Tricuspid Valve Repair Using Tension

Abstract

A method is provided that includes implanting a first tissue-engaging element in a first portion of tissue in a vicinity of a heart valve. A second tissue-engaging element, which is connected to a third tissue-engaging element by a longitudinal sub-member, is implanted in a second portion of tissue of an annulus, and the third tissue-engaging element is implanted in a third portion of tissue of the annulus. A fourth tissue-engaging element is implanted in a portion of a blood vessel that is in contact with an atrium. While the longitudinal sub-member engages the longitudinal member at a junction therebetween, at least a first leaflet of the heart valve is drawn toward at least a second leaflet of the heart valve by adjusting a distance between the portion of the blood vessel and the first portion of tissue in the vicinity of the heart valve. Other embodiments are also described.

1 . A method, comprising:
 implanting a first tissue-engaging element in a first portion of tissue in a vicinity of a heart valve of a heart of a patient, the first portion of tissue selected from the group consisting of: a portion of tissue of an annulus of the heart valve, and a portion of tissue of a wall of an atrium of the heart above the annulus of the heart valve;   implanting, in a second portion of tissue of the annulus, a second tissue-engaging element that is connected to a third tissue-engaging element by a longitudinal sub-member;   implanting the third tissue-engaging element in a third portion of tissue of the annulus;   implanting a fourth tissue-engaging element in a portion of a blood vessel that is in contact with the atrium of the heart of the patient; and   while the longitudinal sub-member engages the longitudinal member at a junction therebetween, drawing at least a first leaflet of the heart valve toward at least a second leaflet of the heart valve by adjusting a distance between the portion of the blood vessel and the first portion of tissue in the vicinity of the heart valve of the patient.   
     
     
         2 . The method according to  claim 1 , wherein adjusting the distance between the portion of the blood vessel and the first portion of tissue in the vicinity of the heart valve of the patient comprises pulling a longitudinal member that connects the first and fourth tissue-engaging elements. 
     
     
         3 . (canceled) 
     
     
         4 . The method according to  claim 1 , wherein adjusting the distance between the portion of the blood vessel and the first portion of tissue in the vicinity of the heart valve of the patient comprises applying tension to one or more elements selected from the group consisting of the first tissue-engaging element and the fourth tissue-engaging element. 
     
     
         5 . The method according to  claim 1 , further comprising monitoring a level of regurgitation of the heart valve in conjunction with the adjusting the distance between the portion of the blood vessel and the first portion of tissue in the vicinity of the heart valve of the patient. 
     
     
         6 . The method according to  claim 1 , wherein adjusting the distance between the portion of the blood vessel and the first portion of tissue in the vicinity of the heart valve of the patient comprises pulling the first tissue-engaging element toward the portion of the blood vessel. 
     
     
         7 . The method according to  claim 92 , wherein adjusting the distance between the portion of the blood vessel and the first portion of tissue in the vicinity of the heart valve of the patient comprises achieving bicuspidization of the tricuspid valve. 
     
     
         8 . The method according to  claim 1 , wherein adjusting the distance between the portion of the blood vessel and the first portion of tissue in the vicinity of the heart valve of the patient comprises actuating an adjusting mechanism that is coupled to a portion of a longitudinal member that connects the first and fourth tissue-engaging elements. 
     
     
         9 . The method according to  claim 1 , wherein implanting the fourth tissue-engaging element in the portion of the blood vessel comprises expanding a stent in the portion of the blood vessel. 
     
     
         10 - 12 . (canceled) 
     
     
         13 . The method according to  claim 92 , wherein the blood vessel is selected from the group of blood vessels consisting of: a superior vena cava, and an inferior vena cava. 
     
     
         14 . The method according to  claim 1 , wherein implanting the first tissue-engaging element in the first portion of tissue in the vicinity of the heart valve of the patient comprises engaging the first portion of tissue by performing one or more actions selected from the group consisting of: puncturing and squeezing the first portion of tissue and advancing at least a portion of the first tissue-engaging element into the first portion of tissue. 
     
     
         15 . The method according to  claim 14 ,
 wherein the first portion of tissue in the vicinity of the heart valve includes a portion of tissue of that is opposite the portion of the blood vessel of the patient,   wherein engaging the first portion of tissue comprises engaging the portion of tissue that is opposite the portion of the blood vessel of the patient, and   wherein drawing the first leaflet of the heart valve toward the second leaflet of the heart valve comprises adjusting a distance between the portion of the blood vessel of the patient and the portion of tissue that is opposite the portion of the blood vessel of the patient.   
     
     
         16 . The method according to  claim 14 , wherein the first portion of tissue in the vicinity of the heart valve is the portion of tissue of the wall of the atrium of the heart above the annulus of the heart valve, and wherein engaging the first portion of tissue comprises engaging the portion of tissue of the wall of the atrium. 
     
     
         17 . The method according to  claim 14 , wherein the first portion of tissue in the vicinity of the heart valve is the portion of tissue of the annulus of the heart valve, and wherein engaging the first portion of tissue comprises engaging the portion of tissue of the annulus of the heart valve. 
     
     
         18 . The method according to  claim 17 , wherein the portion of tissue of the annulus of the heart valve includes a portion of tissue that is between a middle portion of an anterior leaflet of the heart valve and a middle portion of a posterior leaflet of the heart valve. 
     
     
         19 - 88 . (canceled) 
     
     
         89 . The method according to  claim 1 , wherein the first portion of tissue is the portion of tissue of the annulus of the heart. 
     
     
         90 . The method according to  claim 1 , wherein the first portion of tissue is the portion of tissue of the wall of the atrium of the heart about the annulus of the heart valve. 
     
     
         91 . The method according to  claim 1 , wherein drawing comprises drawing while the longitudinal sub-member is hooked on or looped over the longitudinal member at the junction. 
     
     
         91 . The method according to  claim 1 , wherein drawing comprises drawing while the longitudinal sub-member is coupled to the longitudinal member at the junction by a ring. 
     
     
         92 . The method according to  claim 1 , wherein the heart valve is a tricuspid valve. 
     
     
         93 . The method according to  claim 92 , wherein implanting the first, the second, and the third tissue-engaging elements comprises:
 implanting one of the first, the second, and the third tissue-engaging elements at a septal side of the tricuspid valve in a caudal part of a base of the septal leaflet; and   implanting the other two of the first, the second, and the third tissue-engaging elements at a mural side of the tricuspid valve.