Transvalvular intraannular band and chordae cutting for ischemic and dilated cardiomyopathy

Abstract

Mitral valve prolapse and mitral regurgitation can be treating by implanting in the mitral annulus a transvalvular intraannular band. The band is positioned so that it extends transversely across a coaptive edge formed by the closure of the mitral valve leaflets, to inhibit prolapse into the left atrium. At least one marginal chordae is severed, to permit leaflet closure against the band.

1 . A method of treating mitral valve prolapse, the method comprising:
 implanting in the mitral annulus an intraannular band comprising an elongate and arcuate body having a first end, a first anchoring portion located proximate the first end, a second end, a second anchoring portion located proximate the second end, and a central portion, the central portion displaced out of the plane containing the first end and the second end;   attaching the first anchoring portion to one portion of the mitral annulus;   attaching the second anchoring portion to another portion of the mitral annulus such that the intraannular band extends transversely across a coaptive edge formed by the closure of the mitral valve leaflets and the central portion is displaced towards the left ventricle relative to the first anchoring portion and the second anchoring portion; and   severing at least one marginal chordae.   
   
   
       2 . A method of treating a mitral valve, comprising the steps of:
 providing a transvalvular band having a convex side and a projection extending from the convex side;   securing the band to a valve annulus such that the convex side extends across the plane of the annulus in the direction of the ventricle, and the projection extends in a downstream blood flow direction, so that a first leaflet closes against a first side of the projection and a second leaflet closes against a second side of the projection; and   severing at least one marginal chordae.   
   
   
       3 . A method of treating a mitral valve as in  claim 2 , wherein the securing step comprises securing a first end and a second end of the band within the plane of the annulus such that the convex side extends from the plane in the direction of the ventricle to cause early leaflet closure. 
   
   
       4 . A method of treating a mitral valve as in  claim 2 , further comprising the step of securing a portion of the first and second leaflets to the projection. 
   
   
       5 . A method of treating ischemic or dilated cardiomyopathy, comprising the steps of:
 providing an intraannular, transvalvular band dimensioned for attachment within the plane of the mitral valve annulus;   attaching the band within the plane of the annulus such that a portion of the band extends into the ventricular side of the plane to support the leaflets and elevate the position of the coaptive edges in the direction of the ventricle during valve closure and   manipulating at least one marginal chordae to permit leaflet coaption.   
   
   
       6 . A method as in  claim 5 , wherein the elevate the position step comprises elevating the position of the coaptive edges by at least about 4 mm. 
   
   
       7 . A method as in  claim 5 , wherein the elevate the position step comprises elevating the position of the coaptive edges by an amount within the range of from about 6 mm to about 12 mm. 
   
   
       8 . A method as in  claim 5 , wherein the manipulating step comprises severing at least one marginal chordae. 
   
   
       9 . A method as in  claim 8 , comprising severing at least two marginal chordae. 
   
   
       10 . A method as in  claim 5 , wherein the manipulating step is accomplished prior to the attaching step. 
   
   
       11 . A method as in  claim 5 , wherein the manipulating step is accomplished following the attaching step. 
   
   
       12 . A method as in  claim 5 , wherein the manipulating step is accomplished with a sharpened edge. 
   
   
       13 . A method as in  claim 5 , wherein the manipulating step comprises applying RF energy. 
   
   
       14 . A method of treating a patient, comprising the steps of deploying an implant to resist prolapse of a mitral valve leaflet into the left atrium, and cutting at least one marginal chordae. 
   
   
       15 . A system for treating a patient, comprising at least one catheter for accessing the heart; an implant for positioning in contact with at least one mitral valve leaflet, and a marginal chordae cutter.