Cardiac valve leaflet enhancer devices and systems
The disclosure relates to a device that is configured to be implanted on the native leaflet of a heart valve to increase its length and/or thickness and thereby to improve the valve function and reduce regurgitation. The device may include a leaflet section. The leaflet section may include a central member. The central member may include a first portion, a second portion that opposes the first portion, and a base portion disposed between the first portion and the second portion. The first section may extend from the first portion and the second section may extend from the second portion. The device may include one or more engaging members extending from the central member at an angle with respect to the first section and the second section. The second section may be larger than the first section. The leaflet section may define a three-dimensional region or a bulge.
1. A method comprising:
delivering to a native heart valve of a patient an implant having a first arm and a second arm each integrally formed with and extending from a leaflet section, the leaflet section resiliently biasing the first arm and second arm towards a closed configuration in which the first and second arms are proximate to each other, the leaflet section being resiliently deformable to permit the first and second arms to be displaced into an open configuration in which the first and second arms are spaced from each other a sufficient distance to permit at least an edge portion of a first native valve leaflet of the native heart valve to be received therebetween, the implant including a cover coupled to the leaflet section;
during at least a portion of the delivering, applying tension to a tether that is coupled to the implant and removable from the implant while the implant is disposed in the native heart valve, to urge the first arm and second arm away from each other into the open configuration;
positioning the implant with at least the edge portion of the first native valve leaflet at least partially disposed in a space between the first arm and the second arm; and
allowing the leaflet section to urge the first arm and second arm towards the closed configuration to clamp the first native valve leaflet therebetween,
the implant being disposed on the first native valve leaflet in a position in which the cover can engage with a portion of a second native valve leaflet of the native heart valve during a systolic portion of a cardiac cycle of the native heart valve and to be spaced from the portion of the second native valve leaflet during a diastolic portion of the cardiac cycle of the native heart valve,
the first arm and the second arm clamping the first native valve leaflet with a force sufficient to retain the implant on the first native valve leaflet throughout the cardiac cycle of the native heart valve.
2. The method of claim 1 , wherein the cover is or includes an echogenic material, thereby enabling identification of a location of the implant under image guidance.
3. The method of claim 1 , wherein a first planar portion of the first arm and a second planar portion of the second arm are coplanar in the closed configuration.
4. The method of claim 3 , wherein the first arm includes an opening and the second arm is at least partially received in the opening of the first arm in the closed configuration.
5. The method of claim 1 , wherein the tether is coupled to one of the first arm or the second arm during the applying tension.
6. The method of claim 5 , wherein the allowing the leaflet section to urge the first arm and the second arm towards the closed configuration includes releasing at least a portion of the tension from the tether.
7. The method of claim 1 , wherein the implant further includes a tissue gripping member coupled to the first arm and configured to engage a surface of the first native valve leaflet.
8. The method of claim 1 wherein the native heart valve is selected from the group consisting of a mitral valve, a tricuspid valve, an aortic valve, and a pulmonary valve.
9. The method of claim 1 , wherein the implant is configured to non-destructively couple to the native heart valve.
10. The method of claim 1 , wherein the implant includes at least one pair of radiopaque metallic elements, the method further comprising identifying a location and relative orientation of the first and second arms with respect to each other and with respect to the leaflet section.
11. A method comprising:
delivering to a native heart valve of a patient an implant having a first arm and a second arm each extending from a leaflet section, the leaflet section resiliently biasing the first arm and second arm towards a closed configuration, the leaflet section being resiliently deformable to permit the first and second arms to be displaced into an open configuration in which the first and second arms are spaced from each other a sufficient distance to permit at least an edge portion of a first native valve leaflet of the native heart valve to be received therebetween;
applying tension to a tether that is removably coupled to the implant during the delivering to urge the first and second arms into the open configuration;
positioning the implant with at least the edge portion of the first native valve leaflet at least partially disposed in a space between the first arm and the second arm;
releasing the tension on the tether to allow the first arm and second arm to resiliently bias towards the closed configuration to clamp the first native valve leaflet therebetween; and
removing the tether from the implant, leaving the implant clamped to the first native leaflet,
the implant being disposed on the first native valve leaflet in a position in which the leaflet section can engage with a portion of a second native valve leaflet of the native heart valve during a systolic portion of a cardiac cycle of the native heart valve and to be spaced from the portion of the second native valve leaflet during a diastolic portion of the cardiac cycle of the native heart valve,
the first arm and the second arm clamping the first native valve leaflet with a force sufficient to retain the implant on the first native valve leaflet throughout the cardiac cycle of the native heart valve.
12. The method of claim 11 , wherein the tether is a suture.
13. The method of claim 11 , wherein the tether is a wire.
14. The method of claim 11 , wherein the tether is a first tether that is removably coupled to the first arm during the delivering, a second tether being removably coupled to the second arm during the delivering, the method further comprising:
applying tension to the second tether to urge the first and second arms into the open configuration; and
releasing the tension on the second tether to allow the first arm and the second arm to move towards the closed configuration to clamp the first native valve leaflet therebetween.
15. The method of claim 11 , wherein the tether is formed of at least one of a suture or a wire, and is routed through a hole defined by the first arm or the second arm when the tether is removably coupled to the implant, the applying tension to the tether includes applying tension to two end portions of the tether.
16. The method of claim 15 ,
wherein the removing includes, after the releasing the tension on the tether, releasing one of the two end portions and withdrawing the other of the two end portions to remove the tether from the implant, leaving the implant clamped to the first native valve leaflet.
17. The method of claim 11 , wherein the implant includes a cover coupled to the leaflet section.
18. The method of claim 11 , wherein the first arm and the second arm are integrally formed.
19. The method of claim 11 , wherein the first arm includes an opening and the second arm is at least partially received in the opening of the first arm in the closed configuration.
20. The method of claim 11 , wherein the implant further includes a tissue gripping member coupled to the first arm and configured to engage a surface of the first native valve leaflet.
21. The method of claim 11 wherein the native heart valve is selected from the group consisting of a mitral valve, a tricuspid valve, an aortic valve, and a pulmonary valve.
22. The method of claim 11 , wherein the implant is configured to non-destructively couple to the native heart valve.
23. The method of claim 11 , wherein the applying the tension also deforms the leaflet section.
24. The method of claim 15 , wherein the tether is a first tether and the hole is a first hole defined by the first arm, the tether being routed through the first hole and a second hole defined by the first arm when the tether is removably coupled to the implant,
a tether being removably coupled to the second arm of the implant during the delivering, the second tether being formed of at least one of a suture or a wire and is routed through a first hole and a second hole both defined by the second arm when the second tether is removably coupled to the second arm, the method further comprising:
applying tension to two end portions of the second tether to urge or retain the implant in the open configuration.
25. The method of claim 1 , wherein the tether is a first tether that is removably coupled to the first arm during the delivering, a second tether being removably coupled to the second arm during the delivering, the method further comprising:
applying tension to the second tether to urge the first and second arms into the open configuration or maintain the first and second arms in the open configuration; and
releasing the tension on the second tether to allow the first arm and the second arm to clamp the first native valve leaflet therebetween.
26. The method of claim 1 , wherein the tether is formed of at least one of a suture or a wire, and is routed through a hole defined by the first arm or the second arm when the tether is removably coupled to the implant, the applying tension to the tether includes applying tension to two end portions of the tether.
27. The method of claim 26 , wherein the allowing the leaflet section to urge the first arm and the second arm towards the closed configuration includes releasing tension on the tether, the method further comprising, after the releasing the tension on the tether, releasing one of the two end portions and withdrawing the other of the two end portions to remove the tether from the implant, leaving the implant clamped to the first native valve leaflet.
28. The method of claim 1 , wherein the tether is a first tether and the first tether is removably coupled to the first arm during the application of tension to the first tether, the method further comprising:
before and during the applying tension to the first tether, applying tension to a second tether that is coupled to the second arm and removable from the second arm while the implant is disposed in the native heart valve, to stabilize the second arm during the applying tension to the first tether.
29. The method of claim 28 , wherein during the allowing the leaflet section to urge the first arm and second arm towards the closed configuration to clamp the first native valve leaflet therebetween, the first arm is disposed on a ventricular side of the first native valve leaflet and the second arm is disposed on an atrial side of the first native valve leaflet.
30. The method of claim 1 , wherein the delivering the implant includes delivering the implant with the implant coupled to a delivery catheter, the tether being routed through the catheter and looped through a hole in the first arm or the second arm of the implant during the delivering, the tether entering a distal portion of the catheter that is spaced distal to the hole in the first arm or the second arm during the applying tension to the tether to urge the first arm and second arm away from each other into the open configuration.