Abstract: Systems and apparatuses for use with a guidewire are provided. The systems/apparatuses can include a first housing, shaped to define a first channel through which the guidewire is slidable and a second housing, shaped to define a second channel through which the guidewire is slidable in at least a first direction toward the first housing. The systems/apparatuses can also include a guidewire-engaging element, disposed within the second housing, and configured to inhibit the guidewire from sliding through the second channel in a second direction away from the first housing. A tubular member having a lumen through which the guidewire is slidable and being slidably coupled to the first housing can also be included. Other embodiments are also described.

Abstract: A radiopaque frame is transluminally advanced to an atrium of a heart of a subject. The frame is expanded within a valve adjacent the atrium such that part of the frame remains disposed in the atrium. While the frame remains expanded within the valve, progressive portions of an annuloplasty structure are progressively positioned and anchored around the annulus using multiple anchors by, for each of the anchors sequentially (i) while fluoroscopically imaging the frame and a distal end of a delivery tool, and facilitated by mechanical guidance from the frame, positioning the distal end of the delivery tool between the frame and a wall of the atrium; and (ii) driving the anchor into the annulus laterally from the frame. Subsequently, the frame is contracted and withdrawn from the subject while leaving the annuloplasty structure anchored around the annulus. Other embodiments are also described.

Abstract: Methods are described for use with a valve of a heart of a subject, the valve having an annulus, a first leaflet and an opposing leaflet, the heart having an atrium upstream of the valve, and a ventricle downstream of the valve. A tissue anchor, and an implant that includes a flexible frame, are transluminally advanced to the atrium. The implant is deployed within the atrium. Via anchoring of the tissue anchor to the annulus of the valve, the implant is secured within the heart by a first part of the frame being secured to the annulus, such that the frame extends over the first leaflet toward the opposing leaflet with a first side of the frame facing the first leaflet. Part of the frame can be disposed between the first leaflet and the opposing leaflet. Other embodiments are also described.

Abstract: A method is described for use with a heart of a subject, the heart having a valve and an atrium upstream of the valve. The method includes transluminally advancing multiple tissue anchors to the atrium; and securing an elongate contraction member at least partly around an annulus of the valve by anchoring the tissue anchors to the annulus, such that the tissue anchors are distributed along the elongate contraction member. The method further includes subsequently contracting the annulus by applying tension the elongate contraction member, such that a radiopaque indicator that is disposed within the heart and that is coupled to the contraction member undergoes a conformational change in response to the tension. The conformational change of the radiopaque indicator within the heart is observed, and the tension is adjusted responsively to the observed conformational change. Other embodiments are also described.

Abstract: A linking member extends from a first linking site of a longitudinal member to a second linking site of the longitudinal member. An anchor driver is configured to anchor portions of the longitudinal member to tissue using tissue anchors. A distal portion is anchorable to a first tissue location while the first linking site is within a catheter. While the distal portion is anchored to the first location, and the second linking site is within the catheter, a second portion is advanceable distally out of the catheter and is anchorable to a second tissue location. While the second portion is anchored to the second location, the second linking site and a third portion are advanceable distally out of the catheter. After the second linking site has been advanced out of the catheter, the third portion is anchorable to a third tissue location. Other embodiments are also described.

Abstract: An implant, disposed within a catheter, comprises a ring, anchors, and adjustment elements. The ring comprises struts arranged in a pattern of alternating peaks and troughs. Each strut has a first end-portion and a second end-portion. Each peak is defined by convergence of adjacent first end-portions disposed at an angle with respect to each other, and each trough is defined by convergence of adjacent second end-portions. Each of the anchors has a longitudinal axis, is coupled to the ring at a respective trough, and is configured to be driven along the longitudinal axis with respect to the trough and into tissue of the heart. Each of the adjustment elements is configured to adjust an angular disposition between a respective pair of the struts. A first adjustment element is coupled to its pair, and a second adjustment element is coupled to its pair distal to the first adjustment element.

Abstract: An anchor includes (a) an anchor head; and (b) a tissue-engaging member extending distally away from the anchor head until a distal tip of the tissue-engaging member, and configured to anchor the anchor to tissue. An anchor driver can include (a) a longitudinal shaft, having a flexible distal portion and a distal end; (b) a deployment element at the distal end of the shaft, reversibly lockable to the anchor head, and reversibly movable between (i) a locked state that retains locking between the deployment element and the anchor head, and (ii) an unlocked state that unlocks the deployment element from the anchor head; and (c) a tissue-piercing lance, reversibly movable between (i) an extended state in which the lance extends distally from the shaft past the distal tip of the anchor, and retains the deployment element in the locked state, and (ii) a retracted state in which the deployment element automatically moves into the unlocked state.

Abstract: An implant comprises a first fabric and a second fabric. The first fabric comprises first fibers, disposed in a first orientation, and second fibers interwoven with the first fibers and disposed in a second orientation that is different to the first orientation. The second fabric comprises third fibers, and fourth fibers interwoven with the third fibers. The second fabric is attached to the first fabric in a manner in which: the first and second fabrics collectively form a body portion of the implant, the third fibers are disposed in a third orientation that is different to the first and second orientations, and the fourth fibers are disposed in a fourth orientation that is different to the first, second, and third orientations. The body portion is configured to be secured to an upstream surface of a native valve of a heart of a subject. Other embodiments are also described.

Abstract: An implant that includes a ring, anchors, and adjustment elements is advanced to a subject's heart valve. The ring includes hinges, and struts arranged in a pattern of alternating peaks and troughs. The ring circumscribes a central axis. At least one hinge is disposed at each trough. Each strut has a first end-portion and a second end-portion. Each peak is defined by convergence of adjacent first end-portions. Each trough is defined by convergence of adjacent second end-portions. Each anchor has a longitudinal axis. Within the heart, the longitudinal axis of at least one of the anchors is deflected with respect to the central axis, and each of the anchors is driven along its longitudinal axis with respect to the trough and into tissue of the heart. Subsequently, tissue of the heart is contracted by rotating the plurality of adjustment elements. Other embodiments are also described.

Abstract: An annuloplasty implant comprises a flexible member, helical anchors, and non-compressible portions. The helical anchors are configured to anchor the flexible member at least partway around the valve by being screwed into tissue of the heart of a subject. Each of the non-compressible portions comprises a helical coil having a plurality of turns, and at rest has a helix pitch that contacts each turn of the coil with an adjacent turn of the coil. The flexible member extends through the non-compressible portions. The implant is configured such that applying tension to the flexible member from one end thereof contracts the implant, thereby drawing the anchors closer to each other, the helical coil of each of the non-compressible portions inhibiting contraction of the implant at the non-compressible portion.

Abstract: Apparatus is provided for adjusting at least one dimension of an implant. The apparatus includes a rotatable structure having a channel extending between first and second openings of the rotatable structure. The channel is configured for passage therethrough of an elongate tool. The rotatable structure has a lower surface that is shaped to define a first coupling. The apparatus includes a mechanical element having a surface coupled to the lower surface of the rotatable structure. The mechanical element is shaped to provide a second coupling configured to engage the first coupling during a resting state of the mechanical element, in a manner that restricts rotation of the rotatable structure. The mechanical element has a depressible portion that is disposed in communication with the second opening, and is configured to disengage the first and second couplings in response to a force applied thereto by the elongate tool.

Abstract: Apparatus is provided including a percutaneously-implantable implant and an adjustment device. The adjustment device can comprise an adjustment mechanism, coupled to the implant, and configured to change a dimension of the implant upon actuation of the adjustment mechanism and a lock. The adjustment device can have a locked state in which the lock inhibits actuation of the adjustment mechanism and an unlocked state in which the adjustment mechanism is actuatable. The adjustment device can be reversibly movable between the locked state and the unlocked state. The apparatus can include a longitudinal guide member and an adapter. An unlocking mechanism can be configured such that, while the adapter is coupled to the adjustment device, actuation of the unlocking mechanism moves the lock between the locked state and the unlocked state. Other applications are also described.

Abstract: Systems and apparatuses for use with a guidewire are provided. The systems/apparatuses can include a first housing, shaped to define a first channel through which the guidewire is slidable and a second housing, shaped to define a second channel through which the guidewire is slidable in at least a first direction toward the first housing. The systems/apparatuses can also include a guidewire-engaging element, disposed within the second housing, and configured to inhibit the guidewire from sliding through the second channel in a second direction away from the first housing. A tubular member having a lumen through which the guidewire is slidable and being slidably coupled to the first housing can also be included. Other embodiments are also described.

Abstract: Apparatus for use with a guidewire is provided, the apparatus including (1) a first housing, shaped to define a first channel through which the guidewire is slidable; (2) a second housing, shaped to define a second channel through which the guidewire is slidable in at least a first direction toward the first housing; (3) a guidewire-engaging element, disposed within the second housing, and configured to inhibit the guidewire from sliding through the second channel in a second direction away from the first housing; and (4) a tubular member, (a) shaped to define a lumen therethrough, through which the guidewire is slidable, and (b) coupled to the second housing and slidably coupled to the first housing. Other embodiments are also described.

Abstract: An implant that includes a ring, anchors, and adjustment elements is advanced to a subject's heart valve. The ring includes hinges, and struts arranged in a pattern of alternating peaks and troughs. The ring circumscribes a central axis. At least one hinge is disposed at each trough. Each strut has a first end-portion and a second end-portion. Each peak is defined by convergence of adjacent first end-portions. Each trough is defined by convergence of adjacent second end-portions. Each anchor has a longitudinal axis. Within the heart, the longitudinal axis of at least one of the anchors is deflected with respect to the central axis, and each of the anchors is driven along its longitudinal axis with respect to the trough and into tissue of the heart. Subsequently, tissue of the heart is contracted by rotating the plurality of adjustment elements. Other embodiments are also described.

Abstract: A linking member extends from a first linking site of a longitudinal member to a second linking site of the longitudinal member. An anchor driver is configured to anchor portions of the longitudinal member to tissue using tissue anchors. A distal portion is anchorable to a first tissue location while the first linking site is within a catheter. While the distal portion is anchored to the first location, and the second linking site is within the catheter, a second portion is advanceable distally out of the catheter and is anchorable to a second tissue location. While the second portion is anchored to the second location, the second linking site and a third portion are advanceable distally out of the catheter. After the second linking site has been advanced out of the catheter, the third portion is anchorable to a third tissue location. Other embodiments are also described.

Abstract: Apparatus for use at a native heart valve of a subject is described. For some applications, the apparatus comprises a prosthetic valve support, configured (a) to be implanted at the native valve, (b) to facilitate, at a first period, implantation at the native valve of a first prosthetic valve, and (c) to facilitate, at a second period, implantation at the native valve of a second prosthetic valve. Other embodiments are also described.

Abstract: For some applications, apparatus is provided for facilitating implantation of a prosthetic valve at a native heart valve of a subject, the apparatus comprising a prosthetic valve support, the prosthetic valve support (a) being configured to be transluminally-deliverable to the native valve and to be deployable at the native valve, and (b) comprising one or more tissue-engaging elements, configured to couple the prosthetic valve support to leaflets of the native valve without eliminating check valve functionality of the native valve. Other embodiments are also described.

Abstract: Apparatus is provided, comprising a ring, comprising a plurality of struts arranged in a pattern of alternating peaks and troughs, each strut having a first end-portion and a second end-portion, each peak defined by convergence of adjacent first end-portions disposed at an angle with respect to each other, and each trough defined by convergence of adjacent second end-portions. The apparatus also comprises a plurality of anchors. Each anchor has a longitudinal axis, is configured to be driven along the longitudinal axis into tissue of the heart, and is coupled to the ring at a respective trough in a manner that facilitates (i) movement of the anchor along the longitudinal axis with respect to the trough, and (ii) deflection of the longitudinal axis with respect to the trough.

Abstract: An anchor includes (a) an anchor head; and (b) a tissue-engaging member extending distally away from the anchor head until a distal tip of the tissue-engaging member, and configured to anchor the anchor to tissue. An anchor driver can include (a) a longitudinal shaft, having a flexible distal portion and a distal end; (b) a deployment element at the distal end of the shaft, reversibly lockable to the anchor head, and reversibly movable between (i) a locked state that retains locking between the deployment element and the anchor head, and (ii) an unlocked state that unlocks the deployment element from the anchor head; and (c) a tissue-piercing lance, reversibly movable between (i) an extended state in which the lance extends distally from the shaft past the distal tip of the anchor, and retains the deployment element in the locked state, and (ii) a retracted state in which the deployment element automatically moves into the unlocked state.