Heart valve repair system

Abstract

Techniques are described for use with one or more sutures. For some applications, techniques are described for fixedly-coupling two or more sutures to each other. For some applications, such techniques are used for treating a heart valve of a subject. Techniques are also described for treating a heart valve of a subject by coupling leaflets of the heart valve to a support using tissue-piercing elements. Other embodiments are also described.

1 . Apparatus for use with a heart valve of a patient, the heart valve including at least two leaflets, the apparatus comprising:
 a support, having a leaflet-engaging side, configured to be placed against a first side of the heart valve in a position in which the support overlaps more than one of the leaflets; and   a securing element, which comprises:
 a core; 
 two or more arms, an inner end of each arm being coupled to the core, and the arms extending radially outward from the core; and 
 a plurality of leaflet-piercing elements, coupled to respective outer ends of each arm, and deliverable to a second side of the heart valve of the patient, and configured to couple the support to the heart valve by (1) piercing the leaflets of the heart valve from the second side of the heart valve to the first side of the heart valve, and (2) coupling to the support while the support is in the position on the first side of the heart valve, wherein one of the first and the second sides of the heart valve is an upstream side of the heart valve, and the other of the first and the second sides of the heart valve is a downstream side of the heart valve. 
   
     
     
         2 . The apparatus according to  claim 1 , wherein the support is flat. 
     
     
         3 . The apparatus according to  claim 1 , wherein the support is generally circular. 
     
     
         4 . The apparatus according to  claim 1 , wherein the support has a delivery configuration in which the support is generally cylindrical, and a deployed configuration in which the support is generally flat. 
     
     
         5 . The apparatus according to  claim 1 , wherein the support comprises a braided wire mesh. 
     
     
         6 - 8 . (canceled) 
     
     
         9 . The apparatus according to  claim 99 , wherein the leaflet-piercing elements are configured to couple to the support by being configured to protrude into the support. 
     
     
         10 . The apparatus according to  claim 9 , wherein the leaflet-piercing elements are configured to couple to the support by being configured to protrude through the support. 
     
     
         11 - 12 . (canceled) 
     
     
         13 . The apparatus according to  claim 99 , further comprising a securing element, comprising:
 a core;   two or more arms, an inner end of each arm being coupled to the core, and the arms extending radially outward from the core; and   the leaflet-piercing elements, coupled to respective outer ends of each arm.   
     
     
         14 . The apparatus according to  claim 1 , wherein the securing element is transluminally deliverable to the second side of the heart valve independently of the support. 
     
     
         15 . The apparatus according to  claim 1 , wherein the apparatus is configured such that the leaflet-engaging elements are configured to be coupled to the support by the securing element being configured to be coupled to the support. 
     
     
         16 . The apparatus according to  claim 15 , wherein the apparatus is configured such that coupling the leaflet-engaging elements to the support while the support is in the position on the first side of the heart valve, sandwiches the leaflets of the heart valve between the support and the securing element. 
     
     
         17 . The apparatus according to  claim 1 , wherein the core defines a coupling portion, configured to couple the core to the support. 
     
     
         18 . The apparatus according to  claim 17 , wherein the apparatus is configured such that the coupling of the core to the support facilitates the coupling of the leaflet-piercing elements to the support. 
     
     
         19 . The apparatus according to  claim 17 , wherein the support defines an inner perimeter that defines an opening through the support, and wherein the coupling portion is configured to couple the core to the support, by being configured to secure at least part of the coupling portion within the opening. 
     
     
         20 . The apparatus according to  claim 17 , wherein the core is configured to extend between the leaflets of the heart valve, from the second side of the heart valve to the first side of the heart valve, such that the coupling portion is couplable to the support at the first side of the heart valve. 
     
     
         21 . The apparatus according to  claim 1 , wherein the securing element has a delivery configuration and a deployed configuration, and wherein the outer end of the arms are closer to each other in the delivery configuration than in the deployed configuration. 
     
     
         22 . The apparatus according to  claim 21 , wherein:
 the securing element is disposable within a sheath, and is removable from the sheath,   the delivery configuration defines a constrained configuration, the sheath being configured to constrain the securing element in the constrained delivery configuration,   the deployed configuration defines an unconstrained configuration, and   the securing element is configured to automatically move from the delivery configuration to the deployed configuration when the securing element is removed from the sheath.   
     
     
         23 - 95 . (canceled) 
     
     
         96 . The apparatus according to  claim 1 ,
 wherein the first side of the heart valve is the downstream side of the heart valve, and the second side of the heart valve is the upstream side of the heart valve, and   wherein the leaflet-engaging side of the support is configured to be placed against the downstream side of the heart.   
     
     
         97 . The apparatus according to  claim 1 ,
 wherein the first side of the heart valve is the upstream side of the heart valve, and the second side of the heart valve is the downstream side of the heart valve, and   wherein the leaflet-engaging side of the support is configured to be placed against the upstream side of the heart.   
     
     
         98 . The apparatus according to  claim 1 , further comprising:
 a delivery sheath, in which the leaflet-piercing elements are removably constrained in a delivery configuration; and   a catheter, distinct from the delivery sheath, in which the support is removably constrained in a compressed configuration.   
     
     
         99 . Apparatus for use with a heart valve of a patient, the heart valve including at least two leaflets, the apparatus comprising:
 a support, having a leaflet-engaging side, configured to be placed against a first side of the heart valve in a position in which the support overlaps more than one of the leaflets, wherein the support comprises a braided wire mesh; and   a plurality of leaflet-piercing elements, deliverable to a second side of the heart valve of the patient, and configured to couple the support to the heart valve by (1) piercing the leaflets of the heart valve from the second side of the heart valve to the first side of the heart valve, and (2) coupling to the support while the support is in the position on the first side of the heart valve, wherein one of the first and the second sides of the heart valve is an upstream side of the heart valve, and the other of the first and the second sides of the heart valve is a downstream side of the heart valve.   
     
     
         100 . The apparatus according to  claim 99 , wherein the support is flat. 
     
     
         101 . The apparatus according to  claim 99 , wherein the support is generally circular. 
     
     
         102 . The apparatus according to  claim 99 , further comprising a catheter, in which the support is removably constrained in a generally-cylindrical delivery configuration, wherein the support is configured, upon deployment from the catheter, to assume an uncompressed configuration in which the support is flat.