Abstract: Prosthetic valves and methods of implanting prosthetic valves may be provided, including an expandable prosthetic valve for implantation within a native heart valve. The prosthetic valve may include an annular valve body and atrial anchoring arms configured to extend radially outward from the annular valve body. Each atrial anchoring arm may have a proximal arm end and a distal arm end. The flexibility of at least one atrial anchoring arm may vary substantially from the proximal arm end thereof to the distal arm end thereof. The prosthetic valve may also include a plurality of ventricular anchoring legs configured to extend radially outward from the annular valve body. Each ventricular anchoring leg may have a proximal leg end and a distal leg end. Each ventricular anchoring leg may have a substantially constant flexibility from the proximal leg end to the distal leg end.

Abstract: A frame assembly (222) includes a tubular portion (32) that defines a lumen along an axis; a plurality of arms (46) coupled to the tubular portion at a first axial level, each of the arms extending radially outward from the tubular portion to a respective arm-tip; and a plurality of ventricular legs (50) that are coupled to the tubular portion at a second axial level, and that extend radially outward from the tubular portion. A first sheet (440) has a greater perimeter (446), and a smaller perimeter (448) that defines an opening. The first sheet is stitched onto the plurality of arms, with the opening aligned with the lumen. Subsequently, an outer perimeter (454) of a second sheet (450) is stitched to the greater perimeter of the first sheet. Subsequently, the second sheet is everted by passing an inner perimeter (452) of the second sheet around the arm-tips.

Abstract: Apparatus includes an implant including a flexible longitudinal member extending along a longitudinal length of the implant and a flexible contracting member extending alongside the longitudinal member and along the longitudinal length of the implant. The contracting member is configured to facilitate reduction of a perimeter of the implant by applying a contracting force to the longitudinal member in response to an application of force to the contracting member. The contracting member is disposed at a radially outer perimeter of the longitudinal member and configured to apply a pushing force to the longitudinal member responsively to the application of the force to the contracting member.

Abstract: An implant includes a prosthetic valve and is transitionable from a compressed to an expanded state. The implant includes a frame assembly including a plurality of struts that collectively define an upstream-frame-assembly-perimeter at an upstream end of the frame assembly and a downstream-frame-assembly-perimeter at a downstream end of the frame assembly. The frame assembly includes a valve frame that defines a lumen, and one or more appendages disposed at and extending in a downstream direction from the downstream-frame-assembly-perimeter. A plurality of prosthetic leaflets are disposed within the valve frame lumen and facilitate one-way upstream-to-downstream fluid flow through the lumen. The implant includes a fabric and, in the expanded state of the implant, the fabric obscures the one or more appendages and defines a downstream perimeter of the fabric at a downstream end of the implant. Additional embodiments are described.

Abstract: An expandable prosthetic valve for implantation within a native heart valve may be provided. The prosthetic valve may include an expandable annular valve body. The valve body may include an atrial inlet opening and a ventricular outlet opening. The valve body may additionally include a plurality of tissue anchors extending from the valve body. The prosthetic valve may additionally include a flexible annular protective sleeve positioned about the rim of the valve body outlet opening and affixed to the outlet opening.

Abstract: A prosthetic valve for implantation within a native heart valve may be provided. The prosthetic valve may include an annular outer frame having a plurality of ventricular anchoring legs extending therefrom, as well as an inner frame having a plurality of atrial anchoring arms extending therefrom. A portion of each ventricular anchoring leg may be configured to overlap with a portion of each atrial anchoring arm in a common lateral plane. As a result, a prosthetic valve with a reduced axial length may be provided.

Abstract: An expandable prosthetic valve for implantation within a native heart valve may be provided. The prosthetic valve may include an expandable annular valve body. The valve body may include an atrial inlet opening and a ventricular outlet opening. The valve body may additionally include a plurality of tissue anchors extending from the valve body. The prosthetic valve may additionally include a flexible annular protective sleeve positioned about the rim of the valve body outlet opening and affixed to the outlet opening.

Abstract: A valve body circumscribes a longitudinal axis and defines a lumen along the axis. Upstream arms are coupled to the valve body, and extend radially outward from the valve body to respective arm-tips. Downstream legs are coupled to the valve body, and extend radially outward from the valve body and toward the plurality of arms. A flexible pouch extends radially outward from the valve body. The arms and the legs narrow the pouch therebetween to form a narrowed portion of the pouch, thereby defining, in an interior space of the pouch: (a) an inner portion, radially inward from the narrowed portion, and in fluid communication with the lumen, and (b) an outer portion, radially outward from the narrowed portion, and in fluid communication with the inner portion via the narrowed portion. Other embodiments are also described.

Abstract: A prosthetic valve configured for implantation within a native valve may be provided. The prosthetic valve may include an expandable valve body having an inner lumen extending along a longitudinal axis of the valve body. The prosthetic valve may additionally include a plurality of ventricular tissue anchors configured to extend from the valve body to ventricular anchor distal ends, as well as a plurality of atrial tissue anchors configured to extend from the valve body to atrial anchor distal ends. Each atrial tissue anchor may include a rigid portion, and a flexible portion situated between a distal end of the rigid portion and the atrial anchor distal end. The ventricular anchor distal end of a ventricular tissue anchor and the distal end of the rigid portion of an atrial tissue anchor may be configured to be equidistant from the longitudinal axis of the valve body.

Abstract: A prosthetic valve for implantation within a native mitral valve may be provided. The prosthetic valve may include an annular valve body. The prosthetic valve may also include a plurality of tissue anchors arranged about the valve body and configured to extend from connection points on the valve body. The prosthetic valve may also include at least one protective fabric covering extending over each of the connection points between each tissue anchor and the valve body.

Abstract: A unitary flexible sheet is folded to defines a panel, and first and second tabs. Each of the tabs has an inner layer and an outer layer. First and second prosthetic leaflets are coupled to a tubular frame via the sheet. Each of the leaflets has a respective commissural portion. For each of the commissural portions, a first region of the commissural portion is sandwiched between inner layers of the first and second tabs, and a second region of the commissural portion is disposed flat against the panel. Other embodiments are also described.

Abstract: Apparatus is provided for use with a heart of a subject, the apparatus including an inner stent frame defining a tubular portion, and an outer stent frame. The apparatus has a relaxed expanded state in which an outer-stent-frame relaxed expanded diameter defined by the outer slept frame is smaller than an inner-stent-frame expanded diameter defined by the tubular portion. Together, the inner stent frame and the outer stent frame define a frame assembly in which outer-frame coupling elements are fixed to inner-frame coupling elements. The frame assembly is expandable into an expanded state in which the tubular portion defines an inner-stent-frame constrained expanded diameter that is smaller than the inner-stent-frame relaxed expanded diameter. The frame assembly includes prosthetic leaflets secured to, and disposed within, the tubular portion, and has a compressed state in which the frame assembly is transluminally advanceable to the heart. Other embodiments are also described.

Abstract: Prosthetic valves and methods of implanting prosthetic valves may be provided, including a prosthetic valve for implantation within a native heart valve. The prosthetic valve may include an annular valve body, a plurality of atrial anchoring arms, and a plurality of ventricular anchoring legs. The arms and legs may extend radially outward from the annular valve body and may each include a native valve tissue engaging portion. The arms may be angularly offset from the legs, with the tissue engaging portion of each arm and each leg arranged such that when the arms and legs are positioned on opposing sides of native heart valve tissue, the native heart valve tissue may assume a serpentine arrangement between the arms and the legs.

Abstract: A prosthetic valve for implantation within a native mitral valve may be provided. The prosthetic valve may include an annular valve body. The prosthetic valve may also include a plurality of tissue anchors arranged about the valve body and configured to extend from connection points on the valve body. The prosthetic valve may also include at least one protective fabric covering extending over each of the connection points between each tissue anchor and the valve body.

Abstract: A unitary flexible sheet is folded to defines a panel, and first and second tabs. Each of the tabs has an inner layer and an outer layer. Commissural portions of prosthetic leaflets are sandwiched between inner layers of the first and second tabs. The tabs protrude from a first side of the panel, and are shaped such that progressively downstream parts of each tab protrude progressively further away from the panel portion. Other embodiments are also described.

Abstract: A frame assembly (222) includes a tubular portion (32) that defines a lumen along an axis; a plurality of arms (46) coupled to the tubular portion at a first axial level, each of the arms extending radially outward from the tubular portion to a respective arm-tip; and a plurality of ventricular legs (50) that are coupled to the tubular portion at a second axial level, and that extend radially outward from the tubular portion. A first sheet (440) has a greater perimeter (446), and a smaller perimeter (448) that defines an opening. The first sheet is stitched onto the plurality of arms, with the opening aligned with the lumen. Subsequently, an outer perimeter (454) of a second sheet (450) is stitched to the greater perimeter of the first sheet. Subsequently, the second sheet is everted by passing an inner perimeter (452) of the second sheet around the arm-tips.

Abstract: A unitary flexible sheet is folded to defines a panel, and first and second tabs. Each of the tabs has an inner layer and an outer layer. Commissural portions of prosthetic leaflets are sandwiched between inner layers of the first and second tabs. The tabs protrude from a first side of the panel, and are shaped such that progressively downstream parts of each tab protrude progressively further away from the panel portion. Other embodiments are also described.

Abstract: A frame assembly includes a valve body, a plurality of arms that each extend radially outward from the valve body to a respective arm-tip, and a plurality of ventricular legs that are coupled to the valve body and that extend radially outward from the valve body and toward the plurality of arms. A liner lines the lumen. Prosthetic leaflets are attached to the liner within the lumen. A first sheet of flexible material is attached to the plurality of arms. A second sheet of flexible material is attached to the first sheet and extends radially inwards and downstream, and is attached to the valve body. The first sheet, the second sheet, and the liner define an inflatable pouch therebetween. The apparatus defines a plurality of windows from the lumen into the pouch.

Abstract: A prosthetic valve includes a tubular valve body, snares, and an upstream support. A native valve of a heart of a subject is disposed between an atrium and a ventricle of the heart, and has an annulus and leaflets. The prosthetic valve is advanced to the heart while in a compressed state. The prosthetic valve is positioned within the heart such that the snares are disposed upstream of the annulus and leaflets. The snares are expanded radially outwardly upstream of the leaflets. Subsequently, the prosthetic valve is moved in a downstream direction such that the snares become disposed downstream of the leaflets. While the snares remain downstream of the leaflets, the upstream support is expanded within the atrium, and the upstream support is placed against an upstream surface of the annulus. Other embodiments are also described.

Abstract: A tubular valve body has an upstream end and a downstream end, and has a central longitudinal axis, and defines a lumen along the axis. Prosthetic leaflets are disposed within the lumen, and are configured to facilitate one-way movement of fluid through the lumen in an upstream-to-downstream direction. The valve body has a cellular structure defined by a plurality of joists connected at nodes, the joists and nodes delimiting cells of the cellular structure. The nodes include minor nodes at which 2-4 joists are connected, and major nodes at which 6-8 joists are connected. The cells of the cellular structure comprise a first circumferential row of first-row cells. Each of the first-row cells is connected to each of its circumferentially-adjacent first-row cells at a respective one of the major nodes, and is longitudinally delimited by two of the minor nodes. Other embodiments are described.