EXTERIORLY MOUNTED TISSUE ON EXPANDABLE FRAME FOR IMPROVED HEMODYNAMIC PERFORMANCE

1 . A replacement heart valve prosthesis for transcatheter repair of a native valve, the replacement heart valve comprising:

a frame having a distal end, a proximal end, and a length between the distal end and the proximal end, the frame further comprising an exterior surface and an interior surface defining a lumen, the frame expandable from an unexpanded state to an expanded state, wherein the frame further comprises:

an expandable region near the distal end of the frame; and

a cusp region near the proximal region comprising a plurality of valve attachment features; and

a valve construct mounted to the exterior surface of the frame, wherein the valve construct is attached to the valve construct at least at the valve attachment features.

2 . The prosthesis of claim 1 , wherein the cusp region comprises a plurality of posts.

3 . The prosthesis of claim 2 , wherein each post is connected to a circumferentially adjacent post with a strut, the strut defining a cusp opening.

4 . The prosthesis of claim 3 wherein each leaflet spans an adjacent cusp opening and the leaflet traverses the cusp opening into the lumen of the frame.

5 . The prosthesis of claim 3 , wherein the strut is an arched strut.

6 . The prosthesis of claim 1 , wherein the valve construct comprises at least two leaflets.