Abstract: A system includes an annulus-marking device that comprises a two or more pull wires coupled to an expandable braided mesh. Pulling the pull wires can transition the braided mesh into a shape in which the mesh assumes (1) a sloped upper portion configured for positioning within an atrium of a heart of the subject, (2) a bulging ledge portion configured for positioning above the heart valve, and (3) a narrow portion for positioning within the heart valve. The system can also include an implant configured for placement along a native heart valve annulus of a subject. The implant can include a body portion comprising flexible material, the body portion having a longitudinal axis that runs along a length of the body portion. Other embodiments are also described.

Abstract: Apparatus, usable with a valve disposed between an atrium and a ventricle of a heart, the valve having a first leaflet (S) and at least one opposing leaflet (A,P). The apparatus comprises an augmenter (700) that comprises a flexible pouch (710) and an anchor (780). The pouch has an external surface, an interior, an outside, and a downstream opening that provides fluid communication between the interior and the outside of the pouch. The anchor is coupled to the pouch, and configured to anchor the pouch to the lip of the first leaflet by the anchor being anchored to the first leaflet. The anchoring is such that the downstream opening opens into the ventricle. Responsively to ventricular systole, the pouch inflates via the downstream opening, and the external surface coapts against the opposing leaflet(s).

Abstract: An apparatus is provided, for use with a tissue anchor, the apparatus comprising an implant and an anchor-delivery tool. The implant is dimensioned to be advanced into a body of a subject. The tool comprises an anchor-delivery channel and an implant-gripping element. The anchor-delivery channel defines a lumen, and is dimensioned to be moveable within the implant. The implant-gripping element is disposed at a distal end portion of the anchor-delivery channel, and comprises multiple teeth configured to reversibly grip an inner wall of the implant during implantation of the tissue anchor via the anchor-delivery channel. Other embodiments are also described.

Abstract: During a percutaneous transcatheter procedure, an annuloplasty structure is secured at least partially around an annulus of a mitral valve of a subject by coupling a plurality of tissue anchors to the annulus such that (i) a longitudinal contracting member of the annuloplasty structure extends at least partially around the annulus, and (ii) the plurality of tissue anchors is distributed at least partially around the annulus. A longitudinal density of the anchors along a middle scallop of a posterior leaflet of the mitral valve is at least twice as great as a longitudinal density of the anchors along a lateral scallop of the posterior leaflet, and/or at least twice as great as a longitudinal density of the anchors along a medial scallop of the posterior leaflet. Thereafter, at least part of the annulus is contracted by contracting a longitudinal portion of the annuloplasty structure by tightening the longitudinal contracting member.

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: 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: Tensioning devices are described that include a handle, a line carriage configured to be coupled to a tensioning line, and an electrical motor assembly configured to axially translate the tensioning line relative to the handle to thereby modify a tension in the tensioning line. Other implementations are also described, including a tensioning device including a handle, a line carriage configured to be coupled to a tensioning line, and a manually-manipulatable actuator configured to be selectively transitioned between a fine-tensioning configuration and a gross-tensioning configuration.

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: An implant structure, comprises a body portion, a first adjusting mechanism, and a second adjusting mechanism. The body portion is configured to be secured within a heart of a patient. The first adjusting mechanism is coupled to a first portion of the body portion, and comprises a first ring that surrounds the first portion and is moveable with respect to the body portion. The second adjusting mechanism is coupled to a second portion of the body portion, and comprises a second ring that surrounds the second portion and is moveable with respect to the body portion. A first elongate tool is configured to remodel tissue of the heart by actuating the first adjusting mechanism. A second elongate tool is configured to remodel tissue of the heart by actuating the second adjusting mechanism.

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 annuloplasty implant includes an elongate contraction member. A leading anchor, at a distal portion of the implant, is transluminally advanced to an atrium of a heart of a subject, the atrium being upstream of a valve of the heart. The leading anchor has a leading-anchor tissue-engaging element. Subsequently, the distal portion is secured to an annulus of the valve by anchoring the leading-anchor tissue-engaging element to the annulus. Subsequently, the implant is secured at least partly around the annulus using multiple additional anchors, each of which has an additional-anchor tissue-engaging element that is smaller than the leading-anchor tissue-engaging element. For each of the additional anchors, sequentially, (i) the additional anchor is transluminally advanced to the implant in the atrium, and (ii) the additional-anchor tissue-engaging element is anchored to the annulus. Subsequently, the annulus is contracted by applying tension to the contraction member. Other embodiments are also described.

Abstract: For repairing a valve situated between an atrium and a ventricle of a heart of a subject, and having a first leaflet and a second leaflet, apparatus is provided that includes an implant and a delivery tool. The implant includes a flexible patch defining slots along an edge of the patch; a first anchor; and a second anchor. The delivery tool is adapted to transluminally deliver the implant to the heart; and implant the implant in the ventricle by securing the patch against a ventricular surface of the first leaflet by anchoring the first anchor to the first leaflet, and against a ventricular surface of the second leaflet by anchoring the second anchor to the second leaflet, such that (i) chordae of the valve extend through the slots, and (ii) the patch bridges a gap between the first leaflet and the second leaflet. Other embodiments are also disclosed.

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 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: 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: A system includes an anchor, a delivery tool, and a data-processing system. The delivery tool is configured to deliver the anchor to the heart of the subject, and to drive the anchor into tissue of the heart. The data-processing system is adapted to, subsequently to the delivery tool delivering the anchor to the heart, receive, via the delivery tool, a first electrical signal from the anchor, at the tissue, the anchor serving as an electrode. The data-processing system is adapted to receive, via the delivery tool, a second electrical signal from a distal part of the delivery tool within the heart. The data-processing system is adapted to, responsively to both the first signal and the second signal, determine a location of the anchor within the heart, and provide an output indicative of the location. Other embodiments are also disclosed.

Abstract: An annuloplasty structure includes a contracting member. A fastener is configured to receive the contracting member therethrough, the fastener including a housing and a clamping structure disposed therein. The fastener has an open state in which the contracting member can pass through the fastener, and is biased toward assuming a closed state in which the clamping structure clamps onto the contracting member disposed through the fastener. A stop is coupled to the fastener in a manner that maintains the fastener in the open state. A tool includes static and dynamic cutting elements, and is configured to (a) apply tension to the contracting member by pulling the contracting member proximally through the fastener, (b) lock the tension in the contracting member by pulling the stop proximally out from the fastener, and (c) sever the contracting member by moving the dynamic cutting element. 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 method of repairing a mitral valve of a heart of a subject comprises positioning an elongate support of an implant at the heart such that the support is aligned with a coronary sinus of the heart. A first anchor of the implant is anchored to a first location on an anterior side of the valve, such that a first tether-segment of the implant spans across the valve between the first anchor and a first end of the support. A second anchor of the implant is anchored to a second location on the anterior side of the valve, such that a second tether-segment of the implant spans across the valve between the second anchor and a second end of the support. Other embodiments are also described.