Prosthetic heart valve devices and associated systems and methods
Prosthetic heart valve devices for percutaneous replacement of native heart valves and associated systems and method are disclosed herein. A prosthetic heart valve device configured in accordance with a particular embodiment of the present technology can include an expandable support having an outer surface and configured for placement between leaflets of the native valve. The device can also include a plurality of asymmetrically arranged arms coupled to the expandable support and configured to receive the leaflets of the native valve between the arms and the outer surface. In some embodiments, the arms can include tip portions for engaging a subannular surface of the native valve.
1. A prosthetic treatment apparatus for treating a native atrioventricular valve having a native annulus and native leaflets, the prosthetic treatment apparatus comprising:
a support having a downstream portion configured to be positioned toward a ventricle and an upstream portion configured to be positioned toward an atrium, wherein the support is expandable from a low-profile configuration for delivery to an expanded configuration for implantation at the native atrioventricular valve;
a prosthetic valve mounted to the support and adapted to allow blood flow in a downstream direction and to block blood flow in an upstream direction;
a plurality of arms at the downstream portion of the support, wherein the arms extend outwardly from the support in an upstream direction when the support is in the expanded configuration; and
a skirt having a first end coupled to the upstream portion of the support and a second end downstream of the first end,
wherein at least a portion of the skirt extends radially outwardly from the support separate from the arms such that the first end of the skirt has a first diameter and a portion of the skirt between the first end of the skirt and the second end of the skirt has a second diameter greater than the first diameter, the skirt extends around an entire circumference of the support, and the skirt is configured to fill gaps between the support and native tissue to inhibit blood flow therethrough; and
wherein the second end of the skirt is disposed between the arms and the support when the support is in the expanded configuration.
2. The prosthetic treatment apparatus of claim 1 , wherein the skirt radially expands with the support.
3. The prosthetic treatment apparatus of claim 1 , wherein the arms are biased outwardly.
4. The prosthetic treatment apparatus of claim 1 , wherein the arms are configured to capture native tissue between the arms and the support as the support expands.
5. The prosthetic treatment apparatus of claim 1 , wherein the skirt is configured to be urged against the native tissue at or below the native annulus by blood.
6. The prosthetic treatment apparatus of claim 1 wherein the arms are configured to engage native tissue downstream of the native annulus.
7. The prosthetic treatment apparatus of claim 1 , further comprising one or more of a cover or a coating disposed on at least a portion of the arms in a manner that distributes forces applied by the arms on native tissue.
8. The prosthetic treatment apparatus of claim 1 , wherein the arms comprise a tip at an end of one or more arms configured to atraumatically engage tissue.
9. The prosthetic treatment apparatus of claim 1 , wherein the arms are configured to push against at least one of leaflets or chordae of the native mitral valve.
10. The prosthetic treatment apparatus of claim 1 , wherein the arms are distributed circumferentially around the support in a manner that distributes pressure across the subannular surface of the native atrioventricular valve.
11. The prosthetic treatment apparatus of claim 1 , wherein the arms comprise curved elbow portions, and wherein the curved elbow portions of the arms comprise arcuate portions that extend from a downstream end of the downstream portion of the support.
12. The prosthetic treatment apparatus of claim 11 , wherein the arcuate portions extend radially inward relative to an outer surface of the support.
13. The prosthetic treatment apparatus of claim 1 , wherein the support comprises a frame having a plurality of struts.
14. The prosthetic treatment apparatus of claim 1 , further comprising:
an interior skirt coupled to an interior of the support.
15. The prosthetic treatment apparatus of claim 1 , further comprising wires coupled to the skirt configured to maintain a desired shape of the skirt.
16. The prosthetic treatment apparatus of claim 1 , wherein each of the plurality of arms includes a first portion extending in a downstream direction from the downstream portion of the support, a bend at a downstream end of the first portion, a second portion extending in an upstream direction from the bend, and tip portion at an upstream end of the second portion.
17. The prosthetic treatment apparatus of claim 16 , further comprising:
a plurality of coverings, each covering of the plurality of coverings coupled to a respective one of the plurality of arms such that each of the plurality of arms and each of the plurality of coverings combine to form a plurality of atraumatic tips.
18. The prosthetic treatment apparatus of claim 17 , wherein each atraumatic tip includes a cross-sectional diameter that is greater than a cross-sectional diameter of the corresponding arm covered with the covering in a portion other than the tip portion.
19. The prosthetic treatment apparatus of claim 17 , wherein each of the plurality of atraumatic tips has a length and has a greater surface area along that length than the surface area of a corresponding length of a portion other than the tip portion of the arm with the covering.
20. The prosthetic treatment apparatus of claim 17 , wherein the tip portion of each arm is atraumatic.
21. The prosthetic treatment apparatus of claim 20 , wherein each tip portion comprises one or more of a bumper, a cotton-swab-shaped tip, a broadened clubhead, a disk, a curved tip, a loop, a cap, an eyelet, a spherical ball, a non-spherical ball, or a teardrop shaped structure.
22. The prosthetic treatment apparatus of claim 17 , wherein each of the plurality of coverings comprises a material promoting one or more of tissue in-growth or tissue encapsulation.
23. The prosthetic treatment apparatus of claim 17 , wherein the plurality of coverings comprises one or more of polyethylene terephthalate (PTE), polytetrafluoroethylene (PTFE), or expanded polytetrafluoroethylene (ePTFE).
24. The prosthetic treatment apparatus of claim 17 , wherein each of the plurality of arms is part of the same structure as the support.
25. The prosthetic treatment apparatus of claim 17 , wherein the plurality of arms is one or more separate components coupled to the support.
26. The prosthetic treatment apparatus of claim 17 , wherein the support includes a plurality of struts in a zig-zag pattern, and a downstream edge of the support is defined by a plurality of nodes, wherein the first portion of each of the plurality of arms is coupled to a respective single node of the plurality of nodes, and wherein the tip portion of each arm is a free end.