Leaflet suturing

Abstract

The methods, devices, and systems are provided for performing endovascular repair of atrioventricular and other cardiac valves in the heart. Regurgitation of an atrioventricular valve, particularly a mitral valve, can be repaired by modifying a tissue structure selected from the valve leaflets, the valve annulus, the valve chordae, and the papillary muscles. These structures may be modified by suturing, stapling, snaring, or shortening, using interventional tools which are introduced to a heart chamber. Preferably, the tissue structures will be temporarily modified prior to permanent modification. For example, opposed valve leaflets may be temporarily grasped and held into position prior to permanent attachment.

1 . A method for suturing valve leaflets in a patient's heart, said method comprising:
 providing a suturing device, the suturing device comprising an inner elongate shaft, an outer elongate shaft having a circumference and slidably disposed over the inner elongate shaft, a pair of tissue penetrating needles adjacent a distal end of the suturing device, and a length of suture operably coupled to the inner elongate shaft, wherein the length of suture comprises a first and a second free end;   slidably advancing the suturing device through the patient's vasculature into the heart;   capturing a first cardiac valve leaflet and a second cardiac valve leaflet with the suturing device;   advancing the pair of needles in a first direction so that a first needle of the pair pierces the first valve leaflet and the second needle of the pair pierces the second valve leaflet, wherein the pair of needles remain within the circumference of the outer shaft during the advancement in the first direction;   pulling the first free end of the suture through the first valve leaflet, and pulling the second free end of the suture through the second valve leaflet, wherein the pair of needles remain within the circumference of the outer shaft while the first and the second free ends are pulled; and   fastening the free ends of the length of suture together thereby holding the valve leaflets into apposition with one another and reducing regurgitation across the valve.   
   
   
       2 . The method of  claim 1 , wherein the pair of needles are releasably coupled to a distal portion of the inner shaft. 
   
   
       3 . The method of  claim 1 , wherein the first and the second valve leaflets are captured while the patient's heart remains beating. 
   
   
       4 . The method of  claim 1 , wherein the capturing step comprises capturing the first valve leaflet in a first leaflet receptacle and capturing the second valve leaflet in a second leaflet receptacle, both first and second receptacles disposed near a distal end of the suturing device. 
   
   
       5 . The method of  claim 1 , wherein the advancing step comprises linearly advancing the needles. 
   
   
       6 . The method of  claim 1 , wherein the advancing step comprises slidably advancing the needles through the valve leaflets. 
   
   
       7 . The method of  claim 1 , wherein the advancing step comprises proximally retracting the inner shaft relative to the outer shaft. 
   
   
       8 . The method of  claim 1 , wherein the first needle and the second needle are advanced simultaneously. 
   
   
       9 . The method of  claim 1 , wherein the pulling of the first and the second free ends comprises pulling the first and the second free ends proximally. 
   
   
       10 . The method of  claim 1 , wherein the pulling of the first and the second free ends comprises proximally retracting the pair of needles. 
   
   
       11 . The method of  claim 1 , wherein the pulling of the first and the second free ends comprises proximally retracting the outer shaft relative to the inner shaft. 
   
   
       12 . The method of  claim 1 , further comprising releasing the pair of needles from the inner shaft. 
   
   
       13 . The method of  claim 1 , wherein the first free end and, the second free ends are pulled simultaneously. 
   
   
       14 . The method of  claim 1 , wherein the fastening step comprises tying the first end and the second end together so as to form a knot. 
   
   
       15 . The method of  claim 1 , wherein the fastening step comprises securing the first end to the second end with a mechanical fastener. 
   
   
       16 . The method of  claim 1 , wherein the advancing of the suturing device into the heart comprises advancing both the inner shaft and the outer shaft through the vasculature into the heart. 
   
   
       17 . The method of  claim 1 , wherein the first and the second valve leaflets comprises the leaflets of a mitral valve.