Cinch device and method for deployment of a side-delivered prosthetic heart valve in a native annulus
The invention relates to anchor channels and subannular anchors for a transcatheter heart valve replacement (A61F2/2412), and in particular for an orthogonally delivered transcatheter prosthetic heart valve having a annular support frame having compressible wire cells that facilitate rolling and folding the valve length-wise, or orthogonally to the central axis of the flow control component, allowing a very large diameter valve to be delivered and deployed to the tricuspid valve from the inferior vena cava or superior vena cava, or trans-atrially to the mitral valve, the valve having a height of about 5-60 mm and a diameter of about 25-80 mm, without requiring an oversized diameter catheter and without requiring delivery and deployment from a catheter at an acute angle of approach.
1. A prosthetic heart valve, comprising:
a valve frame defining a central channel extending along a central axis of the prosthetic heart valve, the valve frame including a distal subannular anchoring element and a proximal subannular anchoring element;
a flow control component mounted within the central channel and configured to permit blood flow in a first direction along the central axis from an inflow end to an outflow end of the flow control component and block blood flow in a second direction, opposite the first direction; and
a cinching system releasably coupled to the valve frame in at least one location,
the prosthetic heart valve compressible along the central axis and a lateral axis perpendicular to the central axis to place the prosthetic heart valve in a compressed configuration to allow side-delivery of the prosthetic heart valve into a heart of a patient via a delivery catheter, each of the central axis and the lateral axis being perpendicular to a longitudinal axis of the delivery catheter when the prosthetic heart valve is in the compressed configuration within the delivery catheter, the prosthetic heart valve configured to transition from the compressed configuration to an expanded configuration when the prosthetic heart valve is released from the delivery catheter,
the cinching system actuatable when the prosthetic heart valve is in the expanded configuration in the heart to transition at least one of the distal subannular anchoring element or the proximal subannular anchoring element from a first configuration to a second configuration to allow the prosthetic heart valve to be seated in an annulus of a native heart valve, the cinching system actuatable after the prosthetic heart valve is seated in the annulus to release the at least one of the distal subannular anchoring element or the proximal subannular anchoring element to the first configuration.
2. The prosthetic heart valve of claim 1 , wherein the prosthetic heart valve in the expanded configuration has a first height along the central axis and a first lateral width along the lateral axis, and
the prosthetic heart valve in the compressed configuration has a second height along the central axis less than the first height and a second lateral width along the lateral axis less than the first lateral width.
3. The prosthetic heart valve of claim 2 , wherein the prosthetic heart valve in the expanded configuration has a first longitudinal length along a longitudinal axis perpendicular to each of the central axis and the lateral axis, and
the prosthetic heart valve in the compressed configuration has a second longitudinal length along the longitudinal axis greater than the first longitudinal length, the longitudinal axis of the prosthetic heart valve in the compressed configuration is parallel to the longitudinal axis of the delivery catheter when the prosthetic heart valve is within the delivery catheter.
4. The prosthetic heart valve of claim 3 , wherein the prosthetic heart valve in the expanded configuration has the first longitudinal length along the longitudinal axis when the at least one of the distal subannular anchoring element or the proximal subannular anchoring element is in the first configuration, and
the prosthetic heart valve has a third longitudinal length along the longitudinal axis less than the first longitudinal length when the at least one of the distal subannular anchoring element or the proximal subannular anchoring element is in the second configuration.
5. The prosthetic heart valve of claim 1 , wherein each of the distal subannular anchoring element and the proximal subannular anchoring element is configured to be in contact with subannular tissue after the cinching system is actuated to release the at least one of the distal subannular anchoring element or the proximal subannular anchoring element.
6. The prosthetic heart valve of claim 5 , wherein the valve frame includes a body that defines the central channel and an atrial collar coupled to a top edge of body, the atrial collar configured to be in contact with supra-annular tissue when the prosthetic heart valve is seated in the annulus of the native valve.
7. The prosthetic heart valve of claim 1 , wherein the cinching system includes at least one tether temporarily coupled to the proximal subannular anchoring element.
8. The prosthetic heart valve of claim 7 , wherein actuating the cinching system to transition the at least one of the distal subannular anchoring element or the proximal subannular anchoring element from the first configuration to the second configuration includes increasing a tension along the at least one tether to transition the proximal subannular anchoring element from an expanded configuration to a folded configuration, and
wherein actuating the cinching system to release the at least one of the distal subannular anchoring element or the proximal subannular anchoring element to the first configuration includes reducing the tension along the at least one tether to allow the proximal subannular anchoring element to transition from the folded configuration to the expanded configuration.
9. The prosthetic heart valve of claim 1 , wherein the valve frame defines the central channel when the prosthetic valve is in each of the compressed configuration and the expanded configuration.
10. The prosthetic heart valve of claim 1 , wherein the valve frame includes a body that defines the central channel, the body including a plurality of wire cells having an orientation that allows compression of the prosthetic heart valve along the central axis.
11. A prosthetic heart valve, comprising:
a valve frame defining a central channel extending along a central axis of the prosthetic heart valve, the valve frame including a distal subannular anchoring element and a proximal subannular anchoring element;
a flow control component mounted within the central channel and configured to permit blood flow in a first direction along the central axis from an inflow end to an outflow end of the flow control component and block blood flow in a second direction, opposite the first direction; and
a cinching system releasably coupled to the valve frame in at least one location and having a tether coupled to the proximal subannular anchoring element,
the prosthetic heart valve compressible along the central axis and a lateral axis perpendicular to the central axis to place the prosthetic heart valve in a compressed configuration to allow side-delivery of the prosthetic heart valve into a heart of a patient via a delivery catheter, each of the central axis and the lateral axis being perpendicular to a longitudinal axis of the delivery catheter when the prosthetic heart valve is in the compressed configuration within the delivery catheter, the prosthetic heart valve configured to transition from the compressed configuration to an expanded configuration when the prosthetic heart valve is released from the delivery catheter,
the cinching system actuatable when the prosthetic heart valve is in the expanded configuration in the heart to transition the proximal subannular anchoring element from a first configuration to a second configuration to allow the prosthetic heart valve to be seated in an annulus of a native heart valve, the cinching system actuatable after the prosthetic heart valve is seated in the annulus to release the proximal subannular anchoring element to the first configuration.
12. The prosthetic heart valve of claim 11 , wherein the prosthetic heart valve in the expanded configuration has a first height along the central axis and a first lateral width along the lateral axis, and
the prosthetic heart valve in the compressed configuration has a second height along the central axis less than the first height and a second lateral width along the lateral axis less than the first lateral width.
13. The prosthetic heart valve of claim 12 , wherein the prosthetic heart valve in the expanded configuration has a first longitudinal length along a longitudinal axis perpendicular to each of the central axis and the lateral axis, and
the prosthetic heart valve in the compressed configuration has a second longitudinal length along the longitudinal axis greater than the first longitudinal length, the longitudinal axis of the prosthetic heart valve in the compressed configuration is parallel to the longitudinal axis of the delivery catheter when the prosthetic heart valve is within the delivery catheter.
14. The prosthetic heart valve of claim 13 , wherein the prosthetic heart valve in the expanded configuration has the first longitudinal length along the longitudinal axis when the proximal subannular anchoring element is in the first configuration, and
the prosthetic heart valve has a third longitudinal length along the longitudinal axis less than the first longitudinal length when the proximal subannular anchoring element is in the second configuration.
15. The prosthetic heart valve of claim 11 , wherein the distal subannular anchoring element is configured to be in contact with subannular tissue when the prosthetic heart valve is seated in the annulus, and
the proximal subannular anchoring element is in contact with subannular tissue after the cinching system is actuated to release the proximal subannular anchoring element.
16. The prosthetic heart valve of claim 15 , wherein the valve frame includes a body that defines the central channel and an atrial collar coupled to a top edge of body, the atrial collar configured to be in contact with supra-annular tissue when the prosthetic heart valve is seated in the annulus of the native valve.
17. The prosthetic heart valve of claim 16 , wherein the cinching system includes a steerable catheter temporarily coupled to the atrial collar, the tether being at least temporarily coupled to the steerable catheter.
18. The prosthetic heart valve of claim 11 , wherein actuating the cinching system to transition the proximal subannular anchoring element from the first configuration to the second configuration includes increasing a tension along the tether to transition the proximal subannular anchoring element from an expanded configuration to a folded configuration, and
wherein actuating the cinching system to release the proximal subannular anchoring element to the first configuration includes reducing the tension along the tether to allow the proximal subannular anchoring element to transition from the folded configuration to the expanded configuration.
19. The prosthetic heart valve of claim 11 , wherein the valve frame defines the central channel when the prosthetic valve is in each of the compressed configuration and the expanded configuration.
20. The prosthetic heart valve of claim 11 , wherein the valve frame includes a body that defines the central channel, the body including a plurality of wire cells having an orientation that allows compression of the prosthetic heart valve along the central axis.
21. A prosthetic heart valve, comprising:
a valve frame defining a central channel extending along a central axis of the prosthetic heart valve, the valve frame including an atrial collar coupled to a top edge of a body of the valve frame defining the central channel;
a flow control component mounted within the central channel and configured to permit blood flow in a first direction along the central axis from an inflow end to an outflow end of the flow control component and block blood flow in a second direction, opposite the first direction; and
a cinching system releasably coupled to the valve frame in at least one location,
the prosthetic heart valve compressible along the central axis and a lateral axis perpendicular to the central axis to place the prosthetic heart valve in a compressed configuration to allow side-delivery of the prosthetic heart valve into a heart of a patient via a delivery catheter, each of the central axis and the lateral axis being perpendicular to a longitudinal axis of the delivery catheter when the prosthetic heart valve is in the compressed configuration within the delivery catheter, the prosthetic heart valve configured to transition from the compressed configuration to an expanded configuration when the prosthetic heart valve is released from the delivery catheter,
the cinching system actuatable when the prosthetic heart valve is in the expanded configuration in the heart to radially compress at least a portion of the body of the valve frame to reduce a circumference of at least the portion of the body of the valve frame to allow the prosthetic heart valve to be seated in an annulus of a native heart valve, the cinching system actuatable after the prosthetic heart valve is seated in the annulus to allow at least the portion of the body of the valve frame to radially expand to allow the circumference of at least the portion of the body of the valve frame to increase.
22. The prosthetic heart valve of claim 21 , wherein the prosthetic heart valve in the expanded configuration has a first height along the central axis, a first lateral width along a lateral axis perpendicular to the central axis, and
the prosthetic heart valve in the compressed configuration has a second height along the central axis less than the first height and a second lateral width along the lateral axis less than the first lateral width.
23. The prosthetic heart valve of claim 22 , wherein the prosthetic heart valve in the expanded configuration has a first longitudinal length along a longitudinal axis perpendicular to each of the central axis and the lateral axis, and
the prosthetic heart valve in the compressed configuration has a second longitudinal length along the longitudinal axis greater than the first longitudinal length, the longitudinal axis of the prosthetic heart valve in the compressed configuration is parallel to the longitudinal axis of the delivery catheter when the prosthetic heart valve is within the delivery catheter.
24. The prosthetic heart valve of claim 23 , wherein the prosthetic heart valve in the expanded configuration has the first longitudinal length along the longitudinal axis when the portion of the body of the valve frame is radially expanded, and
the prosthetic heart valve has a third longitudinal length along the longitudinal axis less than the first longitudinal length when the cinching system is actuated to radially compress at least the portion of the body of the valve frame.
25. The prosthetic heart valve of claim 21 , wherein the portion of the body of the valve frame includes at least a subannular portion of the body of the valve frame, the subannular portion of the body of the valve frame including a distal anchoring element and a proximal anchoring element.
26. The prosthetic heart valve of claim 25 , wherein each of the distal anchoring element and the proximal anchoring element is configured to be in contact with subannular tissue after the cinching system is actuated to allow at least the subannular portion of the body of the valve frame to radially expand.
27. The prosthetic heart valve of claim 21 , wherein the valve frame defines the central channel when the prosthetic valve is in each of the compressed configuration and the expanded configuration.
28. The prosthetic heart valve of claim 21 , wherein the body of the valve frame includes a plurality of wire cells having an orientation that allows compression of the prosthetic heart valve along the central axis.