Abstract: A method includes advancing apparatus including a core toward a patient's heart valve. The core tapers in a distal direction toward the smallest perimeter of the core. The apparatus includes a first ventricular arm, which is articulatable with respect to a first atrial arm at a first articulation site, and a second ventricular arm, which is articulatable with respect to a second atrial arm at a second articulation site. The articulation sites are adjacent to the smallest perimeter. The tapering of the core defines a minimum nonzero angle of the atrial arms with respect to a central longitudinal axis of the core. The method also includes clamping the first and second leaflets between the respective atrial arms and the respective ventricular arms. Other embodiments are also described.

Abstract: Apparatus is provided for use at a native atrioventricular valve of a heart of a subject. A prosthetic valve structure includes prosthetic leaflets configured to facilitate upstream-to-downstream bloodflow longitudinally through the prosthetic valve structure. The apparatus includes an annular portion configured to be positioned at the native atrioventricular valve and curved anchors that point in a circumferential direction around the annular portion. The anchors each having a leading tip configured to gather chordae tendineae of the heart between the anchors and the annular portion. Rotation of the prosthetic valve structure in the circumferential direction causes the anchors to gather the chordae tendineae between the anchors and the annular portion by the anchors moving, leading tip first, in the circumferential direction. Other embodiments are also described.

Abstract: Implantable first atrial and ventricular arms are articulatable at a first articulation site to clamp a first heart valve leaflet. A first implantable elongate transitioning member is (a) connected at a fixed connection point at a portion of the first ventricular arm farthest from the first articulation site, (b) has a portion that faces an opposite surface of the first ventricular arm, and (c) is controllable to move the first ventricular arm. Implantable second atrial and ventricular arms are articulatable at a second articulation site to clamp a second leaflet. A second implantable elongate transitioning member is (a) connected at a fixed connection point at a portion of the second ventricular arm farthest from the second articulation site, (b) has a portion that faces an opposite surface of the second ventricular arm, and (c) is controllable to move the second ventricular arm. Other embodiments are also described.

Abstract: An implant is coupled to first and second native leaflets of a native heart valve of a patient. The implant includes a proximal collar, a distal collar, and first and second clasps. Each of the clasps has first and second tissue-engaging portions that are (1) disposed distal to the proximal collar and proximal to the distal collar, and (2) movable, with respect to each other, to clamp one of the leaflets between the tissue-engaging portions of the clasp. The implant is configured such that, when the leaflets are clamped by the clasps, the clasps form the first and second native leaflets into a double orifice, each orifice configured to function as a respective check-valve. Fabric extends distally from the proximal collar on either side of the central longitudinal axis, and is coupled to the clasps. Other embodiments are also described.

Abstract: An implant is configured to be coupled to first and second native leaflets of a native heart valve of a patient. The implant includes a proximal collar, a distal collar, and first and second clasps. Each of the first and second clasps has first and second tissue-engaging portions that are (1) disposed distal to the proximal collar and proximal to the distal collar, (2) movable, with respect to each other, to clamp one of the leaflets between the first and second tissue-engaging portions of the clasp, and (3) movable, when clamped to the leaflet, toward and away from a central longitudinal axis of the implant. The implant includes fabric (i) extending distally from the proximal collar on either side of the central longitudinal axis, and (ii) coupled to the first and second clasps. Other embodiments are also described.

Abstract: An implant includes first and second clasps, each having first and second tissue-engaging portions which are movable with respect to each other to clamp one of the native heart valve leaflets between respective tissue-engaging surfaces. Each of the tissue-engaging portions has a surface opposite the respective tissue-engaging surface. For each clasp, the implant includes a respective leg portion and a respective intermediate portion. Each intermediate portion is (i) coupled to the opposite surface of the second tissue-engaging portion of the clasp such that an orientation of the intermediate portion is fixed with respect to an orientation of the opposite surface of the second tissue-engaging portion of the clasp, and (ii) coupled to the leg portion at a respective portion of the implant that allows movement of the leg portion with respect to the intermediate portion. Other embodiments are also described.

Abstract: Apparatus is provided for use at a native atrioventricular valve of a heart of a subject. A prosthetic valve structure includes prosthetic leaflets configured to facilitate upstream-to-downstream bloodflow longitudinally through the prosthetic valve structure. The apparatus includes an annular portion configured to be positioned at the native atrioventricular valve and curved anchors that point in a circumferential direction around the annular portion. The anchors each having a leading tip configured to gather chordae tendineae of the heart between the anchors and the annular portion. Rotation of the prosthetic valve structure in the circumferential direction causes the anchors to gather the chordae tendineae between the anchors and the annular portion by the anchors moving, leading tip first, in the circumferential direction. Other embodiments are also described.

Abstract: Apparatus including a core is advanceable toward a patient's heart valve. The core tapers in a distal direction toward the smallest perimeter of the core. The apparatus includes a first ventricular arm, which is articulatable with respect to a first atrial arm at a first articulation site, and a second ventricular arm, which is articulatable with respect to a second atrial arm at a second articulation site. The articulation sites are adjacent to the smallest perimeter. The tapering of the core defines a minimum nonzero angle of the atrial arms with respect to a central longitudinal axis of the core. The first atrial arm and the first ventricular arm are arranged so as to clamp the first native leaflet. The second atrial arm and the second ventricular arm are arranged so as to clamp the second native leaflet. Other embodiments are also described.

Abstract: Apparatus is provided, including: (A) a valve body (204) including a first frame (206) shaped to define a lumen therethrough, and a valve member (205) disposed within the lumen, (B) an upstream support (210), configured to be placed against an upstream surface of a native heart valve, and (C) a flexible sheet (214) that couples the upstream support to the valve body. The valve body has a compressed state in which the first frame has a first diameter, and an expanded state in which the first frame has a second diameter that is greater than the first diameter. The support includes a second frame (212) that has a compressed state, and an expanded state in which the second frame is annular, has an inner perimeter that defines an opening through the second frame, and has an outer perimeter. Other embodiments are also described.

Abstract: Apparatus and methods are described including a prosthetic atrioventricular valve (10) for coupling to a native atrioventricular valve (12). The prosthetic valve includes a support frame (20) and a covering (22), which at least partially covers the support frame. The support frame and the covering are shaped so as to define a downstream skirt (24). A plurality of prosthetic leaflets (40) are coupled to at least one element selected from the group consisting of: the support frame and the covering. An elongated anchoring member (152) is positioned around the downstream skirt in a subvalvular space (150), such that the anchoring member presses native leaflets (30) of the native valve against the downstream skirt, thereby anchoring the prosthetic valve to the native valve. Other applications are also described.

Abstract: A method includes advancing apparatus including a core toward a patient's heart valve. The core tapers in a distal direction toward the smallest perimeter of the core. The apparatus includes a first ventricular arm, which is articulatable with respect to a first atrial arm at a first articulation site, and a second ventricular arm, which is articulatable with respect to a second atrial arm at a second articulation site. The articulation sites are adjacent to the smallest perimeter. The tapering of the core defines a minimum nonzero angle of the atrial arms with respect to a central longitudinal axis of the core. The method also includes clamping the first and second leaflets between the respective atrial arms and the respective ventricular arms. Other embodiments are also described.

Abstract: An implant is configured to be coupled to first and second native leaflets of a native heart valve of a patient. The implant includes a proximal collar, a distal collar, and first and second clasps. Each of the first and second clasps has first and second tissue-engaging portions that are (1) disposed distal to the proximal collar and proximal to the distal collar, and (2) movable, with respect to each other, to clamp one of the leaflets between the first and second tissue-engaging portions of the clasp. The implant is configured such that, when the leaflets are clamped by the first and second clasps, the first and second clasps form the first and second native leaflets into a double orifice, each orifice configured to function as a respective check-valve. Other embodiments are also described.

Abstract: Implantable first atrial and ventricular arms are articulatable at a first articulation site to clamp a first heart valve leaflet. A first elongate transitioning member is (a) connected at a fixed connection point at a portion of the first ventricular arm farthest from the first articulation site, (b) has a portion that faces an opposite surface of the first ventricular arm, and (c) is controllable to move the first ventricular arm. Implantable second atrial and ventricular arms are articulatable at a second articulation site to clamp a second leaflet. A second elongate transitioning member is (a) connected at a fixed connection point at a portion of the second ventricular arm farthest from the second articulation site, (b) has a portion that faces an opposite surface of the second ventricular arm, and (c) is controllable to move the second ventricular arm. Other embodiments are also described.

Abstract: An implant is configured to be coupled to first and second native leaflets of a native heart valve of a patient. The implant includes a proximal collar, a distal collar, and first and second clasps. Each of the first and second clasps has first and second tissue-engaging portions that are (1) disposed distal to the proximal collar and proximal to the distal collar, (2) movable, with respect to each other, to clamp one of the leaflets between the first and second tissue-engaging portions of the clasp, and (3) movable, when clamped to the leaflet, toward and away from a central longitudinal axis of the implant. Other embodiments are also described.

Abstract: A prosthetic valve structure, for use at a native atrioventricular heart valve, includes a frame, prosthetic leaflets, an upper skirt, and a lower skirt. The frame circumscribes a longitudinal axis of the structure. The leaflets are configured to facilitate upstream-to-downstream bloodflow through the structure. The upper skirt has an upstream perimeter. The lower skirt is downstream of the upper skirt, and has a downstream perimeter. The upper skirt extends away from the lower skirt, in an upstream direction and radially outward toward the upstream perimeter. The lower skirt extends away from the upper skirt, in a downstream direction and radially outward toward the downstream perimeter. A downstream portion of the frame is disposed downstream of at least part of the downstream perimeter of the lower skirt.

Abstract: An implant includes first and second clasps, each having first and second tissue-engaging portions which are movable with respect to each other to clamp one of the native heart valve leaflets between respective tissue-engaging surfaces. Each of the tissue-engaging portions has a surface opposite the respective tissue-engaging surface. For each clasp, the implant includes a respective leg portion and a respective intermediate portion. Each intermediate portion is (i) coupled to the opposite surface of the second tissue-engaging portion of the clasp such that an orientation of the intermediate portion is fixed with respect to an orientation of the opposite surface of the second tissue-engaging portion of the clasp, and (ii) coupled to the leg portion at a respective portion of the implant that allows movement of the leg portion with respect to the intermediate portion. Other embodiments are also described.

Abstract: Apparatus is provided, including: (A) a valve body (204) including a first frame (206) shaped to define a lumen therethrough, and a valve member (205) disposed within the lumen, (B) an upstream support (210), configured to be placed against an upstream surface of a native heart valve, and (C) a flexible sheet (214) that couples the upstream support to the valve body. The valve body has a compressed state in which the first frame has a first diameter, and an expanded state in which the first frame has a second diameter that is greater than the first diameter. The support includes a second frame (212) that has a compressed state, and an expanded state in which the second frame is annular, has an inner perimeter that defines an opening through the second frame, and has an outer perimeter. Other embodiments are also described.

Abstract: A catheter is transluminally advanced to a heart of a subject. Via the catheter, a prosthetic valve is advanced to the native valve. The prosthetic valve includes an upstream skirt, and a downstream skirt that has a first portion and a second portion. The first portion defines a lumen therethrough. The second portion circumscribes the first portion, and defines a plurality of anchoring arms that are coupled to the second portion. A plurality of prosthetic leaflets, within the lumen, are attached to the first portion. The upstream skirt is expanded in the atrium, and the anchoring arms are expanded in the ventricle, the anchoring arms extending radially outward and toward the upstream skirt. Subsequently, native valve tissue is squeezed between the upstream skirt and the anchoring arms by causing the anchoring arms to move with respect to the prosthetic leaflets, and toward the upstream skirt.

Abstract: Prosthetic heart valves and methods of use of prosthetic heart valves may be provided. In one implementation, a prosthetic heart valve may include an annular spacer configured for implantation with a native heart valve opening and a central valve section configured for disposal within the annular spacer. The central valve section may include at least one anchoring protrusion configured to anchor the central valve section against axial movement relative to the annular spacer. During deployment, the central valve section may be expanded radially within the heart into an at least partially-expanded configuration while at least a portion of the central valve section is situated outside of a space opening of the annular spacer, and moved upstream while remaining in the at least partially-expanded configuration until the anchoring protrusion engages the annular spacer.

Abstract: Prosthetic heart valves and methods of use of prosthetic heart valves may be provided. In one implementation, a prosthetic heart valve may include an annular spacer configured for implantation with a native heart valve opening and a central valve section configured for disposal within the annular spacer. The central valve section may include at least one anchoring protrusion configured to anchor the central valve section against axial movement relative to the annular spacer. During deployment, the central valve section may be advanced downstream beyond the implanted annular spacer, and moved upstream until the anchoring protrusion engages the annular spacer.