Methods, systems and devices for cardiac valve repair

Abstract

Disclosed are methods, systems, and devices for the endovascular repair of cardiac valves, particularly the atrioventricular valves which inhibit back flow of blood from a heart ventricle during contraction. The procedures described herein can be performed with interventional tools, guides and supporting catheters and other equipment introduced to the heart chambers from the patient's arterial or venous vasculature remote from the heart. The interventional tools and other equipment may be introduced percutaneously or may be introduced via a surgical cut down, and then advanced from the remote access site through the vasculature until they reach the heart.

1 . A valve leaflet support system, comprising:
 a delivery catheter configured for percutaneous delivery through a patient's vasculature to a mitral valve in the heart from a location remote from the heart;   a support member comprising a fluid-expandable bladder, the support member sized for intravascular delivery through the delivery catheter to the mitral valve; and   one or more anchoring elements integrated with at least a portion of the support member;   wherein the support member has a contact surface sized for placement adjacent to an inferior surface of a posterior mitral leaflet such that placement of the support member adjacent to the inferior surface of the posterior mitral leaflet facilitates functional coaptation between the posterior mitral leaflet and an anterior mitral leaflet to reduce backflow through a gap in the mitral valve.   
     
     
         2 . The system of  claim 1 , wherein the posterior mitral leaflet is restricted and the support member pushes the posterior mitral leaflet upwards. 
     
     
         3 . The system of  claim 1 , wherein the posterior mitral leaflet is fixed in a closed position. 
     
     
         4 . The system of  claim 3 , wherein the anterior mitral leaflet coapts against the fixed posterior mitral leaflet. 
     
     
         5 . The system of  claim 1 , wherein the support member comprises more than one fluid-expandable bladder. 
     
     
         6 . The system of  claim 1 , wherein the support member further comprises a stent. 
     
     
         7 . The system of  claim 1 , wherein the one or more anchoring elements attach to the inferior surface of the posterior mitral leaflet. 
     
     
         8 . The system of  claim 1 , wherein the one or more anchoring elements attach to a portion of the coronary sinus. 
     
     
         9 . The system of  claim 1 , wherein the one or more anchoring elements attach to a portion of a mitral valve annulus. 
     
     
         10 . The system of  claim 1 , wherein the one or more anchoring elements comprise a magnet. 
     
     
         11 . The system of  claim 1 , wherein the one or more anchoring elements comprise a first anchoring element having a first magnet and a second anchoring element having a second magnet, wherein the first and second magnets exert an attractive force relative to each other to anchor the support member to the inferior surface of the posterior mitral leaflet. 
     
     
         12 . A valve leaflet support system, comprising:
 a delivery catheter configured for percutaneous delivery through a patient's vasculature to a mitral valve in the heart from a location remote from the heart;   an expandable bladder sized for intravascular delivery through the delivery catheter to the mitral valve, the expandable bladder configured for fluid filling upon delivery to the mitral valve; and   one or more anchoring elements integrated with at least a portion of the expandable bladder;   wherein the expandable bladder has a contact surface sized for placement adjacent to an inferior surface of a posterior mitral leaflet such that placement of the expandable bladder adjacent to the inferior surface of the posterior mitral leaflet facilitates functional coaptation between the posterior mitral leaflet and an anterior mitral leaflet to reduce backflow through a gap in the mitral valve.   
     
     
         13 . The system of  claim 12 , wherein the one or more anchoring elements attach to the inferior surface of the posterior mitral leaflet. 
     
     
         14 . The system of  claim 12 , wherein the one or more anchoring elements attach to a portion of the coronary sinus. 
     
     
         15 . The system of  claim 12 , wherein the one or more anchoring elements attach to a portion of a mitral valve annulus. 
     
     
         16 . The system of  claim 12 , wherein the one or more anchoring elements comprise a magnet. 
     
     
         17 . The system of  claim 11 , wherein the one or more anchoring elements comprise a first anchoring element having a first magnet and a second anchoring element having a second magnet, wherein the first and second magnets exert an attractive force relative to each other to anchor the expandable member to the inferior surface of the posterior mitral leaflet. 
     
     
         18 . A method of treating a heart, comprising:
 percutaneously accessing a patient's vasculature at a location remote from the heart;   advancing a delivery catheter through the vasculature to the heart;   delivering through the delivery catheter to the mitral valve in the heart a support member comprising one or more anchoring elements and a fluid-expandable bladder;   positioning the fluid-expandable bladder adjacent to an inferior surface of a posterior mitral leaflet;   expanding the fluid-expandable bladder such that it contacts the inferior surface of the posterior mitral leaflet;   attaching the support member to a location adjacent the mitral valve using the one or more anchoring elements; and   facilitating functional coaptation between the posterior mitral leaflet and an anterior mitral leaflet to reduce backflow through a gap in the mitral valve.   
     
     
         19 . The method of  claim 18 , further comprising pushing the posterior mitral leaflet upwards with the fluid-expandable bladder. 
     
     
         20 . The method of  claim 18 , wherein expanding the fluid-expandable bladder comprises fixing the posterior mitral leaflet in a closed position. 
     
     
         21 . The method of  claim 20 , wherein the anterior mitral leaflet coapts against the fixed posterior mitral leaflet. 
     
     
         22 . The method of  claim 18 , wherein the support member comprises more than one fluid-expandable bladder. 
     
     
         23 . The method of  claim 18 , wherein the support member further comprises a stent. 
     
     
         24 . The method of  claim 18 , wherein attaching the support member to a location adjacent the mitral valve comprises attaching the one or more anchoring elements to the inferior surface of the posterior mitral leaflet. 
     
     
         25 . The method of  claim 18 , wherein attaching the support member to a location adjacent the mitral valve comprises attaching the one or more anchoring elements to a portion of the coronary sinus. 
     
     
         26 . The method of  claim 18 , wherein attaching the support member to a location adjacent the mitral valve comprises attaching the one or more anchoring elements to a portion of a mitral valve annulus. 
     
     
         27 . The method of  claim 18 , wherein the one or more anchoring elements comprise a magnet. 
     
     
         28 . The method of  claim 18 , wherein the one or more anchoring elements comprise a first anchoring element having a first magnet and a second anchoring element having a second magnet, wherein the first and second magnets exert an attractive force relative to each other to anchor the support member to the inferior surface of the posterior mitral leaflet.