Abstract: Access to the left side of the heart is gained through a heart wall. A delivery instrument includes a guide that may include or carry a puncturing instrument that is adapted to be directed toward the heart wall. In some embodiments a distal portion of the delivery instrument may be adapted to be co-located with the coronary sinus. In addition, the guide may be located a known distance from the portion of the delivery instrument that is co-located with the coronary sinus. Access to the left side of the heart may thus be readily gained by positioning the delivery instrument relative to the coronary sinus.

Abstract: Apparatus and methods for repairing a bone. The apparatus and methods may involve transferring a mechanical load from a first bone fragment to a second bone fragment. For example, the first bone fragment may be at the end of the bone. The second bone fragment may be in the diaphyseal region of the bone. The bone fragment at the end of the bone may be separated by a fracture from the bone fragment in the diaphyseal region of the bone. The fracture may interfere with transmission of the load from the bone fragment at the end of the bone to the bone fragment in the diaphyseal region of the bone. Transmission of the load across the fracture by the apparatus may promote healing of the fracture.

Abstract: Apparatus and methods for securing a bone implant are provided. The implant may be an expandable implant. The implant may be a non-expandable implant. The implant may be for repairing a bone fracture. The implant may be secured to a bone by anchors. The implant may include anchor receiving features. The anchor receiving features may be configured to direct an anchor into cortical bone. The anchor receiving features may be configured to receive an anchor driven through cortical bone. The implant may include bone engaging members configured to engage cancellous bone. An implant may include different profiles. The different profiles may be configured to secure the implant. The profiles may be configured to support the bone. The implant may have different flexing properties configured to position the implant in the bone. The implant may be positioned to receive an anchor driven through an outside of the bone.

Abstract: Apparatus and methods for preparing the interior of a bone for therapy. The therapy may include therapy for a bone fracture. The apparatus and methods may involve orienting a surgical instrument for proper deployment in the interior of the bone. An instrument guide may be positioned and retained against translation along, and rotation about one or more of three substantially orthogonal axes. Apparatus placed exterior to the bone may register the guide to a region inside the bone that is designated for preparation or treatment. One or more broaching members may be used to prepare the region for treatment. A broaching member may be expandable inside the bone. A broaching member may be flexible such that it broaches bone having a relatively lower density and it leaves bone having a relatively higher density substantially intact.

Abstract: Apparatus and method for repairing a fractured bone. The apparatus and methods may involve an intramedullary rod. The rod may include a first elongated member and a second elongated member. Each of the first and second elongated members may be configured to bend in a first direction and to resist bending in a second direction. The first and second elongated members may be arranged such that: (1) the rod is bendable when the first direction of the first elongated member is aligned with the first direction of the second elongated member; and (2) the rod is rigid when the first direction of the first elongated member is aligned with the second direction of the second elongated member. Some embodiments may include rods that have sections that may be configured to be curved and rigid.

Abstract: Access to the left side of the heart is gained through a heart wall. A delivery instrument includes a guide that may include or carry a puncturing instrument that is adapted to be directed toward the heart wall. In some embodiments a distal portion of the delivery instrument may be adapted to be co-located with the coronary sinus. In addition, the guide may be located a known distance from the portion of the delivery instrument that is co-located with the coronary sinus. Access to the left side of the heart may thus be readily gained by positioning the delivery instrument relative to the coronary sinus.

Abstract: The invention describes methods and apparatus for creating permanent occlusion of body lumens such as the fallopian tubes. The methods and apparatus use non-surgical approaches to deliver permanent implants which create acute occlusion of desired body lumens which resolve to permanent occlusions of the lumens.

Abstract: Apparatus and methods for bone fracture repair. The apparatus may include a structural support for positioning a first bone segment relative to a second bone segment. The apparatus may include an anchoring substrate. The anchoring substrate may be configured to compress the first bone segment to the second bone segment. The anchoring substrate may transmit tension from a distal bone segment anchor in the first bone segment to a proximal bone segment anchor in the second bone segment. The apparatus may be configured to be deployed percutaneously in an inner cavity of a bone. The apparatus may be installed in an open fracture. The apparatus may be expanded, self-expanding or configured for mechanically actuation. Some embodiments of the apparatus may include a central axis member that may be used in conjunction with expansion of one or both of the structural support and the anchoring substrate to configure the apparatus.

Abstract: An implant structure for use in pulling two soft body tissue areas closer together in a patient (e.g., two points along or adjacent to the patient's mitral valve annulus) includes at least two tissue anchor structures that are respectively implantable into the two tissue areas. A tether structure links the two tissue anchors and can be shortened and held in that condition by a cinch structure. Bracing structures are used between the anchors and the tether to help keep the longitudinal axes of the anchors transverse to the tether axis even when the tether is under tension. The tether may be sheathed in a cushioning sleeve to help protect adjacent tissue from erosion by the tether.

Abstract: Soft body tissue structure can be remodeled by shortening the distance between first and second portions of that tissue structure. First and second anchor structures are respectively implanted in the first and second portions of the tissue structure. These anchor structures are linked by a linking structure, the length of which between the anchor structures can be shortened to pull the tissue structure portions toward one another. Each of the anchor structures may include two screw structures that are driven into the associated tissue structure portion transverse to the linking structure and with a spacer between the two screws. The entire prosthesis can be implanted percutaneously if desired. An illustrative use of the prosthesis is to shorten the annulus of a patient's mitral valve, with at least a portion of the prosthesis implanted in the patient's coronary sinus.

Abstract: Apparatus is provided that can be delivered through a catheter to a remote location in a patient's body. The apparatus may include a first structure that can be positioned in all dimensions in a controlled manner and stabilized in that desired position, a second structure that can then position a lumen axis at a desired angle relative to the first structure, and a third member that can pass through the lumen and approach and engage with force (e.g., penetrate) a desired location on the anatomy without compromising maintaining the desired position. The apparatus effectively separates the forces needed for positioning and the forces needed for tissue engagement (e.g., penetration).

Abstract: A structure that can be used to provide an anchor in or adjacent to a patient's soft body tissue (rather than bone) includes an annular array of flexible members that extend between two axially spaced but aligned tubular members. The space between the tubular members can be selectively changed to affect the amount by which portions of the flexible members between the tubular member project radially outward relative to the tubular members. When the flexible members project radially out, the structure resists axial movement relative to adjacent tissue and therefore acts as an anchor. When the flexible members do not project radially out, they permit axial movement of the structure through adjacent tissue.

Abstract: Methods and apparatus for delivering and installing a new length of tubing between two sections of a patient's existing body organ tubing and at least partly outside of that existing structure. For example, the new length of tubing may be for the purpose of providing the patient with a coronary bypass. The new tubing may be an artificial graft, a natural graft (harvested elsewhere from the patient), or both. The new tubing is installed at the operative site primarily by providing at least one graft location with instrumentation inserted through the patient's existing tubular body organ structure. Assistance in installing the new tubing may be provided by minimally invasive surgical access openings in the patient's chest. The tubing may be delivered through the patient's existing tubular body structure or, alternatively, through the surgical access openings.

Abstract: Methods and apparatus are provided that gather a patient's body tissue and then secure the gathered tissue in a reduced area utilizing a securing structure. The securing structure mainly resides on one side of the tissue to minimize or eliminate both foreign material and the amount of manipulation or activity on the other side of the tissue. The securing device is matched to the desired amount of tissue manipulation to minimize the structure. The gathered and secured tissue can surround a septal defect to obstruct or close the defect itself.