Percutaneous Tether Locking

Abstract

An implant is provided that includes first and second tissue anchors, which include (a) first and second tissue-coupling elements, respectively, and (b) first and second heads, respectively, which include first and second tether interfaces; and one or more tethers, which are connected to the first tether interface, and coupled to the second tether interface. The first and second tissue anchors are removably positioned in a catheter shaft of a multiple-anchor delivery tool at first and second longitudinal locations, respectively, the first longitudinal location more distal than the second longitudinal location. First and second torque cables of the delivery tool (a) are removably coupled to the first and second heads, respectively, (b) extend within the catheter shaft proximally from the first and second heads, respectively, and (c) transmit torque when rotated. A portion of the first torque cable is removably positioned alongside the second tissue anchor in the catheter shaft.

1 - 127 . (canceled) 
     
     
         128 . An implant system comprising:
 (i) an implant, which comprises:
 at least first and second tissue anchors, which comprise (a) first and second tissue-coupling elements, respectively, and (b) first and second heads, respectively, which comprise first and second tether interfaces; and 
 one or more tethers, which are connected to the first tether interface, and coupled to the second tether interface; and 
   (ii) a multiple-anchor delivery tool, which comprises:
 a catheter shaft having proximal and distal ends, wherein the first and the second tissue anchors are removably positioned in the catheter shaft at first and second longitudinal locations, respectively, the first longitudinal location more distal than the second longitudinal location; and 
 first and second torque cables, which (a) are removably coupled to the first and the second heads, respectively, (b) extend within the catheter shaft proximally from the first and the second heads, respectively, and (c) transmit torque when rotated, wherein a portion of the first torque cable is removably positioned alongside the second tissue anchor in the catheter shaft. 
   
     
     
         129 . The implant system according to  claim 128 ,
 wherein the implant further comprises a third tissue anchor, which comprises (a) a third tissue-coupling element and (b) a third head, which comprises a third tether interface,   wherein the one or more tethers are coupled to the third tether interface,   wherein the third tissue anchor is removably positioned in the catheter shaft at a third longitudinal location that is more proximal than the second longitudinal location, and   wherein the multiple-anchor delivery tool further comprises a third torque cable, which (a) is removably coupled to the third head, (b) extends within the catheter shaft proximally from the third head, and (c) transmits torque when rotated, wherein a portion of the second torque cable is removably positioned alongside the third tissue anchor in the catheter shaft.   
     
     
         130 . The implant system according to  claim 128 , wherein the first tether interface is rotatable with respect to the first tissue-coupling element. 
     
     
         131 . The implant system according to  claim 128 , wherein the first torque cable is shaped so as to define a lumen therethrough, and wherein the multiple-anchor delivery tool further comprises a wire, which removably passes through the lumen. 
     
     
         132 . The implant system according to  claim 131 ,
 wherein the head is shaped so as to define a proximal coupling element, wherein the head, including the proximal coupling element, is shaped so as to define a first longitudinal channel at least partially therethrough, which channel is coaxial with the head,   wherein a distal end of the first torque cable comprises a distal coupling element, which is shaped so as to define a second longitudinal channel therethrough, which channel is coaxial with the lumen of the first torque cable,   wherein the proximal and the distal coupling elements are shaped so as to define corresponding interlocking surfaces, and   wherein the wire, when disposed through the first and the second channels, prevents decoupling of the distal coupling element from the proximal coupling element.   
     
     
         133 . The implant system according to  claim 131 , wherein the wire is shaped so as to define a sharp distal tip. 
     
     
         134 . The implant system according to  claim 131 , wherein the first and the second tissue-coupling elements are configured to puncture tissue. 
     
     
         135 . The implant system according to  claim 131 , wherein the first and the second anchor heads are coaxial when the first and the second tissue anchors are removably positioned in the catheter shaft. 
     
     
         136 . The implant system according to  claim 131 , wherein the multiple-anchor delivery tool further comprises a control handle, which is configured to allow separate rotation of each of the first and the second torque cables. 
     
     
         137 . A method comprising:
 advancing a distal end of a catheter shaft of a multiple-anchor delivery tool into a body of a subject, while (a) first and second tissue anchors are removably positioned in the catheter shaft at first and second longitudinal locations, respectively, the first longitudinal location more distal than the second longitudinal location, wherein the first and the second tissue anchors include (i) first and second tissue-coupling elements, respectively, and (ii) first and second heads, respectively, which include first and second tether interfaces, and (b) one or more tethers, which are connected to the first tether interface, and are coupled to the second tether interface, are removably positioned in the catheter shaft, wherein the multiple-anchor delivery tool includes first and second torque cables, which (A) are removably coupled to the first and the second heads, respectively, (B) extend within the catheter shaft proximally from the first and the second heads, respectively, and (C) transmit torque when rotated, wherein a portion of the first torque cable is removably positioned alongside the second tissue anchor in the catheter shaft;   implanting the first tissue anchor in tissue of the subject;   decoupling the first torque cable from the first tissue anchor;   after implanting the first tissue anchor, distally advancing the second tissue anchor in the catheter shaft;   implanting the second tissue anchor in tissue of the subject; and   decoupling the second torque cable from the second tissue anchor.   
     
     
         138 . The method according to  claim 137 , wherein implanting the first tissue anchor comprises rotating the first torque cable. 
     
     
         139 . The method according to  claim 137 ,
 wherein the first torque cable is shaped so as to define a lumen therethrough,   wherein the multiple-anchor delivery tool further comprises a wire, which removably passes through the lumen, and which is initially positioned such that a distal end of the wire extends distally out of a distal end of the lumen, and   wherein the method further comprises withdrawing the wire proximally.   
     
     
         140 . The method according to  claim 139 ,
 wherein the head is shaped so as to define a proximal coupling element,   wherein the head, including the proximal coupling element, is shaped so as to define a first longitudinal channel at least partially therethrough, which channel is coaxial with the head,   wherein a distal end of the first torque cable includes a distal coupling element, which is shaped so as to define a second longitudinal channel therethrough, which channel is coaxial with the lumen of the first torque cable,   wherein the proximal and the distal coupling elements are shaped so as to define corresponding interlocking surfaces,   wherein the wire, when disposed through the first and the second channels, prevents decoupling of the distal coupling element from the proximal coupling element, and   wherein withdrawing the wire proximally comprises decoupling the distal coupling element from the proximal coupling element by withdrawing the wire proximally.   
     
     
         141 . The method according to  claim 140 , wherein the wire is shaped so as to define a sharp distal tip. 
     
     
         142 . The method according to  claim 141 , wherein implanting the first tissue anchor comprises inserting the sharp distal tip of the wire into the tissue. 
     
     
         143 . The method according to  claim 137 ,
 wherein advancing comprises advancing the distal end of the catheter shaft into the body while (a) a third tissue anchor is removably positioned in the catheter shaft at a third longitudinal location that is more proximal than the second longitudinal location, wherein the third tissue anchor includes (i) a third tissue-coupling element and (ii) a third head, which comprises a third tether interfaces, and (b) the one or more tethers are coupled to the third tether interface,   wherein the multiple-anchor delivery tool further includes a third torque cable, which (a) is removably coupled to the third head, (b) extends within the catheter shaft proximally from the third head, and (c) transmits torque when rotated, wherein a portion of the second torque cable is removably positioned alongside the third tissue anchor in the catheter shaft, and   wherein the method further comprises:
 after implanting the second tissue anchor, distally advancing the third tissue anchor in the catheter shaft; 
 implanting the third tissue anchor in tissue of the subject; and 
 decoupling the third torque cable from the third tissue anchor. 
   
     
     
         144 . The method according to  claim 137 , wherein the first tether interface is rotatable with respect to the first tissue-coupling element. 
     
     
         145 . The method according to  claim 137 , wherein the first and the second anchor heads are coaxial when the first and the second tissue anchors are removably positioned in the catheter shaft. 
     
     
         146 . The method according to  claim 137 , wherein advancing the distal end of the catheter shaft comprises transvascularly advancing the distal end of the catheter shaft.