Collapsible and re-expandable prosthetic heart valve cuff designs and complementary technological applications
A prosthetic heart valve is provided with a cuff having features which promote sealing with the native tissues even where the native tissues are irregular. The cuff may include a portion adapted to bear on the LVOT when the valve is implanted in a native aortic valve. The valve may include elements for biasing the cuff outwardly with respect to the stent body when the stent body is in an expanded condition. The cuff may have portions of different thickness distributed around the circumference of the valve in a pattern matching the shape of the opening defined by the native tissue. All or part of the cuff may be movable relative to the stent during implantation.
1. A prosthetic heart valve adapted to be delivered to a target site as a single unit, the prosthetic heart valve comprising:
(a) a stent that is radially collapsible to a collapsed condition for mounting on a delivery device and radially expandable from the collapsed condition to an expanded condition, the stent extending in a distal longitudinal direction from an inflow end to an outflow end;
(b) a valve element mounted within the stent, the valve element being collapsible and expandable along with the stent, the valve element being adapted to allow flow in the distal direction and block flow in a proximal direction opposite to the distal direction when the stent is in the expanded condition; and
(c) a cuff attached to the stent, the cuff including a first wall, a second wall radially outward of the first wall and radially outward of the stent, at least one pocket between the first wall and the second wall and at least one opening for entry of blood into the pocket, the at least one pocket being sized, shaped and positioned on the stent for disposition within a native valve to impede perivalvular leakage, the first wall extending distally beyond the second wall.
2. The prosthetic heart valve according to claim 1 , wherein the second wall is biased outwardly into engagement with the native valve annulus by retrograde blood flow.
3. The prosthetic heart valve according to claim 1 , wherein the second wall is biased outwardly into engagement with the native valve annulus by antegrade blood flow.
4. The prosthetic heart valve according to claim 1 , wherein the cuff includes a plurality of pockets.
5. The prosthetic heart valve according to claim 1 , wherein the stent is self-expanding.
6. The prosthetic heart valve according to claim 1 , wherein the stent is balloon expandable.
7. The prosthetic heart valve according to claim 1 wherein the least one pocket is disposed adjacent the inflow end of the stent.
8. The prosthetic heart valve according to claim 1 wherein the second wall of the cuff extends distally from the inflow end of the stent.
9. An assembly for delivering a prosthetic heart valve to a target site in a patient, comprising:
(a) a delivery device having a retractable sheath; and
(b) a prosthetic heart valve adapted to be mounted on the delivery device and implanted by the delivery device at the target site as a single unit, the prosthetic heart valve including:
(1) a stent extending in a distal longitudinal direction from an inflow end to an outflow end, the stent being radially collapsible to a collapsed condition in which the stent can be covered by the sheath and radially expandable from the collapsed condition to an expanded condition;
(2) a valve element mounted within the stent for collapse and expansion along with the stent, the valve element being adapted to allow flow in the distal direction and block flow in a proximal direction opposite to the distal direction when the stent is in the expanded condition, and
(3) a cuff including a first wall, a second wall radially outward of the first wall and radially outward of the stent, at least one pocket between the first wall and the second wall, and at least one opening for entry of blood into the at least one pocket, the at least one pocket being and sized, shaped and positioned on the stent for disposition within a native valve to impede perivalvular leakage, the first wall extending distally beyond the second wall.
10. The assembly according to claim 9 , wherein the at least one pocket has an open side facing toward the outflow end of the stent, the pocket being sized and shaped to impede perivalvular leakage around the outside of the stent.
11. The assembly according to claim 9 , wherein the at least one pocket has an open side facing toward the inflow end of the stent, the pocket being sized and shaped to impede perivalvular leakage around the outside of the stent.
12. The assembly according to claim 9 , wherein the delivery device includes an expandable member for moving the stent from a collapsed condition to an expanded condition.
13. The assembly according to claim 12 , wherein the expandable member is a balloon.
14. The prosthetic heart valve according to claim 9 wherein the least one pocket is disposed adjacent the inflow end of the stent.
15. The prosthetic heart valve according to claim 9 wherein the second wall of the cuff extends distally from the inflow end of the stent.
16. A prosthetic heart valve adapted to be implanted at a target site in a patient percutaneously, the prosthetic heart valve comprising:
(a) a stent that is radially collapsible for mounting on a delivery device having a sheath for covering the stent, the stent extending in a longitudinal direction between an inflow end and an outflow end;
(b) a valve element mounted within the stent, the valve element being collapsible and expandable along with the stent; and
(c) a cuff connected to the stent, the cuff including a first wall, a second wall radially outward of the first wall, and at least one pocket between the first wall and the second wall, the first wall having a first length in the longitudinal direction from the inflow end and the second wall having a second length in the longitudinal direction from the inflow end, the second length being less than the first length, the pocket being sized and shaped to fill with blood by blood flow around the stent to bias the second wall outwardly into engagement with a native valve annulus.
17. The prosthetic heart valve according to claim 16 , wherein the at least one pocket has an open side facing toward the outflow end of the stent, the pocket being sized and shaped to impede perivalvular leakage around the outside of the stent.
18. The prosthetic heart valve according to claim 16 , wherein the at least one pocket has an open side facing toward the inflow end of the stent, the pocket being sized and shaped to impede perivalvular leakage around the outside of the stent.
19. The prosthetic heart valve according to claim 16 , wherein the stent is self-expanding.
20. The prosthetic heart valve according to claim 16 , wherein the stent is balloon expandable.
21. An assembly for delivering a prosthetic heart valve percutaneously to a target site in a patient, comprising:
(a) a delivery device having a retractable sheath; and
(b) a prosthetic heart valve adapted to be mounted on the delivery device, covered by the sheath, and implanted at the target site percutaneously, the prosthetic heart valve including a radially collapsible and expandable stent, a valve element mounted within the stent, and a cuff connected to the stent, the stent extending in a longitudinal direction between an inflow end and an outflow end, the valve element being collapsible and expandable along with the stent, and the cuff including at least one pocket between the first wall and the second wall, the first wall having a first length in the longitudinal direction from the inflow end, the second wall having a second length in the longitudinal direction from the inflow end, the second length being less than the first length, and the pocket being sized and shaped to fill with blood by blood flow around the stent to bias the second wall outwardly into engagement with a native valve annulus.
22. The assembly according to claim 21 , wherein the pocket has an open side facing toward the outflow end of the stent, the pocket being sized and shaped to impede perivalvular leakage around the outside of the stent.
23. The assembly according to claim 21 , wherein the pocket has an open side facing toward the inflow end of the stent, the pocket being sized and shaped to impede perivalvular leakage around the outside of the stent.
24. The assembly according to claim 21 , wherein the delivery device includes an expandable member for moving the stent from a collapsed condition to an expanded condition.