Abstract: An implant to separate a vertebral cut has an upper portion, lower portion, and inner member. The inner member communicates with a swivelable coupling located at each end of the inner member. Each swivelable coupling also interacts with a respective one of the upper and lower portion, within an inner bore thereof. Movement of the inner member relative to one or both of the upper and the lower portions, via one or both swivelable couplings, translates the upper portion away from the lower portion, about a vertebral cut, to widen the vertebral cut and expand the spinal canal. Swivelable action of the couplings allows angulation of the inner member, relative to a longitudinal axis of the implant, to accommodate a natural lateral shift occurring during a widening of a vertebral cut.

Abstract: Embodiments disclosed herein provide compression/distraction methods and tools useful for fitting a spinal stabilization system in a patient through minimally invasive surgery. The spinal stabilization system may comprise screws anchored in vertebrae. The vertebrae may need to be compressed or distracted. One embodiment of an instrument disclosed herein may comprise a shaft for engaging one of the screws through an extender sleeve. A driver may engage another screw through an opening of the instrument. Through this engagement, a surgeon may use the rack and pinion of the instrument to compress or distract one or more levels of the vertebrae in a parallel motion, which can be advantageous clinically in certain situations.

Abstract: The present invention describes an intramedullary nail for use in orthopedic surgery for the fixation of bone fractures and fusion sites. The nail employs one or more internal loaded springs, biocompatible elastic or rubber bands, or other mechanism that provides continuous dynamic compression across the healing site throughout the healing process. By altering the size, tension and/or number of the internal compression devices, the amount of compression may be customized on a case-by-case basis. Further, the slots within the nail for its attachment can be utilized to create a torsional force when desired. The nail can have a cross-sectional shape that prevents its rotation. A system and method of use is also described.

Abstract: A bone plate screw-blocking system and method that comprises a plate with at least two bone screw receiving holes, blocking elements, bone screws, and a tool capable of simultaneously actuating at least two blocking elements. The plate includes an upper surface and a lower surface with bone screw receiving holes that extend through both surfaces of the plate. The bone screws couple the plate to the bone via the bone screw receiving holes. The blocking elements are movably positioned proximate each bone screw receiving hole. In an initial unblocked position, the blocking elements do not cover the bone screw receiving holes. Upon movement into final blocked positions, the blocking elements cover at least a portion of the bone screw receiving holes and preferably extend over at least a portion of the bone screw during use.

Abstract: A system for treating a bone includes an insert for a bone screw or a fixation nail. The insert includes a shaft that extends between proximal and distal ends of the insert and a cap. The shaft includes an opening in the proximal end and a cannulation extending from the opening through at least a portion of the shaft. The shaft further includes a fenestration disposed along the cannulation such that the cannulation is configured to provide a pathway for a substance between the opening and the fenestration. The cap is fastened to and seals the opening in the proximal end of the shaft and adjoins the cannulation. The cap is configured to provide a needle access through the cap to the cannulation following implantation of the system within the bone, and is further configured to self-seal after the needle is removed.

Abstract: Some embodiments of the invention include a cannulated bone screw including a screw shaft with screw thread, a proximal end, a distal end, and a channel extending through the screw shaft. Some embodiments include an inlet port coupled to the channel and extending through the distal end, and an outlet port coupled to the channel by a curved or angled channel region. In some embodiments, the outlet port extends through the screw shaft and exits a side that is substantially parallel to the shaft longitudinal axis. In some embodiments, the cannulated bone screw can form part of a therapy delivery device. In some embodiments, the outlet port extends through a portion of the screw shaft and exits at the distal end. In some embodiments, the valve includes a plunger with a plunger rod within the screw shaft, and a valve seat for control of fluid flow out of the screw.

Abstract: The present disclosure relates to bone cement formulations that have an extended working time for use in vertebroplasty procedures and other osteoplasty procedures together with cement injectors that include energy delivery systems for on-demand control of cement viscosity and flow parameters. The bone cement formulations may include a liquid component having at least one monomer and a non-liquid component including polymer particles and benzoyl peroxide (BPO). The non-liquid component may be further configured to allow controlled exposure of the BPO to the liquid monomer so as to enable control of the viscosity of the bone cement composition.

Abstract: The present invention is related to a technique for simultaneously forming a plurality of paste filled tunnels. The plurality of paste filled tunnels are connected to a surgical tube directly or indirectly and emptied one after another, until a desired amount of the paste is injected into a bone cavity, organ or a tissue via the surgical tube. The paste may be a bone cement paste, a drug powder paste, viscous fluid or gel. The injected bone cement paste will set in the bone cavity to act as a medical implant.

Abstract: A device is disclosed for reducing a vertebral compression fracture, comprising a superior end plate and an inferior end plate disposed along a vertical axis. The superior end plate and the inferior end plate are slidably separable in a vertical direction along the vertical axis. An interior chamber is provided in fluid communication with a port extending from an exterior to the interior chamber. The device is deployable within a vertebral body and expandable within the vertebral body by injecting a flowable material into the interior chamber thereby displacing the superior and inferior end plates along the vertical axis.

Abstract: A surgical assembly includes a first guidewire and a second guidewire, in which each of the first guidewire and the second guidewire are configured to be received by a bone block, a first suture loop, a second suture loop, a first locking component, and a second locking component, in which the first locking component is coupled to the first suture loop and the second locking component is coupled to the second suture loop. The locking component has a hole formed therethrough, in which the hole of the locking component is configured to receive the suture, and may be tethered to a suture by knots engaging a counterbore at opposed ends of a bore defined by the hole.

Abstract: A bipolar electrosurgical device is disclosed. The bipolar electrosurgical device includes a handle having a shaft and a distal end. The handle can be coupled to a source of electrical energy and a fluid source. A U-shaped first electrode extends distally in a plane from a pair of openings on the distal end of the shaft. The first electrode is in electrical communication with one of an active pole or a return pole of the source of electrical energy. A longitudinal second electrode extends distally from a middle opening on the distal end of the shaft. The second electrode is coplanar to the first electrode and electrically isolated from the first electrode. The second electrode is in electrical communication with the other of the active pole or the return pole of the source of electrical energy. The second electrode forms a lumen configured to be in fluid communication with the fluid source and a fluid opening for dispersing fluid.

Abstract: An intravascular catheter is provided, including a flexible elongate body; an expandable element positioned on the elongate body; a substantially linear thermal segment located proximally of the expandable element, the thermal segment defining a first flexibility, where the thermal segment is positioned between two portions of the catheter body each including a flexibility less than that of the thermal segment; a first fluid flow path in fluid communication with the expandable element; and a second fluid flow path in fluid communication with the thermal segment.

Abstract: Methods and apparatus for the treatment of a body cavity or lumen are described where a heated fluid and/or gas may be introduced through a catheter and into treatment area within the body contained between one or more inflatable/expandable members. The catheter may also have optional pressure and temperature sensing elements which may allow for control of the pressure and temperature within the treatment zone and also prevent the pressure from exceeding a pressure of the inflatable/expandable members to thereby contain the treatment area between these inflatable/expandable members. Optionally, a chilled, room temperature, or warmed fluid such as water may then be used to rapidly terminate the treatment session.

Abstract: Devices and methods for controlling ablation therapy are provided herein. In one embodiment, an ablation device is provided that includes an elongate body having proximal and distal ends, and an inner lumen extending therethrough. The inner lumen can be configured to receive fluid therein and to deliver fluid to the distal end of the elongate body. The device can also include an ablation element positioned at a distal end of the elongate body that is configured to heat surrounding tissue, and a heater element disposed within the inner lumen adjacent to a distal end of thereof, the heater element being configured to heat fluid flowing through the inner lumen.

Abstract: Transducer-based systems can be configured to display a graphical representation of a transducer-based device, the graphical representation including graphical elements corresponding to transducers of the transducer-based device, and also including between graphical elements respectively associated with a set of the transducers and respectively associated with a region of space between the transducers of the transducer-based device. Selection of graphical elements and/or between graphical elements can cause activation of the set of transducers associated with the selected elements. Selection of a plurality of graphical elements and/or between graphical elements can cause visual display of a corresponding activation path in the graphical representation. Visual characteristics of graphical elements and between graphical elements can change based on an activation-status of the corresponding transducers.

Abstract: An electrosurgical system comprising: a handpiece including: a first working arm, a second working arm, and an activation circuit having a first switch state and a second switch state, wherein a therapy current is conducted between the first working arm and the second working arm when the activation circuit is in the second switch state and the handpiece is in a first position; wherein the therapy current is conducted between the first working arm or the second working arm, and an adjacent handpiece component when the activation circuit is in the second switch state and the handpiece is in a second position; and wherein the therapy current is not conducted when the activation circuit is in the first switch state.

Abstract: Tissue treatment systems include an actuator handle assembly coupled with a clamp assembly having a first jaw mechanism and a second jaw mechanism. A first jaw mechanism includes a first flexible boot, a first flexible ablation member coupled with the first flexible boot, and a first rotatable jawbone disposed within the first flexible boot. A second jaw mechanism comprises a second flexible boot, a second flexible ablation member coupled with the second flexible boot, and a second rotatable jawbone disposed within the second flexible boot.

Abstract: An electrosurgical instrument includes a housing, an elongated shaft, and an end-effector assembly. The proximal end of the shaft is operably associated with the housing. The end-effector assembly is operably coupled to the distal end of the shaft and includes first and second jaw members. Each of the first and second jaw members includes a sealing plate and a bipolar electrode. Either one or both of the first and second jaw members is movable from a position in spaced relation relative to the other jaw member to at least one subsequent position wherein the sealing plates cooperate to grasp tissue therebetween. The electrosurgical instrument includes a semiconductor switch operably coupled to at least one of the sealing plates and at least one of the bipolar electrodes. The semiconductor switch is configured to enable user selection between energizing the at least one sealing plate or the at least one bipolar electrode.

Abstract: The present invention relates to a method of removing a tumor by radiofrequency ablation, comprising providing a guiding device (6) having at least two first concentric through holes (8, 81, 82) and a plurality of second through holes (10, 11) at a periphery of the guiding device (6). The method further comprising placing the guiding device against the skin of a patient and inserting two first electrodes (3, 4, 5) into the first through holes (8, 81, 82) of the guiding device and into a patient's skin and then applying a first radiofrequency current between the two first electrodes (3, 4, 5). The method further comprising inserting a second electrode (5) through a second through hole (10, 11) and into the patient's skin and then applying a second radiofrequency current between a first electrode (3, 4) and the second electrode (5).

Abstract: Methods and apparatus are provided for monopolar neuromodulation, e.g., via a pulsed electric field. Such monopolar neuromodulation may effectuate irreversible electroporation or electrofusion, necrosis and/or inducement of apoptosis, alteration of gene expression, action potential attenuation or blockade, changes in cytokine up-regulation and other conditions in target neural fibers. In some embodiments, monopolar neuromodulation is applied to neural fibers that contribute to renal function. In some embodiments, such monopolar neuromodulation is performed bilaterally.

Abstract: A system for creating an arteriovenous (AV) fistula comprises a vessel access sheath having a hollow interior and an exit port, a side access needle catheter configured to fit within the hollow interior of the sheath, a needle configured to be inserted into a blood vessel through the side access needle catheter, a toggle delivery catheter configured to fit within the hollow interior of the sheath, and a toggle apparatus configured to be delivered into a vessel through the toggle delivery catheter. The toggle apparatus comprises a shaft and a toggle member pivotably attached to a distal end of the shaft. A source of RF energy or resistive heat energy may be provided for application to the toggle member and/or to a heater insert in the toggle delivery catheter, for the purpose of creating the fistula.

Abstract: A microwave surgical device with high energy efficiency produces, at an antenna, an asymmetric heating pattern directed towards the side and it comprises: a plain curved portion extending from the distal end of said external conductor; and an inflection point at said distal end of the external conductor, so that said curved portion has a single cavity directed towards the axis of the coaxial end part.

Abstract: Methods and devices for delivering therapeutic or diagnostic energy (e.g., light, ultrasound, ionizing radiation (e.g., x-ray), vibration, heat energy, etc.) into the eye. An energy emitting device is positioned on the eye and used to deliver energy into the eye. The device may be constructed to allow the subject's eyelids to open and close while the device is positioned on the eye. The device is useable for various energy based or energy-mediated therapies, including crosslinking of corneal collagen, light therapy, photodynamic therapy, photo-activation of drugs, etc.

Abstract: An apparatus has a pump module providing pump energy, a resonator and a controller. The resonator includes a gain medium receiving the pump energy from the pump module and producing light; reflective surfaces reflecting light produced by the gain medium back toward the gain medium; and a variable light attenuator receiving light produced by the gain medium. The controller controls the amount of light attenuated by the variable light attenuator such that the apparatus emits windows of pulses of laser light at spaced time intervals, each window containing a plurality of pulses of laser light and each interval between windows being larger than an interval between pulses within a window. The emitted windows of pulses of laser light heat tissue to a temperature that causes coagulation without vaporization.

Abstract: A torque-limiting device may include a shaft extending axially through upper and lower shanks and a spring to connect to a nut. The upper and lower shanks may be under a force from the spring and further configured to selectively engage within a predetermined torque limit and disengage at above the predetermined torque limit. Accordingly, the shaft may receive torque up to the predetermined limit as provided by a user operating a handle of the torque-limiting device. The torque-limiting device may be disposable, reusable, economical, and have high torque capabilities.

Abstract: A cartridge device is provided for applying a fiber matrix to a tubular member such as a saphenous vein graft. The cartridge includes a housing, a tubular member holder, a rotational drive, and a polymer delivery assembly. The housing defines a chamber which surrounds the tubular member holder. The rotational drive rotates the tubular member during the fiber application process.

Abstract: A device includes a channel, which defines an inner space for receiving medical equipment. The channel is reversibly deformable between a first stable spatial configuration and at least one second stable spatial configuration. The device includes a plurality of holders for supporting the channel over a bearing surface. The device also includes a distal wall and a proximal wall longitudinally closing off the inner space.

Abstract: A surgical control system is provided including a glove having a plurality of sensory elements disposed therein, the plurality of sensory elements configured to provide sensory signals and at least one surgical instrument configured to be responsive to the sensory signals when the glove is within a functional range of the at least one surgical instrument. The plurality of sensory elements are magnetic elements or conductive elements. At least one surgical instrument includes a plurality of sensors positioned therein for sensing the magnetic elements or the conductive elements of the glove. Movement of the glove having the plurality of magnetic or conductive elements disposed therein, relative to the at least one surgical instrument, causes the plurality of sensors positioned within the at least one surgical instrument to activate at least one operation of the at least one surgical instrument.

Abstract: A toothbrush has a frame, a bristle holder movably mounted to a distal end of the frame, and a power transmission assembly operatively connectable to a drive motor and operatively connected to the bristle holder so as to move bristle tips on the bristle holder along an oval path relative to the frame. In a single cycle of movement along the oval path, the bristles shift away from the frame and towards the teeth, then along and in contact with the teeth in a direction away from the gum line, then back towards the frame and away from the teeth, and subsequently along the frame and out of contact with the teeth.

Abstract: A method of cleaning teeth by providing a device for generating a chemical agent in situ on an as-needed basis via the application of an electrical potential across a pair of conductors in communication with an electrolyte. The chemical agents may include ozone, hydrogen peroxide, peroxide, chlorine and/or hypochlorite. The device may include a voltage source and a first set of electrodes for applying an electrical potential to the electrolyte. The device may also include a second set of electrodes disposed about an anode of the first set of electrodes. The first and second sets of anodes cooperate to produce ions, peroxides, ozone and/or other chemical agents via the application of electrical potential to the electrolyte.

Abstract: The invention consists of a rapidly crosslinkable, two-component silicone elastomer together with a specially designed tray that serves as a form for the silicone resin and forms an integral portion of a dental appliance.

Abstract: A differential pressure body suit with external support against body suit migration. In its preferred embodiment, such body suit may comprise a close-fitting, multi-layered suit sealed against a mammal's skin to contain the differential pressure, or a looser-fitting suit that bends at the mammal's joints with minimal force. External support structure includes either fixed or movable mechanical supports attached to the body suit, extraordinary air pressure levels for making the body suit rigid, or exoskeletons attached to the body suit. A cyclic control system can turn the differential pressure condition within the body suit on and off on a selective basis to accommodate the movement of the legs of the mammal. This differential pressure body suit provides a portable and convenient system for, e.g., rehabilitating a skeletal joint injury or training the mammal for injury prevention or athletic performance.

Abstract: Described are devices, implants, kits, and related methods for treating pelvic conditions such as urinary in incontinence, in a male or a female patient.

Abstract: The present invention refers to a vaginal device of an elastic material, the vaginal device comprising a longitudinal portion having a geometrical center line, an upper end and a lower end and which vaginal device is intended to be inserted securely fixated inside of a vagina, the upper end being the innermost of the vaginal device in the vagina during use, to support against the urethra, through the vaginal wall, to prevent urinary stress incontinence in a woman, wherein the vaginal device comprises at least one supporting portion protruding from the longitudinal portion and a reference member protruding from the longitudinal portion at the lower end, which reference member during use is fixated against the vaginal introitus, holding the vaginal device securely fixated inside of the vagina and ensuring the at least one supporting portion to support against the urethra.

Abstract: The present invention relates to a prosthetic knit based on at least a first yarn of biocompatible polymer material defining first and second opposite and openwork faces, and on at least a second biocompatible and heat-fusible monofilament yarn, forming barbs that protrude outwards from at least said first face and are obtained by melting loops generated by said second yarn, the chart followed for the knitting of said first and second yarns on a warp knitting machine having three guide bars B1, B2, B3 being the following, according to the ISO 11676 standard:—Bar B1: 1.0/0.1//—Bar B2: 1.0/7.7/6.6/7.7//—Bar B3: 2.1/5.5/3.4/0.0// said second yarn following the chart of bar B3. The present invention also relates to a process for manufacturing such a knit.

Abstract: According to one aspect of the present disclosure, ureteral stents are provided that comprise an elongated stent body, at least one deployable retention structure, and at least one sleeve and/or sheet of drug-releasing material. In various embodiments, at least one sleeve and/or sheet of drug-releasing material is deployed concurrently with the deployment of at least one deployable retention structure. The ureteral stents of the present disclosure are adapted to release the urologically beneficial drug into a subject.

Abstract: The bending flexibility profile of a stent closely matches the flexibilities of the stent delivery system on either side of the stent. In one embodiment, a stent has a longitudinal axis and at least one link attaching each ring to an adjacent ring. The links closest to the stent end rings have the greatest bending flexibility and the links closest to the center of the stent have the least bending flexibility.

Abstract: A vascular prosthesis configured for direct connection to an artery. The vascular prosthesis may include a tube of material other than autologous vascular tissue, having an end formation, which is configured for surgical connection to an opening formed in the artery, and a narrower portion prior to commencement of the end formation. The end formation may have an enlarged chamber adapted to induce a concave section in the blood vessel upon attachment thereto.

Abstract: Articles comprising an expanded polytetrafluoroethylene membrane having serpentine fibrils and having a discontinuous coating of a fluoropolymer thereon are provided. The fluoropolymer may be located at least partially in the pores of the expanded fluoropolymer membrane. In exemplary embodiments, the fluoropolymer is fluorinated ethylene propylene. The application of a tensile force at least partially straightens the serpentine fibrils, thereby elongating the article. The expanded polytetrafluoroethylene membrane may include a microstructure of substantially only fibrils. The articles can be elongated to a predetermined point at which further elongation is inhibited by a dramatic increase in stiffness. In one embodiment, the articles are used to form a covered stent device that requires little force to distend in the radial direction to a first diameter but is highly resistant to further distension to a second diameter (stop point).

Abstract: An implant suitable for being anchored with the aid of mechanical vibration in an opening provided in bone tissue. The implant is compressible in the direction of a compression axis under local enlargement of a distance between a peripheral implant surface and the compression axis. The implant includes a coupling-in face which serves for coupling a compressing force and the mechanical vibrations into the implant, which coupling-in face is not parallel to the compression axis. The implant also includes a thermoplastic material which, in areas of the local distance enlargement, forms at least a part of the peripheral surface of the implant.

Abstract: A support is coupled to the lens capsule to increase accommodation. The support may be adjustable, such that patient refraction and accommodation can be adjusted following surgery. The support may comprise rigidity sufficient to decrease radial movement of the intermediate portion of the lens capsule. The support can be placed on the intermediate portion to decrease radial movement of the intermediate portion of the lens capsule and increase radial stretching of an outer portion of the lens capsule extending between the zonules and the intermediate portion coupled to the support, such that the amount of accommodation of the eye is increased. The support may comprise a biocompatible material capable of stable coupling to the lens capsule following implantation, such that the far vision refraction and accommodation of the eye can be stable following surgery.

Abstract: Apparatus for performing intraocular implant surgery, including surgical apparatus for performing intraocular implant surgery, an autorefraction device associated with the surgical apparatus, wherein the autorefraction device is configured to perform autorefraction on the aphakic eye to provide one or more aphakic refraction measurements, and a processor connected to the autorefraction device, wherein the processor is configured to process the aphakic refraction measurements and provide the user of the apparatus with information regarding the power of the intraocular lens.

Abstract: Provided is an intraocular lens including a lens and a pair of right and left loop-shaped support portions, and a folding-back portion is provided in the front end of each support portion. A sclera tunnel is formed in the circumferential direction at a position of a depth corresponding to the half of the thickness of the sclera in two symmetrical positions with respect to the visual axis in a portion adjacent to a limbus of the sclera. The front end of the support portion is extracted from the ciliary sulcus and is inserted into the sclera tunnel, so that the intraocular lens is fixed into the eye. Furthermore, at that time, the folding-back portion is hooked to a certain portion inside the sclera tunnel, so that the support portion is strongly restrained inside the sclera tunnel. As a result, the intraocular lens is more reliably fixed.

Abstract: Intraocular devices for use in and attached to the natural lens capsule of an eye are provided. The lens capsule may be maintained in a configuration to avoid post-operative changes that are deleterious to vision. Single or dual optic systems are provided, which may be accommodating. Combinations of devices to obtain dual optic systems are disclosed.

Abstract: A device (200) for implantation in or near an annulus of a tricuspid valve comprising at least one blood flow control element (202) adapted to capture a volume of blood therein. Optionally or alternatively, the blood flow control element is adapted to allow at least some volume of blood (406) to regurgitate through the annulus during at least some part of systole. Optionally or alternatively, the device comprises a relatively rigid annulus with an arc length of less than 300 degrees. Optionally or alternatively, the relatively rigid annulus comprises a plurality of tissue fixation elements positioned along no more than 300 degrees of a circumference of the annulus, for example to avoid damaging conduction pathways between an atria and a chamber.

Abstract: Disclosed is a prosthetic heart valve incorporating one or more linking elements adapted for anchoring, aligning, stabilizing, fixing, or otherwise enabling the implantation of other prosthetic devices, including other prosthetic heart valves, in or around the heart.

Abstract: A method of preventing ingress of material into the left atrium of a heart includes providing a delivery sheath, advancing the sheath distal end through an opening between the right atrium and the left atrium of the heart, providing an expandable cage, delivering the expandable cage to the left atrium, and expanding the expandable cage within the left atrium. The expandable cage includes a proximal end, a distal end, and a plurality of supports extending therebetween. The expandable cage also includes a first membrane provided at its proximal end and a second membrane provided at its distal end. The expandable cage has a collapsed configuration so that it can be received within the lumen of the delivery sheath, and an expanded configuration for deployment within the heart. When expanded, the first membrane is positioned at an opening between the left and right atria of the heart, and the second membrane is positioned at the ostium of the left atrial appendage.

Abstract: A medical device for treating a heart valve insufficiency, with an endoprosthesis which can be introduced into a patient's body and expanded to secure a heart valve prosthesis in the patient's aorta with a catheter. In an embodiment, the endoprosthesis has a plurality of positioning arches configured to be positioned with respect to a patient's aorta and a plurality of retaining arches to support a heart valve prosthesis. The endoprosthesis includes a collapsed mode during the process of introducing it into the patient's body and an expanded mode when it is implanted. The endoprosthesis may be introduced into a patient's body and expanded via a catheter. In an embodiment, the catheter has first and second slide mechanisms configured to independently manipulate first and second sleeve elements to sequentially expand the endoprosthesis from the collapsed mode to the expanded mode.

Abstract: A delivery system and a method for deploying a cardiovascular prosthetic implant using a minimally invasive procedure are disclosed. The delivery system comprises an introducer catheter, a delivery catheter having a proximal end and a distal end, and a seal assembly, wherein an outer diameter of the distal end of the delivery catheter is greater than an inner diameter of the distal end of the introducer catheter.

Abstract: Apparatus and methods are provided for use with a mitral valve of a heart of a subject. The apparatus includes a P1-anchor, a P2-anchor, and a P3-anchor, that are anchored to tissue in a vicinity of, respectively, P1, P2and P3segments of a posterior leaflet of the mitral valve, a tether being fixedly coupled to the P2-anchor, and slidably coupled to the P1and P3anchors. A cardiac-site anchor anchors the tether to an anchoring location that is at a cardiac site that is anterior and inferior to the posterior leaflet. Other embodiments are also described.