Abstract: This invention discloses a percutaneously deliverable heart valve and methods of implantation thereof comprising a valve implantation system to be placed at a body channel of a patient comprising a flexible tissue valve with a plurality of valvular leaflets, each of the leaflets having an in-flow edge, an out-flow edge, and side edges, the plurality of leaflets being sewn together at least a potion of their side edges to form an annulus at about the in-flow edge and a plurality of commissure tissues; an annulus base support secured to the annulus, wherein the annulus base support is collapsible and expandable, and commissural fixation means for securing each of the plurality of commissure tissues onto a wall of the body channel.

Abstract: An apparatus for the repair of a cardiovascular valve has leaflets comprising a grasper capable of grabbing and co-apting the leaflets of the valve. In a preferred embodiment the grasper has jaws that grasp and immobilize the leaflets, and then a fastener is inserted to co-apt the leaflets. The apparatus is particularly useful for repairing mitral valves to cure mitral regurgitation.

Abstract: A sizing apparatus and a method for ascertaining a size for a cardiac prosthesis are disclosed. Specifically, the sizing is implemented by positioning a contact member at a patient's heart valve for engagement by one or more viable leaflets of the patient's valve. The size is determined based on the engagement between the contact member and the leaflet (or leaflets) of the patient's valve.

Abstract: A cardiomyoplasty method for treating cardiomyopathy using a myometrial compostion of myometrial tissue, and a device for implantation without injection into the myocardium. The myometrial composition may include cut, granulated, ground or cultured myometrial tissue. The myometrial composition may also be treated with one or more additives such as cDNA vascular endothelial growth factor (VEGF), a patient's blood, or an adhesive. A first implantation device includes a tubular double lumen body having a first and second pathway, a spray opening adapted to deliver the myometrial composition, and a pressure valve to release unsafe pressure within the pericardium. A second implantation device includes a tubular lumen outer body and a first and second tubular lumen inner bodies. The first inner body has an expandable portion to carry a myometrial tissue patch. The expandable portion may include longitudinal slots to carry the myometrial composition.

Abstract: A mitral valve therapy device effects the condition of a mitral valve annulus of a heart. The device includes an elongated member dimensioned to be placed in the coronary sinus of the heart adjacent the mitral valve annulus. The elongated member is flexible when placed in the heart in a first orientation to position the device in the coronary sinus adjacent the mitral valve annulus and relatively inflexible when rotated into a second orientation after the device is positioned in the coronary sinus adjacent to the mitral valve annulus to substantially straighten and increase the radius of curvature of the mitral valve annulus.

Abstract: There is disclosed a method of implanting a mitral valve therapy device in a patient's coronary sinus adjacent the patient's mitral valve annulus. The method includes the steps of positioning the mitral valve therapy device within the coronary sinus of the patient adjacent to the mitral valve annulus, evaluating effectiveness of the device, and assessing arterial perfusion of the heart.

Abstract: The various aspects of the invention pertain to devices and related methods for treating heart conditions, including, for example, dilatation, valve incompetencies, including mitral valve leakage, and other similar heart failure conditions. The devices and related methods of the present invention operate to assist in the apposition of heart valve leaflets to improve valve function. According to one aspect of the invention, a method improves the function of a valve of a heart by placing an elongate member transverse a heart chamber so that each end of the elongate member extends through a wall of the heart, and placing first and second anchoring members external the chamber. The first and second anchoring members are attached to first and second ends of the elongate member to fix the elongate member in a position across the chamber so as to reposition papillary muscles within the chamber.

Abstract: An improved holder and method for implanting a tissue-type prosthetic mitral heart valve that prevents suture looping and may also constrict the commissure posts of the valve. An upstanding or shaft member axially positioned on the holder causes the lengths of attachment sutures to extend axially beyond the commissure post tips to create a tent and prevent looping of any of an array of pre-implanted sutures around the tips during deployment of the valve. The shaft member may be axially movable such that it can be initially retracted and then actuated just prior to valve deployment. The shaft member may have notches on its distal tip for capturing the attachment sutures, which are crossed over along the valve axis to ensure engagement by the notches. The attachment sutures may be strands or filaments, or may be wider bands of flexible biocompatible material. If bands are used, they desirably cover the commissure post tips to further help prevent suture looping thereover.

Abstract: A valve repair device and method of repair for the mitral valve of the heart is disclosed. The valve repair device includes a leaflet portion, a muscle portion, and a plurality of chords connecting the leaflet portion to the muscle portion. The valve repair device is attached to the diseased valve by suturing the leaflet portion to the affected leaflet and suturing the muscle portion to the affected muscle. The leaflet portion and muscle portion are constructed of cloth made from expanded polytetraflouroethylene. The chords are sutures also constructed from expanded polytetraflouroethylene. The suture position for the muscle portion is determined by positioning the valve repair device adjacent to a normal marginal chord. The valve repair device may be employed to repair the anterior leaflet or posterior leaflet of the mitral valve.

Abstract: A method of treating the intraluminal disease in a coronary artery by injecting therapeutic agents perivascularly into the myocardium near the site of disease.

Abstract: Magnetic force, preferably with one or more permanent magnets, is used to hold together flaps of tissue inside the body, particularly flaps of a PFO. A device or magnets within a device can be retrieved such that no permanent implant is left behind.

Abstract: The present invention relates to a minimally invasive method of performing annuloplasty. According to one aspect of the present invention, a method for performing annuloplasty includes accessing a left ventricle of a heart to provide a discrete plication element to the left ventricle, and engaging the plication element to tissue near a mitral valve of the heart. Engaging the plication element includes causing the plication element to gather a portion of the tissue to create a plication. In one embodiment, accessing the left ventricle of the heart to provide the plication element includes accessing the left ventricle of the heart using a catheter arrangement.

Abstract: This invention discloses a percutaneous delivered heart valve and delivery means thereof, wherein the percutaneous delivered heart valve is a twistedly foldable heart valve prosthesis comprising a generally cylindrical support element with a diameter, wherein the support element is twistedly foldable to a smaller diameter, a flexible heart valve with a plurality of valvular leaflets releasably attached to said support element, and a receptacle having a plurality of connecting members secured to the cylindrical support element, wherein the receptacle is releasably matched to an expanding element capable of untwisting the receptacle adapted for un-twisting and unfolding said heart valve.

Abstract: A jacket of biological compatible material has an internal volume dimensioned for an apex of the heart to be inserted into the volume and for the jacket to be slipped over the heart. The jacket has a longitudinal dimension between upper and lower ends sufficient for the jacket to surround a lower portion of the heart with the jacket surrounding a valvular annulus of the heart and further surrounding the lower portion to cover at least the ventricular lower extremities of the heart. The jacket is adapted to be secured to the heart with the jacket surrounding at least the valvular annulus and the ventricular lower extremities. The jacket is adjustable on the heart to snugly conform to an external geometry of the heart and assume a maximum adjusted volume for the jacket to constrain circumferential expansion of the heart beyond the maximum adjusted volume during diastole and to permit unimpeded contraction of the heart during systole.

Abstract: Suturing rings and methods of use thereof facilitating initial implantation of new and replacement of dysfunctional tissue or mechanical heart valve mechanisms supported by the suturing ring are disclosed. The suturing ring annulus is adjustable to receive and engage the valve frame of the heart valve mechanism within the annulus. An interlocking mechanism applies restraint to fix the adjusted suturing ring annulus engaged against the valve frame to support the heart valve mechanism during chronic implantation. Sutures affixing the suturing ring to the valvar rim can be routed and entrapped between the suturing ring annulus and the valve frame when the suturing ring is restraint is applied. The restraint is released to replace a dysfunctional heart valve mechanism and reapplied when a new heart valve mechanism is fitted into the annulus.

Abstract: The present invention relates to a minimally invasive method of performing annuloplasty. According to one aspect of the present invention, a method for performing annuloplasty includes accessing a left ventricle of a heart to provide a discrete plication element to the left ventricle, and engaging the plication element to tissue near a mitral valve of the heart. Engaging the plication element includes causing the plication element to gather a portion of the tissue to create a plication. In one embodiment, accessing the left ventricle of the heart to provide the plication element includes accessing the left ventricle of the heart using a catheter arrangement.

Abstract: A method for inducing vascular remodeling and related methods for treating patients having diseased vasculature. The method of inducing remodeling of the vascular system includes altering the blood flow dynamics in portions of the vascular system via mechanical mechanisms. Remodeling of certain coronary vasculature may be induced by creating a passage in a heart wall between a heart chamber and a blood vessel so as to permit blood flow communication, for example, direct blood flow communication, between the chamber and the vessel. A method of inducing vascular remodeling may include providing a blood flow passage between a heart chamber and the coronary vessel, or other flow dynamics altering structure, such that enlargement of at least a portion of the coronary vessel occurs.

Abstract: The present invention relates to a minimally invasive method of performing annuloplasty. According to one aspect of the present invention, a method for performing a procedure on a mitral valve of a heart includes inserting an implant into a left ventricle and orienting the implant in the left ventricle substantially below the mitral valve. The implant and tissue around the mitral valve are connected and tension is provided to the implant, in one embodiment, in order to substantially reduce an arc length associated with the mitral valve. In another embodiment, the implant is inserted into the left ventricle through the aorta and the aortic valve.

Abstract: A prosthetic stentless aortic tissue valve includes a substantially annular valve body having a leaflet carried therein for occluding blood flow therethrough. A root extends generally coaxially from the valve body. Visual marking are provided on the root and act as a sculpting guide for a surgeon during implantation of the prosthetic heart valve to sculpt portions of sinus areas of the root.

Abstract: A supportless atrioventricular valve intended for attaching to a circumferential valve ring and papillary muscles of a patient comprising a singular flexible membrane of tissue or synthetic biomaterial, wherein a minimally invasive delivery system is provided through a percutaneous intercostal penetration and a penetration at the cardiac wall into a left atrium of the heart.

Abstract: Septal defect occluders are disclosed which can be used with a catheter deployment system to occlude a septal defect. The septal defect occluders of the present invention comprise a metallic frame structure that supports a biodegradable member. The frame structure is made from a shape memory metal such as Nitinol. The frame forms two opposing umbrella or disc shaped halves that are connected via a central region. The biodegradable member is attached to the umbrella or disc shaped halves and can be any of numerous biodegradable materials and is preferably a co-polymer of glycolide and lactide. This material initially forms a barrier to blood flow that occludes the defect. Over time, this material is replaced by the body with scar tissue formation and endothelial cells. The metal frame is left coated with the body's own material that blocks the defect.

Abstract: A method for reducing mitral regurgitation includes deploying deforming matter into a selected one of (i) a mitral valve annulus adjacent a posterior leaflet, and (ii) tissue adjacent the mitral valve annulus and proximate the posterior leaflet, to cause conformational change in the mitral valve annulus to increase mitral valve leaflet coaptation.

Abstract: The invention is directed to two minimally invasive therapeutic procedures, particularly for patients with congestive heart failure which may be performed separately or together. One procedure involves providing a valved passageway through the patient's left ventricular wall at the apex of the patient's heart and advancing instruments through the valved passageway to connect the valve leaflets of the patient's heart valve, e.g. the mitral valve, in a “Bow-Tie” configuration to prevent or minimize regurgitation through the valve. The second procedure involves advancing a pacing lead and a pacing lead implanting device through a trocar in the patient's chest and implanting the pacing lead on an exposed epicardial region of the patient's heart wall. The pacing lead has a penetrating electrode which is secured within the heart wall.

Abstract: Devices and methods are provided for securing leaflets of a cardiac valve together. The subject devices include an assembly having a fastener, means for temporarily securing the fastener to the leaflets and means for permanently securing the fastener to the leaflets and means for anchoring the fastener to the heart wall. The subject methods are characterized by temporarily grasping the leaflets of a valve together at an apposition point, assessing at least one of blood flow and pressure gradient across said valve, determining whether to permanently secure the valve leaflets at said selected apposition point based upon at least one of the measured blood flow and pressure gradient, and performing one of permanently attaching the leaflets together at the apposition site or releasing the grasped leaflets. Also included are assemblies which include a subject device and a delivery device and may include a pressure monitoring member and/or a flow monitoring member.

Abstract: A valve prosthesis which is especially useful in the case of aortic stenosis and capable of resisting the powerful recoil force and to stand the forceful balloon inflation performed to deploy the valve and to embed it in the stenotic aortic annulus, comprises a collapsible valvular structure and an expandable frame on which said valvular structure is mounted. The valvular structure is composed of physiologically compatible valvular tissue that is sufficiently supple and resistant to allow the valvular structure to be deformed from a closed state to an opened state. The valvular tissue forms a continuous surface. The valve prosthesis can be delivered percutaneously, surgically, or endoscopically.

Abstract: The present invention relates to the implantation of one or more prosthetic valve(s) in the pulmonary vein(s) of a subject for decreasing or preventing an increase in pulmonary venous pressure. The present invention accordingly provides for novel treatment strategies for the treatment of medical disorders associated with elevated pulmonary venous pressure, including congestive heart failure, as well as for prosthetic pulmonary vein valves and their delivery systems. Expandable as well as fixed-dimension non-expandable pulmonary vein prosthetic valves for implantation by a variety of surgical and percutaneous procedures are also described.

Abstract: A prosthetic device inserted into a blood vessel decreases the severity of valve regurgitation during ventricular contraction. The prosthetic device reduces the circumference of the valve annulus, causing the valve leaflets attached to the annulus to close more completely. A first preferred embodiment is an elongated member that includes distal and proximal segments separated by an intermediate segment. The prosthetic device has at least one anchor control wire to anchor the device in the blood vessel and at least one length control wire. A second preferred embodiment is an elongated member that includes distal and proximal segments that are connected by a pivot or hinge joint. A control wire is anchored on the distal segment and pivotally moves the distal and proximal segments closer together. Rotation of the length control wire of the first embodiment or the control wire of the second embodiment reduces the circumference of the valve annulus.

Abstract: A mitral valve annuloplasty ring and method for implanting a mitral valve annuloplasty ring to treat mitral insufficiency by reestablishing the normal shape and contour of the mitral valve annulus. The annuloplasty ring is flexible and can be readily adjusted to different sizes and shapes. The method substantially eliminates scarring subsequent to the annuloplasty procedure to maintain flexibility of the ring and the annulus indefinitely.

Abstract: Expandable heart valves for minimally invasive valve replacement surgeries are disclosed. The valves are rolled into a first, contracted configuration for minimally invasive delivery using a catheter, and then unrolled or unfurled at the implantation site. One- and two-piece stents may be used in conjunction with a plurality of flexible leaflet-forming membranes. The stents may include an annulus section, a sinus section with the membranes attached over sinus apertures, and an outflow section. Lockout tabs and making slots secure the stents in their expanded shapes. Alignment structure ensures concentric unfurling of the stent. Anchoring elements at the stent edges or in the stent body secure the valve within the annulus. A method of manufacture includes shape setting the sheet-like stent to ensure an outward bias during deployment. The stent may also include dear tracks for engagement with a gear mechanism for deployment.

Abstract: An apparatus (10) for helping improve operation of a heart valve includes a generally annular base (12) and a buttress (20) extending generally axially from and inwardly relative to an arc portion of the base (12). When the apparatus (10) is when implanted at an annulus of a heart valve, the buttress (20) thereof provides a surface with which a leaflet of the heart valve may move into and out of engagement for helping control blood flow relative to the apparatus (10) and heart valve.

Abstract: A design and method of implantation is disclosed for a flexible annuloplasty system for repairing a valve in a patient's heart. The annuloplasty system includes an elongate, flexible band with a needle attached to one end of the band and a fit adjuster attached to the other end of the band. The band is made of silicone and includes a plurality of fibers that are configured to prevent axial elongation of the band. In addition, the plurality of fibers ensure that a suture will catch on the fibers and prevent the suture from tearing out of the band.

Abstract: Apparatus for reducing mitral regurgitation, by applying a force to the wall of the coronary sinus so as to force the posterior leaflet anteriorly and thereby reduce mitral regurgitation.

Abstract: Apparatus for reducing mitral regurgitation, including a bendable elongated body adapted to be inserted into the coronary sinus of a patient in the vicinity of the posterior leaflet of the mitral valve, the elongated body being adjustable between a first configuration adapted to be delivered into the coronary sinus and a second configuration adapted to exert a force onto the posterior annulus. The body includes a flexible spine having a proximal end and a distal end, and a flexible wire mounted on the spine and having a distal end fixed to the spine proximate to the distal end of the spine, and having a proximal portion extending from the proximal end of the spine. Axial movement of the wire causes a change in the spine from the first configuration to the second configuration to exert the force on the posterior annulus and thereby reduce mitral regurgitation.

Abstract: Methods and devices for passively assisting the cardiac function of the heart are disclosed. A method of increasing the cardiac output of a heart includes providing a site of surgical access to the portion of the heart to be restrained, reducing the cardiac expansion of the portion of the heart to be restrained, and maintaining the reduction of cardiac expansion of the portion of the heart to be restrained for a substantial amount of time. Cardiac assist devices for increasing the cardiac output of the heart are disclosed comprising a reinforcing portion configured to contact a portion of the heart tissue wherein the reinforcing portion restricts the expansion of the portion of the heart tissue. The reinforcing portion can be a number of structures, including pads, frames, straps, and other retaining means for limiting cardiac expansion of the portion of the heart tissue to be restrained.

Abstract: Disclosed is a conduit that provides a bypass around a stenosis or occlusion in a coronary artery. The conduit is adapted to be positioned in the myocardium to provide a passage for blood to flow from a heart chamber to a coronary artery, at a site distal to the blockage or stenosis in the coronary artery. The conduit has a one-way valve positioned therein to prevent the backflow of blood from the coronary artery into the heart chamber.

Abstract: The present invention relates to a minimally invasive method of performing annuloplasty. According to one aspect of the present invention, a method for performing a procedure on a mitral valve of a heart includes inserting an implant into a left ventricle and orienting the implant in the left ventricle substantially below the mitral valve. The implant and tissue around the mitral valve are connected and tension is provided to the implant, in one embodiment, in order to substantially reduce an arc length associated with the mitral valve. In another embodiment, the implant is inserted into the left ventricle through the aorta and the aortic valve.

Abstract: An artificial valve for repairing a damaged heart valve having a plurality of cusps separating upstream and downstream regions. The artificial valve includes a flexibly resilient frame with a plurality of peripheral anchors for anchoring the frame in position between the regions. The frame includes a central portion located between the anchors. The valve includes a flexible valve element attached to the central portion of the frame having an upstream side and a downstream side opposite the upstream side. The valve element moves to an open position when fluid pressure in the upstream region is greater than fluid pressure in the downstream region to permit downstream flow. The valve element moves to a closed position when fluid pressure in the downstream region is greater than fluid pressure in the upstream region to prevent flow reversal. The valve may be used in beating heart procedures, avoiding cardiopulmonary bypass and cardioplegia.

Abstract: A mitral annuloplasty and left ventricle restriction device is designed to be transvenously advanced and deployed within the coronary sinus and in some embodiments other coronary veins. The device places tension on adjacent structures, reducing the diameter and/or limiting expansion of the mitral annulus and/or limiting diastolic expansion of the left ventricle. These effects may be beneficial for patients with dilated cardiomyopathy.

Abstract: The valve implantation system has a valve displacer for displacing and holding the native valve leaflets open in a first aspect of the invention. A replacement valve may be attached to the valve displacer before or after introduction and may be positioned independent of the valve displacer. In another aspect of the invention, the valve displacer and valve are in a collapsed condition during introduction and are expanded to deploy the valve displacer and valve. The valve is a tissue valve mounted to an expandable support structure. The support structure may have protrusions for engaging the valve displacer or barbs for anchoring the valve displacer to the heart or blood vessel. A temporary valve mechanism may be used to provide temporary valve functions during and after deployment of the valve displacer.

Abstract: There are disclosed various systems and methods for installing a synthetic, artificial heart valve within a patient. One system generally includes a plurality of sutures, each suture having a staple attached to a distal end thereof; a surgical stapler for radially discharging the staples into a heart at a location adjacent a site for installing the heart valve; a support assembly for releasably supporting the plurality of sutures; and a heart valve setter assembly, the heart valve setter assembly being operable to move the heart valve into position within the site in the heart.

Abstract: A semilunar stentless valve is formed entirely of biological tissue, and has a plurality of leaflets that are joined to form an annulus and coapt to form a one-way valve. The leaflets open fully to minimize obstruction. A narrow rim of tissue is provided over commissures where the leaflets join and around a base of the valve for a serving ring. The valves can be sutured to heart tissue wall in a single suture row.

Abstract: Methods and apparatus for direct coronary revascularization wherein a transmyocardial passageway is formed between a chamber of the heart and a coronary blood vessel to permit blood to flow therebetween. In some embodiments, the transmyocardial passageway is formed between a chamber of the heart and a coronary vein. The invention includes unstented transmyocardial passageways, as well as transmyocardial passageways wherein protrusive stent devices extend from the transmyocardial passageway into an adjacent coronary vessel or chamber of the heart. The apparatus of the present invention include protrusive stent devices for stenting of transmyocardial passageways, intraluminal valving devices for valving of transmyocardial passageways, intracardiac valving devices for valving of transmyocardial passageways, endogenous tissue valves for valving of transmyocardial passageways, and ancillary apparatus for use in conjunction therewith.

Abstract: A prosthesis delivery system having a balloon catheter with an inflatable balloon on its exterior. The balloon is inflatable by injection of fluid through a lumen in the catheter and the balloon is initially partially constrained against inflation by a constraint. A tubular prosthesis is disposed on the catheter over at least a portion of the balloon and a portion of the constraint. The tubular prosthesis has a contracted condition and an expanded condition. The tubular prosthesis is initially disposed on the catheter in the contracted condition. Further, a balloon catheter includes a constraint so that the balloon may be sequentially,inflated for dilatation purposes such as in a valvuloplasty operation.

Abstract: The present invention comprises a method for deploying an aortic valve prosthesis. This valve prosthesis may include any of the known aortic valves including, but not limited to, stented and unstented bioprosthetic valves, stented mechanical valves, and expandable or self-expanding valves, whether biological or artificial. The method involves the steps of: making a first opening leading to the left atrium; passing a valve prosthesis through the opening and into a cardiac chamber of the left side of the heart using a first manipulation instrument; making a second opening in the arterial system and advancing one end of a second manipulation instrument through the arterial opening and into the aforementioned cardiac chamber; securing the second manipulation instrument to the valve prosthesis; and using the second manipulation instrument to retract at least some portion of the valve prosthesis out of the aforementioned cardiac chamber.

Abstract: A heart valve with a structural stent and radially moveable cusps and commissures. The stent may be of three separate elements, each having a cusp portion and two commissure portions. The commissures may be pivotally or flexibly coupled, and may separate into independent leaflets. A connecting band may be provided that follows the cusps and commissures and extend outwardly. The valve may be connected to the natural tissue along the undulating connecting band. A multi-legged holder having legs alternating between each cusp and commissure may be used for implantation. A method of implantation is also disclosed, as is a system for implanting independent valve leaflets in the native annulus.

Abstract: An assembly for holding a substantially flexible suture guide of predetermined length in a substantially taut position used to achieve a suture line having a dimension equal to the length of the suture guide, such as the circumference about a heart valve annulus. The assembly includes a rigid suture guide holder having a surface against which the length of suture guide is releasably positioned. The guide holder can have a shape or geometry, such as a circumference or circumferential segment, equivalent to the shape or geometry of the intended suture line. The shape of the guide holder can therefore be selected to hold the suture guide in the shape most advantageous to placing the desired suture line.

Abstract: An apparatus and method are disclosed for supporting a heart valve with a flexible girdle. The girdle has an elongated cylindrical sidewall having an axial length at least commensurate with the heart valve. The girdle is disposed around a tubular valve wall of the heart valve being implanted so that the inflow end of the girdle is adjacent the inflow end of the tubular valve wall. The inflow ends of the girdle and heart valve may then be sutured together to implant the valve. The girdle provides support to stabilize the heart valve and inhibit deformation thereof.

Abstract: A mitral valve annuloplasty ring and method for implanting a mitral valve annuloplasty ring to treat mitral insufficiency by reestablishing the normal shape and contour of the mitral valve annulus. The annuloplasty ring is flexible and can be readily adjusted to different sizes and shapes. The method substantially eliminates scarring subsequent to the annuloplasty procedure to maintain flexibility of the ring and the annulus indefinitely.

Abstract: A cardiovascular valve system including a permanent base unit that is affixed to the patient using conventional sutures or staples, and a collapsible valve having a collapsible frame that mates with the permanent base unit, and supports valve leaflets. An installed collapsible frame may be re-collapsed and disengaged from the permanent housing. A new collapsible valve is then installed, to resume the function of the prosthesis.

Abstract: An assembly for holding a substantially flexible suture guide of predetermined length in a substantially taut position used to achieve a suture line having a dimension equal to the length of the suture guide, such as the circumference about a heart valve annulus. The assembly includes a rigid suture guide holder having a surface against which the length of suture guide is releasably positioned. The guide holder can have a shape or geometry, such as a circumference or circumferential segment, equivalent to the shape or geometry of the intended suture line. The shape of the guide holder can therefore be selected to hold the suture guide in the shape most advantageous to placing the desired suture line.