Device and methods for endoscopic annuloplasty
The methods, devices, and systems are provided for performing endovascular repair of atrioventricular and other cardiac valves in the heart. Regurgitation of an atrioventricular valve, particularly a mitral valve, can be repaired by modifying a tissue structure selected from the valve leaflets, the valve annulus, the valve chordae, and the papillary muscles. These structures may be modified by suturing, stapling, snaring, or shortening, using interventional tools which are introduced to a heart chamber. The tissue structures can be temporarily modified prior to permanent modification. For example, opposed valve leaflets may be temporarily grasped and held into position prior to permanent attachment. In one aspect, a structure is deployed in a gutter region of the valve annulus to modify the shape of the valve.
1. A method of modifying a heart valve of a patient, comprising:
advancing an access catheter through the patient's vasculature into the heart from a vascular access point remote from the heart, the access catheter having a central lumen and a distal end;
extending a delivery catheter through the central lumen of the access catheter through the distal end of the access catheter, the delivery catheter comprising an actuatable grasping element and a lumen extending through the actuatable grasping element;
deploying a structure from the delivery catheter through the lumen extending through the actuatable grasping element into a gutter on the ventricular side of the annulus of the heart valve, the structure adapted to modify the annulus so as to reduce regurgitation in the heart valve;
holding leaflets of the heart valve together using the actuatable grasping element of the delivery catheter so as to reduce regurgitation in the heart valve during the deployment of the structure from the delivery catheter; and
withdrawing the actuatable grasping element of the delivery catheter after the structure is deployed in the gutter of the ventricular side of the annulus of the heart valve, such that the structure remains deployed in the gutter of the annulus once the actuatable grasping element is withdrawn.
2. A method as in claim 1 , wherein advancing the access catheter comprises:
advancing the access catheter into the right atrium;
penetrating the interatrial septum to form an opening in the interatrial septum;
advancing the access catheter through the opening in the interatrial septum into the left atrium;
advancing the access catheter downward through the mitral valve.
3. A method as in claim 2 , further comprising deflecting the distal end of the delivery catheter upwardly toward the gutter such that the structure approaches the gutter from below the mitral valve.
4. A method as defined in claim 1 , wherein holding the leaflets of the valve together comprises permanently attaching opposed points on or along the valve leaflets together.
5. A method as defined in claim 1 , wherein holding the leaflets of the valve together comprises suturing, clipping, stapling, riveting, gluing, or fusing opposed points on or along the valve leaflets together.
6. A method as defined in claim 1 , wherein holding the leaflets of the valve together further comprises linking opposed chordae of the valve leaflets together.
7. A method as defined in claim 6 , wherein linking comprises suturing, capturing, fusing, clipping, or gluing the opposed chordae.
8. A method as in claim 1 , wherein modifying the annulus comprises circumferentially shortening the annulus.
9. A method as in claim 1 , wherein the structure comprises a ring that at least partially surround the annulus within the gutter.
10. A method as in claim 1 , wherein the structure comprises a plurality of staples positioned in an annular formation in the gutter about the annulus.
11. A method as in claim 1 , wherein the structure includes at least one securing member that secures the structure in the gutter.
12. A method as in claim 1 , wherein the heart valve comprises the mitral valve.
13. A method as in claim 1 , further comprising:
permitting scar tissue to grow around the structure within the gutter;
re-shaping the structure in order to modify the shape of the annulus, wherein the scar tissue provides a strengthened attachment between the structure and the gutter.
14. A method as in claim 13 , wherein the structure is re-shaped after passage of a period of time comprising four to twenty four weeks.