Post-Implantation Tensioning in Cardiac Implants

Abstract

A method of treating a heart of a patient is provided. The method includes implanting a first tissue anchor in cardiac tissue of the patient and a second tissue anchor in the patient, such that the first and the second tissue anchors are coupled together by one or more tethers. Thereafter, after allowing at least 24 hours for tissue growth on the first tissue anchor to strengthen anchoring of the first tissue anchor in the cardiac tissue, tension is applied between the first and the second tissue anchors using at least a longitudinal portion of the one or more tethers. Other embodiments are also described.

1 . A method of treating a heart of a patient, comprising:
 implanting a first tissue anchor in cardiac tissue of the patient and a second tissue anchor in the patient, such that the first and the second tissue anchors are coupled together by one or more tethers;   thereafter, after allowing at least 24 hours for tissue growth on the first tissue anchor to strengthen anchoring of the first tissue anchor in the cardiac tissue, applying tension between the first and the second tissue anchors using at least a longitudinal portion of the one or more tethers.   
     
     
         2 . The method according to  claim 1 , wherein the one or more tethers are slack before applying the tension. 
     
     
         3 . The method according to  claim 1 , wherein the one or more tethers are one or more first tethers, and wherein applying the tension comprises:
 coupling a second tether to a coupling site along the one or more first tethers; and   applying the tension between the first and the second tissue anchors using the at least a longitudinal portion of the one or more first tethers and the second tether.   
     
     
         4 . The method according to  claim 3 , wherein coupling the second tether to the coupling site comprises coupling, to the coupling site, a coupling element that is attached to the second tether. 
     
     
         5 . The method according to  claim 4 , wherein the coupling element comprises a hook. 
     
     
         6 . The method according to  claim 3 , wherein applying the tension comprises coupling the second tether to the second tissue anchor. 
     
     
         7 . The method according to  claim 6 , wherein the second tissue anchor comprises a stent that comprises a plurality of struts, and wherein coupling the second tether to the second tissue anchor comprises coupling, to one or more of the struts, a coupling element that is attached to the second tether. 
     
     
         8 . The method according to  claim 7 , wherein the coupling element comprises a hook. 
     
     
         9 . The method according to  claim 7 , wherein the coupling element is shaped so as to define an opening. 
     
     
         10 . The method according to  claim 7 , wherein at least one of the struts is oriented axially as a backbone, and wherein coupling the coupling element to the one or more of the struts comprises coupling the coupling element to the backbone. 
     
     
         11 . The method according to  claim 10 , wherein the backbone is shaped so as to define one or more hooks, and wherein coupling the coupling element to the backbone comprises coupling the coupling element to one or more of the hooks. 
     
     
         12 . The method according to  claim 1 , wherein a longitudinal portion of the one or more tethers passes through one or more openings of a locking frame so as to form a tether loop, and wherein applying the tension comprises enlarging the tether loop by pulling on the tether loop. 
     
     
         13 . The method according to  claim 12 , wherein the one or more openings are two openings, and wherein the longitudinal portion of the one or more tethers passes through the two openings. 
     
     
         14 . The method according to  claim 1 , wherein applying the tension comprises applying the tension after allowing at least one week for tissue growth on the first tissue anchor. 
     
     
         15 . The method according to  claim 1 , wherein applying the tension comprises applying the tension within two months after implanting the first tissue anchor. 
     
     
         16 . The method according to  claim 1 , wherein implanting the first tissue anchor comprises implanting the first tissue anchor in the vicinity of the tricuspid valve of the patient. 
     
     
         17 . The method according to  claim 1 , wherein implanting the second tissue anchor comprises implanting the second tissue anchor in a blood vessel selected from the group consisting of: a superior vena cava (SVC), an inferior vena cava (IVC), and a coronary sinus. 
     
     
         18 . A method of treating a heart of a patient, comprising:
 implanting a first tissue anchor in cardiac tissue of the patient;   thereafter, after allowing at least 24 hours for tissue growth on the first tissue anchor to strengthen anchoring of the first tissue anchor in the cardiac tissue:
 implanting a second tissue anchor in the patient; 
 coupling the first and the second tissue anchors together using one or more tethers; and 
 applying tension between the first and the second tissue anchors using the one or more tethers. 
   
     
     
         19 . The method according to  claim 18 , wherein coupling the first and the second tissue anchors together comprises coupling the first and the second tissue anchors together after implanting the second tissue anchor. 
     
     
         20 . The method according to  claim 18 , wherein coupling the first and the second tissue anchors together comprises coupling the first and the second tissue anchors together before implanting the second tissue anchor. 
     
     
         21 . The method according to  claim 18 ,
 wherein the one or more tethers are one or more first tethers,   wherein the method further comprises implanting a third tissue anchor in cardiac tissue of the patient, such that the first and the third tissue anchors are coupled together by one or more second tethers,   wherein coupling the first and the second tissue anchors together comprises coupling the first, the second, and the third tissue anchors together using the one or more first tethers and the one or more second tethers, and   wherein applying the tension between the first and the second tissue anchors comprises applying the tension between the first, the second, and the third tissue anchors using the one or more first tethers and the one or more second tethers.   
     
     
         22 . The method according to  claim 21 , wherein implanting the third tissue anchor comprises implanting the third tissue anchor within three hours of implanting the first tissue anchor. 
     
     
         23 . The method according to  claim 21 ,
 wherein the one or more first tethers are attached to the second tissue anchor and comprise a coupling element, and   wherein coupling the first, the second, and the third tissue anchors together using the one or more first tethers and the one or more second tethers comprises coupling the coupling element to the one or more second tethers.   
     
     
         24 . The method according to  claim 23 , wherein the coupling element comprises a hook, and wherein coupling the coupling element to the one or more second tethers comprises hooking the hook onto the one or more second tethers. 
     
     
         25 . The method according to  claim 18 ,
 wherein the first tissue anchor comprises a tissue-anchoring element and a first coupling element,   wherein the one or more tethers are attached to the second tissue anchor and comprise a second coupling element, and   wherein coupling the first and the second tissue anchors together using the one or more tethers comprises coupling the second coupling element to the first coupling element.   
     
     
         26 . The method according to  claim 25 , wherein the first coupling element comprises a ball, wherein the second coupling element comprises a socket, and wherein coupling the first and the second tissue anchors together comprises coupling the socket to the ball. 
     
     
         27 . The method according to  claim 26 , wherein the ball is connected to a head of the first tissue anchor by a rod. 
     
     
         28 . The method according to  claim 26 , wherein coupling the socket to the ball comprises transitioning the socket from an open, unlocked state to a closed, locked state around the ball. 
     
     
         29 . The method according to  claim 25 , wherein the first coupling element comprises a socket, wherein the second coupling element comprises a ball, and wherein coupling the first and the second tissue anchors together comprises coupling the ball to the socket. 
     
     
         30 . The method according to  claim 25 , wherein the first coupling element comprises a loop, wherein the second coupling element comprises a hook, and wherein coupling the first and the second tissue anchors together comprises hooking the hook onto the loop. 
     
     
         31 . The method according to  claim 25 , wherein the second coupling element comprises a loop, and wherein coupling the first and the second tissue anchors together comprises coupling the loop to the first coupling element. 
     
     
         32 . The method according to  claim 31 , wherein the first coupling element comprises a hook, and wherein coupling the loop to the first coupling element comprises coupling the loop to the hook. 
     
     
         33 . The method according to  claim 25 , wherein the first coupling element is coated with a tissue-growth-inhibiting coating. 
     
     
         34 . The method according to  claim 25 , wherein the tissue-anchoring element is coated with a tissue-growth-enhancing coating. 
     
     
         35 . The method according to  claim 18 , wherein implanting the second tissue anchor comprises implanting the second tissue anchor after allowing at least one week for tissue growth on the first anchor. 
     
     
         36 . The method according to  claim 18 , wherein implanting the second tissue anchor comprises implanting the second tissue anchor within two months after implanting the first tissue anchor. 
     
     
         37 . The method according to  claim 18 , wherein the first tissue anchor comprises a helical tissue-anchoring element. 
     
     
         38 . The method according to  claim 18 , wherein the second tissue anchor comprises a stent. 
     
     
         39 . The method according to  claim 18 , wherein implanting the second tissue anchor comprises implanting the second tissue anchor in a blood vessel selected from the group consisting of: a superior vena cava (SVC), an inferior vena cava (IVC), and a coronary sinus. 
     
     
         40 . The method according to  claim 18 , wherein implanting the first tissue anchor comprises implanting the first tissue anchor in the vicinity of the tricuspid valve. 
     
     
         41 . The method according to  claim 40 , wherein applying the tension between the first and the second tissue anchors using the one or more tethers reduces tricuspid valve regurgitation.