Abstract: A prosthetic valve delivery system may be provided. The prosthetic valve delivery system may include a first catheter and a first steering mechanism configured to bend the first catheter within a first steering plane. The prosthetic valve delivery system may also include a second catheter coaxially arranged within the first catheter and a second steering mechanism configured to bend the second catheter within a second steering plane, different from the first steering plane. Moreover, the prosthetic valve delivery system may include a capsule positioned distal to both the first catheter and the second catheter. The capsule may be configured to retain a prosthetic valve therein during transvascular advancement of the capsule.

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.

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 unitary flexible sheet is folded to define: (i) a panel, defining a plane, and having a first side facing in a first direction away from the plane, (ii) a first tab, disposed on the first side of the panel, and protruding in the first direction away from the panel, and (iii) a second tab, disposed on the first side of the panel, and protruding in the first direction away from the panel. Between the first tab and the second tab are secured (i) a first-leaflet commissural portion of a first prosthetic leaflet, and (ii) a second-leaflet commissural portion of a second prosthetic leaflet. At the first tab, the sheet is folded to define a first cushion at a downstream edge of the first tab. At the second tab, the sheet is folded to define a second cushion at a downstream edge of the second tab.

Abstract: A unitary flexible sheet is folded to define: (i) a panel, defining a plane, and having a first side facing in a first direction away from the plane, (ii) a first tab, disposed on the first side of the panel, and protruding in the first direction away from the panel, and (iii) a second tab, disposed on the first side of the panel, and protruding in the first direction away from the panel. Between the first tab and the second tab are secured (i) a first-leaflet commissural portion of a first prosthetic leaflet, and (ii) a second-leaflet commissural portion of a second prosthetic leaflet. At the first tab, the sheet is folded to define a first cushion at a downstream edge of the first tab. At the second tab, the sheet is folded to define a second cushion at a downstream edge of the second tab.

Abstract: In an unfolded state, a sheet defines a panel at a medial region, and tab portions disposed peripherally to the panel. A method comprises (A) sandwiching, between a first tab portion and a second tab portion, (i) a first commissural portion of a first leaflet, and (ii) a second commissural portion of a second leaflet; (B) attaching the first tab portion and the second tab portion to the sheet by stitching a first stitching through the tab portions and the commissural portions; (C) subsequently, covering the first stitching by: (i) forming the first tab portion into a first tab having an outer layer and an inner layer, and (ii) forming the second tab portion into a second tab having an outer layer and an inner layer; and (D) subsequently, stitching a second stitching through the outer and inner layers, and the commissural portions. Other embodiments are also described.

Abstract: In an unfolded state, a sheet defines a panel at a medial region, and tab portions disposed peripherally to the panel. A method comprises (A) sandwiching, between a first tab portion and a second tab portion, (i) a first commissural portion of a first leaflet, and (ii) a second commissural portion of a second leaflet; (B) attaching the first tab portion and the second tab portion to the sheet by stitching a first stitching through the tab portions and the commissural portions; (C) subsequently, covering the first stitching by: (i) forming the first tab portion into a first tab having an outer layer and an inner layer, and (ii) forming the second tab portion into a second tab having an outer layer and an inner layer; and (D) subsequently, stitching a second stitching through the outer and inner layers, and the commissural portions. 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: 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: 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: 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 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: 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: 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.