Method and apparatus for transvascular implantation of neo chordae tendinae
Methods and devices for transvascular prosthetic chordae tendinea implantation are disclosed. A catheter is advanced into the left atrium, through the mitral valve, and into the left ventricle. A ventricular anchor is deployed from the catheter and into a wall of the left ventricle, leaving a ventricular suture attached to the ventricular anchor and extending proximally through the catheter. A leaflet anchor is deployed to secure a mitral valve leaflet to a leaflet suture, with the leaflet suture extending proximally through the catheter. The leaflet suture is secured to the ventricular suture to limit a range of travel of the leaflet in the direction of the left atrium. Also disclosed is an assembled in situ mitral valve leaflet restraint, having a neo papillary muscle and a neo chordae tendinea.
1. A method of securing a leaflet anchor to a mitral valve leaflet, comprising:
advancing a catheter into a left atrium;
securing a temporary leaflet connector to the mitral valve leaflet from an atrial side of the mitral valve leaflet; and
after securing the temporary leaflet connector to the mitral valve leaflet, advancing a needle preloaded with the leaflet anchor through the mitral valve leaflet from the atrial side to secure the mitral valve leaflet to a leaflet suture.
2. The method of claim 1 , wherein securing the temporary leaflet connector comprises transiently applying a cooling effect to the mitral valve leaflet.
3. The method of claim 1 , wherein the securing the temporary leaflet connector comprises transiently applying a suction to the mitral valve leaflet.
4. The method of claim 1 , wherein the securing the temporary leaflet connector comprises transiently grasping the mitral valve leaflet.
5. The method of claim 1 , wherein the securing the temporary leaflet connector comprises transiently piercing the mitral valve leaflet.
6. The method of claim 1 , further comprising advancing a delivery tube through the catheter, with the temporary leaflet connector carried by the delivery tube.
7. The method of claim 1 , further comprising advancing the needle distally out of the catheter and advancing the leaflet anchor distally out of the needle.
8. The method of claim 1 , further comprising:
proximally retracting the needle and removing the temporary leaflet connector from the mitral valve leaflet; and
leaving the leaflet anchor on a ventricular side of the mitral valve leaflet and the leaflet suture extending proximally through the mitral valve leaflet.
9. The method of claim 1 , further comprising securing the temporary leaflet connector to the mitral valve leaflet to stabilize the temporary leaflet connector against moving.
10. The method of claim 1 , further comprising deploying of the leaflet anchor from the needle by advancing the leaflet anchor through an internal lumen of the needle.
11. A method of securing a leaflet anchor to a mitral valve leaflet, comprising:
advancing a catheter into a left atrium;
securing a temporary leaflet connector to a mitral valve leaflet from an atrial side of the mitral valve leaflet; and
after securing the temporary leaflet connector to the mitral valve leaflet, advancing the leaflet anchor through the mitral valve leaflet to secure the mitral valve leaflet to a leaflet suture,
wherein the leaflet anchor is radially enlargeable from a delivery configuration to an enlarged configuration to secure the mitral valve leaflet to the leaflet suture, and wherein the radially enlargeable leaflet anchor is carried within a needle having a sharpened end for piercing the mitral valve leaflet.
12. The method of claim 11 , wherein the radially enlargeable leaflet anchor comprises a pledget.
13. The method of claim 12 , wherein the pledget comprises the leaflet suture positioned between two sheets of material.
14. The method of claim 12 , wherein the pledget is transformable from an elongate strip configuration to a radially enlarged, axially shortened configuration by proximal retraction of the leaflet suture.
15. The method of claim 12 , wherein the pledget is transformable from a reduced cross section conformation with two wings rolled around a longitudinal axis of the pledget to a radially enlarged configuration by proximal retraction of the leaflet suture.
16. The method of claim 12 , wherein the leaflet suture is integrally formed with the pledget.
17. The method of claim 11 , wherein the enlarged leaflet configuration of the leaflet anchor is configured to seat against the atrial side of the mitral valve leaflet.
18. The method of claim 11 , further comprising anchoring the leaflet suture in the mitral valve leaflet.
19. The method of claim 11 , wherein the leaflet suture remains extending through the catheter from the leaflet anchor after anchoring the leaflet suture to the mitral valve leaflet.