Devices and methods for heart valve repair

Abstract

Devices and methods provide enhanced treatment of a cardiac valve annulus. Methods generally involve contacting an anchor delivery device with the valve annulus and releasing a plurality of coupled anchors from the anchor delivery device to secure the anchors to the annulus. Anchors, which in some embodiments are super-elastic or shape memory self-securing anchors, are then drawn together to tighten the annulus. Devices generally include an elongate catheter having a housing at or near the distal end for releasably housing a plurality of coupled anchors. The housing may be flexible, may conform to a valve annulus, and in some embodiments may be coupled with an expandable member to enhance contact of the housing with annular tissue. In one embodiment, self-securing anchors lie approximately flat within the delivery device housing, allowing anchors with relatively large deployed shapes to be housed in and deployed from a relatively narrow delivery device.

1 . A method of constricting a valve annulus in a heart, the method comprising:
 contacting an anchor delivery device with a length of the valve annulus;   delivering a plurality of coupled anchors from the anchor delivery device to secure the anchors to the annulus; and   drawing the anchors together to circumferentially tighten the valve annulus.   
     
     
         2 . A method as in  claim 1 , wherein contacting, delivering and drawing are performed on a mitral valve annulus of the heart. 
     
     
         3 . A method as in  claim 2 , wherein the anchor delivery device is contacted with the length of the mitral valve annulus from within a left ventricle of the heart. 
     
     
         4 . A method as in  claim 3 , wherein the anchor delivery device is contacted with the length of the mitral valve annulus on an inferior side of an intersection of a left ventricular wall and at least one mitral valve leaflet of the heart. 
     
     
         5 . A method as in  claim 2 , wherein the anchor delivery device is contacted with the mitral valve annulus from within a left atrium of the heart. 
     
     
         6 . A method as in  claim 1 , wherein contacting, delivering and drawing are performed on a tricuspid valve annulus of the heart. 
     
     
         7 . A method as in  claim 1 , wherein contacting, delivering and drawing are performed via intravascular access to the heart. 
     
     
         8 . A method as in  claim 7 , wherein the valve annulus is a mitral valve annulus, the method further comprising advancing the anchor delivery device through an aorta and into a left ventricle of the heart to contact a length of the mitral valve annulus on an inferior side of an intersection of a left ventricular wall and at least one mitral valve leaflet of the heart. 
     
     
         9 . A method as in  claim 7 , wherein the valve annulus is a mitral valve annulus, the method further comprising advancing the anchor delivery device through a central vein and into a right atrium of the heart, across an interatrial septum, and into a left ventricle of the heart to contact a length of the mitral valve annulus on an inferior side of an intersection of a left ventricular wall and at least one mitral valve leaflet of the heart. 
     
     
         10 . A method as in  claim 7 , wherein the valve annulus is a mitral valve annulus, the method further comprising advancing the anchor delivery device into a coronary sinus of the heart to contact a length of the mitral valve annulus through the coronary sinus. 
     
     
         11 . A method as in  claim 1 , wherein contacting, delivering and drawing are performed as part of an open heart surgical procedure. 
     
     
         12 . A method as in  claim 1 , wherein contacting, delivering and drawing are performed without stopping the heart. 
     
     
         13 . A method as in  claim 1 , wherein contacting, delivering and drawing are performed through one or more minimally invasive incisions. 
     
     
         14 . A method as in  claim 1 , further comprising deforming a flexible distal portion of the anchor delivery device to conform the distal portion to the length of valve annulus prior to contacting the anchor delivery device with the annulus. 
     
     
         15 . A method as in  claim 14 , further comprising advancing the flexible distal portion within a space between a left ventricular wall, at least one mitral valve leaflet and at least one chordae tendineae of the heart. 
     
     
         16 . A method as in  claim 15 , further comprising expanding an expandable member coupled with the flexible distal portion to urge the flexible distal portion against an intersection of the left ventricular wall and the at least one mitral valve leaflet. 
     
     
         17 . A method as in  claim 14 , wherein deforming the flexible distal portion comprises expanding a shaped expandable member to deform the distal portion. 
     
     
         18 . A method as in  claim 14 , wherein deforming the flexible distal portion comprises articulating the distal portion in at least two directions. 
     
     
         19 . A method as in  claim 14 , wherein deforming the flexible distal portion comprises applying tension to at least a first tensioning cord to cause a first bend in the distal portion. 
     
     
         20 . A method as in  claim 19 , wherein deforming the flexible distal portion further comprises applying tension to at least a second tensioning cord to cause a second bend in the distal portion. 
     
     
         21 . A method as in  claim 20 , wherein the first bend comprises approximately a C-shaped bend to conform the distal portion to the annulus, and the second bend comprises an upwardly directed bend. 
     
     
         22 . A method as in  claim 14 , wherein deforming the flexible distal portion comprises introducing a fluid into a shape-memory distal portion. 
     
     
         23 . A method as in  claim 14 , further comprising locking the shape of the flexible distal portion. 
     
     
         24 . A method as in  claim 1 , wherein delivering the plurality of anchors comprises releasing the anchors to allow them to change from an undeployed shape to a deployed shape to secure to the annulus. 
     
     
         25 . A method as in  claim 24 , wherein the anchors are constrained in their undeployed shape and elastically spring to their deployed shape when released from constraint. 
     
     
         26 . A method as in  claim 25 , wherein the deployed shape of each of the plurality of anchors has a radius of at least about 3 mm, and wherein the delivery device has a cross-sectional diameter of about 1.67 mm or less. 
     
     
         27 . A method as in  claim 25 , wherein releasing the plurality of coupled anchors from constraint comprises applying force to each of the anchors with an anchor contacting member, wherein the applied force causes each anchor to exit the anchor delivery device through at least one opening therein. 
     
     
         28 . A method as in  claim 27 , wherein the force is applied sequentially to the anchors by the anchor contacting member to cause the anchors to exit the delivery device sequentially. 
     
     
         29 . A method as in  claim 27 , wherein applying force to each of the anchors comprises retracting the anchor contacting member proximally relative to the anchor delivery device. 
     
     
         30 . A method as in  claim 27 , wherein each anchor comprises two arms with sharpened tips, and wherein the arms curve in opposite directions when each anchor is released from the delivery device to change from its undeployed to its deployed shape. 
     
     
         31 . A method as in  claim 25 , wherein the anchors are released from the delivery device simultaneously. 
     
     
         32 - 117 . (canceled)