Abstract: A method of suturing a tissue opening can comprise placing a tissue-facing surface of a first pad, a second pad and a third pad over respective tissue areas adjacent to the tissue opening. The second pad can be positioned on a first side of the first pad and the third pad can be positioned on a second side of the first pad. The first and second pads can be coupled to a suture, the suture forming a stitch over the upper surface of each of the respective pads. The suture can be stitched through an area of tissue between the first pad and the second pad, between the second pad and the third pad, and between the third pad and the first pad. A first distal portion and a second distal portion of the suture can be coupled to the third pad for forming the purse-string suture.

Abstract: An annuloplasty ring for repair of mitral valves whose shape can be altered directly or remotely to perform post-implant size and/or shape adjustments. One version of the annuloplasty ring has a size-adjustable remodeling inner core within an outer suture-permeable interface for attaching the ring to an annulus. The inner core has a size-adjustable segment formed by short spaced-apart tubular sections that can move toward and way from one another such as on rails. Alternatively, short sections separated by compressible connectors may be used. One or more tethers may be attached to one side of the size-adjustable segment and pulled from the other side to constrict the segment. Multiple tethers may be connect at different locations around the ring to provide some control over where the ring constricts. An adjustment handle with a flexible shaft may be operated from outside the body to adjust the ring post-implant.

Abstract: A tissue anchor delivery device includes a handle, an elongate shaft extending from the handle, a pusher tube disposed at least partially within a lumen of the elongate shaft, a pusher hub coupled to the pusher tube, a needle disposed at least partially within a lumen of the pusher tube, a needle hub coupled to the needle, and an actuator configured to be fixed to the pusher hub and the needle hub. The actuator is further configured to advance the needle hub and the pusher hub a first distance, thereby causing a tip of the needle to protrude from a distal end of the elongate shaft, disengage from the needle hub, and advance the pusher hub a second distance relative to the needle hub, thereby causing a distal end of the pusher tube to advance over the needle and push a coiled suture form off of the needle.

Abstract: A device for treating a heart valve comprising a curved frame and a covering at least partially enclosing the curved frame.

Abstract: A method of tethering can comprise providing a tether deployment device. The tether deployment device can comprise an elongate shaft comprising a lumen extending from a proximal end to a side opening, an atraumatic distal effector coupled to a distal end of the elongate shaft, and a tether deployment assembly at least partially received within the lumen. The method can include advancing the distal portion of the elongate shaft into a heart chamber, positioning a distally oriented surface of the atraumatic distal effector against a first tissue area, and advancing a distal portion of the tether deployment assembly through the side opening of the shaft. A portion of at least one tether can be deployed to the target tissue area using the tether deployment assembly while the distally oriented surface of the atraumatic distal effector is against the first tissue area.

Abstract: Septal defect repair involves advancing an elongate shaft into an atrium of a heart of a patient through an outer atrial wall of the heart, contacting an atrial septum of the heart with a distal end of the elongate shaft, deploying a plurality of tissue anchors from the elongate shaft in tissue of the atrial septum, and cinching suture tails associated with the plurality of tissue anchors to at least partially close a defect in the atrial septum.

Abstract: Techniques relate to analyzing image data to determine an annuloplasty ring to implant for an annuloplasty procedure. For example, image data can be received that depicts a heart valve. The image data can be analyzed to identify one or more image features that represent one or more anatomical features of the heart valve. Based on the one or more image features, heart data can be generated that indicates a measurement and/or another characteristic of the heart valve. An annuloplasty ring can be determined based on the heart valve data and/or annuloplasty ring data indicating characteristics of one or more annuloplasty rings. User interface data can then be generated that indicates the annuloplasty ring.

Abstract: Described herein are devices and methods for mitral valve repair. The devices and methods implant a plurality of distal anchors at an annulus of the mitral valve (e.g., the posterior annulus) and tension artificial chordae to pull the portion of the annulus toward an opposite edge and inward into the ventricle. This can effectively reduce the size of the orifice and increase coaptation. The delivery devices can be configured to be actuated to form a distal anchor made of a pre-formed knot. The delivery devices deliver the pre-formed knot in an elongate configuration. Actuation of the delivery device causes the pre-formed knot to transition from the elongate configuration to the deployed configuration by approximating opposite ends of a suture coupled to a coiled configuration to form one or more loops. After formation of the knot, the delivery device can be withdrawn.

Abstract: Systems, apparatuses, and methods disclosed herein may be directed to clips for medical implementation, including clips for a portion of a heart. The clips may be configured to close the portion of the heart, to reduce blood flow therethrough as well as passage of clots or other undesired materials. In examples, the clips may be configured to close the left atrial appendage (LAA). The closure of the LAA may reduce the possibility of stroke or other maladies stemming from fluid flow with the LAA. In examples, the clips may be positioned exterior of the LAA, to extend over an outer surface of the LAA for closure.

Abstract: A tissue anchor includes an elongate tube including a distal tubular portion, a medial tubular portion, a proximal tubular portion, a distal radially-expandable portion positioned between the distal tubular portion and the medial tubular portion, and a proximal radially-expandable portion positioned between the medial tubular portion and the proximal tubular portion. The tissue anchor further includes a suture disposed within a lumen of the elongate tube and passing axially through the distal tubular portion, the distal radially-expandable portion, the medial tubular portion, the proximal radially-expandable portion, and the proximal tubular portion. Longitudinal slits can be implemented to facilitate radial expansion of the proximal and distal radially-expandable portions of the tube.

Abstract: Described herein are devices and methods for mitral valve repair. The devices and methods implant a plurality of distal anchors at an annulus of the mitral valve (e.g., the posterior annulus) and tension artificial chordae to pull the portion of the annulus toward an opposite edge and inward into the ventricle. This can effectively reduce the size of the orifice and increase coaptation. The delivery devices can be configured to be actuated to form a distal anchor made of a pre-formed knot. The delivery devices deliver the pre-formed knot in an elongate configuration. Actuation of the delivery device causes the pre-formed knot to transition from the elongate configuration to the deployed configuration by approximating opposite ends of a suture coupled to a coiled configuration to form one or more loops. After formation of the knot, the delivery device can be withdrawn.

Abstract: An introducer device includes a proximal hub including a first port and a second port, first and second fluid valves associated with the first port and the second port, respectively, a first elongate lumen projecting distally from the proximal hub, the first elongate lumen being in fluid communication with the first port, and a second elongate lumen projecting distally from the proximal hub, the second elongate lumen being in fluid communication with the second port and fluidly isolated from the first elongate lumen.

Abstract: A tissue anchor delivery device includes a handle, an elongate shaft extending from the handle, a pusher tube disposed at least partially within a lumen of the elongate shaft, a pusher hub coupled to the pusher tube, a needle disposed at least partially within a lumen of the pusher tube, a needle hub coupled to the needle, and an actuator configured to be fixed to the pusher hub and the needle hub. The actuator is further configured to advance the needle hub and the pusher hub a first distance, thereby causing a tip of the needle to protrude from a distal end of the elongate shaft, disengage from the needle hub, and advance the pusher hub a second distance relative to the needle hub, thereby causing a distal end of the pusher tube to advance over the needle and push a coiled suture form off of the needle.

Abstract: A delivery system comprises two or more needles including at least a first needle comprising a distal tip configured to pierce a valve leaflet of a heart, two or more leaflet anchors, each of the two or more leaflet anchors configured to be delivered via one of the two or more needles, and a shaft comprising a first interior lumen configured to slidably receive the two or more needles, the shaft having a first opening into the first interior lumen at a distal end of the shaft, the first opening configured to allow at least the first needle to exit the shaft.

Abstract: A suture system can comprise a first and a second curved double arm needle, and a needle docking device configured to maintain the first and the second curved double arm needles in alignment with and parallel to one another and at predetermined orientations relative to the needle docking device. The system can include a needle manipulating instrument having a distal portion configured to engage the first and the second curved double arm needles while the first and second curved double arm needles are in the needle docking device, and to maintain the needles in predetermined orientations.

Abstract: A method comprises advancing an elongate tube to a target implantation site, the elongate tube having a needle disposed at least partially therein that has a coiled sutureform wrapped around at least a portion thereof, contacting a distal end of the elongate tube to a target tissue, projecting a tip of the needle from the distal end of the elongate tube to pierce through the target tissue such that the tip of the needle and at least a portion of the coiled sutureform project through the target tissue, advancing a pusher device within the elongate tube and over the needle to push the at least a portion of the coiled sutureform off of the tip of the needle, and proximally pulling one or more suture tails associated with the coiled sutureform to form the coiled sutureform into a knot on a distal side of the target tissue.

Abstract: A medical device shaft includes a rigid, elongate shaft, an end effector form coupled to a distal end of the elongate shaft, and echogenic additives associated with at least one of the elongate shaft and the end effector. The shaft exhibits improved echogenicity, and is suitable for devices that are manipulated or positioned with under echo guidance.

Abstract: Described herein are methods and apparatus for implanting grafts to leaflets for cardiac procedures that are performed minimally-invasively while the heart is beating. The graft elongates, reinforces, and patches the leaflet. In certain disclosed examples, the graft is secured to the atrium or ventricle side of the leaflet with an artificial cord implanted on an edge of the graft to improve coaptation. In some disclosed examples, the graft is secured to both leaflets to enable an edge-to-edge procedure similar to the Alfieri technique. Some examples of the disclosed methods including introducing the graft into the ventricle and guiding it into place using artificial cords previously implanted in the leaflet.

Abstract: A method of suturing a tissue opening can comprise placing a tissue-facing surface of a first pad, a second pad and a third pad over respective tissue areas adjacent to the tissue opening. The second pad can be positioned on a first side of the first pad and the third pad can be positioned on a second side of the first pad. The first and second pads can be coupled to a suture, the suture forming a stitch over the upper surface of each of the respective pads. The suture can be stitched through an area of tissue between the first pad and the second pad, between the second pad and the third pad, and between the third pad and the first pad. A first distal portion and a second distal portion of the suture can be coupled to the third pad for forming the purse-string suture.

Abstract: An apparatus includes a needle having a bore and a distal tip, a pusher having a distal end, the pusher being disposed within the bore of the needle for movement between a delivery position within the needle and a deployed position distal to the distal tip of the needle, an elongate tissue anchor including a distal portion and a proximal portion separated by one or more hinges, and a suture disposed at least partially within the pusher and coupled to the elongate tissue anchor.