Methods and devices for termination

Abstract

Devices and methods used in termination of a tissue tightening procedure are described. Termination includes the cinching of a tether to tighten the tissue, locking the tether to maintain tension, and cutting excess tether. In procedures involving anchors secured to the tissue, the tether is coupled to the anchors and the tissue is tightened via tension applied to the anchors by cinching the tether. In general, the devices and methods can be used in minimally invasive surgical procedures, and can be applied through small incisions or intravascularly. A method for tightening tissue by fixedly coupling a first anchor to a tether and slidably coupling a second anchor to the tether, securing both anchors to the tissue, applying tension to the tether intravascularly, fixedly coupling the tether to the second anchor, and cutting the tether is described. The tissue to be tightened can comprise heart tissue, in particular heart valve annulus tissue. Various devices and methods for locking the tether in place and cutting excess tether are described.

1 . A termination device for locking an implantable and cinchable tether, the termination device comprising: 
 an elongate body; and    a locking feature releasably attached to the distal end of the elongate body, the locking feature configured to couple to the tether; the locking feature having an unsecured state, wherein the tether may move with respect to the locking feature, and a secured state, wherein the tether is secured by the locking feature.    
   
   
       2 . The termination device of  claim 1 , further comprising a tether cutter.  
   
   
       3 . The termination device of  claim 2 , wherein the tether cutter is located distally to the locking feature.  
   
   
       4 . The termination device of  claim 2 , wherein the tether cutter comprises a cutting tube within the elongate body.  
   
   
       5 . The termination device of  claim 1 , wherein the elongate body is configured as a catheter.  
   
   
       6 . The termination device of  claim 1 , further comprising a force applicator for releasing the locking feature from the rest of the termination device.  
   
   
       7 . The termination device of  claim 6 , wherein the force applicator comprises a push rod extending longitudinally within the elongate body of the termination device.  
   
   
       8 . The termination device of  claim 1 , further comprising a releasable attachment region between the locking feature and the elongate body.  
   
   
       9 . The termination device of  claim 8 , wherein the releasable attachment region comprises a frangible region.  
   
   
       10 . The termination device of  claim 1 , further configured to separate the locking feature from the elongate body when a force of greater than about  2  lbs is applied to the locking feature.  
   
   
       11 . The termination device of  claim 8 , wherein the releasable attachment region comprises a perforated region.  
   
   
       12 . The termination device of  claim 1 , wherein the locking feature comprises a different material than the elongate body.  
   
   
       13 . The termination device of  claim 1 , wherein the locking feature comprises a clamp.  
   
   
       14 . The termination device of  claim 1 , wherein the locking feature comprises a plug configured compress the tether against a wall of the locking feature in the secured state.  
   
   
       15 . The termination device of  claim 1 , wherein the locking feature comprises a plug configured to fix the tether in a tight winding path within the locking feature in the secured state.  
   
   
       16 . A termination device comprising: 
 an elongate body;    a locking feature releasably attached to the distal end of the elongate body, the locking feature configured to couple to the tether; and    a tether cutter coupled to the elongate body, wherein the tether cutter may be activated to cut the tether.    
   
   
       17 . A method of securing a cinchable tether comprising: 
 coupling the tether to a termination device, wherein the termination device comprises: 
 an elongate body; and  
 a locking feature releasably attached to the distal end of the elongate body, the locking feature configured to couple to the tether;  
   cinching the tether; and    securing the tether with the locking feature.    
   
   
       18 . The method of  claim 17 , further comprising cutting the tether.  
   
   
       19 . The method of  claim 17 , further comprising separating the locking feature from the elongate body.  
   
   
       20 . The method of  claim 19 , wherein the step of separating the locking feature from the elongate body comprises: applying force to separate the locking feature from the elongate body.  
   
   
       21 . The method of  claim 20 , wherein the step of applying force comprises pushing a push rod located at least partly within the elongate body.