Transvalvular intraannular band for aortic valve repair

Abstract

Aortic regurgitation can be treating by implanting in the aortic annulus a transvalvular intraannular band. The band has 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 is positioned so that it extends transversely across a coaptive edge formed by the closure of the aortic valve leaflets. The band may be implanted via translumenal access or via thoracotomy.

1 . A transvalvular 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 transversely from a plane which includes the first end and the second end;   wherein the first end and the second end are configured to be attached to the aortic valve annulus within the plane of the annulus and the central portion is configured to support the aortic valve leaflets at a point displaced toward the ventricle from the plane.   
   
   
       2 . The transvalvular band of  claim 1 , wherein the central portion is narrower than both the first anchoring portion and the second anchoring portion. 
   
   
       3 . The transvalvular band of  claim 1 , wherein the central portion comprises an offset support portion and a first arm portion and a second arm portion, the offset support portion wider than the first arm portion and second arm portion. 
   
   
       4 . The transvalvular band of  claim 1 , wherein the central portion has a substantially triangular cross-section. 
   
   
       5 . A method of treating aortic regurgitation, the method comprising:
 implanting in the aortic annulus a transvalvular band comprising an elongate and arcuate body having a first end, a first anchoring portion located proximate the first end, a second end, and a central portion, the central portion displaced out of the plane containing the first end and the second end; and   attaching the first anchoring portion to one portion of the aortic annulus.   
   
   
       6 . The method of  claim 5 , wherein the band is configured to transversely span a distance of less than about 70% of the diameter of the aortic annulus. 
   
   
       7 . The method of  claim 5 , wherein the band further comprises a second anchoring portion located proximate the second end. 
   
   
       8 . The method of  claim 7 , further comprising:
 attaching the second anchoring portion to another portion of the aortic annulus such that the transvalvular band extends transversely across a coaptive edge formed by the closure of the aortic valve leaflets and the central portion is displaced towards the left ventricle relative to the first anchoring portion and the second anchoring portion.   
   
   
       9 . A method of treating an aortic 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.   
   
   
       10 . A method of treating an aortic valve as in  claim 9 , 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. 
   
   
       11 . A method of treating an aortic valve as in  claim 9 , further comprising the step of securing a portion of the first and second leaflets to the projection. 
   
   
       12 . A method of moving aortic valve leaflet coaption to an earlier point in the cardiac cycle, comprising the steps of:
 providing an intraannular, transvalvular band dimensioned for attachment within the plane of the aortic 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.   
   
   
       13 . A method of moving aortic valve leaflet coaption as in  claim 12 , wherein the elevate the position step comprises elevating the position of the coaptive edges by at least about 4 mm. 
   
   
       14 . A method of moving aortic valve leaflet coaption as in  claim 12 , 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. 
   
   
       15 . A method of treating aortic regurgitation, comprising:
 delivering a first tissue anchor to a first location along the wall of an aortic interleaflet triangle;   delivering a second tissue anchor to a second location along the wall of the aortic interleaflet triangle, the second tissue anchor operably connected to the first tissue anchor; and   reducing the distance from the first location to the second location to improve aortic leaflet coaptivity during diastole.   
   
   
       16 . The method of  claim 15 , wherein the first tissue anchor and the second tissue anchor are operably connected via a tether. 
   
   
       17 . The method of  claim 16 , wherein reducing the distance from the first location to the second location comprises applying tension to the tether. 
   
   
       18 . The method of  claim 17 , wherein tension is applied using a cinching mechanism.