METHOD AND DEVICE FOR TREATMENT OF VALVE REGURGITATION
A prosthetic valve coaptation assist device includes an anchor and a single valve assist leaflet. The anchor may be a supporting ring frame, brace or arc structure and will usually be radially self-expandable so that it can expand against surrounding tissue. The valve assist leaflet may be made of pericardium or other biological or artificial material and is shaped like the native target valve leaflet. The valve assist leaflet is typically sized larger than the target leaflet so that after implantation a significant overlap of the device body occurs.
This application is a continuation of U.S. patent application Ser. No. 14/901,468, filed Dec. 28, 2015, now U.S. Pat. No. ______; which is national stage entry of PCT Application No. PCT/IB2014/002155, filed Jun. 13, 2014; which claims the benefit of U.S. Provisional Patent Application Nos. 61/956,683, filed Jun. 14, 2013; 61/963,330, filed Dec. 2, 2013; and 61/982,307, filed Apr. 21, 2014; the full disclosures of which are incorporated herein by reference.
BACKGROUND OF THE INVENTION 1. Field of the InventionThe present invention relates generally to medical devices and methods. More particularly, this invention relates to prosthetic devices and methods for improving the function of prolapsing heart and other circulatory valves.
Mitral valve insufficiency, either organic (primary) or functional (secondary), such as but not limited to prolapsed, regurgitation, and dithering (MVI) is a valvular heart disease characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole which can result in poor coaptation of the individual valve leaflets and valve leakage against backpressure. There are various types of MVI, broadly classified as classic and non-classic. In its non-classic form, MVI carries a low risk of complications and often can be kept minimal by dietary attention. In severe cases of classic MVI, complications include mitral regurgitation, infective endocarditis, congestive heart failure, and, in rare circumstances, cardiac arrest, usually resulting in sudden death. The aortic valve can also suffer from prolapse, and valves of the venous circulation can suffer from a similar condition which can lead to chronic venous insufficiency resulting from damaged or “incompetent” valves which are characterized by poor coaptation.
It would be desirable to provide apparatus and methods for improving valve function in a patient suffering from any of the conditions identified above and, in particular, for improving coaptation of cardiac vales, including both mitral valves and aortic valves, as well as venous valves. At least some of these objectives will be met by the inventions described below.
2. Background ArtU.S. Pat. Nos. 6,419,695; 6,869,444; and 7,160,322; and U.S. Patent Publication Nos. 2012/0197388 and 2013/0023985 all have disclosure pertinent to the present invention.
SUMMARY OF THE INVENTIONThe description of a prosthetic valve device and implantation method is provided. The present invention generally provides medical devices, systems and methods often used for treatment of mitral valve regurgitation and other valvular diseases including tricuspid regurgitation.
The prosthetic valve device is comprised of a single leaflet sutured to a supporting ring frame, brace or arc structure. The ring frame (referred to henceforth as device ring) is radially self-expandable so that it can expand against the walls of the atrium. The valve device leaflet (referred to henceforth as device body) is made of pericardium or other biological or artificial material and is shaped like the native target valve leaflet. The device body is sized larger than the target leaflet so that after implantation a significant overlap of the device body occurs.
The invention described herein is generally comprised of a percutaneous transcatheter delivery system, a coaptation assisting device and the implantable device body is capable of assuming both a delivery and operational configuration; the delivery configuration being of a small enough size to enable delivery to the implantation site via a percutaneous transcatheter.
The device ring is generally made of metal (e.g. Nitinol), polymer (e.g. polyurethane) or organic substance (e.g. pericardium). At the treatment site the device ring generally is fixed to the annular base of the target valve by anchors which may be part of the device itself or separate from it.
The device body is generally made of synthetic substance (e.g. Dacron or Polyurethane) or organic substance (e.g. pericardium) in some embodiments with an embedded skeleton made of metal, synthetic substance or organic substance, and in some embodiments with a specially designed inferior ledge to prevent systolic prolapsing of the device body.
The device body is generally placed in atrioventricular direction along the blood flow path like the leaflets of the native valve to move back and forth between an open-valve configuration and a closed-valve configuration.
During implantation the device ring should be positioned closely above the ostium of the target valve from the atrial side (e.g. by a transseptal approach). After insertion of the device, the device body leaflet moves within the blood flow synchronously with the target valve leaflet. In the systole after closing of the target valve, the overlap of the device body will be stopped by the edge of the opposing leaflet of the target valve. Thereby the device overlaps the effective regurgitation area (ERO) and minimizes or eliminates the valve regurgitation.
To close or diminish the gap caused by malcoaptation of the native leaflets the device body will be disposed between the native leaflets, thereby providing a surface to coapt against for at least one of the native leaflets, while effectively replacing the function of the second native leaflet in the area of the valve, which it would occlude during systole.
Among other uses, the coaptation assistance device, device body implants and methods described herein may be configured for treating functional and/or degenerative mitral valve regurgitation (MR) by creating an artificial coaptation zone within which at least one of the native mitral valve leaflets can seal. The structures and methods herein will largely be tailored to this application, though alternative embodiments might be configured for use in other valves of the heart and/or body, including the tricuspid valve, valves of the peripheral vasculature, the inferior vena cava, or the like.
In a first specific aspect, the present invention comprises a prosthetic valve coaptation assist device including an anchor configured to be attached to a native valve annulus and a single valve assist leaflet attached to the anchor and configured to lie over a superior surface of a first native valve leaflet when the anchor is attached to the native valve annulus. The single valve assist leaflet is sufficiently flexible so that it will move in unison with the first native valve leaflet and will coapt with a second native valve leaflet in response to blood flow through the valve. In this way, valve prolapse can be reduced and leakage minimized.
In some embodiments of the prosthetic valve coaptation assist device, the anchor is configured to self-expand to attach to the native valve annulus. In other embodiments, the anchor may be configured to be sutured to the native valve annulus. For both self-expanding and sutred anchors, the anchor may be further configured to either fully or partially circumscribe the valve annulus. Anchors which partially circumscribe the valve annulus will frequently have barbs or other tissue-penetrating element which help hold the anchor in place, although barbs may be included on fully circumscribing anchors as well.
The anchors may be formed from metals, polymers, or other biocompatible materials having sufficient strength to remain attached to the valve annulus for indefinite periods after implantation. The valve assist leaflets will typically be formed from flexible materials which may be of the type used in prosthetic heart valves, such as tissues, e.g. pericardium which has been treated to promote stabilization, as well as various synthetic polymers. The valve assist leaflet may also be reinforced with a metal or polymeric a reinforcement structure attached over all or a portion of either or both surfaces of the leaflet.
In a second specific aspect of the present invention, a method for promoting valve coaptation in a patient comprises identifying a prolapsing valve in the patient, e.g. using conventional ultrasonic or other imaging techniques. A single prosthetic valve assist leaflet is implanted over a superior surface of a first native leaflet of the prolapsing valve. The single valve assist leaflet moves in unison with the first native valve leaflet and will coapt with a second native valve leaflet in response to blood flow through the valve. In this way, valve prolapse can be reduced and leakage minimized.
In some embodiments of the methods for promoting valve coaptation of the present invention, the native valve may be a cardiac valve, such a mitral valve or an aortic valve. In other embodiment, the native valve may a venous valve typically a peripheral venous valve.
Implanting may comprise implanting the single prosthetic valve leaflet in an open surgical procedure, but will more typically comprise advancing the single prosthetic valve leaflet endovascularly. transseptally, or transapically, as illustrated in detail below.
When introduced endovascularly. transseptally, or transapically, implanting usually comprises self-expanding an anchor coupled to the single prosthetic valve leaflet within the native valve annulus. The anchor may be expanded to fully circumscribe the valve annulus or may be expanded to partially circumscribe the valve annulus. In both cases, and particularly when the anchor partially circumscribes the annulus, the anchor may include one or more barbs or other tissue penetrating elements which penetrate the native valve annulus as the anchor expands to assist in fixing the anchor to the annulus. Alternatively, in some cases, implanting may comprise suturing an anchor coupled to the single prosthetic valve leaflet to the native valve annulus.
In a third specific aspect of the present invention, a method for delivering a prosthetic valve coaptation assist device to a native valve site comprises providing the prosthetic valve coaptation assist device having an anchor and a single prosthetic valve assist leaflet constrained within a delivery device. The delivery device is advanced to the native valve site, and the prosthetic valve coaptation assist device is deployed from the delivery device at the native valve site. The prosthetic valve coaptation assist device has an anchor which expands within an annulus of the native valve to locate the single prosthetic valve assist leaflet over a superior surface of a native valve leaflet. The single valve assist leaflet moves in unison with the first native valve leaflet and will coapt with a second native valve leaflet in response to blood flow through the valve. In this way, valve prolapse can be reduced and leakage minimized.
In some embodiments of the method for delivering a prosthetic valve coaptation assist devices, the native valve may be a cardiac valve, such a mitral valve or an aortic valve. In other embodiment, the native valve may a venous valve typically a peripheral venous valve.
Advancing may comprise advancing the single prosthetic valve leaflet endovascularly. transseptally, or transapically, as illustrated in detail below.
Deploying will typically comprise releasing prosthetic valve coaptation assist device from constraint so that the anchor self-expands within the native valve annulus to hold the single prosthetic valve leaflet in place over the first native valve leaflet. The anchor may self-expand to fully circumscribe the valve annulus. Alternatively, the anchor may self-expand to partially circumscribe the valve annulus. In either case, and particularly in the case of the partial exansion, the anchor may include one or more barbs which penetrate the native valve annulus as the anchor self-expands.
The Figures of the present application use the following reference numbers:
In
In
A cross section of the anchoring portion of an embodiment similar to that of
The device of
In an alternate embodiment the coupling elements may be terminated in an anchoring mechanism, which is then used to affix the mitral assist device to the myocardium.
When the device body is comprised of a molded material as shown in
Claims
1.-35. (canceled)
36. A method for assisting coaptation of a native cardiac valve, the method comprising:
- identifying that the native cardiac valve suffers from valve insufficiency; and
- implanting only one valve assist leaflet such that:
- a fixed end of the valve assist leaflet is fixed with respect to a first portion of a native valve annulus of the native cardiac valve, and the valve assist leaflet lies over a superior surface of a first native valve leaflet of the native cardiac valve, and
- an open space is formed between (a) a ventricular end of the valve assist leaflet opposite the fixed end of the valve assist leaflet and (b) a second portion of the native valve annulus opposite the first portion of the native valve annulus, the open space accommodating movement of a second native valve leaflet of the cardiac valve in response to blood flow through the native cardiac valve,
- wherein the valve assist leaflet is sufficiently flexible and the ventricular end of the valve assist leaflet is freely moveable such that the valve assist leaflet moves in unison with the first native valve leaflet and coapts with the second native valve leaflet in response to the blood flow through the native cardiac valve.
37. The method according to claim 36, wherein implanting the valve assist leaflet comprises implanting the valve assist leaflet such that first and second curved lateral edges of the valve assist leaflet face in generally opposite directions from each other and extend between the ventricular end and the fixed end.
38. The method according to claim 37, wherein the open space is a first open space, and wherein implanting the valve assist leaflet comprises implanting the valve assist leaflet such that second and third open spaces are formed in a radial direction between the native valve annulus and the first and the second curved lateral edges, respectively.
39. The method according to claim 37, wherein the first and the second curved lateral edges are shaped so as to define respective first and second concave portions.
40. The method according to claim 36, wherein implanting the valve assist leaflet comprises implanting the valve assist leaflet such that the valve assist leaflet entirely covers the superior surface of the first native leaflet.
41. The method according to claim 36, wherein a length of the valve assist leaflet in an atrioventricular direction is greater than a greatest width of the valve assist leaflet.
42. The method according to claim 36, wherein implanting the valve assist leaflet comprises anchoring the valve assist leaflet to cardiac tissue using an anchor, and wherein the valve assist leaflet is coupled to the anchor only at the fixed end of the valve assist leaflet.
43. The method according to claim 42, wherein anchoring the valve assist leaflet to the cardiac tissue comprises attaching the anchor to the native valve annulus.
44. The method according to claim 43, wherein attaching the anchor to the native valve annulus comprises self-expanding the anchor within the native valve annulus.
45. The method according to claim 44, wherein self-expanding the anchor within the native valve annulus comprises self-expanding the anchor within the native valve annulus to fully circumscribe the native valve annulus.
46. The method according to claim 45, wherein the anchor includes a ring.
47. The method according to claim 44, wherein self-expanding the anchor within the native valve annulus comprises self-expanding the anchor within the native valve annulus to partially circumscribe the valve annulus.
48. The method according to claim 44, wherein anchor includes one or more barbs, and wherein self-expanding the anchor within the native valve annulus comprises self-expanding the anchor within the native valve annulus such that the one or more barbs penetrate the native valve annulus as the anchor self-expands.
49. The method according to claim 43, wherein attaching the anchor to the native valve annulus comprises suturing the anchor to the native valve annulus.
50. The method according to claim 42, wherein anchoring the valve assist leaflet to the cardiac tissue comprises attaching the anchor to myocardial tissue of a cardiac wall above the native valve annulus.
51. The method according to claim 42, wherein a length of the anchor is greater than a greatest length of the valve assist leaflet in an atrioventricular direction.
52. The method according to claim 36, wherein the native cardiac valve is a mitral valve or an aortic valve.
53. The method according to claim 36, wherein the native cardiac valve is a venous valve.
54. The method according to claim 36, wherein implanting comprises implanting the valve assist leaflet in an open surgical procedure.
55. The method according to claim 36, wherein implanting comprises advancing the valve assist leaflet endovascularly.
56. The method according to claim 36, wherein implanting comprises advancing the valve assist leaflet transseptally.
57. The method according to claim 36, wherein implanting comprises advancing the valve assist leaflet transapically.
58. The method according to claim 36, wherein the valve assist leaflet defines an atrioventricular-oriented axis between the fixed and the ventricular ends, and has:
- a first width at the fixed end and a first location along the atrioventricular-oriented axis,
- a second width at a second location along the atrioventricular-oriented axis between the fixed and ventricular ends greater than the first width, and
- a third width less than the second width at a third location along the atrioventricular-oriented axis, the third location being between the second location and the ventricular end along the atrioventricular-oriented axis.
59. The method according to claim 36, wherein the ventricular end is entirely convex.
60. The method according to claim 36, wherein the valve assist leaflet defines an atrioventricular-oriented axis between the fixed and the ventricular ends, and has:
- a first width at the fixed end and a first location along the atrioventricular-oriented axis,
- a second width at a second location along the atrioventricular-oriented axis between the fixed and the ventricular ends less than the first width, and
- a third width greater than the second width at a third location along the atrioventricular-oriented axis, the third location being between the second location and the ventricular end along the atrioventricular-oriented axis.
61. The method according to claim 60, wherein the valve assist leaflet has a fourth width less than the third width at a fourth location along the atrioventricular-oriented axis, the fourth location being between the third location and the ventricular end along the atrioventricular-oriented axis.
62. A method for assisting coaptation of a cardiac valve, the method comprising:
- identifying that the cardiac valve suffers from valve insufficiency; and
- implanting only one valve assist leaflet such that:
- a fixed end of the valve assist leaflet is fixed with respect to a first portion of a valve annulus of the cardiac valve, and the valve assist leaflet lies over a superior surface of a first valve leaflet of the cardiac valve, and
- an open space is formed between (a) a ventricular end of the valve assist leaflet opposite the fixed end of the valve assist leaflet and (b) a second portion of the valve annulus opposite the first portion of the valve annulus, the open space accommodating movement of a second valve leaflet of the cardiac valve in response to blood flow through the cardiac valve,
- wherein the valve assist leaflet is sufficiently flexible and the ventricular end of the valve assist leaflet is freely moveable such that the valve assist leaflet moves in unison with the first valve leaflet and coapts with the second valve leaflet in response to the blood flow through the cardiac valve.
63. The method according to claim 62, wherein the ventricular end is entirely convex.
64. The method according to claim 62,
- wherein implanting the valve assist leaflet comprises implanting the valve assist leaflet such that first and second curved lateral edges of the valve assist leaflet face in generally opposite directions from each other and extend between the ventricular end and the fixed end, and
- wherein the open space is a first open space, and wherein implanting the valve assist leaflet comprises implanting the valve assist leaflet such that second and third open spaces are formed in a radial direction between the valve annulus and the first and the second curved lateral edges, respectively.
65. The method according to claim 62, wherein a length of the valve assist leaflet in an atrioventricular direction is greater than a greatest width of the only one valve assist leaflet.
Type: Application
Filed: Jul 6, 2020
Publication Date: Dec 10, 2020
Inventor: Jury SCHEWEL (Hamburg)
Application Number: 16/921,687