Abstract: Apparatus is provided, the apparatus comprising (i) a housing (22, 222), shaped to define a channel (24, 224) having an anchor-storage zone (26, 226) and an opening (28, 228) configured to provide access for an anchor driver (60) to the anchor-storage zone; (ii) a tissue anchor (40), stored in the anchor-storage zone and slidable through the channel; and (iii) a retaining member (30, 230). The retaining member (a) has a retaining state in which the retaining member is configured to retain the tissue anchor in the anchor-storage zone, and (b) is configured, by moving in response to a proximally-directed force applied to the tissue anchor, to allow the tissue anchor to leave the anchor-storage zone in response to the proximally-directed force. The proximally-directed force is greater than a pre-determined threshold force. Other embodiments are described.

Abstract: An anchor-storage device comprises (i) a housing, shaped to define a channel having an anchor-storage zone and an opening configured to provide access for an anchor driver to the anchor-storage zone; and (ii) a retaining member. A tissue anchor is stored in the anchor-storage zone and is slidable through the channel. The retaining member (a) has a retaining state in which the retaining member is configured to retain the tissue anchor in the anchor-storage zone, and (b) is configured, by moving in response to a proximally-directed force applied to the tissue anchor, to allow the tissue anchor to leave the anchor-storage zone in response to the proximally-directed force. The proximally-directed force is greater than a pre-determined threshold force. Other embodiments are also described.

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: 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: Apparatus for use at a native heart valve of a subject is described. For some applications, the apparatus comprises a prosthetic valve support, configured (a) to be implanted at the native valve, (b) to facilitate, at a first period, implantation at the native valve of a first prosthetic valve, and (c) to facilitate, at a second period, implantation at the native valve of a second prosthetic valve. Other embodiments are also described.

Abstract: For some applications, apparatus is provided for facilitating implantation of a prosthetic valve at a native heart valve of a subject, the apparatus comprising a prosthetic valve support, 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, configured to couple the prosthetic valve support to leaflets of the native valve without eliminating check valve functionality of the native valve. Other embodiments are also described.

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 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: 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 elongated lumen and an annuloplasty structure axis extending along the lumen. 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 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 for regulating blood flow of a subject is provided, the apparatus comprising a prosthetic valve (20) that comprises a tubular element (22), shaped to define a lumen (23) therethrough, and a valve member (24), configured to be coupled to the tubular element (22) and to be disposed within the lumen (23). The prosthetic valve (20) has (1) a compressed configuration in which the lumen (23) has a compressed width, the valve member (24) is generally cylindrical, and the prosthetic valve (20) is configured to be percutaneously delivered into the subject, and (2) an expanded configuration in which the lumen (23) has an expanded width that is greater than the compressed width, and the valve member (24) is generally disc-shaped, is coupled to the tubular element (22), and is disposed within the lumen (23). 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: 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: 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: 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: 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 and methods are described, including apparatus for puncturing a fossa ovalis of a heart. The apparatus includes a catheter shaped to define a catheter lumen. A puncturing element is slidably disposed within the catheter lumen, and is deployed from a distal portion of the catheter and to puncture the fossa ovalis. A probing element is deployed from the distal portion of the catheter. Upon being deployed, the probing element probes tissue near the fossa ovalis, the probing element having a first configuration thereof upon probing the tissue near the fossa ovalis. Upon probing tissue of the fossa ovalis, the probing element facilitates positioning of the puncturing element, by automatically adopting a second configuration thereof that is different from the first configuration. 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: 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.