Method and apparatus for catheter-based annuloplasty using local plications

Abstract

The present invention relates to a minimally invasive method of performing annuloplasty. According to one aspect of the present invention, a method for performing annuloplasty includes accessing a left ventricle of a heart to provide a discrete plication element to the left ventricle, and engaging the plication element to tissue near a mitral valve of the heart. Engaging the plication element includes causing the plication element to gather a portion of the tissue to create a plication. In one embodiment, accessing the left ventricle of the heart to provide the plication element includes accessing the left ventricle of the heart using a catheter arrangement.

1 . A method for performing annuloplasty, the method comprising:
 accessing a left ventricle of a heart to provide a plication element to the left ventricle; and   engaging the plication element to tissue near a mitral valve of the heart, wherein engaging the plication element includes causing the plication element to gather a portion of the tissue to create a plication.   
     
     
         2 . A method as recited in  claim 1  wherein accessing the left ventricle of the heart to provide the plication element includes accessing the left ventricle of the heart with a catheter arrangement. 
     
     
         3 . A method as recited in  claim 2  wherein accessing the left ventricle of the heart using the catheter arrangement includes inserting the catheter arrangement into the left ventricle between a plane defined by the mitral valve and a plane associated with papillary muscles of the heart. 
     
     
         4 . A method as recited in  claim 2  wherein engaging the plication element to tissue near the mitral valve includes:
 piercing the tissue using the plication element, wherein piercing the tissue using the plication element causes a first portion of the plication element to be positioned on an atrial side of the mitral valve and a second portion of the plication element to be positioned on a ventricular side of the mitral valve. 
 
     
     
         5 . A method as recited in  claim 4  wherein the catheter is configured to cause the first portion of the plication element to be positioned on the atrial side of the mitral valve. 
     
     
         6 . A method as recited in  claim 1  wherein the plication element includes a first bar element and a second bar element, the first bar element and the second bar element being coupled to a thread, the thread further being coupled to a locking mechanism, and wherein engaging the plication element to tissue near the mitral valve includes:
 inserting the first bar element and the second bar element through the tissue to an atrial side of the mitral valve; and 
 positioning the locking mechanism against the tissue on a ventricular side of the mitral valve, wherein positioning the locking mechanism against the tissue causes the plication to be formed substantially between the first bar element, the second bar element, and the locking mechanism. 
 
     
     
         7 . A method as recited in  claim 6  wherein the locking mechanism includes a pledget. 
     
     
         8 . A method as recited in  claim 6  wherein the locking mechanism includes a spring element, the spring element being arranged to cause the locking mechanism to engage, wherein when the locking mechanism engages, the first bar element and the second bar element are brought into contact with the tissue. 
     
     
         9 . A method as recited in  claim 6  wherein accessing the left ventricle of the heart to provide the plication element includes accessing the left ventricle of the heart using a catheter arrangement, the catheter arrangement being configured to introduce the first bar element and the second bar element through the tissue to an atrial side of the mitral valve and to position the locking mechanism against the tissue on the ventricular side of the mitral valve. 
     
     
         10 . A method as recited in  claim 1  wherein engaging the plication element to tissue near the mitral valve to cause the plication element to gather the portion of the tissue to create the plication includes gathering the portion of the tissue on a ventricular side of the mitral valve 
     
     
         11 . A method as recited in  claim 1  wherein the plication element is one selected from the group consisting of a suture structure and a clip. 
     
     
         12 . A method for performing an annuloplasty, comprising:
 accessing tissue located near the mitral valve of a heart; and   creating a first discrete plication in the tissue using a first plication element, the first discrete plication being positioned to cause an arc length of the mitral valve to be reduced.   
     
     
         13 . A method as recited in  claim 12  wherein accessing the tissue includes accessing the tissue through a left ventricle of the heart. 
     
     
         14 . A method as recited in  claim 13  wherein the tissue is accessed through the left ventricle of the heart using a catheter. 
     
     
         15 . A method as recited in  claim 14  further including providing the first plication element through the catheter. 
     
     
         16 . A method as recited in  claim 15  wherein the catheter is configured to cause the first plication element to create the first discrete plication. 
     
     
         17 . A method as recited in  claim 15  wherein creating the first discrete plication in the tissue using the first plication element includes creating the first discrete plication in the tissue using the first plication element and the catheter. 
     
     
         18 . A method as recited in  claim 17  wherein the first plication element is a clip element, and creating the first discrete plication in the tissue using the first plication element and the catheter includes engaging the tissue using the clip element. 
     
     
         19 . A method as recited in  claim 17  wherein the first plication element is a locking element, the locking element including a first piece and a second piece, and creating the first discrete plication in the tissue using the first plication element and the catheter includes:
 penetrating the tissue with a part of the first piece and a part of the second piece; and 
 engaging the tissue between the first piece and the second piece of the locking element. 
 
     
     
         20 - 21 . (canceled) 
     
     
         22 . A system for use in an annuloplasty procedure, the system comprising:
 a catheter assembly configured for insertion through an aorta of the heart into a left ventricle of the heart to reach a region of the left ventricle substantially below the mitral valve; and   a bendable member, wherein the bendable member is movable between a first position for insertion into a left ventricle through the catheter assembly and a second position, the bendable member being configured to create a plication in tissue located near a mitral valve when the bendable member is in the second position.   
     
     
         23 - 36 . (canceled)