Methods for controlled heart valve delivery

1. A method of implanting a prosthetic heart valve, the method comprising:

advancing a prosthetic heart valve into a patient's vasculature with a delivery apparatus, wherein the prosthetic heart valve comprises a plurality of apices which are circumferentially-spaced apart relative to each other, wherein at least some of the apices comprise first apertures, wherein the delivery apparatus comprises a plurality of release arms and a plurality of locking arms, wherein the release arms comprise second apertures configured to receive the apices of the prosthetic heart valve, wherein the locking arms are configured to extend through the first apertures of the prosthetic heart valve to retain the apices of the prosthetic heart valve within the second apertures of the release arms, and wherein a length of at least one of the locking arms is different than a length of another one of the locking arms;

positioning the prosthetic heart valve at an implantation location within the patient's heart; and

moving the locking arms axially together relative to the release arms from a first position to a second position, wherein in the first position, the apices the prosthetic heart valve comprising the first apertures are retained within the second apertures of the release arms by the locking arms, wherein in the second position, one or more other apices of the prosthetic heart valve comprising the first apertures are retained within the second apertures of the release arms by the locking arms and one or more other apices of the prosthetic heart valve comprising the first apertures are released from the release arms such that a longitudinal axis of the prosthetic heart valve is held at a tilted position relative to a longitudinal axis of the delivery apparatus.

2. The method of claim 1 , wherein a length of at least one of the release arms is different than a length of another one of the release arms.

3. The method of claim 1 , wherein a length of each of the release arms is the same as a length of the other release arms.

4. The method of claim 1 , further comprising moving the locking arms axially together relative to the release arms from the second position to a third position, wherein in the third position, all of the apices of the prosthetic heart valve are released from the release arms.

5. The method of claim 1 , wherein at least one of the second apertures of the release arms has a different length than another one of the second apertures of the release arms.

6. The method of claim 1 , wherein the locking arms comprises distal end portions that flare radially outwardly relative to proximal end portions of the locking arms.

7. The method of claim 1 , wherein prior to the act of moving the locking arms, the method further comprises retracting a sheath of the delivery apparatus relative to the prosthetic heart valve.

8. The method of claim 1 , wherein in the tilted position, the longitudinal axis of the prosthetic heart valve is angled relative to the longitudinal axis of the delivery apparatus at an angle up to 60 degrees.

9. A method of implanting a prosthetic heart valve, the method comprising:

advancing a prosthetic heart valve into a patient's vasculature with a delivery apparatus, wherein the prosthetic heart valve comprises a plurality of apices which are circumferentially-spaced apart relative to each other, wherein at least some of the apices comprise first apertures, wherein the delivery apparatus comprises a plurality of release arms and a sheath, wherein a length of at least one of the release arms is different than a length of another one of the release arms, wherein the release arms comprise second apertures configured to receive the apices of the prosthetic heart valve, and wherein at least one of the second apertures of the release arms has a different length than another one of the second apertures of the release arms,

positioning the prosthetic heart valve at an implantation location within the patient's heart;

retracting the sheath of the delivery apparatus relative to the prosthetic heart valve;

allowing the prosthetic heart valve to self-expand from a radially compressed state to a radially expanded state; and

while the prosthetic heart valve is coupled to the delivery apparatus, pivoting the prosthetic heart valve relative to the release arms such that a longitudinal axis of the prosthetic heart valve is tilted relative to a longitudinal axis of the delivery apparatus.

10. The method of claim 9 , wherein the longitudinal axis of the prosthetic heart valve is tilted relative to the longitudinal axis of the delivery apparatus at an angle between 0-60 degrees.

11. The method of claim 9 , wherein the delivery apparatus further comprises a plurality of sleeves, and wherein the sleeves are axially slidable relative to the second apertures of the release arms.

12. A method of implanting a prosthetic heart valve, the method comprising:

advancing a prosthetic heart valve into a patient's vasculature with a delivery apparatus, wherein the prosthetic heart valve comprises a plurality of apices which are circumferentially-spaced apart relative to each other, wherein at least some of the apices comprise apertures, wherein the prosthetic heart valve is coupled to the delivery apparatus by a plurality of arms that extend through the apertures of the prosthetic heart valve;

positioning the prosthetic heart valve at an implantation location within the patient's heart; and

retracting a sheath of the delivery apparatus relative to the prosthetic heart valve;

allowing the prosthetic heart valve to self-expand from a radially compressed state to a radially expanded state, wherein the arms of the delivery apparatus expand to a first expanded state when the prosthetic heart valve self-expands to the radially expanded state; and

moving a frusto-conically-shaped expansion element of the delivery apparatus relative to the arms of the delivery apparatus to radially expand the arms from the first expanded state to a second expanded state in which the arms disengage the apices of the prosthetic heart valve.

13. The method of claim 12 , wherein the expansion element is in a first position relative to the arms when the arms are in the first expanded state, wherein the expansion element is in a second position relative to the arms when the arms are in the second expanded state, and wherein the first position is distal relative to the second position.

14. The method of claim 12 , wherein the expansion element is in a first position relative to the arms when the arms are in the first expanded state, wherein in the first position, the expansion element is spaced apart from the arms, wherein the expansion element is in a second position relative to the arms when the arms are in the second expanded state, and wherein in the second position, the expansion element contacts the arms.

15. The method of claim 12 , wherein the act of moving the expansion element comprises rotating a shaft of the delivery apparatus relative to the expansion element, which results in the expansion element moving axially relative to the arms of the delivery apparatus.

16. The method of claim 15 , wherein the expansion element comprises axially-extending slots configured to receive the arms, and wherein the arms prevent the expansion element from rotating when the shaft is rotated.

17. The method of claim 15 , wherein the expansion element is fixedly coupled to a sleeve which is coupled to the sheath such that the expansion element is prevented from rotating when the shaft is rotated.

18. The method of claim 12 , wherein the prosthetic heart valve and the arms of the delivery apparatus contact the patient's native anatomy when the prosthetic heart valve is in the radially expanded state.