Transvalvular intraanular band and chordae cutting for ischemic and dilated cardiomyopathy
Mitral valve prolapse and mitral regurgitation can be treating by implanting in the mitral annulus a transvalvular intraannular band. The band is positioned so that it extends transversely across a coaptive edge formed by the closure of the mitral valve leaflets, to inhibit prolapse into the left atrium. At least one marginal chordae is severed, to permit leaflet closure against the band.
1. A method of treating a cardiac valve comprising:
providing an intraannular band dimensioned for attachment within a mitral valve annulus, wherein the intraannular band comprises a body having a first end, a second end, and a convex shaped central portion, wherein the intraannular band does not comprise an annuloplasty ring; and
attaching the intraannular band within the mitral valve annulus such that the convex shaped central portion extends transversely across a coaptive edge formed by mitral valve leaflets, and such that the convex shaped central portion is convex in a direction of a ventricle.
2. The method as in claim 1 , further comprising elevating a position of the coaptive edge by at least about 4 mm.
3. The method as in claim 1 , further comprising elevating a position of the coaptive edge in the range of from about 6 mm to about 12 mm.
4. The method as in claim 1 , wherein the convex shaped central portion comprises a narrowed portion configured to reduce resistance to blood flow.
5. The method as in claim 1 , wherein the body further comprises first and second anchoring portions, the first anchoring portion located proximate the first end, the second anchoring portion located proximate the second end, wherein the first and second anchoring portions are configured to be attached to tissue proximate the mitral valve annulus.
6. The method as in claim 5 , wherein the body further comprises first and second shoulder portions, the first shoulder portion located between the first anchoring portion and the convex shaped central portion, the second shoulder portion located between the second anchoring portion and the convex shaped central portion, wherein part of the convex shaped central portion is narrower than the first and second shoulder portions to reduce resistance to blood flow, and wherein part of the first and second shoulder portions are narrower than the first and second anchoring portions to reduce resistance to blood flow.
7. The method as in claim 5 , wherein the body further comprises first and second shoulder portions, the first shoulder portion located proximate the first anchoring portion and the convex shaped central portion, the second shoulder portion located proximate the second anchoring portion and the convex shaped central portion, wherein the first and second shoulder portions taper from a first width to a second width, the second width less than the first width.
8. The method as in claim 7 , wherein the first width comprises a width of the first or second anchoring portion and the second width comprises a width of the convex shaped central portion.
9. A method of treating a cardiac valve comprising:
implanting in a mitral annulus an intraannular band comprising a body having a first end, a first anchoring portion located proximate the first end, a second end, a second anchoring portion located proximate the second end, and a convex shaped central portion, wherein the convex shaped central portion is displaced out of a reference plane containing the first and second ends;
attaching the first anchoring portion to a first portion of tissue proximate the mitral annulus; and
attaching the second anchoring portion to a second portion of tissue proximate the mitral annulus such that the intraannular band extends transversely across a coaptive edge formed by the closure of mitral valve leaflets during systole, and such that the convex shaped central portion is convex in a direction of the left ventricle,
wherein attaching the first and second anchoring portions does not affect the size and shape of the mitral annulus.
10. The method as in claim 9 , wherein the body further comprises first and second shoulder portions, the first shoulder portion located between the first anchoring portion and the convex shaped central portion, the second shoulder portion located between the second anchoring portion and the convex shaped central portion, wherein part of the convex shaped central portion is narrower than the first and second shoulder portions to reduce resistance to blood flow, and wherein part of the first and second shoulder portions are narrower than the first and second anchoring portions to reduce resistance to blood flow.
11. The method as in claim 10 , wherein the first and second shoulder portions taper from a first width to a second width, the second width less than the first width, wherein the first width comprises a width of the first or second anchoring portion and the second width comprises a width of the convex shaped central portion.
12. The method as in claim 9 , further comprising elevating a position of the coaptive edge by at least about 4 mm.
13. A method of treating a cardiac valve comprising:
providing an intraannular band dimensioned for attachment within an intraannular plane of a heart valve annulus, wherein the intraannular band comprises a body having a first end, a second end, and a convex shaped central portion; and
attaching the intraannular band within the intraannular plane of the heart valve annulus such that the convex shaped central portion extends out of a reference plane including a portion of the first and second ends, such that the convex shaped central portion extends transversely across a coaptive edge formed by two or three valve leaflets, and such that the convex shaped central portion is convex in a direction of an outflow side of the intraannular plane to support the two or three valve leaflets.
14. The method as in claim 13 , wherein the first and second anchoring portions comprise an arcuate shape, wherein the arcuate shape is configured to extend around a portion of a circumference proximate the heart valve annulus.
15. The method as in claim 13 , wherein the body further comprises first and second anchoring portions and first and second shoulder portions, the first anchoring portion located proximate the first end, the second anchoring portion located proximate the second end, the first shoulder portion located proximate the first anchoring portion and the convex shaped central portion, the second shoulder portion located proximate the second anchoring portion and the convex shaped central portion, wherein the convex shaped central portion comprises a narrowed portion narrower than part of the first and second shoulder portions to reduce resistance to blood flow, and wherein the first and second shoulder portions comprise a narrowed portion narrower than part of the first and second anchoring portions to reduce resistance to blood flow.
16. The method as in claim 15 , wherein the first and second shoulder portions taper from a first width to a second width, the second width less than the first width, wherein the first width comprises a width of the first or second anchoring portion and the second width comprises a width of the convex shaped central portion.
17. The method as in claim 13 , wherein the convex shaped central portion is formed with a frame, the frame comprising at least one strut extending between the first and second ends.
18. The method as in claim 13 , wherein the heart valve annulus is a mitral valve annulus or an aortic valve annulus.
19. The method as in claim 13 , wherein further comprising elevating a position of the coaptive edge by at least about 4 mm.
20. The method as in claim 13 , wherein further comprising elevating a position of the coaptive edge in the range of from about 6 mm to about 12 mm.
21. The method as in claim 13 , wherein the cardiac valve is a tricuspid valve.