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 collapsible device, such as an annuloplasty ring or prosthetic heart valve, is configured to be collapsed prior to being introduced into a patient via minimally-invasive access points such as port holes or intercostal incisions. A holder is configured to hold the collapsible device, and to selectively collapse the device for introduction into the patient and then re-enlarge the device at the desired deployment site. Collapsible devices include devices that can hingedly fold about hinge lines, and devices that can elongate to form substantially spiral forms with reduced diameters.

Abstract: Sealable and repositionable implant devices are provided with one or more improvements that increase the ability of implants such as endovascular grafts to be precisely deployed or re-deployed, with better in situ accommodation to the local anatomy of the targeted recipient anatomic site, and/or with the ability for post-deployment adjustment to accommodate anatomic changes that might compromise the efficacy of the implant. A surgical implant includes an implant body and a selectively adjustable assembly attached to the implant body, having adjustable elements, and operable to cause a configuration change in a portion of the implant body and, thereby, permit implantation of the implant body within an anatomic orifice to effect a seal therein under normal physiological conditions.

Abstract: The invention relates in some aspects to a device for use in the transcatheter treatment of mitral valve regurgitation, including steerable guidewires, implantable coaptation assistance devices, anchoring systems for attaching a ventricular projection of an implantable coaptation device, a kit, and methods of using an implantable coaptation assistance device among other methods.

Abstract: An anchor anchors a therapeutic device having an elongated body within a body lumen. The anchor includes a fixation member carried on the device which is adjustable from a first configuration that permits placement of the device in the body lumen to a second configuration that anchors the device within the body lumen. The anchor further includes a lock that locks the fixation member in the second configuration. The fixation member may be locked in any one of a plurality of intermediate points between the first configuration and a maximum second configuration.

Abstract: In a surgical method for improving cardiac function, an implantable scaffold or valve support device is inserted inside a patient's heart and attached to the heart in a region adjacent to a natural mitral or other heart valve. The scaffold or valve support device defines an orifice and, after the attaching of the scaffold or valve support device to the heart, or temporary support while native valve leaflets and/or subvalvular structures are captured, a prosthetic or bio-prosthetic valve seated in the orifice, and the native valve may be retracted into the scaffold/replacement assembly to create a gasket for sealing the complex.

Abstract: One embodiment of the present invention includes a filamentary fixation system including a sleeve formed of filamentary material including an interior and an exterior surface along a length defined between a first end and a second end, the sleeve having a coating adapted to allow for tissue ingrowth, and a filament formed of filamentary material including a first free end and a second free end, and a length therebetween, at least a portion of the filament positioned within the interior of the sleeve.

Abstract: The present disclosure relates to repair devices and methods for repair of regurgitant tricuspid valves. A repair method includes positioning a repair device at a tricuspid valve in a collapsed configuration. The repair device includes a proximal disk and a distal disk joined by a neck section. The distal disk is deployed by passing it from the collapsed state to an expanded configuration on a first side of the tricuspid valve. The proximal disk is then deployed by passing it from the collapsed state to an expanded configuration on a second side of the tricuspid valve so as to grasp all three tricuspid valve leaflets between the deployed distal disk and the deployed proximal disk.

Abstract: An annuloplasty prosthesis and delivery system for implanting the prosthesis adjacent an annulus of a heart valve having leaflets for adjusting the annulus to improve valve function includes a ring prosthesis made of shape memory material and having tissue attachment members which attach to the annulus in the atrium and commissural legs extending from the ring between the leaflets and secure against the underside of the valve in the ventricle. The prosthesis is carried via an orientation loop and attaches to the heart tissue such that when the prosthesis is manipulated and relaxed the annulus is adjusted to reduce or eliminate regurgitation.

Abstract: A prosthetic system for heart valve replacement comprises an annular support structure within which a valved prosthetic body can be expanded until it meets opposition. The annular support is provided in ring segments having terminal connectors for forming, in the condition of use of the prosthetic system, a stable and durable annular structural continuity capable of withstanding the opposition exerted by the valved prosthetic body. The prosthetic system is deployed using guide wires within a cardiac chamber guided through an introducer catheter having through lumens, within which at least two first guide catheters are positioned. These guide catheters have respective deflected or deflectable distal ends adapted to emerge from the distal end of the introducer catheter to convey and direct the distal ends of respective guide wires, placed within the guide catheters, towards a capture member of a capture system which is provided within the introducer catheter.

Abstract: The present disclosure relates to an arrangement, a loop-shaped support, a prosthetic heart valve and a method of repairing or replacing a native heart valve. With the method or the arrangement, leakage or regurgitation between a prosthetic heart valve and the surrounding valve tissue is prevented. In one embodiment, an arrangement for replacement or repair of a native heart valve is provided, which comprises a loop-shaped support 41 and a prosthetic heart valve 70 and wherein an outer segment 32 of the loop-shaped support 41 is positionable towards surrounding valve tissue of a native heart valve and wherein an outer surface 74 of the prosthetic heart valve 70 is positionable towards an inner segment 34 of the loop-shaped support 41 so as to prevent paravalvular leakage or regurgitation between the prosthetic heart valve 70 and the surrounding valve tissue of the native heart valve.

Abstract: An annuloplasty ring holder including a head having an upper surface and an annuloplasty ring receiving surface facing opposite the upper surface. The annuloplasty ring holder also includes means for attaching an annuloplasty ring to the annuloplasty ring receiving surface. The means for attaching an annuloplasty ring to the annuloplasty ring receiving surface may include one or more suture guides operatively associated with the head and configured to position one or more sutures to removably associate an annuloplasty ring with the annuloplasty ring receiving surface. The head may include a central hub and more than one spoke radiating out from the central hub. If the head is thus configured, each spoke will include a portion of the annuloplasty ring receiving surface.

Abstract: Apparatus is provided, comprising a ring, comprising a plurality of struts arranged in a pattern of alternating peaks and troughs, each strut having a first end-portion and a second end-portion, each peak defined by convergence of adjacent first end-portions disposed at an angle with respect to each other, and each trough defined by convergence of adjacent second end-portions. The apparatus also comprises a plurality of anchors. Each anchor has a longitudinal axis, is configured to be driven along the longitudinal axis into tissue of the heart, and is coupled to the ring at a respective trough in a manner that facilitates (i) movement of the anchor along the longitudinal axis with respect to the trough, and (ii) deflection of the longitudinal axis with respect to the trough.

Abstract: Various systems, devices and methods associated with the placement of a dock or anchor (72) for a prosthetic mitral valve (120). The anchor (72) may take the form of a helical anchor having multiple coils (104, 108) and/or a stent-like structure. Various methods include different levels of minimal invasive procedures for delivering the prosthetic valve anchor (72) and prosthetic valve (120), as well as tissue anchors for plication or other purposes to the mitral valve position in the heart (14).

Abstract: A device for improving the function of a heart valve has a first and a second shape. The device comprises two contact points, and the device in the first shape exhibits a distance between the two contact points essentially corresponding to a distance between two commissures of the heart valve and the device in the second shape exhibits an increased distance between the contact points. The device is in the first shape arranged for insertion to the heart valve to establish a contact between the contact points and the commissures. The device is transferable from the first shape to the second shape, and the device is in the second shape arranged for extending in abutment with valve tissue throughout a cycle of heart action. The device may change the shape of the heart valve by stretching it between the commissures for improving the ability of the heart valve to close.

Abstract: A mitral cerclage annuloplasty apparatus comprises a tissue protective device and a knot delivery device. The tissue protective device comprises a first protective tube and a second protective tube. The knot delivery device comprises a tube wherein a loose knot is looped around its distal end through a hole and wherein tight knot is formed when the distal end of the tube is cut open. Alternatively, the knot delivery device comprises an inner tube and outer tube. The inner tube is insertable and rotatable inside the outer tube. When the tubes are in a closed position by rotating either the outer tube or the inner tube, a hole is created near its distal end. When the tubes are in open position by rotating either the outer tube or the inner tube, the hole joins the opening of the outer tube and lengthens.

Abstract: A device for improving the function of a heart valve comprises: a support member formed from a shape memory material, and a restraining member providing a restraining action on a course of the support member. The support member may abut one side of the valve conforming to the shape of the valve annulus upon said shape memory material assuming an activated shape while the restraining member restrains the course of the support member. The restraining action is removable for allowing the support member to assume a desired, altered course. The restraining member may be biodegradable to be degraded within a patient or may be detachable from the support member to be withdrawn. The support member according to another embodiment presents a shape change in that an increased cross-section is associated with a shortened length of the support member. The support member according to yet another embodiment has a first and a second activated shape.

Abstract: An implant for implantation around a circumferential tissue structure in a heart, includes a flexible elongated component having a longitudinal axis and a first distal end portion, a second distal end portion and an intermediate portion extending between the first and second distal end portions, and an inner lumen extending longitudinally between the first and second distal end portions and through the intermediate portion; and a locking member for allowing the first distal end portion to be fixedly connected to the second distal end portion so as to provide the elongated component as a closed loop. The first distal end portion is provided with a first distal opening which connects the inner lumen with an outside of the component. The second distal end portion is provided with a second distal opening which connects the inner lumen with the outside of the component.

Abstract: Disclosed herein are prosthetic devices and related methods for implantation at the native mitral valve of the heart by drawing an atrial portion and a ventricular portion toward each other from opposite sides of the native mitral valve, clamping the native mitral valve therebetween. One or more retention members passing through the mitral valve orifice or through a puncture in the native valve anatomy can couple the atrial and ventricular members together and keep them anchored onto the native mitral valve anatomy. The atrial portion can seat against the atrial side of the mitral annulus while the ventricular portion can include hooks and/or a sub-annular ring that engage and capture the native mitral valve apparatus to provide anchorage. The described technology can avoid the need to use sutures to anchor a prosthetic device at the mitral valve region.

Abstract: The present invention provides an artificial heart valve annuloplasty ring, including an outer layer (6) and an annular main body (8) integrally formed from multiple ring sections, the outer layer (6) is a fiber fabric layer covered on the outside of the annular main body (8), the annular main body (8) includes a tube with a tube wall that has a slotted structure capable of adjusting the rigidity of the annuloplasty ring. The artificial heart valve annuloplasty ring provided in the present invention has a simple structure, easy-to-adjust rigidity, and does not need to separately design and manufacture a mold for the main body of the annuloplasty ring during manufacturing.

Abstract: Systems and methods treat a heart valve using a magnetically adjustable annuloplasty ring attached to or near a cardiac valve annulus. A changing magnetic field may be used to selectively increase or decrease a circumference of, or otherwise modify the shape of, the implanted annuloplasty ring. The adjustable annuloplasty ring includes a tubular body member, one or more adjustable members, and an internal magnet within the tubular body member. The tubular body member and the one or more adjustable members form a ring shape. The internal magnet is configured to rotate in response to a rotating external magnetic field. The internal magnet is coupled to the one or more adjustable members to change a dimension of the ring shape as the internal magnet rotates. A system for treating a heart valve may include an external adjustment device having one or more external magnets to generate the rotating external magnetic field.

Abstract: A method is provided that includes implanting (a) a venous first tissue anchor in a vein selected from the group of veins consisting of: a superior vena cava and an inferior vena cava, (b) an atrial second tissue anchor at an atrial site selected from the group of sites consisting of: an annulus of a tricuspid valve, and a wall of a right atrium of a heart above the annulus of the tricuspid valve, (c) a venous third tissue anchor in a coronary sinus, and (d) one or more tethers, which connect the venous first tissue anchor, the atrial second tissue anchor, and the venous third tissue anchor. A size of a tricuspid orifice is reduced by tensioning the one or more tethers. Other embodiments are also described.

Abstract: A device is in various embodiments configured to repair a native heart valve or to secure a prosthetic heart valve within a native valve of the heart of a patient. Embodiments of the device include at least an upper coil and a lower coil, where the device is configured to assume an axially expanded state where the entire upper coil is positioned on a first side of the lower coil relative to the central axis, and an axially compressed state where at least a portion of the upper coil is positioned on a second side of at least a portion of the lower coil opposite to the first side relative to the central axis.

Abstract: A method is provided that includes implanting (a) a first venous tissue anchor in a superior vena cava, an inferior vena cava, or a coronary sinus, (b) exactly two atrial tissue anchors, which consist of second and third atrial tissue anchors, at respective different atrial sites, each of which sites is selected from: an annulus of a tricuspid valve, and a wall of a right atrium of a heart above the annulus, and (c) a pulley system, which includes (i) a pulley, which is connected to the second atrial tissue anchor, and (ii) a tether, which (A) is connected to the first venous tissue anchor and the third atrial tissue anchor, (B) is moveable through the pulley, and (C) has a length, measured between the first venous and the third atrial tissue anchors, of at least 30 mm. A size of a tricuspid orifice is reduced by tensioning the tether.

Abstract: The present teachings provide devices and methods of treating a tricuspid valve regurgitation. Specifically, one aspect of the present teachings provides devices and methods of identifying a suitable location on the tricuspid annulus, placing a wire across the tricuspid annulus at such an identified location, deploying a tissue anchor across such an identified location, deploying two or more tissue anchors and coupling the tissue anchors with a flexible tensioning member, and applying tension to a flexible tensioning member that is coupled with the two or more tissue anchors, plicating tissues between each pair of the two or more tissue anchors, and reducing the circumference of the tricuspid annuls. As a result, a regurgitation jet is reduced or eliminated.

Abstract: Devices and methods are described for treating a mitral valve defect. The device described includes features that allow the device to conform to the actual pathology of the valve, rather than attempting to replicate a healthy valve (which the patient does not have). In this way, the device allows the patient's actual value to work as well as possible, given the valve's diseased condition. The actual pathology of the valve is accommodated by providing for multiple dimensions of adjustability of the device, including adjustability of the size (e.g., diameter) of the device as well as adjustability of the elevation or inclination of one portion of the device (e.g., the portion supporting the posterior leaflet) with respect to another portion of the device.

Abstract: Disclosed here are devices and methods for treating functional tricuspid valve regurgitation and related conditions. Disclosed devices are adapted for applying force to an area of a patient's heart along or near the atrioventricular groove, and can include a tensioning element configured to be delivered by a flexible member guided through a catheter and positioned generally along or near the atrioventricular groove, and a compression member positionable along the tensioning element and over a desired segment of the atrioventricular groove to develop force to be applied to an adjacent area of the heart by selective tensioning of the tensioning element.

Abstract: The device is intended to be positioned in a sealed introducer arranged in the thoracic cavity between two ribs in order to penetrate into the left ventricle, passing through the apex of the heart. According to the invention, the device includes a body having a handle and at least one control member capable of acting on an assembly for installing and securing a braid to the mitral annulus by means of suturing elements, the assembly has a mechanism capable of enabling the extraction of a suture through the mitral valve while also being capable of enclosing the braid and becoming anchored to the periphery of the mitral annulus under the clamping effect of the suture, exerting two opposing pressure-bearing forces.

Abstract: One embodiment is directed to a system for closing a wound created across a portion of a tissue structure, comprising a suture member having proximal and distal ends; an anchor member coupled to the distal end of the suture member; a tension retainer assembly releasably coupleable to the suture member; and a suture buttress movably intercoupled to the suture member between the anchor member and the tension retainer and configured to minimize direct sliding contact between the suture member and the tissue structure portion around the location of the suture buttress.

Abstract: Apparatus includes an annuloplasty structure, including: (i) a tubular body portion that is configured to be disposed at an annulus of a valve of a heart, and is shaped to define a perimeter; (ii) a flexible member, disposed within the tubular body portion; (iii) a first adjustment mechanism, attached to the tubular body portion and to the flexible member such that reversible actuation of the first adjustment mechanism reversibly adjusts a first dimension of the body portion by adjusting tension of the flexible member; (iv) a second adjustment mechanism, coupled to the tubular body portion, and reversibly actuatable to reversibly adjust a second dimension of the body portion. The apparatus further includes one or more elongate tools, reversibly couplable to the first and second adjustment mechanisms, and configured to independently actuate the first and second adjustment mechanisms by applying force thereto while the heart is beating.

Abstract: An epicardial clip for reshaping the annulus of the mitral valve of a heart. The epicardial clip includes a curved member having an anterior segment configured to be positioned in the transverse sinus of the heart, a posterior segment configured to be positioned on the posterior side of the heart, such as on or inferior to the atrioventricular groove, and a lateral segment extending between the anterior segment and the posterior segment. The lateral segment includes a curve such that the first end of the member is positioned at or above the plane of the mitral valve and the second end of the member is positioned at or below the plane of the mitral valve.

Abstract: A method and apparatus for securing soft tissue to bone can include forming a bore in the bone and carrying a flexible suture anchor into the bore. The flexible anchor can include a passage and can be coupled to a suture construct. The suture construct can include at least one self-locking adjustable loop, and the flexible anchor can include a first profile while being carried into the bore. A shape of the flexible anchor can be changed from the first profile to a second profile forming an anchoring mass to retain the flexible anchor in the bore. Tension can be applied to a portion of the suture construct to reduce a size of the self-locking adjustable loop and secure the soft tissue relative to the flexible anchor and the bone.

Abstract: The invention is a cardiac implant, and associated methods therefore, configured to repair and/or replace a native heart valve, and having a support frame configured to be reshaped into an expanded/changed form in order to receive and/or support an expandable prosthetic heart valve therein. The implant may be configured to have a generally rigid and/or expansion-resistant configuration when initially implanted to replace/repair a native valve (or other prosthetic heart valve), but to assume a generally non-rigid and/or expanded/expandable form when subjected to an outward force such as that provided by a dilation balloon. The implant may be configured to have a generally D-shaped configuration when initially implanted, but to assume a generally circular form when subjected to an outward force such as that provided by a dilation balloon.

Abstract: Apparatus is provided that includes an annuloplasty system for use on a subject. The system includes an annuloplasty ring, which includes a sleeve having a lumen, and at least one anchor, shaped so as to define a coupling head and a tissue coupling element, which tissue coupling element is shaped so as to define a longitudinal axis, and is configured to penetrate cardiac tissue of the subject in a direction parallel to the longitudinal axis. The system further includes an anchor deployment manipulator, configured to be removably positioned within the lumen of the sleeve, and, while so positioned, to deploy the tissue coupling element from a distal end of the deployment manipulator through a wall of the sleeve into the cardiac tissue in the direction parallel to the longitudinal axis of the tissue coupling element and parallel to a central longitudinal axis through the distal end of the deployment manipulator.

Abstract: Sealable and repositionable implant devices are provided with features that increase the ability of implants such as endovascular grafts and valves to be precisely deployed or re-deployed, with better in situ accommodation to the local anatomy of the targeted recipient anatomic site, and/or with the ability for post-deployment adjustment to accommodate anatomic changes that might compromise the efficacy of the implant. A surgical implant includes an implant body and a selectively adjustable assembly attached to the implant body, the assembly having adjustable elements and being operable to cause a configuration change in a portion of the implant body and, thereby, permit implantation of the implant body within an anatomic orifice to effect a seal therein under normal physiological conditions.

Abstract: A method is provided for treating mitral valve regurgitation, including inserting a band around between 90 and 270 degrees of a mitral valve of a heart, including around at least a portion of a posterior cusp of the valve, in a space defined by (a) a ventricular wall, (b) a ventricular surface of the posterior cusp in a vicinity of an annulus of the valve, and (c) a plurality of chordae tendineae of one or more types of chordae tendineae selected from the group consisting of: second-order chordae tendineae and third-order chordae tendineae. The method also includes applying pressure to the posterior cusp by inflating the band.

Abstract: A method for reducing regurgitation in a mitral valve using a blood flow controlling apparatus. The blood flow controlling apparatus comprises a leaflet coaptation member, a connecting member, and an anchor suitable for anchoring the apparatus to the interventricular septum. The leaflet coaptation member coapts with the native mitral valve leaflets during systole when disposed therebetween, thereby reducing mitral valve regurgitation. During diastole, the native leaflets release coaptation with the leaflet coaptation member, permitting blood flow from the left atrium into the left ventricle.

Abstract: Prosthetic mitral valves and their methods of manufacture and use.

Abstract: An implantable device is provided for controlling at least one of shape and size of an anatomical structure or lumen. An implantable device has an adjustable member configured to adjust the dimensions of the implantable device. An adjustment tool is configured to actuate the adjustable member and provide for adjustment before, during and after the anatomical structure or lumen resumes near normal to normal physiologic function.

Abstract: Apparatus is provided that includes an implant structure, which includes a contracting mechanism, which includes a rotatable structure, arranged such that rotation of the rotatable structure contracts the implant structure. A longitudinal member is coupled to the contracting mechanism. A tool for rotating the rotatable structure is configured to be guided along the longitudinal member, to engage the rotatable structure, and to rotate the rotatable structure in response to a rotational force applied to the tool. Other embodiments are also described.

Abstract: The present disclosure relates to an arrangement, a loop-shaped support, a prosthetic heart valve and a method of repairing or replacing a native heart valve. With the method or the arrangement, leakage or regurgitation between a prosthetic heart valve and the surrounding valve tissue is prevented. In one embodiment, an arrangement for replacement or repair of a native heart valve is provided, which comprises a loop-shaped support (41) and a prosthetic heart valve (70) and wherein an outer segment (32) of the loop-shaped support (41) is positionable towards surrounding valve tissue of a native heart valve and wherein an outer surface (74) of the prosthetic heart valve (70) is positionable towards an inner segment (34) of the loop-shaped support (41) so as to prevent paravalvular leakage or regurgitation between the prosthetic heart valve (70) and the surrounding valve tissue of the native heart valve.

Abstract: In one embodiment of the present invention, a fixation device including a sleeve member including an interior and an exterior surface along a length defined between a first end and a second end, and at least two openings positioned along the length and extending from the interior and through the exterior surface; and a filament including a first free end and a second free end and a length therebetween, the filament positioned relative to the sleeve member such that the free ends extend from the sleeve member at the first and second ends of the sleeve member, the filament being disposed inside the interior from the first end to a first opening, outside the sleeve member from the first opening to a second opening, and inside the interior from the second opening to the second end of the sleeve member.

Abstract: Prosthetic mitral valves and their methods of manufacture and use.

Abstract: The invention includes methods of and apparatus for endovascularly replacing a heart valve of a patient. One aspect of the invention provides a method including the steps of endovascularly delivering a replacement valve and an expandable anchor to a vicinity of the heart valve in an unexpanded configuration; and applying an external non-hydraulically expanding or non-pneumatically expanding actuation force on the anchor to change the shape of the anchor, such as by applying proximally and/or distally directed force on the anchor using a releasable deployment tool to expand and contract the anchor or parts of the anchor. Another aspect of the invention provides an apparatus including a replacement valve; an anchor; and a deployment tool comprising a plurality of anchor actuation elements adapted to apply a non-hydraulically expanding or non-pneumatically expanding actuation force on the anchor to reshape the anchor.

Abstract: The invention is a prosthetic heart valve, and associated methods therefore, configured to replace a native heart valve, and having a support frame configured to be reshaped into an expanded form in order to receive and/or support an expandable prosthetic heart valve therein. The prosthetic heart valve may be configured to have a generally rigid and/or expansion-resistant configuration when initially implanted to replace a native valve (or other prosthetic heart valve), but to assume a generally non-rigid and/or expanded/expandable form when subjected to an outward force such as that provided by a dilation balloon.

Abstract: An apparatus for delivering an implanted structure to a desired target site within a body lumen of a patient includes a catheter having a longitudinally extending catheter lumen and adapted to provide access to the body lumen. A framing member has a collapsed condition in which the framing member is adapted for insertion into the body lumen through the catheter lumen and an expanded condition in which the framing member is adapted for placement within the body lumen. At least one target point is carried by the framing member and is adapted for placement adjacent the desired target site. A holding mechanism is carried by the framing member and is adapted to releasably grasp the implanted structure. At least one target pathway is attached to at least one target point. At least a portion of the target pathway extends through the catheter lumen.

Abstract: Methods and devices for treating obesity are provided, and more particularly, methods and devices for performing gastric bypasses are disclosed. In one exemplary embodiment a gastric bypass procedure is provided that includes forming a gastro-entero anastomosis between a stomach and an intestine and forming an entero-entero anastomosis between a portion of the intestine distal to the gastro-entero anastomosis and a portion of the intestine proximal to the gastro-entero anastomosis. A surrogate path is formed between the esophagus and the gastro-entero anastomosis to at least partially direct fluid from the esophagus to the intestine by way of the gastro-entero anastomosis, thereby bypassing the stomach. A variety of devices that are particularly useful in gastric bypass procedures are also disclosed. The devices include anastomotic devices that can be coupled to or integrally formed with a shunt. The devices can include a plurality of tubular bodies that are configured to have an adjustable length.

Abstract: Tissue restraining systems and devices as well as methods of using these devices are disclosed herein. According to aspects illustrated herein, there is provided a tissue restraining device that may include a first anchor having one or more contact points along a portion of the first anchor in a spaced relation to one another. The tissue restraining device may also include a second anchor for placement in a substantially opposing relation to the first anchor. A restraining matrix may extend from the contact points of the first anchor to the second anchor.

Abstract: An annuloplasty ring is secured around an annulus of a heart valve of a subject by securing an anterior-configured portion of the annuloplasty ring, a posterior-configured portion of the annuloplasty ring, a first commissural portion of the annuloplasty ring, and a second commissural portion of the annuloplasty ring, to respective portion of the annulus. Subsequently, and while the heart is beating, the first commissural portion of the annuloplasty ring is moved inferiorly downwardly with respect to another portion of the annuloplasty ring by rotating a respective first adjusting mechanism of the annuloplasty ring structure, and the second commissural portion of the annuloplasty ring is moved inferiorly downwardly with respect to the other portion of the annuloplasty by rotating a respective second adjusting mechanism of the annuloplasty ring structure. Other embodiments are also described.

Abstract: A method of minimally invasively replacing a cardiac valve of a patient including inserting a delivery catheter intraluminally, inserting a valve resecting instrument intraluminally through the delivery catheter to a position adjacent the cardiac valve of a patient, manipulating the valve resecting instrument to resect the cardiac valve, removing the resected valve through the delivery catheter, and providing a delivery instrument having a replacement valve contained therein. The delivery instrument is advanced into the delivery catheter and intraluminally so that a distal end portion of the instrument is adjacent an annulus of a patient, and a first portion of the valve is exposed from the delivery instrument to position it on a first side of the annulus, and thereafter a second portion of the valve is exposed to position it on a second side of the annulus.