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: For some applications, apparatus is provided for facilitating implantation of a prosthetic valve (150) at a native heart valve (120) of a subject, the apparatus comprising a prosthetic valve support (22), the prosthetic valve support (a) being configured to be transluminally-deliverable to the native valve and to be deployable at the native valve, and (b) comprising one or more tissue-engaging elements (24), configured to couple the prosthetic valve support to leaflets (128) of the native valve without eliminating check valve functionality of the native valve. 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: 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: An implant comprises an elongate member, and anchors distributed along the elongate member. A gripper comprises a locking element that, in a locked state thereof, inhibits sliding of the elongate member through the gripper by clamping the elongate member. A tool is configured to, while (i) the elongate member extends proximally from a proximal-most of the anchors, and through the gripper, and (ii) an unlocker is positioned within the gripper in a manner that obstructs the locking element from assuming the locked state: (A) advance transluminally toward the proximal-most anchor, and (B) tension the elongate member by pulling the elongate member proximally through the gripper while the unlocker obstructs the locking element from assuming the locked state. The tool is also configured to subsequently facilitate the locking element clamping the elongate member via withdrawal of the unlocker from the gripper. 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.

Abstract: An anchor-handling device comprises a housing shaped to define a channel having an anchor-storage zone and a proximal opening. A tissue anchor is stored in the anchor-storage zone. The anchor-handing device is configured such that, while the tissue anchor is stored in the anchor-storage zone, the tissue anchor is movable out of the anchor-storage zone toward the proximal opening in response to a proximally-directed force being applied to the tissue anchor. The anchor-handling device comprises an element that serves as an indicator of movement of the tissue anchor out of the anchor-storage zone toward the proximal opening by the element moving in response to the proximally-directed force. Other embodiments are also described.

Abstract: A first part of an annuloplasty structure is anchored to an annulus of a valve of a heart by using a driver to screw a tissue-coupling element of a first anchor into a first site of the annulus, such that the tissue-coupling element enters cardiac tissue in a direction parallel to a central longitudinal axis of the driver through the distal end of the anchor driver. The same is subsequently done for second and third parts of the annuloplasty structure using second and third anchors at second and third sites of the annulus, mutatis mutandis. Between anchors, the driver is retracted out of the heart. Subsequently, the valve is treated by reducing a distance between the first site and the second site, and a distance between the second site and the third site, by tightening a flexible and elongate contracting member of the annuloplasty structure.

Abstract: An annuloplasty implant comprises an elongate member, a plurality of anchors, and a gripper. The elongate member has a proximal end, and a distal portion that includes a distal end. The plurality of anchors are distributed along the elongate member. The elongate member extends proximally from a proximal-most anchor and through the gripper. The gripper comprises a locking element that, in a locked state, inhibits sliding of the elongate member through the gripper. An unlocker, disposed within the gripper, obstructs the locking element from assuming the locked state, and is pullable proximally out of the gripper. The gripper automatically assumes the locked state upon the unlocker being pulled proximally out of the gripper. A tool tensions the distal portion of the elongate member by pulling the elongate member proximally through the gripper while the unlocker obstructs the locking element from assuming the locked state. Other embodiments are also described.

Abstract: An annuloplasty structure includes a flexible sleeve and an elongate contraction wire. The sleeve has a first sleeve-end-portion, a second sleeve-end-portion, and a circumferential wall that defines a longitudinal lumen between the first and second sleeve-end-portions. The contraction wire has a first wire-end and a second wire-end, the first wire-end being attached to the sleeve at the first sleeve-end-portion. The wire extends, in association with the circumferential wall, from the first sleeve-end-portion to the second sleeve-end-portion. The wire is arranged with respect to the sleeve such that increasing a longitudinal proportion of the wire that is disposed within the lumen longitudinally contracts the sleeve. Other embodiments are also provided.

Abstract: An embolization microcatheter for embolization of peripheral arteries including an elongated tubular member comprising a distal end having a length of 150-500 mm and an outer diameter of less than 0.8 mm, wherein the elongated tubular member comprises a multiplicity sections, each having a length of 5 mm -150 mm, wherein a wall of each of the multiplicity of sections comprises a braid, a polymer formed around the braid and an inner liner coating an inner surface thereof; wherein the polymer of the multiplicity sections differ; and a distal tip having a length of 1 mm - 3 mm and extending between a proximal end of a first radiopaque marker of the elongated tubular member and a distal end opening of the elongated tubular member; the wall of the distal tip is devoid of braid.

Abstract: An anchor-handling device comprises a housing shaped to define a channel having an anchor-storage zone and a proximal opening. An anchor driver comprises an anchor-engaging head, the anchor-engaging head being dimensioned to be advanceable through the proximal opening toward the anchor-storage zone. A tissue anchor is stored in the anchor-storage zone, and comprises a coupling head configured to be locked to the anchor-engaging head. The tissue anchor is movable out of the anchor-storage zone toward the proximal opening in response to a proximally-directed force being applied to the tissue anchor by the anchor driver. The anchor-handling device comprises an element that serves as an indicator of movement of the tissue anchor out of the anchor-storage zone toward the proximal opening, by moving in response to the proximally-directed force such that at least part of the element protrudes out of the housing. Other embodiments are also described.

Abstract: An embolization microcatheter with a wall including a braid, a polymer formed around the braid and an inner liner coating an inner surface of the wall, a radiopaque marker located in proximity to the distal end opening; wherein the part of the microcatheter extending between the proximal end of the radiopaque marker and the distal end opening is devoid of the liner and wherein the wall has a thickness of about 120 microns or less.

Abstract: Apparatus and methods are described including a prosthetic valve support (40) configured to be placed at a patient's native atrioventricular valve annulus. The valve support defines an annular element (44) that defines an inner cross-sectional area thereof. An expandable prosthetic valve (80) is placed into the patient's ventricle, the prosthetic valve including an expandable frame (79) and prosthetic valve leaflets (82) coupled to the frame. When the frame is in a non-constrained state thereof, a cross-sectional area of the frame, along at least a given portion L of the frame's length, is greater than the cross-sectional area defined by the annular element. The prosthetic valve is couplable to the prosthetic valve support at any location along the portion, by the frame being expanded when the location along the portion is aligned with the annular element. Other applications are also described.

Abstract: Apparatus includes a delivery tool and a prosthetic valve, the prosthetic valve includes a first frame, and a second frame coupled to the first frame. The delivery tool includes a first catheter, a second catheter, and a rod. A steerable portion of the second catheter extends out of the first catheter, and a steerable distal portion of the rod extends out of the second catheter. An extracorporeal rod-controller is operably coupled to the rod such that operating the extracorporeal rod-controller steers the steerable distal portion of the rod. In a delivery state of the apparatus, the prosthetic valve is compressed onto the rod, distal to the distal end of the second catheter, and the apparatus is transfemorally and transseptally advanceable into a left atrium of a heart of a subject. Other embodiments are also described.

Abstract: An embolization microcatheter is configured to deliver embolization particles to a target area and minimize or prevent embolization of a non-target area. The microcatheter includes a section, located between the distal and proximal ends of the microcatheter, having a skeleton formed of braided wires and a polymeric layer intercalated into and/or overlaying the skeleton. This section includes a plurality of axial slits, each slit having a smallest cross-sectional dimension configured to prevent outflow of the embolization particles.

Abstract: Apparatus and methods are described including a left-ventricular assist device (20) that includes a pump-outlet tube (28). A mixed-flow impeller (100) is configured to pump blood from a subjects left ventricle to the subjects aorta, by pumping the blood into the pump-outlet tube (28) via one or more blood inlet openings (108) disposed within the left ventricle, and by pumping blood out of the pump-outlet tube (28) via one or more blood outlet openings (30) disposed within the aorta. The mixed-flow impeller (100) includes an expandable portion (116) disposed along its axis and shaped such that a diameter of the expandable portion increases from a distal end of the expandable portion to its proximal end. The mixed-flow impeller (100) is configured to impart radial flow components to blood as the blood flows from its distal end to its proximal end. Other applications are also described.

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: System for use with tissue of a heart comprises a tissue anchor comprising an engaging head that has a coupling eyelet that defines an eyelet plane, and a helical tissue-coupling element, reversibly anchorable to the tissue, and having a central helix axis that lies on the eyelet plane. The system also comprises an anchor driver, having a distal portion that has a casing that defines a slot, the slot defining a slot plane, and dimensioned to receive at least part of the eyelet therein in a manner in which the eyelet plane is coplanar with the slot plane. The anchor driver also comprises a detent, configured to reversibly inhibit movement of the eyelet with respect to the slot. The anchor driver is configured to anchor the tissue anchor to the tissue by rotating the tissue anchor by applying a rotational force to the eyelet. Other embodiments are also provided.