Sequentially deployed transcatheter mitral valve prosthesis
A sequentially deployed prosthetic cardiac valve includes a self-expanding frame having an atrial skirt, a ventricular skirt, and an annular region disposed therebetween. A first anterior tab is disposed on an anterior portion of the frame. A posterior tab is on a posterior portion of the self-expanding frame. The frame may be designed so that any portion may expand sequentially in any desired order. For example, a portion of the first anterior tab and a portion of the posterior tab may partially self-expand first. Next, the first anterior tab may fully self-expand before the posterior tab fully self-expands. The posterior tab may fully self-expand next followed by the ventricular skirt, or the ventricular skirt may self-expand next followed by full expansion of the posterior tab.
1. A method of delivering an implantable prosthetic valve to a patient's heart, the patient's heart having a mitral valve with an anterior leaflet and a posterior leaflet, said method comprising:
providing a prosthetic valve, wherein the prosthetic valve comprises an expandable frame having a first end, a second end opposite the first end, a first anterior tab on an anterior portion of the expandable frame, a posterior tab on a posterior portion of the expandable frame, and a ventricular skirt adjacent the first end of the expandable frame;
delivering the prosthetic valve in a collapsed configuration to the patient's heart;
expanding the first anterior tab radially outward such that the first anterior tab engages a first fibrous trigone on a first side of the anterior leaflet of the mitral valve;
after radially expanding the first anterior tab, radially expanding the ventricular skirt outward thereby engaging the anterior leaflet,
wherein the anterior leaflet and adjacent anterior chordae tendineae are disposed between the first anterior tab and an outer anterior surface of the ventricular skirt;
after radially expanding the ventricular skirt, radially expanding the posterior tab outward such that the posterior leaflet of the mitral valve and adjacent posterior chordae tendinae are disposed between the posterior tab and an outer posterior surface of the ventricular skirt.
2. The method of claim 1 , wherein delivering the prosthetic valve comprises transapically delivering the prosthetic valve from a region outside the heart to the left ventricle of the heart.
3. The method of claim 1 , wherein delivering the prosthetic valve comprises transseptally delivering the prosthetic valve from the right atrium to the left atrium of the heart.
4. The method of claim 1 , wherein delivering the prosthetic valve comprises positioning the prosthetic valve across the mitral valve so that the first end of the expandable frame is inferior to a portion of the mitral valve and the second end of the expandable frame is superior to a portion of the mitral valve.
5. The method of claim 1 , wherein expanding the first anterior tab comprises retracting a constraining sheath from the first anterior tab so that the first anterior tab is free to self-expand radially outward.
6. The method of claim 1 , wherein the prosthetic valve further comprises a second anterior tab on the anterior portion of the expandable frame, the method further comprising expanding the second anterior tab radially outward such that the second anterior tab engages a second fibrous trigone on a second side of the anterior leaflet opposite the first side of the anterior leaflet, and
wherein the anterior leaflet and adjacent anterior chordae tendineae are disposed between the second anterior tab and the outer anterior surface of the ventricular skirt.
7. The method of claim 6 , wherein the second anterior tab expands radially outward concurrently with the radial expansion of the first anterior tab.
8. The method of claim 6 , wherein prior to engaging the first fibrous trigone or the second fibrous trigone with the respective first or second anterior tab, and prior to disposing the anterior leaflet and the adjacent chordae tendineae between the first or second anterior tab and the outer anterior surface of the ventricular skirt, the method comprises partially expanding the first or the second anterior tab radially outward such that the first or the second anterior tab is transverse to a longitudinal axis of the prosthetic valve.
9. The method of claim 6 , wherein expanding the second anterior tab comprises retracting a constraining sheath from the second anterior tab so that the second anterior tab is free to self-expand radially outward.
10. The method of claim 1 , wherein radially expanding the ventricular skirt comprises retracting a constraining sheath from the ventricular skirt so that the ventricular skirt is free to self-expand radially outward.
11. The method of claim 1 , wherein expanding the ventricular skirt displaces the anterior and posterior valve leaflets radially outward without contacting an inner wall of the left ventricle, and without obstructing a left ventricular outflow tract.
12. The method of claim 1 , wherein radially expanding the ventricular skirt expands the ventricular skirt asymmetrically such that an anterior portion of the ventricular skirt is substantially flat, and a posterior portion of the ventricular skirt is cylindrically shaped.
13. The method of claim 1 , wherein prior to disposing the posterior leaflet of the mitral valve and the adjacent posterior chordae tendineae between the posterior tab and the outer posterior surface of the ventricular skirt, the method comprises partially expanding the posterior tab radially outward such that the posterior tab is transverse to a longitudinal axis of the prosthetic valve.
14. The method of claim 1 , wherein after the anterior leaflet and the adjacent chordae tendineae are disposed between the first anterior tab and the outer anterior surface of the ventricular skirt, the method comprises partially expanding the posterior tab radially outward such that the posterior tab is transverse to a longitudinal axis of the prosthetic valve, and wherein the posterior tab is partially expanded without disposing the posterior leaflet of the mitral valve and the adjacent posterior chordae tendineae between the posterior tab and the outer posterior surface of the ventricular skirt.
15. The method of claim 1 , wherein the prosthetic valve comprises an alignment element, and wherein a second fibrous trigone is disposed on a second side of the anterior leaflet opposite the first side of the anterior leaflet, the method further comprising aligning the alignment element with an aortic root and disposing the alignment element between the first and second fibrous trigones.
16. The method of claim 15 , wherein aligning the alignment element comprises rotating the prosthetic valve.
17. The method of claim 1 , wherein the prosthetic valve further comprises an atrial skirt, the method further comprising:
expanding the atrial skirt radially outward so as to lie over a superior surface of the mitral valve; and
engaging the atrial skirt against the superior surface of the mitral valve.
18. The method of claim 17 , wherein expanding the atrial skirt comprises retracting a constraining sheath from the atrial skirt so that the atrial skirt is free to self-expand radially outward.
19. The method of claim 1 , wherein the prosthetic valve further comprises an annular region, the method further comprising:
expanding the annular region radially outward so as to conform with an annulus of the mitral valve; and
engaging the annular region with the mitral valve annulus.
20. The method of claim 19 , wherein expanding the annular region comprises retracting a constraining sheath from the annular region so that the annular region is free to self-expand radially outward.
21. The method of claim 19 , wherein expanding the annular region comprises asymmetrically expanding the annular region such that an anterior portion of the annular region is substantially flat, and a posterior portion of the annular region is cylindrically shaped.