit forces along the leaflets and to the frame.

Abstract: Apparatus is provided that includes an implant structure, which includes a contracting mechanism, which includes a rotatable structure, arranged such that rotation of the rotatable structure contracts the implant structure. A longitudinal member is coupled to the contracting mechanism. A tool for rotating the rotatable structure is configured to be guided along the longitudinal member, to engage the rotatable structure, and to rotate the rotatable structure in response to a rotational force applied to the tool. Other embodiments are also described.

Abstract: A collapsible valve prosthesis includes an armature and a set of prosthetic valve leaflets supported by the armature. The armature is expandable from a contracted condition to an expanded condition for anchoring at an annulus of a natural valve site, and includes a tubular intra-annular portion defining a blood flow lumen having an inflow side and an outflow side. The tubular intra-annular portion supports the prosthetic valve leaflets in the blood flow lumen and is provided with outward formations for coupling with the natural valve site. The armature includes an over-annular portion linked to the intra-annular portion to extend collar-like over the annulus of the natural valve site at the inflow side of the blood flow lumen. The armature may also include an under-annular portion to extend collar-like at the outflow side of the blood flow lumen. The prosthesis may permit mitral valve replacement (MVR) without removing the native valve leaflets and the chordae tendineae.

Abstract: Annuloplasty device for implantation adjacent an annulus of a tricuspid valve, the annulus comprising anterior, posterior and septal aspects adjacent anterior, posterior and septal leaflets, respectively, of the tricuspid valve, the device comprising: a ring body comprising: an anterior portion, a posterior portion and a septal portion shaped to conform to, and for implantation adjacent, the anterior, posterior and septal aspects of the annulus, respectively; and first and second ends; wherein the ring body is curvilinear, with substantially no flat portions, forming a shape, and the ends are configured such that when the device is implanted, the first end will be located near the junction of the septal and anterior aspects of the annulus and the second end will be located near the septal aspect of the annulus. Related methods.

Abstract: An artificial mitral valve is anchored in the left atrium by placing the valve between the annulus of the natural mitral valve and an artificial annulus. The artificial annulus is formed by inserting a tool into the coronary sinus, and adjusting the tool to force the wall of the left atrium to form an annulus above the artificial valve, this locking it in place and forming a hemostatic seal.

Abstract: A prosthetic tricuspid remodeling annuloplasty ring having two free ends and at least one inward bow to help reduce chordal tethering. The ring may have segments corresponding to the anterior, posterior and septal leaflets, with inward bows located adjacent one, two or all leaflets. Convex corners separate the concave inward bows, with inflection points therebetween. The ring has a semi-rigid inner body covered by fabric or a suture interface such as silicone and fabric.

Abstract: Annuloplasty rings and methods for inserting annuloplasty rings are herein disclosed. The annuloplasty ring has a ring shell and a plurality of anchoring fasteners for anchoring the ring shell to adjacent heart tissue. To maintain the shape of the annuloplasty ring upon attachment of the ring to the patient's heart, a hardening polymer is inserted into the ring shell, which is permitted to cure, thereby providing support for the annuloplasty ring and the patient's heart valve.

Abstract: Apparatus, systems, and methods are provided for repairing heart valves through percutaneous transcatheter delivery and fixation of annuloplasty rings to heart valves. An annuloplasty ring includes an outer hollow body member including a plurality of regions. Adjacent regions cooperate with one another to change the body member from an elongate insertion geometry to an annular operable geometry. Adjacent regions are coupled by a biasing element or a stepped connector to allow expansion to an expanded state and contraction to a contracted state in the annular operable geometry. The annuloplasty ring also includes an internal anchor member located at least partially within the body member and having a plurality of anchors configured to attach the annuloplasty ring to tissue of a heart valve annulus. An angled ring closure lock allows coupling of the ends of an annuloplasty ring at an apex of a D-shape annular operable geometry.

Abstract: A method for repairing a mitral valve, the method comprising: positioning a crossing guidewire across the mitral valve, the crossing guidewire passing through the annulus of the mitral valve at a first location and passing through the annulus of the mitral valve at a second location; using the crossing guidewire to position a spanning implant across the mitral valve, with the spanning implant extending from the first location to the second location; anchoring the spanning implant at the first location; tensioning the spanning implant so as to draw the first location and the second location together; and anchoring the spanning implant at the second location.

Abstract: Devices, apparatus, and methods for catheter-based repair of cardiac valves, including transcatheter-mitral-valve-cerclage annuloplasty and transcatheter-mitral-valve reapposition. In particular, a target and capture device is provided for guiding a cerclage traversal catheter system through a cerclage trajectory, particularly through a reentry site of the cerclage trajectory. The target and capture device provides the user with a target through which the cerclage traversal catheter system must be guided, particularly under imaging guidance, so as to properly traverse the cerclage trajectory at any desired location, particularly at a reentry site. The target and capture device can, further, ensnare and externalize the cerclage traversal catheter system.

Abstract: An annuloplasty ring for attachment to an annulus of a tricuspid valve comprises an elongate tube of suturable material comprising a central segment and first and second end segments. An arcuate stiff ener is received in the central segment of the tube and extends the length thereof. The arcuate stiffener is circumferentially confined within the central segment to prevent circumferential movement of the stiffener relative to the tube. The first and second end segments of the tube lack a stiffener and are axially deformable.

Abstract: An adjustable annuloplasty ring includes a body in the form of an endless loop having an internal lumen therethrough, an adjustment suture extending through at least a portion of the internal lumen, a first portion of the suture exiting the lumen through a first opening in the body and a second portion of the suture exiting the lumen through a second opening in the body, and a first adjustment marker on the first portion of the suture outside of the body. The suture may be adapted to reduce the length of the body around the loop when tightened.

Abstract: Embodiments of prosthetic valves for implantation within a native mitral valve are provided. A preferred embodiment of a prosthetic valve includes a radially compressible main body and a one-way valve portion. The prosthetic valve further comprises at least one ventricular anchor coupled to the main body and disposed outside of the main body. A space is provided between an outer surface of the main body and the ventricular anchor for receiving a native mitral valve leaflet. The prosthetic valve preferably includes an atrial sealing member adapted for placement above the annulus of the mitral valve. Methods and devices for delivering and implanting the prosthetic valve are also described.

Abstract: An apparatus for repairing a cardiac valve includes an annuloplasty ring having an expandable support member with oppositely disposed proximal and distal end portions and a main body portion between the end portions. The proximal end portion includes a plurality of wing members extending from the main body portion. Each of the wing members includes at least one hook member for embedding into a cardiac wall and a valve annulus to secure the annuloplasty ring therein. The apparatus also includes an energy delivery mechanism for selectively contracting the annuloplasty ring to restrict the valve annulus and correct valvular insufficiency. The energy delivery mechanism includes a detachable electrical lead having distal and proximal end portions. The distal end portion has a securing member for operably attaching the distal end portion to a portion of the expandable support member. The proximal end portion is operably connected to an energy delivery source.

Abstract: Mitral valve prolapse and mitral regurgitation can be treating by implanting in the mitral annulus a transvalvular intraannular band having an elongate and arcuate body. The elongate and arcuate body has a first end, a first anchoring portion located proximate the first end, a second end, a second anchoring portion located proximate the second end, and a central portion. The central portion is displaced from the plane containing the first end and the second end. The transvalvular band is positioned so that it extends transversely across a coaptive edge formed by the closure of the mitral valve leaflets and the central portion is displaced towards the left ventricle relative to the first anchoring portion and the second anchoring portion. The ventricular direction displacement moves coaption to an earlier point in the cardiac cycle.

Abstract: 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.

Abstract: During a minimally invasive deployment of a mitral valvuloplasty device into the coronary sinus near realtime tracking of the device is monitored to determine whether the device is compressing the left circumflex coronary artery or is likely to do so. In one embodiment of the invention, one or more position sensors are included in the catheter that is used to deploy the constricting implant and or in the implant itself. The position of the device is determined during deployment, and compared to the location of the left circumflex coronary artery, which may be determined by mapping relative to a pre-acquired image or by simultaneous intracardiac ultrasound imaging.

Abstract: In one embodiment, the present invention provides a prosthesis that can be implanted within a heart to at least partially block gaps that may be present between the two mitral valve leaflets. In one preferred embodiment, the prosthesis includes an anchoring ring that expands within the left atrium to anchor the prosthesis and a pocket member fixed to the anchoring ring. The pocket member is positioned within the mitral valve, between the leaflets so that an open end of the pocket member is positioned within the left ventricle. When the mitral valve is open, blood flows past the pocket member, maintaining the pocket member in a collapsed state. When the mitral valve closes, the backpressure of the blood pushes into the pocket member, expanding the pocket member to an inflated shape. The mitral valve leaflets contact the expanded pocket member, allowing the prosthesis to block at least a portion of the openings between the leaflets, thereby minimizing regurgitated blood flow into the left atrium.

Abstract: A method for implanting a heart valve assembly includes a first annular prosthesis for implantation within a tissue annulus, a second valve prosthesis, and a multi-lobed connection adapter to secure the second prosthesis to the first prosthesis. In one embodiment, the adapter is arranged to allow the second prosthesis to be secured to the first prosthesis in a predetermined angular orientation. During use, the first annular prosthesis is implanted into the annulus, and the second valve prosthesis is inserted into the annulus. The adapter secures the second prosthesis relative to the first prosthesis to align the second prosthesis with the first prosthesis in a predetermined angular orientation; and secure the second prosthesis to the first prosthesis in the predetermined angular orientation.

Abstract: An artificial mitral valve is anchored in the left atrium by placing the valve between the annulus of the natural mitral valve and an artificial annulus. The artificial annulus is formed by inserting a tool into the coronary sinus, and adjusting the tool to force the wall of the left atrium to form an annulus above the artificial valve, this locking it in place and forming a hemostatic seal.

Abstract: A prosthetic tricuspid remodeling annuloplasty ring having two free ends can be configured to be stiff in the XY plane and relatively flexible along the Z axis. A tricuspid ring can be provided with a substantially elliptical shape in the XY plane, and a saddle shape in the Z direction. Disclosed tricuspid rings can include an inner core, an elastomeric interface, and an outer fabric covering. In some embodiments, the inner core can include a plurality of stacked layers of different materials. In some embodiments, the inner core can be formed of a single material and sized specifically to create a tricuspid ring that has a greater stiffness in the XY plane than along the Z axis.

Abstract: A method is provided, including providing an implant shaped to define a lumen and a flexible strip disposed at least in part within the lumen, and a plurality of recesses, the implant including a locking mechanism to which first and second ends of the strip are coupled such that the strip defines a closed loop which shortens when the first end is advanced through the locking mechanism in a first direction, and expands when the first end is advanced in a second opposite direction; advancing the first end in first and second opposing directions with respect to the second end; maintaining a recess-engaging portion in a position in which the recess-engaging portion is not disposed in any of the recesses during the advancing; and restricting the advancing by facilitating active positioning of the recess-engaging portion in one of the recesses. Other embodiments are also described.

Abstract: A delivery device for an annular implant that includes a balloon expansion mechanism and an annular implant having an adjustable dimension. The balloon expansion mechanism includes an inflation tube attached to a non-occluding balloon collar which is supported by trusses radially extending from a trocar. The annular implant further includes a flexible ring core, contiguous coiled spacers, and anchoring blocks. The flexible ring core is adjusted via a cinching mechanism. The anchoring blocks are spaced along the ring core by the contiguous coiled spacers, which keeps the distance between each pair of anchoring blocks equidistant as the ring core diameter is manipulated by the device user. The annular implant can also include gunbarrel elements housed in the trocar. Each gunbarrel element contains a gunbarrel pusher which drives an attachment element into the annular implant and annular tissue.

Abstract: A tissue shaping device adapted to reshape target tissue adjacent to a lumen. In some embodiments, the device includes an expandable and contractable anchor, with the anchor having an adjustable height anchoring portion adapted to engage a wall of the lumen in at least first and second anchor heights, the anchoring portion being further adapted to be changed from the first anchor height to the second anchor height by a substantially proximally or a substantially distally directed actuation force. The invention is also a tissue shaping system including a tissue shaping device and a tool for adjusting the height of an anchor of the device. The invention also includes methods of using such tissue shaping devices and systems.

Abstract: Methods, delivery systems and engaging apparatuses for the placement and treatment of an insufficient or stenotic cardiac valve, such as the mitral valve are disclosed. One such method is based on a two step procedure, where during the first step the engaging apparatus is brought to the valve annulus using a delivery system which permits continued normal blood flow. In some preferred embodiments, this is implemented with a balloon and other preferred embodiments it is implemented using a multi-pronged structure that is collapsible like an umbrella frame. The second step is performed after the engaging apparatus has been integrated into the annular wall by natural processes of tissue healing and remodeling. In the second step the engaging apparatus is tightened leading to tightening of the valve annulus and correction of existing valvular insufficiency.

Abstract: Systems and methods treat a heart valve using a magnetically adjustable annuloplasty ring attached to or near a cardiac valve annulus. A changing magnetic field may be used to selectively increase or decrease a circumference of, or otherwise modify the shape of, the implanted annuloplasty ring. The adjustable annuloplasty ring includes a tubular body member, one or more adjustable members, and an internal magnet within the tubular body member. The tubular body member and the one or more adjustable members form a ring shape. The internal magnet is configured to rotate in response to a rotating external magnetic field. The internal magnet is coupled to the one or more adjustable members to change a dimension of the ring shape as the internal magnet rotates. A system for treating a heart valve may include an external adjustment device having one or more external magnets to generate the rotating external magnetic field.

Abstract: Methods of repairing the mitral valve and reducing mitral regurgitation. One method includes securing a first tissue anchor to a position on a posterior portion of the annular tissue of the mitral valve and a second tissue anchor to a position on an anterior portion of the annular tissue of the mitral valve. At least one tensile member spans between the first and second tissue anchors and across the orifice of the mitral valve. When tension is applied to the at least one tensile member, the posterior portion of the annular tissue is pulled toward the anterior portion.

Abstract: The present invention relates to an assembly comprising: a ring having anchoring elements for attaching the ring in a passage surrounded by body tissue, in particular blood vessel tissue. An applicator for fitting the ring in the passage; in which the anchoring elements have an anchoring position in which they protrude with respect to the ring, and in which the anchoring elements comprise a memory material, such as a memory metal or memory polymer, and are designed so that they can be bent from an anchoring position counter to a spring force into a fitting position and can be frozen in this fitting position by a temperature treatment in order to bend the anchoring elements back from the fitting position by the effect of this spring force into the anchoring position when a predetermined threshold temperature is exceeded, and in which the applicator is provided distally with a carrier for carrying the ring.

Abstract: An annuloplasty ring, configured for implantation in the annulus of a heart valve, comprising multiple segments each of which are geometrically shaped from a three dimensional perspective to conform to the anatomic shape of the valve annulus. In one embodiment, the annuloplasty ring is configured to facilitate a reduction of tension on heart valve tissue and eliminate a substantial portion of potential pressure or force that may be applied to the atrioventricular node by the annuloplasty ring when implanted. In another embodiment, at the annuloplasty ring is configured to include an assembly that facilitates selective adjustment of a segment's respective length and/or shape. The adjustment of the length of one of the ring segment's results in an adjustment of at least one angle between at least one set of other ring segments, thereby causing an adjustment to the geometric characteristics of the ring.

Abstract: A catheter-based annuloplasty system for use in repairing a heart valve having leaflets and a valve annulus, includes a delivery catheter having a proximal end and a distal end, and an expandable stent disposed on the distal end of the catheter. An adjustable annuloplasty ring is disposed on the expandable stent and is configured to expand and contract in response to expansion and contraction of the stent.

Abstract: Apparatus is provided including a first tissue-engaging element, a first flexible longitudinal member coupled at a first end portion thereof to at least a portion of the first tissue-engaging element, and a first flexible-longitudinal-member-coupling element coupled to the first flexible longitudinal member at a second end portion of the first flexible longitudinal member. Apparatus includes a second tissue-engaging element, a second flexible longitudinal member coupled at a first end portion thereof to at least a portion of the second tissue-engaging element, and a second flexible-longitudinal-member-coupling element coupled to the second flexible longitudinal member at a second end portion of the second flexible longitudinal member, the first and second flexible-longitudinal-member-coupling elements being couplable to couple together the first and second flexible longitudinal elements. Other applications are also described.

Abstract: Apparatus is provided, including a locking mechanism, an implant, and a flexible strip within the implant having a plurality of recesses. A perimeter of the strip shortens and expands when the first end of the strip is advanced bidirectionally with respect to a second end of the strip. The locking mechanism includes a moveable recess-engaging portion, a mechanical support removably coupled to the recess-engaging portion, and a force applicator which maintains the recess-engaging portion in a position in which the recess-engaging portion is not disposed in any of the recesses. Upon decoupling of the mechanical support from the recess-engaging portion, the force applicator restricts motion of the plurality of recesses of the strip with respect to the second end of the strip, by facilitating positioning of the recess-engaging portion in one of the plurality of recesses. Other embodiments are also described.

Abstract: An annuloplasty ring system for repairing an atrioventricular cardiac valve includes an external support ring (2), an inner adjustable ring (4), a sliding pushing element (6) mounted between the external and inner rings (2, 4), and actuating element designed to control the pushing element (6). The pushing element (6) is designed, when actuated by the actuating element, to slide between the external ring (2) and the inner ring (4) and to press on the inner ring (4) by using the external ring (2) as a support, in such a way that a precise part of the inner ring (4) is deformed without modifying the perimeter of the inner ring (4).

Abstract: Adjustable annuloplasty rings for repair of a mitral or tricuspid valve which incorporate at least two separate parts that are adjustably interconnectable to create a ring the circumference of which can be changed in dimension. Rings having interconnections at spaced-apart lateral locations, which interconnections allow bidirectional movement to either shorten or lengthen the ring at either such location, afford a surgeon opportunity to make further adjustments to the dimensions of the annuloplasty ring after its initial partial securing to the heart valve tissue and thereby adjust the AP diameter of the valve being repaired. The mating interconnections at two lateral locations on the ring can be constructed so as to allow hinged movement about an axis defined by the interconnections to permit hinged movement between the two separate parts.

Abstract: Devices and methods for the repair of the functioning of heart valves are provided. A device may comprise a first section having a generally spiral shape and a second section connected to the first section. A method involves positioning the device such that chords associated with the heart valve are positioned within the path of the generally spiral shape of the first section and positioning the second section on an opposite side of the heart valve. The first section may be turned in a manner such that the chords move closer to the center of the first section. The first section draws the chords closer together, thereby pulling the valve leaflets closer together in order to facilitate their coaptation and proper closing.

Abstract: A tricuspid remodeling annuloplasty ring having two free ends that are upturned in the inflow direction to help avoid unnecessary leaflet abrasion. The free ends are separated across a gap that is large enough to reduce the risk of passing sutures through the conductive system of the heart, yet not too large that support of the septal leaflet of the tricuspid annulus is degraded. The ring may have four sequential segments looking from the inflow side and extending in a clockwise direction from a free end located adjacent the antero septal commis sure after implant. The ring may define an inflow bulge in the first segment and/or an inflow bulge in the fourth segment that help the ring conform to the natural bulges created by the adjacent aorta, thereby reducing stress and the potential for ring dehiscence. Desirably, the ring has variable flexibility, either gradual and/or between or within different segments.

Abstract: An implantable structure includes a flexible sleeve, having first and second sleeve ends, and a contracting assembly, which is configured to longitudinally contract the sleeve, and includes a contracting mechanism, which is disposed longitudinally at a first site of the sleeve, and a longitudinal contracting member, having (a) a first member end, (b) a second member end, which is coupled to the sleeve longitudinally at a second site longitudinally between the first site and the second sleeve end, exclusive, and (c) a first member end portion, which is coupled to the contracting mechanism. The sleeve is arranged in a closed loop, such that first and second portions of the sleeve together define a longitudinally overlapping portion of the sleeve. The implantable structure is configured such that the contracting assembly longitudinally applies a longitudinal contracting force only between the first and the second sites, and not along the overlapping portion.