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 mitral valve annular tissue, comprising:
 attaching first, second and third annular tissue fasteners to mitral valve annular tissue, wherein the first, second and third annular tissue fasteners are pre-coupled to a plurality of slidably coupled tether segments;   applying a tensile force to the plurality of tether segments;   shortening a distance between the first and second annular tissue fasteners and a distance between the second and third annular tissue fasteners; and   locking the plurality of tether segments in a tensioned state.   
     
     
         80 . The method of  claim 79 , wherein the tether assembly comprises two tether segments forming a distal loop and each tether segment is coupled to each annular tissue fastener. 
     
     
         81 . The method of  claim 80 , wherein each tether segment is slidably coupled to a separate eyelet on each annular tissue fastener. 
     
     
         82 . The method of  claim 79 , wherein at least a portion of the plurality of tether segments has a parallel tether segment configuration. 
     
     
         83 . The method of  claim 79 , wherein locking the plurality of tether segments comprises crimping the plurality of tether segments using a crimp member. 
     
     
         84 . The method of  claim 83 , wherein a portion of the third annular tissue fastener is crimped to at least one tether segment. 
     
     
         85 . The method of  claim 79 , further comprising attaching a fourth tissue fastener to the mitral valve annular tissue, wherein the fourth tissue fastener is pre-coupled to the plurality of slidably coupled tether segments. 
     
     
         86 . The method of  claim 79 , further comprising penetrating through an atrial surface of the mitral valve annular tissue with at least one annular tissue fastener. 
     
     
         87 . The method of  claim 79 , further comprising penetrating through a ventricular surface of the mitral valve annular tissue with at least one annular tissue fastener. 
     
     
         88 . The method of  claim 87 , further comprising penetrating through an atrial surface of the mitral valve annular tissue with at least one annular tissue fastener. 
     
     
         89 . The method of  claim 79 , further comprising inserting the first, second and third annular tissue fasteners 
     
     
         90 . The method of  claim 79 , wherein at least one annular tissue fastener comprises a clip. 
     
     
         91 . The method of  claim 79 , wherein at least one annular tissue fastener comprises a T-shaped configuration. 
     
     
         92 . The method of  claim 79 , further comprising inserting a stabilizing element into the coronary sinus. 
     
     
         93 . The method of  claim 79 , further comprising cutting the plurality of tether segments. 
     
     
         94 . The method of  claim 83 , further comprising cutting the plurality of tether segments with a crimping and cutting device. 
     
     
         95 . The method of  claim 79 , wherein applying a tensile force to the plurality of tether segments comprises generating a generally inward directed force towards the center of the mitral valve.