Methods and systems for delivering prostheses using rail techniques
Exemplary embodiments provide methods and systems for delivering a prosthesis to a target location in a luminal system of a patient. At least one tether is secured proximate the target location to serve as a rail, and a prosthesis is advanced along the rail to the target location and secured in place. Exemplary methods and systems provide for repair of the mitral and tricuspid valves, as well as abdominal aortic aneurysms, stomach valves, fallopian tubes and the pulmonary system, among others. Also disclosed are various prostheses suitable for use with the disclosed methods and systems.
1 . A method of delivering a first prosthesis to a cardiac valve annulus, comprising:
introducing a distal end of an anchor delivery catheter to a location proximate a cardiac valve;
forming a first new, non-native passageway through cardiac tissue adjacent a first commissure of the cardiac valve;
advancing a first elongate tether through the first new, non-native passageway;
coupling a distal end of a first further tether to a proximal end of the first elongate tether;
advancing the first elongate tether distally to pull a portion of the first further tether through the first new, non-native passageway;
forming a second new, non-native passageway through cardiac tissue adjacent a second commissure of the cardiac valve;
advancing a second elongate tether through the second new, non-native passageway;
coupling a distal end of a second further tether to a proximal end of the second elongate tether;
advancing the second elongate tether distally to pull a portion of the second further tether through the second new, non-native passageway;
advancing the first prosthesis over the first further tether and the second further tether to direct the first prosthesis into place proximate the cardiac valve annulus; and
securing the first prosthesis in place proximate the cardiac valve annulus.
2 . The method of claim 1 , wherein the securing step includes locking the first prosthesis in place by engaging at least one lock onto at least one of the first further tether and second further tether.
3 . The method of claim 1 , wherein the first prosthesis occupies a full circumference of the cardiac valve annulus, and further wherein the first prosthesis is ring-shaped.
4 . The method of claim 1 , wherein the first prosthesis occupies only a portion of a circumferential extent of the cardiac valve annulus, and further wherein the first prosthesis is arcuately shaped.
5 . The method of claim 1 , wherein the first prosthesis defines a plurality of tether guide conduits therethrough, wherein each said tether guide conduit receives one of the respective first further tether and second further tether therethrough.
6 . The method of claim 5 , wherein the securing step includes locking each said further tether into a respective tether guide conduit of the plurality of tether guide conduits.
7 . The method of claim 6 , wherein each said further tether is locked into a respective tether guide conduit by way of an interference fit between each said further tether and each said tether guide conduit.
8 . The method of claim 1 , wherein the first prosthesis defines a fully open channel therethrough to serve as a platform for attaching a second prosthesis.
9 . The method of claim 8 , further comprising:
advancing the second prosthesis over the first further tether and second further tether to direct the second prosthesis toward the first prosthesis; and
coupling the second prosthesis to the first prosthesis.
10 . The method of claim 9 , wherein the second prosthesis includes a replacement cardiac valve.
11 . The method of claim 10 , wherein the replacement cardiac valve is a full replacement cardiac valve that occupies a full circumferential extent of the cardiac valve annulus.
12 . The method of claim 10 , wherein the replacement cardiac valve is a partial replacement cardiac valve that occupies only a portion of a circumferential extent of the cardiac valve annulus.
13 . The method of claim 1 , wherein the first prosthesis includes a plurality of radiopaque markers disposed about its circumference to facilitate axial and rotational alignment of the first prosthesis with respect to the cardiac valve annulus.
14 . The method of claim 1 , wherein the cardiac valve is a mitral valve.
15 . The method of claim 1 , wherein the cardiac valve is a tricuspid valve.