Tricuspid valve repair using tension
A method is provided, including implanting at least a first tissue-engaging element in a first portion of tissue in a vicinity of a heart valve of a patient, implanting at least a second tissue-engaging element in a portion of a blood vessel that is in contact with an atrium of a heart of the patient, and drawing at least a first leaflet of the valve toward at least a second leaflet of the 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. Other applications are also described.
1. A method, comprising:
implanting at least a first tissue-engaging element in a first portion of tissue in a vicinity of a tricuspid valve of a patient;
implanting at least a second tissue-engaging element in a portion of a blood vessel selected from the group of blood vessels consisting of: a superior vena cava and an inferior vena cava; and
drawing at least a first leaflet of the tricuspid valve toward at least a second leaflet of the tricuspid valve by performing a tensioning method selected from the group consisting of:
(a) adjusting a distance between the portion of the blood vessel and the first tissue portion, and maintaining the adjusted distance using tension applied to the first tissue-engaging element and the second tissue-engaging element by a longitudinal member that connects the first and the second tissue-engaging elements, and
(b) adjusting the distance between the portion of the blood vessel and the first tissue portion by applying tension to the first tissue-engaging element and the second tissue-engaging element using the longitudinal member.
2. The method according to claim 1 , wherein adjusting the distance between the portion of the blood vessel and the first tissue portion comprises pulling the longitudinal member that connects the first and second tissue-engaging elements.
3. The method according to claim 1 , further comprising monitoring repair of the tricuspid valve in conjunction with the adjusting the distance between the portion of the blood vessel and the first tissue portion.
4. The method according to claim 1 , wherein adjusting the distance between the portion of the blood vessel and the first tissue portion of tissue comprises pulling the first tissue-engaging element toward the portion of the blood vessel.
5. The method according to claim 1 , wherein adjusting the distance between the portion of the blood vessel and the first tissue portion comprises achieving bicuspidization of the tricuspid valve.
6. The method according to claim 1 , wherein adjusting the distance between the portion of the blood vessel and the first tissue portion comprises actuating an adjusting mechanism that is coupled to a portion of the longitudinal member that connects the first and second tissue-engaging elements.
7. The method according to claim 1 , wherein the second tissue-engaging element comprises a stent, and wherein implanting the second tissue-engaging element in the portion of the blood vessel comprises expanding the stent in the portion of the blood vessel.
8. The method according to claim 1 , wherein implanting the first tissue-engaging element in the first tissue portion comprises engaging the first portion of tissue by performing one or more actions selected from the group consisting of: puncturing and squeezing the first tissue portion and advancing at least a portion of the first tissue-engaging element into the first tissue portion.
9. The method according to claim 8 , wherein:
the first tissue portion includes a portion of tissue of that is opposite the portion of the blood vessel of the patient,
engaging the first tissue portion comprises engaging the portion of tissue that is opposite the portion of the blood vessel of the patient, and
drawing the first leaflet of the tricuspid valve toward the second leaflet of the tricuspid 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.
10. The method according to claim 8 , wherein the first tissue portion includes a portion of tissue of a wall of a right atrium of the heart above an annulus of the tricuspid valve, and wherein engaging the first tissue portion comprises engaging the portion of tissue of the wall of the right atrium.
11. The method according to claim 8 , wherein the first tissue portion includes a portion of tissue of an annulus of the valve, and wherein engaging the first tissue portion comprises engaging the portion of tissue of the annulus of the valve.
12. The method according to claim 11 , wherein the portion of tissue of the annulus of the valve includes a portion of tissue that is between a middle portion of an anterior leaflet of the valve and a middle portion of a posterior leaflet of the valve.
13. The method according to claim 1 , wherein performing the tensioning method comprises adjusting the distance between the portion of the blood vessel and the first tissue portion, and maintaining the adjusted distance using the tension applied to the first tissue-engaging element and the second tissue-engaging element by the longitudinal member.
14. The method according to claim 1 , wherein performing the tensioning method comprises adjusting the distance between the portion of the blood vessel and the first tissue portion by applying tension to the first tissue-engaging element and the second tissue-engaging element using the longitudinal member.
15. The method according to claim 1 , wherein implanting the first tissue-engagement element comprises advancing a catheter through vasculature of the patient to the vicinity of the tricuspid valve, and deploying the first tissue-engaging element from the catheter.
16. The method according to claim 2 , wherein pulling the longitudinal member comprises pulling the longitudinal member prior to implanting the second tissue-engaging element.
17. The method according to claim 2 , wherein adjusting the distance between the portion of the blood vessel and the first portion of tissue in the vicinity of the tricuspid valve comprises pulling on the second tissue-engaging element in order to pull the longitudinal member.
18. The method according to claim 3 , wherein monitoring the repair of the tricuspid valve comprises monitoring the drawing together of the first and the second leaflets of the tricuspid valve.
19. The method according to claim 3 , wherein monitoring the repair of the tricuspid valve comprises monitoring a level of regurgitation of the tricuspid valve in conjunction with the adjusting the distance.
20. The method according to claim 7 , wherein expanding the stent comprises expanding the stent in the portion of the blood vessel so as to allow free flow of blood through the stent throughout a cardiac cycle of the patient.