Contraction of an annuploplasty structure

Abstract

An implant for use at a heart of a subject includes a contraction wire. The contraction wire extends from a first portion of the implant, to which a first wire-end of the contraction wire is attached, to a second portion of the implant. An adjustment mechanism, including a pulley system including a first pulley and a second pulley, is coupled to the contraction wire. Actuation of an actuator increases the distance between the first and second pulleys, thereby drawing the contraction wire into the adjustment mechanism and drawing the first portion and the second portion closer together. Other embodiments are also described.

1 . An apparatus for use at a heart of a subject, the apparatus comprising:
 an implant having a first portion and a second portion, and comprising:
 a contraction wire having a first wire-end and a second wire-end, the first wire-end being attached to the first portion, and the wire extending from the first portion to the second portion; and 
 an adjustment mechanism, coupled to the contraction wire, and comprising:
 a pulley system comprising at least a first pulley and a second pulley; and 
 an actuator, mechanically coupled to the pulley system such that actuation of the actuator adjusts a distance between the first pulley and the second pulley, 
 
   
       wherein:
 the wire is arranged with respect to the first portion, the second portion, and the adjustment mechanism, such that drawing the wire into the adjustment mechanism draws the first portion and the second portion closer together, and 
 the pulley system is engaged with the wire such that increasing the distance between the first and second pulleys draws the wire into the adjustment mechanism, thereby drawing the first portion and the second portion closer together. 
 
     
     
         2 . The apparatus according to  claim 1 , wherein the implant comprises a flexible sleeve having a wall that defines a longitudinal lumen between the first and second portions. 
     
     
         3 . The apparatus according to  claim 1 , wherein the wire is arranged in a back-and-forth arrangement within the adjustment mechanism. 
     
     
         4 . The apparatus according to  claim 1 , wherein the adjustment mechanism further comprises a housing that houses the pulley system and the actuator. 
     
     
         5 . The apparatus according to  claim 1 , wherein the pulley system comprises one of at least three pulleys, at least four pulleys, and at least five pulleys. 
     
     
         6 . The apparatus according to  claim 1 , wherein the pulley system and the wire mechanically cooperate such that increasing the distance by a distance-increase amount draws, into the adjustment mechanism, a portion of the wire that is longer than the distance-increase amount. 
     
     
         7 . The apparatus according to  claim 6 , wherein the pulley system and the wire mechanically cooperate such that increasing the distance by the distance-increase amount draws, into the adjustment mechanism, a portion of the wire that is one of at least twice as long as the distance-increase amount, at least four times as long as the distance-increase amount, and at least six times as long as the distance-increase amount. 
     
     
         8 . The apparatus according to  claim 1 , wherein the pulley system and the wire mechanically cooperate such that increasing the distance by a distance-increase amount draws the first portion and the second portion closer together by a contraction length that is greater than the distance-increase amount. 
     
     
         9 . The apparatus according to  claim 8 , wherein the pulley system and the wire mechanically cooperate such that increasing the distance by the distance-increase amount draws the first portion and the second portion closer together by a contraction length that is one of at least twice as great, at least four times greater, and at least six times greater than the distance-increase amount. 
     
     
         10 . The apparatus according to  claim 1 , wherein the first pulley comprises a first wheel and the second pulley comprises a second wheel. 
     
     
         11 . The apparatus according to  claim 10 , wherein the first wheel and the second wheel are unpowered and configured to rotate passively in response to the wire moving thereover. 
     
     
         12 . The apparatus according to  claim 1 , wherein the actuator is a linear actuator. 
     
     
         13 . The apparatus according to  claim 1 , wherein the actuator comprises a rotational element, and is actuated via rotation of the rotational element. 
     
     
         14 . The apparatus according to  claim 13 , further comprising a tool that is (i) transluminally advanceable to the implant, (ii) intracorporeally reversibly engageable with the rotational element, and (iii) while engaged with the rotational element, configured to rotate the rotational element. 
     
     
         15 . An apparatus for use at a heart of a subject, the apparatus comprising an annuloplasty structure that comprises:
 a flexible sleeve having a first sleeve-end-portion, a second sleeve-end-portion, and a circumferential wall that defines a longitudinal lumen between the first and second sleeve-end-portions;   an elongate contraction wire having a first wire-end and a second wire-end, the first wire-end being attached to the sleeve at the first sleeve-end-portion, and the wire extending, in association with the circumferential wall, from the first sleeve-end-portion to the second sleeve-end-portion; and   an adjustment mechanism, coupled to the sleeve, and comprising:
 a pulley system comprising at least a first pulley and a second pulley; and 
 an actuator, mechanically coupled to the pulley system such that actuation of the actuator adjusts a distance between the first pulley and the second pulley, 
   
       wherein:
 the wire is arranged with respect to the sleeve and the adjustment mechanism such that drawing the wire into the adjustment mechanism longitudinally contracts the sleeve, and 
 the pulley system is engaged with the wire such that increasing the distance between the first and second pulleys draws the wire into the adjustment mechanism, thereby longitudinally contracting the sleeve. 
 
     
     
         16 . The apparatus according to  claim 15 , wherein the wire is arranged in a back-and-forth arrangement within the adjustment mechanism. 
     
     
         17 . The apparatus according to  claim 15 , wherein the adjustment mechanism is disposed outside of the lumen of the sleeve. 
     
     
         18 . The apparatus according to  claim 15 , wherein the adjustment mechanism is disposed inside the lumen of the sleeve. 
     
     
         19 . The apparatus according to  claim 15 , wherein the pulley system and the wire mechanically cooperate such that increasing the distance by a distance-increase amount draws, into the adjustment mechanism, a portion of the wire that is longer than the distance-increase amount. 
     
     
         20 . The apparatus according to  claim 19 , wherein the pulley system and the wire mechanically cooperate such that increasing the distance by the distance-increase amount draws, into the adjustment mechanism, a portion of the wire that is at least twice as long as the distance-increase amount. 
     
     
         21 . The apparatus according to  claim 15 , wherein the pulley system and the wire mechanically cooperate such that increasing the distance by a distance-increase amount longitudinally contracts the sleeve by a contraction length that is greater than the distance-increase amount. 
     
     
         22 . The apparatus according to  claim 21 , wherein the pulley system and the wire mechanically cooperate such that increasing the distance by the distance-increase amount longitudinally contracts the sleeve by a contraction length that is at least twice as great as the distance-increase amount. 
     
     
         23 . The apparatus according to  claim 15 , wherein the actuator comprises a rotational element, and is actuated via rotation of the rotational element. 
     
     
         24 . The apparatus according to  claim 23 , further comprising a tool that is (i) transluminally advanceable to the annuloplasty structure, (ii) intracorporeally reversibly engageable with the rotational element, and (iii) while engaged with the rotational element, configured to rotate the rotational element.