Abstract: An annuloplasty implant is implanted along a valve annulus of a heart of a subject using a driver that includes a flexible shaft and a deployment element at a distal end of the shaft by, for each of the anchors in turn, beginning with the distal anchor: (1) using the driver to move the anchor out of a corresponding anchor-storage area of a tool; (2) advancing the anchor distally through a tube of the tool, with the shaft of the driver extending past the anchor-storage area; (3) anchoring the anchor to tissue of the heart; (4) disengaging the driver from the anchor; and (5) retracting the driver proximally beyond the corresponding anchor-storage area and, at a successively-proximal anchor-storage area, engaging the anchor with the successive anchor. Other embodiments are also described.

Abstract: A percutaneous delivery tool includes a shaft, and proximal and distal capsules which move axially with respect to the shaft. A prosthetic valve includes a tubular portion, an upstream support portion extending therefrom and a plurality of flanges each having a respective flange end-portion. The prosthetic valve is restrainable by the delivery tool, such that the shaft and a downstream end of the tubular portion are disposed within the distal capsule, and the upstream support portion and the flange end-portions are disposed within the proximal capsule. Other embodiments are also described.

Abstract: A delivery tool including a shaft and a proximal capsule and a distal capsule is dimensioned for percutaneous delivery to the heart. An open end of the proximal capsule faces the open end of the distal capsule. The capsules are coupled to the shaft in a manner that allows axial movement of the capsule with respect to the shaft. A prosthetic heart valve includes a tubular portion that defines a lumen and prosthetic leaflets disposed within the lumen. The prosthetic heart valve is restrainable in a compressed state by the delivery tool, such that a downstream end of the tubular portion is disposed within the distal capsule. The distal capsule is shaped so as to define an opening for visualizing ensheathing of at least a portion of the downstream end of the tubular portion within the distal capsule. Other embodiments are also described.

Abstract: Apparatus is provided for repairing a cardiac valve, the apparatus including a catheter sized for delivery through vasculature of a subject and an elongated and flexible annuloplasty structure having an annuloplasty structure axis. The annuloplasty structure is sized and configured for delivery to a heart of the subject through the catheter substantially along a catheter axis of the catheter while the annuloplasty structure axis is substantially parallel to the catheter axis. The apparatus also includes a plurality of anchors configured for delivery to a region of cardiac tissue from a proximal end of the catheter toward a distal end of the catheter and substantially along the annuloplasty structure axis and the catheter axis while at least a portion of the annuloplasty structure is within a delivery passage of the catheter. Other embodiments are also described.

Abstract: A tubular system comprising a catheter is configured to deliver an implant into the heart. The implant comprises a coupling head and a tissue-engaging element that comprises a first electrode. A driver is configured to, via engagement with the coupling head, (i) advance the implant out of a distal end of the tubular system and place the tissue-engaging element in contact with tissue of the heart, and (ii) secure the implant within the heart by fastening the tissue-engaging element to the tissue. A control unit, electrically couplable to (i) the first electrode via the driver, and (ii) a second electrode contacting the subject, is configured, to (i) receive an electrical signal from the electrodes, and (ii) based on the electrical signal, display information indicative of contact between the first electrode and the tissue. Other embodiments are also described.

Abstract: A tubular system is configured to transluminally deliver an implant comprising a tissue anchor having a coupling head and a distal helical tissue-engaging element, into a heart of a subject. The tissue anchor is slidable through a channel of the system, the channel being slidable within a catheter. An anchor driver is configured, while coupled to the coupling head of the tissue anchor, to drive the tissue anchor through the system and out the system's distal end, to anchor the tissue-engaging element to tissue of the heart. While a first electrode is in contact with the subject and a second electrode is inside the heart of the subject, a control unit receives an electrophysiological signal from the electrodes, and based on the electrophysiological signal, indicates a position of the second electrode inside the heart. Other embodiments are also described.

Abstract: An implant includes a support frame, having a compressed state, and an expanded state in which the support frame defines an opening therethrough, and is dimensioned to be placed against an upstream surface of a native heart valve. The implant includes a valve frame having a compressed state, and an expanded state in which the valve frame defines a lumen therethrough, and including a valve member disposed within the lumen. The valve frame is coupled to the support frame via a flexible sheet such that when the support and valve frames are in their expanded state, the valve frame is not in contact with the support frame. The implant is housed in the catheter for implanting transfemorally, with the valve frame closer to a distal end of the catheter than the support frame is to the distal end of the catheter. Other embodiments are also described.

Abstract: A wearable pharmaceutical delivery device is disclosed including a compressed elastic power source and a cylindrical pharmaceutical reservoir. Optionally, the compressed power source is positioned along a bent path. Alternatively or additionally, the compressed power source may power discharge of the pharmaceutical. Alternatively or additionally, the compressed power source may power extension of an injection needle. In some embodiments, a tensile element may activate an indicator when delivery of the pharmaceutical is complete.

Abstract: A guidewire is slidable through a percutaneous medical device. A distal end of the percutaneous medical device is moved in a proximal direction away from an anatomical site of a body of a subject. Simultaneously, a position of a distal end of the guidewire, with respect to the anatomical site, is maintained by moving a housing toward another housing that is coupled to the medical device. Other embodiments are also described.

Abstract: A method for treating a native heart valve of a patient includes anchoring a plurality of anchors of an implant into tissue around an annulus of the valve. At the annulus, a force-distribution element is incorporated into the implant such that the force-distribution element extends along a longitudinal portion of the elongate contracting member. The method can also include circumferentially tightening the annulus by pulling the plurality of anchors closer together, such as by actuating a contracting mechanism of a contracting system, such that (i) the contracting mechanism, coupled to an elongate contracting member of the implant, applies a longitudinal tensioning force to the elongate contracting member, and (ii) the force-distributing element distributes the longitudinal tensioning force over at least two of the anchors. Other embodiments are also described.

Abstract: A prosthetic valve includes a tubular valve body, snares, and an upstream support. A native valve of a heart of a subject is disposed between an atrium and a ventricle of the heart, and has an annulus and leaflets. The prosthetic valve is advanced to the heart while in a compressed state. The prosthetic valve is positioned within the heart such that the snares are disposed upstream of the annulus and leaflets. The snares are expanded radially outwardly upstream of the leaflets. Subsequently, the prosthetic valve is moved in a downstream direction such that the snares become disposed downstream of the leaflets. While the snares remain downstream of the leaflets, the upstream support is expanded within the atrium, and the upstream support is placed against an upstream surface of the annulus. Other embodiments are also described.

Abstract: An extender for filling a syringe cartridge at a filling station having an elevating bar has a connector portion connecting a proximal portion of the extender to a distal portion of the syringe cartridge. A head on a distal portion of the extender is sized and shaped to engage the elevating bar of the filling station. The syringe cartridge having the extender may be provided to a filling station that is configured for filling a long syringe cartridge having a long syringe-cartridge length greater than a length of the syringe cartridge. The syringe cartridge and extender may be supported on a syringe support of the filling station and passed through the filling station to fill the syringe cartridge.

Abstract: A guidewire is slidable through a percutaneous medical device. A distal end of the percutaneous medical device is moved in a proximal direction away from an anatomical site of a body of a subject. Simultaneously, a position of a distal end of the guidewire, with respect to the anatomical site, is maintained by moving a housing toward another housing that is coupled to the medical device. Other embodiments are also described.

Abstract: A tubular system is configured to transluminally deliver an implant comprising a tissue anchor having a coupling head and a distal helical tissue-engaging element, into a heart of a subject. The tissue anchor is slidable through a channel of the system, the channel being slidable within a catheter. An anchor driver is configured, while coupled to the coupling head of the tissue anchor, to drive the tissue anchor through the system and out the system's distal end, to anchor the tissue-engaging element to tissue of the heart. While a first electrode is in contact with the subject and a second electrode is inside the heart of the subject, a control unit receives an electrophysiological signal from the electrodes, and based on the electrophysiological signal, indicates a position of the second electrode inside the heart. Other embodiments are also described.

Abstract: A stand comprises a track. A first handle is mountable on the stand such that the stand supports the first handle. A first catheter defines a first lumen, and is coupled to the first handle. A second handle is mountable on the stand proximally from the first catheter in a manner in which the stand also supports the second handle. A second catheter defines a second lumen, and is coupled to the second handle. The second catheter is extendable through the first lumen. A third handle is slidably mountable on the track proximally from the second handle, such that the third handle is axially slidable along the track. A third catheter defines a third lumen, and is coupled to the third handle. A distal end of the third catheter is advanceable out of the second lumen. Other embodiments are also described.

Abstract: A leaflet support for use with a native valve of a heart of a subject includes a frame that defines an array of adjoining cells, as well as an aperture between an upstream side and a downstream side of the frame. When placed against an annulus of the heart, the frame facilitates blood flow, via the cells, between the upstream side and the downstream side. The leaflet support further includes a barrier that is impermeable to blood flow, and that is coupled to the frame in a manner that obstructs blood flow through the aperture. The leaflet support further includes ventricular legs, that each extend radially outward and upstream, toward the frame. 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, advanced toward an anatomical site, has a proximal end and a steerable distal end. An anchor is advanced through the catheter. An anchor driver drives the anchor out of the catheter's distal end, anchoring the anchor at the site. A first constraining member engages tissue, and inhibits, after the anchor has been driven out of the catheter and before the anchoring, movement of at least the anchor driver's distal end, on a first axis between the anchor driver's distal end and a site at which the first constraining member engages the tissue. A second constraining member inhibits, after the anchor has been driven out of the catheter and before the anchoring, movement of at least the anchor driver's distal end, on a second axis. Other embodiments are also described.

Abstract: A prosthetic heart valve implant is provided including a frame shaped so as to define upstream and downstream openings at upstream and downstream ends of the frame, respectively, when the implant is in an expanded state for implantation at a heart native valve. A sheet is coupled to the frame. When the implant is in the expanded state, the frame is shaped so as to define the following longitudinal portions arranged along a central longitudinal axis of the prosthetic heart valve implant: a substantially cylindrical mid portion having a diameter greater than respective diameters of the upstream and the downstream ends of the frame; an upstream portion, extending upstream and radially inward from the mid portion; and a downstream portion, extending downstream and radially inward from the mid portion. Other embodiments are also described.