Transcatheter deliverable prosthetic heart valves and methods of delivery
A prosthetic valve includes a frame and a flow control component. The frame has an aperture extending through the frame about a central axis. The flow control component is mounted within the aperture and is configured to permit blood flow in a first direction approximately parallel to the vertical axis from an inflow end to an outflow end of the flow control component and to block blood flow in a second direction, opposite the first direction. The frame has an expanded configuration with a first height along the central axis, a first lateral width along a lateral axis perpendicular to the central axis, and a first longitudinal length along a longitudinal axis perpendicular to the central axis and the lateral axis. The frame has a compressed configuration with a second height less than the first height and a second lateral width less than the first lateral width.
1. A prosthetic valve, comprising:
a tubular frame having a sidewall and an atrial collar attached around a top edge of the sidewall;
a distal subannular anchoring tension arm extending from a lower distal edge of the side wall of the tubular frame, the distal subannular anchoring tension arm extending away from the distal side wall of the tubular frame; and
a flow control component mounted within the tubular frame and configured to permit blood flow in a first direction through an inflow end of the prosthetic valve and block blood flow in a second direction, opposite the first direction, through an outflow end of the prosthetic valve,
wherein the prosthetic valve is compressible to a compressed configuration for introduction into the body using a delivery catheter and expandable to an expanded configuration for implanting at a desired location in the body, the prosthetic valve having a long-axis oriented at an intersecting angle of between 45-135 degrees to the first direction when the prosthetic valve is in each of the compressed configuration and the expanded configuration, and
wherein when the prosthetic valve in the compressed configuration is disposed in a lumen of the delivery catheter, the long-axis of the prosthetic valve is substantially parallel to a length-wise cylindrical axis of the lumen of the delivery catheter.
2. The prosthetic valve of claim 1 , wherein the sidewall of the tubular frame is a trans-annular tubular segment of the tubular frame, the atrial collar includes a flared atrial cuff joined to the trans-annular tubular segment around a circumference of a top edge of the trans-annular tubular segment.
3. The prosthetic valve of claim 1 , wherein the tubular frame is formed of one or more of a braid, wire, or laser-cut wire frame, an inner surface and an outer surface of the tubular frame being covered with a biocompatible material.
4. The prosthetic valve of claim 3 , wherein the biocompatible material includes one or more of pericardial tissue and a woven synthetic polyester material.
5. The prosthetic valve of claim 1 , wherein the tubular frame has a side profile forming an hourglass shape.
6. The prosthetic valve of claim 1 , wherein the flow control component has a plurality of leaflets of pericardial material joined to form a rounded cylinder at an inflow end of the flow control component and having a flat closable aperture at an outflow end of the flow control component.
7. The prosthetic valve of claim 1 , wherein the distal subannular anchoring tension arm is a wire loop or wire frame, an integrated frame section, or a stent.
8. The prosthetic valve of claim 1 , wherein the distal subannular anchoring tension arm has a length of 10-40 mm.
9. The prosthetic valve of claim 1 , further comprising:
a proximal subannular anchoring tension arm extending from a lower proximal edge of the side wall of the tubular frame; and
at least one tissue anchor connected to the tubular frame for engaging native tissue.
10. A frame for a prosthetic valve, the frame comprising:
a tubular frame defining a central lumen extending along a vertical axis of the tubular frame, the tubular frame having an outer circumferential surface engageable with native annular tissue; and
a subannular tension arm extending away from one side of a subannular portion of the tubular frame, the subannular tension arm being formed of wire loop or wire frame, integrated frame section, or stent,
wherein the tubular frame is compressible to a compressed configuration for introduction into the body using a delivery catheter and expandable to an expanded configuration for implanting at a desired location in the body, the prosthetic valve having a horizontal long-axis oriented at an intersecting angle between 45-135 degrees relative to the vertical axis of the of the tubular frame when the prosthetic valve is in each of the compressed configuration and the, and
wherein when the tubular frame in the compressed configuration is disposed in a lumen of the delivery catheter, the horizontal long-axis of the tubular frame is substantially parallel to a lengthwise cylindrical axis of the lumen of the delivery catheter.
11. The frame of claim 10 , wherein the tubular frame includes a flared atrial cuff joined to a trans-annular tubular segment around a top edge of the trans-annular tubular segment, the outer circumferential surface being an outer circumferential surface of the trans-annular tubular segment.
12. The frame of claim 10 , wherein said tubular frame is formed of a braid, wire, or laser-cut wire frame and is covered with a biocompatible material.
13. The frame of claim 10 , wherein the tubular frame is coupleable to a flow control component along an inner circumferential surface of the tubular frame, the flow control component having a plurality of leaflets of pericardial material joined to form a rounded cylinder at an inflow end of the flow control component and having a closable aperture at an outflow end of the flow control component.
14. The frame of claim 10 , further comprising:
an upper tension arm attached to and extending away from an upper edge of the tubular frame, the upper tension arm formed of wire loop or wire frame; and
a lower tension arm attached to and extending away from a lower edge of the tubular frame, the lower tension arm formed of wire loop or wire frame, integrated frame section, or stent.
15. A method for delivering a prosthetic valve to an annulus of a native valve between a ventricle and an atrium of a heart, the method comprising:
advancing to the atrium of the heart a delivery catheter containing the prosthetic valve in a compressed configuration, the prosthetic valve including a tubular frame and a flow control component mounted within the tubular frame and configured to permit blood flow in a first direction through the prosthetic valve and block blood flow in a second direction, opposite the first direction, the prosthetic valve having a long-axis oriented at an intersecting angle of between 45-135 degrees to the first direction, the long-axis of the prosthetic valve when in the compressed configuration being substantially parallel to a length-wise cylindrical axis of the delivery catheter;
releasing at least a distal subannular anchoring tension arm of the prosthetic valve from the delivery catheter by pushing the prosthetic valve in a distal direction relative to the delivery catheter using a pushing rod that is releasably connected to the prosthetic valve;
delivering the distal subannular anchoring tension arm to the ventricle side of the annulus of the native valve;
releasing a remainder of the prosthetic valve from the delivery catheter to allow the prosthetic valve to expand to an expanded configuration; and
seating the prosthetic valve so the tubular frame is disposed within the annulus of the native valve.
16. The method of claim 15 , further comprising:
positioning the distal subannular anchoring tension arm of the prosthetic valve into the right ventricular outflow tract of the right ventricle; and
positioning a distal upper tension arm of the prosthetic valve into a supra-annular position, the distal upper tension arm providing a supra-annular force in a direction of the ventricle and the distal subannular anchoring tension arm providing a sub-annular force in a direction of the atrium.
17. The method of claim 15 , further comprising:
rotating the prosthetic valve using a steerable catheter along an axis parallel to a plane of the annulus of the native valve,
wherein a distal upper tension arm of the prosthetic valve is pressure locked against supra-annular tissue on an atrium side of the native valve, and
wherein the distal subannular anchoring tension arm of the prosthetic valve is pressure locked against sub-annular tissue on a ventricle side of the native valve.
18. The method of claim 15 , wherein prior to the seating the prosthetic valve, the method further comprising:
allowing blood to flow from the atrium to the ventricle through both of the native valve and the prosthetic valve.
19. The method of claim 15 , wherein prior to the advancing to the atrium of the heart the delivery catheter containing the prosthetic valve in the compressed configuration, the method further comprising:
transitioning the prosthetic valve to the compressed configuration by compressing the prosthetic valve laterally in a direction perpendicular to the first direction and compressing the prosthetic valve axially in a direction parallel to the first direction; and
loading the prosthetic valve in the compressed configuration into the lumen of the delivery catheter such that the long-axis of the prosthetic valve is substantially parallel to the length-wise cylindrical axis of the delivery catheter.