Abstract: A rod (508) is transfemorally advanceable to the heart. An implant (460) comprises (i) a first frame (462), compressed around a first longitudinal site of a distal portion of the rod, (ii) a second frame (464), compressed around a third longitudinal site of the distal portion, (iii) a valve member (50), disposed within the second frame, and (iv) a flexible sheet (466), coupling the first frame to the second frame, and disposed around a second longitudinal site of the distal portion, the second longitudinal site being between the first longitudinal site and the third longitudinal site. An extracorporeal controller (569) is coupled to a proximal portion of the rod, and is operably coupled to the distal portion of the rod. Operating the controller bends the distal portion of the rod causing articulation between the frames. Other embodiments are also described.

Abstract: A prosthetic valve is advanced to a heart of a subject while the prosthetic valve is in a compressed state thereof, the prosthetic valve including a plurality of snares coupled to a tubular valve body. The prosthetic valve is positioned within the heart such that the plurality of snares is disposed upstream of the leaflets, and the plurality of snares is expanded upstream of the leaflets. Subsequently the prosthetic valve is moved in a downstream direction such that the plurality of snares is disposed downstream of the leaflets. Subsequently, the prosthetic valve is secured at the native valve while the plurality of snares remains disposed downstream of the leaflets.

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: Apparatus is provided, including 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 longitudinal member has first and second ends, and the first end is movable with respect to the second end responsively to the applying of the contracting force to the longitudinal member by the contracting member. The apparatus includes a lock coupled to the longitudinal member. The lock is engageable with the longitudinal member to restrict movement of the longitudinal member.

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 stent 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: 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: 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, a plurality of atrial anchoring arms configured to extend radially outward from the annular valve body, and a plurality of ventricular anchoring legs configured to extend radially outward from the annular valve body. The arms may be configured to engage an atrial portion of the native mitral valve and the ventricular anchoring legs may be configured to engage a ventricular portion of the native mitral valve. The atrial anchoring arms and the ventricular anchoring legs may be positioned relative to each other such that when the atrial anchoring arms and ventricular anchoring legs engage the native mitral valve, a volume between the atrial anchoring arms and ventricular anchoring legs is configured to be substantially filled with tissue.

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: Prosthetic heart valves and methods of implanting prosthetic heart valves may be provided, including a method of implanting an expandable prosthetic valve within a native mitral valve between a heart atrium and a heart ventricle. The prosthetic valve may be constrained from expansion during delivery and may include an annular valve body, a plurality of ventricular anchors, and a plurality of atrial anchors. The method may include releasing the plurality of ventricular anchors within the atrium, releasing the plurality of atrial anchors within the atrium, moving the released ventricular anchors through the mitral valve and into the ventricle, and after moving the released ventricular anchors from the atrium to the ventricle, releasing the annular valve body. As a result, the prosthetic valve may be anchored within the mitral valve.

Abstract: A heart valve delivery system may be provided. The heart valve delivery system may include at least a first catheter movable relative to second and third catheters, arranged in a telescoping configuration. The second catheter may be movable relative to and extend from the distal end of the third catheter. The delivery system may include a first adjustable flexure radius associated with the second catheter, and a second flexure radius. The delivery system may include at one control handle assembly configured to permit the catheters to rotate together, independently adjust the first and second flexure radii, cause relative axial movement between the catheters, and permit the ejector to cause relative movement between a heart valve and a capsule connected to the first catheter.

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: 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 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 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: A prosthetic valve for implantation within a native heart valve may be provided. The prosthetic valve may include an annular valve body, as well as a plurality of ventricular anchoring legs and a plurality of atrial anchoring arms configured to extend radially outward from the annular valve body. The ventricular anchoring legs and grasping segments of the atrial anchoring arms may be configured to substantially restrict axial movement of the annular valve body within the native heart valve. In addition, anchoring segments of the atrial anchoring arms may be configured for lateral deformation relative to the native heart valve.

Abstract: A prosthetic valve for implantation within a native mitral valve may be provided. The prosthetic valve may include an annular valve body and a plurality of atrial anchoring arms and a plurality of ventricular anchoring legs configured to extend radially outward from the annular valve body. The prosthetic valve may also include a blood-inflatable cuff situated between the arms and legs and fastened to at least one arm. The cuff may be configured to extend radially outward beyond a terminal end of at least one arm when fully inflated with blood.

Abstract: An expandable prosthetic valve for implantation within a native mitral valve may be provided. The prosthetic valve may include an expandable valve body having an atrial end, a ventricular end opposite the atrial end, and an intermediate portion extending between the atrial end and the ventricular end. The valve body may include a plurality of struts intersecting at junctions. The prosthetic valve may also include a plurality of tissue anchoring legs extending from junctions within the intermediate portion of the valve body. At least one of the tissue anchoring legs may have a cross-sectional area which is larger by at least 20% than a cross-sectional area of a strut extending between the at least one tissue anchoring leg and an adjacent tissue anchoring leg.

Abstract: A prosthetic heart valve, which may include an expandable annular outer frame having a tubular portion and at least one tissue anchor portion configured to extend from the tubular portion, may be provided. The at least one tissue anchor portion may have a plurality of attachment locations. The prosthetic heart valve may also include an expandable inner frame configured at least partially within the expandable annular outer frame. The expandable inner frame may be connected to the expandable annular outer frame solely at one or more of the plurality of attachment locations of the at least one tissue anchor portion.

Abstract: A prosthetic valve for implantation within a native mitral valve may be provided. The prosthetic valve may include an annular valve body, a plurality of atrial anchoring arms configured to extend radially outward from the valve body, and a plurality of ventricular anchoring legs configured to extend radially outward from the valve body. The prosthetic valve may also include a blood-inflatable cuff situated between the arms and legs. The cuff may be configured to substantially fill a volume between the arms and the legs when the cuff is fully inflated with blood.