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: Apparatus is provided for adjusting at least one dimension of an implant. The apparatus includes a rotatable structure having a channel extending between first and second openings of the rotatable structure. The channel is configured for passage therethrough of an elongate tool. The rotatable structure has a lower surface that is shaped to define a first coupling. The apparatus includes a mechanical element having a surface coupled to the lower surface of the rotatable structure. The mechanical element is shaped to provide a second coupling configured to engage the first coupling during a resting state of the mechanical element, in a manner that restricts rotation of the rotatable structure. The mechanical element has a depressible portion that is disposed in communication with the second opening, and is configured to disengage the first and second couplings in response to a force applied thereto by the elongate tool.

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: Apparatus is provided for use at a native valve of a heart of a subject. The apparatus includes a delivery tube, transluminally advanceable to the heart; and a prosthetic valve support, configured to support a prosthetic valve at the native valve, and comprising an upstream support portion. The upstream support portion has a working configuration in which it is generally annular and has (1) a tissue-contacting side configured to be placed against an atrial surface of the native valve, and (2) an opposing side, and defines an opening therebetween. The upstream support portion also has a delivery configuration in which the upstream support portion is rolled up to define a channel, and is disposed within the delivery tube. The upstream support portion is configured to be transitioned from the delivery configuration to the working configuration by being exposed from the delivery tube, and unrolled.

Abstract: An implant having an implant body, a gripper, an elastic pouch, and an elongate member. The pouch can be coupled to the gripper, can have a first part and a second part, can have a contracted state toward which the pouch is elastically biased, and can be reversibly stretchable into a stretched state. The elongate member can have a first end portion coupled to the implant body, a second end portion fastened to the second part of the pouch, and a mid-portion extending (i) from the second end portion, through the pouch to the first part of the pouch, and (ii) out of the pouch to the first end portion. In at least one state of the gripper, the mid-portion can be slidable through the gripper and into the pouch. 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: 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 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: Embodiments of the present disclosure provide an apparatus comprising a delivery tool and a prosthetic valve, the prosthetic valve comprising a first frame, and a second frame coupled to the first frame. The delivery tool comprises 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: A prosthetic valve comprises a valve body, comprising a tubular frame and a plurality of leaflets; an upstream support, comprising a second frame; and a flexible sheet that couples the upstream support to the valve body. The prosthetic valve is compressible into a delivery tool such that the prosthetic valve is in a compressed state in which the second frame and the tubular frame are arranged in series within the tool, and the valve body has a compressed body-diameter. The prosthetic valve is deployable from the tool such that the prosthetic valve automatically expands into an expanded state. In the expanded state, the second frame defines an inner perimeter, the sheet extends inwardly from the inner perimeter to the valve body, and the prosthetic valve defines a conduit through the upstream support and the valve body. Other embodiments are also described.

Abstract: A method is provided for puncturing a fossa ovalis of a heart, the method including inserting a catheter into a right atrium of the heart, and advancing a distal portion of the catheter toward an interatrial septum of the heart. A flexible longitudinal member is slid through openings disposed at the distal portion of the catheter, such that the flexible longitudinal member is made to loop around a portion of an inside perimeter of the fossa ovalis. While the flexible longitudinal member is looped around the portion of the inside perimeter of the fossa ovalis, a hole is punctured in the fossa ovalis at a puncturing point.

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 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: 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: A prosthetic valve comprises a first frame, defining an arrangement of cells; a second frame, a first protrusion, and a second protrusion. In an expanded state of the valve, the first frame is generally cylindrical and has an expanded width, and the valve defines a lumen having a first end and a second end. In a compressed state of the valve, the first and second frames are both generally cylindrical, and the first frame has a compressed width that is smaller than the expanded width. In the expanded state, the valve provides directional fluid flow through the lumen. The valve defines first and second coupling points, and an axis therebetween, the axis lying on a transverse cross-section of the first frame. The first and second coupling points couple the second frame to the first frame by protruding into respective first and second slots defined by the first frame.

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 example anchor-manipulation tool includes (i) at a distal portion of the tool, an anchor-engaging element and an actuator, (ii) at an extracorporeal proximal portion of the tool, a controller, and (iii) a flexible longitudinal member extending between the proximal portion and the distal portion. The distal portion of the tool can be transluminally advanced to an anchor that is intracorporeally implanted in a subject. Subsequently, the anchor-engaging element can be engaged with an eyelet defined by a head of the anchor. Subsequently, the controller can be used to transition the tool into an articulatably-coupled state in which: (i) the eyelet at least in part inhibits movement of the anchor-engaging element away from the anchor, and (ii) the distal portion of the anchor-manipulation tool is deflectable with respect to the anchor. Subsequently, the anchor can be de-anchored by using the anchor-manipulation tool to apply a de-anchoring force to the eyelet.

Abstract: Apparatus is provided for use with a native valve of a heart of a subject. The apparatus includes: (1) an annular upstream support portion, comprising an expandable first frame, the upstream support portion configured to be placed against an upstream surface of the native valve; (2) a flexible polyester connector; and (3) an anchoring element, flexibly coupled to the upstream support portion by the connector, and configured to anchor the upstream support portion to the native valve by engaging tissue of the native valve.

Abstract: A first element (91) includes a first arm (92) and a second arm coupled thereto and having a concavity (103) facing the first arm and defining a space (96). In an open state, a tissue anchor portion (46) moves into the space through a gap between distal portions (94) of the first and second arms. In the closed state, the anchor portion is not movable through the gap. A second element (82) is movable with respect to the first element, such that, while the portion (46) of the anchor (40) is within the space, and the first element is in the closed state, in a first position of the second element, the portion of the anchor is movable within the space, and in a second position of the second element, the second element applies torque to the anchor by rotating the second element. Other embodiments are also described.

Abstract: Apparatus is provided for repairing a cardiac valve, the apparatus can include a flexible annuloplasty structure having a sleeve with an elongated tubular side wall and a distal tip. A first tissue anchor can passing through the distal tip of the sleeve, and a second tissue anchor can pass through a section of the tubular side wall. The first and second tissue anchors can extend in a substantially same direction. A longitudinal portion of the tubular side wall can be disposed between the first and second tissue anchors, and have a first lateral part opposite a second lateral part and closer to the first and second tissue anchors than the second lateral part is to the first and second tissue anchors. The second lateral part can have a degree of tension that is larger than a degree of tension of the first lateral part.