Abstract: Apparatus is provided, including a first catheter having a distal end portion transluminally advanceable to a vicinity of an anatomical site, a second catheter having a distal end portion advanceable through a first lumen and out of the first lumen, and a longitudinal implant, advanceable through the second lumen and out of the second lumen. The first and second catheters are assembled to facilitate sliding of the first and second catheters and of the implant, to configure them to assume a multi-bend formation having first and second bends separating first, second, and third domains. The first domain includes parts of the first and second catheters. The second domain includes the distal end portion of the second catheter, part of the implant, and none of the first catheter. The third domain includes part of the implant and none of the first nor second catheters. Other embodiments are also described.

Abstract: A catheter (14), advanced toward an anatomical site, has a proximal end and a steerable distal end. An anchor (32, 2332) is advanced through the catheter. An anchor driver (36) drives the anchor out of the catheter's distal end (104), anchoring the anchor at the site. A first constraining member (1602, 1652) 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 (26) 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: An anchor deployment tool is provided that includes a flexible tube, which defines an anchor storage area in which tissue anchors are stored before deployment, and a distal anchor manipulation area that has a length of at least 3 cm. The tool also includes a rotating deployment element, which is positioned within the flexible tube, and is configured to, while the distal anchor manipulation area is disposed within a lumen defined by a wall of a sleeve, (i) directly engage the anchors in the anchor storage area a single one at a time, (ii) advance each of the anchors, while thus directly engaged, in a distal direction into the anchor manipulation area, and (iii) anchor the sleeve to tissue of a subject by deploying each of the tissue anchors through a distal end of the flexible tube, through the wall of the sleeve, and into the tissue.

Abstract: A prosthetic valve is advanced to a heart of a subject while the prosthetic valve is in a compressed state thereof, the prosthetic valve including a plurality of snares coupled to a tubular valve body. The prosthetic valve is positioned within the heart such that the plurality of snares is disposed upstream of the leaflets, and the plurality of snares is expanded upstream of the leaflets. Subsequently the prosthetic valve is moved in a downstream direction such that the plurality of snares is disposed downstream of the leaflets. Subsequently, the prosthetic valve is secured at the native valve while the plurality of snares remains disposed downstream of the leaflets.

Abstract: An apparatus can include: (1) a steerable tube, having a proximal section, a distal section, and a central longitudinal axis, the tube defining a primary lumen and two secondary lumens; (2) two wires, each extending from the distal section proximally through a respective secondary lumen; (3) a handle, coupled to the proximal section, and including a steering knob that is coupled to the wires such that rotation of the knob adjusts a degree of tension in the wires; (4) a pull ring coupled to the distal section of the tube such that the pull ring circumscribes the longitudinal axis at the distal section of the tube, and defining two recesses, a distal end portion of each wire being disposed in a respective one of the recesses; and (5) at least one cap, bridging the recesses and the distal end portion of the wires. Other embodiments are also described.

Abstract: During a percutaneous procedure, a flexible sleeve of an annuloplasty structure is introduced into an atrium and arranged completely around an annulus as a closed loop, such that none of one or more longitudinal contracting members thereof is positioned along an anterior portion of the annulus between fibrous trigones of the valve. The annuloplasty structure is fastened to the annulus. At least a portion of a posterior portion of the annulus is tightened, while preserving a length of an anterior portion of the annulus between fibrous trigones of the valve, by contracting, using the one or more longitudinal contracting members, a longitudinal portion of the sleeve not positioned along the anterior portion of the annulus between the fibrous trigones of the valve. Thereafter, the one or more longitudinal contracting members are locked.

Abstract: A rod (508) is transfemorally advanceable to the heart. An implant (460) comprises (i) a first frame (462), compressed around a first longitudinal site of a distal portion of the rod, (ii) a second frame (464), compressed around a third longitudinal site of the distal portion, (iii) a valve member (50), disposed within the second frame, and (iv) a flexible sheet (466), coupling the first frame to the second frame, and disposed around a second longitudinal site of the distal portion, the second longitudinal site being between the first longitudinal site and the third longitudinal site. An extracorporeal controller (569) is coupled to a proximal portion of the rod, and is operably coupled to the distal portion of the rod. Operating the controller bends the distal portion of the rod causing articulation between the frames. Other embodiments are also described.

Abstract: An implant structure includes a contracting mechanism, including a rotatable structure for contracting the implant structure, and a locking mechanism. A rotation tool is configured to engage and rotate the rotatable structure. A longitudinal guide member is removably coupled to the contracting mechanism, configured to guide the rotation tool to the rotatable structure, and includes a distal force applicator. The rotation tool is axially moveable with respect to the guide member. The contracting mechanism is arranged such that the locking mechanism is (a) unlocked when the guide member is coupled to the contracting mechanism in a first state, thereby allowing the rotatable structure to rotate, and (b) locked when (i) the guide member is coupled to the contracting mechanism in a second state, thereby restricting the rotation of the rotatable structure, and (ii) the guide member is not coupled to the contracting mechanism, thereby restricting the rotation of the rotatable structure.

Abstract: Apparatus for percutaneous access to a patient's body comprising a first steerable tube (12), shaped to define a first lumen, and a first coupling (152) at a longitudinal site of the first tube; and a second steerable tube (14), shaped to define a second lumen and a second coupling (154), the second coupling being intracorporeally couplable to the first coupling, the apparatus having (A) an unlocked state in which the second tube is rotatable within the first lumen, and (B) a locked state in which the second coupling is coupled to the first coupling, and rotation of the second tube is inhibited. The apparatus is configured such that when the second coupling becomes disposed at the longitudinal site in a given rotational orientation of the second tube, the apparatus moves into the locked state by the second coupling automatically coupling to the first coupling. Other embodiments are also described.

Abstract: A method is provided including introducing into a heart atrium, an annuloplasty structure having a sleeve with an elongated tubular side wall, anchoring a first section of the sleeve by deploying a first tissue anchor through the first section and into a first portion of annulus tissue, and anchoring a second section of the sleeve by deploying a second tissue anchor through the second section and into a second portion of annulus tissue. A longitudinal portion of the tubular side wall is disposed between the first and second tissue anchors and has first and second lateral parts. The first lateral part is closer to the annulus than the second lateral part is to the annulus, and the second lateral part is opposite the first lateral part and has a larger degree of tension than a degree of tension of the first lateral part.

Abstract: A method is provided, including positioning an annuloplasty structure along an annulus of an atrioventricular valve of a subject, the annuloplasty structure including a sleeve having a lumen. The annuloplasty structure is fastened to the annulus. Thereafter, an elongate member is advanced into the lumen, such that an elongate contraction-restricting element of the elongate member occupies a longitudinal contraction-restricted portion of the sleeve. Thereafter, a contractible portion of the sleeve is contracted, while the contraction-restricting element restricts contraction of the contraction-restricted portion of the sleeve.

Abstract: Apparatus is provided for use with a subject, including an implant comprising a sleeve shaped so as to define a lumen therein, the sleeve having first and second portions. A contracting mechanism is coupled to a portion of an outer surface of the sleeve in a vicinity of the first portion of the sleeve. An elongated contracting member is coupled at a first end portion thereof to the contracting mechanism, and coupled at a second end portion thereof to the sleeve in a vicinity of the second portion of the sleeve. The contracting mechanism comprises a driving interface that is positioned so as to be accessible from the portion of the outer surface of the sleeve. The contracting mechanism is configured such that rotation of the driving interface contracts the implant by tightening the elongated contracting member. Other applications are also described.

Abstract: A cartridge comprising a reservoir part and an extension extending from said reservoir part, said extension defining a fluid path and comprising a molding and a first needle extending from said molding, the extension turning to a finite angle with respect to an axis of said reservoir part and wherein at least part of said first needle is likewise at said finite angle, at least some of said part of said first needle at said finite angle being enclosed within said molding of said fluid path. A drug delivery device may be used with the cartridge and includes a skin-contacting surface. In use, the longitudinal axis of the interior of the cartridge may be disposed substantially parallel to the skin-contacting surface.

Abstract: A method is provided, including introducing into a heart atrium, an annuloplasty structure having a sleeve with an elongated tubular side wall and at least one distal end wall having a surface substantially transverse to a lateral surface of the tubular side wall. A first tissue anchor is deployed through the surface of the end wall of the sleeve and into a first portion of annulus tissue. A second tissue anchor is deployed through a portion of the tubular side wall and into a second portion of annulus tissue, such that the first tissue anchor and the second tissue anchor are both deployed consecutively, to extend in a substantially same direction and into a common, substantially planar surface of a valve annulus, the common, substantially planar surface including the first and second portions of the annulus tissue. Other applications are also described.

Abstract: Apparatus is provided that includes an implant structure, which includes a contracting mechanism, which includes a rotatable structure, arranged such that rotation of the rotatable structure contracts the implant structure. A longitudinal member is coupled to the contracting mechanism. A tool for rotating the rotatable structure is configured to be guided along the longitudinal member, to engage the rotatable structure, and to rotate the rotatable structure in response to a rotational force applied to the tool. Other embodiments are also described.

Abstract: An anchor deployment tool is provided that includes a flexible tube, which defines an anchor storage area in which tissue anchors are stored before deployment, and a distal anchor manipulation area that has a length of at least 3 cm. The tool also includes a rotating deployment element, which is positioned within the flexible tube, and is configured to, while the distal anchor manipulation area is disposed within a lumen defined by a wall of a sleeve, (i) directly engage the anchors in the anchor storage area a single one at a time, (ii) advance each of the anchors, while thus directly engaged, in a distal direction into the anchor manipulation area, and (iii) anchor the sleeve to tissue of a subject by deploying each of the tissue anchors through a distal end of the flexible tube, through the wall of the sleeve, and into the tissue.

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 (14), advanced toward an anatomical site, has a proximal end and a steerable distal end. An anchor (32, 2332) is advanced through the catheter. An anchor driver (36) drives the anchor out of the catheter's distal end (104), anchoring the anchor at the site. A first constraining member (1602, 1652) 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 (26) 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 method is provided, including introducing into a heart atrium, an annuloplasty structure having a sleeve with an elongated tubular side wall and at least one distal end wall having a surface substantially transverse to a lateral surface of the tubular side wall. A first tissue anchor is deployed through the surface of the end wall of the sleeve and into a first portion of annulus tissue. A second tissue anchor is deployed through a portion of the tubular side wall and into a second portion of annulus tissue, such that the first tissue anchor and the second tissue anchor are both deployed consecutively, to extend in a substantially same direction and into a common, substantially planar surface of a valve annulus, the common, substantially planar surface including the first and second portions of the annulus tissue. Other applications are also described.

Abstract: Apparatus and methods are described including an annuloplasty structure configured for implantation along an annulus of an atrioventricular valve of a heart of a subject. The structure includes a coiled element comprising at least one first portion thereof which is flexible and longitudinally compressible, and at least one second portion thereof in series with the first portion, the second portion being flexible and less longitudinally compressible than the first portion. Other applications are also described.