Devices and methods for heart valve repair

Abstract

Methods and devices provide constriction of a heart valve annulus to treat cardiac valve regurgitation and other conditions. Embodiments typically include a device for attaching a cinching or tightening apparatus to a heart valve annulus to reduce the circumference of the annulus, thus reducing valve regurgitation. Tightening devices may include multiple tethered clips, multiple untethered crimping clips, stabilizing devices, visualization devices, and the like. In one embodiment, a plurality of tethered clips is secured circumferentially to a valve annulus, and the tether coupling the clips is cinched to reduce the circumference of at least a portion of the annulus. Methods and devices may be used in open heart surgical procedures, minimally invasive procedures, catheter-based procedures, and/or procedures on beating hearts or stopped hearts.

1 - 78 . (canceled)  
     
     
         79 . A method of tightening tissue comprising: 
 attaching a plurality of clips comprising a first clip, an intermediate clip and a terminal clip to the tissue, wherein the clips are coupled to a tether before attaching to the tissue;    shortening the length of the tether between the clips;    securing a proximal end of the tether to the terminal clip.    
     
     
         80 . The method of  claim 79 , wherein shortening the length of the tether between the clips comprises cinching the tether by drawing the tether in the proximal direction through an eyelet of at least the intermediate clip and the terminal clip.  
     
     
         81 . The method of  claim 80 , wherein cinching comprises applying tensile force to the tether.  
     
     
         82 . The method of  claim 81 , wherein applying tensile force comprises pulling the tether proximally through an applicator which has introduced the terminal clip  
     
     
         83 . The method of  claim 79 , wherein attaching a plurality of clips comprises attaching the first clip to the tissue wherein the first clip is secured near the distal end of the tether.  
     
     
         84 . The method of  claim 79 , wherein the individual clips are secured successively to the tissue.  
     
     
         85 . The method of  claim 79 , further comprising coupling individual clips to the tether immediately before attaching the individual clip to the tissue.  
     
     
         86 . The method of  claim 79 , wherein the individual clips are simultaneously secured to the tissue.  
     
     
         87 . The method of  claim 79 , wherein securing a proximal end of the tether to the terminal clip comprises deforming the terminal clip so that the terminal clip becomes fixed to the tether.  
     
     
         88 . The method of  claim 79 , wherein securing a proximal end of the tether to the terminal clip comprises attaching a clamping device to the proximal end of the tether.  
     
     
         89 . The method of  claim 79 , further comprising visualizing the tissue.  
     
     
         90 . The method of  claim 89 , wherein visualizing is performed using a visualization device comprising at least one of an ultrasound device, an angioscopic device, a transesophageal echocardiogram device and a fluoroscopic device  
     
     
         91 . The method of  claim 89 , wherein visualization is performed using an ultrasound device comprising a gel-containing cone for enhancing ultrasound visualization.  
     
     
         92 . The method of  claim 89 , further comprising determining the amount to shorten the length of the tether between the clips based on the visualization of the tissue.  
     
     
         93 . The method of  claim 79 , wherein the attaching and shortening steps are performed as part of a minimally invasive surgery.  
     
     
         94 . The method of  claim 79 , wherein the attaching and shortening steps are performed intravascularly.  
     
     
         95 . A method of cinching an annulus comprising: 
 attaching a plurality of clips comprising a first clip, an intermediate clip and a terminal clip spaced at least partly around the annulus, wherein the clips are coupled to a tether before attaching;    cinching by shortening the length of the tether between the clips;    securing a proximal end of the tether to the terminal clip.    
     
     
         96 . The method of  claim 95 , wherein the cinching comprises applying tensile force to the tether.  
     
     
         97 . The method of  claim 96 , wherein applying tensile force comprises pulling the tether proximally through an applicator which has introduced the terminal clip.  
     
     
         98 . The method of  claim 95 , wherein securing a proximal end of the tether to the terminal clip comprises attaching a clamping device to the proximal end of the tether.  
     
     
         99 . A method for constricting a valve annulus in a beating heart, said method comprising: 
 viewing at least a portion of the annulus;    securing individual clips at circumferentially spaced-apart locations about at least a portion of the annulus while viewing; and    cinching a tether through the clips to circumferentially tighten the annulus.    
     
     
         100 . A method as in  claim 97 , wherein the method is performed intravascularly.